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Retired NBME 21 Answers

nbme21/Block 2/Question#26 (reveal difficulty score)
A healthy 32-year-old woman at 35 weeks' ...
Birth canal reflex ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +14  upvote downvote
submitted by โˆ—hayayah(1212)
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Stretch or dilation of the cervix and vagina are strong stimuli for oxytocin secretion, mediated by neural pathways called the Ferguson reflex.

Article: https://www.sciencedirect.com/topics/neuroscience/ferguson-reflex

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readit  This is also why ob-gyn's will massage the uterus (which is part of the birth canal) after delivery. It's to get the body to release oxytocin and cause the uterus to contract (to prevent postpartum hemorrhage) +5
jennybones  Please why is estrogen not the answer, I thought estrogen would upregulate oxytocin receptors and increase oxytocin secretion? +3
drzed  During pregnancy, oxytocin RECEPTORS are upregulated (by estrogen) as parturition approaches, but the ferugson reflex creates a positive feedback loop where the dilation of the cervix further releases more oxytocin. The inciting event that starts this feedback loop is the dilation of the cervix leading to a direct release of oxytocin, not the presence of more oxytocin receptors. +4
bbr  To add, the positive feedback loop here is pretty elegant. Basically, it seems like the cervix doesnt want anything in it. When its stretched --> oxytocin --> contract uterus --> push baby --> more stretch at cervix---> more oxytocin (and forward). The positive feedback loop aspect is that oxytocin-based contractions cause more dilation of the cervix (as the baby moves into it!). +3



 +0  upvote downvote
submitted by medschoollovin(14)
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"Upon application of pressure to the internal end of the cervix, oxytocin is released (therefore increase in contractile proteins), which stimulates uterine contractions, which in turn increases pressure on the cervix (thereby increasing oxytocin release, etc.), until the baby is delivered.

Sensory information regarding mechanical stretch of the cervix is carried in a sensory neuron, which synapses in the dorsal horn before ascending to the brain in the anterolateral columns (ipsilateral and contralateral routes). Via the median forebrain bundle, the efferent reaches the PVN and SON of the hypothalamus. The posterior pituitary releases oxytocin due to increased firing in the hypothalamo-hypophyseal tract. Oxytocin acts on the myometrium, on receptors which have been upregulated by a functional increase of the estrogen-progesterone ratio. This functional ratio change is mediated by a decrease in myometrial sensitivity to progesterone, due to an increase in progesterone receptor A, and a concurrent increase in myometrial sensitivity to estrogen, due to an increase in estrogen receptor ฮฑ. This causes myometrial contraction and further positive feedback on the reflex.[1]"

https://en.wikipedia.org/wiki/Ferguson_reflex

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seagull  https://www.ncbi.nlm.nih.gov/pubmed/8665768 a counter argument for PGE if you chose that answer. However, the author believes oxytocin is superior. +
usmleuser007  1) PGE rises initially that causes the uterine contractions= this would be equivalent to when someone say #of contractions per time period. 2) Oxytocin is increased when the cervix is manipulated (ie. the birth canal reflex). +8
jennybones  Please why is estrogen not the answer, I thought estrogen would upregulate oxytocin receptors and increase oxytocin secretion? +1



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