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IM 6 Test 3 > Conception, Infertility and Fetal Development > Flashcards

Conception, Infertility and Fetal Development Flashcards

1
Q

Infertility definition

A

inability to conceive or maintain a pregnancy after 12 months of unprotected intercourse OR 6 moths if older than 35

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2
Q

primary infertility

A

never had a successful pregnancy

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3
Q

secondary infertility

A

had a child and now can’t have another pregnancy

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4
Q

abnormalities of the sperm X2

A

azoospermia

oligospermia

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5
Q

azoospermia

A

absent sperm in semen

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6
Q

oligospermia

A

decreased sperm in semen

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7
Q

what can impair the number and function of sperm X11

A 
hormones
illness
GI tract infections
anatomic abnormalities
exposure to toxins
medication/treatments
excessive drug use
elevated scrotal temperature
immunologic factors
abnormal erections/ejaculation
abnormailites of seminal fluid
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8
Q

variocele

A

abnormal enlargement of the scrotu

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9
Q

disorders in ovulation X2

A

hypothalamus/pituitary dysfunction

failure to respond to FSH or LH

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10
Q

failure to respond to FSH or LH is caused by X11

A 
PCOS
cranial tumors
stress 
obesity/anorexia
disease
anatomic abnormalities
preemie ovarian failure (early menopause)
decreased reserve
chemo
excessive alcohol intake
cigarette smoking
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11
Q

abnormalities of the fallopian tubes

A

endometriosis

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12
Q

recurrent pregnancy loss can be caused by

A 
abnormalities of:
fetal chromosomes
cervix/uterus
endocrine system
immunologic/thrombotic factors
environmental agents
infections
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13
Q

who is test first when it comes to infertility

A

men

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14
Q

how are men tested for infertility X5

A 
semen analysis
ultrasonography
endocrine analysis
testicular biopsy
sperm penetration assay
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15
Q

how are women tested for infertility X9

A 
ovulation prediction
hormone analysis
hysterosalpingography
hysteroscopy
laparoscopy
basal body temperature
spinnbarkeit
ultrasonography
postcoital test
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16
Q

when is a semen analysis taken

A

after 2-3 days of abstinence

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17
Q

hysterosalpingography CI

A

iodine allergy

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18
Q

hysteroscopy pro

A

no dye needed - allergy risk minimized

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19
Q

what is spinnbarkeit

A

examination of the cervical mucus

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20
Q

what does the postcoital test determinate

A

if cervical mucus is hostile

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21
Q

taking BBT

A

every morning at same time before doing ANYTHING and plot on a chart

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22
Q

how long can it take to predict ovulation after starting to monitor BBT

A

3-4 months

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23
Q

what indicates ovulation with BBT

A

temp rise of 0.5 degrees over a 48 hr period

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24
Q

when are the highest chances of getting pregnant in r/t ovulation

A

2 days prior to ovulation

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25
Q

how does weight loss affect pregnancy in PCOS

A

losing 5-10% of body weight can help achieve pregnancy

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26
Q

how does weight gain help in anorexia/super athletes

A

gaining 5-10% of body weight can achieve pregnancy

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27
Q

lifestyle changes to promote pregnancy X2

A

quitting smoking, drinking, drugs, etc

men wearing boxers

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28
Q

STD’s and fallopian tubes

A

STD’s can cause scarring in the fallopian tubes

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29
Q

Ovarian stimulation medications X2

A

clomiphene citrate***

letrozole

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30
Q

clomiphene citrate MOA

A

stimulates PITUITARY GLAND to increase secretion of LH AND FSH

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31
Q

clomiphene citrate AE

A

can cause ovarian hyperstimulation syndrome

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32
Q

clomiphene citrate pt ed

A

increased risk of multiples d/t hyperstimulation syndrome

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33
Q

letrozole is used in women with

A

ovulation problems
unexplained pregnancy
PCOS***

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34
Q

letrozole pt ed

A

increased risk of multiples

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35
Q

why do ovarianstimulants make women feel crappy

A

excess hormones

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36
Q

bromocriptine MOA

A

corrects excess prolactin secretion by pituitary

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37
Q

metformin MOA

A

adjunct tx for use in PCOS

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38
Q

menotropins/human menopausal gonadotropins MOA

A

promotes follicle development

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39
Q

follitropins/synthetically manufactured FSH

A

stimulatory effect on ovarian follicles

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40
Q

follitropin pt ed

A

increased risk of multiples

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41
Q

human chorionic gonadotropin (hCG) MOA

A

stimulates ovulation in female, spermatogenesis in males

stimulates progesterone production by corpus luteum

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42
Q

progesterone MOA

A

luteal phase support
prepares uterine lining
promotes implantation of embryo

basically makes the uterus comfy for baby

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43
Q

Intrauterine insemination (IUI)

A

prepared sperm placed in uterus at ovulation

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44
Q

pros of IUI

A

bypasses cervical mucus

removes antibodies that interfere with sperm mobility and ability to penetrate ovum

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45
Q

in vitro fertilization-embryo transfer (IVF-ET)

A

eggs are collected from ovaries, fertilized in a lab and then transferred to uterus

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46
Q

cons of IVF

A

not approved by the catholic church

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47
Q

when is IVF used

A

fallopian tube scarring - low sperm count

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48
Q

when are assisted reproductive technologies used

A

only when drug options are exhausted

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49
Q

cons of assisted reproductive technologies

A

not as stable as a natural pregnancy

high r/o preemie/miscarriage, etc

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50
Q

intracytoplasmic sperm injection

A

single sperm is selected and injected directly into the ovum

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51
Q

when is intracytoplasmic sperm injection done

A

low sperm count

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52
Q

cons of intracytoplasmic sperm injections

A

$$$

done outside body - nono to catholics

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53
Q

gamete intrafallopian transfer (GIFT)

A

oocytes retrieved and placed with prepared motile sperm then placed in fallopian tubes

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54
Q

pros of GIFT

A

conception occurs inside body - okay with catholics

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55
Q

zygote intrafallopian transfer (ZIFT)

A

zygote is placed in fallopian tub instead of uterus

56
Q

cons of ZIFT

A

conception occurs outside body - nono wtih catholics

57
Q

donor oocyte

A

donated eggs collected, inseminated and embryos placed in recipient uterus

58
Q

donor embryo

A

donated embryo placed in recipients uterus

59
Q

gestational carrier

A

couple who goes through IVF with embryo placed in a woman with NO GENETIC TIES

60
Q

surrogate mother

A

woman inseminated with semen and carries fetus to birth

61
Q

therapeutic donor insemination

A

use of donor sperm

62
Q

zygote

A

fertilized oocyte with diploid chromosomes (46)

63
Q

where does fertilization take place

A

fallopian tubes

64
Q

blastocyst

A

5 days post-conception

STEM CELLS ONLY

65
Q

when does the blastocyst imbed into the uterus

A

between day 6 and 10

66
Q

common s/sx with implanation

A

implantation bleeding/spotting

67
Q

what makes the endometrium become thicker and more vascular

A

estrogen and progesterone

68
Q

how does the zygote let the body know pregnancy has begun

A

hCG secretion

69
Q

how does implantation occur

A

trophoblast/chorion secretes enzymes to digest endometrial surface

70
Q

where does implantation occur

A

upper part of posterior wall of uterus

71
Q

implantation aka

A

Nidation

72
Q

embryo length

A

implantation-8 weeks

73
Q

exposure to teratogens and embryo

A

severe consequences

74
Q

how long is the embryo at the 8th gest. week

A

3 cm with all organ systems formed

75
Q

when does the heart form and beat

A

forms during the 3rd gestational week and circulates blood during the 4th gestational week

76
Q

how big is the heart when it is first formed

A

as big as a poppyseed

77
Q

12 week characteristics X4

A

kidneys produce urine
sucking reflex present
bile formed by liver
male/female external genitalia can be distinguished by appearance

78
Q

12 week length

A

87 mm

79
Q

16 week characteristics X3

A

urine excreted into amniotic fluid
meconium is formed in intestines
fingerprints developing

80
Q

16 week length

A

140 mm

81
Q

20 week characteristics X2

A

peristalsis well developed

skin is thin and covered with vernix

82
Q

20 week length

A

160 mm

83
Q

24 week characteristic X3

A

alveoli form in lungs and begin to produce surfactant***
respiratory movements can be detected
fingerprints and footprints developed

84
Q

24 week length

A

230 mm

85
Q

28 week characteristics X3

A

sufficient alveoli, surfactant and capillary network to allow respiratory function
eyelids no longer fused at 26 weeks
major sulci and gyri present in brain

86
Q

28 week length

A

270 mm

87
Q

32 week characteristics X3

A

surfactant production nears mature levels
maturation of parasympathetic nears that of sympathetic
lanugo disappearing

88
Q

32 week length

A

300 mm

89
Q

38 week characteristic X7

A 
sulci and gyri fully developed
gas exchange capability fully developed
both testes usually palpable at birth
newborn ovaries contain 1 mill follicles
vernix present in major body creases
fetus is plump
lanugo present on upper back and shoulders only
90
Q

fetus time

A

week 9 to birth

91
Q

fetal sensitivity to toxins

A

not as sensitive but CNS is still vulnerable to damaging agents

92
Q

where does exchange of substances between mother and fetus occur

A

intervillous spaces of placenta

93
Q

how frequently is the blood in the intervillous space changed

A

3-4 times/minute

450-750 mL/minute for perfusion

94
Q

hormones produced by placenta X4

A

progesterone
estrogen
hCG
hPL

95
Q

viruses can/cannot cross placental membrane

A

can

96
Q

drugs can/cannot cross placental membrane

A

can

97
Q

how many membranes form the amniotic sac

A

amnion and chorion

98
Q

what makes up amniotic fluid

A

fetal urine and fluid, epithelial cells, vernix, lanugo

99
Q

purposes of amniotic fluid X6

A 
cushions impacts
prevents fetal adherence to membranes
allows freedom of fetal movement
provides consistent thermal environment
essnetial for fetal lung development
allows symmetric development
100
Q

oligohydramnios

A

abnormally small amniotic fluid
<50% of amount expected for gestation OR
<400 mL at term

101
Q

oligohydramnios occurs in moms with

A

vascular changes r/t T1DM

102
Q

oligohydramnios causes X4

A

poor placental blood flow
PPROM
failure of kidney development
blocked urinary tract

103
Q

oligohydramnios fetal effects X2

A

poor fetal lung development

malformations such as skeletal abnormalities

104
Q

hydramnios/polyhydramnios

A

quantity may exceed 2000 mL

105
Q

hydramnios is seen mostly in which population

A

diabetic mothers

106
Q

hydramnios causes

A

poorly controlled DM leading to large quantities of fetal urine and elevated glucose levels

107
Q

hydramnios fetal effects X2

A

chromosomal abnormalities

multiple gestations

108
Q

umbilical cord

A

lifeline between fetus and placenta consisting of
2 arteries
one vein

109
Q

what surrounds the umbilical vessels and what is it’s purpose

A

Wharton’s jelly and it protects the vessels from compression

110
Q

succenturiate placenta

A

one or more accessory lobe of fetal villi have developed

111
Q

vascular connection origins in succenturiate placenta

A

fetal origin

112
Q

biggest complication of succenturiate placenta

A

accessory lobe can be retained during third stage of labor leading to hemorrhage

113
Q

circumvallate placenta

A

fetal surface of placenta exposed through ring opening around umbilical cord

114
Q

complications of circumvallate placenta

A

increased incidence of late abortion, preemie and fetal death

increasedrisk for antepartum hemorrhage, abnormal maternal bleeding

115
Q

battledore placenta

A

umbilical cord inserted at or near placental margin

116
Q

complication of battledore placenta

A

high chances of preemie labor

117
Q

degenerative placenta

A

infarcts and placental calcifications that interfere with uterine placental fetal O2 exchange

118
Q

when is degenerative placenta most common

A

preeclampsia, smokers and drug use

119
Q

when is degenerative placenta dangerous

A

30ish weeks

120
Q

what is degenerative placenta not related to

A

natural placental degeneration

121
Q

velamentous cord insertion

A

vessels are unprotected by Wharton’s jelly and transverse membranes before coming together into umbilical cord

122
Q

when is velamentous cord insertion most common

A

multiple gestations

123
Q

major risk with velamentous cord insertion

A

vasa previa

124
Q

vasa previa

A

vessels going across cervical opening

125
Q

vasa previa leads to

A

hemorrhage and misscarriage

126
Q

average cord length

A

55 cm

127
Q

short cord associated with X3

A

umbilical hernias
abruptio placentae
cord rupture

128
Q

long cords do what to fetus X2

A

twist, tangle

129
Q

monozygotic twins

A

one zygote - genetically identical

one fertilized egg

130
Q

monochorionic

A

one placenta - 2 cords

131
Q

twin to twin transfusion

A

blood transfused from donor twin to recipient twiin due to imbalance in blood flow

132
Q

monoamniotic

A

share same amniotic sac

133
Q

dichorionic

A

two placentas

134
Q

dizygotic twins

A

two zygotes

two fertilized eggs

135
Q

dizygotic twins are always what

A

dichorionic but may fuse if implanted closely

will still have own blood vessels

136
Q

conjoined twins

A

aberration in twinning process

137
Q

risks for women in multiple gestations

A 
increased BV
pregnancy induced HTN
gestational diabetes
anemia
preemie ROM

IM 6 Test 3 (4 decks)

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