GYN Basics Flashcards by Stephanie Hawks

Human Chorionic Gonadotropin(hCG) is made by —- and peaks at —.

placental syncytiotrophoblast, 10 weeks

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Human Placental Lactogen(hPL) is simular to —– and causes—-.

GH & Prolactin, antagonizes the cellular actions of insulin = pregnancy glucose intolerance

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Estradiol

dominant during reproductive years = from granulosa cells

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Estriol

dominant during pregnancy = from placenta

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Estrone

dominant during menopause = from adipose tissue

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Why do you get these skin changes in prego: Striae gravidarum, spider angiomas & palmer erythema, Chadwich Sign, Linea Nigra, Chloasma.

Striae gravidarum = stretch makrs, spider angiomas & palmer erythema = increased skin vascularity, Chadwich Sign = bluish or purple discoloration of the vagina and cervix as a result of increased vascularity, Linea Nigra = midline pigmentation, Chloasma = blotchy pigmentation fo the nose and face

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Changes in Prego w/CV

decrease BP in 1st trimester, lowest at 24wks(should never see elevated arterial bp in prego). increase in plasma volume, decrease in SVR, increase in CO(loest in supine, highest in left later pos). left sternal systolic ejection murmer

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Changes in Prego w/Endocrine

increase in pituitary size and vasculitty, increase cortisol, increase in TBG due to estrogen = elevated T3/T4 total but normal free T3/T4

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Changes in Prego w/Renal

increase in volume = increase in kidney size, increase GFR, dec BUN, dec Cr, glucosuria

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Changes in Prego w/Pulmonary

tidal volume increases due to elevated diaphragm, residual volume decreases ==> RESPIRATORY ALKALOSIS from dec Pco2 & inc pH

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Changes in Prego w/GI

decreased GI motility & gastric motility due to increased progesterone

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Changes in Prego w/Heme

increase in RBC MASS; will see dillutional anemia, increased WBC count(max 16,000 @3rd trimester), normal platlets, increased coag factors from liver

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—- murmer can be normal in prego.

SYSTOLIC(left sternal) = due to increase blood volume. diastolic murmers are never normal and should be investigated

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3 in utero shunts within fetus

Ductus Venosus: umbilical vein –> IVC
Foramen Ovale: RA –> LA
Ductus Arteriosus: Pulmonary A —> descending aorta

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puberty takes — yrs to complete and is usually done by age —.

3-4, 16 yoa

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dafuq do the following do for lactation: Progest, Estro, Prolac, oxytocin

Progest: increase lobules, alveoli
Estrogen: increase ducts
Prolac: milk production
Oxy: milk let down

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Colostrum

first secretion of mammary ducts after deliver, high in protein low in fat. contains IgA for passive immunity.

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how many days after delivery for milk production to reach appreciable levels

1-3d

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estrogens effect on prolactin

estrogen helps ducts develop but also antagonizes positive effect of prolactin on milk production; once placenta is removed prolactin can go to work.

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What happens wk 1 postconception?

implantation of the blastocysts on the endometrium

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What happens wk 2 postconception?

bilaminar germ disk with epiblast and hypoblast layers; invasion of material sinusoids by syncytiotrophoblast = 1st time bhCG prego test can be positive

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What happens wk 3 postconception?

trilaminar germ disk with ectoderm, mesoderm & endoderm is formed

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What happens wk 4-8 postconception?

Major organs formed most important time

after 9 wks teratogens will mostly effect..

organ hypertrophy and hyperplasia

Ionizing Radiation in pregnancy

no single diagnostic procedure results in radiation exposure to a degree that woudl threaten the developing baby.

Chemotherapy in prego..

greatest risk in first trimester; 2-3 is most resitant

Tobaccos fx on prego

causes intrauterine growth restriction(IUGR)

Fetal Alcohol Syndrome

midfacial hypoplasia, microcephaly, mental retardation, IUGR, short palpebral fissures, long philtrum, cardiac defects

Cocaine use in prego

assoc w/placental abruption, preterm deliver, intraventricular hemorrhage, IUGR

Marijuana use in prego

preterm delivery

Diethylstilbestrol(DES) in pregnancy..

"estrogen" that caused T-shaped uterus, vaginal adenosis w/risk of clear cell carcinoma, cervical hood, incomplete cervix, preterm delivery

Dilantin in pregnancy

aka phenytoin. can cause: fetal hydantoin syndrome(IUGR, craniofacial dysmorphism(epicanthal folds, depressed nasal bridge, oral clefts), mental retardation, microcephaly, nail hypoplasia, heart defects)

Isotretinoin(accutane) in pregnancy

congenital deafness, microtia, CNS defects, congential heart defects

Lithium in prego

ebsteins anomaly =atrialization of the right ventrical due to tricuspid valve being displaced down into the ventrical

streptomycin in prego

inhibits 30s ribosome. Causes CN8 dmg(hearing) = hearing loss

tetracyclin in prego

blocks 30s ribosome. teeth discoloration/anomalies after the 4th month

thalidomide in prego...what does this treat?

tx multiple myeloma. causes: phocomelia(malformed limbs), limb retardation, ear/nasal anomalies, cardiac defects, pyloric or duodenal stenosis

Trimethadione in prego..

anticonvulsant. causes: facial dysmorphisms(short upturned nose, slanted eyebrows), cardiac defects, IUGF, mental retardation

Valproic acid(depakote) in prego

NTD(spina bifida), cleft lip, renal defects

Warfarin(Coumadin) in prego

Chondrdysplasia(strippled dpiphysis), microcephaly, mental retardatoin, optic atrophy

define: abortion

loss prior to 20 wks

define: antepartum death

death between 20 wks and labor

define: intrapartum death

death from onset of labor to birth

define: perinatal death

death between 20 wks and 28 days of life

define: infant death

death between birth and 1yr

define: maternal death

death during pregnancy or within 90 days after birth

MC trisomy causing 1st trimester lost

trisomy 16

MC trisomy @term

Klinefelter Syndrome

47XXY; dx usually made during puberty = tall, testicular atrophy, azopermia, gynecomastia, truncal obesity, learning disorder, AI dz, low IQ

Down Syndrome

trisomy 21: mental retardation short stature, muscular hypotonia, brachycephaly, short neck, oblique orbital fissure, flat nasal bridge, small ears, nystagmus, protruding tongue, congential heart disease, duodenal atresia

Edward Syndrome

trisomy 18: profound mental retardation, rocker bottom feet, clenched fist, F > M; mean survival = 14days

Patau Syndrome

trisomy 13: frofound mental retardation, IUGR, Cyclopia, Proboscis, holoprosencephaly, severe cleft lip w/palate. meav survual = 2days

AD dz's

polydactyly, hunting chorea, achondroplasia, marfan, myotonic dystrophy, PCKD, NF, Osteogenesis imperfecta

AR dz's

deafness, CF, thalassemia, albinism, SS anemia, Tay-Sachs dz, PKU, CAH, Wilson

XLR Dz's

Hemophila A, Color blindness, complete androgen insensitivity, diabetes insipidus, hydrocephalus, G6PD deficiency, Duchenne muscular dystrophy

neural tube should close by ---- postconception.

22-28 d

women at risk for NTD should consume ---mg of folic acid. Those who are not shoudl take ---mg.

risk = 4mg; no risk = 0.4 mg