Pregnancy and Childbirth

Where is HCG produced?

By the fertilized ovum, and then later by the placenta.

Immediately afterbirth, what does the breast produce and for how long. What is it high in?

Colostrum, which is high in protein is produced for the first 30 days.

What estrogen is produced by the placenta?

Estrial

What hormones does the placenta produce?

Estrogen, Progesterone, HCG and HPL

How does the placenta produce estrial?

From androstenedione that is produced by the fetus' adrenal gland.

What is the second stage of labor?

From the time the cervix is fully dilated to delivery. It's shorter than stage one. It is the pushing stage.

What are Braxton Hicks Contractions?

Irregular, painless, uncoordinated contractions. They begin in the first trimester and increase in frequency and number throughout the pregnancy.

What is HCGs role.

It is a transition hormone- It keeps the corpus luteum alive (it screams DONT DIE! WE'RE PREGNANT!)

Where is the placenta derived from and who does it share genetic information with?

It is derived from the ovum and it is genetically identical to the ovum.

What does the mesoderm develop in to?

Skeletal System, Musculature, Vasculature

What is goodell's sign? When is apparent by?

Softening of cervix due to engorgement with blood during pregnancy. It is apparent by 5 weeks.

What are the chorionic villae?

The babies vasculature inside the placenta.

What is a mom with morning sickness positively correlated with?

The baby, in adulthood liking sodium.

Who does it take over for?

The fertilized ovum

What will the inner call mass become?

The fetus

What is organogenesis?

The first stage of fetal development where rudimentary structures and organs are set aside. The fetus is very vulnerable to assault in this period.

What is the name of the clump of cells inside the trophoblast?

The inner cell mass

What changes does the vagina undergo during pregnancy?

The lining thickens to strengthen walls. Blood supply to vaginal walls increase so that cells remain healthy and fresh.

What is the main hormone producing site throughout pregnancy?

The placenta

When does excess salivation occur and what causes it?

1st trimester and estrogen.

What pharmacalogical options are available for pain relief?

local anesthesia (typically for pre or post episiotomy) IV narcotics- reduces pain messages to the brain Nueraxial medications in the spinal column- epidural and spinal block

What cardiovascular changes occur during pregnancy?

-Blood pressure declines from pre pregnant levels for the first 22 weeks and then returns to pre-pregnant levels.

What skeletal changes occur during pregnancy?

-General softening of the ligaments of the sacroiliac (lower back) and pelvis, which allows joints between bones to widen and reduces risk of broken bones during labor.

What changes occur in the cervix during pregnancy?

-Goodell's sign -Cervical mucus increases in volume -Mucus becomes really thick and pasty and forms a plug at the os -In preparation for labor the cervix effaces and the os dilates

What changes does the uterus undergo during pregnancy?

-Increase in size -Increase in cell number -Increase in blood vessels -Increase in blood flow -Braxton Hicks Contractions

What changes do the breasts undergo during pregnancy?

-Maximum development of the mammary glands -Increased vasculature -Darker areola -Development of secondary areola

What are the 3 phases of the 1st stage of labor?

1. Latent phase 3-5cm 2. Active phase 4-7cm 3. Transition phase 8-10cm

How do you know labor has begun?

1. Plug lets go, a small amount of blood and mucus released 2. Contractions become more frequent and are progressive 3. The rupture of the amniotic sac

When does brain development occur?

2nd trimester to 4 years old.

How long does it take to develop?

30 to 60 days

If the ovum is fertilized how long are we going to need the corpus luteum? How long do they sometimes last anyways?

30 to 60 days. They sometimes stay alive for whole pregnancy.

In what percent of women does morning sickness occur?

50 to 80%

How often does toxemia occur? What can it develop in to if not treated?

6/100 pregnancies. It can develop in to pre eclamsia and eventually eclampsia

How much bigger and how much more capacity does the uterus get?

6X the bigger 2000X the capacity

What is thalidomide?

A drug that, when taken on a very specific day in the 1st trimester prevents the limb buds from developing. It's original purpose was to treat morning sickness.

What is the name of the tiny ball of cells that becomes hallow through cell division of the fertilized ovum (the whole thing).

Blastocyst.

When does it abate?

After the first trimester

What does the ectoderm develop in to?

Central Nervous System, Peripheral Nervous System and the Epidermis

What are progesterone levels like Day 1 to 14? Day 15 to 28? First Trimester? Second Trimester? Third Trimester? 24 hours before childbirth?

Day 1 to 14---1 to 1.5 ng/ml Day 15 to 28---2-28 ng/ml First Trimester--- 9 to 47ng/ml Second Trimester---17-147 ng/ml Third Trimester--- 55-200 24 hours before labor--- Drop off

What is the third stage of labor?

Delivery of the placenta. It lasts just a few minutes.

How many layers does the inner cell mass develop in to and what are their names.

Ectoderm Mesoderm Endoderm

What are the 2 actions of estrial?

Growth of uterine muscle mass Works with progesterone to stimulate the growth of the mammary glands.

What does the endoderm develop in to?

Guts, lungs, liver

What do pregnancy tests look for?

HCG

What do high levels of pregesterone tell us? What don't they tell us? Why?

High progesterone levels tell us of the viability of the placenta, but not of the fetus. Unlike estrial, the fetus is not needed to produce progestrone. The placenta can do it on it's own with cholesterol from mom.

What are the placentas roles?

Hormone production Point of exchange between the mother and fetus

What does HCG stand for?

Human Chorionic Gonadotropin

What is HPL

Human Placental Lactogen- it works with estrogen and progesterone to 1. increase the number of alveoli in the mammary glands 2. make alveoli functional (capable of producing milk)

What might cause morning sickness?

Increased estrogen levels

What are the action of progesterone during pregnancy.

Inhibits coordinated contractions of the uterus. Works with estrogen and Human Placental Lactogen to stimulate the development of the mammary glands.

What happens with progesterone right before childbirth and what is the effect?

Levels drop off and the effect is that coordinated contractions can occur.

Where does the cholesterol that the fetus uses to make progesterone come from?

Mom eats it.

What happens to the gastrointestinal system during pregnancy?

Morning Sickness Excess Salivation Heartburn

Do mom and fetus' blood mix?

No

What are the stages of fetal development?

Organogenesis (1st tri) Integration (2nd tri) Growth and Integration (3rd tri)

What are the secondary areola and who are they most visible in?

Outer ring that forms around the areola and they are most visible in white people.

What hormones are very high during labor?

Oxytocin and prostaglandin levels are high, they stimulate contractions of the uterus.

What is growth and integration?

Rapid increase in size of structures and more maturation of systems.

What are non-drug coping mechanisms

Reduction of stress and anxiety Relaxation technique Movement (changing positions, rhythmic movement) Calm environment Reduction of hunger/thirst

What hormone induces the skeletal changes?

Relaxin

How is the production of estrial by the placenta different from the production of estrogen in the woman herself?

Placenta cannot produce estrial from cholesterol.

What is pre eclampsia and what is eclampsia?

Pre-eclamsia is high blood pressure, edema, high urine protein levels Eclampsia

Why and when does heartburn occur?

Pressure from the uterus presses on the stomach and pushes partially digested food up in to the esophagus. The cardiac sphincter is weakened. It is more common in the 2nd and 3rd trimester.

What is an almost immediate affect of a big uterus that is full of blood?

Pressure on the bladder and frequent urination.

What is integration?

The second stage of fetal development where physiological system begin to connect and work together.

What is the level of estrogen in mom's blood a measure of? Why?

The viability of the fetus. If the fetus is producing estrogen which is contributing to the high estrogen levels in mom's blood that means the fetus is alive and active.

What will happen if the corpus luteum dies before 30 to 60 days?

There wont be enough estrogen or progesterone to keep fetus alive.

What if progesterone and estrial are low?

There's either a problem with the fetus and the placenta, or just a problem with the placenta.

How do HCG and LH compare?

They are very similar, chemically.

What are the levels of progesterone and estrogen like across the pregnancy?

They increase rapidly in the first semester, then continue to climb at a slower rate throughout the second and third trimester.

Why were old pregnancy tests so ineffective?

They weren't very good at telling LH and HCG apart.

What is the name of the outer shell of the blastocyst?

Trophoblast

What is the cause of labor?

Unknown. It seems to be a complex interplay between ongoing changes in several components- the baby, the uterus and the placenta. Mom is just along for the ride.. not an active participant.

How are waste and nutrients exchanged from mom to fetus?

Via a concentration gradient. Anything in higher concentration in one, goes to the other.

What is the Cult of Pregnancy?

Women that have been pregnant don't tell women that have not been pregnant what its really like.

Is high blood pressure in pregnancy worrisome?

YES, it is a serious condition called toxemia.

Can progesterone be produced by the placenta from cholesterol?

Yes, unlike estrial.

What is morning sickness associated with?

hunger pangs

What will the trophoblast become?

the placenta