Pregnancy Hormones, APGAR & abortion

Danielle Richardson
Mind Map by Danielle Richardson, updated more than 1 year ago
Danielle Richardson
Created by Danielle Richardson almost 5 years ago
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Degree Medicine (Physiology) Mind Map on Pregnancy Hormones, APGAR & abortion, created by Danielle Richardson on 04/09/2015.
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Pregnancy Hormones, APGAR & abortion
1 hCG
1.1 hCG rises quickly, then drops as placenta produces oestrogen and progesterone instead of corpus luteum
1.1.1 Produced by syncytiotrophoblast
1.1.2 Can be used to stimuate ovulation in fertility treatment
1.1.3 Maintains endometrium
1.1.4 Doubles every 2-3 days
2 Oestrogen slowly rises
2.1 Promotes gap junctions (connexins) to link myometrial cells
2.1.1
2.2 Makes myometrium more receptive to hCG
2.2.1 Increases uterine contractibility
2.3 Increases PGE2 (prostaglandin production)
2.3.1 Softens cervix
2.4 Promotes mammary development- ducts
2.5 Other
2.5.1 increases angiotensinogen
2.5.2 Increases thyroid binding globulin
2.5.3 Increases adrenal androgens
3 Progesterone slowly rises then drops at end
3.1 Inhibits uterine contractibility
3.2 Promotes cervical plug development
3.3 Promotes milk gland development
3.4 Smooth muscle relaxant
3.4.1 vasodilation
3.4.1.1 Lowered BP
3.4.1.2 and more fluid
3.4.1.2.1 so less RBC concentration
3.4.1.3 blood
3.4.1.3.1 increase WBC
3.4.1.3.2 hypercoagulable state
3.4.2 delayed gastric emptying
3.4.2.1 Indigestion
3.4.3 Increased risk of urine infections
3.5 Makes chemoreceptors in brain more sensitive to CO2
3.5.1 Ventillation increases
4 Relaxin
4.1 Polypeptide
4.2 Secreted from
4.2.1 Placenta
4.2.2 CL
4.2.3 Mammary gland
4.2.4 Prostate in men
4.2.4.1 In men, aids semen motility and helps penetration of oocyte
4.3 Relaxes pubic symphysis
4.4 Softens and dilates cervix
4.5 Inhibits uterine contractions
5 Corticotrophin releasing hormone CRH
5.1 Produced by hypothalamus and placenta
5.1.1 From hypothalamus- Adrenocorticotropic hormone ACTH
5.2 Cortisol matures fetal lungs
6 Prolactin
6.1 Secreted by placenta, endometrium and pituitary
6.2 Causes milk production
6.3 Inhibits GnRH and FSH
7 HPL human placental lactogen = human chorionic somatotropin HCS
7.1 Anti-insulin
7.1.1 Increases blood glucose
8 Pregnancy
8.1 Surfactant
8.1.1 Released by type 2 alveolar cells
8.1.1.1 After 34 weeks, loads produced
8.1.1.2 Fat ones in alveoli
8.1.1.2.1 type 1 are thin- on alveolar walls- helps gas exchange
8.1.2 Production stimulated by glucocorticoids, thyroxine, and prolactin
8.2 Pregnancy stages
8.2.1 Embryonic phase
8.2.1.1 Until end of week 8
8.2.1.1.1 major congenital abnormalities can occur
8.2.2 Fetal phase
8.2.2.1 functional defects and minor abnormalities
8.3 By 10-12 weeks, placenta is primary support for fetus
8.4 Antenatal Screening
8.4.1 Downs syndrome
9 Oxytocin
9.1 Acts on corpus luteum
9.2 Contracts myoepithelial cells of breast for milk secretion
9.3 Syntocinon is artificial oxytocin
9.4 dilates cervix

Annotations:

  • so does PGE2
10 APGAR
10.1 activity
10.2 pulse
10.3 grimace
10.4 appearance
10.5 respiration
11 Breast feeding

Annotations:

  • Good because: lowers risk of obesity infection sleep apnoea SIDS Dental problems Higher IQ
11.1 Baby suckles
11.1.1 Sensory nerve to brain
11.1.1.1 Anterior pituitary
11.1.1.1.1 prolactin
11.1.1.1.1.1 Progesterone and oestrogen block this during pregnancy
11.1.1.1.1.2 Produces milk in alveoli
11.1.1.1.1.3 Exposure of placenta relases prolactin binding sites in acini
11.1.1.1.1.3.1 Surge of prolactin primes receptor site in first 4 hours
11.1.1.1.1.3.1.1 No feed= receptor sites shut down
11.1.1.2 Posterior pituitary
11.1.1.2.1 Oxytocin
11.1.1.2.1.1 Makes myoepithelial cells of alveoli contract
11.1.1.2.1.1.1 Milk release
11.1.1.2.1.2 Also causes uterus to contract
11.1.1.2.1.2.1 Can cause severe abdominal pain
11.1.1.2.1.3 Oxytocin reflex
11.1.1.2.1.3.1 aka let down reflex
11.1.1.2.1.3.2 when mother hear baby, expects feed, or baby suckles oxytocin released
11.1.1.2.1.4 Reduces stress, calmness
11.1.2 Good attachment
11.1.2.1 areola, tissues below it are in baby's mouth
11.1.2.2 Baby's tongue forward over longer gums
11.1.2.3 Suckling breast not nipple
11.2 Barriers
11.2.1 Education
11.2.2 Cultural norm
11.2.3 Family influence
11.2.4 Lack of support
11.2.5 Mother/baby unwell
11.3 Skin to skin important
11.3.1 regulates HR and resp rate
11.3.2 Keep baby warm
11.3.3 share skin flora
11.3.4 Pre feeding behaviour
11.3.5 Oxytocin release
12 Abortion
12.1 Law
12.1.1 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
12.1.2 2 doctors must agree that it would cause the woman less physical or mental harm to have the abortion
12.1.3 Doctor with moral objections doesn't have to do it
12.1.3.1 But must recommend another doctor that will
12.1.4 Can be under 16
12.1.4.1 if 2 drs believe its in your best interest and fully understand what it involves
12.1.5 Abortion forms
12.1.5.1 HSA1
12.1.5.1.1 normal abortion form

Annotations:

  • 2 drs sign before abortion, and kept for 3 yrs
12.1.5.2 HSA2
12.1.5.2.1 emergency abortion form

Annotations:

  • within 24hrs, kept for 3 years
12.1.5.3 HSA4
12.1.5.3.1 Completed and send to CMO within 14 days
12.1.6 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 
12.2 Procedure

Annotations:

  • Normal investigations as with pregnancy and VTE assessment which is assessing risk of thromboembolism as they do with any surgery 
12.2.1 Medical
12.2.1.1 Early- Up to 9 weeks
12.2.1.1.1 Mifepristone
12.2.1.1.1.1 Blocks hormone maintaining womb lining
12.2.1.1.1.2 Followed by misopristol (PG)
12.2.1.1.2 2 days later= prostaglandin
12.2.1.1.2.1 Breaks down womb lining within 4-6 hours
12.2.1.1.2.1.1 Can be painful
12.2.1.2 Late- 9-20 weeks
12.2.1.2.1 Same as early
12.2.2 Surgical

Annotations:

  • Later as won't be able to find fetus
12.2.2.1 7-15 weeks
12.2.2.1.1 Vacuum aspiration
12.2.2.1.1.1 Tablet used to dilate cervix
12.2.2.1.1.2 Suction device used to remove fetus and placenta
12.2.2.1.1.3 Under general or local anaesthetic
12.2.2.1.1.4 5- 10 minutes
12.2.2.1.1.5 Bleeding up to 21 days after
12.2.2.2 15+ weeks
12.2.2.2.1 Dilation and evacuation
12.2.2.2.1.1 Bleeding up to 21 days after
12.2.2.2.1.2 General anaesthetic
12.2.3 Late abortion
12.2.3.1 20-24 weeks
12.2.3.1.1 Surgical 2 stage abortion
12.2.3.1.1.1 First stop fetus heart
12.2.3.1.1.2 Next day remove fetus
12.2.3.1.1.3 Under general anaesthetic
12.2.3.1.2 Medically induced abortion
12.2.3.1.2.1 Prostaglandin injected into womb
12.2.3.1.2.1.1 contracts
12.2.3.1.2.1.1.1 6-12 hours
12.2.3.1.2.1.2 D and E may be used afterwards to ensure all fetus removed
12.2.4 Antibiotic prophylaxis giveb
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