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OB 🚺 > Female and Reproductive Physiology > Flashcards

Female and Reproductive Physiology Flashcards

1
Q

Approximately 28 days

A

Ovarian cycle

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2
Q

Ovarian cycle (PHASES)

A

Follicular (Preovulatory) Phase

Ovulation

Luteal (Postovulatory) Phase

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3
Q

Endometrial cycle (PHASES)

A

Proliferative phase

Secreetory phase

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4
Q

The functional unit of the ovary

A

Ovarian follicle

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5
Q

OOCYTES

A

Fetal period: 6-7 million oocytes

At birth: 1-2 million oocytes

Onset if puberty: 400,000 oocytes

400 oocytes will ovulate: 99% will become atretic

Eggs ovulated in a lifetime - 500

Depleted at a rate of 1000/month

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6
Q

2 important cells

A

Granulosa cells - with the FSH receptors

Theca cells - with the LH receptors

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7
Q

Formed by 5th fetal month

Started their first meiotic division

Arrested in Prophase from 5th fetal month until the onset of puberty

Will become the first meiotic division at the onset of puberty

A

Primary oocyte

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8
Q

Formed after completion of Meiotic I

Release of the first Polar Body during ovulation

Arrested in Metaphase II until fertilization

Completion of 2nd Meiotic Division only occurs if there is fertilization

A

Secondary oocyte

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9
Q

Cyclical shedding of the uterine endometrium

Estrogen and progesterone

A

Uterine/Menstrual cycle

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10
Q

Periodic changes on the ovary

Gonadotrophic hormones

A

Ovarian cycle

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11
Q

A series of changes controlled by hormones that help prepare the female uterus for a possible pregnancy

Average length of 28 days (+/-7days)

Menstrual blood is mainly arterial

A

Menstrual cycle

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12
Q

Cyclical ovulation

25-35 day intervals

40 years

400 oppurtunities for pregnancy ➡️ 1200 DAYS (the day of ovulation and its 2 preceeding days

A

OVARIAN-ENDOMETRIAL CYCLE

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13
Q

Under LH stimulation, desmolase is activated and cholesterol is converted to PREGNENOLONE

PREGNENOLONE is converted to ANDROGENS, but majority will enter the adjacent granulosa cells to be converted to ESTROGEN

A

Thecal cells

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14
Q

Under FSH stimulation, aromatase activity is increased and conversion of ANDROGENS to ESTRADIOL

also release INHIBITIN which also inhibit the release of FSH from anterior pituitary

A

Granulosa cells

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15
Q

Inhibit the further release of FSH and LH from anterior pituitary resulting in subsequent decrease in FSH and LH

Act locally on Granulosa cells to increease their sensitivity to FSH and their proliferation resulting in very high level of estrogen during follicular phase

A

Estradiol (produced by GRANULOSA CELLS)

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16
Q

EFFECTS OF ESTROGEN DURING FOLLICULAR PHASE

A

On the uterus: cause of endometrial cells of the uterine mucosal layers to oncrease theri rate of mitotic division (Proliferative phase)

On the cervical mucous:

  • cause the cervical mucus to be thin and waterey, making the cervix essy for sperm to traverse
  • cause ferning of the cervical mucous
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17
Q

EFFECT OF LH SURGE

A

Triggering of ovulation and follicular rupture

Release of the cumulus-oocyte complex

Induction of the resumption of oocyte meiotic maturation

Luteinization of Granulosa cells

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18
Q

Peak of LH secretion occurs 10-12 hours before ovulation

Takes place approximately on DAY 14

Allows the release of the oocyte-cumulus complex

Formation of Spinnbarkeit

Pregnancy most likely: the day of ovulation, 2 days preceeding the ovulation

A

OVULATION

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19
Q

CORPUS LUTEUM

A

Luteinization

Corpus hemorrhagicum

Corpus luteum

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20
Q

A process in which the remains of the Graffian Follicle becomes corpus hemorrhagicum and finally a mature corpus luteum

A

Luteinization

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21
Q

Causes MITTELSCHMERZ or midcycle pain

A

CORPUS HEMORRHAGICUM

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22
Q

Theca cells + Granulosa cells = Luteal cells or Corpus Luteum

Produce large amount of progesterone

A

Corpus luteum

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23
Q

EFFECTS OF PROGESTERONE

A

On the endometrium:

  • it causes the uterine endometrium to become secretory, providing a source of nutrients for the blastocyst
  • presence of subnucleolar vacuoles
  • stroma becomes edematous

On the cervical mucous: it causes the cervical mucous to become thick

Other systemic effects: it has therrmogenic properties, increase water retention

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24
Q

Corneal luteum develops from the remains of the dominant or Graafian follicle in process called luteinization

Will regress 9-11 days after ovulation in the absence of pregnancy

Regression of the corpus luteum and drop in the circulating steroid signal the start of events leading to menstruation

The low levels of progesterone (and estrogen) will no longer support the uterus

And the superficial layer of the endometrium will break down

A

LUTEAL PHASE

25
Q

NOTABLE HISTOLOGIC CHARACTERISTIC OF THE PREMENSTRUAL PHASE OF THE ENDOMETRIUM

A

Occurs 1-2 days before menses

Infiltration of the stroma by PMN, giving a pseudoinflammatory appearance to the tissue

Key to the initiation of ECM breakdown of the functional layer is the infiltration of leukocytes

IL8 is the chemotactic activating factor for neutrophils

26
Q

Spiral arteries coiling become sufficiently severe, resistance to blood flow increase resulting in tissue hypoxia (the most striking and constant event observed in the mestrual cycle is period of vasoconstriction that precedes the onset of mesntruation)

The superficial layer is the one that is shed

By 5th day of menses, the endometrium has been restored completely

The most important factor in the recovery of endometrium after menses is the slight increase in estrrogen in the early follicular phase

A

MENSTRUATION

27
Q

Low progesterone

Slowly rising estrogen level

A

Early Follicular phase

28
Q

Low progesterone

Rapidly rising estrogen level

A

Late follicular phase

29
Q

Elevated level of progesterone

A

Luteal phase

Pregnancy

30
Q

Transformation of the secretory endometrium to decidua

The highly modified endometrium of pregnancy

Dependent on the actions of estrogen and progesterone

Dependent on the substances secreted by the blastocyst

A

DECIDUALIZATION

31
Q

Decidua layers

A

Decidua basalis

Decidua capsularis

Decidua parietalis

32
Q

Directly beneath the site of blastocyst

Will be part of the placenta

The spiral arteries loose their smooth muscles and endothelial cells due to invasion of large amounts of trophoblastic cells

They become unresponsive to vasoactive agents

A

DECIDUA BASALIS

33
Q

Portion overlying the enlarging blastocyst

Initially separating if from the uterine cavicty

Most prominent durinf he 2nd month of pregnancy

The one in contact with chorion

Is lost evetually due to obliteration by the growing fetus

A

DECIDUA CAPSULARIS

34
Q

Lines the remainder of the uterus

Sometimes called the decidua vera during time of development

Will remain the same

Still the spiral arteries

Still responsive to vasoactive agents

In contact with chorion later on

A

DECIDUA PARIETALIS

35
Q

Events in FERTILIZATION

A

The sperm binds to zona pellucida of the secondary oocyte and triggers the acrosome reaction, causing release of acrosomal enzymes

Sperm penetrates the zona pellucida and unite with the oocyte’s plasma membrane, eliciting the cortical reaction and rendering the secondary oocyte impermeable to other sperm

Sperm and secondary oocyte cell membranes fuse and contents of the sperm enter the cytoplasm

  • male genetic material forms the male pronucleus
  • Tail and mitochondrial degenerate

Secondary oocyte completes meiosis II, forming a mature ovum. The nucleus of the ovum is the female pronucleus

The male and female pronuclei fuse to form a zygote

36
Q

POST CONCEPTION WEEK 1

A

Cleavage

Blastocyst formation

Implantation

37
Q

Zygote cytoplasm is successively cleaved to form a blastula, which consists of increasing smaller blastomeres

At 32-cell stage, the blastomeres forma morula, which consists of an inner cell mass and outer cell mass

The morula enters the utereine cavity at about 3 days post conception

A

CLEAVAGE

38
Q

Occurs when fluid secreted within the morula forms the blastocyst cavity

Inner cell mass - future embryo, is now called EMBRYOBLAST

Outer cell mass - future placenta, is now called TROPHOBLAST

A

BLASTOCYST FORMATION

39
Q

Blastocyst implants at around 7 days post conception within the posterior superior wall of the uterus

This is during the secretory phase of the menstrual cycle, so implantation occurs within the functional layer of endometrium

A

IMPLANTATION

40
Q

POST CONCEPTION WEEK 2

A

Embryoblast

Trophoblast

41
Q

Differentiates into two distinct cell layers, the Epiblast and Hypoblast, forming a Bilaminar Embryonic Disk

EPIBLAST - clefts develop within the Epiblast to form the amniotic cavity

HYPOBLAST - form the yolk sac

A

EMBRYOBLAST

42
Q

Cytotrophoblast divide mitotically

Syncytiotrophoblast

  • does not divide mitotically
  • produces the HCG
  • continues its growth into the endometrium to make contact with the endometrial blood vessels
A

TROPHOBLAST

43
Q

EMBRYONIC PERIOD WEEK 3-8

A

The beginning of the development of major organ system

Coincides with the first missed menstrual period

Period of high susceptibility to teratogen

Gastrulation is a process that establishes the 3 primary germ layers, forming a trilaminar embryonic disk

44
Q

Germ layers

A

Ectoderm - CNS & PNS, sensory organs of seeing & hearing, integument layer

Endoderm - lining of the GIR and respiratory tract

Mesoderm - muscles, cartilages, CVS, urogenital system, rbc

45
Q

Folic acid must be given before conception

A

.4 mg (usual dose)

40 mg (hs of pregnancy)

46
Q

Fetal to maternal: MEMBRANES

A

Amnion - avascular, provides tensile strength, first identifiable at 7th to 8th day of life, from fetal ectoderm

Chorion

Decidua parietalis (endometrium)

Myometrium

Serosa

47
Q

AMNIOTIC FLUID

A

Normal amniotic fluid volume:

  • by 12 weeks = 60ml
  • by 34-36 weeks = 1L
  • by term = 840ml
  • by 42 weeks = 540ml

Production of amniotic fluid

  • initially by amniotic epithelium
  • fetal kidneys and urine production

Amniotic fluid volume is also dependent on the extent of maternal plasma expansion

Removal and regulation of amniotic fluid volume

  • fetal swallowing
  • fetal aspiration
  • exchange through skin and fetal membranes
48
Q

THE PLACENTA AT TERM

A

Volume 497 ml

Weight 508grams (450-500 grams)

Surfaces:

  • fetal: covered with amniotic membrane giving it white, glistening appearance; where the umbilical cord arises
  • maternal: attached to the decidua, deep bloody appearance arranged into 15-20 irregular lobes, cotyledons

Hofbauer cells

49
Q

CIRCULATION IN THE MATURE PLACENTA

A

Fetal surface covered by amnion beneath which the fetal chorionic vessels course chorionic villi ➡️ intervillous spsce ➡️ decidual plate ➡️ myometrium

50
Q

FUNIS

A

Umbilical cord

Two artery, one vein

Average length: 55cm

WHARTON JELLY - extracellular matrix of specialized connective tissue

Anticlockwise spiral is present in 50 to 90 percent of fetuses

51
Q

PLACENTAL HORMONES

A

Trophoblast

Steroid hormones

hPL, hCG, parathyroid hormone-related protein (PTH-rP), calcitonin, relaxin, inhibins, activins and atrial natriuretic peptide

Hypothalamic-like releasing and inhibiting hormones: thyrotropin-releasing hormone (TRH), gonadotrophin-releasing hormone (GnRH), corticotrophin-releasing hormone (CRH), somatostatin and growth hormone-releasing hormone (GHRH)

52
Q

Almost exclusively produced by the placenta

Glycoproteins

Alpha and beta subunit

Functions: rescue and maintenance of function of the corpus luteum, stimulates fetal testicular testosterone secretion, maternal thyroid gland stimulation (chorionic thyrotropins), promotion of relaxin secretion

Detectable in plasma of pregnant women 7 to 9 days after the midcycle surge of Lah that precedes ovulation

Plasma levels increase rapidly, doubling every 2 days, with maximal levels being attained at 8 to 10 weeks

At 10 to 12 weeks, plasma levels begin to decline, and a nadir is reached by about 16 weeks

Clearance: mainly hepatic, renal (30%)

A

hCG

Human chorionic gonadotropin

53
Q

Similar to hCG

Detected in maternal serum as early as 3 weeks

Maternal plasma concentrations are linked to placental mass, and they rise steadily until 34-36 weeks

Production rate near term: approximately 1g/day

Functions: maternal lipolysis, anti-insulin or “diabetogenic”, potent angiogenic

A

hPL

Human placental lactogen

54
Q

Source:

  • first 6-7 weeks of pregnancy: CORPUS LUTEUM (ovary)
  • after 8 weeks: PLACENTA (syncytiotrophoblast)

Function:

  • affects tubal motility, the endometrium, uterine vasculature and parturition
  • inhibits T-lymphocyte-mediated tissue rejection

Preferred precursor of progesterone biosynthesis by the TROPHOBLAST: MATERNAL PLASMA LDL, CHOLESTEROL

A

PROGESTERONE

55
Q

Pregnancy near term is hyperestrogenic

Produced exclusively by SYNCYTIOTROPHOBLAST

Placenta produce all types of estrogen

A

ESTROGEN

56
Q

What is the post menopausal estrogen?

A

ESTRONE

57
Q

What is the non pregnant estrogen?

A

ESTRADIOL

58
Q

What is the placental estrogen?

A

ESTRIOL

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