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3rd year > Reproduction Physiology > Flashcards

Reproduction Physiology Flashcards

1
Q

Where is oestrogen sourced from?

A

Ovaries, placenta, blood.

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2
Q

Where is progesterone sourced from?

A

Corpus luteum, placenta,

Adrenal cortex.

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3
Q

What are the function of oestrogen?

A

Proliferation of the endometrium.
Promotes development of genitalia.
Promotes growth of follicle.
Causes LH surge.
Responsible for female fat distribution.
Increases hepatic synthesis of transport proteins.
Upregulates oestrogen, progesterone, and LH receptors.
Increases TBG levels.

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4
Q

What are the functions of progesterone?

A

Maintenance of endometrium and pregnancy.
Thickens cervical mucous.
Decreases myometrial excitability.
Increases body temperature.
Responsible for spiral artery development.

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5
Q

What are the 2 phases of the ovarian cycle?

A
  1. Follicular phase

2. Luteal Phase

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6
Q

What are oognium?

A

Stem cells in the ovaries - undergo mitotic division to produce primary oocytes which is completed at or shortly after birth. Meiosis starts but arrested in the prophase.

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7
Q

What does the secondary oocyte do?

A

Completes second meiotic division when fertilised by a sperm to form the mature ovum and second polar body.

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8
Q

What happens to breasts during pregnancy?

A

Increased size and vascularity - warm tense and tender.
Increased pigmentation of areola and nipple.
Colostrum like fluid can be expressed from the end of 3rd month.

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9
Q

What happens to the CVS in pregnancy?

A

Increased circulating blood volume - 50-70% of non-pregnant.
Systemic vascular resistance falls. Increased heart rate. Increased oxygen consumption.
Co increases by 10% in labour and by 80% in 1st post delivery hr.

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10
Q

What are the postpartum CVS changes?

A

Return to normal by 3 months.
Blood volume decreases by 10% 3 days post delivery.
BP falls.

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11
Q

What are the Respiratory changes in pregnancy?

A

Increase O2 demand.
Increased resp rate.
Increased tidal volume.
PCO2 falls.

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12
Q

What are the renal changes in pregnancy?

A

Dramatic dilatation of the urinary collecting system.
Increased renal plasma flow.
GFR increases and creatine clearance increases by up to 50%.
80% woman develop oedema.

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13
Q

What are the haematological changes in pregnancy?

A

Plasma volume increases cf birthweight.
Decreases platelet count.
2-3 fold increase in requirement for iron.
WCC increases.

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14
Q

What are the non-contraceptive benefits of combined hormonal therapy?

A

Regulate/reduces bleeding.
Stops ovulation.
Reduction in functional ovarian cysts.
50% reduction in ovarian and endometrial cancers.
Improve acne.
Reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis.

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15
Q

What are some of the serious risks associated with combines hormonal contraception?

A

Increased risk of DVT, PE.
Increased risk of arterial thrombosis.
Increased risk of cervical cancer, and breast cancer..
No overall increased cancer risk for CHC users.

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16
Q

What are the benefits of Progesterone only pill?

A

Injectable or implant. Oestorgen free so very few contraindications.

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17
Q

What are the side effects of progesterone only?

A 
Appetite increase 
Hair loss or gain 
Mood change 
Bloating 
Headache
Acne. 
AVOID if breast cancer or liver tumour past/present.
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18
Q

How does the injection work?

A

Deep intramuscular every 13 weeks.
Prevent ovulation, alters cervical mucus, endometrium unsuitable for implantation.

Delay in return to fertility - weight gain - reversible reduction in bone density.

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19
Q

How does the intrauterine coil work?

A

Takes 10 mins to be put in. Very small infection risk, can be fitted at any age.
Hormone free, toxic to sperm, 5-10years lasting.

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20
Q

When is the highest chance of pregnancy?

A

Between days 8-19 of 28 day cycle.
Can get pregnant 21 days after delivery, 5 days after miscarriage and abortion.
Breast feeding is contraceptive for first 6 months if feeding every 4 hours.

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21
Q

What does the 1967 Abortion act state?

A

2 doctor’s sign woman’s request. Under 24 weeks - 20 weeks in scotland.
12 weeks for surgical.
No effect on future fertility or pregnancy or delivery.
1 in 3 women have them in UK.

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22
Q

What happens in the initiation of labour?

A

Triggered paracrine, autocrine signals generated by maternal, fetal and placental factors which interplay.
Cervix softens.
Myometrial tone change to allow co-ordinated contractions.
Progesterone decreases whilst oxytocin and prostaglandins increase to allow for labour to initiate.

23
Q

What happens in stage 1 of labour?

A

Complete when the cervix is fully dilated (5cm dilated).

Needs to move forward, soften, efface (relax and thin) and dilate.

24
Q

What happens in stage 2 of labour?

A

Passive and active stage:
Passive – Finding full dilatation of the cervix before or in the absence of involuntary expulsive contractions.
Active – Presenting part is visible, expulsive contractions.

25
Q

What would you expect in a 1. prim and 2. multi birth?

A
  1. Birth expected within 2 hours after 2nd stage.

2. Expected birth within the hour.

26
Q

What happens in stage 3 of labour?

A

Time of birth of baby to the expulsion of the placenta and membranes.
Active management - optimal cord clamping and controlled cord traction.
Physiological management- no cord clamping until pulsation has stopped, delivery of placenta by maternal effort.

27
Q

What is termed a prolongued 3rd stage?

A

If not completed within 30 minutes of the birth with active management or within 60 minutes of the birth with physiological management.

28
Q

What monitoring is carried out in the progression of labour?

A 
Maternal observations.
Abdominal palpation. 
Vaginal examination. 
Monitoring of liquor.
Auscultation of the fetal heart, palpation of the uterine muscle contraction.
29
Q

What are the different fetal lies?

A

Oblique lie
Longitudinal lie
Transverse lie
Face presentation, Brow presentation, vertex presentation, Breech presentation, Shoulder presentation.

30
Q

What is the mechanism of Labour?

A

Descent. Flexion. Internal rotation of the head. Crowning and extension of the head. Restitution. Internal rotation of the shoulders. External rotation of head. Lateral flexion.

31
Q

What would be normal labour?

A

Longitudinal lie, attitude is one of good flexion. Presentation is cephalic, position is LOA or ROA. Denominator is the occiput, presenting part is the anterior parietal bone.

32
Q

What are the stages of delivery?

A
  • Before engagement.
  • Engagement, flexion, descent.
  • Descent, rotation.
  • Complete rotation, early extension.
  • Complete extension
  • Restitution
  • Anterior shoulder delivery
  • Posterior shoulder delivery
33
Q

Analgesics in labour

A

Breathing, massage, TENS, Paracetamol.
Water, Entoxon, opiods, epidural, maternal position.
Evidence shows that continuous midwifery care reduces need for analgesics and increases likelihood of SVD and maternal satisfaction.

34
Q

What are the indications for induction?

A

Diabetes, post dates + 7 days.
Maternal health problems.
Foetal reasons - growth concerns.

35
Q

What is induction?

A

Artificially instigate labour using meds or devices that ripen the cervix, followed by rupture of membranes. Bishops score used to assess the cervix.
Amniotomy can be performed if bishops score of 7+ artificial rupture of fetal membrane.

36
Q

What is PPP?

A

Powers, passages, passenger.

Inadequate progress – malposition, malpresentation, Cephalopelvic disproportion. Fetal distress.

37
Q

What happens in terms of power in the progress of labour?

A

Cervical effacement
Cervical dilation.
Descent of the fetal head through the maternal pelvis.

38
Q

In active first stage of labour suboptimal progress is defined as cervical dilatation - at how many cm is this?

A

Less than 0.5cm per hour for primigravid women.

Less than 1cm per hour for parous women.

39
Q

What happens when there is inadequate uterine activity?

A

Fetal head will not descend and exert force on the cervix - cervix will not dilate.
Giving synthetic IV oxytocin to the mother can increase strength and duration of the contractions.

40
Q

Whats important to note in inadequate uterine activity?

A

Must exclude obstructive labour as could cause ruptured uterus.

41
Q

What are some of the malpositions of the baby?

A

Fetal head in incorrect position for labour.

Occipito-posterior and occipito-transverse.

42
Q

Whats important to understand when there is fetal distress?

A

Avoid too many contractions as this can result in fetal distress due to insufficient placental blood flow.

43
Q

What determines fetal wellbeing in labour?

A

Intermittent auscultation of the fetal heart, cardiotocography, fetal blood smapling ( when abnormal CTG), fetal ECG.

44
Q

What situations are there when labour is not advised?

A

Obstruction to birth canal (placenta praevia).
Malpresentation (transverse, shoulder, hand). Medical condition of mother, specific previous labour complications, fetal conditions.

45
Q

What are some of the 3rd stage complications in labour?

A

Retained placenta
post partum haemorrhage
Tears. (graze - 4th degree)

46
Q

Forceps and vacuum extraction account for around 15% of births.

A

Caesarean section is essential procedure for management of obstructed labour or fetal distress before cervix is fully dilated. About 25%.

47
Q

What are the common post natal problems that occur?

A

Haemorrhage: primary = >500ml within 24hrs.
Secondary = >500ml 24hrs post to 6 weeks.

Venous thromboembolism - ECG, leg doppler, CXR - warfarin can be used when breast feeding as its teratogenic.

Psychiatric disorders - baby blues, postnatal depression, puerperal psychosis.

Pre-eclampsia / eclampsia.

48
Q

What are the 4ts of haemorrhage?

A

Tone
Trauma
Tissue
Thrombin

49
Q

What is the leading cause of maternal death in UK?

A

Sepsis

Prompt IV antibiotic, full septic screen.

50
Q

What can be the 3 delays of a pregnant woman to receive care?

A
  1. Decision to seek care - lack of understanding.
  2. Delay in reaching care - Geographical: islands.
  3. Delay in receiving care - supplies.
51
Q

How can maternal mortality be prevented?

A

Antenatal care - 4 visits, monitoring weight, blood pressure and proteinuria, folic acid, malaria prophylaxis.

Skilled attendant at birth.

Emergency Obstetric care - clean delivery, active management of 3rd stage, parenteral antibiotics / oxytocins / magnesium sulphate, manual removal of placenta / products of conception, blood transfusion, caesarean section, operation delivery.

52
Q

What is meant by:

  1. Stillbirth
  2. Early neonatal death
  3. Late neonatal death
  4. Perinatal mortality
  5. Infant
  6. Child
A
  1. Birth of a dead baby after 20/24/28 weeks gestation or weighing more than 500g.
  2. Death of baby within first week of life.
  3. Death within first 28days.
  4. Includes stillbirth and neonatal mortality.
  5. Within first year
  6. Within first 5 years.

40% of stillbirths remain unexplained.

53
Q

What is essential newborn care? (ENAP)

A

Ensuring the baby is breathing, starting the newborn on exclusive breastfeeding right away, keeping baby warm, washing hands before touching baby.
Integrated maternal newborn and child health care package.

3rd year (22 decks)

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