Term
| How do progesterone, estrogen, cortisol, and prolactin affect sleep during pregnancy? |
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Definition
Progesterone has a sedative effect and increases non-REM sleep.
Prolactin increases both REM & non-REM sleep
Estrogen and cortisol decrease REM |
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Term
| How early in pregnancy do sleep changes occur? |
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Definition
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Term
| What is the difference in sleep time between the first half and second half of pregnancy? |
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Definition
First half: total sleep time increases as does napping
Second half: women have less overall sleep time and more night awakenings |
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Term
| What are some of the causes of night awakenings during pregnancy? |
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Definition
Nocturia
Dyspnea
Heartburn
Uterine activity
Nasal congestion
Muscle aches
Back ache
Leg cramps
Restless legs
Urinary frequency
Fetal activity
Stress
Anxiety |
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Term
| What effect may sleep loss in the last week of pregnancy have on labor? |
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Definition
| Sleep loss in the last 3-4 weeks of pregnancy may increase labor length and need for cesarean birth. |
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Term
| Pregnant women who snore have a higher incidence of |
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Definition
HTN
Preeclampsia
Gestational diabetes
Fetal growth restriction |
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Term
| List the expected postpartum changes in NREM and REM sleep |
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Definition
Stage 1 NREM sleep is longer immediately after birth than before birth.
Stage 4 NREM sleep is also longer immediately after birth than before birth, with a gradual change to prepregnancy levels by about 2 weeks.
REM sleep is decreased and awake time increased on first postpartum night, with a reversal of these findings by 3 days (i.e. REM sleep increased and awake time decreased). These changes are probably related to the initial euphoria and discomfort after childbirth, followed by fatigue and restoration.
Postpartum women have less overall sleep time and more night awakenings than non-pregnant women.
These changes normalize after the first few weeks PP however primiparas may experience for up to 3mo. |
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Term
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Definition
body pain, usually at or near the surface of the skin, and is easily localized.
During labor, somatic pain is caused by pressure of the presenting part on the birth canal, vulva, and perineum.
Somatic pain is more intense and localized.
Somatic pain is experienced during transition and the second stage of labor |
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Term
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Definition
| Diffuse, deep in the body’s tissues, and originates from an organ system. During labor, visceral pain is related to contraction of the uterus and dilation and stretching of the cervix. Visceral pain is experienced primarily during the first stage of labor. |
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Term
| How is visceral pain transmitted to the pain centers in the brain? |
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Definition
| During the first stage of labor, visceral pain is transmitted to the pain centers in the brain by afferent fibers to the sympathetic chain of the posterior spinal cord at T10 to T12, and L1. In early labor, pain is transmitted primarily to T11 & T12. |
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Term
| How is somatic pain transmitted to the pain centers in the brain? |
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Definition
| Pain by the presenting part are transmitted by the pudendal nerves through the posterior roots of the parasympathetic chain at S2, S3, and S4. |
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Term
| The major site of pain during labor is probably the |
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Definition
| cervical area, due to it being densely innervated |
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Term
| What are beta endorphins and enkephalins? |
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Definition
Endogenous opiate peptides that alter the release of neurotransmitters from afferent nerves and interfere with efferent pathways from the spinal cord to the brain producing a feeling of analgesia and euphoria that enables women to tolerate the pain of labor and delivery.
They may also alter mood in pregnancy. |
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Term
| Where are beta endorphins and enkephalins produced? |
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Definition
These substances are prohormones derived from precursor proteins such as prepro-opiomelanocortin (POMC) for B-EP and preproenkephalin for enkephalin.
POMC is found in the anterior pituitary gland, B-EP is produced by the placenta. |
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Term
| Describe referred pain during the first stage of labor |
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Definition
| The nerve impulses from the uterus and cervix stimulate spinal cord neurons, innervating both the uterus and the abdominal wall. As a result, the woman experiences pain over the abdominal wall between the umbilicus and symphysis pubis, around the iliac crests to the gluteal area, radiating down the thighs, and in the lumbar and sacral regions. |
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Term
| Describe how pain can increase anxiety and influence physiologic responses and labor |
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Definition
| physical manifestations of anxiety may include muscular tension, hyperventilation, increased sympathetic activity, and norepinephrine release, which can lead to increased cardiac output, blood pressure, metabolic rate, and oxygen consumption and impaired uterine contractility. Anxiety can also increase fear and tension, reducing pain tolerance, which decreases uterine contractility. Relaxation techniques such as progressive muscle relations, touch, breathing, imagery, and autosuggestion help reduce anxiety and prevent or stop this cycle. |
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Term
| List non-pharmacologic, cognitive, behavioral and sensory techniques for helping women in labor cope with pain. |
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Definition
Relaxation
Cognitive and behavioral childbirth preparation
Hypnosis
Acupuncture
Movement
Positioning
Vocalizations
Touch/massage
Music
Biofeedback
TENS units
Hydrotherapy |
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Term
| Describe sterile water injections as a form of pain relief |
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Definition
| In 1989, AJOG published an article (see readings, above) that introduced the usage of sterile water injections (4) in the sacral area of a laboring women. The woman’s back is cleansed. Then 0.1-0.15 cc of sterile water is injected intradermally into four places on the sacral area. Preferably, two persons do the injections simulateously, one on each side These injections cause an intense burning sensation of 30-90 seconds. Relief from laboring low back pain should be noticed in 2-3 minutes. Because of the intensity of the injection pain, constant emotional support should be offered during the procedure. |
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Term
| How do sterile water injections work? |
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Definition
| The somatic pain induced by the injections, according to the gate control theory, block the transduction of visceral pain typically felt in the lower back during the first stage of labor. Although these injections do not provide relief from contraction pain, often once the back pain if alleviated, the laboring woman can cope better with her labor. Likewise, often the relaxation of the back can assist in the proper descent and positioning of the baby, leading to a shorter labor. With no known side effects, and no medications entering the body, sterile water injections may become the treatment of choice for pain referral during the first stage of labor |
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Term
| Gate Control Theory of pain |
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Definition
| In 1965, the “Gate Control theory of pain” was first introduced, which suggests that nerve cells from touch fibers can close the gate on pain signals to the brain, giving the perception of minimized pain. |
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Term
| Neuromatrix theory of pain |
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Definition
expands on the gate control theory and emphasizes that pain is a multi-dimensional, whole body-mind-spirit experience that may underlie the basis for the efficacy of nonpharmacologic pain interventions during labor.
Includes the physiological understanding of the gate control theory, but adds to that framework the inclusion of elements such as the patient’s past experiences, cultural factors, emotional state, cognitive input, stress regulation, and immune systems, as well as immediate sensory input, coming from 3 parallel processing networks: sensory-discriminative, affective-motivational, and evaluative-cognitive. |
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Term
| Are Beta endorphin levels higher in colostrum or maternal serum? |
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Definition
Colostrum
May help newborn transition to extrauterine life and mediate the stressful events of labor and delivery. |
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Term
| What is the etiology of postpartum headaches? |
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Definition
The most common forms of HA in breastfeeding women are those caused by muscular contraction/tension or migraines without aura.
Tension HAs are characterized by a persistent band like or viselike pain extending from the base of the neck to the forehead. The woman often notices the headache on awakening, with worsening of symptoms during the evening. The discomfort may be aggravated by postural changes or stress. |
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Term
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Definition
A disorder involving rapid, brief, non-rhythmic, involuntary, jerky movements of the limbs, nonpatterned facial grimacing, and slurred speech.
Mild cases may involve only persistent restlessness and clumsiness.
Seen in both in preg and in women on oral contraceptives.
Symptoms usually begin in the first trimester and may persist to the pp period.
30% of pg women w/ this disorder become asymptomatic by the 3rd trimester; the remainder become asymptomatic shortly after delivery.
A recurrence rate of 20% has been reported w/ subsequent pgs.
Cause is unknown, although it is r/t strep and is most common in women w/ hx of rheumatic fever or heart disease. |
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Term
| What factors in pregnancy seem to decrease the frequency of migraine without aura? |
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Definition
| Increaseing estrogen and progesterone |
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Term
| What is thought to cause restless leg |
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Definition
| Iron or folate deficiency |
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Term
| What are the causes of increased heat generation in pregnancy? |
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Definition
Thermogenic effects of progesterone
Alterations in maternal metabolism and basal metabolic rate
Dissapation of heat generated by fetus |
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Term
| What are the physiologic mechanisms for heat dissipation in pregnancy? |
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Definition
| Peripheral vasodilation with a fourfold to sevenfold increase in cutaneous blood flow and increased activity of the sweat glands. |
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Term
| List the causes of increased body temperature during labor. |
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Definition
Physical activity w/ uterine contractions
Release of substances from the fetal-placental unit
Epidural analgesic |
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Term
| What is the most common cause of maternal fever during labor? |
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Definition
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Term
| What is the mechanism for maternal fever when epidural anesthesia is used? |
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Definition
Epidural analgesia may increase thermogenesis because of the frequent incidence of shivering associated with its use among laboring women.
The autonomic block w/ epidural analgesia inhibits peripheral vasoconstriction and sweating in the lower body. The impairment of sweating and behavioral responses may decrease heat loss. Maternal fever w/ epidural is associated w/ an inflammatory state w/ increased cytokines, esp. IL-6, but this state is rarely d/t infection. |
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Term
| What is thought to be the cause of postpartum chills or shivering? |
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Definition
Cause is unknown.
May represent:
Muscular exhaustion
May result from disequilibrium between the internal and external thermal gradients secondary to muscular exertion during L&D
May be caused by the sudden changes in intraabdominal pressure w/ emptying of the uterus
May be caused by small amniotic fluid emboli. |
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Term
| What are the potential effects of maternal fever on the fetus? |
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Definition
Hypoxia secondary to maternal and fetal tachycardia and altered hemodynamics.
Teratogenesis.
Preterm labor from the fever per se, from underlying infection, or from associated hemodynamic alterations. |
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Term
| What happens to uterine blood flow during aerobic exercise? |
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Definition
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Term
| The most likely reason for a low grade temperature elevation PP is |
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Definition
Dehydration
Transient bacterial endometritis |
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Term
| Temperature elevation that occurs after 24 hours PP is most likely caused by |
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Definition
Puerperal infection
Mastitis
Endometritis
UTI |
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Term
| List the changes in the hypothalamic-pituitary-adrenal (HPA) axis that result in increased HPA function during pregnancy. |
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Definition
Progressive inc in serum prolactin
Doubling of anterior pituitary
Production of placental growth hormone
Activation of maternal and fetal pituitary
Increase in CRH
Increased ACTH and cortisol
Decline in TSH in first trimester
Decline in plasma osmolality
Decline in osmotic threshold for thirst |
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Term
| Which of the maternal endocrine hormones cross the placenta to the fetus? |
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Definition
CRH ??
TSH can cross and cause transient hyperthyroidism in neonate |
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Term
| List the changes in the hypothalamic-pituitary-thyroid (HPT) axis during pregnancy. |
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Definition
The availability of thyroid homones increases 40 to 100%.
Increased estrogen leads to a 2-3 fold increase in thyroid-binding globulin (TBG) production by the liver.
Inc TBG decreases levels of free thyroid hormone & stimulates the HPT axis.
Increased HCG, which is similar to TSH, stimulates increased T3 & T4.
Peripheral metabolism of thyroid hormones increases in the 2nd & 3rd term.
Adaptations mimic hyperthyroidism. |
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Term
| What is resin T3 uptake and what does it measure? |
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Definition
| It measures TBG-binding capacity by quantifying the number of unbound sites, and approximates the amt of free T4. Although T4-binding sites and capacity increase in pg, the number of binding sites exceeds the available T4. The increased number of unbound sites is reflected by decreased RT3U. |
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Term
| How does total T3 and total T4 change during pregnancy? |
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Definition
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Term
| Explain how human chorionic gonadotropin (hCG) affects thyroid function. |
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Definition
| It mimics TSH, thereby stimulating T3 and T4 and elevated thyroid function. |
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Term
| How does thyroid iodine uptake change during pregnancy? |
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Definition
| It increases because of a decrease in the total body iodine pool. |
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Term
| What happens during pregnancy to decrease the iodine pool? |
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Definition
| There is increased iodine loss d/t increased renal blood flow and GRF and placental transfer of iodine to fetus. |
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Term
| What hormone appears to trigger labor? |
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Definition
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Term
| What hormone increases seven (7) times normal limits with labor onset and during labor? |
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Definition
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Term
| What happens to total and free T3 during labor? |
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Definition
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Term
| During the postpartum period the HPA axis depression plays a role in |
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Definition
postpartum mood disorders
exacerbation of autoimmune disorders. |
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Term
| Describe how thyroid binding globulin, TSH, and T4 respond to the delivery of the placenta. |
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Definition
Hepatic synthesis of TBG decreases
T4 is decreased in the first 3-4d
TSH is elevated in the first 3-4d |
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Term
| What are the consequences of iodine deficiency in pregnancy? |
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Definition
Mental retardation
Increased risk of spontaneous aborttion and stillbirth.
Increased the risk of later neurodevelopmental impairment of offspring in women w/ subclinical thyroid dysfunction |
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Term
| What are the effects of prenatal stress on offspring? |
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Definition
Prematurity
Low birth weight
Delivery complications
Impaired prenatal and postnatal growth and development.
Epigenetic changes in gene expression that increase the risk of later metabolic, vascular, and neurodevelopmental disorders…Type II diabetes, HTN, obesity, CAD, ARF, and depression |
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Term
| Kimberly, 30 weeks EGA, is experiencing signs of hyperthyroidism. What laboratory tests would be most appropriate for diagnosis? |
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Definition
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Term
| Nausea and vomiting of pregnancy has been linked to alterations in |
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Definition
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