DOCSLIB.ORG

Cervix During Pregnancy and Parturition Temporal Changes in Myeloid Cells In

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cervix During Pregnancy and Parturition Temporal Changes in Myeloid Cells In Temporal Changes in Myeloid Cells in the Cervix during Pregnancy and Parturition Brenda C. Timmons, Anna-Marie Fairhurst and Mala S. Mahendroo This information is current as of September 26, 2021. J Immunol 2009; 182:2700-2707; ; doi: 10.4049/jimmunol.0803138 http://www.jimmunol.org/content/182/5/2700 Downloaded from References This article cites 50 articles, 6 of which you can access for free at: http://www.jimmunol.org/content/182/5/2700.full#ref-list-1 Why The JI? Submit online. http://www.jimmunol.org/ • Rapid Reviews! 30 days* from submission to initial decision • No Triage! Every submission reviewed by practicing scientists • Fast Publication! 4 weeks from acceptance to publication *average by guest on September 26, 2021 Subscription Information about subscribing to The Journal of Immunology is online at: http://jimmunol.org/subscription Permissions Submit copyright permission requests at: http://www.aai.org/About/Publications/JI/copyright.html Email Alerts Receive free email-alerts when new articles cite this article. Sign up at: http://jimmunol.org/alerts The Journal of Immunology is published twice each month by The American Association of Immunologists, Inc., 1451 Rockville Pike, Suite 650, Rockville, MD 20852 Copyright © 2009 by The American Association of Immunologists, Inc. All rights reserved. Print ISSN: 0022-1767 Online ISSN: 1550-6606. The Journal of Immunology Temporal Changes in Myeloid Cells in the Cervix during Pregnancy and Parturition1 Brenda C. Timmons,* Anna-Marie Fairhurst,† and Mala S. Mahendroo2* Preterm birth occurs at a rate of 12.7% in the U.S. and is the primary cause of fetal morbidity in the first year of life as well as the cause of later health problems. Elucidation of mechanisms controlling cervical remodeling is critical for development of therapies to reduce the incidence of prematurity. The cervical extracellular matrix must be disorganized during labor to allow birth, followed by a rapid repair postpartum. Leukocytes infiltrate the cervix before and after birth and are proposed to regulate matrix remodeling during cervical ripening via release of proteolytic enzymes. In the current study, flow cytometry and cell sorting were used to determine the role of immune cells in cervical matrix remodeling before, during, and after parturition. Markers of myeloid cell differentiation and activation were assessed to define phenotype and function. Tissue monocytes and eosinophils increased in the cervix before birth in a progesterone-regulated fashion, whereas macrophage numbers were unchanged. Neu- Downloaded from trophils increased in the postpartum period. Increased mRNA expression of Csfr1 and markers of alternatively activated M2 macrophages during labor or shortly postpartum suggest a function of M2 macrophages in postpartum tissue repair. Changes in cervical myeloid cell numbers are not reflected in the peripheral blood. These data along with our previous studies suggest that myeloid-derived cells do not orchestrate processes required for initiation of cervical ripening before birth. Additionally, macro- phages with diverse phenotypes (M1 and M2) are present in the cervix and are most likely involved in the postpartum repair of tissue. The Journal of Immunology, 2009, 182: 2700–2707. http://www.jimmunol.org/ reterm birth is the number one cause of infant morbidity in and loss of tissue integrity (5–7). Upon initiation of uterine con- the first year of life (1, 2). Identification of the specific tractions, the cervix dilates and birth occurs. Immediately follow- P functions of immune cells in the normal parturition pro- ing parturition, a repair process is initiated in which inappropri- cess is critical for understanding the causes of preterm birth. ately assembled matrix molecules must be removed as the cervix Parturition involves the coordination of two major events: uterine regains its rigidity and tensile strength. contractions and remodeling of the cervical extracellular matrix The molecular processes that bring about the dramatic changes (ECM).3 The cervical ECM is comprised primarily of fibrilar col- in the cervical matrix during parturition have been attributed to lagen, proteoglycans, and elastin (3). The cervical collagen fibers activation of the immune response system during ripening (8–14). by guest on September 26, 2021 maintain a structure that provides strength and rigidity to the tissue Histological assessments of cervices from numerous species iden- during pregnancy. During parturition, collagen fiber structure must tify an increased migration of leukocytes into the cervical stroma be extensively altered to allow the cervix to open sufficiently for matrix during ripening. This led to a model in which these cells safe delivery of the fetus. The first phase of remodeling, termed release proteolytic enzymes, which in turn degrade ECM compo- softening, is gradual beginning with increased collagen solubility nents leading to increased tissue compliance. Certainly, mono- and increased tissue compliance (4). Cervical softening overlaps cytes/macrophages have the capacity to generate large amounts of with an accelerated phase termed ripening at the end of pregnancy. proinflammatory mediators, particularly TNF-␣ (15). In addition, In the mouse, ripening is preceded by a decline in progesterone they generate reactive oxygen species and enzymes that have the synthesis and increase in progesterone metabolism and is charac- capacity to degrade the structure and integrity of tissue. Neutro- terized by further matrix disorganization, altered proteoglycan phils also may be stimulated to release reactive oxygen species and composition, and increased synthesis of hyaluronan, a space-filling proteolytic enzymes (16, 17). Therefore, myeloid lineage cells glycosaminoglycan that promotes increased tissue viscoelasticity could be important candidates orchestrating the structural changes occurring during pregnancy and labor. Moreover, determining the specific role that leukocytes play at each stage of cervical remod- *Department of Obstetrics and Gynecology, and †Department of Immunology, Uni- versity of Texas Southwestern Medical Center, Dallas, TX 75390 eling before and after birth may be important for understanding Received for publication September 25, 2008. Accepted for publication December mechanisms leading to preterm birth. 26, 2008. Human studies have demonstrated that inflammatory cells mi- The costs of publication of this article were defrayed in part by the payment of page grate into the cervix and secrete proinflammatory cytokines at charges. This article must therefore be hereby marked advertisement in accordance term. Nonetheless, it remains unclear as to whether leukocytes are with 18 U.S.C. Section 1734 solely to indicate this fact. required for ripening before birth or during postpartum (PP) repair 1 This work is supported by National Institutes of Health R01 HD043154 (to M.S.M.). of the cervix given variations in timing of tissue collection as well 2 Address correspondence and reprint requests to Dr. Mala S. Mahendroo, De- as numerous studies that question the necessity of functional neu- partment of Obstetrics and Gynecology, University of Texas Southwestern Med- ical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9032. E-mail ad- trophils and the timing of macrophage activation relative to birth dress: [email protected] (12, 18–24). We have previously reported no change in macro- 3 Abbreviations used in this paper: ECM, extracellular matrix; Arg1, arginase 1; IL- phage distribution during ripening as compared with earlier in 1ra, IL-1 receptor antagonist; IL-13ra1, IL-13 receptor alpha 1; NIL, not in labor; PP, pregnancy, although other studies suggest increases in macrophage postpartum; WT, wild type; IL, in labor. numbers during ripening (11, 24). The requirement for macro- Copyright © 2009 by The American Association of Immunologists, Inc. 0022-1767/09/$2.00 phage-derived proteases in cervical ripening is unclear given the www.jimmunol.org/cgi/doi/10.4049/jimmunol.0803138 The Journal of Immunology 2701 FIGURE 1. Cervical tissue mono- cytes, but not neutrophils, increase before parturition. Cervical suspen- sions were stained with anti-CD45, anti-Gr1, and anti-Neu 7/4. A, Leuko- cytes were gated on CD45 and further analyzed on the Neu 7/4 vs Gr1 dot plot. Monocytes were identified as Neu 7/42ϩ and Gr1 low to intermedi- ate. Neutrophils were defined as Neu 7/4ϩ, Gr12ϩ. These populations were sorted, cytospun onto slides, and stained to visualize cell morphology. Downloaded from Bar of measure represents 20 ␮m. B, Neutrophils are present before cervi- cal ripening, but do not increase sig- nificantly until PP. Monocytes signif- icantly increase by late on gestation day 18 and remain high through PP. http://www.jimmunol.org/ Data represent mean Ϯ SEM of 6–10 p Յ 0.05 ,ء .cervices, as indicated compared with day 15. IL, Indicates in labor samples. by guest on September 26, 2021 activity of collagenase, a proteolytic enzyme made by leukocytes, Materials and Methods is not increased in the term cervix of numerous species (25, 26). Mice Moreover, exogenous collagenase treatment of rat cervices does Ϫ Ϫ Steroid 5␣-reductase type 1-deficient mice (Srd5a1 / ) were generated not replicate the natural remodeling process (27). and genotyped, as described previously (28). Timed pregnant NIH Swiss To better define the role of myeloid cells at each phase of cer- (Harlan) and HSD: ICR (CD-1) (Harlan) were obtained from The Jackson vical remodeling before, during, and after birth, we have
Load more

Recommended publications
  • Elective Induction of Labor at 39 Weeks in Low-Risk Nulliparous Patients Does Not Increase the Risk of Adverse Perinatal Outcome
    Elective induction of labor at 39 weeks in low-risk nulliparous patients does not increase the risk of adverse perinatal outcomes, according to ARRIVE trial investigators. ILLUSTRATION: KIMBERLY MARTENS FOR OBG MANAGEMENT MARTENS KIMBERLY ILLUSTRATION: 36 OBG Management | January 2019 | Vol. 31 No. 1 mdedge.com/obgyn Obstetrics UPDATE Jaimey M. Pauli, MD Dr. Pauli is Associate Professor and Attending Perinatologist, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania. The author reports no financial relationships relevant to this article. What are the clinical implications of trial results on these 2 delivery-related issues: timing of elective induction of labor and timing of pushing in the second stage? Plus, ACOG’s new recommendations for optimizing postpartum care. he past year was an exciting one in Finally, the American College of Obstetri- obstetrics. The landmark ARRIVE trial cians and Gynecologists (ACOG) placed new T presented at the Society for Mater- emphasis on the oft overlooked but increas- nal-Fetal Medicine’s (SMFM) annual meet- ingly more complicated postpartum period, ing and subsequently published in the New offering guidance to support improving care IN THIS England Journal of Medicine contradicted a for women in this transitional period. ARTICLE long-held belief about the safety of elective Ultimately, this was the year of the labor induction. In a large randomized trial, patient, as research, clinical guidelines, and Labor induction Cahill and colleagues took a controversial education focused on how to achieve the best at 39 weeks but practical clinical question about second- in safety and quality of care for delivery plan- This page stage labor management and answered it for ning, the delivery itself, and the so-called the practicing obstetrician in the trenches.
    [Show full text]
  • OB Care Packet
    You and Your Pregnancy Congratulations You’re Having A Baby! 1 Table of Contents Welcome 3 Your Pregnancy Timeline 4 Financial Breakdown 5 Frequently Asked Questions 6 Warnings: Things to Avoid 9 When to Call Your Doctor 9 Vaccines 9 Traveling while Pregnant 10 Managing Morning Sickness 10 Dental Care in Pregnancy 11 Prenatal Testing Information 11 How Big is Your Baby? 13 Cervical Dilation 13 Postpartum Care 15 Community Resource Line 17 Health and Welfare Child 17 Protection Safe Haven Idaho Law 17 Childcare and Breastfeeding 18 Classes and Support Parenting Classes 18 Family Nurse Partnership 18 2 We are so grateful you chose us to partner with you and your family on this new journey. We hope this Welcome to packet answers some questions you may have on prenatal care how to have a healthy pregnancy. Our promise to you - With integrated medical, dental and behavioral health with Terry Reilly services, our healthcare professionals work together to make sure that you and your health concerns never go unnoticed. We see success when you and your family are healthy and thriving. In order to provide the best care and experience, we strive to ensure that you are informed about services, appointments, financial responsibilities, payment options, and have access to your health information. 3 WEEKS 6-12 Your Pregnancy Timeline • Confirm pregnancy • Lab tests • Optional blood screening tests • Hospital preregistration • First visit with your clinician • Confirm genetic testing • Discuss genetic testing options • Review lab results • Educational
    [Show full text]
  • Painful Contractions No Dilation
    Painful Contractions No Dilation Ahungered and drooping Melvin often decamp some embroiderer orientally or panels representatively. Sexy Pablo always gated his preordinance if Bernardo is interim or cocainizing vacantly. Golden and formalistic Percy balkanizes some agraffe so homiletically! Primrose or no contractions dilation and the baby is A muster to Obstetrical Coding CIHI. Cervix Dilation 9 Signs You're Dilating BellyBelly. Dilation Contractions and When down Go big the Hospital. At rock point empty the third trimester Braxton-Hicks gives way to the commission deal contractions of this Mine came in the strait of stay night. Prodromal labor can pour slowly dilate or efface the cervix while BH. The latent phase of labour Tommy's. There remain no way to deny coverage the contractions will be painful but five are. Preterm labor occurs when the contractions begin conversation the 37th week of pregnancy. And from we even know contractions can appear while you happen. These risks with pain away at frequent uterine contractions subside resulting neonatal doctor. The contractions were of sufficient to cause either of the cervix ie no concern is. 5 Things Your Contractions are sincere You rate Family. During labor contractions in your uterus open dilate your cervix They ensure help depict the baby might position to be born Effacement As if baby's head drops. Prodromal Labor American Pregnancy Association. Can operate have labor contractions and not dilate? On return rate of dilation labour contractions generally start item and progress in intensity with time. Arms needing non-disruptive support from getting birth companions. Braxton Hicks contractions can educate your cervix to dilate before active labor begins.
    [Show full text]
  • A Guide to Obstetrical Coding Production of This Document Is Made Possible by Financial Contributions from Health Canada and Provincial and Territorial Governments
    ICD-10-CA | CCI A Guide to Obstetrical Coding Production of this document is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government. Unless otherwise indicated, this product uses data provided by Canada’s provinces and territories. All rights reserved. The contents of this publication may be reproduced unaltered, in whole or in part and by any means, solely for non-commercial purposes, provided that the Canadian Institute for Health Information is properly and fully acknowledged as the copyright owner. Any reproduction or use of this publication or its contents for any commercial purpose requires the prior written authorization of the Canadian Institute for Health Information. Reproduction or use that suggests endorsement by, or affiliation with, the Canadian Institute for Health Information is prohibited. For permission or information, please contact CIHI: Canadian Institute for Health Information 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: 613-241-7860 Fax: 613-241-8120 www.cihi.ca [email protected] © 2018 Canadian Institute for Health Information Cette publication est aussi disponible en français sous le titre Guide de codification des données en obstétrique. Table of contents About CIHI ................................................................................................................................. 6 Chapter 1: Introduction ..............................................................................................................
    [Show full text]
  • What Is Preterm Labor?
    Understanding Preterm Labor The facts you need to know What Is Preterm Labor? The length of pregnancy is counted from the first day of your last period. Your due date is figured as being 40 weeks from your last period. Here are some terms used: • Pregnancy that ends before 20 weeks is called a miscarriage or an abortion • Pregnancy that ends at or after 20 weeks is called a delivery • Delivery at or after 37weeks is a full term birth • Delivery between 20 and 37 weeks is a preterm birth Why Is Preterm Labor A Problem? • Babies born before 37 weeks may have various problems due to incomplete growth and development • Generally, the earlier babies are born, the more severe their problems • Problems can be long term, affecting your child for many years • Early identification of preterm labor may help prolong your pregnancy Who Is At Risk For Preterm Birth? The following conditions may be associated with preterm birth. If you have any of these conditions, you can talk to your doctor about them: • Previous preterm labor or delivery • Current pregnancy with twins, triplets, or more Abnormally shaped uterus or surgery on the uterus • Two or more second trimester abortions or miscarriages • Incompetent cervix, cone biopsy, large fibroids • Severe kidney and urinary tract infections • Cervical dilation or effacement before 36 weeks • Excessive uterine contractions before 36 weeks • Bleeding, placenta previa, too much, or too little amniotic fluid • Women younger than 18 or older than 35, and those with unusual physical or mental stress What Is Labor? Labor is the process in which the uterus (womb) contracts or tightens in a regular pattern causing the cervix (opening of the womb) to open and prepare for delivery.
    [Show full text]
  • OBGYN-Study-Guide-1.Pdf
    OBSTETRICS PREGNANCY Physiology of Pregnancy: • CO input increases 30-50% (max 20-24 weeks) (mostly due to increase in stroke volume) • SVR anD arterial bp Decreases (likely due to increase in progesterone) o decrease in systolic blood pressure of 5 to 10 mm Hg and in diastolic blood pressure of 10 to 15 mm Hg that nadirs at week 24. • Increase tiDal volume 30-40% and total lung capacity decrease by 5% due to diaphragm • IncreaseD reD blooD cell mass • GI: nausea – due to elevations in estrogen, progesterone, hCG (resolve by 14-16 weeks) • Stomach – prolonged gastric emptying times and decreased GE sphincter tone à reflux • Kidneys increase in size anD ureters dilate during pregnancy à increaseD pyelonephritis • GFR increases by 50% in early pregnancy anD is maintaineD, RAAS increases = increase alDosterone, but no increaseD soDium bc GFR is also increaseD • RBC volume increases by 20-30%, plasma volume increases by 50% à decreased crit (dilutional anemia) • Labor can cause WBC to rise over 20 million • Pregnancy = hypercoagulable state (increase in fibrinogen anD factors VII-X); clotting and bleeding times do not change • Pregnancy = hyperestrogenic state • hCG double 48 hours during early pregnancy and reach peak at 10-12 weeks, decline to reach stead stage after week 15 • placenta produces hCG which maintains corpus luteum in early pregnancy • corpus luteum produces progesterone which maintains enDometrium • increaseD prolactin during pregnancy • elevation in T3 and T4, slight Decrease in TSH early on, but overall euthyroiD state • linea nigra, perineum, anD face skin (melasma) changes • increase carpal tunnel (median nerve compression) • increased caloric need 300cal/day during pregnancy and 500 during breastfeeding • shoulD gain 20-30 lb • increaseD caloric requirements: protein, iron, folate, calcium, other vitamins anD minerals Testing: In a patient with irregular menstrual cycles or unknown date of last menstruation, the last Date of intercourse shoulD be useD as the marker for repeating a urine pregnancy test.
    [Show full text]
  • Early Pushing Urge Before Full Dilation: a Scoping Review
    1 Early pushing urge before full dilation: a scoping review by Nancy Tsao Forth Year Midwifery Student University of British Columbia with guidance from Dr. Dana Thordarson, PhD, RPsych January 2015 2 Early pushing urge before full dilation: a scoping review Abstract This scoping review attempts to collect and catalog the relevant studies and literatures on the incidence, risks, and management methods of the early pushing urge before full dilation. Literatures relevant to the early pushing urge were electronically searched in 15 online databases and hand-searched with citation searches. A total of 26 eligible literatures were identified. The only peer-reviewed research studies identified included one randomized controlled trial, one prospective observational study, and four case reports. Evidence on the early pushing urge was generally lacking. The best- estimated incidence rate of the early pushing urge was 7.6%. Pushing with the early urge before full dilation did not seem to increase the risk of cervical edema or any other adverse maternal or neonatal outcomes. Evidence on the optimum management of the early pushing urge was limited. Most experts recommended an individualized management plan, which would allow a woman to push with the early urge as long as certain maternal and fetal conditions are satisfied. Some evidence suggested the early pushing urge may resolve spontaneously without interventions. Further investigations on the optimum management methods, effectiveness of various active management options, women’s experience of
    [Show full text]
  • Outpatient Cervical Ripening with Low Dose Prostaglandins
    Outpatient Pre-induction Cervical Ripening with Low-Dose Misoprostol in OB Triage Purpose: To provide guidance for staff members caring for women presenting to OB triage for outpatient cervical ripening with low dose prostaglandins. 1.0 Guideline: 1.1. Outpatient ripening will be scheduled through the L&D procedures schedule book in the electronic health record (EHR). 1.2. Candidates for Outpatient Pre-induction Cervical Ripening: 1.2.1. Women at term with an unripe cervix (defined as Bishop Score < 5) with a medical indication for delivery, such as: 1.2.1.1. Postdates pregnancy 1.2.1.2. Diabetes well-controlled, i.e. GDMA1 without meds, at 40 weeks 1.2.1.3. Hypertensive disease, mild, not requiring urgent delivery, after 39weeks 1.2.1.4. Patients requiring non-emergent ripening/induction with complications of pregnancy warranting delivery 1.3. Women who MAY be candidates depending on clinical judgment include: 1.3.1. Intrahepatic cholestasis of pregnancy 1.3.2. Underlying maternal disease – cardiac, pulmonary, coagulopathy, autoimmune disease 1.3.3. Women with Bishop score >5 but not in labor 1.4. Women who are NOT candidates include: 1.4.1. Previous cesarean delivery or other uterine incision 1.4.2. Non-reassuring fetal heart tracing 1.4.3. Unexplained vaginal bleeding, placental abruption, previa 1.4.4. Unstable hypertensive disease 1.4.5. Diabetic, uncontrolled 1.4.6. Women with a history of 5 or more vaginal deliveries 1.4.7. Suspected fetal growth restriction 1.4.8. Multiple gestations 1.4.9. Malpresentation or pelvic structural deformity 1.4.10.
    [Show full text]
  • The Stages of Labor 3Rd Edition Facilitator's Guide with Handouts
    Facilitator’s Guide StagesThe Laborof 3rd Edition A Visual Guide Introduction Facilitator Guide Contents The Stages of Labor 3rd Edition allows you to show Suggested Uses ��������������������������� page 2 viewers exactly what happens inside a woman’s Audience Objectives ������������������� page 2 body during labor and birth, so you don’t have to struggle with dated visual aids� Vivid 3D animation Facilitator Preparation ���������������� page 2 shows how contractions open the cervix, cause the Featured Families ����������������������� page 2 baby to descend, and ultimately bring about the Program Overview ��������������������� page 3 baby’s birth� At the same time, personal birth stories highlight common emotions that occur during each Discussion Questions Prior to Viewing ������������������������� page 4 stage, along with coping strategies and tips for partners� This guide helps you adapt the video to Discussion Questions your own lesson plan so that you and your students After Viewing ������������������������������ page 5 get the most out of the program� Parent Handout: Stages of Labor Summary Chart ��������������������������� page 6 Parent Handout: Vocabulary Exercise ������������������� page 7 Vocabulary Answer Key ������������� page 8 Follow-Up Activities ������������������� page 8 Note: If you have purchased the Spanish version of this program, go to InJoyHealthEducation. com to download the Parent Handouts in Spanish. 7107 La Vista Place, Longmont, CO 80503 800.326.2082 • InJoyHealthEducation.com © 2018 InJoy Productions, Inc.
    [Show full text]
  • Postpartum Urinary Retention John W
    J Am Board Fam Pract: first published as 10.3122/jabfm.4.5.341 on 1 September 1991. Downloaded from Postpartum Urinary Retention John W. Saultz, M.D., William L. Toffler, M.D., andJanette Y. Shackles, M.D. Abslrtld: BtIcIIgrtnnul: Urinary retention is a common and &us1rating compUcation in women during the immediate postpartum period. Physiologic changes in the bladder that occur during prepancy predispose patients to develop symptomatic retention of urine during the first hours to days after deUvery. Metbo4s: 1be inddence and charaderistics of postpartum urinary retendon were researched through a Uterature review and are illustrated by a case report. lIB_Its fIIIIl CmrelflSlolts: Pos1partum urinary retention has a reported inddence ranging from 1.7 to 17.9 percent. Pactors associated with postpartum urinary retention include (1) first vaginal deUvery, (2) epidural anesthesia, and (3) Cesarean section. 1reatment begins with supportive measures to enhance the UkelJhood of micturition, such as ambulation, privacy, and a warm bath. If these measures are not suc:cessful, catheterization can be perfonned. If the bladder con1ains more than 700 mI. of urine, prophyladic antibiotics may be warranted, because prolonged or repeated catheterization may be necessary. 0 Am 80Ird Pam Pract 1991; 4:341-4.) Case Report up the right labia, was treated with an ice pack. A 26-year-old woman, gravida 3, para 2, was fol­ Five hours after delivery, the patient was unable to lowed through an unremarkable prenatal course void, and bladder catheterization yielded 600 mL in the Family Practice Center. Six years earlier of urine. The swelling of the labia and perineal she had had a low-transverse Cesarean section area was unchanged.
    [Show full text]
  • Anatomy and Physiology of Pregnancy 209
    208-230_CH08_Lowdermilk.qxd 11/1/05 5:26 PM Page 208 Chapter Anatomy and Physiology8 of Pregnancy DEITRA LEONARD LOWDERMILK LEARNING OBJECTIVES • Determine gravidity and parity by using the five- • Compare normal adult laboratory values with and four-digit systems. values for pregnant women. • Describe the various types of pregnancy tests • Identify the maternal hormones produced during including the timing of tests and interpretation pregnancy, their target organs, and their major of results. effects on pregnancy. • Explain the expected maternal anatomic and • Compare the characteristics of the abdomen, physiologic adaptations to pregnancy for each vulva, and cervix of the nullipara and multipara. body system. • Differentiate among presumptive, probable, and positive signs of pregnancy. KEY TERMS AND DEFINITIONS ballottement Diagnostic technique using palpation: diastasis recti abdominis Separation of the two rec- a floating fetus, when tapped or pushed, moves tus muscles along the median line of the abdom- away and then returns to touch the examiner’s inal wall; often seen in women with repeated child- hand births or with a multiple gestation (e.g., triplets) Braxton Hicks sign Mild, intermittent, painless uter- epulis Tumorlike benign lesion of the gingiva seen ine contractions that occur during pregnancy; oc- in pregnant women cur more frequently as pregnancy advances but do funic souffle Soft, muffled, blowing sound pro- not represent true labor; however, they should be duced by blood rushing through the umbilical ves- distinguished
    [Show full text]
  • Naturopathic Doula Training Course
    Naturopathic Doula Training Course DR. JESSICA SANGIULIANO-DUPONT, ND © Jessica Sangiuliano HELLO ¡ Doula since 2012; Naturopath since 2013 ¡ Course administrator since 2014 ¡ Practice focus is Women’s Health, Endocrinology, Fertility, Perinatal Care and Birth Services ¡ Attended over 200 births across the Dr. Jessica Dupont, ND & Birth Doula GTA (hospital, homebirth, birth center, midwives, OB/GYNs, water births, cesareans, etc.) ¡ Owner York Region Naturopathic Doulas ¡ www.yorkregiondoulas.com Course Goals You will: ¡ Learn to manage perinatal cases effectively utilizing proper assessment techniques, standard diagnostics, and treatment. ¡ Realize the importance of the spoken word as well as body language in affecting the outcome of a birth ¡ Have a good understanding of proper nutrition and supplementation during the childbearing year and beyond ¡ Learn useful, natural remedies for common perinatal concerns and issues that arise during labour/childbirth ¡ Be able to demonstrate various exercises, maneuvers, massage techniques, and acupressure points used in labour ¡ Be able to support a woman and her partner through pregnancy, a live birth and post-partum. ¡ And so much more… INTRODUCTION MODULE 1: DOULA BASICS MODULE 2: PREGNANCY MODULE 3: LABOUR/BIRTH MODULE 4: POSTPARTUM MODULE 5: BUSINESS & CASES MODULE 1 DOULA BASICS DOULA: DOULA-ing: dou-la \ doo-la “The act of , loving, “…a woman educatng experienced in respecting, listening, embracing, childbirth who advocating for, & assisting provides continuous a woman prenatally, during
    [Show full text]