Lecture 15 - Normal Birth Flashcards Preview

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Flashcards in Lecture 15 - Normal Birth Deck (20):
1

Challenges in human parturition

quiescence, timing, activation, birth (fetal-neonatal adaptations) and involution (haemostasis, establishing lactation)

2

Quiescence?

uterine muscle contractions poorly synchronised, low amplitude and frequency, progesterone @ Ca driven

3

Anti-progesterone durg?

mifeprestone

4

Gestation length determinants (timing)?

unknown - links to parity, race and age

5

Activation involvments?

intact fetus, uterine stretch, fetal HPA axis, melatonin and circadian rhythms, upregulation of myometrium, abnormal membrane rupture

6

Activation - upregualtion of myometrium?

increased CAPS, gap junctions, prostaglandin receptors and oxytocin receptors leading to co-ordinated contractions

7

Contraction associated proteins

Actin and myosin (increased contractility), v gated Ca channels (increased myocyte excitability), gap junctions, multimers of cx43 (increased intercellular connectivity)

8

Origin of prostaglandins in labour?

phospholipases release Archidonic acid from cell membranes

9

Oxytocin in labour?

not essential, requires gap junction presence (like prostaglandins), induce and augment labour, prevent post-partum haemorrhage

10

Cervix in labour?

softens and rippens, looser cell structure

11

Membranes?

amnion and chorion, sit of PG production not essential in inducing labour but sufficient from PG release

12

5 conditions for birth?

mature fetus, pelvic ligaments softened, uterus excitable w coordinated contractions, cervix soft and easily dilated, membranes possibly ruptured for mechanical benefits

13

Stages of labour?

1st - until full dilation (10cm); 2nd - until birth of baby; 3rd - util delivery of placenta

14

Active phase?

more than 4cm dilation, brakes are oof no stopping

15

1sst stage?

contractions, cervical enfacement and dilation, either: spontaneus rupture of membranes (RM), rupture of membranes (ROM) or premature rupture of membranes (PROM)

16

Feeling of pain?

25 cmH2O

17

First breath proportions?

90% fine, 10% some assistance, 1% major resuscitation

18

CVS adaptation at first breath?

closure of foramen ovale, ventilation output through lungs, reduction in pulmonary vascular resistance, reduction-closure of ductus arteriosus

19

Birth thermogenesis?

vascualr brown fat, sympathetic nervous control, canmaintain 23 degrees in first hour, dry baby to prevent evaporation heat loss

20

Involution?

placental separation, cleavage through decidua basalis, contractions to prevent PPH, increased uterine sensitivity to oxytocin