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Endo/Repro Final > Part 2: Physiology Of Pregnancy, Parturition, And Lactation > Flashcards

Part 2: Physiology Of Pregnancy, Parturition, And Lactation Flashcards

1
Q

When does human birth occur?

A

40 weeks of gestation

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2
Q

What is involved in parturition?

A

Transformation of the myometrium from quiescent to contractile

Remodeling of the uterine cervix; softens and dilates

Rupture of fetal membranes

Expulsion of uterine contents

Return of the uterus to its prepregnant state

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3
Q

Labor is a series of regular, rhythmic, and forceful contractions that develop to facilitate _____.

How long do contractions last? What is the result?

What sustains labor?

A

Thinning and dilation of the cervix

Several hours, day, of longer; result is expulsions of the fetus, placenta, and membranes

Series of positive feedback mechanisms

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4
Q

What are the characteristics of the stages of parturition?

0:
1:
2:
3:

A

Uterine tranquility and refractoriness to contraction

Uterine awakening, initiation of parturition extending to complete cervical dilation: increase number of gap junctions

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5
Q

Stages of parturition:

_____ is relaxed, quiescen, relatively insensitive to hormones that stimulate ____

A

Uterus; contractions

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6
Q

When is uterine excitability increased?

A

Towards the end of pregnancy

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7
Q

Prior to labor, _____ transforms to a more contractile state

What stage is this?

What is produced?

A

Myometrium

Stage 1: transformation/activation

Contraction-associated hormones and proteins:

Prostaglandins F2alpha receptors
Oxytocin receptors
Enzymes involved in prostaglandin synthesis
Enzymes that break down collagen matrix in cervix
Gap junctions complexes

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8
Q

What state is active labor induced?

What three major factors induce contractions?

A

Stage 2

Increased levels of prostaglandins, increased myometrium cell interconnectivity, increased myometrium responsiveness to PG and oxytocin

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9
Q

Contractions forces ____ again the cervix. It becomes more compliant as the _____ remodels.

____ dilates enough to allow fetus through the birth canal.

A

Fetal head; extracellular matrix

Cervix

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10
Q

Reciprocal changes in uterin progesterone and estrogen receptors

A

Kjj

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11
Q

Jkj

A

Kj

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12
Q

J

A

Kjk

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13
Q

What is the fx of prostaglandins?

Synthesis of prostaglandins are stimulated by ______, _____, and _____.

A

Increase in

Estrogen in fetal membranes

Oxytocin in uterine cells

Uterine stretch

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14
Q

Uhh

A

Huh

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15
Q

Uterus is insensitive to oxytocin until ____ weeks. ____ increases oxytocin receptors. These receptors increase 80x higher than baseline by ___ weeks. Increase ____x by early labor.

A

20

Estrogen

36

200

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16
Q

During active labor, _____ stimulates uterine contractions that sustain labor.

Stimulate ____ production in decidual cells.

This hormone is the primary stimulus for release of distention of the ____ known as the ____ reflex.

A

Oxytocin

PGF 2alpha

Cervix; Ferguson

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17
Q

What is relaxin>

A

Jkj

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18
Q

What are the mechanical changes of the uterus during labor>

A

Jkj

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19
Q

What does the placenta produce during labor?

When do maternal levels rise of this hormone?

What is the fx?

Does it accumulate in fetal circulation? It stimulates fetal ____ secretion.

A

CRH

Later pregnancy and labor

Promotes myometrial contractions -> sensitizing uterus to prostaglandins and oxytocin

Yes; ACTH

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20
Q

Kj

A

Jk

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21
Q

Most of pregnancy uterus undergoes periodic episodes of ____ called ____.

They become strong during ____ of pregnancy into active labor.

What is their fx?

A

Weak and slow contractions; Braxton hicks contractions

Last hours

Kjkj

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22
Q

Kj

A

Kj

23
Q

Jkj

A

Jkj

24
Q

Fetal station

A

K

25
Q

Dilation and effacement

A

Kjj

26
Q

Dilation and eff

A

Kj

27
Q

Descent and expulsion

A

Cervix fully dilated

Contractions are stongest at top pushing fetus down

28
Q

Expulsion of placenta

A

Uterus contracts refusing area of attachment

Separation of placenta results in bleeding and clotting

29
Q

What is prolonged labor?

What is the cause?

A

Labor lasting more than 18-24 hours

Poor uterine contractions, baby’s position of size being abnormal or issues with the pelvis or birth canal

30
Q

What is obstructed labor or labor dystocia?

What is the causes?

A

Uterus is contracting normally, but the baby does not exit the pelvis during childbirth due to being physically blocked

Breech, macrosomia, occipital posterior, malpresentation, compound presentation, congenital abnormalities

31
Q

What is a breech presentation?

What are the types?

What are the causes?

What are the risks of labor?

A

Non-vertex presenting part (buttocks)

Complete, footling, frank breech

Large baby, no fluid, birth defects, uterine anomalies

Fetal injury, cord prolapse, entrapment, maternal injury

32
Q

When the integrity of the myometrial wall is breached, this causes _____.

When can this occur?

What are the risks?

A

Ruptured uterus

Active labor, late pregnancy

Uterine scar,

Abdominal pain, vaginal bleeding, deterioration of fetal HR (sign), loss of fetal station on manual vagnial exam

33
Q

What is considered preterm labor?

Early uterine contractions cause what?

A

Before 37th week

Cervix to open earlier than normal

34
Q

When does preeclampsia occur?

What is it characterized by?

A

After week 20 of pregnancy

High BP and signs of damage to another organ system (kidneys)

35
Q

Disease of the placenta might be involved in ____. Associated with limited blood supply to ____ causing ischemia and endothelial damage with release of cytokines. The placenta is characterized by ____ invasion.

A

Preeclampsia

Uterine arteries

Trophoblastic invasion

36
Q

How many lobes are in mammary glands?

What type of tissue do they consist of?

Each lobe is made of lobules of ____, blood vessels, and ____.

A

15-20

Glandular and fibrous and adipose tissue

Alveoli; lactiferous ducts

37
Q

What are the two types of epithelium in mammary glands?

A

Alveolar epithelium

Myoepithelial cells

38
Q

The breast consists of a serious of _____ the empty into ductules.

A

Secretory lobues

39
Q

At birth, mammary gland almost entirely ______ with few alveoli.

The breast remains in this state until ____.

Under the actions of ____, lactiferous ducts sprout and branch

A

Lactiferous ducts

Puberty

Estrogens

40
Q

As menstrual cycle is established, mammary tissue is exposed to ____ and ____ inducing additional _____ growth.

Cyclic changes to breast occurs such as what?

A

Estrogen and progesterone; ductal-lobular-alveolar growth

Increase in breast volume, breast tenderness, secretory activity, involution

41
Q

Yet

A

Tyt

42
Q

What is complete by mid pregnancy in the mammary glands?

Inhibition of lactogenesis by ____ and ____ render mammary cells unresponsive to prolactin.

Small amounts of ___ are produced late pregnancy containing high concentration of immunoglobulins

A

Duct and lobule proliferation complete; differentiation of alveolar cells

Estrogen and progesterone

Colostrum

43
Q

Following parturition there is a drop in ____ hormone levels.

In the absence of sucking, milk secretion will last up to ____ weeks.

Suckling stimulates prolactin secretion via a _____ reflex.

A

Steroid

3-4 weeks

Neuroendocrine reflex

44
Q

Prolactin

A

J

45
Q

What is the fx of oxytocin in milk lactation?

A

Enhances milk ejection by stimulating the contraction of the network of myoepithelial cells surrounding the alveoli and ducts of the breast (galactokinetic effect)

46
Q

What are the five pathways that alveolar epithelial cells secrete milk components?

A

Secretory pathway

Trans cellular endocytosis and exocytosis

Lipid pathway

Transcellular salt and water transport

Paracellular pathway

47
Q

Describe the secretory pathway of milk production

A

Lactalbumin and casein synthesized in the ER

Ca and Pi added to lumen of golgi

48
Q

J

A

J

49
Q

J

A

J

50
Q

J

A

J

51
Q

J

A

J

52
Q

What are the four effects of sucking on hormone release?

A

Sucking stimuli (or sight of sound of child)

Dopamine release is inhibited

Spinal cord neurons stimulate production and release of oxytocin from posterior pituitary

Spinal cord neurons inhibit the arcuate and preoptic area of the hypothalamus causing a fall in GnRH production

53
Q

When the sucking discontinues, the milk ____.

There is distention and mechanical atrophy of ____, rupture of ____ walls, compression of ____ resulting in _____ _____.

Cell and glandular debris are ____.

Lobular-acinar structures become ____.

____ system predominates.

Full involution can take ____ months

A

Accumulates

Epithelial structures; alveolar; capillaries; alveolar hypoxia

Phagocytosed

Smaller

Ductal

3

Endo/Repro Final (20 decks)

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