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Medicine Sem 1 > Case 1 Pregnancy > Flashcards

Case 1 Pregnancy Flashcards

1
Q

Which 2 cycles make up the female reproductive cycle

A

Ovarian cycle

Menstrual Cycle

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2
Q

What are the phases of the menstrual cycle

A

Menstrual > Proliferative > Secretory

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3
Q

What occurs at different stages of the menstrual cycle

A

Hypothalamus releases Gonadotropin Releasing Hormone (GnRH)

Triggers Anterior Pituitary to release Follicle Stimulating Hormone (FSH)

Follicle begins to grow, releases Estradiol

Estradiol causes Anterior Pituitary to release Luteinising hormone (LH)

LH released back into the bloodstream triggers release of ovum (ovulation)

Corpus luteum releases progesterone and estradiol which gradually decreases, as this decreases menstruation begins

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4
Q

When do FSH and LH peak?

A

Just before ovulation - proliferative phase

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5
Q

When does progesterone peak? (include day number)

A

Approx. day 21 - secretory phase

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6
Q

How long does the menstrual phase last?

A

1 - 7 days

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7
Q

What stimulates release of GnRH

A

Leptin triggers Kisspeptin (the main GnRH pulse generator in females)
Comes from body fat - skinnier women/girls start menstruating later

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8
Q

What occurs if menstrual/ovarian cycles are not in sync?

A

Potential issues with fertility

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9
Q

What causes FSH levels to decrease?

A

Negative feedback from inhibin

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10
Q

What are the different stages of follicle development?

A

Primordial follicle > Preantral follicle > Antral follicle > Pre-ovulatory follicle > Ovulation > Corpus luteum formation

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11
Q

What is progesterone’s role in the ovulatory cycle

A

Maintain endometrium wall thickness to ensure viable pregnancy implants

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12
Q

Where does folliculogenesis occur?

A

The cortex of the ovary

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13
Q

What is a Graafian follicle?

A

The final form of the follicle before the ovum is released

The Graafian follicle contains a secondary oocyte

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14
Q

What surrounds the ovum?

A

Corona radiata

Zona pellucida

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15
Q

What are the three types of contraceptive pill?

A

Combined pill (oestrogen and progesterone - Microgynon or Rigevidon)

Progesterone only (Cerazette, Cerelle)

Continuous or extended-use pill

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16
Q

How does progesterone inhibit pregnancy?

A

Inhibits follicular development:

  • NEGATIVE FEEDBACK at hypothalamus, decreases pulse frequency of GnRH
  • Leads to reduced FSH and LH
  • No FSH surge prevents follicle developing
  • No LH surge means no ovulation
  • No follicle development leads to no Estradiol production

Also makes endometrial wall thick and mucousy so unviable for sperm

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17
Q

What defines fertilisation?

A

Fertilisation of process of fertilising an egg/female animal/plant involving the fusion of male and female (haploid) gametes to form a zygote

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18
Q

Where in the female reproductive system does fertilisation occur?

A

Between ampulla and isthmus of uterine tube

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19
Q

What is the process of gradual loss of follicles called?

A

Atresia - hormonally controlled apoptosis

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20
Q

What can occur in a pregnant woman with a folate deficiency?

A

Folic acid deficiency can lead to neural tube defects such as spina bifida and anencephaly

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21
Q

What is folic acid an essential component of?

A

DNA replication

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22
Q

Excluding neural tube defects, what else can folic acid help with during pregnancy?

A

Prevents congenital heart defects, oral clefts, pre-term births

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23
Q

How does a pregnancy test work?

A

Detects human chorionic gonadotropin (hCG)

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24
Q

How is hCG secreted?

A

Secreted by the syncytiotrophoblast of implanting blastocyst and from placenta soon after pregnancy is established

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25
How long after fertilisation can hCG be detected?
As soon as 9 days after fertilisation
26
When is hCG's peak production?
Weeks 12 - 14 of pregnancy
27
How is hCG detected?
Detection of hCG in the urine by using monoclonal antibodies to the hCG (anti-hCG) - technique is immunoassay
28
What are the two protective layers of the oocyte?
Zona pellucida | Corona radiata
29
What is the role of prostaglandins in fertilisation and pregnancy?
Assist in propulsion of sperm to site of fertilisation Used to kick-start labour process Also thought to control ovulatory processes
30
What do sperm utilise to break through corona radiata?
Hyaluronidase - breaks down bonds between adjacent follicle cells
31
What occurs in the fertilisation process?
Sperm reach oocyte Release hyaluronidase from head to break down corona radiata Sperm break through and bind to receptors in zona pellucida Sperm and oocyte fuse to become zygote
32
What occurs to prevent polyspermy?
Fast block - zygote depolarises plasma membrane to prevent more sperm fusing with membrane Slow block - influx of Ca2+ triggers cortical granules to to release zonal inhibiting proteins, hardening zona pellucida and releasing any other sperm attached to membrane
33
What kind of reaction is the slow block?
Cortical reaction
34
What is the purpose of the fimbriae?
Infundibulum moves to site of ruptured follicle Fimbriae direct ovum to uterine tube
35
What is polyspermy?
Multiple sperm fusing to gamete resulting in 3+ times the chromosomal number (incompatible with life)
36
What is the fertilisation membrane?
Mucopolysaccharides released in slow block coat the zygote in an impenetrable barrier This together with the hardened zona pellucida becomes the fertilisation membrane
37
Once the sperm has fused to the zygote, what process occurs?
Meiosis 2
38
Define cleavage
Cell division without growth
39
How long does it take to form the pre-embryo after fertilisation?
30 hours
40
What milestone comes after zygote formation?
Formation of the morula
41
What is a morula?
Approx. 8 blastomeres contained within zona pellucida
42
What occurs after the morula is formed?
Morula develops into blastula - a hollow sphere of blastomeres surrounding a fluid filled cavity known as a blastocoel
43
What does pluripotent mean?
Pluripotent cells can develop into any type of cell in the body
44
What are the stages of formation of cleavage?
Zygote > Morula > Blastula > Blastocyst
45
What does it mean by asynchronous division during cleavage?
Each cell divides independently of one another so an uneven number of cells may be seen under the microscope
46
What occurs during differentiation?
Cells in the BLASTOCYST compact, outer and inner cells differentiate from one another
47
What are the different layers of the blastocyst?
TROPHOBLAST > Cells surrounding outside of blatocyst EPIBLAST > Inner cell mass (inner) HYPOBLAST > Inner cell mass (outer)
48
How long does it take for the epiblast and hypoblast to diffrentiate?
Two weeks
49
What do the epiblast and hypoblast develop into?
The bilaminar disk
50
What is the stage following BLASTULATION?
Implantation
51
What occurs during Implantation?
Blastocyst enlarges Blastocyst makes contact with endometrium TROPHOBLAST cells divide rapidly, thickening this layer Inner layer becomes CYTOTROPHOBLAST Outer layer becomes SYNCYTIOTROPHOBLAST
52
When does the implantation take place?
Implantation window - days 7 to 11
53
What is hyaluronidase used for by the syncytiotrophoblast?
Creates a path through endometrium wall where blastocyst stays for further development
54
Which part of the developing embryo produces hCG?
Syncytiotrophoblast
55
What is the purpose of the release of hCG by syncytiotrophoblast?
Prevents the corpus luteum from degenerating leading to sustained production of oestrogen and progesterone
56
How does maternal blood extend to developing fetus?
Syncytiotrophoblast spreads through endometrium Trophoblastic extensions form around endometrial capillaries Maternal blood percolates trophoblastic channels Syncytiotrophoblast spreads and breaks down endometrial arteries/veins, blood flows through LACUNAE
57
When does embryogenesis occur?
Implantation to week 9
58
What occurs during gastrulation?
Formation of primitive streak and germ layers
59
What do the ectoderm, mesoderm and endoderm go on to form?
ECTODERM - Nervous system MESODERM - Heart, cardiovascular, renal system ENDODERM - GI tract, respiratory system
60
What occurs during neurulation?
Formation of notochord, neural plate and neural crest
61
What is the yolk sac formed from and why?
Cells from hypoblast form thin membrane then migrate around blastocoel forming extra embryonic membrane - it is the primary nutrient source for the inner cell mass
62
What occurs on day 8 of embryogenesis?
Embryoblast cells differentiate to form a flat disk, amniotic cavity appears in epiblast
63
What occurs/has occurred by day 15 of embryogenesis?
Bilaminar disk has formed Primitive streak begins to form, germ layers start to differentiate
64
What is the process of invagination?
Inward movement of bilaminar disk leading to formation of the ectoderm, mesoderm and endoderm
65
What occurs during embryonic folding?
Cephalic (head) and caudal (tail) end begin to form the 3D embryo
66
From which direction does an embryo develop?
Cephalocaudally
67
What occurs overall during neurulation?
Neural plate forms the neural tube
68
What steps occurs during neurulation?
Lateral edges of neural plate lift, forming neural groove Edges of neural groove fuse, forming neural tube When neural tube is fully fused/formed, neurulation is complete
69
At what week have all the major organs formed?
Week 10
70
What occurs during placentation? When does it begin?
Begins at DAY 9 - syncytiotrophoblast erodes maternal tissues, maternal blood enters lacunae network By the END OF WEEK 3 - Embryonic vessels begin to form in embryonic mesoderm, turning secondary chorionic villi into tertiary villi Tertiary villi grow towards decidua basalis of maternal uterus and spread across it forming cytotrophoblastic shell
71
What are the functions of the placenta?
Metabolic function: glycogen and lipid synthesis Exchange: gas, waste products, glucose transport, amino acid transport Endocrine function: progesterone, oestrogen, placental lactogen, relaxin
72
How is the placenta linked to gestational diabetes mellitus?
Placental lactogen raises maternal blood glucose and can make the mother less sensitive to insulin
73
What hormone relaxes the ligaments of the pelvis to prepare for labour?
Relaxin
74
What are some symptoms of pregnancy during the first trimester?
``` No menstruating Bloating Tender breasts Nausea/vomiting/constipation/upset stomach Headaches Heartburn Weight gain ```
75
When does each trimester start/finish?
1st > 0 - 12 weeks 2nd > 13 - 28 weeks 3rd > 29 - 40 weeks
76
What are some symptoms of the 2nd trimester of pregnancy?
``` Body aches Darkening of skin round nipples Patches of darker skin on the face Numbness/tingling in hands and feet Itching on abdomen, palms and soles Swelling of face and fingers ```
77
What is the dating scan? What information can be gained from this scan? When does it occur?
12 weeks Sonographer estimates due date May include nuchal translucency scan Looks at position of baby
78
What does a nuchal translucency scan screen for?
Down's syndrome
79
How is a due date estmated?
Date of last missed period | Size/measurements of baby
80
What occurs at a 20-week pregnancy scan?
Checks physical development of baby - able to see any birth defects at this stage (spina bifida, anencephaly, cleft lip, cardiac abnormalities, skeletal dysplasia, Edward or Patau's syndrome)
81
How does an ultrasound work?
Small device gives off sound waves that creates "echoes" when the waves bounce off surfaces, able to create a physical image on a screen
82
What are the different types of ultrasound?
External Internal Endoscopic
83
What foods should be avoided during pregnancy?
Mouldy cheese/blue cheese Caffeine Alcohol/drugs Cold cured meats
84
What are some symptoms of foetal alcohol syndrome?
Small head and generally smaller overall Poor organ growth and damage Learning difficulties
85
What effects does smoking while pregnant have on a baby?
Premature birth Underweight SIDS/cot death Miscarriage
86
What support does a mother have after birth?
Midwifes and neonatal nurses or paediatrician checks baby is healthy after birth Offered physical examination within 72 hours On days 5 - 8 newborn screening test and blood spot test is offered
87
Why are blood pressure checks and urine samples taken frequently throughout pregnancy?
PRE-ECLAMPSIA - Urine tested for excess protein and glucose (protein for pre-eclampsia, glucose for diabetes) - Blood pressure tested for high blood pressure
88
What are the signs of pre-eclampsia and eclampsia developing during pregnancy?
High blood pressure - pre-eclampsia causes hypertension so HBP could be a symptom Protein in the urine Eclampsia is a severe form of pre-eclampsia that causes seizures and is life threatening
89
What is a corpus luteal cyst?
A functional ovarian cyst that forms when a corpus luteum fails to regress following ovum release Sometimes they can be filled with blood Most regress after time, some cause pain but it will not last long
90
What are the three stages of labour?
Effacement Fetal delivery Placental delivery
91
What occurs during fetus descent?
Potential braxton-hicks contractions as body prepares for labour Increased abdominal muscle tone
92
When does effacement stage end?
When cervix is fully dilated (10cm)
93
What muscles assist with placental delivery?
Abdominal AND uterine contractions
94
Release of what hormone begins the process of labour?
Release of fetal oxytocin
95
What is the process of labour?
Fetal pituitary releases oxytocin This trigger increase of myometrial contractions Prostaglandin production increases Uterine contractions force amniotic sac against cervical canal (or head of fetus if membrane has ruptured) Uterine and abdominal contractions begin to force fetus through lower pelvis Contractions come in pulses and speed up as the baby is birthed
96
Where is the ductus arteriosus shunt?
Connects right ventricle and pulmonary artery
97
Where is the ductus venosus shunt?
Bypasses the liver (placenta > bypass liver > right atrium of embryo)
98
Where is the foramen ovale shunt?
Connects right and left atria together
99
What adaptations occur in a newborn after birth?
Shunts close Placental circulation stops, adult circulation begins Baby usually changes from blue to pink due to oxygen levels rising from ~65% to ~95%
100
What hormones are involved in labour? What is the role of
Prolactin - Controls milk production/secretion Oxytocin - Induces labour and uterus shrinking Prostaglandins - Open cervix, make body more receptive to oxytocin Relaxin - Relaxes and softens cervix Oestrogen - Release prostaglandins, prep uterus for labour Progesterones - Maintain uterus lining, decreases during labour for uterine muscle contraction

Medicine Sem 1 (2 decks)

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