Female Repro Physiology Flashcards
1
Q
Gonads are activated by _____ from the
pituitary
A
gonadotropins
2
Q
hypothalamic, pituitary, and ovarian
hormones involved in female repro
A
- GnRH = gonadotropin releasing hormone
- LH = luteinizing hormone
- FSH = follicle-stimulating hormone
3
Q
GnRH function
A
binds to the anterior pituitary gland →
release of LH and FSH → ovary
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
5
Q
Granulosa cell function
A
- Granulosa cells → aromatase →
converts androstenedione to
estrogen
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
7
Q
Follicular phase
A
- Begins on day 1 of the cycle
- Corresponds to the growth
and development of a
dominant follicle
8
Q
Luteal phase
A
- Midcycle surge in LH levels
- Induces ovulation,
promotes formation and
survival of the corpus
luteum
9
Q
This is when Endocrine and gametogenic functions of the
gonads first develop to the point where
reproduction is possible
A
Puberty
10
Q
Thelarche
A
1 st event, development of
breasts
11
Q
Pubarche
A
Development of axillary and
pubic hair
12
Q
Menarche
A
First menstrual period
* Initial periods generally anovulatory for 1st year
13
Q
At the time of birth, there are _____
follicles containing immature ova
A
~ 2 million
14
Q
At the time of puberty there are ____ ova
A
~ 300,000
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)
16
Q
Ovarian Cycle phases
A
- Menstrual phase
- Proliferative/follicular
phase - Ovulation
- Secretory/luteal
phase
17
Q
3 phases of the menstrual cycle:
A
- Menstruation
- Proliferative phase
- Secretory phase
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
19
Q
> _____ ml is considered abnormal blood loss for menses
A
80
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
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
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
23
Q
____ is the most potent estrogen
A
Estradiol
24
Q
_____ is the least potent estrogen
A
Estriol
25
Explain Estrogens feedback process
* Estrogen inhibits FSH secretion
* Estrogen inhibits LH at LOW
CONCENTRATIONS
* At HIGH CONCENTRATIONS, estrogen
stimulates LH production
26
Progesterone function
* 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
27
Inhibin function
* Two types
* Secreted by ovarian granulosa cells
* Peaks during the luteal phase
* Negative feedback
* After ovulation
* Inhibin directly inhibits FSH
28
What is the main effect of estrogen?
Builds up endometrial lining growth
29
What is the main effect of progesterone?
Maintains endometrial lining
30
Fertilization normally occurs in the _____
oviduct
* Must take place within a day of ovulation
* Spermatozoa must be present in the fallopian tube at the time of oocyte arrival
31
Blastocyst implantation timeline and steps
* 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
What does it mean if twins are Dizygotic?
* Maturation and fertilization
of 2 ova during a single
ovulatory cycle
* Genetically different
33
What does it mean if twins are monozygotic?
* Division of 1 fertilized zygote into 2
* Can occur at various times following fertilization
34
Are dizygotic or monozygotic twins more common?
Dizygotic
35
Factors that increase dizygotic twinning
* 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
____ begins with the first day of the
last menstrual cycle prior to pregnancy
Gestation
37
Due date calculations
* 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
Calculate a due date for a mother whose first day of her last period was 3 weeks ago today
______
39
Secretions from the placenta
hCG, Estrogen, progesterone
40
Functions of the placenta
* 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
T/F Maternal and fetal blood cells do not cross the placental membrane
T
42
Umbilical cord formation
* Fully formed by the 3 rd month
* 3 vessel cord
* 2 umbilical arteries, 1 umbilical vein
43
Blood exits the fetus via the _____
two umbilical arteries
44
Blood flows from the umbilical vein via two routes:
* 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
What things happen in the First Trimester?
* 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
Relaxin function
* 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
Second Trimester factors
* 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
Third Trimester factors
* 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
Estrogen effects on the myometrium during the third trimester
* 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
CRH function furing pregnancy
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
Congenital Anomalies: vaginal septa
* Longitudinal
* Partial may interfere with fetal descent
* Transverse
* May require incision to permit delivery
52
Congenital Anomalies: uterus
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
Nasal granuloma gravidarum
* Unilateral
* Benign
* Resolves spontaneously after delivery in most cases
* Can be excised under local anesthesia if necessary
54
Respiratory changes during pregnancy
* 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
Cardiovascular physical changes with pregnancy
* 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
Renal changes during pregnanncy
* 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
Bladder changes during pregnancy
* 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
Endocrine system changes with pregnancy
* Thyroid enlarges 10-15% in size
* hCG and estrogen
* ↓ TSH in first trimester
59
GI changes in pregnancy
* 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
Importance of iron in pregnancy
* 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
Importance of folic acid in pregnancy
* 400 micrograms daily
* Before and during early
pregnancy
* Spina bifida, anencephaly
62
Extra calories needed per day during pregnancy
* Extra calories per day
* 1st trimester = 85 calories/day
* 2nd trimester = 285 calories/day
* 3rd trimester = 475 calories/day
63
Total average weight gain during pregnancy
25-35 pounds
64
Is maternal basal metabolic rate increased or decreased with pregnancy?
Increased by 10-20%
65
What do stretch marks (striae) result from?
* Reddish, slightly depressed streaks resulting from stretching of the dermis
* Breast (25%)
* Thighs (25%)
* Abdomen (50%)
66
Diastasis recti changes with pregnancy
* Muscles of the abdominal wall do not
withstand the tension
* Separation of the rectus abdominal muscle
67
Linea nigra
Dark brown-black pigmentation of the
midline of the anterior abdominal wall skin
68
Melasma gravidarum
Irregular brownish patches of varying
size on face and neck
69
Ophthalmic changes in pregnancy
* 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
What is preeclampsia?
Blurry vision, light sensitivity, temporary vision loss, auras/flashing lights
71
Dental changes in pregnancy
* 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
Review fetal circulation
:)
