Exam #1 Flashcards
Urogenital anatomy begins to develop at the _____ developmental week. Development begins with formation of the ________ _______.
4th
Urogenital ridge
The urogenital ridge contains a _________ region, a ________ region, and a ________ region.
Pronephric region
Mesonephric region
Metanephric region
The pronephros forms at ____ weeks. It functions, very minimally, as the ________. It differentiates into one long _________ on each side.
3
Kidney
Nephron
By ___ to ____ weeks, the embryo needs more filtration. The pronephros begins to die by ________, as the _________ takes over.
4-4.5 weeks
Apoptosis
Mesonephros
The mesonephros develops from ________ to _________, and performs filtration from about ____ to _____ weeks gestation
Superior to inferior
4 to 10 weeks
Eventually the mesonephros is replaced by the ___________, which becomes the adult _________. This structure begins to form at week ____ of development and becomes functional around week _______.
Metanephros
Kidney
Week 5
Week 9-10
Gonads begin to form during week ____ and ______
5 and 6
The gonads develop from a thickening of the _________ ________, called the _______ _______.
Urogenital ridge
Gonadal Ridge
The gonads contain: (1) (2) and (3)
- Coelomic epithelium (lining)
- Inner mesenchyme (mesoderm)
- Primordial germ cells
Early in the ____ week, the primordial germ cells migrate to the ________ ________, traveling along the bowel mesentery via _______ ________. By the end of week _____, the PGC become incorporated into the ______ ______ _____.
6th
Genital ridge
Amoeboid movement
Primary sex cords
Before ____ weeks (known as the _______ stage), both male and female genital ducts are present. The male duct system develops from the ____________ / ____________ ducts, and the female duct system develops from the ____________ / ____________ ducts.
10
Indifferent
Mesonephric / Wolffian
Paramesonephric / Mullerian
The mesonephric and paramesonephric ducts form the __________ genital structures. This process begins around the _____ month of gestation.
Internal
3rd month
The SR-Y region of the Y chromosome codes for a protein called ____________, which causes __________ ducts to differentiate into male genital structures, and _____________, which causes the __________ ducts to regress.
TDF (testis determining factor)
Wolffian/Mesonephric
MIS (mullerian inhibiting substance)
Mullerian/Paramesonephric
Without an SR-Y region, there is no ____________, therefore the _________ ducts regress and the gonads become __________, and since there is no ______________, the _________ ducts develop into female internal genitalia.
TDF (testis determining factor) Wolffian Ovaries MIS (mullerian inhibiting substance) Mullerian/Paramesonephric
The primary sex cords of testes (also known as the _________ ______), contain the ________ _____ _____. The cords contain two types of cells: 1. ____________ (“Nurse” cells for developing sperm) and 2. ___________ (developed from primordial germ cells)
Spermatic Cords
Primordial germ cells
1. Sertoli cells
2. Spermatoblasts
The spermatic cords canalize to form the ____________ _________, which are separated by mesenchyme to form the ________ ______ (cells of _________), which make testosterone.
Seminiferous tubules
Interstitial Cells
Cells of Leydig
In males, the sex cords become _________ ________, while in females, the sex cords become _________ _________.
Seminiferous tubules
Primordial follicles
What two substances do the fetal testes produce?
- Androgens - stimulate the Wolffian ducts
2. MIS - suppress the Mullerian ducts
A __________ is a common opening shared by the digestive, reproductive, and the urinary tracts. Humans develop this in utero, but it becomes divided by week ____ of gestation
Cloaca
Week 7
In cloacal separation, the genital tubercle develops and elongates to form the ________. ________ folds then appear, and the cloacal membrane divides into two, creating a _______ _______ By week 7, separate urogenital and rectal openings have formed, called ________. The phallus elongates to form the ________, and the ________ swellings meet and form ________.
Phallus Urogenital Urorectal septum Sinuses Penis Labioscrotal swellings Scrotum
Incomplete fusion of the urethral folds. Typically more distal, though proximal variations can occur.
Hypospadias
The penis is homologous to the:
Clitoris
The phallic shaft is homologous to the:
Clitoral body
The foreskin is homologous to the:
Clitoral hood and labia minora
The phallic and scrotal raphe is homologous to the:
Vulval and labial openings
The scrotum is homologous to the:
Labial majora
The testicles descend to the level of internal inguinal ring at about which time point during gestation?
Seventh month
Scrotum Layers
Skin Dartos muscle External spermatic fascia Cremaster muscle Internal spermatic fascia Tunica vaginalis Testis
In ovarian development, first the _____ _____ increase in size. The ______ ______ ______ are incorporated into them. The cords break up, forming ________ ________ at _____ weeks. These follicles contain: (1) and (2). Active _______ of the __________, forms millions of ______ ______.
Sex cords Primordial germ cells Primordial follicles 16 weeks 1. Oogonium 2. Follicular cells (surround oogonium as layer) Mitosis Oogonium Primordial follicles
No oogonia form __________ - all are formed prior to _______. Many oogonia ______ before birth.
Postnatally
Birth
Degenerate
About ____ million oogonia remain to become primary ______ at the time of birth. By the time of puberty, only about ________ million exist.
2 million
Oocytes
1/2
In the development of the female genital ducts and glands, the __________ ducts fuse to form a Y-shaped _________ _________. This will become the _______ and ____________.
Paramesonephric
Uterovaginal primordium
Uterus and upper 1/3 of the vagina.
The uterus and upper 1/3 of the vagina is developed from the __________ __________.
Uterovaginal primordium
The fallopian tubes develop from unfused, cranial part of the _________ _______. The endometrial stroma and myometrium and derived from _________ _________.
Paramesonephric ducts
Splanchnic mesenchyme
The paramesonephric ducts fuse, and brings together the peritoneal fold, forming the ______ ________. This process also forms two compartments, the ________ _______ and the _________ _______.
Broad ligament
Rectouterine pouch
Vesicouterine pouch
In development of the vagina, an enlargement at the end of the ________ _______ induces formation of the ________ ______, which form the _______ _______.
Urogenital sinus
Sinovaginal bulbs
Vaginal plate
The vaginal plate is formed by the _________ ______, which is formed by the __________ _______.
Sinovaginal bulbs
Urogenital sinus
The cells of the vaginal plate are broken down, forming the _________ of the lower ________. This forms with the lowest part of _______ tissue to form the ______ ________.
Lumen of the lower vagina
Uterovaginal tissue
Upper vagina
The urogenital sinus and sinovaginal bulbs come together to form the:
Vagina
The ______ is formed by invagination of the ______ sinus.
Hymen
Urogenital
The urogenital folds form the _________ and ___________
Labia minor and majora
The labioscrotal folds form the _________ and ______________
Anterior and Posterior Labial Commissures
_________ produced by the placenta and fetal ovaries causes the phallus to stop growing, and becomes a clitoris
Estrogen
The precursor for all steroid hormones is ________
Cholesterol
________ and _______ are the sex hormones responsible for sexual growth and characteristics
Estrogen
Testosterone
What would happen if 21a-hydroxylase was completely missing in someone’s adrenals?
Abundance of testosterone, shortage of aldosterone
What would happen if 11b-hydroxylase was completely missing in someone’s adrenals?
Abundance of testosterone and estrogen; shortage of aldosterone
90% of the time, congenital adrenal hyperplasia is due to a deficiency of ___________, and the remaining 10% is due to deficiency of __________.
21a-hydroxylase
11b-hydroxylase
Deficiency of 21a or 11b in CAH causes a deficiency in _________ (and sometimes ________), which causes the fetal pituitary to make more ________. With enough _______, ______ is finally made, but much more _________ is made as well. In this case, the adrenal cortex makes much much more ___________.
Cortisol Aldosterone ACTH ACTH Cortisol Androgen Testosterone
If you suspect CAH, you can check for _________, which is the step right before ___________. It will be elevated in both the ______ and ______.
Urine 17-OHP
21a-hydroxylase
Urine and serum
In females, estrogen is produced by the _________ _________ of the _______.
Developing follicles of the ovaries
The major form of estrogen made by the ovaries is __________. A less-active form of estrogen is _______, which is made in fat cells. The much less active form is _______, which is created in small amounts in the liver, and high amounts in the _____.
Estrodiol
Estrone
Estriol
Placenta
In males, testosterone is produced by the ____________ of the testes
Leydig cells
Testosterone has a direct effect on peripheral tissues - it enters the cell and directly binds to a ______ _____ _____. However, in testes, prostate, seminal vesicles, and skin, testosterone acts only when converted to ________ by an enzyme, _________. _______ _______ are quite resistant to this conversion.
Nuclear binding protein
5a-DHT
5a-reductase
Anabolic steroids
Effect of higher peripheral androgens:
Increased muscle mass Increased bone growth Increased liver toxicity Elevated cholesterol levels Increased risk of cardiovascular disease Increased mood effects (roid rage) Paranoia and delusions
Effect of lower 5a-DHT:
Decreased sperm counts Decreased size of reproductive organs Infertility Decreased libido Depression
Puberty occurs between ____ and ____ in girls, and _____ and _____ in boys.
8 and 14 yrs
9 and 14 yrs
Burst of hormones activate maturation of the testes, caused by increased testosterone production
Puberty
Precocious puberty
Abnormally early puberty
Eunuchoidism
Delayed or not occurring puberty
Cryptorchidism
Undescended testicle by birth
Smooth muscle fibers in the subcutaneous tissue that contract to give the scrotum its wrinkled appearance
Dartos muscle
Controls the position of the scrotum and testes. When it is cold or a man is sexually aroused, this muscle contracts to pull the testes closer to the body for warmth.
Cremaster muscle
The testes are covered by the:
Tunica albuginea
There are about _____ lobules in each testis. Each contains ____ to ____ seminiferous tubules.
250
1 to 4
A long tube where sperm complete their maturation process and become fertile as they move through the structure. Mature sperm are stored in the ______ ______, or ______
Epididymis
Lower portion, or tail
From spermatogonium to the seminiferous tubule
- Spermatogonia
- Primary spermatocyte
- Secondary spermatocyte
- Spermatid
- Sperm
- Into the seminiferous tubule
A fibromuscular tube that is continuous with the epididymis. It enters the abdominopelvic cavity through the _______ _______ and passes along the lateral pelvic wall, behind the bladder and toward the prostate gland
Ductus Deferens
Inguinal Canal
Glands posterior to the urinary bladder. Each has a short duct that joints with the ductus deferens at the ampulla to form an ejaculatory duct, which empties into the urethra.
Seminal Vesicles
The fluid from the seminal vesicle is ______ and contains ______, ________, and ________
Viscous
Fructose
Prostaglandins
Proteins
Each ductus deferens, at the ampulla, joins the duct from its corresponding seminal vesicle to form this area. The _______ _____ passes through the prostate gland and empties into the urethra.
Ejaculatory duct
The urethra is divided into three regions: the _______ urethra, the _________ urethra, and the ______ urethra
Prostatic
Membranous
Penile
The secretions of the prostate are thin, milky colored, and _________. They function to enhance _______ _______.
Alkaline
Sperm motility
Small (about the size of a pea) and located near the base of the penis. In response to sexual stimulation, this secretes an alkaline mucus-like fluid
Bulbourethral Glands (Cowper’s)
Seminal Fluid by Volume:
____% from seminal vesicle
____% from prostate
____ from bulbourethral glands
60%
40%
Tiny amount
There are between ____ to _____ million sperm per mL of semen. Sperm counts < ___ to _____ million/mL can present fertility problems.
50 to 150
10 to 20
The penis consists of three columns of erectile tissue that are wrapped in connective tissue: two dorsal columns, called ______________, and a single, ventral column surrounding the urethra, the ____________
Corpora cavernosa
Corpus spongiosum
A loose fold of skin, called the ______, or _______, covers the glans penis
Prepuce
Foreskin
Hormone that stimulates spermatogenesis
FSH
Hormone that stimulates production of testosterone
LH
Sperm are produced within the __________ ________
Seminiferous tubules
Spermatogonia divide by _________, and some become _________ __________
Mitosis
Primary spermatocytes
Primary spermatocytes go through ___________ to produce two __________ __________, each with ______ chromosomes (haploid)
Meiosis I
Secondary spermatocytes
23
Secondary spermatocytes go through __________ to produce two _________
Meiosis II
Spermatids
As a result of the two meiotic division, each primary spermatocyte produces _____ spermatids, each with ______ chromosomes (haploid)
4
23
The head of a mature sperm contains the 23 chromosomes, surrounded by a _____ ______. The tip of the head is covered by an ________, which contains enzymes to help the sperm penetrate the female gamete. The midpiece contains __________
Nuclear membrane
Acrosome
Mitochondria (ATP)
Sperm production begins at ________ and continues throughout the life of a male. The entire process, beginning with a primary spermatocyte, takes about _____ days. After ejaculation, the sperm can live for about _____ hours in the female reproductive tract.
Puberty
74
48+
Sequence of events in female puberty
Adrenarche
Thelarche
Pubarche
Menarche
________ is an elevation in adrenal androgens which begins up to ___ years prior to puberty. The hallmark of this is the ______ _____.
Adrenarche
6
Growth spurt
Onset of puberty is signalled by the secretion of ________ of _______.
Pulses of GnRH
Just after birth, sex hormones and gonadotropins (FSH, LH) are present at ______ levels. Those levels _______ in the months after birth.
Adult
Reduce
What influences activation of the hypothalamic-pituitary-gonadal axis?
Pulsatile GnRH
Genetics (50-80% of variation in pubertal timing)
Environmental factors (nutritional status)
Leptin
Adrenarche refers to change in _______.
Thelarche refers to change in _______ ________.
Pubarche refers to change in ________ _______.
Menarche refers to change in _______ _____ ______.
Height
Breast development
Sexual hair
Onset of menses
Pubic and axillary hair growth is a sign of adrenal _______ secretion
Androgen
Thelarche often develops _______ at first. This is usually 2-3 years before menarche.
Unilaterally
A more rapid increase in the growth of _________ _______ can be the “herald” of menses for girls (will usually start within ____ ______ of so)
Sexual hair
6 months
The endometrium is affected by __________. It undergoes cycles of proliferation and regression until the point when estradiol levels have risen so high that withdrawal of estrogen results in _________.
Estradiol
Menarche
After menarche, a girl’s height typically increases by only about ____%
4%
How to stop precocious puberty?
Control it by stopping the pulsation of GnRH
Ovarian development occurs with rising levels of plasma __________
Gonadotropins
First ovulation occurs about ____ to _____ months after menarche. Rising _______ indicates that ovulation is happening.
6 to 9 months
Progesterone
The prepubertal uterus is ______ shaped. Following production of estrogens, the uterus becomes larger and more _________ shaped.
Tear-drop shaped
Pear shaped
Fallopian tubes have several distinct regions. What are they, starting on the ovarian end?
Fimbriae Infundibulum Ampulla Isthmus Interstitial
The menstrual cycle is controlled by hormones of the ______ ______ and _______. The menstrual cycle occurs in _____ stages.
Pituitary gland and ovaries
4 stages
4 stages of the menstrual cycle:
- Follicular
- Ovulation
- Luteal
- Menstruation
In the follicular phase, the pituitary produces ______ which causes ________ to form/mature. As the _____ grows, its cells produce ______ in increasing amounts. This causes the uterine lining (endometrium) to _____ _______.
FSH Follicles (egg cell capsules) Follicle Estrogen Grow thicker
Ovarian follicles have 3 different types of cells:
- Granulosa Cells - several cells thick
- Cumulus Cells - directly surrounds egg
- Theca Cells - two thick layers of cells
The _______ and _______ cells are the ones that make estrogen when they are stimulated by FSH to divide
Granulosa
Theca
During the follicular phase, estrogen is __________ to FSH, but ___________ to LH. When estrogen climbs rapidly as the _______ _______ gets bigger, LH production has a ______ ______
Inhibitory
Stimulatory
Dominant follicle
Sudden spike/surge
The _____ ______ causes the follicle to rupture, and the egg is released.
LH Surge
Activin is made by ________ in the follicular phase. It potentiates ________, and stimulates the pituitary production of ______
Follicles
GnRH
FSH
Inhibin _______ FSH.
Inhibits
During the luteal phase, the ruptured follicle heals inside the ovary, forming the _______ _______, which produces __________.
Corpus luteum (yellow body) Progesterone
If a blastocyst implants and the ovulated egg is fertilized, the embryo in the uterus will secrete ______, which mimics ________, maintaining the uterine lining. These both keep the corpus luteum from decomposing, which maintains __________ levels. Therefore, the endometrium is not shed when ______ is present.
HCG
LH
Progesterone
HCG
If no blastocyst implants, menstruation happens because ______ levels decrease after the LH surge. If an embryo is not implanted within ____ days of ovulation, there is no source of _______, and the corpus luteum decomposes. When this happens, _______ and ________ decrease. When these are decreased, the endometrium is shed and moves out through the vagina.
LH
14
HCG
Estrogen and progesterone
4 Phases of sexual response
Excitation
Plateau
Orgasm
Resolution
What are the 2 physiologic processes responsible for most of the human sexual response in men and women?
Vasocongestion
Myotonia
Excitation focuses on ___________ in both men and women.
Vasocongestion
In female plateau, as the the orgasmic platform is formed, the _____ ______ of the ______ thickens and swells. Without this, no orgasm can occur.
Outer third of the vagina thickens and swells
In male plateau, the ___________ glands secrete fluid through the tip of the penis (may contain live sperm)
Bulbourethral (Cowper’s) glands
Orgasm in males happens in 2 stages: (1) and (2)
- Contraction of the seminal vesicles, vas deferens, and prostate
- Contraction of urethra and penis –> ejaculation
___________ is a major player in female orgasm
Oxytocin
Health benefits associated with orgasm: (4)
Strengthens immune system
Relieves pain of menstrual cramps and raises pain tolerance in general
Men who have more than 5 ejaculations a week have significantly lower rate of prostate cancer later
Can ward off depression
The hormone _________, which may play a role in feelings of love and intimacy, increases fivefold during orgasm
Oxytocin
The neurotransmitter __________, released during orgasm, triggers a stress-reducing, sleep-inducing response that may last up to two hours
Dopamine
_________ phase is slower in women
Excitation
Three types of female orgasm have been identified:
- From clitoral stimulation, via pudendal nerve
- From G-spot stimulation, via pelvic nerves
- A blend of both
The urinary valve that opens into the bladder is open as the semen heads toward the urethra. Semen flows into the bladder instead (path of least resistance).
Retrograde Ejaculation
Retrograde ejaculation is more common in men with (4)
- MS
- DM
- Hx of bladder surgery
- Hx of prostate surgery
The female equivalent of the prostate, developed from the same embryonic tissue, are the _________ or __________ glands. They line the outside of the urethra, with some ducts found going into the urethra.
Skene’s or paraurethral glands
The _____________ nervous system is responsible for orgasm, while the _________ nervous system is responsible for excitation
Sympathetic - Orgasm
Parasympathetic - Excitation
In erection, the ________ _______ _______ responds to stimulation, and sends a message via __________ to relax the penile arteries, causing more blood to flow to the penis
Sacral spinal cord
Parasympathetic
Ejaculation occurs ________ in the spinal cord because the __________ trunk is higher. A message to the ________ system causes muscle contractions
higher
sympathetic
sympathetic
Women have ______ the amount of testosterone as men but are _____ times more sensitive to it
1/10
10
A weak androgen that is secreted by adrenal glands. It’s a pro hormone.
DHEA (dehydroepiandrosterone)
Sexual signalers for both sexes. Sensed by the nose.
Pheromones
Hormone released by the pituitary when touching or being touched by loved ones, even not in a couple relationship. Important for attachment.
Oxytocin
Called “the molecule of love,” it produces euphoria. Low levels of this are associated with depression.
PEA (phenylethylamine)
Produced in the brain, released in response to touch and sex, produce positive feelings
Endorphins
Testosterone antagonist, can lower sex drive. Mild sedative, calming effect
Progesterone
A low levels it intensifies sex drive; at high levels it decreases it
Serotonin
Neurotransmitter associated with all pleasure. It increases sex drive and promotes action
Dopamine
Decreases sex drive, especially in men
Prolactin
This hormone is produced by the pituitary and increases blood volume and blood pressure. It is identified as the “monogamy molecule”
Vasopressin
Hormones are NOT directly responsible for human sexual behavior, as they are in most animals. _________ _______ and __________ are the most important determinants.
Psychosocial context
Culture
The 5 C’s of approaching a patient with a sexual problem:
- Confidence
- Comfort
- Compassion
- Communication
- Consultation
On Kinsey’s 7 point continuum, a 0 correlates to exclusive contact with and erotic attraction to the ______ _______ while a 6 correlates to exclusive contact and erotic attraction to the ______ _______. On the scale, _______ are more likely to be found on the far ends.
Other sex
Same sex
Men
Psychosocial meaning of maleness and femaleness
Gender
Subjective sense of being male or female
Gender Identity
For all sexual dysfunction disorders, to differentiate from transient dysfunction, the problems must last for a minimum of ______ _______.
6 months
Qualifiers for sexual dysfunction and disorders: For patients who struggle with sexual dysfunction their whole lives
Lifelong type
Qualifiers for sexual dysfunction and disorders: For patients in which normal sexual functioning preceded the disorder
Acquired Type
Qualifiers for sexual dysfunction and disorders: The dysfunction is present during all sexual situations
Generalized type
Qualifiers for sexual dysfunction and disorders: Dysfunction is tied to particular situations
Situational Type
Sexual dysfunction affects up to _____% of men and _____% of women at some point in their lives
30%
50%
In which order do the branches of the internal iliac artery?
Uterine Artery
Obturator Artery
Umbilical Artery
Characterized by a lack of interest in sex and little sexual activity in males. Often associated with erectile dysfunction/ejaculatory concerns.
Male Hypoactive Sexual Desire Disorder
Characterized by lack of or significantly reduced sexual interest and thought in women. Absent or reduced pleasure in 75% of encounters, lack of or reduced vasocongestion and lubrication. Frequently associated with lack of orgasm, pain during sex/relationship difficulties, and mood disorders
Female Sexual Interest/Arousal Disorder
Characterized by persistent reaching of orgasm and ejaculation with little sexual stimulation. Typical of young, sexually inexperienced men. May also be related to anxiety, hurried masturbation experiences, or poor recognition of arousal.
Premature Ejaculation
Characterized by a repeated inability to reach orgasm or by a very delayed orgasm after normal sexual excitement. Prevalence is uncertain, but less than 1% of the population has symptoms > 6 months
Delayed Ejaculation
Marked delay or absence of orgasm or significantly reduced intensity of orgasmic sensations in women. Do not diagnose when significant relationship or context factors are present
Female Orgasmic Disorder
_____% of women never experience orgasm in their lifetime
10%
Involuntary contractions of the muscles of the outer third of the vagina is referred to as ____________. Generic severe pain in the genitalia during sexual activity is referred to as __________. This is referred to as persistent or recurrent difficulties with vaginal penetration, marked pain during attempts/intercourse, marked fear/anxiety about penetration, marked tensing or tightening of pelvic floor muscles.
Genito-Pelvic Pain/Penetration Disorder
In genito-pelvic pain/penetration disorder, the patient must be evaluated for an underlying medical condition, such as:
Lichen sclerosis PID VVS Vulvovaginal atrophy Vaginal Infections Cystitis
Most likely caused by a “neuro-inflammatory” condition. “Burning” pain at the opening of the vagina. In severe cases, pain can be present during normal daily activities as well as during sex. Can be treated with estrogen cream, lidocaine application, or vestibuloplasty
Vulvar Vestibulitis Syndrome (VVS)
Medications that can cause sexual dysfunction
Antidepressants Antipsychotics Antihypertensives Hormones CV drugs Cytotoxic GI
All of the follicles in each ovary have already started ________ (they did so in utero). They are arrested in ________ of _________
Meiosis
Prophase
Meiosis I
The ______ _______ causes stimulated oocytes to complete Meiosis I and begin Meiosis II. This is why the ___ ______ is needed when collecting eggs for ART
LH Surge
LH Surge
The oocytes arrest at _______ of meiosis II until a sperm nucleus enters the ovum
Metaphase
Fertilization begins with the direct contact of sperm DNA and the secondary oocyte, which occurs in the ____ ______
Tubal Ampulla
To fertilize, sperm must get through which 3 layers of the ovulated egg?
- Corona radiata
- Zona pellucida
- Oocyte cell membrane
Sperm are able to penetrate all of the layers of the ovulated egg only once they are _________. This causes the flagellum to beat more rapidly
Capacitated
Na+ influx into the ovum changes the resting membrane potential to ______ mEv instead of -70 mEV
+20
Ca++ influx into the ovum causes the release of many granules from within the cell membrane to just outside the cell, where they elevate the _____ ________, creating an area that will trap any additional sperm
Zona pellucida
The nuclei of sperm and egg are referred to as __________. Prior to this fusion, each one goes through an _________
Pronuclei
S phase
Cell division of the zygote occur every ______ hours. At the 8-cell stage, the zygote is referred to as a ________. Arrival to the uterus/uterine will happen on day ____ at the _______ stage. Implantation occurs around day ____ to day ____, and the implanting blastocyst has about _____ to _____ cells
12-24 Morula 6 Blastocyst Day 7 to Day 9 100 to 300 cells
At the time of implantation, the blastocyst consists of an inner cell mass (ICM) and outer cells called the ________. The ICM will become the _______, and the trophoblast will become the _______ and fetal _______
Trophoblast
Embryo
Placenta
Fetal membrane
Over the next ___ weeks, cells of the trophoblast contribute to penetration into the _____ wall. As these cells contact maternal vascular cells, connection is made between maternal _______ and embryonic ______
2 weeks
Endometrial
Capillaries
Villi
Bleeding in the first trimester occurs in ___ to ____% of all pregnancies
20-25%
Differential diagnosis of 1st trimester bleeding
Normal intrauterine pregnancy
Threatened abortion
Abnormal intrauterine pregnancy
Ectopic pregnancy
bhCG may become positive as soon as __ to __ days after ovulation. At the date of expected menses (about 14 days after ovulation, bhCG is usually ______ IU/L.
6 to 8
100 IU/L
During the first ___ days of pregnancy (weeks 3-8), bhCG approximately doubles every _______ hours
30 days
48-72 hours
The lower limit of hCG at which an examiner can reliably visualize pregnancy on ultrasound is it _____ to _______ IU/L with vaginal ultrasound and ______ to _____ IU/L with abdominal ultrasound.
bhCG Discriminatory Value
1000-2000
5000-6000
At 5 weeks, bhCG should be > _______, and should be able to visualize a ______ _____
1500
Gestational sac
At 6 weeks, bhCG should be > ________, and should be able to visualize a _____ _______
5200
Fetal pole
At 7 weeks, bhCG should be > _______, and should be able to visualize ______ _______
17,500
Cardiac motion
Innocent causes of first trimester bleeding: (3)
Cervical ectropion
Implantation bleeding
Vaginal infection/irritation
In ____ _______, the cervix has a raw-looking granular appearance. It appears as a red, velvet-like area. It is benign, not a disease that is associated with hormone changes.
Cervical Ectopy
Spontaneous abortion usually refers to the first _____ weeks of pregnancy. If the fetus dies after _____ weeks, it’s called an intrauterine fetal demise or stillbirth.
20
20
Spontaneous abortion is likely if ultrasound measurements are:
- _____ mm and there’s no fetal heart rate
- _____ mm and there’s no yolk sac
- _____ and there’s no fetal pole
5
10
20
Spontaneous abortion is also likely is there is < ____% rise in bhCG in over _____ hours
15%
48 hours
Normally growing early pregnancy, but with vaginal bleeding. Also referred to as vaginal bleeding before the 20th week. Diagnosis is made by bhCG or ultrasound
Threatened abortion
Empty gestational sac, embryo never formed
Blighted ovum/anembryonic pregnancy
Up to ___% of spontaneous abortions are due to _______ ________
50%
Chromosomal abnormalities
Smoking > 20 cigarettes a day increases chance of SAB by _____x
4
Alcohol > 7 drinks/week increases chance of SAB by ____x
4
