Final Exam Lecture Flashcards
hemorrhage
severe bleeding
uterine atony
uterus does not contract
sepsis
widespread infection
placenta accreta
placenta grown into uterus
sustainable development goal
reduce global MMR to 70 per 100,000 live births
intimate partner violence
30% Of women
how many women will have an abortion by the age of 45
one in 4 women
27%
How does birth control prevent pregnancy
interfere with any step
stop the ovary from growing eggs
stop the egg from leaving the ovary
stop the egg from passing through the tube
stop the sperm from leaving the testess
stop the sperm from entering the uterus
stop a fertilized egg from landing in the uterus
contraception efficacy
how well can it work?
ideal/perfect use: method exactly as prescribed
ie: COC’s have efficacy of >99%
failure: 3:1000
contraception effectiveness
how well does it work
typical use: what happens in the real world
actual effectiveness of COC is closer to 92%
failure rate= 8%
estrogenic hormonal contraceptives
suppress FSH and LH
suppress ovulation
92-98% of cycles
endometrial changes at cellular level
progestinhormonal contraceptives
suppress LH
thicken cervical mucus
inhibit capacitation of sperm
endometrial changes
What are the 3 types of emergency contraceptive
progestin only pills
ullapristal pills
What are the modes of STD trasmission
- direct sexual contact
- vertical transmission (from infected woman to her fetus)
- contact with body fluids
Safe Sex concept
- know your partner
- protection
- vaccination
- limit sexual partners
Bacterial STDS
Chlamydia (most common)
gonorrhea
syphillis
Fungal STDS
candida albicans
Viral STDS
herpes simplex viruses (HSV-1 and HSV-2)
human papilloma virus
Hepatitis B
HIV
How many new cases of chlamydia each year in the US
3 million new cases
reinfection is common
Serovars A to C (chlamydia)
D to K
L1 to L3
can cause trachoma of the eyes (blindness)
can cause STI’s that are cervicitis, urethritis
can cause Lymphomogranuloma venereum
what is the leading cause of cervical cancer in women
hpv
what are the risks of home births
transportation system hospital access inadequate training of attendants risk selection inadequate home birth attendant support
Gender dysphoria
condition where a person experiences discomfort or distress because there’s a mismatch between their biological sex (or genitalia or sex assigned at birth) and gender identity
must continue for at least 6 mos
desire must be present and verbalized
pros/cons of puberty blockers
inhibits sexual development
can prevent suicidal ideation
reduces need for other surgeries
mostly reversible
unknown evidence on bone, cardiac and cognition
loss of fertility
may complicate further surgeries
pros/cons of hormones
affirming
“passing”
reduces self-harm
loss of fertility
increased cancer risk
EBM risks unknown
lack of disclosure can cause harm
pros/cons of surgery
“whole”
sexual function
procreative gpasl
reversible
surgery risks
healing
infertility
not pregnant after 12 months of trying
6 month
How long does it take to get pregnant?
after 6 months of trying: 66%
after 12 months: 81%
per first month: 20%
13th month: 3%
ovarian cycle
FSH/Estrogen primordial follicle meiosis I has been arrested in the primary oocyte inside it corpus luteum forms ovulation occurs follicle grows and matures
PROGESTIN
releases secondary oocyte/polar bodies
corpus luteum forms from the remnants of the ruptured follicle
when no pregancy occurs, the corpus luteum degenerates
What hormone stimulates the endometrium to grow?
estrogen
what hormone allows the embryo to transplant?
progesterone
Ovulation predictor kits
predict the LH surges (hormone concentration)
according to menstrual cycle when did ovulation occur?
14 days prior from latest period
ovulation (28-day cycle): day 14
ovulation (35-day cycle): day 21
9 days after a period stops
ovarian reserve
the graph of the number of eggs as a female ages
Which hormone is produced in the ovary?
AMH
produced by the cells that surround the growing eggs
the more eggs, the more cells; the more cells, the higher the AMH level (good)
What causes adhession of fallopian tubes
gonorrhea, chlamydia
intestinal or pelvic endometriosis
Uterine Myomas
fibroids 30% of women monoclonal (come from a single abnormal gene) benign estrogen responsive
intrmural fibroid
submucosal fibroid
subserosal fibroid
what are normal sperm counts?
> 1.5 cc volume
contains 15 million sperms per cc
40% motility
4% normal morphology
causes of low sperm counts
genetic: large or small chromosomal defects
infectious: chlamydia, other assorted bacteria
congenital: absence of the vas deferens
hormonal: low gonadotropins
Selective Estrogen Receptor Modulator
clomiphene
estradiol
clomiphene
Blocks estrogen at the level of the brain, tricks the body into thinking there is no estrogen on board
The body responds by trying to make more estrogen
It does this by increasing the output of FSH and LH
First evaluated as a possible oral contraceptive
IVF
2 weeks of injected hormones
6-7 office visits
- egg retrieval
- insemination
- embryo culture
- embryo testing
- embryo transfer
Why a Elective Single Embryo Transfer
the average time so singleton delivery is 40 weeks
the average time for twins is 35 weeks
twins have a 7 times higher rate of Cerebral Palsy
the divorce rate is higher in parents of twins
Euploidy
normal # of chromosomes
Aneuploidy
abnormal # of chromosomes
trisomies, monosomies, complex abnormals
embryos from at 34 yo: 40% abnormal
from a 40% yo: 90% are abnormal
most common cause for implantation failure and miscarriage is aneuploidy
genetic testing for
cystic fibrosis
spinal muscular atrophy
hemoglobinopathies
fragile x syndrome
genotyping
looking for specific mutations in the gene that are common/known
even if test is negative, theres always a chance to have some rare mutation
sequencing
when genotyping test is positive, entire sequence of the gene is read for mutations
if only one partner is a carrier
the baby will not inherit the condition
if both are carriers
there is a 25% chance of inheriting the condition
first trimester combined screening
Pregnancy Associated Plasma Protein A ( PAPP-A)
BhCG
Fetal nuchal translucency (NT)
ultrasound
Noninvasive Prenatal Test
can be performed as early as 9 weeks
tells the chances of the fetus having a chromosomal abnormality
screens for fetal sex
done via a maternal blood sample from the mother’s arm
Chorionic Villus Sampling
at 10 weeks
1 in 100
Amniocentesis
at 15 weeks
miscarriage rates: 1 in 300 to 1 in 500
PreImplantation Genetic Screening
PGS
tests for chromosomal abnormality such as trisomies, monosomies and others
screes for fetal sex
Preimplantation Genetic Diagnosis
specific genetic diseases
BRCA
Cystic Fibrosis
Mosaicism
different cells in a single embryo
biopsy is done on the trophoblast
CRISPR-CAS9
allows you to edit parts of DNA
benefits:
- target design simplicity
- efficiency
- multiple genes simultaneously
reproductive toxicology
studies the effects of chemicals on the reproductive and neuro-endocrine systems of:
embryo fetus neonate child adult
endocrine disruptor
exogenous substance/mixture that alters the function of the endocrine system causing adverse heath effects on organism, its progeny, or pop.
they interfere with the sythesis, storage, release, metabolism, transport, elimination or receptor binding of endogenous hormones
major effects of endocrine disruptors/
females
- miscarriages
- cancer
- irregularities of menstrual cycle
- infertility
males
- decrease in sperm count/quality
- cancer
- cryptochidism
- hypospadias
chemicals that are ED’s
DES--> SERM (ERa agonist) BPA--> SERM (ERa agonist) DDE--> SERM (ERa antagonist) PCBs/Dioxines--> SERM DDT --> SARM (ERa antagonist/ERB agonist) DEHP--> SARM(ar antagonist) DBP--> SARM (ar antagonist) B[a]P--> DNA damage
Diethylstilbestrol (DES)
synthethic non-steroidal estrogen
DES daughters
- reproductive tract malformations
- Cancer
- endometriosis
- uterine fibroids
- ectopic pregnancy
sons
- urogenital tract abnormalities (epididymal cysts, hypospadias, cryptochoridism)
- prostate weight
DDT used to control malaria/typhus, insecticide/pesticide
“Silent Spring”
males:
- Cryptorchidism (undescended testicle)
- Urogenital malformations (including hypospadias)
- Oligospermia (low sperm count)
- Prostate cancer
- Later puberty onset and delayed testicular maturation
females:
- Preterm birth
- Subfertility (difficulty to become pregnant) later in life
- Breast cancer later in life
Bisphenol-A (BPA)
baby bottles and infant formula packaging
BPA exposure has been linked to increased prostate size, benign prostate hyperplasia (BPH), reduced efficacy of prostate cancer treatment
Polychlorinated biphenyls (PCBs)
PCBs exposure was linked to: Decreased spermatogenesis Delayed puberty Reduced fertility Cancer
Dioxins
Dioxins are not metabolized and build up primarily in fatty tissues over time, so even small exposures may eventually reach dangerous levels
Developmental abnormalities in the enamel of children’s teeth
Central and peripheral nervous system pathology
Thyroid disorders
Diabetes
Endometriosis
Cancer
Phtalates
effects on sertoli cells:
In Utero:
- Decreased anti-Mullerian hormone (AMH)
- Germ cell death
Prepubertal:
-Dysruption of tight junction proteins
decreasing semen quality and male infertility
Teratogens causing detrimental effects during pregnancy
mercury Lead Cadmium Arsenic PCBs DDT Benzene Carbon tetrachloride
Thalidomide
used to treat morning sickness
Day 20 of pregnancy caused central brain damage
Day 21 would damage the eyes
Day 22 the ears and face
Day 24 the arms
Day 24-28 leg damage would occur if taken up to day 28
NSAIDS
could harm the fetal heart by blocking the synthesis of prostaglandins that are required for keeping the ductus arteriosus open in utero
persistent pulmonary hypertension
what else
Pseudoephedrine Guaifenesin prozac coffee alcohol/smoking drug use zika--> microcephaly
what is the basis of reproductive aging in women
the deterioratin of oocyte folliculogenesis and sex steroid secretion
ovarian follicles are the main source of sex steroids
men do not have the same problem since their sex steroids come from leydig cells
age-related ovarian failure stops the secretion of estradiol that maintain the sexual phenotype
stops the secretion of estradiol that maintain the sexual phenotype
fetal ovary contains
oocyte activation is ongoing from fetal life to the menopause
the full store of
oocytes that a women will ever have
How do we estimate follicle count (ovarian reserve) in women?
- ultrasound (antral follicle count)
- anti-mullerian hormone
- follicle stimulating hormone on third day of menstrual cycle
antral follicle count and AMH are most accurate
effects of advanced age on pregnancy
- increased multiple pregnancies
- increased chromosomal errors
- increased risk of pregnancy indused hypertension
- increased risk of gestational diabetes
- increased risk of thromboelbolism (blot clots)
- increased risk of preterm birth
what causes aging in the oocyte’s nucleus?
telomere shortening causes aging which disrupt meiotic spindles
telomeres
caps to protect chromosome ends
what can delay oocyte aging
sirtuin agonists
antioxidants
freezing
avoiding smoking
menopause
1 year without period with lack of ovarian follicular function
estrogen deficiency
natural;surgical
from pre to post menopausal women will experience
changes in serum estradiol and follicle stimulating hormone a
the average age of menopause is
51 years old
~2,000,000 women become menopausal annually
hot flashes
are due to opening of skin blood vessels that causes the sudden feeling of warmth followed by compensatory sweating
kisspeptin/neurokinin
KNDY neurons
new effectors of steroid hormone action in the brain
estrogen is linked to the loss of
bone mineral mass–> fractures
(osteopenia/osteoporosis)
prevents cardiovascular disease (leading cause of death in women)
morphology
compounding factors in human childbirth
menopause as an adaptation
women become infertile to take care of the last child
stressful on older women
ensures defective eggs are not fertilized
mother theory
grandmother theory
nonselection theory
- women are programmed to live 12-15 years beyond the birth of their last child
- women can provide resources to their grandchildren
- an artifact of the extension of the life span
