1st Trimester Flashcards by Lauren Lover

Are early pregnancies a GYN or OB domain why?

GYN

many pregnant don’t make it out of the 1st trimester

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the follicles in the ovary are arrested in what stage?

prophase of meiosis I

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the LH surge causes the oocytes to complete Meiosis I and begin ____

Meiosis II

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When does the production of progesterone from the corpus luteum begin?

just after ovulation

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for every primary oocyte ____ mature eggs are produced after LH surge and __ polar bodies are produced

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Where does fertilization occur

in the tubal ampulla

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of the 200-500 million sperm that are ejaculated, only ___ sperm reach the secondary oocyte to attempt fertilization

200

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the secondary oocyte if fertilized for only __-__ hrs after ovulation

12-24

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to fertilize, sperm must get through what 3 layers of the secondary oocyte

corona radiata (follicle cell layer surrounding oocyte)
zona pellucida (glycoprotein layer surrounding ovum)
oocytes cell membrane

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To have the ability to pass through the layer of the oocyte, the sperm must be ____ by losing their ____, these are usually lost in the femal vaginal tract

Capacitated

Decapacitation factors
** this must be mimiced for in vitro fertilization to work

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Capacitation also causes the ___ to beat more rapidly

flagellum

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what chemical reaction occurs when the sperm is exposed to glycoproteins

acrosomal reaction

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Where does the acrosomal reaction occure in the oocyte

zona pellucida

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the acrosomal reaction Allows sperm plasma membrane to fuse with ovum plasma membrane to…..

drop the sperm nucleus into the ovum’s cytoplasm

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What happens when the ovum’s cell membrane fuses with the sperm cell membrane

Meiosis II re-starts at metaphase and completes, creating another polar body

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Fusion with sperm triggers changes that prevent ____

polyspermy

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The nuclei of sperm and egg are referred to as ____

Each has a ___number of chromosomes, and only one copy of each.

pronuclei

haploid

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Prior to the nuclei fusing, each one goes through an __ phase.
The 2 nuclei then fuse, and the single cell is called a ___

zygote

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implantation and HcG production occurs ___ days after fertilization

7-9

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cell division occurs every 12-24 hours

at the 8 cell stage ~ 3 days the cell is called a _____

morula

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arrival to the uterus / wall occurs about day 6, now the egg is called a ____

blastocyst

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A blastocysts consists of what?

inner cell mass

trophoblast (outer cell)

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Does the inner cell mass or trophoblast (outer cell) become the embryo

what does the other thing become?

inner cell mass

the placenta and metal membranes (amnion, chorion)

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As the trophoblast gains access to inner layers of endometrium they proliferate and create folds called ___(surface area!)
As these cells contact maternal vascular cells, connection is made between ____ and embryonic villi.
At these sites, two cell layers exist between maternal blood supply and embryonic blood supply.
Maternal capillaries proliferate and gradually coalesce, forming ___.

villi
maternal capillaries
lacunae

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Bleeding in the first trimester happens in ___-___% of all pregnancies. Not all will be lost

20% to 25%

Pregnancy loss are ~ __-__% of those who experience first trimester bleeding.

25% -50% *so 50-75% pregnancies will continue

Risk of pregnancy loss or non-viability increases if .... (20

Bleeding becomes heavy | Bleeding is accompanied with cramping or pain

Risk of pregnancy loss or nonviability decreases significantly (to 3-7%) if: (2)

An intrauterine gestation with + FCA (fetal cardiac activity) is detected BHCG values rise appropriately for gestational age

What are the DDx of 1st trimester bleeding

Normal intrauterine pregnancy Threatened abortion Abnormal intrauterine pregnancy Ectopic pregnancy

Urine pregnancy test (UHCG or UPT) | Accurate on first day of ____

expected menses

βhCG May become positive as soon as __-__ days after ovulation

6-8

Date of expected menses (@14 days after ovulation) – βhCG is usually ~____ IU/L

100 IU/L

During the first 30 days of pregnancy (~weeks 3-8) What happens to βhCG levels

Doubles every 48-72 hours

The two early pregnancy dx tools include

HCG and US

innocent causes of 1st trimester bleeding

cervical ectropion implantation bleeding vaginal infection/irritaiton

implantation is accompanied by bleeding in ___% of women

30%

when does implantation bleeding occur how long does it last?

occurs: 6-12 days after ovulation (22-25 of cylce lasts ~3 days

what are s/s of implanations bleeding?

``` meager bleeding (pink or brown coor) painless ```

the cervix in a cervical ectopy appears _____ because the inner lining of the cervical canal comes out.

raw-looking granular appearance

The lower limit of hCG at which an examiner can reliably visualize pregnancy on ultrasound. It is ___-____ IU/L with vaginal ultrasound and____-___ IU/L with abdominal ultrasound.

1000-2000 5000-6000

The absence of a uterine pregnancy with B-HCG above the discriminatory value signifies an _____

abnormal pregnancy usually ectopic or incomplete abortion

If β-hCG levels are still below the discriminatory value, what should be done?

serial β-hCG’s and ultrasounds should be done bc it indicated an abnormal pregnancy.

In a normal pregnancy a ___% or greater increase in serum β-hCG levels should be observed every __ hours

66 | 48

What steps should you take if Bleeding occurs in early pregnancy with unknown location of the gestation

1. check serum BHCG 2. If it is above the discriminatory zone (DZ), an intrauterine pregnancy should be seen. 3. Then do an ultrasound to see if you see the pregnancy. ** if you cent see anything--> assume ectopic

at 5 weeks the BhCG ___ what can be visualized at 6 weeks the BhCG ___ what can be visualized at 7 weeks the BhCG ___ what can be visualized

>1500, gestational lab >5200, fetal pole >17500, cardiac motion

spontaneous abortion usually refers to the 1st ____ weeks of pregnancy

If fetus dies in uterus after 20wks GA, it’s called an ___ or ___

intrauterine fetal demise (IUFD or FDIU) or stillbirth

SAB is likely if.. ** know these exist only memorize #1 of Changes in bHCG**** US measurements are 1. 2. 3. or Changes in bHCG is 1. 2. 3.

1. 5mm CRL, there is no fetal heart rate 2. 10mm mean sac diamter, no yolk sac 3. 20mm mean sac, no fetal pole 1. <15% rise in bhCG over 48 hrs 2. gestational sac grwoth <22mm over 5 days 3. gestational sac growth <3mm over 7 days

____ is a normally growing early pregnancy, but with vaginal bleeding bleeding occurs befor 20th week other definition: bleeding in early pregancy with no pregancy loss

threatened abortion

how is threatened abortion diagnosed

US or BhCG

what are the types of SAB/EPF? (7)

``` complete incomplete inevitable chemical prenancy blighted ovum/anembryonic pregnancy missed septic ```

___ is intrauterine pregnancy with cervical dilation & vaginal bleeding

Inevitable:

___ is an cervix open, some tissue has passed

Incomplete:

___: is +βhcg but no sac formed may account for __-___% of all miscarriages.

Chemical pregnancy 50-75

___ is missed/incomplete abortion becomes infected

Septic:

___ is a total miscarriage without medications or surgical intervention

Complete

___ is when an embryo never formed or demised, but uterus hasn’t expelled the sac

Missed

___ is empty gestational sac, embryo never formed

Blighted ovum/anembryonic pregnancy

__-___% of all clinically recognized pregnancies end as SAB’s (ACOG)* ___% of these occur in the first 12 weeks

10-25 80

Probability of 2 consecutive miscarriages is

5 Chromosomal or non-chromosomal

Up to ____% of SAB’s are due to chromosomal abnormalities 1/2 are trisomies 1/2 are triploidy, tetraploidy, or 45,X0

what are the 6 non-chromosomal causes of SAB

``` Maternal systemic dz infectious factors Endocrine factors abnormal placentation anatomic considerations environmental factors ```

Maternal systemic disease causes of SAB include....

Antiphospholipid antibody syndrome lupus coagulation disorders

Infectious factors of SAB include.... (7)

``` Brucella chlamydia mycoplasma Listeria toxoplasma malaria TB ```

Endocrine factors of SAB include....

DM hypothyroidism “luteal phase defect” from progesterone deficiency

what are environmental factors that case SAB?

Smoking >20 cigarettes per day (increased 4X) Alcohol >7 drinks/week (increased 4X) Increasing age

Management of bleeding without diagnosis of SAB, Pelvic rest (has/has not) been shown to improve outcome

HAS NOT

Management options for dx'd SAB

Uterine evacuation by - suction (manual/electric) - medication conservative tx: many will spontaneously complete on their own

advantages of surgical management of SABs?

ensures products of conception are fully evacuated minimal anesthesia needed can often be done in office women are very satisfied with method

what medication is used in the management of SAB?

Misoprostol - synthetic prostaglandin - inexpensive, orally active