Antepartum Part 1 Flashcards
3 female hormones
estrogen
progesterone
prostaglandins
estrogen
female secondary sex characteristics
follicle maturation
proliferation of endometrial mucosa
Progesterone
decrease urine motility & contractility to build up the endometrium
proliferation of the endometrium
secretion of thick viscous mucous by the cervix
prostaglandins
promote smooth muscle relaxation
neurohormonal basis of female reproductive cycle
Hypothalamus secretes GnRH
causes anterior pituitary to release
- FSH - LH
FSH
follicle stimulating hormone
helps w/ maturation of the follicle
LH
Luteinizing hormone
Increases production of prgesterone
release of mature follicle from the ovary
Ovarian Cycle
Includes follicular phase and luteal phase
Follicular Phase
days 1-14
under dual control of FSH & LH
ovulation
body temp increases after ovulation
Luteal Phase
Days 15-28
begins when ovum leaves follicle
Endometrial Cycle
“uterine or menstrual cycle”
includes: -menstrual phase
- proliferative phase
- secretory phase
- ischemic phase
Menstrual Phase
menstruation occurs in response to low levels of estrogen & progesterone
Proliferative Phase
the endometrial glands enlarge in response to increased estrogen levels
Secretory Phase
endometrium undergoes slight cellular growth due to estrogen
progesterone causes marked swelling and growth
Ischemic Phase
begins if fertilization does NOT occur
Fertilization
women usually ovulate 14 days before their next menses
after ovulation the ovum can remain viable for approx 24 hrs
sperm remains fertile for 72 hrs and up to 5 days
Calculating window for fertility
calendar based isn’t accurate, especially w/ irreg cycles
can check cervical mucous:
- scant, thick & sticky = ovulation - mucous becomes thin and clear before ovulation= promotes sperm movement
Infertility
failure to achieve pregnancy after 12 mos.
- sterility - primary infertility - secondary infertility - fecundidity
Sterility
inability to produce pregnancy
Primary infertility
those who have never conceived
Secondary infertility
those who have conceived in the past
Fecundidity
the state of being fertile; capable of producing offspring
Causes for infertility
ovulatory dysfunction
tubal & peritoneal pathology
male factors
Ovulatory Dysfunction
increases w/ age, fertility peak @20-24 yrs
increase is due to: -progressive follicular depeltion
-PCOS
-hypothyroidism & hyperprolactimemia
Tubal & pelvic problems
endometriosis and uterine surgery tubal scarring from PID ghonorrhea & chlamydia Asherman's syndrome most common cause is D&C
lifestyle and environmental factors
can affect both men and women smoking & drug use alcohol obesity repeated exposure to chemicals, radiation & heavy metals
Male Factors
abnormalities in #, shape, swimming motion & viscosity of sperm endocrine disorders adrenal hyperplasia sexual dysfunction anatomic disorders
Gametogenisis
requires meosis
production of new organism (2 stages)
results in gametes (sperm & ovum) unite to form zygote (46 chromosomes)
Gametogenisis 1st division
chromosomes replicate, pair & exchange info
chromosome pairs separate & cell divides
Gametogenisis 2nd division
chromatids seperate and move to opposite poles
cells divide forming 4 daughter cells
haploid cells (23 chromosomes, 22 autosomes, 1 sex chromosome)
Mutations (trisomy)
Germinal stage
pre-embryonic
first 14 days of human development morula is formed (12-16 cells) blastocyst (100 cells) inner cell mast develops into fetus trophoblast (outer layer of blastocyst) develops into placenta & fetal membranes
Implantation of Conceptus
right place, right time
site: fundus
critical to have continuous supply of hormones
occurs between 6th-10th days
zygote secretes HCG-> corpus luteum continues to secrete estrogen and progesterone
False negative pregnancy tests
HCG can’t be detected until after implantation
–> results in false negative if the test is done too early
Monozygotic Twins
single ovum & sperm divides into 2 identical twins
same genetic material, same gender
two amnions, one chorion, one placenta
Dizygotic Twins
two ova fertilized by 2 sperms
may or may not be same gender, not identical
two amnions, 2 chorions, 2 placentas
HCG & Progesterone
HCG 17-7340 mIU/ml- normal @5 wks
Progesterone 12-20 ng/ml @5-6 wks
HCCG should increase 60% q 2-3 days or double q 48-72 hrs
progesterone should increase 1-3 ng/ml every couple days
Embryonic Stage
3rd-8th week
most likely time for any fetal damage due to teratogens
all organs are forming
Week 3
menstrual period missed
embryonic disk- 3 germ layers form
early heart development starts
Week 4
folds at head and tail forming "C" neural tube closes beginnings of internal eye and ear upper ext. bud lungs & GI tract start development
Week 5
embryo is 4 in w/ large head
heart develops 4 chambers
lower ext bud
placenta works its way into endometrium & blood vessels, embryo rids itself of waste products
Week 6
heart reaches final 4 chamber form
facial & ear develop
midline gap closes, tail starts to recede
digits develop
yolk sac inside GI sac–> earliest source of nutrients
Week 7
eyelids & internal organs form
-liver, intestines, kidneys
Week 8
every system is formes
eyelids are formed and fuse
external genitalia still differentiating
Teratogens
TORCH
toxoplasmosis other (syphillis, ghonorrhea, chlamydia etc) Rubella Cytomegalovirus Herpes Genitalis
Toxoplasmosis
Risks: eating raw/ undercooked meat, cleaning cat litter box
leads to miscarriage, mental retardation, anemia, jaundice, deafness & seizures
later in pregnancy the inf. occurs= less severe to fetus
