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58 Cards in this Set
- Front
- Back
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What 2 process must occur for implantation to be successful?
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1. Endometrim must have undergone hormonally-dependent differentiation
2. Embryo must have acquired the ability to interact with the endometrium |
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When does implantation occur?
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- 8-10 days after LH surge
- 6-7 days after ovulation |
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What are the 3 phases of implantation?
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1. Apposition
2. Adhesion 3. Invasion |
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What occurs during the apposition phase of implantation?
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Microvili on trophoblast interdigitate with pinopodes on surface of uterine epithelium
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What is the most common location for implantation?
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Upper, posterior fundal wall of the uterus
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How much oxygen and glucose does the placenta use?
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- 50% of oxygen
- 66% of glucose |
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What is energy used for in the placenta?
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- Energy storage
- Production - Transport |
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What changes does placental villi undergo?
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- Villi become smaller and highly vascular
- Fetal vessel move to a more ecentric location - Cytotrophoblast degenerate - Fusion of fetal capillaries and syncytiotrophoblast forming Vasculosyncytial membrane (3rd trimester) |
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What is the key determinant of fetal oxygenation?
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Maternal uterine blood flow
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What produces hCG?
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Syncytiotrophoblast
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When is hCG detectable?
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8-9 days post-ovulation
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How does hCG concentration change?
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- Doubles every 2 days
- Peaks at 10 - Declines afterwards |
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When does placenta take over progesteron production?
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Week 6
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What is hPL?
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Human Placental Lactogen
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What produces hPL?
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Produced by syncytiotrophoblast
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How does concetration of hPL change?
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Increase until week 34-36
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What are action of estrogen in the pregnant mother?
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- Increased uterine blood flow and cardiac output (Peripheral vasodilation & RAS)
- Increased liver production of hormone-binding globulins |
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What are action of corticosteroid in the pregnant mother + fetus? (2)
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- Promotes fetal lung maturation
- Maternal fluid expansion |
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What is the function of amniotic fluid? (5)
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- Cushion fetus
- Prevent compression of umbilical cord - Allows room for fetus to gorw - Bacteriostatic - Temperature homeostasis |
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What produces first trimester amniotic fluid?
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Transudate of maternal and fetal plasma
- Transmembranous: Exchange between maternal and fetal - Intramembranous: Exchange from one fetal compartment to another |
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What produces second & third trimester amniotic fluid?
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Production:
- Fetal urine (90%) - Fetal lung liquid Resorption: - Fetal swallowing - Intramembranous pathway |
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Is the fetal urine hyper/hypo/isotonic?
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hypotonic
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When does fetal skin get keratinized?
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Second trimester
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How do you assess amniotic fluid volume?
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Ultrasound: Amniotic fluid index or Deepest vertical pocket
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What causes Oligohydroamnios?
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Acute
- Rupture of membrane Chronic - Fetal anomalies (Renal & Outflow) - Chronic fetal hypoxia - Maternal NSAID use - Maternal dehydration |
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What is Phase 0 Parturition?
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- Uterine quiescence
- Contractile tranquility |
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What is Phase I Parturition?
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- Uterine prepardenss
- Functional change in myometrium & cervix |
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What is Phase II Parturition?
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- Active labour
- Progressive cervical dilation and fetal delivery |
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What is Phase III Parturition?
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- Uterine involution
- Fertility restored |
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What leads to initiation of labour in sheep?
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Estrogen/progesterone balance.
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What are Uterotropins?
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Set the stage of contractions and cervical change
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What are examples of Uterotropins? (4)
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- Estrogen
- Relaxin - Ca dependant phospholipases - Prostaglandins |
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What are Uterotonins?
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Directly involved in contraction of myometrial smooth muscles
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What are examples of Uterotonins? (3)
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- Oxytocin
- Prostagladins F2a - Endothelin-1 |
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What are the effects of PGE2 during labour?
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- Breakdown of the rigid structure of collagen fibers
- Softens extracellular matrix |
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What are the effects of PGF2a during labour?
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- Cause increase in intracellular Ca
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What role does gap junctions play with uterine contraction?
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Allows ion exchange between cells --> Increased muscle shortening
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What increases/decrease gap junction?
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- Estradiol increase
- Progesterone decrease |
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What is the definition of labour?
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Progressive cervical dilation, effacement, or both, resulting from regular uterine contractions every 5 minutes lasting 30-60 sec.
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What happens in the 1st stage of labour?
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Latent phase:
- Regular painful contractions every 5 min lasting 30-60sec - Cervix <3cm dilated - Duration variable Active Phase: - Regular painful contractions every 2-3 min lasting 45-60sec - Cervix 3-10cm dilated |
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What happens in the 2nd stage of labour?
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- Full cervical dilation to delivery of fetus
- < 3 hrs |
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What are the cardinal fetal movements?
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1. Engagement
2. Descent 3. Flexion 4. Internal rotation 5. Extension 6. External rotation/restitution 7. Expulsion |
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What happens in the 3rd stage of labour?
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Delivery of baby to delivery of placenta
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What are the classic signs of placental separation? (4)
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- Gush of blood
- Lengthening of cord - Fundus rises up - Uterus becomes firm and globular |
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What happens in the 4th stage of labour?
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- 1-1.5 hours after delivery of placenta
- Bleeding slows - Uterus remains contraction - Maternal stabilization and bonding - First attempt at breastfeeding |
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What are the vaginal discharge after birth?
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Red: Lochia rubra
Yellow-white: Lochia serosa Yellow: Lochia alba |
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Fetal oxygenation is influenced by? (5)
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- Maternal oxygenation
- Uterine blood flow - Pacental oxygen transfer - Umbilical cord blood flow - Fetal oxygen capacity & fetal circulation |
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Maternal oxygenation is influenced by? (3)
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- Hemoglobin concentration & saturation
- Hemoglobin's oxygen affinity - Oxygen dissolved in plasma |
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Umblical cord has how many arteries and veins?
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- 1 Vein
- 2 Arteries |
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What is fetal oxygen capacity influenced by?
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- Fetal hemoglobin concentration
- Fetal hemoglobin's oxygen affinity |
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Despite low pO2, fetal blood can transport roughly the same quantity of O2 as the mother because? (3)
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- Higher Hb concetraiont
- Hb has higher O2 carrying capacity - Higher Cardiac output -> Greater perfusion |
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What is fetal hemoglobin composed of?
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HbF
- 2 Alpha - 2 Gamma |
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What umbilical cord pH would indicate increased risk of brain injury?
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< 7.00
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What are the morphological changes of decidualization of the endometrium? (4)
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- Increase in cell size
- Change in cell shape (Fibroblastic to polyhedral) - Development of intracellular organelles for protein synthesis & secretion - Formation of intracellular junctions |
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In phase II, stage I, active how much does the cervix dilate in nulliparas?
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1cm/hr
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In phase II, stage I, active how much does the cervix dilate in multiparas?
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1.2cm/hr
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Placental gas exchange depends upon?
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- O2 & CO2 gradient
- O2 & CO2 affinity of maternal & fetal blood - Rates of fetal and maternal blood flow - Diffusion capacity of the placenta for O2 & CO2 |
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How do you diagnosis pre-eclampsia?
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- Diastolic >90 or Systolic > 140 and 0.3g/day proteinuria (or +2 on dipstick)
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