Management of Normal and Abnormal Labors Overview Gross & molecular structure of the myometrium and cervix Biochemical aspects of uterine contractions Birth canal Stages of labor Diagnosis, causes, & management of abnormal labor Gross & molecular structure of the myometrium and smooth muscle surrounded by collagen and glycoaminoglycans cervix to fundus muscle component increases o contractions strongest in fundus blood vessel course in between muscle fibers o blood flow decreases during contractions fetal oxygenation post partum hemorrhage Early Pregnancy few cellular contacts uncoordinated contractions Late Pregnancy Placental estriol increases o gap junctions o electrical communications o coordinated contractions Cervix less smooth muscle collagen feels firm Physiology of cervical ripening collagen fibers fractures o proteolytic enzymes o hyaluronic acid replaces glycosaminoglycans o water content increases
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Management of Normal and Abnormal Labors
Overview Gross & molecular structure of the myometrium and cervix Biochemical aspects of uterine contractions Birth canal Stages of labor Diagnosis, causes, & management of abnormal labor
Gross & molecular structure of the myometrium and smooth muscle surrounded by collagen and glycoaminoglycans cervix to fundus muscle component increases
o contractions strongest in fundus blood vessel course in between muscle fibers
o blood flow decreases during contractions fetal oxygenation post partum hemorrhage
Early Pregnancy few cellular contacts uncoordinated contractions
Late Pregnancy Placental estriol increases
o gap junctionso electrical communications o coordinated contractions
Cervix less smooth muscle collagen feels firm
Physiology of cervical ripening collagen fibers fractures
o proteolytic enzymeso hyaluronic acid replaces glycosaminoglycanso water content increaseso cervix softens, effacement begins, dilates
Regulators of cervical ripening Inhibitor
o progesterone Promoters
o estriol - oxytocin receptorso relaxin
o oxytocino PGE1 and 2
o Laminaria rods
Physiology of uterine contractions
Inhibition of Uterine Contractions
Promotors of uterine contractions
oxytocin PGF2
o release of calcium from sarcoplasmic reticulum influx of calcium from Ca channels
Characteristics of the maternal birth canal Inlet
o sacral promontoryo linea terminaliso posterior symphysis
Conjugates True - superior symphysis to sacral promontory
o not relevant to child birth Diagonal - inferior symphysis to sacral promontory
o clinical estimate of obstetrical conjugate (-1.5cm) Obstetrical - posterior symphysis to sacral promontory
o what the fetus passes through
Mid-pelvis sacrum
o hollow lateral
o ischial spines A-P = sagittal line
o inferior symphysis through bispinous diameter to sacrumo anterior sagittalo posterior sagittal
Outlet diamond shape
o mid symphysiso 2 ischial tuberositieso coccyx
Gynecoid pelvis round inlet hollow sacrum spines not prominent
o anterior sagittal > posterior occiput anterior presentations gentle curved symphysis most common type and best prognosis