Lecture 04 AP Female Reproduction Flashcards
Where is the Bartholins Gland located and what does it do?
located on posterior on either side of vagina opening at 4 and 8 o’clock Secretes clear mucous to lubricate
Why is the fourchette important to note?
When we talk about STDs and herpes. Herpes will be lesions and blisters, and may have skin tear regions in that area.
Describe the AP of Vagina and pH level
Fibro-muscular, tubular with rugae( transverse folds allow expansion during childbirth)Few sensory nerve ending with an acidic pH of 4-5
What is the uterus like? What are the 3 layers to the uterine wall?
3 layers to uterine wall
Endometrium: area that sloughs off if woman isn’t pregnant
Myometrium
Perimetrium
AP of cervix
cylindrical opening at bottom of uterus made up of fibrous connective & elastic tissue which thins and opens during vaginal delivery (effacement and dilatation)
Describe the fallopian tubes and size.
attached to fundus of uterus, allows passage from ovary to uterus of ovum. (10cm long x 1cm wide)
What does ovaries do? What 3 hormones does it produce? Size of ovaries?
ovulation (release of a mature egg/ova) and hormone (estrogen, progesterone & androgen production). (2.5 – 5 cm long x 1.5 – 3 cm wide)
Menstrual Cycle Terminology
Puberty def:
transitional stage b/w childhood and sexual maturity; marked increase in estrogen production b/w 8~11 weeks
Menstrual Cycle Terminology
Menarche
First menstruation, typically around age 12, it’s dif from puberty
Menstrual Cycle Terminology
Menopause
end of woman’s productive phase; occurs b/w ages 50 & 55
Menstrual Cycle Terminology
Perimenopause
beings in late 40s. Irregular menses, sx of menopause beings, gradual decline of estrogen
Menstrual Cycle Terminology
Menstruation
periodic uterine bleeding that begins approx 14 days after ovulation. Complex feedback system that prepares uterus for pregnancy. When pregnancy doesn’t occur, menstruation occurs. Best time to get pregnant is 12,14,16 days before next menses. It’s not advised to have sex twice a day, since it takes a man 36 hours for sperms to really regenerate.
What occurs during ovulation?
Ovulation - Approximately mid-cycle (day 14) the dominant follicle releases an ovum, or egg into the fallopian tube. Divides ovarian cycle from endometrial cycle;
After ovulation, ova live for 24 hours without fertilization; remains of the dominant follicle in the ovary become a corpus luteum;
What does the Corpus luteum do?
Corpus luteum produces large amounts of progesterone which causes the endometrium (uterine lining) to thicken/prepare for potential implantation of an embryo to establish a pregnancy.
What occurs if implantation doesn’t happen?
If implantation does not occur within approximately two weeks, the corpus luteum will involute, causing sharp drops in levels of both progesterone and estrogen. These hormone drops cause the uterus to shed its lining and egg in a process termed menstruation. Menstrual bleeding is endometrial tissue, mucous & blood
Cycle is complex interplay between the Hypothalumus-Pituitary gland and Ovaries
What occurs during the endometrial cycle?
menstruation occurs. Stimulated by increasing amounts of estrogen in the follicular phase, endometrium thickens.
Fertilization: Where does it take place in the fallopian tube?
what occurs?
- Takes place in the distal/outer 1/3 of the fallopian tube (“ampulla’)
- Cellular replication occurs as the fertilized ovum (zygote) travels the fallopian tube into the uterus. Usually takes 3 – 4 days
Implantation: When does it occur?
Why does ovulation cease during pregnancy?
- 6~10 days after conception, tophoblast cells embed in the endometrium. Implantation bleeding can occur.
- Ovulation ceases during pregnancy due to high levels of estrogen and progesterone.
What occurs during an ectopic pregnancy?
- Fertilized ovum does not implant in endometrium, 95% of ectopic pregnancies occur in the ampulla of the fallopian tube.
Leading cause of 1st trimester pregnancy related death.
What increases the incidences of ectopic pregnancy?
- Birth control
- STI
- Other hormones being taken
What are Sx of ectopic pregnancies?
- Missed/late menstrual period, dark red/brown vaginal bleeding, unilateral pain, tenderness. Pain escalates from dull to colicky as tube stretches.
- Bleeding into peritoneal cavity causes referred shoulder pain, acute deep LQ pain.
- If internal bleeding, symptoms of vertigo, lightheadedness, hypotension
What are Dx (diagnosis) of ectopic pregnancies?
- High index of suspicion, pregnancy test, transvaginal ultrasound
- Active bleeding associated with tubal rupture
- Main concern is rupture and shock
What are two treatment options for ectopic pregnancies?
- Surgical
2. Medical
What does Surgical treatment of ectopic pregnancies consist of?
Surgical removal of ectopic pregnancy
(salpingostomy) before rupture or
laparoscopic removal