Chapter 2: Anatomy+Physiology Of Pregnancy Flashcards
ANATOMY AND PHYSIOLOGY OF PREGNANCY You are a trainee intern in general practice with Nina, a 25 year old Māori woman who is a nursing student. Nina is presenting for her first cervical smear. Nina asks you about the structure and function of the cervix. From the following options, which statement is MOST CORRECT about the structure and main function of the cervix?
The cervix is a muscular structure. Its main function is to contract after ovulation.
The cervix is a fibrous structure. Its main function is to hold a pregnancy in place
The cervix is a muscular structure. Its main function is to secrete mucus at midcycle, and thus be a reservoir for sperm.
The cervix is a muscular structure. Its main function is to stretch and open up in labour
The cervix is a fibrous structure. Its main function is to secrete acidic mucus prior to ovulation
The cervix is a fibrous structure. Its main function is to hold a pregnancy in place
ANATOMY AND PHYSIOLOGY OF PREGNANCY You are a trainee intern in an antenatal clinic seeing Guo, a 28 year old Malaysian woman who is 34 weeks pregnant.
Guo has been referred to clinic by her LMC because of foetal growth restriction. An ultrasound was arranged as Guo palpated small for dates. The ultrasound has shown that the baby has an estimated foetal weight of 1400gms. This is below the 5th centile on customised GROW chart. The liquor volume is also reduced. The Doppler studies show a low Cerebroplacental ratio (CPR).
Guo had a low risk MSS1 screen. Her morphology scan at 19 weeks is reported as normal. Guo feels well. She has had no loss of fluid vaginally.
Guo asks you about the significance of the ultrasound finding of reduced amniotic fluid.
From the following options, what is the BEST response?
The reduced fluid is likely caused by the placenta not functioning well. The poor placental function is also causing the foetal growth restriction and abnormal Dopplers.
The fluid is needed so that the baby can practice important functions such as swallowing so the baby may have difficulties swallowing and need to be tube fed initially.
The amniotic fluid is important so that the umbilical cord can pulsate and pump nutrients to the baby. The reduced amniotic fluid is causing the abnormal Dopplers and growth restriction.
As the fluid is mostly formed by the baby producing urine, the baby may have a problem with its kidneys.
The reduced fluid may signify that Guo is not eating and drinking enough fluid nutrients and fluid.
The reduced fluid is likely caused by the placenta not functioning well. The poor placental function is also causing the foetal growth restriction and abnormal Dopplers.
ANATOMY AND PHYSIOLOGY OF PREGNANCY You are a trainee intern in birthing suite examining a baby at birth. The mother, Shanaya, is a 16 year old Pākehā woman. Shanaya had booked late as she had concealed her pregnancy from her family. Her dates were based on an ultrasound carried out at 34 weeks. Shanaya had a ‘post-dates’ induction at 42 weeks (based on her uncertain dates). When you examine the baby you wonder if the baby is closer to 38 weeks’ gestation rather than 42 weeks’ gestation. Which of the following findings suggests that the baby is closer to 38 weeks’ gestation rather than 42 weeks gestation?
The fingernails and umbilical cord are meconium stained.
The baby weighs 3500 grams
The skin hangs loosely on the extremities, is dry and peeling
The head circumference is 35 cms
There are small patches of lanugo hair on the chest, back and buttocks
There are small patches of lanugo hair on the chest, back and buttocks
ANATOMY AND PHYSIOLOGY OF PREGNANCY You are a trainee intern in a gynaecology ward seeing Willow, a 26 year old primigravid Pākehā woman. Willow is 6 weeks pregnant. She presented with acute abdominal pain. An ultrasound showed a 10cm ovarian cyst and a single intra-uterine pregnancy. Willow had a laparoscopy four hours ago for a suspected ovarian torsion. An ovarian cystectomy was performed for what was thought to be a torted haemorrhagic corpus luteum cyst. Willow is worried about the effect of the surgery on her pregnancy. From the following options, what is the MOST APPROPRIATE response?
HCG from the placenta caused haemorrhage into the corpus luteum which then became a large cyst and torted. This will not impact on the pregnancy.
The corpus luteum was making oestrogen. Because the corpus luteum has been removed, you will need to take oestrogen for the remainder of the pregnancy.
There is no risk of a miscarriage of your baby because the placenta is already making sufficient estrogen and progesterone to maintain the pregnancy.
The baby will be unaffected because the placenta is already making a hormone called human placental lactogen which is responsible for much of the baby’s growth.
The corpus luteum was making progesterone. Because the corpus luteum has been removed, you will need to take progesterone until the placenta takes over the progesterone production. This will be in about 4 weeks.
The corpus luteum was making progesterone. Because the corpus luteum has been removed, you will need to take progesterone until the placenta takes over the progesterone production. This will be in about 4 weeks.
ANATOMY AND PHYSIOLOGY OF PREGNANCY You are a trainee intern in a gynaecology ward seeing Ava, a 26 year old primigravid Pākehā woman. Ava is 14 weeks pregnant. She presented with acute abdominal pain. An ultrasound showed a 10cm ovarian cyst and a single intra-uterine pregnancy. The cyst had been present at Ava’s nuchal translucency scan and was thought to be a haemorrhagic corpus luteum. Ava had a laparoscopy four hours ago for a suspected ovarian torsion. An ovarian cystectomy was performed. Ava is worried about the effect of the surgery on her pregnancy. From the following options, what is the MOST APPROPRIATE response?
The baby will be unaffected because the placenta is already making a hormone called human placental lactogen which is responsible for much of the baby’s growth.
HCG from the placenta caused haemorrhage into the corpus luteum which then became a large cyst and torted. This will not impact on your pregnancy.
You will not need any hormone therapy, because the placenta has already taken over the function of the corpus luteum prior to 14 weeks
The corpus luteum was making progesterone. Because the corpus luteum has been removed, you will need to take progesterone until the placenta takes over the progesterone production. This will be in about 4 weeks.
The corpus luteum was making oestrogen. Because the corpus luteum has been removed, you will need to take oestrogen for the remainder of the pregnancy.
You will not need any hormone therapy, because the placenta has already taken over the function of the corpus luteum prior to 14 weeks
ANATOMY AND PHYSIOLOGY OF PREGNANCY You are a trainee intern on birthing suite assisting at a caesarean section. The caesarean section is being performed on Emeni, a 21 year old nulliparous New Zealander of Tongan descent. Emeni is 39 weeks pregnant in her first pregnancy. The indication for the caesarean section is a breech presentation. Emeni is known to have a uterine didelphys. The pregnancy is in the left uterus. You are aware that a uterine didelphys is a type of Mullerian duct abnormality. If a Mullerian duct abnormality is present, commonly there is an associated abnormality present in another body system. From the following options, which organ most often has an abnormality in women with a Mullerian duct anomalies?
Kidneys
Ovaries
Blood vessels
Liver
Skin
Kidneys
ANATOMY AND PHYSIOLOGY OF PREGNANCY You are a trainee intern in a general practice seeing Tegan, a 26 year old Australian woman who presents for her first smear. When Tegan went through puberty she was diagnosed as having an imperforated hymen that was treated surgically. Tegan has been ‘googling’ the causes of an imperforated hymen. She asks you what the embryological anomaly is that results in an imperforated hymen. From the following options, what is the MOST ACCURATE response?
The paramesonephric ducts fuse to become the body of the uterus but if they do not fuse correctly the result is an imperforated hymen
The mesonephric ducts develop into the vagina but if they do not fuse correctly the result is an imperforate hymen
The abnormality results because there is abnormal fusion of the labia minora
Due to an absence of Anti-Mullerian hormone, the urogenital sinus and the paramesonephric ducts are not canalised correctly resulting in an imperforate hymen
The vaginal lumen is created when the sinovaginal bulbs become canalised. The vaginal lumen is separated from the remainder of the urogenital sinus by the hymen, which normally perforates during fetal life.
The vaginal lumen is created when the sinovaginal bulbs become canalised. The vaginal lumen is separated from the remainder of the urogenital sinus by the hymen, which normally perforates during fetal life.
ANATOMY & PHYSIOLOGY OF PREGNANCY You are a Trainee Intern on Birthing Suite. You are assisting at a caesarean section on Sophie, a 32 year old para 2 Pākehā woman. The indication for the caesarean section is that the baby is a transverse lie. Sophie has had 2 previous caesarean sections. Her first 2 caesarean sections were for breech babies. Sophie is known to have a unicornuate uterus. The registrar reminds you that a unicornuate uterus is a Mullerian duct abnormality. Of the following options, an abnormality in which reproductive organ is part of the spectrum of Mullerian abnormalities?
Lower third of the vagina
Clitoris
Ovaries
Upper third of the vagina
Kidneys
Upper third of the vagina
