Pregnancy Hormones, APGAR & abortion

1. hCG rises quickly, then drops as placenta produces oestrogen and progesterone instead of corpus luteum
   1. Produced by syncytiotrophoblast
   2. Can be used to stimuate ovulation in fertility treatment
   3. Maintains endometrium
   4. Doubles every 2-3 days

1. Promotes gap junctions (connexins) to link myometrial cells
2. Makes myometrium more receptive to hCG
   1. Increases uterine contractibility
3. Increases PGE2 (prostaglandin production)
   1. Softens cervix
4. Promotes mammary development- ducts
5. Other
   1. increases angiotensinogen
   2. Increases thyroid binding globulin
   3. Increases adrenal androgens

1. Inhibits uterine contractibility
2. Promotes cervical plug development
3. Promotes milk gland development
4. Smooth muscle relaxant
   1. vasodilation
      1. Lowered BP
      2. and more fluid
         1. so less RBC concentration
      3. blood
         1. increase WBC
         2. hypercoagulable state
   2. delayed gastric emptying
      1. Indigestion
   3. Increased risk of urine infections
5. Makes chemoreceptors in brain more sensitive to CO2
   1. Ventillation increases

1. Polypeptide
2. Secreted from
   1. Placenta
   2. CL
   3. Mammary gland
   4. Prostate in men
      1. In men, aids semen motility and helps penetration of oocyte
3. Relaxes pubic symphysis
4. Softens and dilates cervix
5. Inhibits uterine contractions

1. Produced by hypothalamus and placenta
   1. From hypothalamus- Adrenocorticotropic hormone ACTH
2. Cortisol matures fetal lungs

1. Secreted by placenta, endometrium and pituitary
2. Causes milk production
3. Inhibits GnRH and FSH

1. Anti-insulin
   1. Increases blood glucose

1. Surfactant
   1. Released by type 2 alveolar cells
      1. After 34 weeks, loads produced
      2. Fat ones in alveoli
         1. type 1 are thin- on alveolar walls- helps gas exchange
   2. Production stimulated by glucocorticoids, thyroxine, and prolactin
2. Pregnancy stages
   1. Embryonic phase
      1. Until end of week 8
         1. major congenital abnormalities can occur
   2. Fetal phase
      1. functional defects and minor abnormalities
3. By 10-12 weeks, placenta is primary support for fetus
4. Antenatal Screening
   1. Downs syndrome

1. Acts on corpus luteum
2. Contracts myoepithelial cells of breast for milk secretion
3. Syntocinon is artificial oxytocin
4. dilates cervix

   Annotations:

   • so does PGE2

1. activity
2. pulse
3. grimace
4. appearance
5. respiration

Annotations:

• Good because: lowers risk of obesity infection sleep apnoea SIDS Dental problems Higher IQ

1. Baby suckles
   1. Sensory nerve to brain
      1. Anterior pituitary
         1. prolactin
            1. Progesterone and oestrogen block this during pregnancy
            2. Produces milk in alveoli
            3. Exposure of placenta relases prolactin binding sites in acini
               1. Surge of prolactin primes receptor site in first 4 hours
                  1. No feed= receptor sites shut down
      2. Posterior pituitary
         1. Oxytocin
            1. Makes myoepithelial cells of alveoli contract
               1. Milk release
            2. Also causes uterus to contract
               1. Can cause severe abdominal pain
            3. Oxytocin reflex
               1. aka let down reflex
               2. when mother hear baby, expects feed, or baby suckles oxytocin released
            4. Reduces stress, calmness
   2. Good attachment
      1. areola, tissues below it are in baby's mouth
      2. Baby's tongue forward over longer gums
      3. Suckling breast not nipple
2. Barriers
   1. Education
   2. Cultural norm
   3. Family influence
   4. Lack of support
   5. Mother/baby unwell
3. Skin to skin important
   1. regulates HR and resp rate
   2. Keep baby warm
   3. share skin flora
   4. Pre feeding behaviour
   5. Oxytocin release

1. Law
   1. Before 24 weeks

      Annotations:

      • Unless mother's life at risk, mother at risk of permanent mental or physical injury, or baby will have significant defects
   2. 2 doctors must agree that it would cause the woman less physical or mental harm to have the abortion
   3. Doctor with moral objections doesn't have to do it
      1. But must recommend another doctor that will
   4. Can be under 16
      1. if 2 drs believe its in your best interest and fully understand what it involves
   5. Abortion forms
      1. HSA1
         1. normal abortion form

            Annotations:

            • 2 drs sign before abortion, and kept for 3 yrs
      2. HSA2
         1. emergency abortion form

            Annotations:

            • within 24hrs, kept for 3 years
      3. HSA4
         1. Completed and send to CMO within 14 days
   6. Northern Ireland

      Annotations:

      • Can terminate if necessary to preserve woman's life, or if their is real and serious risk of adverse effect  on the women's physical or mental health, Can't abort if fetal abnormality 
2. Procedure

   Annotations:

   • Normal investigations as with pregnancy and VTE assessment which is assessing risk of thromboembolism as they do with any surgery 
   1. Medical
      1. Early- Up to 9 weeks
         1. Mifepristone
            1. Blocks hormone maintaining womb lining
            2. Followed by misopristol (PG)
         2. 2 days later= prostaglandin
            1. Breaks down womb lining within 4-6 hours
               1. Can be painful
      2. Late- 9-20 weeks
         1. Same as early
   2. Surgical

      Annotations:

      • Later as won't be able to find fetus
      1. 7-15 weeks
         1. Vacuum aspiration
            1. Tablet used to dilate cervix
            2. Suction device used to remove fetus and placenta
            3. Under general or local anaesthetic
            4. 5- 10 minutes
            5. Bleeding up to 21 days after
      2. 15+ weeks
         1. Dilation and evacuation
            1. Bleeding up to 21 days after
            2. General anaesthetic
   3. Late abortion
      1. 20-24 weeks
         1. Surgical 2 stage abortion
            1. First stop fetus heart
            2. Next day remove fetus
            3. Under general anaesthetic
         2. Medically induced abortion
            1. Prostaglandin injected into womb
               1. contracts
                  1. 6-12 hours
               2. D and E may be used afterwards to ensure all fetus removed
   4. Antibiotic prophylaxis giveb