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68 Cards in this Set

  • Front
  • Back
What is the recommended gain weight during pregnancy?
25 pounds.

Of which: 11 fat, 3 urterine and breast growth, 2 placenta, 1 amniotic fluid, 1 increase in blood volume and the fetus is 7 pounds
What are the physiological changes in a pregnant women?
- increased blood volume
- increased cardiac output
- increased heart rate

Kidneys increase in size and iltration rate > 50%

Increased respiratory rate
What function does the increased respiratory rate serve?
Ratio O2/CO2 towards O2 which facillitates the diffusion to fetus.
What are posible maternal complications?
- Toxemia
- Diabetes Mellitus
- Ectopic pregnancy
What is toximia?
Develops in last 2 months of pregnancy in 6-7%

2 kinds:

1. preeclamsia, symptoms:
= weigh gain
= enema
= high BP
= proteinuria

Eclampsia: severe toxemia
Above symptoms with coma, conculsions and possibly death
How does gestational diabetes mellitus develop?

Weight gain -> insulin resistant -> rise in glucose levels of fetus and mother
What are complications of diabetes mellitus
Due to the high glucose levels: rapid growth in fetus that can make it too large for delivery

-> increased chance to C-section.
What is an ectopic pregnancy, causes?
Implantation in oviduct instead of uterus because of scarring oviducts that interferes with transportation.

Not viable. Surgery to remove.

Causes: STIs (chlymidia + gonorrhea)
What is the function of hormones secreted by the corpus luteum?
- pro/est: maintain development of
- steroids: supports maternal appetiti, fat deposition and breast enlargement
When is hCG secreted and by which cells? (+function?)
Cytotrophoblasts secrete hCG 2 days after implantation.
Why is the corpus luteum not degraded when implantation has occured like in the normal cycle?
hCG, produced 2 days after implantation, contributes to maintenance of the corpus luteum.
What hormones does the placenta secrete?
- hCG (cytotro. and thus later placenta) from d. 12 onwards

- week 5: progesterone and estrogen (3 kinds) secretion.

- human placental lactogen (hPL): similar to prolactin and slightly increase blood glucose and helps prima glands for milk production.

Other hormones: (similar to pituitary hormones)
- prolactin
- corticotropin
- thyrotropin
- endorphins
- oxytocin
How do the placenta and the fetus interact during production of hormones?
Progesterone produced by placenta -> fetal zone of fetal adrenal glands -> DHEA -> fetal liver -> 16-OH-DHEA-sullfate -> placenta -> estriol
How are the pubic bone tissues prepared for labow?
Relaxin (level rises steadily) relaxes the connective tissue between bones.

Moreover, relaxin also prepares the cerxic to soften and dilate.
How is labor initiated?
> relaxin
> cortisol
> pro/est ratio
> prostaglandins
> oxytocin
How does Cortiotropin releasing hormone (CRH) contribute to the preparation and onset of labor?
Increase CRH (placenta)-> Increase cortisol (fetal adrenal glands, POSTIVE FEEDBACK)->

1. maturation of fetal organs
2. increase prostaglandin production
3. increase est/pro ratio
How does cortisol contribute to labor?
- postive feedback loop with CRH
- produce ACTH from pituitary -> more cortisol
- contributes to initiation of labor.
How does the estrogen/progesterone ratio contribute to onset of labor?
- last 5 weeks; initiation of labor?
- increased estrogen: support for uterine contractions
- stimulate prstaglandin production
- produced from fetal membranes

- increase uterine contraction

- postive feedback loop with CRH
- stimulatory effect on uterine contraction

- secreted: fetal p. pituitary and placenta

- est/pro >

- feedbackloop with contractions

- increase prostaglandin production
In which feedback/signalling systems in CRH involved?
- ACTH -> cortisol: postive feedback

- stimulates DHEA -> estradiol production

-postive feedback loop with prostaglandins
How is labor induced?
Oxitocin (form of pinocin) and/or prostaglandins
Why would you want to induce labor?
- post-term: labor is not progressing or not spontaneous occuring

- preterm: possible risks.
When is the due date (bio + clinical)
38 weeks, 40 weeks.

+- 2 weeks is considered normal
Distribution of birth due dates
- females earlier than males

- shorter follicular cylces -> earlier

- exercizing women -> earlier.
What is the seasonal peak in birthrates
Peak during fall (babies made in winter) and low in spring.

Other way around in Europe =)

Why? Men during warmest months lower sperm count?
When does the detus drop into the cavity?
Sometimes 2-3 weeks and women can feel it
What are Braxton-Hicks
Contractioins in the final weeks (esp. the last one) of pregnany that are mild and irregulare urterine contractions but not labor.
What are the stages of labor and delivery?
Stage 1 of labor: cervical dilation and effacement

Stage 2 of labor: Fetus passes through cervix and vagina

Stage 3: delivery of fetus

Stage 4: delivery of placenta
Lengths vary for primi and multiparous women. How?
Primi: longer, 8-14 hours

Multi: 4-9 hours

Normal: within 24 hours
What are differences between male and female pevis'?

- more ovale
- wider pubic sumphesis
- wider pubic arch
- outward turning of ischial tuberosities

=> Larger pelvic outlet.
What is cervical effacement & dilation?
Thinning of the cervical wall and the retraction of the cervix upwards
What happens during this process?
after initial uterine contractions which are not strong enough.. (30-60 s. 5-20 m)

The 1m interval contractions, more intense -> effacement.

Dilates till 10 cm
What is the bloody show?
Around initiation of effacement, the mucus plug of the cervix is released leading to small amount of blood.
How is the amniotic sac broken?
Enzymes release weaken a site of the amniotic membrane -> ruptures.
During effacement progress
What are the functions of the amniotic sac and downstide of manually breaking it
- provides a barrier (prevent infections)
- cushun function (decreases chance for cephalohematoma)
How does the diameter of the cervical os change over time in labor?
initial: 0.3 cm

contraction 1-3 min: progresses and dilates to 10 cm

the more it progresses, the more painful.
What are trnsition dilation/contractions?
During the final stage of effacement/dilation the cervix dilates the last 7-10 cm.

Very painfol and strong.
What happens at stage two of labor?
- 10 cm dilation
- fetus passes through cervix and vagina
- uterine contractions -> assist movement through birth canal.
- episotomy
What is an episotomy?
A small cut in the perineal skin to 'prevent' tearing?
Why is episotomy not as popular anymore?
Studies show:

- longer healing process
- interferes with bonding
- women who underwent episotomy have more and deeper tears that take longer to heal.
What medications can be administered during labor?
- Epidural block injection
- Pudendal block
- Intravenus or oral analgesics, tranuilizers, anxiolytics
- intravenous pitocin (> uterine contractions)
What is an epidural?
Typically an optiate that is injected outside dura of spinal cord.

Numb sensations in body below injections
Pudendal block:
administered around the pudal nerve on each side of vagina
How does the physiology of the fetal sculp aid birth?
Fetal head = largest diameter (33 cm). This is to some extend compensated by the presence of fonanels: "soft spots" on the newborns brains where bones have not fused yet.
What direction does the fetal head come out of the vagina?
Face down. cephalic

Then rotates so t hat shoulders appear up-and-down position.
Possible aids for delivery
- forceps: When not progressing in 2nd stage (eg abnormal fetal position). Two curved steel blades. Rotated and pulled.

- Vacuum pump: fetus pulled out.
Fetal positions (normal + difficult)
normal: face down = cephalic presentation

Difficult positions:
- breech: head up and feet, buttock or knees extending down
- transverse: sideways or transversely in pelvis
Correction mechanisms for fetal position in breech or transverse?
- forceps/vacuum
- midwife external rotation pressure
- midwife internal pressur
- moxibustion with stimulatin if acupoint BL 67
Stage 3 of labor:
After birth: placenta

15-30 min after
Uterine bleeding occurs after which can be relieved by oxytocin release upon breast feeding
The cesearan section - when?
fetal distress, difficulty, breech/transversal

(liability claim avoidance)
The c-section - how?
General or local (spinal) anasthesia or acupunture.
Abdominal incision (below navel), through skin, muscle layer (pushed aside), and infant removed.
Downside c-section
- recovery longer
- interferese with mom-kid bonding immediatly after birth
Are there any other cultures where women deliver children on their back?
Nope, in antropological studies with over 70 cultures: none.
Most of them had midwives, and men did not deliver or were present.
When and how was the "painless delivery developed"
1900 Germany by 'twilight sleep' during labor and delivery.

Horizonal position easier for medication + restrainment easier.

Because of the medications: not able to push -> forceps
How did the episiotomy develop?
During the unconcious deliveries: more space fir forceps to be delivered.
Location of delivery where in 1900 vs now
pre-1900: less than 5%
Most home births by midwifes.
Hospital births had higher mortality rate (infections)

1970: 99%
Advantages of a vertical delivery
- use of gravity (in contractions, effacement, decrease likelihood of c section)

- increase surface of peritonal opening

- decrease pressue on aorta (> blood supply to fetus < chance to fetal stress)
Consequences of monitoring of fetal heart rate
> c sections, but not amount of cerebral palsy

No improvement in outcome of healthy mom's baby.

Continuous monitoring: prevents mother from walking during labor -> not use gravity -> increases lenght of labour and doubles c sections

SOLUTION: flexible monitoring
Why oxytocin has a double effect..
increases uterine contractions..

But also increases painfulness, and therefore increases the demand for pain medication.
Consequences of epidural analgesia
Numb pain of uterine contractions.

- decrease endogenous endorphin production
- decreases sense to push
- decreases sense of involvement and control
- decreases oxytocin and increases csection + oxitocin normally helps with bond formation.

- decrease beta-endorphins
- increase in post partem depression
What is the c-section rate in the us?
1970: 5%
Now: 25-30%
Consequences of csections
- increase illness and mortality

- more fluid in babies lungs

- lower levels of (nor)epi, beta-endorphins
What is a doula?
Female supportive person who works with and for the mom to confort, reduce axiety, allows empowerment etc
How are stress and delivery related to eachother?
Stress: increases cortisol, which increases sym. activity and decreases para. This leads to a decrease in contractions, and thus a prolonged delivery with a larger chance for c sections.

Also depression can work on immunology this way.
What results are there for doula births?
Overall beneficial:

reduces length, oxcytocin use, pain medication, forceps and c-section.
How is the newborn-parental bonding beneficial for the newborn?
If absent: reduces growtih and increases infant death.
What are the benefits for vaginal delivery? (2)
Relatively stressful environment prepares child:

- (nor)epi produced: 1. stimulate cardiovascular system. 2. facillitates adjustment to aerobic environment.

-> beta-endorphins are produced in infant and mother: facillitates bonding