Parturition

Question 1

How does the cervix transition to the stimulation phase?

Answer 1

Dilates
Inflamm caused by:
Functional P4 withdrawal

inflamm and immune cells

fetal HPA/ placental CRH/ oestrogen

Ferguson reflex

Question 2

describe the cervix during the activation period.

Answer 2

Membrane weakens & cervix ripens

increased; iNOS, COX-2, prostaglandins, MMPs (2 and 9), cytokines, immune cells.

Question 3

What are the main treatment approaches for women with pre-term labour?

Answer 3

smooth muscle relaxants 
inhibit contractile pathways 
treat infection 
stop bleeding 
inhibit inflammation related events 
increase progesterone.

Question 4

why aren’t B2 receptor agonists effective as therapies for pre-term labour?

Answer 4

At end of pregnancy Gs of B2 receptors is downregulated

Lot of agonist needed to produce small amountof cAMP.

Question 5

Describe the Ferguson reflex.

Answer 5

Pressure on internal end of cervix
Hypothalamus stimulates oxytocin release
Uterus contracts - positive feedback as more pressure leads to more oxytocin release!!

Question 6

Why may rofecoxib have failed?

Answer 6

Good PG pathways affected
Wrong time
Treatment removal precipitated labour
Wrong group.

Question 7

Why is progesterone therapy perhaps not most suitable?

Answer 7

650 scanned to prevent one PTL
6.6 treated for one PTL

No reduction in inflammation

Approved by FDA but study looking at 2Y outcome coming up.