Pregnancy/Labour

Question 1

Maternal anatomical and physiological changes

Answer 1

First trimester and later
-Altered emotional state
-Altered hormones
-Altered brain function
-Altered immune system
-Altered appetite (quantity and quality)
Second trimester and later 
-Increased blood volume
-Increased blood clotting tendency
-Decreased blood pressure
-Altered fluid balance
Third trimester
-Increased weight
-Altered joints

Question 2

Conceptus

Answer 2

Everything resulting from the fertilised egg (baby, placenta, fetal membranes, umbilical cord)

Question 3

Fetus

Answer 3

Baby for the rest of the pregnancy

Question 4

Infant

Answer 4

Normally applied after delivery but less precise term

Question 5

Embryo

Answer 5

Baby before it is clearly human

Question 6

The main processes of labour

Answer 6

• Cervical ripening and effacement (increasing)
• Coordinated myometrial contractions (increasing)
• Rupture of fetal membranes
• Delivery of infant
• Delivery of placenta
• Contraction of uterus

Question 7

Placental functions

Answer 7

S=separation of maternal and fetal blood systems
E=exchange of nutrients and waste products
B=biosynthesis
I=immunoregulation of pregnancy
C=connection by anchoring the pregnancy in place

Question 8

Labour

Answer 8

Increasing fundally dominant contractions with cervical ripening (softening of the cervix) and cervical effacement (thinning of the cervix)

Question 9

Cervical ripening and effacement

Answer 9

• Change from rigid to flexible structure
• Remodelling of ECM (loss)
• Leukocyte recruitment
• Inflammatory process (prostaglandin E2, IL-8, local change in IL-8)

Question 10

Coordinated myometrial contractions

Answer 10

-Fundal dominance
-Increased contraction coordination
-Increased contraction power
Key mediators of this stage:
-Prostaglandin E2 increased from fetal membranes
-Oxytocin receptor increased
-Contraction-associated proteins

Question 11

Rupture of fetal membranes

Answer 11

-Strength loss due to changes in amnion basement component
-Inflammatory changes and leukocyte recruitment (exacerbated in preterm labour)
-Increased MMP level and activity
Inflammatory process in fetal membranes

Question 12

Maternal endocrinology

Answer 12

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Question 13

Embryology

Answer 13

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Question 14

Placenta anatomy

Answer 14

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Question 15

Placenta key features

Answer 15

• very high branched structure, provides a large surface area
• very effective for transport of molecules between maternal and fetal circulations
• anchors the placenta (and hence baby) securely for 9 months
• intimate contact between maternal and placenta tissues

Question 16

Placental mal-development

Answer 16

• miscarriage (late first trimester)
• miscarriage (second trimester)
• pre-eclampsia (early delivery)
• fetal growth restriction (small infant)

Question 17

Miscarriage

Answer 17

<23 weeks gestation

Question 18

Term

Answer 18

37-41 weeks gestation

Question 19

Pre-term

Answer 19

23-37 weeks gestation

Question 20

Initiation of labour=term

Answer 20

-may be oestrogen, low progesterone, CRH or oxytocin

Question 21

Initiation of labour=pre-term

Answer 21

• intrauterine infection
• intrauterine bleeding
• multiple pregnancy
• stress (maternal)
• other

Question 22

NF-kappaB

Answer 22

• pro-inflammatory transcription factor

- has many initiators

Question 23

Supporting evidence for NF-kappaB

Answer 23

• almost all pro-labour genes have NF-kappaB binding domains in their promoters
• modifcation of NF-kappaB sites in promoter sequences leads to loss of expression in cells or in expression vectors

Question 24

Platelet-activating factor

Answer 24

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Question 25

Progesterone

Answer 25

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