Exam 1 Menstrual Cycle, contraception, preconception, antepartum Flashcards
1
Q
hormonal birth control methods reduce the risk of what types of cancer
A
colon cancer
endometrial cancer
ovarian cancer
2
Q
normal menstruation frequency
A
every 28 days
3
Q
what hormone dominates the follicular phase
A
estrogen
4
Q
what happens during the follicular phase
A
-primary follicle matures - starts secreting estrogen –> at first estrogen leads to negative feedback of FSH/LH, then turns to positive feedback –> LH surge
-ovulation = end of follicular phase
-endometrium: menstruation/shedding at start of follicular phase; lining thin
5
Q
During the luteal phase, the corpus lutes produces what 3 hormones
A
estrogen
progesterone
inhibin
6
Q
during the ____ phase of the menstrual cycle, a primordial follicle develops into a Graafian follicle and neighboring follicles become atretic
A
follicular
7
Q
what ligament anchors the ovary laterally to the pelvic wall
A
suspensory ligament
8
Q
Main hormone controlling follicular phase
A
Estradiol
9
Q
this hormone causes cervical mucus to become copious, watery, and elastic during the follicular phase to aid sperm movement
A
estradiol
10
Q
progesterone levels are high/low during the follicular phase
A
Low
11
Q
At ovulation, the primary oocyte completes meiosis I to yield a ______ and ______
A
secondary oocyte and polar body
12
Q
surge of what hormone causes ovulation
A
LH
13
Q
what hormone stimulates growth of endometrium and elongation of spiral arteries
A
estradiol
14
Q
hormone predominantly secreted by the corpus luteum
A
progesterone
15
Q
throughout the follicular phase, rising ____ levels in the blood stimulates growth of the endometrium and myometrium of the uterus
A
estrogen
16
Q
ectopic pregnancy
A
oocyte is fertilized in the peritoneal cavity or distal portion of the uterine tube and begins developing there
This is a risk because the Fallopian tubes are not continuous with the ovaries
17
Q
FSH hormone stimulates the ovarian production of estrogens by the ____ cells of the ovarian follicle
A
granulosa
18
Q
loss of the hormone ______ triggers shedding of the endometrium in the menstrual phase
A
progesterone
19
Q
Effect of estrogen on HDL levels
A
increases HDL
20
Q
hormone secreted by corpus luteum and placenta that functions to maintain pregnancy if fertilization occurs
A
progesterone
21
Q
When is FSH the highest during the menstrual cycle
A
during the first week of the follicular phase when it recruits 5-7 follicles for entry into the cycle
22
Q
moderate levels of estradiol during the follicular phase inhibit/stimulate GnRH secretion by the hypothalamus
A
Inhibit
23
Q
the 3 naturally occurring estrogens in females
A
estrone
estradiol
estriol
24
Q
during the follicular phase, ______ stimulates growth of the endometrium
A
estradiol
25
ovulation occurs ____ days before menses, regardless of the cycle length
14 days
26
progesterone is significantly higher during the ____ phase of the menstrual cycle compared to other phases
luteal phase
27
how does estrogen affect osteoclastic activity in bones
estrogen inhibits osteoclastic activity
28
progesterone affect on body temp
increases body temperature
29
the ____ phase of the menstrual cycle occurs from day 0 to 14 and the ___ phase occurs from day 15-28
follicular, luteal
30
How do hormonal contraceptive methods protect future fertility
decreasing the risk of endometriosis, ectopic pregnancy, pelvic inflammatory disease, and abortion related complications
31
best evidence-based resource for determining whether a woman is a candidate for particular birth control method
US Medical Eligibility Criteria for Contraceptive Use 2016 (CDC)
32
what are LARCs
long acting reversible contraception
33
LARC examples
IUD
nexplanon / subdermal implants
34
what type of contraception has the highest effectiveness level
LARCs
ACOG 2017 rec: offer LARC as first line method to all women *be vigilant of implicit bias / no coercion
35
benefits and barriers to LARC use
benefits: highest effectiveness, discrete, ease of use, can be used in women of any age or parity
barriers: high up front cost (although lower cost overall), provider inexperience, patient fears about safety
36
paragard IUD class
copper IUD
37
copper IUD MOA
released copper ions that cause inflammatory response - the ions are toxic for sperm in the genital tract fluid (sterile inflammatory response with spermicidal effects)
38
Kyleena/skyla/mirena MOA
IUD - contain reservoir that released levonorgestrel (type of progestin) at varying doses --> local delivery of progestin produces thickening of cervical mucus and an endometrial reaction
39
good IUD choices for nulliparous women / women with cervical stenosis or small uterine cavities
kyleena
skyla
40
how long is the copper IUD effective
10 years
41
how long is mirena / kyleena effective
Kyleena 5 years
Mirena 8 years
42
how long is Skyla effective
3 years
43
how to be reasonably certain a woman is not pregnant (6)
-less than or = to 7 days after start of normal menses
-has not had sex since the start of last normal menses
-has been correctly and consistently using reliable contraception
-is less than or = to 7 days after spontaneous or induced abortion
-is within 4 weeks postpartum
-if fully or nearly fully breastfeeding (greater than 85%), amenorrhea, and less than 6 months postpartum
44
expulsion rate for IUDs
2-10% - most happen in first 3 months
45
discuss common safety concerns patients have about IUDs
-uterine perforation: usually benign; occurs 1 in 1000; more likely in postpartum or breastfeeding women
-infertility: does NOT actually increase infertility
-ectopic pregnancy: tenfold lower for IUD users than in nonusers UNLESS pregnancy result of IUD failure
-infection: risk 1-10 in 1000 within 20 days after insertion
46
dysmenorrhea
menstrual cramps
47
LNG IUD
levonorgestrel IUD
48
menorrhagia
heavy periods
49
non contraceptive benefits of LNG IUDs
menstrual flow reduced (up to 90%)
reduced risk of endometrial cancer and cervical cancer
50
side effects of progestin implant (nexplanon)
irregular bleeding
amenorrhea
headache
bruising at insertion site
weight gain
acne
breast tenderness
51
major disadvantage and main reason for discontinuing nexplanon
irregular bleeding
make sure to educate patient on side effect
52
side effects of tubal occlusion / sterilization
risk of ectopic pregnancy higher
risks related to surgery - hemorrhage, infection, complications
"post-tubal ligation syndrome" - increased dysmenorrhea and abnormalities in menstrual cycle
53
benefit of addition of estrogen to progestin in combined birth control pill
more predictable bleeding pattern due to stabilization of the endometrium
estrogen and progestin's synergistic activity makes it possible to use lower doses (would need to use too high of dose of estrogen only - high side effect risks)
54
why does it take longer to return to fertility after discontinuation of systemic estrogen/progestin pills compared to POPs and LNG IUDs
POPs and LNG IUDs do not inhibit ovulation (local effects only - no effect on HPA axis (LH & FSH) - estrogen/progestin pills do --> when POP/LNG IUD dc'd fertility is expected right away
55
primary MOA of systemic hormonal contraceptives
preventing ovulation
56
benefits of hormonal birth control (COCs)
decreased risk of colon, ovarian, endometrial cancer
decreased risk of endometriosis, RA, asthma
protection against ovarian and uterine cancer may last 28 years after discontinuation
preservation of bone density - may persist up to age 80
decreased risk of PID and ectopic pregnancy
57
combined oral contraception (COC) recommendations for patients with risk for breast cancer
NOT associated with increased risk of breast cancer even if BRCA carrier
58
birth control considerations for postpartum women
COCs/estrogen-containing contraceptives contraindicated 2/2 high risk for DVT/PE after birth
Progestin only methods including IUDs and implants can be initiated right away postpartum
59
medications that can reduce the effectiveness of COCs
antiretroviral therapy
rifampin (abx)
anticonvulsants (carbamazepine, phenytoin, primidone, topiramate, lamictal)
St. Johns wort
60
safety / side effect considerations for COCs
VTE
may increase BP in some women
changes in libido
depression (rare)
increased cholesterol in bile (gallstones)
headaches
breast tenderness
61
non contraceptive benefits of COCs
decreased risk ovarian cancer
deceased risk endometrial cancer by 50%
fewer ectopic pregnancies
decreased PID rates
helps acne
reduced risk of ovarian cysts
regulate menstrual cycles / abnormal bleeding
lighter periods (anemia)
62
Tulane (contraceptive patch) MOA
patch worn on arm releases estradiol/progestin - systemic effect similar to COC pills
woman applies and one buttock, arm, abdomen, anywhere on upper torso except breast once every seven days, then takes one week off every 3rd week (like pills) for withdrawal bleed
63
Vaginal ring (Nuvaring) MOA
releases estradiol and progestin - reaches steady state in serum
ring left in place in vagina for 21 days, then removed for 7 days
64
disadvantages of the patch and ring
only one formulation available of each
ongoing costs
environmental - both methods both contain large amounts of hormones/active ingredients upon disposal
65
progestin only pills efficacy
little data on efficacy, but less than COCs - do not suppress ovulation, rely mostly on thickening of cervical mucus
very time sensitive - need to be taken at same time each day - taking even 3 hours late may allow mucus to return to fertile state
66
common side effects POPs
unscheduled bleeding (esp during first 6 months)
spotting
67
benefits of POPs
improve menstrual symptoms - dysmenorrhea, menorrhagia, PMS, anemia
protective against PID
68
Depo Provera / Depo MOA
IM or SubQ injection of DMPA (synthetic progestogen - different from synthetic progestin in PO contraceptives) - powerful inhibitor of HPA axis at level of hypothalamus --> suppresses ovulation
69
Suzy had the MMR vaccine in your office 2 weeks ago - how long until she should wait to try to get pregnant?
Wait at least 4 weeks after MMR to try for pregnancy
70
individuals who desire a pregnancy and have no history of neural tube defects should be advised to take how much foilc acid during preconception period
400 mcg folic acid in preconception period
71
individuals who eat fish should be encouraged to eat which fish in preconception time period?
salmon
scallops
MN caught sunfish
Avoid: swordfish, MN caught walleye >20 inches
72
what is Hegar's sign
lower segment of the uterus becomes soft for a short period approximately 4-6 weeks after LMP / 2 weeks after conception - can compress lower segment on bimanual exam
73
describe the two processes that cause uterine growth during pregnancy
1. estrogen and progesterone induced hyperplasia of smooth muscle cells in myometrium
2. hypertrophy of the uterine muscles later in pregnancy
74
cervix length in non-pregnant persons
3 cm long
75
Goodell's sign
cervical softening occurring about 4 weeks after first day of LMP; due to increased estrogen
76
Chadwick's sign
bluish discoloration of cervix that occurs 6-8 weeks gestation
77
when is Chadwick's sign first evident during pregnancy
6-8 weeks gestation
78
what is cervical ripening
term used to describe the process of accelerated remodeling and softening that begins weeks prior to the onset of labor
79
hCG functions during pregnancy
-stimulates production of progesterone from corpus luteum
-prevents degeneration of corpus luteum
-promotes angiogenesis in uterine vasculature
-stimulates thyroid production of thyroxine in 1st trimester
-suppresses myometrial contractions
80
human placental lactogen (hPL) functions during pregnancy
-increases insulin resistance
-stimulates production of growth hormones
81
progesterone functions during pregnancy
-promotes systemic vasodilation
-prevents myometrial contractility
-inhibits uterine production of prostaglandins
-suppports mammary growth for lactation
-withdrawal at term --> uterine contractions
82
estrogen functions during pregnancy
-increases uterine blood flod
-promotes growth of uterus and breast glandular tissue
-increases production of insulin-like growth factors
-increases myometrial sensitivity to oxytocin
83
when is hCG first detectable
about 8-10 days after ovulation or shortly before the first missed period
84
Human placental lactogen (hPL) functions during pregnancy
ensures adequate fetal nutrition (glucose) by altering maternal glucose metabolism so glucose is available for fetal uptake; increases maternal insulin resistance --> more glucose in blood for fetus
85
suppresses maternal immune response to fetal antigens so fetal tissue is not rejected
progesterone
86
describe the process of estrogen production during pregnancy
corpus luteum secretes until weeks 8-9
Fetus adrenal glands mature enough to produce estrogen precursors and placenta produces active form of estrogen --> process flies on input from both maternal and fetal adrenal cortex
87
fertilization location (typically) and length
Fallopian tube; 18-24 hours
88
gravida
total number of times a woman has been pregnant, regardless of whether the pregnancy resulted in a termination or if multiple infants (ex: twins) were born from a pregnancy; current pregnancy IS included in gravid count
89
nulligravida
a woman who has never been pregnant
90
primigravida
a woman who is pregnant for the first time
91
multigravida
a woman who has been pregnant more than twice
92
para
the number of times a woman has given birth to a fetus of at least 20 weeks gestation (viable or not viable), counting multiple births as ONE birth event
93
nullipara
a woman who has not remained pregnant beyond 20 weeks gestation
94
primipara
a woman who has had one pregnancy in which the fetus or fetuses reached 20 weeks gestation; this woman has given birth once
95
multipara
a woman who has had two or more pregnancies in which the fetus / fetuses reached 20 weeks gestation; this woman has given birth more than once (counting multiple births as one birth event)
96
G2P0
woman who has been pregnant twice and no births; she may have had abortions or miscarriages
97
G2P1
woman who is currently pregnant. She has had one prior pregnancy that resulted in an infant born at 38 weeks gestation
98
Gravida/para/TPAL 4 digit nomenclature - what does TPAL stand for
T: term; number of term births the woman has experienced; term is any gestation of 37 weeks
P: preterm; number of preterm births the woman has experienced; preamature = born between 20 and 37 completed weeks gestation
A: abortion; number of pregnancies ending in abortion (spontaneous or induced); any delivered fetus before 20 weeks
L: living: number of children living currently
99
G3 P2002
Woman who is currently pregnant with her third pregnancy; she gave birth to a full-term baby with each prior pregnancy; both of whom are living
100
G2 P0101
woman who is currently pregnant. she gave birth to one preterm infant and has one living child.
101
G2 P1103
woman who is currently pregnant w/ 3rd pregnancy; she gave birth to one full-term infant and preterm twins; all 3 offspring are alive
102
First trimester, second trimester, and third trimester weeks gestation
First: week 1-12
Second: 13-28
Third: 28-40
post term = >40 weeks gestation
103
normal hemoglobin pregnancy (each trimester)
1st trimester: 11.6-13.9
2nd: 9.7-14.8
3rd: 9.5-15
104
normal hematocrit pregnancy (each trimester)
1st: 31-41
2nd: 30-39
3rd: 28-40
normal in non-pregnant = 32-45
105
normal WBC count pregnancy (each trimester)
1st: 5,7-13.6
2nd: 5.6-13.8
3rd: 5.9-16.9
normal non-pregnant: 3.9-12.5
106
when in pregnancy is chorionic villus sampling done
first trimester
107
when in pregnancy is amniocentesis performed
second trimester
108
Describe prenatal visit schedule throughout pregnancy
every 4 weeks up to 28 weeks, every 2 weeks from 28-36 weeks, and every 1 week from 36 weeks until delivery
109
risk of gestational DM
-preeclampsia
-polyhydroamnios
-C-section
-infant with macrosomia, shoulder dystocia, hypoglycemia, and hyperbilirubinemia
-developing DM2 after pregnancy
110
When do you screen for GDM during pregnancy
two times - early first trimester/entrance to care and second trimester 24-28 weeks
*If dx with DM in first trimester, dx with DM2. If dx with DM in second trimester, GDM.
111
leading cause of early-onset newborn sepsis in the US
group B strep (normal flora in many women's GU tract - screen for it before birth - around 35-37 weeks)
112
woman's vaginal/rectal culture is positive for group B strep - what do you do
discuss IV penicillin prophylaxis in active labor or after rupture of membranes to prevent sepsis in the newborn
113
recommended total weight gain for underweight pregestational weight
28-40 lbs
114
recommended Toal weight gain for normal pregestational weight (BMI 18-24)
25-35 lbs
115
recommended total weight gain for overweight pregestational weight (BMI 25-29)
15-25 lbs
116
recommended total weight gain for obese pregestational weight (BMI >30)
11-20 lbs
