Laboratory Diagnostics & Reproductive A&P Flashcards
Vaginal pH
Normal level
pH >4.5 indicates what
Normal pH is 3.8-4.5
pH >4.5 indicates bacterial vaginosis, trichomoniasis, atrophic vaginitis
Vaginal wet mount indications and contraindications
Indications: itching, burning, rash, odor, discharge
Cannot do during menses
No vaginal meds w/in 2-3 days
Irritations (tampons, intercourse) can alter results
Wet Mount findings
White cells
Clue cells
Lactobacilli
Trichomonads
White cells: normal is <10 in high powered field - should be more epithelial cells than white cells
Clue cells: vaginal epithelial cells covered w/ bacteria - have shaggy borders w/ stippled appearance
-indicate bacterial vaginosis (fishy smell, pH >4.5)
Lactobacilli: normal flora - decreased w/ yeast infections or bacterial vaginosis
Trichomonads: STI flagellated parasite
Nucleic Acid Amplification Testing (NAAT)
For N. gonorrhoea and C. trachomatis
Can be done from vaginal fluid, endocervix swab, or on UA
NAAT detects more chlamydial infections that culture or early tests
For UA: collect >1 hr after last void, 1st catch UA is optimal
Diethylstilbesterol (DES)
Synthetic estrogen given between 1940-1970 to reduce miscarriages
DES daughters @ increased risk for rare clear cell vaginal cancer, infertility, t-shaped uterus, cervical and breast cancer
DES sons @ increased risk cryptorchidism, hypogonadism, and epidermal cysts
Moms have increased risk breast cancer
Theca cells
Granulosa cells
Preovulatory follicle cells
Theca cells secrete androgens and are stimulated by LH
- possible cancer source
Granulosa cells convert androgens to estrogen and are stimulated by FSH
Blood supply directly connecting anterior pituitary to hypothalamus
Hypothalamic-Hypophyseal portal circulation
No direct nerve connections here
Gonadotropin-releasing hormone (GnRH)
Hypothalamic hormone - responsible for LH and FSH release
Stimulated by norepinephrine, inhibited by dopamine
Low pulse frequency triggers FSH release, high-frequency triggers LH release
Follicular phase
1-12 days - 1st day after menses over
Low estrogen and progesterone state - FSH and LH levels increased
FSH stimulates estrogen release from granulosa cells and causes follicle and egg maturation in ovary
LH: low levels trigger theca cells to release androgens and stimulate estrogen production
Estrogen levels increasing, have initial negative effect on LH and FSH to prevent new follicles maturing
Ovulatory phase
Day 12-14
At day 12 - peak estrogen levels switch to positive feedback on GnRH
This causes a surge of estrogen, FSH and LH
LH surge causes ovulation - egg released and follicle ruptures
Luteal phase
Ruptured follicle (corpus luteum) secretes progesterone & estrogen
These have negative feedback on GnRH
Progesterone maintains the endometrial linings & secretions for 9-11 days
If no conception in luteal phase
After 9-11 days, progesterone levels decrease
Menstrual period triggered w/ rise in FSH
If implantation occurs in luteal phase
Zygote produces HCG
HCG mimics LH -> causes corpus luteum to keep producing progesterone
Endometrial lining remains intact until placenta takes over
Follicular Phase Summary
Proliferative phase
Estrogen dominates
Mature follicle develops
LH surge triggers ovulation
Luteal Phase Summary
Secretory phase
Ovulation must occur to have luteal phase
Progesterone dominates w/ elevated basal body temperature
Further preparation of endometrium to receive fertilized egg
