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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
Q

How long after fertilisation can hCG be detected?

A

As soon as 9 days after fertilisation

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26
Q

When is hCG’s peak production?

A

Weeks 12 - 14 of pregnancy

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27
Q

How is hCG detected?

A

Detection of hCG in the urine by using monoclonal antibodies to the hCG (anti-hCG) - technique is immunoassay

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28
Q

What are the two protective layers of the oocyte?

A

Zona pellucida

Corona radiata

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29
Q

What is the role of prostaglandins in fertilisation and pregnancy?

A

Assist in propulsion of sperm to site of fertilisation
Used to kick-start labour process
Also thought to control ovulatory processes

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30
Q

What do sperm utilise to break through corona radiata?

A

Hyaluronidase - breaks down bonds between adjacent follicle cells

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31
Q

What occurs in the fertilisation process?

A

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

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32
Q

What occurs to prevent polyspermy?

A

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

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33
Q

What kind of reaction is the slow block?

A

Cortical reaction

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34
Q

What is the purpose of the fimbriae?

A

Infundibulum moves to site of ruptured follicle

Fimbriae direct ovum to uterine tube

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35
Q

What is polyspermy?

A

Multiple sperm fusing to gamete resulting in 3+ times the chromosomal number (incompatible with life)

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36
Q

What is the fertilisation membrane?

A

Mucopolysaccharides released in slow block coat the zygote in an impenetrable barrier

This together with the hardened zona pellucida becomes the fertilisation membrane

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37
Q

Once the sperm has fused to the zygote, what process occurs?

A

Meiosis 2

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38
Q

Define cleavage

A

Cell division without growth

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39
Q

How long does it take to form the pre-embryo after fertilisation?

A

30 hours

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40
Q

What milestone comes after zygote formation?

A

Formation of the morula

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41
Q

What is a morula?

A

Approx. 8 blastomeres contained within zona pellucida

42
Q

What occurs after the morula is formed?

A

Morula develops into blastula - a hollow sphere of blastomeres surrounding a fluid filled cavity known as a blastocoel

43
Q

What does pluripotent mean?

A

Pluripotent cells can develop into any type of cell in the body

44
Q

What are the stages of formation of cleavage?

A

Zygote > Morula > Blastula > Blastocyst

45
Q

What does it mean by asynchronous division during cleavage?

A

Each cell divides independently of one another so an uneven number of cells may be seen under the microscope

46
Q

What occurs during differentiation?

A

Cells in the BLASTOCYST compact, outer and inner cells differentiate from one another

47
Q

What are the different layers of the blastocyst?

A

TROPHOBLAST > Cells surrounding outside of blatocyst

EPIBLAST > Inner cell mass (inner)
HYPOBLAST > Inner cell mass (outer)

48
Q

How long does it take for the epiblast and hypoblast to diffrentiate?

A

Two weeks

49
Q

What do the epiblast and hypoblast develop into?

A

The bilaminar disk

50
Q

What is the stage following BLASTULATION?

A

Implantation

51
Q

What occurs during Implantation?

A

Blastocyst enlarges
Blastocyst makes contact with endometrium
TROPHOBLAST cells divide rapidly, thickening this layer
Inner layer becomes CYTOTROPHOBLAST
Outer layer becomes SYNCYTIOTROPHOBLAST

52
Q

When does the implantation take place?

A

Implantation window - days 7 to 11

53
Q

What is hyaluronidase used for by the syncytiotrophoblast?

A

Creates a path through endometrium wall where blastocyst stays for further development

54
Q

Which part of the developing embryo produces hCG?

A

Syncytiotrophoblast

55
Q

What is the purpose of the release of hCG by syncytiotrophoblast?

A

Prevents the corpus luteum from degenerating leading to sustained production of oestrogen and progesterone

56
Q

How does maternal blood extend to developing fetus?

A

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
Q

When does embryogenesis occur?

A

Implantation to week 9

58
Q

What occurs during gastrulation?

A

Formation of primitive streak and germ layers

59
Q

What do the ectoderm, mesoderm and endoderm go on to form?

A

ECTODERM - Nervous system
MESODERM - Heart, cardiovascular, renal system
ENDODERM - GI tract, respiratory system

60
Q

What occurs during neurulation?

A

Formation of notochord, neural plate and neural crest

61
Q

What is the yolk sac formed from and why?

A

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
Q

What occurs on day 8 of embryogenesis?

A

Embryoblast cells differentiate to form a flat disk, amniotic cavity appears in epiblast

63
Q

What occurs/has occurred by day 15 of embryogenesis?

A

Bilaminar disk has formed

Primitive streak begins to form, germ layers start to differentiate

64
Q

What is the process of invagination?

A

Inward movement of bilaminar disk leading to formation of the ectoderm, mesoderm and endoderm

65
Q

What occurs during embryonic folding?

A

Cephalic (head) and caudal (tail) end begin to form the 3D embryo

66
Q

From which direction does an embryo develop?

A

Cephalocaudally

67
Q

What occurs overall during neurulation?

A

Neural plate forms the neural tube

68
Q

What steps occurs during neurulation?

A

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
Q

At what week have all the major organs formed?

A

Week 10

70
Q

What occurs during placentation? When does it begin?

A

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
Q

What are the functions of the placenta?

A

Metabolic function: glycogen and lipid synthesis

Exchange: gas, waste products, glucose transport, amino acid transport

Endocrine function: progesterone, oestrogen, placental lactogen, relaxin

72
Q

How is the placenta linked to gestational diabetes mellitus?

A

Placental lactogen raises maternal blood glucose and can make the mother less sensitive to insulin

73
Q

What hormone relaxes the ligaments of the pelvis to prepare for labour?

A

Relaxin

74
Q

What are some symptoms of pregnancy during the first trimester?

A 
No menstruating
Bloating
Tender breasts
Nausea/vomiting/constipation/upset stomach
Headaches
Heartburn
Weight gain
75
Q

When does each trimester start/finish?

A

1st > 0 - 12 weeks
2nd > 13 - 28 weeks
3rd > 29 - 40 weeks

76
Q

What are some symptoms of the 2nd trimester of pregnancy?

A 
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
Q

What is the dating scan? What information can be gained from this scan? When does it occur?

A

12 weeks

Sonographer estimates due date
May include nuchal translucency scan
Looks at position of baby

78
Q

What does a nuchal translucency scan screen for?

A

Down’s syndrome

79
Q

How is a due date estmated?

A

Date of last missed period

Size/measurements of baby

80
Q

What occurs at a 20-week pregnancy scan?

A

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
Q

How does an ultrasound work?

A

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
Q

What are the different types of ultrasound?

A

External
Internal
Endoscopic

83
Q

What foods should be avoided during pregnancy?

A

Mouldy cheese/blue cheese
Caffeine
Alcohol/drugs
Cold cured meats

84
Q

What are some symptoms of foetal alcohol syndrome?

A

Small head and generally smaller overall
Poor organ growth and damage
Learning difficulties

85
Q

What effects does smoking while pregnant have on a baby?

A

Premature birth
Underweight
SIDS/cot death
Miscarriage

86
Q

What support does a mother have after birth?

A

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
Q

Why are blood pressure checks and urine samples taken frequently throughout pregnancy?

A

PRE-ECLAMPSIA

  • Urine tested for excess protein and glucose (protein for pre-eclampsia, glucose for diabetes)
  • Blood pressure tested for high blood pressure
88
Q

What are the signs of pre-eclampsia and eclampsia developing during pregnancy?

A

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
Q

What is a corpus luteal cyst?

A

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
Q

What are the three stages of labour?

A

Effacement
Fetal delivery
Placental delivery

91
Q

What occurs during fetus descent?

A

Potential braxton-hicks contractions as body prepares for labour
Increased abdominal muscle tone

92
Q

When does effacement stage end?

A

When cervix is fully dilated (10cm)

93
Q

What muscles assist with placental delivery?

A

Abdominal AND uterine contractions

94
Q

Release of what hormone begins the process of labour?

A

Release of fetal oxytocin

95
Q

What is the process of labour?

A

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
Q

Where is the ductus arteriosus shunt?

A

Connects right ventricle and pulmonary artery

97
Q

Where is the ductus venosus shunt?

A

Bypasses the liver (placenta > bypass liver > right atrium of embryo)

98
Q

Where is the foramen ovale shunt?

A

Connects right and left atria together

99
Q

What adaptations occur in a newborn after birth?

A

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
Q

What hormones are involved in labour?

What is the role of

A

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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