complications and lactation

Question 1

what medications can be used during labor

Answer 1

-pain killers (eg: barbiturates, narcotics)
-N2O
-anesthetics (local, regional, general

Question 2

how does an epidural work

Answer 2

injection of local anesthetics into the space surrounding spinal cord produces a block of nerve conduction

Question 3

what is an effect of having an epidural

Answer 3

increases likelihood of using delivery aids (vacuum, C-section)

due to blocking action potentials to and from spinal cord

Question 4

infant mortality between rich blacks and white moms

Answer 4

rich black mothers are twice as likely to have infants die in the first month/year of their lives than rich white moms

Question 5

what defines a monozygotic twin

Answer 5

-genetically identical
-single inner cell mass divides in two
-random event

Question 6

how many sperm and how many ova are involved in formation of monozygotic twins

Answer 6

one sperm, one ovum

Question 7

what defines a dizygotic twin

Answer 7

-two ova “fraternal”
-either one or two placentas, depending on proximity during implantation
-early ultrasound => two placentas, assumed dizygotic

Question 8

how many sperm and how many ova are involved in formation of dizygotic twins

Answer 8

two sperm, two ova

Question 9

how might dizygotic twins arise as a result of abnormal hormone signaling (ie: FSH, LH)

Answer 9

-increase in FSH, increase in secondary to tertiary follicles, increase in granulosa cells, increase in E2, makes 2 graafian follicles

-increase/decrease of LH will not make dizygotic twins arise

Question 10

based on what you already know about initiation of labor, why are twins more likely to have preterm births than singletons

Answer 10

-the trigger for labor is CRH which triggers a positive feedback loop, increase in E2, increase in prostaglandins

-CRH made by placenta so if there is 2 placentas, increase in CRH to initiate labor

Question 11

what is a sesquizygotic twin

Answer 11

in between mono and dizygotic where they:

-share all maternal DNA
-share 75% paternal DNA

Question 12

to feed our newborn infant, we need to:

Answer 12

1. make milk: via prolactin, estrogen and progesterone
2. eject milk at appropriate time: via oxytocin

Question 13

what is the anatomy of a breast

Answer 13

-15-25 lobes, each with several lobules, with alveoli which are surrounded by myoepithelium, and empty into ducts
-5-10 major ducts that exit the nipple

Question 14

what hormones develop the alveoli and the ducts

Answer 14

estrogen and P4

Question 15

why do we need alveoli cells

Answer 15

make prolactin

Question 15

what is prolactin inhibited by

Answer 15

dopamine

Question 15

what hormone increases the production of prolactin

Answer 15

estrogen

Question 16

how does E2 contribute to lactation

Answer 16

-reduces dopamine-mediated inhibition of prolactin
-increases # and size of prolactin-producing cells
-induces genes required for prolactin production

Question 17

where is prolactin released from

Answer 17

anterior pituitary

Question 18

how does progesterone affect prolactin

Answer 18

suppresses action of PRL and when P4 levels fall at birth then PRL starts producing milk (takes 24-48 hours)

Question 19

what should breast milk contain

Answer 19

-casein: phosphoprotein that provides: amino acids, carbs, calcium, and phosphorus
-lactose: sugar
-fat

Question 20

what is colostrum

Answer 20

-made by alveoli cells in small quantities in place of PRL
-high in protein, antibodies (IgA) and immune cells; mild laxative

Question 21

how do PRL levels and suckling correlate

Answer 21

suckling initiates PRL release when there are low levels of estrogen after pregnancy

Question 22

how does suckling feed back to the hypothalamus

Answer 22

-reduces dopaminergic inhibition of prolactin-secreting neurons
-no estrogen, no PRL

Question 23

what is feedback inhibitor of lactation (FIL)

Answer 23

-secreted into milk, stopping production of more milk in a paracrine fashion

Question 24

what happens to alveoli cells when PRL levels drop

Answer 24

-undergo apoptosis
-ducts return to same state as pre-pregnancy