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Applied Anatomy > Female Reprodutive System > Flashcards

Female Reprodutive System Flashcards

1
Q

Why does the uterus change

A

Provide support for the growing fetus
Expel fetus and placenta in labour
Contract after birth to prevent maternal haemorrhage
Remodel by involution to the non pregnant Tagus within 4 eels of birth

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2
Q

What does the uterus grow due to

A

Increased calculation and fluid retention in the mayo metric M under influence of progesterone nd oestrogen an mechanical stretching

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3
Q

What does the uterus change to and from

A

Pelvic organ to abnormal organ almost reaching the border of the liver by full term

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4
Q

What are the layers of the uterus

A

Inner. Endometrium - ciliates epithelium
Middle - myometrium- thick muscle cells
Outer - perimetrium - loose connective tissue protecting uterus room friction with other organs

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5
Q

What does the endometrium become

A

Decidua

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6
Q

What is the process of decidualization

A

Cells differentiate to prepare for implantation, protect from the trophoblast and repae to provide nutrition to th blastocyst
Endometrial thickness of 8mm or more is necessary for successful implantation

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7
Q

What are the three layers of the myometrium

A

Longitudinal
Oblique
Circular

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8
Q

Hyperplasia - myometrium

A

10x increase in number of myocytes in first half of pregnancy

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9
Q

Hypertrophy

A

Increase in size of myocytes in second half of pregnancy

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10
Q

What does hyperplasia and hypertrophy result in

A

Myometrium growth during pregnancy

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11
Q

Uterine contractions - myometrium

A

High levels of progesterone in pregnancy promotes relaxation of myometrium and inhibit production of prostaglandins and oxytocin receptors (inhibits contractions)
T the end of the pregnancy, rise in oestrogen and CCRH trigger activation of xytocin receptors and prostaglandins needed for regular contractions
In established labour, oestrogen, oxytocin and prostaglandins increase the density and permeability of the gap junctions between the myometrial cells so contraction beck more coordinated and forceful.

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12
Q

Cessation of bleeding

A

In the middle oblique muscle layer, each myocytes is a figure or 8 to enable it to constrict around a blood vessel t stop bleeding post birth.

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13
Q

What is the perimetrium

A

B-road ligaments or med by the perimetrium open out to accommodate massive increase in size of uterine and ovarian blood vessels, lymphatics and nerves
Enlarge uterine nerves act as a reservoir for blood during uterine contractions

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14
Q

What is the ishmus

A

The lower uterine segment is formed from the isthmus which does not undergo such hyertrophy and becomes increasily thin and distensible. The muscle fibre are mostly transverse
Lowe segment caesarean section where the uterine in ion follows the direction of the muscle fibres - less vascular- reduce blood loss

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15
Q

How does the blood flow to the uterus change

A

There is.Ten fold increase from 2% cardia output in the non pregnant state to 17% at term
Uterine and ovarian arteries hypertrophy muscle cells increase in size) greatly in pregnancy.
The blood is redistributed within the uterus and a pregnancy progresses 80-0% goes to the placenta and the remainder is equally distributed between the myometrium and the endometrium

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16
Q

What is uterine vascular remodelling

A

Blood vessels within the uterus change significantly during pregnancy

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17
Q

What are arteries like pre preganancy

A

Spiral arteries supply bloood to the endometrium in the menstrual cycle and are narrow in diameter

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18
Q

What are the spiral arteries like in pregnancy

A

Trophoblast causes them to dilate 5-10 x and lose muscle from their walls
The arteries straighten out and increase in diameter so by 2nd trimester maternal blood pools into the intervillous space - pool of maternal blood used for gases exchange between fetus and woman.
The intervillous space will contain 400-500ml oxygen rich blood

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19
Q

How ones the uterus chang postnatally

A

Following birth, the uterus returns to its normal size, tone and position through the process of involutin
Through this process the uterus reverts back to being a pelvic organ from occupying te abdomen
At the end of the first week postnatally the uterus has lost 50% of its muscle bulk
By the end of the sixth week, the uterus should be at me pre pregnant position of anteversion nd anteflexion - normal/.

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20
Q

What ae the three processes that enable myometrium to return to normal thickness

A

Ischaemia
Autolysis
Phagocytosis

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21
Q

Ichaemia

A

Muscle of the uterus retract at te end of 3rd stage of labour to constrict blood vessels at the placental site
Resulting in haemostasis
Uterine blood supply is greatly reduced

22
Q

Autolysis

A

Th process of removal of the redundant actin and myosin muscl fibres and cytoplasm by proteolytic and macrophages. The size of the individual myometrial cells is reduced

23
Q

Phagocytosis

A

Removes the excess fibrous and elastic tissue
process is incomplete and some elastic tissue emails so that a uterus never quite returns to the nulliparous state

24
Q

On what days do the lochia change

A

The superficial layers of the Dudu are shed as bleeding per vaginum with regeneration off the endometrium
Lochia
Rubra - 1-3 days
Serosa - 4-10 days
Alba - 11-21 days

25
Q

What happens to the wall of the cervix

A

Decreases until reared 0.4 cm at term

26
Q

What is the cervix transformed to

A

Under normal control, transformed from closed rigid non distensible, collagen dense structure to a soft distensible and nearly indistinguishable ring of tissue capable of stretching and dilating to permit the passage of a fetus at term

27
Q

What happens as the cervix remodels

A

The tissue softens ad causes collagen scaffold to become disorganised and unstable

28
Q

What is softening of cervix

A

Occurs soon after conception as the collagen fibres are disrupted
Cervical odeoma
Increased vascularity causes bluish tint

29
Q

What is ripening of cervix

A

Can precede onset of labour by several weeks
Cervix loses its structure and becomes soft thin and pliable

30
Q

What is effacement and dilation

A

Muscle fibres pulled up t become part of the lower uterine segment, the length of the cervix shortend - effacements. The external os opens - dilation

31
Q

What is cervi xrepair

A

Going back to pre pregnant state
Not identical

32
Q

What is operculum

A

Columnar epithelial cells of the cervix undergo profileration and secrete mucus that acts as a plug
It provides a protective seal against the entry of pathogens and also has antibacterial properties
Late in the cervical softening phase and before or during early labour the cervical canal may dilate by up to 3cm and the operculum s released as a blood tinged discharge known as show

33
Q

What is the bishop score

A

Pre labour cervical scoring system 0-13
To predict likelihood of spontaneous labour or cervical faourability
Higher the score the higher chance of labour/ success of induction

34
Q

How does the vaginal walls change

A

The epithelial mucosa thickens
Connective tissue loosens and smooth muscle cells hypertrophy - increase in size

35
Q

What changes about cervical secretions

A

Increased during pregnancy to form a thick white discharge - leucorrhea

36
Q

Wat happens to vaginal ph

A

It remains low <4.5 which inhibit s growth of pathological vulvo- vaginal organisms particularly through 2nd and 3 rd trimester

37
Q

What happens to the blood flow and vessels in perineum and Vila

A

Increased vascularity and hyperaemia - blood flow in the skin and muscles of the pperineum and vulva

38
Q

Vulvar varicosites

A

Varicose veins in the Vulcan caused by vasodilation and reduced venous tone
Usually resolve following pregnancy. And do not effect mode of birth

39
Q

Contraception without synthetic hormones

A

Lactational amenorrhea
Fertility awareness - family planning
Condoms
Intrauterine device - copper coil

40
Q

Lactational amenorrhea

A

Suitable if you are exclusive breastfeeding and baby is less than 6 months and if havent had menstrual period
98% effective
High levels of prolactinstps the release of the gonadotropin releasing hormone (GnRH) from the hypothalamus and luteinizing hormoe (LH) from the pituitary gland
The luteinizing hormone sure is preened thus preventing ovulation

41
Q

Cautions of Lactational amenorrhea

A

If breastfeeding frequency is reduced, fertility may return before next menstrual period
Expressing breastmilk rather than breastfeeding increases chance of pregnancy
Scheduledor restricted breastfeeding increases chance of pregnancy

42
Q

Fertility awareness

A

Predicting ovulation through daily monitoring of temperature and cervical fluid monitoring and menstrual tracking
Avoids penetrative sex on fertile days - including das when sperm may survive and egg may survive (8-9 days per month)
Efficacy wh perfect use 91-99% but as low as 75% with typical use
Efficacy of apps is highly variable and nt well trialled

43
Q

Condoms

A

Non hormonal form of barrier contraception
Male condoms worn on penis
Femal =e condoms worn inside vagina
Protect against STIs
When used correctly 98% effective
Some use latex which can be an allergy
Oil lube can degrade condoms

44
Q

Copper coil

A

Safe for breastfeeding
Copper acts as spermicide
Copper increases levels of copper ions - prostagladins and white blood cells within the uterine and tubal fluids. It alters the cervix mucus which makes it ore difficult fr sperm to reach an egg and survive
It can also stop a fertilised egg from being able to implant itself
Lasts 5-10 years
More than 99%effctive

45
Q

What do progestogen based contraceptives do

A

Progestogen is a synthetic versiion of progesterone
It thickens the cervical mucus which makes it difficult for sperm to move through cervix and thins the endometrium o an egg is less likely to able to implant itself
It can also prevent ovulation

46
Q

Intrauterine system - IUS

A

Small t shaped device inserted through cervix
Insertion ad removal may be painful and pain relief may be used
Reese’s progestogen into uterus - local suppressive effect on endometrium with lower plasma level than when taking oral pill

47
Q

Progestogen implant in arm

A

Suitable from 4weeks post birth
Lass three years
More than 9% effective
Fertility returns to normal immediately after removal \small procedure
Side effects - mood swings headaches

48
Q

Progestogen depo injection

A

Intramuscular injection
Perfect use - >99% effective but with typical 94%
Provides contraceptive effects for 8-13 weeks
Su\uitable from 6 weeks post birth
Side effects - changes. To menstrual cycle weight gain headaches
Fertility make take up to a year to return

49
Q

Progestogen only pill

A

The traditional pillPrevents pregnancy by thickening the mucus in the cervix to stop sperm reaching an egg - takes 2 days - has to be taken within 3 ours of the same time each day
The desogestrel pill also stood vulation - takes 7 days - must be taken within th e12hours of the same time each day
if taken perfectly more than 99% effective if not only 91 % effective
2 types of pill
Can start pill 21 days post birth
Suitable whilst breastfeeding

50
Q

How do combined oestrogen and progestogen contraceptives work

A

Suppress mid cycle surge of LH and FSH and thereby inhibiting ovulation

51
Q

Combined pill

A

Contains oestrogen and progestogen
Taken correctly - more than 99% effective
Typical use - 91% effective
Oestrogen increases risk of venous thromboembolism (VTE) so not suitable for raised BMI smoker or history of VTE
Side effects. Breast tenderness, headaches and nausea
Not suitable for first 6 weeks of breastfeeding caution use as oestrogen may affect supply

52
Q

Combined patch

A

Contains oestrogen and progestogen like the combined pill - same mechanism for preventing pregnancy
Same risk of VTE associated with oestrogen based contraceptives
Change patch every 7ths for 3 weeks then have 1 week patch free
Temporary side effect headaches nausea breas tenderness ad mood changes

Applied Anatomy (15 decks)

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