Exam one: class one Flashcards
maternal morbidity and mortality
- infection
- hemorrhage
- hypertension
- emboli
neonatal/fetal morbidity and mortality
- congenital anomalies
- short gestation/low birth weight
- SIDS
- consequences of maternal disease
- unintentional injuries
breast anatomy
- made up of:
1. breast: - glandular tissue for milk production
- connective tissue for support
- adipose tissue for cushion
2. areola - Montgomery’s tubercles for lubrication
3. nipple - 15-20 lactiferous duct openings
outer layers of the uterus
- longitudinal muscle layer
- expulsion of the fetus when it contracts
middle layers of the uterus
- interlacing muscle fibers
- constricts blood vessels
- after birth: will help control bleeding
inner layers of the uterus
- circular muscle fibers
- forms sphincters at the fallopian tubes
- key in maintaining cervical integrity during pregnancy and dilation in labor
- has to relax to thin the cervix lining during labor
multiple cycles that work simultaneously
- hypothalamus- pituitary- ovary cycle
- ovarian cycle
- endometrial cycle: period
where does the cycle start
- with the hypothalamus releasing GnRH
control of the FRC
- hypothalamus»_space; pituitary»_space; ovary cycle: H-P-O or H-P-A
- hypothalamu releases GnRH (gonad releasing hormone)
- then the anterior pituitary releases FSH, LH
- then the ovaries release estrogen, progesterone (elevation of these inhibit GnRH- shuts off the cycle)
other things that can affect the cycle and shut it off (5)
- stress
- low body fat
- extreme athletes
- anorexia
- other eating disorders
anterior pituitary
- FSH: follicule stimulating hormone which stimulates follicle (houses the eggs) in the ovary to grow and mature (from primary to mature egg)
- LH: leutinizing hormone which after ovulation converts the empty follicle into the corpus luteum and supports this structure (which in turn supports an early pregnancy until the placenta forms)
LH
- the production of LH is regulated by GnRH from the hypothalamus.
- In females, an acute rise of LH triggers ovulation and development of the corpus luteum
Primary female hormones
- estrogen: 3 predominant
1. estradiol
2. estriol
3. estrone - progesterone
- prostaglandins
1. PGE
2. PGF
progesterone
- the hormone of pregnancy
Estradiol
- available only during reproductive years
estriol
- available only during pregnancy
estrone
- the estrogen of menopause
PGE
- vasodilatory; smooth muscle relaxant (uterus)
PGF
- vasoconstrictive; smooth muscle contractor (uterus)
how long is the follicular phase
- in 28 day cycle its day 1-14
- variable meaning depending on the cycle length is when this happens
ovarian cycle
- follicular phase
- luteal phase
how long is the luteal phase
- usually occurs during days 15-28
- constant (average is 14 days)
follicular phase
- follicules mature: growth of follicle from primary to mature
- LH surge > release of the egg (day 14)
- estrogen dominance: high levels which tells LH to peak now and ovulation occurs
luteal phase
- conversion of empty follicle into the corpus luteum
- progesterone dominance: high
- day 15-28
uterine/menstrual cycle
- ischemic/menstrual phase: bleed (5-7 days)
- proliferative phase: estrogen dominance
- secretory phase: progesterone dominance, ready for EGG
- if no pregnancy = menstrual phase happens again again
when does conception occur formula
- cycle length (ex: 28)- 14 (luteal phase which doesn’t change)
putting it all together: the menstrual cycle
- hypothalamus releases GnRH
- then FSH (and some LH) is secreted from anterior pituitary which works on the ovary and causes maturation of the egg
- ovary secretes higher levels of estrogen and estrogen will peak and work on endometrium and tells LH to surge
- LH surge will cause ovulation to occur
- after ovulation occurs makes corpus leuteum which will cause the progesterone to rise (estrogen is still high but not as high)
- progesterone works on the endometrial lining getting it ready for the egg
- if there isnt a pregnancy the corpus leuteum breaks down, progesterone and estrogen levels decline, which signals body to shed endometrial linning that built up and got ready then it says GnRH your on again and cycle starts over
when does conception occur in 28 day cycle
- 28-14 = 14
- day 14
- 2 weeks after the 1st day of the last menstrual cycle
gestational age
- includes LMP and the following week (pre ovulation) for standardization
- this adds 2 weeks to pregnancy
how long are you pregnant
- 266 post -conceptual days (from conception on)
- 280 gestational days: 40 weeks, 10 lunar months, 9ish calendar months
- 4-8% born on due date, 80% born +/- 2 weeks
when is the third trimester
28 weeks to delivery
when is the second trimester
- week 13 - 27 and 6/7ths
when is a chid considered pre term
- until 37 weeks
when is a child considered term
- 40 weeks
(38-42)
when is a child considered postmature
- after 42 weeks
when does childbirth on average normally happen
- 8-9 months of gestation
- 31-40 weeks
when is fetal development occurring
- week 10 on
when is embryogenisis
- week 1-10
when is the first trimester
- week 0- 12 and 6/7ths
how many sperms are deposited in the vagina
300 million
- why so many: some get lost
conception/fertilization
where does the egg meet the sperm?
how long does the egg survive?
how long can the sperm survive?
what is capacitation, acrosomal reaction, and zona reaction?
- mature egg meets remaining sperm in the ampulla (outer 1/3 of the fallopian tubes)
- egg survives 12-24 hours (fertile period = 6-12 hours): short period of time after ovulation for conception to occur
- the sperm survives up to 72 hours (some longer): can have sex 3 days before ovulation and the sperm could survive for 3 days and fertilize an egg
- capacitation: removal of sperms plasma membrane which allows acrosomal reaction
- acrosomal reaction: allows production of enzymes to weaken carona radiata (allows sperm in)
- zona reaction- blocks penetration of other sperm
two process of growth
- cellular multiplication
- cellular differentiation
cellular multiplication
- 46 chromosomes (23 from egg and 23 from sperm)
- then the zygote is formed (in the first 2 days)
- then blastomere formed
- then morula of 12-16 cells formed which differentiates into the inner and outer cell mass
- inner cell mass is the blastocyte (100 cells): embryonic disc + amnion
- outer cell mass is the trophoblast and these embed into the uterus and form the placenta: chorion + placenta
zygote
1st 2 days
- 46 chromosomes
cleavage begins: where does mitotic cellular replication begin
- mitotic cellular replication begins in the tube
morula
- day 3 (after fertilization)
- 16 cell ball
- no change in size, about the size of a head of a pin
blastocyte and trophoblast formation
- day 4-5 after ovulation
1. blastocyte: inner mass cells (stem cells) become: embryo, amnion, yolk sac (provides RBC till placenta can take over)
2. trophoblast: outer cell layer becomes chorion and placenta
when will you see a positive pregnancy test
- once hcg is secreted and uterus is implanted
implantation - trophoblasts
- day 6-10
- burrow into endometrium
- early placenta
- formation of chorionic villi: secrete hCG, maintains estrogen and progesterone and inhibits ovarian and menstrual cycles and the production of GnRH
cellular differentiation
- days 10-14 after ovulation where primary germ layers differentiate:
- ectoderm, endoderm, mesoderm: these germ cells determine all of our organ systems
- embryonic membranes form: chorion and amnion
*Chorion= fetal part of placenta (where chorionic villi extend into the maternal blood filled endometrium)
*Amnion: inner cell mass (blastocysts) and adheres to chorion - amniotic fluid
- yolk sac for primitive RBC
- umbilical cord
when is cellular differentiation complete by
- 10 week gestation
chorion (outer membrane)
- fetal part of placenta
- chorionic villi embed into the uterus and extend into maternal blood filled endometrium
- maternal blood filled Endometrium that bathes chorionic villi = intervillous space and is site for gas, nutrient, and waste exchange
amnion (inner cell mass)
- inner cell mass (blastocytes)
- forms the amniotic cavity
- adheres to chorion
embryos critical development stage
- 10-14 days after conception/fertilization/ovulation
- 3 germ layers
1. ectoderm
2. endoderm
3. mesoderm
ectoderm
- epidermis
- hair
- teeth
- nose
- CNS
mesoderm
- dermis
- muscles
- bones
- kidneys
- CVS
- lymphatic tissue
- spleen
endoderm
- respiratory and digestive tract lining
- bladder
- liver
- pancreas
morphologic development after conception
- when these structures are most vulnerable to damage
- week 1: fertilization- blastocyte
- week 2: implantation
- week 3-10 (or 3-8 weeks after conception): mesoderm, ectoderm, endoderm differentiate to form all organ system
- embryo is most likely to be damaged during this time
- there is all or none effect for the first 2 weeks of pregnancy prior to the implementation
why is there an all or none effect for the first two weeks of pregnancy
- since there is no blood supply to the egg some things wont affect the pregnancy while others will.
- either not affected or loss of pregnancy occurs
teratogens
-Cause of abnormal development in an embryo
1. Chromosomal
2. Drug related
-Prescription (Category D or X)
-OTC, Herbal, Caffeine (less is better, 1-2 servings per day)
-Recreational drugs
-ALCOHOL – no documented safe minimum
3. Radiation or other environmental related
4. Infectious agents – TORCH
Category A drugs
- ok
category B drugs
- no risk on animals
category C drugs
- ? risk
Category D drugs
- evidence of risk
Category X drugs
- definite risk
fetal development: heart beats
- 28 days after conception (6 weeks gestational age)
fetal development: male differentiation
- begins at 4-6 weeks
- due to sex region determining gene on the short arm of the Y chromosome
- not seen on US until 16-20 weeks
fetal development: breathing and hearing
- by 16 weeks
fetal development: organ development
- formed by 8 weeks after conception or 10 weeks gestation
fetal development: youngest preterm survivor
21 weeks and 4 days
function of umbilical cord
- supplies blood, nourishment, gas and waste exchange
umbilical cord
- from the connecting stalk
- 2 arteries and 1 vein
- arteries away from the fetus (deoxygenated)
- vein to fetus (oxygenated)
- whartons jelly- surrounds these vessels and prevents crimping and compression
amniotic fluid
- early pregnancy: diffusion from maternal blood
- after 20 weeks: largely fetal urine: fetus swallows and urinates 1000 ml by term
amniotic fluid contents
- urea, uric acid, bilirubin, fructose, fat, leukocytes, proteins, epithelial cells, enzymes, lanugo
amniotic fluid functions (5)
- temperature stability
- prevents adherence to membranes (the amnion and chorion from adhering to the skin)
- allows for MS, GI, breathing practice, swallowing
- protects fetus
- keeps umbilical cord from crimping
placenta
- new temporary organ
- composed of cells from 2 individuals
- part maternal (decidua) and part fetal (chorion)
- uterine lining develops “decidua basalis” that is receptive to chorionic villi
- trophoblasts differentiate into:
1. cytotrophoblasts (inner layer)
2. synchtiotrophoblasts (outer layer)
placenta functions (2 main ones)
- endocrine: hormone production
1. Human placental lactogen (hPL )
2. human chorionic gonadotropin (hCG)- wont be present till embryo implants
3. progesterone
4. estrogen - metabolic:
-facilitates hydrostatic and osmotic pressure gradients for active and facilitated transport to get nutrients and remove waste
vascular arrangment of the placenta
- moms arteries: puts in oxygenated blood
- fetus veins: picks up and takes the oxygenated blood to the fetus
- Fetus Artery: takes de oxygenated blood, waste away from the fetus to the placenta
- Moms veins: picks up the deoxygenated blood and waste
goals of fetal circulation
- maintain flow to the placenta
- shunt blood away from the lungs and liver
- doesnt need to use the lungs and liver so need structures to bypass these
how are the goals of fetal circulation accomplished
3 holes
1. ductus venosus (liver bypass) umbilical to vein to IVC then to the atrium
2. foramen ovale (right ventricle bypass) hole b/t right and left atria
3. ductus arteriosis ( pulmonary artery/lung bypass) hole b/t pulmonary artery and descending aorta
*must close after birth
when does implantation occur and what is a sign?
- 6-10 days after ovulation
- spotting
when does ovulation occur
- 14 days after the first day of the LMP
when does conception occur
- same time as ovulation
- 14 days after the first LMP
- sperm can survive 3 days so you can get pregnant 3 days before ovulation up to 12 hours after ovulation
gestational weeks
- count backwards from the day it is until 1st day of LMP
conception age
- count from the day it is to the ovulation date
- two weeks shorter than gestation age
dizyfotic twins
- fraternal
- occurs 1:80 pregnancies
- two eggs, two sperms
- can be familial or just happen (mostly familial)
- two placenta, two chorion, two amnion
monozygotic tiwns
- identical
- 4/1000 live births
- one egg, one sperm
- just happens
*two embryos, once placenta, one chorion, two amnions (sometimes one which would cause more high risk because they can get entangled)
basic genetics
- All genetic material is carried on strands of DNA known as chromosomes
-2 pairs of 23 chromosomes = 46
22 pairs of autosomes (non-sex)
-1 pair of sex chromosomes (XX or XY)
-Female (XX) always gives X
-Male (XY) can give X or Y, determining sex of offspring
human genome project outcomes
- humanoids are 99.9% identical at the DNA level
- ~ 30,000-40,000 genes make up the human genome
- > 100 genes involved in diseases have been identified
- Currently genetic tests for > 70 inherited diseases
genotype
- “what you are made of”
- Chromosomes
- Bb
-Karyotype is the pictorial analysis
phenotype
- what you look like
-Observable expression of genes in an individual
ex: Brown hair, blue eyes, etc.
penetrance
- Strength of gene (statistical variability)
- Ex. 95% penetrance means 95% will get it, 5% will not
expression (individual variability)
- How penetrant this particular gene actually was
- Ex. Either it is expressed or it isn’t
statistics of chances of baby having issues
Every pregnancy has a 3%-5% chance of resulting in an infant with a birth defect, chromosome abnormality, genetic disease or developmental disability.
euploidy
- correct # of chromosomes
aneuploidy
- incorrect # of chromosomes
1. monosomies (45 chromosomes)- 45x, turner syndrome in females
2. trisomies (47 chromosomes): trisomy 21 (downs syndrome)
*leading cause of pregnancy loss
Chromosomal problems –autosomal dominant
-Autosomal dominant disorders (50% in offspring with 1 affected parent)
- one parent has little big (affected ) and the other has little little (unaffected)
-Equally affect both males and females
-Examples: Marfan Syndrome or Huntington Disease
Chromosomal problems –autosomal recessive
- Characterized by both parents being carriers (25% with disease, 25% unaffected, 50% carrier)
- both parents are little big (carrier)
Autosomal recessive disorders commonly assessed for in pregnancy:
- Cystic fibrosis
- Sickle cell anemia
- Tay Sachs
- Most metabolic disorders (PKU, etc.)
X-linked recessive
- Effects are limited to males
- Males can not pass to sons – by definition, they are giving Y, and this is X-linked
- 50% chance mother will pass gene to her sons
- 50% chance her daughters will be carriers
- 100% chance that daughters of affected men will be carriers
Chromosomal problems-multifactorial defects
- Neural tube defects
- Cleft lip or palate
- Congenital hip dysplasia
- Pyloric stenosis
Alcohol (or teratogens) before implantation
No blood supply so they won’t affect baby most likely before implantation which occurs 6-10 days after conception
