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  1. 1. Parturition Dr. Sadaf Mumtaz 15/02/11
  2. 2. <ul><li>Dilatation of cervix </li></ul><ul><ul><li>Relaxin (corpus luteum & placenta) </li></ul></ul><ul><ul><ul><li>Softens cervix </li></ul></ul></ul><ul><ul><ul><li>Relaxes birth canal by loosening the connective tissue between pelvic bone </li></ul></ul></ul><ul><ul><li>Prostaglandins </li></ul></ul><ul><li>Contraction of Uterine myometrium </li></ul><ul><ul><li>Role of high estrogen levels/ Increases ratio of estrogen to progesterone </li></ul></ul><ul><ul><ul><li>Gap Junctions </li></ul></ul></ul><ul><ul><ul><li>Increased number of oxytocin receptors </li></ul></ul></ul><ul><ul><ul><li>Cervical ripening local prostaglandins cervical enzymes collagen fibers </li></ul></ul></ul><ul><ul><li>Role of oxytocin </li></ul></ul><ul><ul><ul><li>Increased receptors </li></ul></ul></ul><ul><ul><ul><li>Rate of secretion at the time of labour </li></ul></ul></ul><ul><ul><li>Effect of fetal hormones </li></ul></ul><ul><ul><ul><li>Oxytocin </li></ul></ul></ul><ul><ul><ul><li>Cortisol </li></ul></ul></ul><ul><ul><ul><li>Prostaglandins </li></ul></ul></ul>
  3. 3. Role of Inflammation <ul><li>Nuclear factor- ĸ β </li></ul><ul><ul><li>IL-8 </li></ul></ul><ul><ul><li>Prostaglandins </li></ul></ul><ul><li>Increase sensitivity of uterus to contraction </li></ul><ul><li>inducing chemical messengers </li></ul><ul><li>Help soften the cervix </li></ul><ul><li>Factors leading to activation of NF-ĸ β </li></ul><ul><li>Stretching of uterine cervix </li></ul><ul><li>Presence of pulmonary surfactant protein SP-A in the amniotic fluid </li></ul><ul><li>SP-A promotes migration of fetal macrophages to uterus which produce IL-1 β that activates NF-ĸ β </li></ul>
  4. 4. Mechanical Factors <ul><li>Stretch of the uterine musculature </li></ul><ul><ul><li>Fetal movements </li></ul></ul><ul><ul><li>Twins </li></ul></ul><ul><li>Stretch or irritation of cervix </li></ul>BRAXTON-HICKS CONTRACTIONS
  5. 5. Mechanism of Parturition <ul><li>Cervical dilatation </li></ul><ul><ul><li>24 hrs </li></ul></ul><ul><li>Delivery of the baby </li></ul><ul><ul><li>30-90mins </li></ul></ul><ul><li>Delivery of the placenta </li></ul><ul><ul><li>15-30mins </li></ul></ul><ul><ul><li>350 ml of blood lost </li></ul></ul><ul><ul><li>SMC </li></ul></ul><ul><ul><li>Prostaglandins </li></ul></ul>Involution of uterus
  6. 6. Lactation <ul><li>Role of estrogen and progesterone </li></ul><ul><li>Role of hCS </li></ul><ul><li>Colostrum (Fluid secreted during the last few days before and the first few days after parturition) </li></ul><ul><li>Role of growth hormone, cortisol, parathyroid hormone & insulin </li></ul>
  7. 8. Changes in rates of secretion of estrogens, progesterone and prolactin
  8. 9. Advantages of breast feeding <ul><li>Immune cells such as B and T lymphocytes, macrophages, neutrophills, </li></ul><ul><li>Secretory IgA --- Ecoli </li></ul><ul><li>Mucus </li></ul><ul><li>Lactoferrin – decreases availability of iron from bacteria </li></ul><ul><li>Bifidus Factor---promotes growth of non-pathogenic micro-organism lactobacillus bifidus. Growth of this bacteria helps crowd out potentially harmful bacteria </li></ul>
  9. 10. Advantages of breast feeding for the mother <ul><li>Oxytocin released triggered by nursing hastens uterine involution </li></ul><ul><li>Subsequent effect of increased prolactin </li></ul><ul><ul><li>Inhibit GnRH and thereby stopping release of LH and FSH </li></ul></ul>
  10. 11. Assignments <ul><li>Preeclampsia and Eclampsia </li></ul><ul><ul><li>Effects on the mother, fetus and placenta </li></ul></ul><ul><ul><li>Treatment </li></ul></ul><ul><ul><li>Wednesday 23 rd of february </li></ul></ul>
  11. 12. Thankyou