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3MB Reproduction > Physiology of Pregnancy and Labour > Flashcards

Physiology of Pregnancy and Labour Flashcards

1
Q

List the cell stages a fertilised ovum goes through before implantation

A

Fertilised ovum
Cleavage (4-cell/8-cell stages)
Morula
Blastocyst

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2
Q

During which days following fertilisation does the blastocyst enter the uterus?

A

Days 3-5

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3
Q

During which days following fertilisation does the blastocyst attach to the lining of the uterus?

A

Days 5-8

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4
Q

Which surface cells help the blastocyst penetrate and adhere to the endometrium?

A

Trophoblastic cells

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5
Q

By what day following fertilisation does the blastocyst become fully buried in the endometrium?

A

Day 12

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6
Q

Which tissue is the placenta derived from?

A

Trophoblast and decidual tissue

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7
Q

How is the placental cavity formed?

A

Trophoblastic cells differentiate into syncitotrophoblasts which invade the decidua of the endometrium to form cavities filled with maternal blood

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8
Q

How does the embryo communicate with the placenta?

A

Placental villi containing capillaries

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9
Q

There is no direct contact between foetal and maternal blood. True/False?

A

True

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10
Q

By which week of pregnancy are the foetal heart and placenta fully functional?

A

5th week

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11
Q

HCG stimulates the corpus luteum to secrete what hormone?

A

Progesterone

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12
Q

Oxygen-saturated blood goes to the foetus via which vessel?

A

Umbilical vein

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13
Q

Oxygen-poor blood goes from the foetus to the mother via which vessels?

A

Uterine veins

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14
Q

What 3 factors increase the supply of O2 to a foetus?

A

Foetal Hb has increases carrying capacity
Higher Hb concn in foetal blood
Foetal Hb can carry more O2 in low PCO2 (Bohr effect)

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15
Q

Drugs can cross the placental barrier - list some teratogens

A 
Thalidomide
Carbamazepine
Tetracyclines
Alcohol
Nicotine
Heroin, cocaine
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16
Q

What is the effect of human chorionic somatomammotropin (HCS)?

A

Decreases insulin sensitivity of mother
Protein tissue formation
Breast development

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17
Q

What effect does progesterone have on uterine contractility?

A

Decreases contractility

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18
Q

What effect does oestrogen have on the uterus?

A

Increases size of uterus

Relaxation of ligaments

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19
Q

What happens to the cardiac output during pregnancy?

A

Increases to cope with demands of uteroplacental circulation

Can be up to 50% above normal around 24wks!

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20
Q

When does cardiac output typically decrease in pregnancy?

A

Last 8 weeks due to uterus compressing vena cava

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21
Q

What happens to Hb levels during pregnancy? What is the consequence?

A

Decrease due to dilution of blood

Require iron supplements

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22
Q

What effect does progesterone have on CO2 levels?

A

Stimulates brain to lower CO2 levels by increasing respiratory rate

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23
Q

What is pre-eclampsia?

A

Pregnancy-induced hypertension and proteinuria

24
Q

Taking folic acid during pregnancy reduces the risk of what?

A

Neural tube defects

25
Q

Taking vitamin B during pregnancy helps what?

A

Make red blood cells (erythropoeisis)

26
Q

Taking vitamin K before birthing prevents what?

A

Intracranial bleeding during labour

27
Q

Towards the end of pregnancy, how does the ratio of oestrogen:progesterone change?

A

Ratio increases - oestrogen promotes contractility

28
Q

Which hormone secreted from the posterior pituitary helps stimulate contractions in labour?

A

Oxytocin

29
Q

Give an example of positive feedback from the foetus that increases contractility during labour

A

Cervical stretch due to foetus head

N.B. also increases oxytocin release

30
Q

What are the 3 stages of labour?

A

1: cervical dilation (8-24hrs)
2: passage through birth canal (0-30mins)
3: expulsion of placenta

31
Q

Oestrogen and progesterone inhibit milk production. True/False?

A

True

After birth, levels drop to facilitate lactation

32
Q

Which hormone stimulates lactation?

A

Prolactin

33
Q

What 2 stimuli cause lactation in the “milk let-down” reflex?

A

Baby crying

Baby suckling

34
Q

What should be expelled from the uterus in normal labour?

A

Foetus
Membranes
Umbilical cord
Placenta

35
Q

What is Ferguson’s reflex in labour?

A

Pressure on the cervix triggers a hormonal pathway that leads to uterine contractions and dilation of cervix

36
Q

Why might hydrocortisone be given to a pre-term baby?

A

Help mature its lungs

37
Q

There are 3 stages in labour. What does stage 1 comprise of?

A

Latent phase: 3-4 cm cervical dilation

Active phase: 4-10 cm cervical dilation

38
Q

There are 3 stages in labour. What does stage 2 comprise of?

A

Full cervical dilation to delivery of baby

39
Q

There are 3 stages in labour. What does stage 3 comprise of?

A

Delivery of baby to expulsion of placenta and membranes

40
Q

Describe the clinical features of the latent phase of stage 1 of labour

A

Mild irregular intrauterine contractions
Cervix softens and shortens
May last a few days

41
Q

Describe the clinical features of the active phase of stage 1 of labour

A

Contractions become more rhythmic and intense
Cervix achieves full dilation
Slow descent of presenting part of baby

42
Q

When is stage 2 of labour considered prolonged in a nulliparous woman?

A

If it exceeds 3 hours where there is analgesia

If it exceeds 2 hours where there is no analgesia

43
Q

When is stage 2 of labour considered prolonged in a multiparous woman?

A

If it exceeds 2 hours where there is analgesia

If it exceeds 1 hour where there is no analgesia

44
Q

Why are oxytocic drugs recommended for stage 3 of labour?

A

Help contractions

Reduce risk of post-partum haemorrhage

45
Q

What chemical causes cervical softening?

A

Hyaluronic acid

46
Q

What causes cervical ripening during labour?

A

Decrease in collagen fibre alignment and tensile strength

47
Q

What are Braxton Hicks contractions?

A

Tightening of the uterine muscles to aid body to prepare for birth
Not usually felt until 2nd/3rd trimester

48
Q

How long typically are the gaps between “true labour contractions”?

A

5 minutes

49
Q

How do Braxton Hicks contractions differ from true labour contractions?

A

BHC: irregular, do not increase in frequency/intensity, resolve with change in activity
TLC: regular, increasing frequency/intensity, don’t resolve

50
Q

What does it mean if a baby is “born in a caul”?

A

Born with some membrane/amniotic sac still surrounding it

51
Q

Describe the “normal” presentation of a baby as it passes through the pelvic canal

A

Longitudinal lie, cephalic presentation

Occipito-anterior, then occipito-transverse with flexed head

52
Q

What presentations are classified as “abnormal” in a baby’s birth?

A

Transverse/oblique/breech lie

Occipito-posterior engagement

53
Q

There is a relationship between the clinical state of the cervix and the onset of labour. Which 5 parameters are assessed under the Bishops score?

A 
Effacement
Dilation
Firmness
Position
Level of presenting part
54
Q

List options for analgesia during labour

A 
Paracetamol
TENS
Entonox
Diamorphine
Epidural anaesthesia
Remifentanyl
55
Q

What would be considered an abnormal amount of blood loss during labour?

A

More than 500ml

56
Q

When does placental expulsion occur following delivery?

A

5-10 mins

Considered normal up to 30 mins

57
Q

How long does it take tissues to return to non-pregnant state in puerperium?

A

6 weeks

3MB Reproduction (32 decks)

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