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OB GYN > M1: Parturition Phase I > Flashcards

M1: Parturition Phase I Flashcards

0
Q

The average is cycle is ______ with a range of ________.

A

28 days. 25-32 days.

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1
Q

The development of predictable, regular, cyclical and spontaneous ovulatory menstrual cycle is regulated by the complex interactions of the

A

Hypothalamic-pituitary axis, Ovaries & Genital tract “HOG”

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2
Q

Released by the hypothalamus. Initiates the menstrual cycle. Transmitted from the hypothalamus to anterior pituitary gland. It signals the gland begin producing two hormones; ____ & ___.

A

GnRH. FSH & LH.

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3
Q

Active early in the cycle. Responsible for maturation of the ovum. Under the influence of this, the ovary begins to produce estrogen and the endometrium begins to proliferate.

A

FSH

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4
Q

A hormone that becomes most active at midpoint of the cycle. Responsible for ovulation or release of the mature egg cell from the ovary and growth of the uterine lining during the second half of the menstrual cycle. Aids in the formation of progesterone in the corpus luteum.

A

LH

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5
Q

Two members of the transforming growth factor-family. These two are triggers of the follicular development. FSH only enhances.

A

Growth differentiation factor 9 (GDF9) & Bone Morphogenetic protein 15 (BMP15)

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6
Q

Follicular development: FSH rise leading to follicle development is called

A

Selection window of the ovarian cycle

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7
Q

Follicular development: rise in parallel to growth of a dominant follicle and the increase in its number of granulosa cells (exclusive site of FSH receptor expression)

A

Estrogen

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8
Q

Small rise in the number signals ovulation. It maintains the pregnancy.

A

Progesterone

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9
Q

The increase in circulating ______ during the late luteal phase of the previous cycle stimulates an increase in FSH receptors and subsequently, the ability of ___________ to convert androstenedione to __________.

A

FSH. Cytochrome P450 aromatase. Estradiol.

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10
Q

The requirement of thecal cells which respond to LH & granulosa cells which responds to FSH, represents the ____________ for estrogen synthesis.

A

Two-gonadotropin, two-cell hypothesis

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11
Q

Conversion of androstenedione to estradiol

A

Theca cells

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12
Q

Progesterone positive feedback on pituitary leads to LH release. Inhibin negative feedback on pituitary to inhibit FSH.

A

Granulosa cells

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13
Q

The onset of the gonadotropin surge resulting from increasing estrogen secretion by preovulatory follicles is a relatively precise predictor of ovulation. It occurs ________ before the release of the ovum.

A

Ovulation. 34-36 hours.

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14
Q

Induces remodeling of the ECM to allow release of the mature oocyte with surrounding cumulus cells through the surface epithelium

A

LH

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15
Q

34-36hrs before release of the ovum from the follicle

A

Estrogen surge

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16
Q

Peaks at 10-12hrs before ovulation and stimulates the resumption of meiosis in the ovum with the release of the first polar body.

A

LH secretion

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17
Q

Post ovulation. Neovascularization. VEGF. Hypertrophy and increase capacity to synthesize hormones. Estrogen decreases with a secondary rise at the midluteal phase. Toward the end of this phase, there is secondary decrease in estradiol production.

A

Luteal or Postovulatory Phase

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18
Q

Granulosa lutein cells

A

Progesterone

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19
Q

________ develops from the remains of the dominant/graafian follicle in a process called _________. Rapidly regresses _______ days.

A

Corpus Luteum. Luteinization. 9-11.

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20
Q

Loss of luteal cells by apoptotic cell death. Decrease circulating estradiol and progesterone levels which are critical to allow the follicular develolment and ovulation during the next ovarian cycle.

A

Luteolysis

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21
Q

Correspond to follicular phase of the ovarian cycle. Increase estradiol. Re epitheliazation and angiogenesis. Glandular hyperplasia and increased stromal ground substance. Characterized by proliferation of vascular endothelial, stromal & glandular cells.

A

Proliferative/Preovulatory Endometrial Phase

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22
Q

Narrow & Tubular

A

Early proliferative

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23
Q

Endometrium thickens from bot glandular hyperplasia and increased stromal ground substance. Loss of stroma and the glands of the functionalis layer is widely spread.

A

Late proliferative

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24
Q

Determining the menstrual cycle day by endometrial histological criteria but is difficult during proliferative phase because of the considerable variation of phase length among women.

A

Dating

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25
Q

Correspond to luteal phase of the ovarian cycle. 12-14 days. Endometrial dating. Glandular epithelium histology. Window of implantation seem on days _______. Increase vascularization of spiral arteries.

A

Secretory or Postovulatory Endometrial Phase

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26
Q

Important in preparation of blastocyst implantation

A

Pinopodes

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27
Q

Between days _______ is striking changes associated with predecidual transformation of the 2/3 of the ________.

A

22-25. Functionalis layer.

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28
Q

Primarily secretes progesterone which is important to maintain pregnancy

A

Corpus Luteum

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29
Q

Life span of the egg

A

24hrs

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30
Q

Lifespan of the sperm

A

72hrs

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31
Q

Site of fertilization

A

Fallopian tube

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32
Q

Must be present in the fallopian tube at the time of the oocyte arrival

A

Spermatozoa

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33
Q

Still within the fallopian tube. Diploid 46 chromosomes. Surrounded by a thick zona pellucida. Forms the blastomeres, contain the polar body that are non functional and will soon regenerate.

A

Zygote(2/4/8 cell stage)

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34
Q

A solid mulberry like balls of cells. Enters the uterine cavity about 3 days after fertilization. Ends when the blastocyst forms.

A

Morula (16 cell stage

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35
Q

Gradual accumulation of fluid between the cells of the morula forms the early blastocyst. Consists of a single layer of ectoderm. 50-60 blastomeres present. Should be near the uterine cavity. Contains the inner cell mass, the cavity and the cells that will form into ______. The outer cells are called ________.

A

Blastocyst. Trophoblast. Trophectoderm.

36
Q

Normally once fertilized, the _____ moves down the fallopian tube towards the uterus, growing in size and complexity to form the _______. (From which the embryo and placenta will develop)

A

Ovum. Blastocyst.

37
Q

Within the days of conception, the blastocyst attaches itself to the lining of the

A

Upper part of the uterus

38
Q

If the passage of the fertilized ovum along the fallopian tube is delayed, then the blastocyst is ready for attachment before it has reached the uterine cavity, this will lead to

A

Tubal pregnancy

39
Q

Anything that affects the passage of the blastocyst along the fallopian tube may thus increase the likelihood of an

A

Ectopic pregnancy

40
Q

Produces proteases that degrades selected endometrial ECM proteins to allow its invasion

A

Trophoblast

41
Q

Trophoblast should implant at the

A

Posterior upper part of the endometrium

42
Q

If implanted at the bottom (near the internal cervical os) could result to

A

Placenta previa

43
Q

Blastocyst Implantation: ______ after fertilization, the embryo implants at the uterine wall.

A

6-7days

44
Q

Blastocyst Implantation: successful implantation requires a receptive endometrium appropriately primed with estrogen and progesterone by

A

Corpus luteum

45
Q

Blastocyst Implantation: uterine receptivity is limited to days ______ of the cycle.

A

20-24

46
Q

Blastocyst Implantation: if blastocyst approaches the endometrium after day 24, the potential for adhesion is diminished due to ____________ synthesis prevents receptors.

A

Antiadhesive glycoprotein

47
Q

Blastocyst Implantation: expressed on endometrial epithelium are considered a receptivity markers for blastocyst attachment

A

Alpha V beta 3 & Alpha 4 beta 1 Integrins

48
Q

Initial contact of the blastocyst to the uterine wall (upper portion of the uterine wall)

A

Aposition

49
Q

Increased physical contact between the blastocyst and uterine epithelium

A

Adhesion

50
Q

Penetration and invasion of the syncythiotropoblast and cytotroblast into the endometrium, inner third of the myometrium.

A

Invasion

51
Q

Successful endometrial blastocyst adhesion involves modification in expression of

A

Cellular Adhesion Molecules (CAMs)

52
Q

Cell surface receptors that mediate adhesion of cells to ECM proteins

A

Integrins

53
Q

Expressed on endometrial epithelium are considered a marker of receptivity for blastocyst attachment

A

V3 & 41 Integrins

54
Q

Exhibits the most variable structure, function and development pattern of all placental components.

A

Trophoblasts

55
Q

Human placental formation begins in the _________, which appears in the ______ stage. Gives rise to the ________ cell layer encircling the blastocyst.

A

Trophodectoderm. Morula. Trophoblast.

56
Q

Early of Trophoblast Invasion: By ____ day the blastocyst becomes totally encased within the ________.

A

10th. Endometrium.

57
Q

Early of Trophoblast Invasion: At ______ of development, the blastocyst wall facing the uterine lumen is single layer of flattened cells.

A

9 days

58
Q

A specialized, highly modified endometrium of pregnancy. It is essential for hemochorial placentation, that is, one in which maternal blood contacts trophoblasts.

A

Decidualization

59
Q

Transformation of secretory endometrium to decidua, is dependent on estrogen and progesterone and factors secreted by the implanting blastocyst.

A

Decidualization

60
Q

Directly beneath the site of blastocyst implantation

A

Decidua basalis

61
Q

Overlying the enlarging blastocyst and initially separating it from the rest of the uterine cavity

A

Decidua capsularis

62
Q

Lines the rest of the uterus.

A

Decidua parietalis

63
Q

During early pregnancy, there is a space between the decidua capsularis & parietalis because the _________ does not fill the entire uterine cavity. By _______ weeks gestation, the expanding sac has enlarged to completely fill the uterine cavity. The resulting apposition of the decidua capsularis & parietalis creates the _________ and the uterine cavity is functionally obliterated.

A

Gestational sac. 14-16weeks. Decidua vera.

64
Q

The decidua parietalis & basal are composed of three layers

A

Zona compacta, spongiosa & basalis.

65
Q

Surface or compact zone

A

Zona compacta

66
Q

Middle portion or spongy zone with remnants of glands and numerous small blood vessels

A

Zona spongiosa

67
Q

Basal zone

A

Zona basalis

68
Q

The zona compacta & spongiosa together form the _________. The ______ remains after delivery and gives rise to new endometrium.

A

Zona functionalis. Basal zone.

69
Q

Completed only with blastocyst implantation. Decidual cell becomes surrounded by a pericellular membrane. Allow attachment of _________. Protection against selected cytotrophoblastic proteases. Placenta accreta.

A

Decidual reaction. Cytotrophoblasts.

70
Q

Is a zone of fibrinoid degeneration in which invading trophoblasts meet the decidua

A

Nitabuch layer

71
Q

Blood supply to the ________ is lost as the embryo/fetus grows. Blood supply to the ________ through spiral arteries persists, retain a smooth muscle wall and endothelium and thereby remain responsive to vasoactive agents.

A

Decidua capsularis. Decidua parietalis.

72
Q

The spiral arterioles are invaded by the cytotrophoblast destroying its walls leaving only a shell without smooth muscles or endothelial cells so they cannot react to vasoactive agents

A

Decidua basalis

73
Q

Transport blood between the placenta and the fetus contain smooth muscles that can react to vasoactive agent

A

Fetal chronic vessel

74
Q

A product of the same gene that encodes for anterior pituitary prolactin.

A

Decidual prolactin

75
Q

Is the source of prolactin that is present in enormous amounts in amniotic fluid. Not to be confused with placental lactogen (hPL) which is produced only by _________.

A

Decidua. Syncytiotrophoblasts.

76
Q

The protein preferentially enters _________ and little enters the maternal blood. Consequently, prolactin levels in amniotic fluid are extraordinarily high and may reach 10,000 ng/mL during weeks _______. _______ function between maternal and fetal tissues.

A

Amnionic fluid. 20-24. Paracrine.

77
Q

Maintenance of amniotic fluid volume. Because most or all decidual prolactin enters amnionic fluid inside gestational sac.

A

Decidual prolactin

78
Q

Increase fluid inside gestational sac

A

Polyhydramnios

79
Q

Decrease fluid in gestational sac

A

Oligohydramnios

80
Q

Decidual prolactin may act in regulating ___________ during pregnancy. Prolactin receptors in a number of bone marrow derived immune cells, and prolactin may stimulate _______ in an autocrine or paracrine manner.

A

Immunological functions. T cells.

81
Q

May play a role in regulation of angiogenesis during implantation

A

Prolactin

82
Q

Enhances angiogenesis whereas the proteolytic fragment can inhibit new vessel growth

A

Protein

83
Q

Decidual prolactin has been to have a protective function by repressing expression of ______ detrimental to pregnancy maintenance.

A

Genes

84
Q

Acts synergistically with cyclic adenosine monophosphate on endometrial stromal cells in culture to increase prolactin expression

A

Progestins

85
Q

Attenuates the rate of decidual prolactin secretion

A

Arachidonic acid

86
Q

Decrease decidual prolactin secretion

A

Cytokines & EGF

87
Q

First day of menstrual period

A

LMP

OB GYN (5 decks)

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