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Womens Health Exam 1 > Female Repro Physiology > Flashcards

Female Repro Physiology Flashcards

1
Q

Gonads are activated by _____ from the
pituitary

A

gonadotropins

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2
Q

hypothalamic, pituitary, and ovarian
hormones involved in female repro

A
  • GnRH = gonadotropin releasing hormone
  • LH = luteinizing hormone
  • FSH = follicle-stimulating hormone
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3
Q

GnRH function

A

binds to the anterior pituitary gland →
release of LH and FSH → ovary

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4
Q

FSH/LH functions

A
  • FSH stimulates the granulosa cells of follicle →
    aromatase, inhibin
  • LH stimulates theca cells of oocyte to begin
    dividing again → androstenedione
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5
Q

Granulosa cell function

A
  • Granulosa cells → aromatase →
    converts androstenedione to
    estrogen
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6
Q

what triggers Ovulation to occur?

A
  • Monthly formation and release of an oocyte after follicular rupture
  • LH surge on day 14 of cycle, stimulates ovulation within
    24 hours
  • Oocyte leaves and prepares for fertilization
  • Corpus luteum
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7
Q

Follicular phase

A
  • Begins on day 1 of the cycle
  • Corresponds to the growth
    and development of a
    dominant follicle
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8
Q

Luteal phase

A
  • Midcycle surge in LH levels
  • Induces ovulation,
    promotes formation and
    survival of the corpus
    luteum
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9
Q

This is when Endocrine and gametogenic functions of the
gonads first develop to the point where
reproduction is possible

A

Puberty

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10
Q

Thelarche

A

1 st event, development of
breasts

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11
Q

Pubarche

A

Development of axillary and
pubic hair

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12
Q

Menarche

A

First menstrual period
* Initial periods generally anovulatory for 1st year

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13
Q

At the time of birth, there are _____
follicles containing immature ova

A

~ 2 million

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14
Q

At the time of puberty there are ____ ova

A

~ 300,000

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15
Q

Mittleschmerz

A

Minor bleeding from the follicle into the
abdominal cavity results in lower abdominal pain on the side of the ovary that’s releasing an egg (ovulating)

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16
Q

Ovarian Cycle phases

A
  1. Menstrual phase
  2. Proliferative/follicular
    phase
  3. Ovulation
  4. Secretory/luteal
    phase
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17
Q

3 phases of the menstrual cycle:

A
  1. Menstruation
  2. Proliferative phase
  3. Secretory phase
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18
Q

Menstrual blood factors

A
  • Menstrual blood is predominantly
    arterial
  • Contains fibrinolysin from the
    endometrial tissue, which lyses clots, so
    the menstrual blood does not normally
    contain clots unless flow is excessive
  • Usually 3-5 days
  • Average amount of blood loss is 30 mL,
    >80 abnormal
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19
Q

> _____ ml is considered abnormal blood loss for menses

A

80

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20
Q

What is happening during the Proliferative phase?

A
  • Restoration of the epithelium from the
    proceeding menstruation
  • Estrogen from developing follicles
  • Endometrium regenerates and rapidly increases in thickness between days 5-
    16 of the menstrual cycle
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21
Q

What is happening during the Secretory phase?

A
  • Preparation of uterus for implantation of fertilized ovum
  • Endometrium becomes highly vascularized and edematous
  • Progesterone and estrogen from corpus luteum
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22
Q

What are Estrogens?

A
  • Formed from androgens
  • Esterone is metabolized into estriol
    within the liver
  • Estradiol is the most potent
  • Estriol is the least potent
  • Estradiol: ↓ hot flashes and other sx of
    menopause and prevents OA and
    atherosclerosis and associated MI;
    however it ↑ breast and endometrial
    growth leading to cancer of the uterus
    and breast
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23
Q

____ is the most potent estrogen

A

Estradiol

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24
Q

_____ is the least potent estrogen

A

Estriol

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25
Q

Explain Estrogens feedback process

A
  • Estrogen inhibits FSH secretion
  • Estrogen inhibits LH at LOW
    CONCENTRATIONS
  • At HIGH CONCENTRATIONS, estrogen
    stimulates LH production
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26
Q

Progesterone function

A
  • Secreted in large amounts by the corpus
    luteum and placenta
  • Peaks during the luteal phase
  • Thermogenic = rise in body temperature
    during ovulation
  • Negative feedback
  • After ovulation
  • ↑ progesterone inhibits GnRH
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27
Q

Inhibin function

A
  • Two types
  • Secreted by ovarian granulosa cells
  • Peaks during the luteal phase
  • Negative feedback
  • After ovulation
  • Inhibin directly inhibits FSH
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28
Q

What is the main effect of estrogen?

A

Builds up endometrial lining growth

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29
Q

What is the main effect of progesterone?

A

Maintains endometrial lining

30
Q

Fertilization normally occurs in the _____

A

oviduct
* Must take place within a day of ovulation
* Spermatozoa must be present in the fallopian tube at the time of oocyte arrival

31
Q

Blastocyst implantation timeline and steps

A
  • 6 to 7 days after fertilization
  • Apposition = initial contact with uterine wall
  • Adhesion = increased physical contact
  • Invasion = penetration and invasion into
    endometrium, inner 1/3 of myometrium, and
    uterine vasculature
32
Q

What does it mean if twins are Dizygotic?

A
  • Maturation and fertilization
    of 2 ova during a single
    ovulatory cycle
  • Genetically different
33
Q

What does it mean if twins are monozygotic?

A
  • Division of 1 fertilized zygote into 2
  • Can occur at various times following fertilization
34
Q

Are dizygotic or monozygotic twins more common?

A

Dizygotic

35
Q

Factors that increase dizygotic twinning

A
  • Ethnicity
  • Black women (3.5%), White women (3.0%)
  • Increasing maternal age
  • Increasing parity
  • Family history of mother
  • Nutrition → taller, heavier women
  • Conceiving within 1 month of discontinuing oral contraceptives
36
Q

____ begins with the first day of the
last menstrual cycle prior to pregnancy

A

Gestation

37
Q

Due date calculations

A
  • Assumes a 28-day cycle and a single fetus
  • If cycle is > 28 days, baby will likely arrive after 40 weeks
  • If cycle is < 28 days, baby will likely arrive before 40 weeks
  • Add 280 days to the first day of the last
    menstrual cycle
  • Subtract 3 months from the first day of the
    last menstrual cycle, then add 7 days
38
Q

Calculate a due date for a mother whose first day of her last period was 3 weeks ago today

A

______

39
Q

Secretions from the placenta

A

hCG, Estrogen, progesterone

40
Q

Functions of the placenta

A
  • Endocrine gland
  • hCG, Estrogen, Progesterone
  • Semipermeable membrane facilitates exchange between fetus and mother
    surrounding the chorionic villi
    1. Exchange gases (oxygen, carbon dioxide)
    2. Exchange of nutrients (water, glucose, amino acids, minerals)
    3. Immune protection (antibodies, IgG)
  • IgG antibodies are allowed through the placental barrier and provide PASSIVE IMMUNITY for the
    fetus
  • Fetal waste product removal (urea, uric acid, creatinine)
41
Q

T/F Maternal and fetal blood cells do not cross the placental membrane

A

T

42
Q

Umbilical cord formation

A
  • Fully formed by the 3 rd month
  • 3 vessel cord
  • 2 umbilical arteries, 1 umbilical vein
43
Q

Blood exits the fetus via the _____

A

two umbilical arteries

44
Q

Blood flows from the umbilical vein via two routes:

A
  • Ductus venosus, which empties directly into the inferior
    vena cava
  • Numerous smaller openings into the hepatic circulation
  • Blood from the liver flows into the inferior vena cava via the
    hepatic vein
45
Q

What things happen in the First Trimester?

A
  • Fertilization
  • 24 hours - baby’s first division
  • Divides every 12-15 hours
  • 7 days - implantation
  • Placental formation
  • Gastrulation = forms 3 germ layers that produce various tissues
  • Neurulation gives rise to the early peripheral and central nervous systems
  • Major organs begin to form (heart lungs)
  • Heart begins beating between 18-25 days
  • hCG detectable on home pregnancy test
  • Limbs and gonads begin to develop
  • Eyes open and close
46
Q

Relaxin function

A
  • Secreted by corpus luteum, later
    placenta
  • Key role in facilitating maternal physiological adaptations
  • Remodeling of reproductive-tract connective tissue
  • Initiation of augmented renal
    hemodynamics
  • Does not contribute to increasing peripheral joint laxity during pregnancy
47
Q

Second Trimester factors

A
  • Heart is beating faster and continues
    developing (150-160 bpm)
  • Facial features begin to develop (eyes, ears,
    nose, face)
  • Fetus begins moving
  • Woman feels movement (quickening)
  • Pupils respond to light
  • Fetus is more cramped due to growth and
    curls into the fetal position
  • 20-weeks = sex determination can usually
    occur by this point via US
48
Q

Third Trimester factors

A
  • Weight of the fetus more than doubles
  • Final differentiation of tissues and organs
  • Reflexes develop such as grasping and
    suckling
  • Hair growth
  • Cerebrum and brain grow and develop
    convolutions
  • Lungs are matured after 36 weeks
  • Testes migrate into the scrotum
  • Positions head down in preparation for birth
49
Q

Estrogen effects on the myometrium during the third trimester

A
  • Prepares it for birth, sensitizes it to oxytocin
    (coordinates contraction of uterus during labor)
  • Stimulates ↑ in gap junctions (allow coordination
    of contractions)
  • Relaxes smooth muscle
  • Matures milk ducts of breast
  • Releases prostaglandins to soften cervix
50
Q

CRH function furing pregnancy

A

released by the placenta, ↑ at 28 weeks
gestation, stimulates AP to release more ACTH which stimulates placenta to slowly produce more estrogen over the entire
length of pregnancy

51
Q

Congenital Anomalies: vaginal septa

A
  • Longitudinal
  • Partial may interfere with fetal descent
  • Transverse
  • May require incision to permit delivery
52
Q

Congenital Anomalies: uterus

A

Unicornuate
* Rudimentary or underdeveloped horn may be absent
* Associated with renal abnormalities

Bicornuate
* Forms as lack of fundal fusion results in two hemiuteri, with only one cervix and vagina
* Increases risk of miscarriage, preterm birth, and malpresentation

Septate
* Resorption defect leads to a persistent complete or partial
longitudinal uterine cavity septum
* Increased risk of miscarriage, preterm delivery, and malpresentation

Didelphys
* Complete lack of fusion that results in two entirely separate hemiuteri, cervices, and usually two vaginas
* Obstetrical outcomes are similar but less frequent than those with unicornuate uterus

53
Q

Nasal granuloma gravidarum

A
  • Unilateral
  • Benign
  • Resolves spontaneously after delivery in most cases
  • Can be excised under local anesthesia if necessary
54
Q

Respiratory changes during pregnancy

A
  • Subcostal angle can change from 68 to 103
    degrees
  • Rib cage is displaced upward
  • Diaphragm rises by up to 4 cm
  • Chest diameter increases ≥ 2 cm
  • Diaphragmatic excursion increases by up to 2 cm
  • “Barrel chest” appearance during pregnancy
  • Prominent pulmonary vascular markings observed on x-ray are consistent with ↑
    pulmonary blood volume
  • ↑ progesterone → hyperventilation in first
    trimester
55
Q

Cardiovascular physical changes with pregnancy

A
  • Heart rotates on its long axis
  • Left-upward displacement
  • Heart increases in size by 12%
  • 50% elevation in plasma volume
  • Increased red cell volume
  • 30% ↑ in red cell mass
  • Cardiac output ↑ 40%
  • Resting heart fate increases 15 beats/min
  • Venous pressure increases –> edema, varicosities
56
Q

Renal changes during pregnanncy

A
  • Length of kidneys ↑ 1-1.5 cm
  • Renal calyces and pelves dilate
  • Ureters dilate
  • Renal plasma flow ↑ 50-85% above
    nonpregnant values during the first half of
    pregnancy
  • ↑ renal perfusion → ↑ GFR
57
Q

Bladder changes during pregnancy

A
  • Progesterone may relax the ureters and bladder
  • Increased urination
  • ↑ susceptibility to pyelonephritis
  • Urinary stasis
  • Stagnant urine in ureters
  • ↑ blood volume + arterial dilation = increase in kidney filtration rate
58
Q

Endocrine system changes with pregnancy

A
  • Thyroid enlarges 10-15% in size
  • hCG and estrogen
  • ↓ TSH in first trimester
59
Q

GI changes in pregnancy

A
  • Stomach pushed upward
  • Reflux
  • Pregnancy associated with ↑ gastrin → ↑
    stomach volume and acidity of gastric
    secretions
  • Intestines: Transit times decreased in 2nd and 3rd trimesters
  • Gallbladder: Emptying slowed in pregnancy and often incomplete
  • Liver
  • Morphology doesn’t change in normal pregnancy
  • Plasma albumin levels are reduced more than plasma globulins
60
Q

Importance of iron in pregnancy

A
  • Enhanced erythropoiesis of pregnancy increases utilization of iron
  • 6–7 mg per day in second half of pregnancy
  • Many women begin pregnancy in an iron-deficient state
  • Placenta actively transports iron from the mother to the fetus
  • Fetus usually not deficient
61
Q

Importance of folic acid in pregnancy

A
  • 400 micrograms daily
  • Before and during early
    pregnancy
  • Spina bifida, anencephaly
62
Q

Extra calories needed per day during pregnancy

A
  • Extra calories per day
  • 1st trimester = 85 calories/day
  • 2nd trimester = 285 calories/day
  • 3rd trimester = 475 calories/day
63
Q

Total average weight gain during pregnancy

A

25-35 pounds

64
Q

Is maternal basal metabolic rate increased or decreased with pregnancy?

A

Increased by 10-20%

65
Q

What do stretch marks (striae) result from?

A
  • Reddish, slightly depressed streaks resulting from stretching of the dermis
  • Breast (25%)
  • Thighs (25%)
  • Abdomen (50%)
66
Q

Diastasis recti changes with pregnancy

A
  • Muscles of the abdominal wall do not
    withstand the tension
  • Separation of the rectus abdominal muscle
67
Q

Linea nigra

A

Dark brown-black pigmentation of the
midline of the anterior abdominal wall skin

68
Q

Melasma gravidarum

A

Irregular brownish patches of varying
size on face and neck

69
Q

Ophthalmic changes in pregnancy

A
  • Most issues are temporary and minor
  • Dry eyes
  • Contact lenses irritating
  • Artificial tears
  • Blurred vision
  • Pregnant women retain fluid
  • Change in the thickness and shape of cornea
  • Results in distorted vision
  • Preeclampsia: Blurry vision, light sensitivity, temporary vision loss, auras/flashing lights
  • Gestational diabetes
  • Blurred vision
70
Q

What is preeclampsia?

A

Blurry vision, light sensitivity, temporary vision loss, auras/flashing lights

71
Q

Dental changes in pregnancy

A
  • Salivation increases
  • Gums becomes hypertrophic and hyperemic
  • Spongy, friable
  • Bleed easliy
  • Caused by ↑ estrogen
  • Pregnancy does not predispose to tooth decay or
    mobilization of bone calcium
72
Q

Review fetal circulation

A

:)

Womens Health Exam 1 (7 decks)

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