Parturition

Question 1

[…]% of pregnancies are unintended.

Answer 1

~50

Unintended includes mistimed and unwanted

Question 2

What are the health risks to the infant if they are born unintended?

Answer 2

This is largely due to the fact that minority, impoverished women with lots of comorbidities are at higher risk of having unintended pregnancies. Not inherent to the fact that the infant is unintended, just a factor of the health of the mother / environment

Question 3

Goals of preconception care:

• Weight
• Supplementation
• Things to avoid
• Genetic considerations
• Other environmental factors

Answer 3

• Normalize weight prior to getting pregnant is ideal
• Folic acid
• Teratogens (including hyperglycemia)
• Screen for family Hx and genetic risk factors
• See image for bottom ones

Question 4

What are the goals of prenatal care and what factors influence a woman’s satisfaction with her childbirth experience?

Answer 4

Question 5

Pregnancy terms

• Estimated date of delivery
• Term
• Post-term
• Pre-term
• Macrosomia
• Low birth weight
• Large for gestational age
• Small for gestational age
• Intrauterine growth restrictions

Answer 5

Question 6

What are the 2 routine elements of prenatal care in the 1st trimester?

Answer 6

Question 7

What is the most notable thing to do during prenatal care in the 2nd trimester?

Answer 7

Question 8

What is Naegele’s rule?

Answer 8

Human gestation is 280 days from LMP

Question 9

What is the most notable thing to do during prenatal care during 3rd trimester?

Answer 9

Question 10

What are 2 things to be aware of during postpartum care that are critically important?

Answer 10

Question 11

What is the definition of labor?

Answer 11

Regular uterine contractions with progressive cervical dilation and effacement

Question 12

What 3 variables determine the ability of the fetus to successfully negotiate the maternal pelvis during labor and delivery?

Answer 12

Question 13

• In myometrial smooth muscle, when relaxed, the actin assumes the […] form and Ca++ is […]
• In myometrial smooth muscle, when contracted, the actin assumes the […] form and Ca++ is […]

Answer 13

• Globular; low
• Fibrillar; high

Question 14

With respect to the conditions of the uterus and cervix, what conditions maintain pregnancy vs. promote labor?

Answer 14

Uterine quiescence and cervical rigidity maintain pregnancy, while uterine contractions and cervical ripening promote labor

Question 15

What is the role of oxytocin in labor?

Answer 15

• Oxytocin IS NOT responsible for the induction of labor, but it is a hormone that is secreted to maintain uterine contractions due to response of pressure from head on tissue of cervix and stretching that results

Question 16

What can IV oxytocin be used for clinically?

Answer 16

Induce and augment labor

Control postpartum hemorrhage

Question 17

What is normal blood loss during vaginal and cesarean deliveries?

Answer 17

Vaginal = 500cc

Cesarean = 1000cc

Question 18

What is the role of progesterone in labor?

What is a clinical use of intramuscular progesterone?

Answer 18

Maintains uterine quiescence –> promotes maintenance of pregnancy NOT labor

Question 19

• What is the role of estrogen with respect to labor?
• Progesterone and estrogen are produced by the mother, but during pregnancy the fetus/placenta is also responsible for increasing levels of these hormones. Describe how this happens.
• Women with […] deficiency do not experience spontaneous labor.

Answer 19

• Estrogen promotes labor. It’s hypothesized that one of the factors leading to the induction of labor is the ratio of progesterone / estrogen
• See image
• Placental sulfatase

Question 20

Prostaglandins and labor

• Which prostaglandins are important in labor?
• Where are they produced?
• What is their role in labor?
• How can they be used clinically as treatments related to pregnancy and labor?

Answer 20

Question 21

So…what induces labor?

Answer 21

Initiated by a complex interplay between the fetus, mother and placenta. The ratio of progesterone: estrogen, along with oxytocin and prostaglandins are all important in this process. There is no one clear initiator.

Question 22

There has been a lot of pushback against giving birth in a hospital, with the rationale that birth has been and continues to be something that many women in many cultures do at home and more “naturally” without issue. Which is correct - labor is a complex medical process that requires specialized care or a natural process that can be managed at home on your own?

Answer 22

Bits of both, see slide

Question 23

What are the stages of labor?

Answer 23

Question 24

Power of Uterine Contractions

• How often occur?
• Affect on fetal blood flow?
• What is measured on monitors during contractions?

Answer 24

Question 25

The maternal pelvis does not accomodate all dimensions of the fetal skull. What must the fetus do to exit the pelvis?

Answer 25

Question 26

Due to the rough nature of the passage out of the pelvis, what are some common deformities that can be seen on newly born babies?

Answer 26

Note: both these deformities are not permanent, they go away within a few days

Question 27

What are some common deformities that can happen to the mother during delivery?

Answer 27

Question 28

Describe the timing of labor seen in women and what factors affect the timing.

Answer 28

Note: prior poor understanding of timing led to a lot of C-sections b/c doctors thought the woman had failed to progress to labor successfully when really they may have just needed more time. Has led to increased complications for mothers after birth

Question 29

What causes pain in the first stage of labor? What causes pain in the second stage of labor? How does a woman's response to pain affect the delivery?

Answer 29

Question 30

What are options for analgesia in the first and second stages of labor?

Answer 30

Question 31

What changes must happen to the fetus's lungs and heart during the transition to extrauterine life that happen during the birth process?

Answer 31

Question 32

* What is neonatal respiratory distress syndrome? * What can be used as a rescue treatment for this condition? * What can be used prophylactically for this condition? * If a neonate must delivered before 37 weeks, what must a physician do to assess lung maturity?

Answer 32

* Surfactant deficiency caused by premature birth, diabetic mothers, leads to alveolar collapse and impaired gas Ex * Exogenous surfactant * Exogenous surfactant and corticosteriods * Do amniocentesis to check for surfactant components in amniotic fluid to determine if lungs are mature enough to breathe on their own

Question 33

What changes to the CV system must occur in neonate to make transition to extrauterine life?

Answer 33

Question 34

What is the apgar score? What does it measure / not measure?

Answer 34

Question 35

**Lactation** * Describe the pathway and histology of breast milk and breast tissue * What hormonal changes happen in the breast tissue during puberty and pregnancy?

Answer 35

* Pathway: Lobules produce milk --\> lobes --\> lactiferous ducts --\> empty at nipple * Histo: each lobe is made of lobules, which are composed of secretory alveoli, which have myoepithelial cells surrounding them for contraction and expulsion of milk * See image

Question 36

During Pregnancy [...] stimulates prolactin secretion from pituitary lactotropes, however, high [...] levels inhibit lactogenesis explaining why pregnant women don't lactate

Answer 36

Estrogen progesterone

Question 37

At Parturition, following delivery of the [...], the drop in [...] levels allows prolactin to assume a lactogenic effect

Answer 37

placenta progesterone

Question 38

Discuss the physiology of lactation, beginning with infant suckling.

Answer 38

Question 39

What is the colostrum?

Answer 39

Question 40

What is lactational amenorrhea?

Answer 40

Question 41

What are the recommendations surrounding breast feeding?

Answer 41

However bear in mind that not all women can breast feed!

Question 42

Risk factors for postpartum depression?

Answer 42