menstruation and pregnancy

Question 1

what does the corupus luteum produce?

Answer 1

oestrogen and progesterone

Question 2

how long will LH maintain hormones in corpus luteum?

Answer 2

around a week or they will need another signal - this decline is what causes the bleed

Question 3

what are the cascade events in withdrawl of sex steroid?

Answer 3

• vasoconstriction
• tissue hypoxia
• connective tissue breakdown with production of enzymes
• fragmentation

Question 4

what controls blood lose during menstruation?

Answer 4

coagulation factors - concern if blood loss if more than 80mL

Question 5

what does ectopic mean/

Answer 5

when part of the lining is being shed in the wrong place and is either on the outside of the cervix or the fallopian tube

Question 6

how does endometriosis arise/

Answer 6

• Much of it by reflux menstruation – endometrial tissue fragments shed at menses passing through the Fallopian tube, then becoming established in ectopic sites.
• some endometriosis cannot be explained in this way sometimes you see it at remote sites that are no accessible to shed tissue. Stem cells can be remote sites and change into endometrium
• Alternatively it may arise de novo from progenitor cells in ectopic tissues
• Family history is a risk factor

Question 7

what are the symptoms of endometriosis?

Answer 7

• pelvic pain

- infertility

Question 8

what are the treatment options for endometriosis?

Answer 8

• surgery can be used to remove the lesions
• NSAID for pain management
• blocking hormonal cycle

Question 9

which drugs can be used to block hormonal cycle?

Answer 9

o Aromatase inhibitor – catalyzing formation of oestrogens
o Combined oral steroid contraceptive
o Gonadotropin-releasing hormone (GnRH) modulators – bucarilin way of shutting down the cycle

Question 10

when does ovulation occur?

Answer 10

between days 14 to 28

Question 11

where does fertilisation occur?

Answer 11

usually within the upper fallopian tubes, if sperm is present.

Question 12

what is pre-implantation?

Answer 12

around 6 days.

occurs as embryo moves down tube.

Question 13

what is the blastocyst?

Answer 13

where implantation takes place this stage needs to be reached to allow implantation to occur

Question 14

how does contracpetion work?

Answer 14

usually doesnt prevent fertilisation but instead blocks progession of pregnancy by preventing implantation

Question 15

what is interstital implantation?

Answer 15

embryos must develop to blastocyst stage to be able to implant.
embryo has to get under the surface and implant deep, they go dwon into suface within a week so allow pregnancy to progress.

Question 16

what is the implantation window?

Answer 16

mainly related to the LH peak around 36 hours post ovulation.
around day 7 embryo is receptive and if you leave it past this it wont be a successful pregnancy

Question 17

what is hCG?

Answer 17

• The placenta produces the polypeptide hormone hCG from the hatched blastocyst stage onwards
• It appears in measurable quantities in maternal blood (and urine) soon after implantation (used for pregnancy testing)
• Chorionic refers to the outer cells of the placenta
• hCG rescues the corpus luteum (so P continues to rise)
• Lack of timely appearance of hCG probably accounts for the ‘closure’ of the receptive period for implantation

Question 18

what are the levels of oestrogen and progesterone like in pregnancy?

Answer 18

much higher than a normal cycle and continue to rise throughout.

Question 19

when does hCG peak in pregnancy?

Answer 19

around 8-9 weeks, although it is still around it does decline after this time

Question 20

what is progesterone?

Answer 20

• regulates the rate of transport of the egg/embryo through the Fallopian tube, lined by cells that have cilia so they beat and move the embryo down towards the uterus
• prepares the uterus to receive the implanting blastocyst
• sustains the uterine lining (endometrium) throughout pregnancy
• inhibits myometrial contractility, until the end of pregnancy

Question 21

what is the luteoplacental endocrine switch?

Answer 21

• At 7-9 weeks, the placenta takes over the production of estrogen and progesterone from the corpus luteum
• Still produces steroid but it is not the main source as the placenta takes over

Question 22

when does the majority of miscarriages occur?

Answer 22

between week 7-9 when the placement takes over as the main source of steroid production

Question 23

how are steroid hormones produced in pregnancy?

Answer 23

cholesterol is imported into the placenta and converted into progesterone where is goes to the fetues and is convertred to androgens.
the oestroegn is then moved back into circulation.
placenta sends out lots of signals to continue metabolims and prepare for lactation

Question 24

what is an ectopic pregnancy?

Answer 24

tubule gets blocked
can occur in the fallopian tube as it is where fertilisation takes place
similar to endometritsis

Question 25

what are the symptoms of an ectopic pregnancy?

Answer 25

• abdominal pain
• hCG detected from pregnancy test, but this may be formed from a tumour.
• scan– no intrauterine body?
• ectopic pregnancy?
• tubal rupture can be fatal!
• medical management or surgery?
• methotrexate (folate antagonist, blocks DNA synthesis

Question 26

how can you terminate a pregnacy?

Answer 26

• surgically or medically
• up to 24 weeks, majority are done by the 13th week\
• drug similar to progesterine and binds to receptors acting as a antagonist

Question 27

what drug is mainly used to terminate pregnancy/

Answer 27

RU486

Question 28

what is human placental lactogen?

Answer 28

• hPL modulates intermediary metabolism by changing the level of insulin-like growth factor (IGF) in
• in turn this increases glucose and amino acid availability to the fetus to be able to grow. Important through placenta to allow growth of fetus
• polypeptide hormone

Question 29

how do hormones control labour?

Answer 29

progesterone suppresses myometrial contractility until late pregnancy. Initation of labour may be via inflammatory mediators. Things change when humans evolved – you have to have a lower uterine cervix which is capable to hold the conceptors in place.

Question 30

what is oxytocin?

Answer 30

• Peptide hormone (nine-mer)
• Released from posterior pituitary
• Levels rise in last trimester
• Myometrial receptors increase markedly around week 36
• Used, with PG analogues, to induce labou

Question 31

what is given if you need to advance mature fetal lungs/

Answer 31

• Glucocorticoid treatment

Question 32

what are the main types of drug used in pregnany which are safe?

Answer 32

• most diffuse across placenta and into fetal ciruclation
• lipohilic drugs (unionised)
• weakly basic
• larger molecules

Question 33

what are the problems with valproate?

Answer 33

used for the treatment of epilepsy

not safe to use in pregnacy as it is linked to birth defects and life long altering behavioral and learning issues

Question 34

what is pre term?

Answer 34

before 37 weeks

approx 5-10% of babies are premature

Question 35

what are the main thoughts on drug use in pregnancy?

Answer 35

• Try to avoid all drugs in the 1st trimester
• Essential therapy taper to lowest effective dose prior to conception
• If appropriate switch to a safer drug during pregnancy
• Use lowest effective dose for minimal duration