2009 Lecture 23 - Revision history

S8600021: /* Introduction */

2010-04-08T21:10:07Z

Introduction

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	Birth or parturition is a critical stage in development, representing in mammals a transition from direct maternal support of fetal development, physical expulsion and establishment of the newborns own respiratory, circulatory and digestive systems.		Birth or parturition is a critical stage in development, representing in mammals a transition from direct maternal support of fetal development, physical expulsion and establishment of the newborns own respiratory, circulatory and digestive systems.

			{{Template:Birth Links}}

	==Textbooks==		==Textbooks==

MarkHill: /* Newborn Homoeostasis */

2009-10-19T06:47:36Z

Newborn Homoeostasis

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	== Newborn Homoeostasis ==		== Newborn Homoeostasis ==
			[[File:Brown_adipose_histology.jpg\|thumb\|Brown adipose tissue]]
	Newborn has to establish new functioning systems in a balanced and regulated manner (homoeostasis).		Newborn has to establish new functioning systems in a balanced and regulated manner (homoeostasis).

S8600021: /* Respiration */

2009-10-19T00:56:00Z

Respiration

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	[http://embryology.med.unsw.edu.au/Child/page5.htm Postnatal Development - Respiratory]		[http://embryology.med.unsw.edu.au/Child/page5.htm Postnatal Development - Respiratory]

			===Cardiovascular===

			* '''Umbilical Vasculature''' - The umbilical blood vessel cavity is lost postnatally over the course of weeks to months after birth. The adult anatomical remnant of the umbilical vein between the umbilicus and liver is the ligamentum teres.
			* '''Foramen Ovale''' - two separate forms of foramen ovale closure; functional and structural. Functional closure begins at the first breath and is rapid. Structural (anatomical) closure is much slower and generally occurs before the end of the first year.
			* '''Ductus Arteriosus''' - a direct connection between the pulmonary trunk and the dorsal aorta. Postnatal closure occurs initially by by smooth muscle contraction and begins at the first breath and is rapid, completed within the first day (about 15 hr after birth). Anatomical closure is much slower occuring by 2–3 weeks after birth (33% of infants), by 2 months (90% of infants) and by 1 year (99% of infants). The adult anatomical remnant of the ductus arteriosus is the ligamentum arteriosum.
			* '''Ductus Venosus''' - connects portal and umbilical blood to the inferior vena cava. Functional closure occurs postnatally within hours. Structural closure commences days after birth and completes by 18 to 20 days. The adult anatomical remnant of the ductus venosus is the ligamentum venosum (a dorsal fissure on the liver).

	==Neonatal Testing==		==Neonatal Testing==

S8600021: /* Premature Birth */

2009-10-19T00:52:42Z

Premature Birth

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	Data from: Prevention of preterm birth: a renewed national priority] Damus K. Curr Opin Obstet Gynecol. 2008 Dec;20(6):590-6 [http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=18989136&dopt=Abstract PMID: 18989136]		Data from: Prevention of preterm birth: a renewed national priority Damus K. Curr Opin Obstet Gynecol. 2008 Dec;20(6):590-6 [http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=18989136&dopt=Abstract PMID: 18989136]
	===Australia Recommendations===		===Australia Recommendations===
	Perinatal care at the borderlines of viability: a consensus statement based on a NSW and ACT consensus workshop (February 2005) published in The Medical Journal of Australia 2006; 185 (9): 495-500.		Perinatal care at the borderlines of viability: a consensus statement based on a NSW and ACT consensus workshop (February 2005) published in The Medical Journal of Australia 2006; 185 (9): 495-500.

S8600021: /* Premature Birth */

2009-10-19T00:52:28Z

Premature Birth

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	Data from: [http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=18989136&dopt=Abstract ~~Prevention of preterm birth~~: ~~a renewed national priority~~] ~~Damus K. Curr Opin Obstet Gynecol. 2008 Dec;20(6):590-6~~		Data from: Prevention of preterm birth: a renewed national priority] Damus K. Curr Opin Obstet Gynecol. 2008 Dec;20(6):590-6 [http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=18989136&dopt=Abstract PMID: 18989136]
	===Australia Recommendations===		===Australia Recommendations===
	Perinatal care at the borderlines of viability: a consensus statement based on a NSW and ACT consensus workshop (February 2005) published in The Medical Journal of Australia 2006; 185 (9): 495-500.		Perinatal care at the borderlines of viability: a consensus statement based on a NSW and ACT consensus workshop (February 2005) published in The Medical Journal of Australia 2006; 185 (9): 495-500.

S8600021: /* Premature Birth */

2009-10-19T00:51:50Z

Premature Birth

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	{\| class="prettytable"		{\| class="prettytable"
	\| '''Year'''		\| '''Year'''
	\| '''% < 34 weeks '''		\| '''< 34 weeks %'''
	\| '''% 34-36 weeks'''		\| '''34-36 weeks %'''
	\| '''% total preterm'''		\| '''total preterm %'''

	\|-		\|-

S8600021: /* Premature Birth */

2009-10-19T00:51:05Z

Premature Birth

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	{\| class="prettytable"		{\| class="prettytable"
	\| '''Year'''		\| '''Year'''
	\| '''% ~~less than~~ 34 weeks '''		\| '''% < 34 weeks '''
	\| '''% 34-36 weeks'''		\| '''% 34-36 weeks'''
	\| '''% total preterm'''		\| '''% total preterm'''

S8600021: /* Premature Birth */

2009-10-19T00:50:41Z

Premature Birth

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 [[File:Premature infant.jpg|thumb|Premature infant]]
 ===Australia Recommendations===
 Perinatal care at the borderlines of viability: a consensus statement based on a NSW and ACT consensus workshop (February 2005) published in The Medical Journal of Australia 2006; 185 (9): 495-500.

S8600021: /* Uterine Myometrial Changes */

2009-10-19T00:44:05Z

Uterine Myometrial Changes

S8600021: /* Breech Delivery */

2009-10-19T00:43:31Z

Breech Delivery

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	Current research suggests that genetically that both men and women delivered in breech presentation at term could also contribute to an increased risk of breech delivery in their offspring. ([#18369204 Nordtveit TI, etal., 2008])		Current research suggests that genetically that both men and women delivered in breech presentation at term could also contribute to an increased risk of breech delivery in their offspring. ([#18369204 Nordtveit TI, etal., 2008])

			===Meconium aspiration syndrome===
			* meconium is formed from gut and associated organ secretions as well as cells and debris from the swallowed amniotic fluid.
			* Meconium accumulates during the fetal period in the large intestine (bowel). It can be described as being a generally dark colour (green black) , sticky and odourless.
			* Normally this meconium is defaecated (passed) postnatally over the first 48 hours and then transitional stools from day 4.
			* Abnormally this meconium is defaecated in utero, due to oxygen deprivation and other stresses. Premature discharge into the amniotic sac can lead to mixing with amniotic fluid and be reswallowed by the fetus. This is meconium aspiration syndrome and can damage both the developing lungs and placental vessels.

	===Necrotizing Enterocolitis===		===Necrotizing Enterocolitis===

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	* Stimulating contraction - increased estrogen levels (placental secretion sensitizes smooth muscle), increased oxytocin levels (fetal oxytocin release- force and frequency of contraction), fetal pituitary prostaglandin production (estrogen and oxytocin stimulate endometrial production of prostaglandin)		* Stimulating contraction - increased estrogen levels (placental secretion sensitizes smooth muscle), increased oxytocin levels (fetal oxytocin release- force and frequency of contraction), fetal pituitary prostaglandin production (estrogen and oxytocin stimulate endometrial production of prostaglandin)

	Progesterone		'''Progesterone'''
	* maintains pregnancy - initially synthesized by corpus luteum, then levels maintained by placenta		* maintains pregnancy - initially synthesized by corpus luteum, then levels maintained by placenta
	* hyperpolarizes myometrial cells (-65 mV), reduces excitability and conductivity		* hyperpolarizes myometrial cells (-65 mV), reduces excitability and conductivity
	* Level in plasma may fall just before parturition, definitely decreases following delivery of placenta		* Level in plasma may fall just before parturition, definitely decreases following delivery of placenta

	Estrogens		'''Estrogens'''
	* Group of steroidal hormones, peak when parturition begins		* Group of steroidal hormones, peak when parturition begins
	* induce increased synthesis of actomyosin and ATP in myometrial cells		* induce increased synthesis of actomyosin and ATP in myometrial cells
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	* Estriol - synthesized by fetus and placenta		* Estriol - synthesized by fetus and placenta

	Oxytocin		'''Oxytocin'''
	* Peptide hormone (8aa) from maternal posterior pituitary, initiation and maintenance of labour (synthetic form labour induction)		* Peptide hormone (8aa) from maternal posterior pituitary, initiation and maintenance of labour (synthetic form labour induction)
	* myometrium sensitivity to oxytocin (increased by estrogen, decreased by progesterone)		* myometrium sensitivity to oxytocin (increased by estrogen, decreased by progesterone)
	* stimulus for release - mechanical stimulation of uterus, cervix and vagina (ethanol inhibits release)		* stimulus for release - mechanical stimulation of uterus, cervix and vagina (ethanol inhibits release)

	Prostaglandins		'''Prostaglandins'''
	* hydroxy fatty acids - sythesized by placenta, amniotic fliud contains mainly PGF2 alpha, causes myometrial contraction (also in maternal plasma)		* hydroxy fatty acids - sythesized by placenta, amniotic fliud contains mainly PGF2 alpha, causes myometrial contraction (also in maternal plasma)
	* PGF2 alpha and PGE2 - used to induce labour (intravenous, oral, intravaginal, intraamniotic)		* PGF2 alpha and PGE2 - used to induce labour (intravenous, oral, intravaginal, intraamniotic)