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69 Cards in this Set
- Front
- Back
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How many weeks is a term pregnancy and who is in control?
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37-42 wks, The fetus
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What are the components involved in the process of parturition?
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the fetus, placenta, and maternal systems
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What happens with parturition?
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There is a removal of the mechanisms that maintain uterine quiescence
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What does Parturition recruit?
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Factors that promote uterine activity
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What are the signals during parturition like?
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They are sequential and that makes it hard to single out one particular process that is "responsible"
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How is parturition characterized?
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characterized physiologically as a release from the inhibitory effects of preg. on the myometrium
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What 4 changes are included in Parturition?
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*Increase in prostaglandin synthesis & release in the uterus
*Increase in myometrial gap junction formation *Up-regulation of myometrial oxytocin receptors *Final change is the activation of the fetal HPA axis |
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What 3 things in Parturtition are the role of the fetus?
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*Fetal HPA axis
*DHEAS *CRH (corticotropin releasing horomone) |
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What does the Fetal HPA axis do?
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enhances fetal pitutitary ACTH secretion that leads to the release of DHEAS from the fetal adrenal gland
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What is DHEAS?
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a estrogen precursor
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What releases DHEAS?
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the placenta?
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What happens after DHEAS is released?
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estradiol, estrone and estriol are released.
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What is CRH (corticotropin releasing horomone) released by?
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the hypothalamus
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What does CRH stimulate?
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pituitary ACTH secretion and adrenal cortisol production and prostiglandin production
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When does the CRH stimulation process start?
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around 35 weeks gestation
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What is the role of Estrogen in Parturition?
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doesn't cause uterine contractions, but promotes myometrial changes
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What myometrial changes happen during Parturition because of estrogen?
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*increasing # of prostaglandin receptors
*Increasing oxytocin receptors *increasing # of gap junctions & up-regulating enzymes responsible for muscle contractions |
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What happens with removal of corpus luteum or use of RU486?
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pregnancy loss
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What is progesterone useful for in parturition?
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cervical ripening
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What is used for prevention of pre term labor?
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17-hydroxyprogesterone used as weekly injections
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does there need to be a total withdrawl of progesterone to start labor?
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No
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Are circulating levels of progesterone indicative of tissue levels?
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no
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What 2 hormones have antagonistic actions?
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cortisol & progesterone
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What does cortisol promote?
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cervical ripening and UC's
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What does progesterone inhibit?
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prostaglandin production
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What does oxytocin do?
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acts directly on the myometrium to cause UC's
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What does PGF2a do?
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Up regulates prostaglanding production
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What is PGE2 and where is it from?
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It is a hormone that plays a role in cervical ripening and ROM, is of fetal/placental origin
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What are the 3 dimensions of importance in the true pelvis?
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Inlet
Midplane Outlet |
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What are you measuring in regards to the inlet?
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Diagonal conjugate: subtract 1.5cm to obtain obstetric conjugate
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What is the midplane?
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the plane of least dimension (ischial spines, imagine making a peace sign to measure)
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What is the outlet measuring?
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the pubic arch
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What are the 4 types of fetal sutures?
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Sagital
coronal Frontal Lambdoidal |
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What are the 3 types of bones in the fetal skull?
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occiput
parietal frontal |
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What are the 2 types of fontanels?
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Posterior
Anterior |
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What is the biparietal diameter of the fetal skull?
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9.5cm
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what is the subocciputbregmatic diameter and when is it measured?
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9.5cm, when vertex
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What is the occipitofrontal diameter and when is it measured?
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11.5cm, when military (sinciput)
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What is the occipitomental diameter and when is it measured?
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12.5-13.5cm, brow presentation
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What is the largest diameter of the fetal head?
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occipitomental
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What is the Trachelo (submental) bregmatic diameter and when is it measured?
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9.5cm, face presentation
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What is the fetal Lie?
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relationship of the long axis of the fetus to the long axis of the mother
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What are some examples of fetal lie?
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longitudinal, transverse, oblique
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What is presentation?
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the presenting part of the fetus
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what are some examples of presentation?
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cephalic, breech, shoulder
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What is fetal attititude?
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the characteristic posture and the effect it has on fetal spine
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What are some examples of fetal attititude?
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vertex, sinciput, brow, face
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What is position?
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relationship of the presenting part to the maternal R or L
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What is variety?
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defines position in relation to the anterior, posterior, or transverse portion of the pelvis
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What are the first 3 cardinal movements of vertex presentation?
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*engagement
*Decent *Flexion |
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What is engagement?
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when the biparietal diameter passes through the pelvic inlet
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How and when does decent happen?
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occurs throughout labor d/t contraction and pushing
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When does flexion happen?
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when fetal head meets resistance, it is essential to further decent
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Fill in the blank:
Internal rotation_____ to the _____ position |
45degrees, OA
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Fill in the blank:
Birth of the head by______ |
Extension
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Fill in the blank:
Restitution ____ to the _____ position |
45 degrees, Left or Right
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Fill in the blank:
External Rotation_____to the _____position |
45 degrees, LOT/ROT
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Fill in the blank:
Birth of the shoulders and body by _______ via______ |
lateral flexion, the curve of carus
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what way is the sagital suture pointing during restitution?
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oblique
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What is the definition of adaptation to the pelvis?
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relationship of the sagital suture of the fetal head to the symphsis pubis and sacrum of the mother
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What are examples of adaptation to the pelvis?
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synclitism & asynclitism
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What is the diagnosis of labor?
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Regular painful uterine contractions leading to progressive cervical change
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Who was Friedman?
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He defined the statistical limit of normal as 2 standard deviations from the mean in laboring women
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What is the statistical limit for nulliparas (active-phase, 1st stage & 2nd stage)
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8.5 hr active phase, first stage
1.75hr second stage |
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What is the statistical limit for mulips?
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7.0hr active phase, first stage
1.0 hr second stage |
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What does fasting during labor doing?
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increases the concentration of HCL & doesn't eliminate stomach contents
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How many calories per hour are needed during active labor?
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50-100
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What does a lack of glucose lead to?
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Ketones -> lactic acid with decrease effeciency of UC's
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What does stress do during labor?
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increases catecholamine production -> decreases effeciency of UC's ->
vasoconstricts flo to uterus & lengthening labor |
