OB Basics Flashcards
1
Q
Adult Derivatives of the Urogenital Sinus, Female
A
Lower 3/4 of the vagina
Vestibule (including vestibular glands)
Bladder
Urethra (including urethral and paraurethral glands)
2
Q
Adult Derivatives of the Urogenital Sinus, Male
A
Bladder
Urethra
Prostate
Bulbourethral glands
3
Q
Scrotal ligament (male) : _________ (female)
A
Gubernaculum testis
Female: Round ligament of the uterus
4
Q
Timeline for the hormones of sexual differentiation
A
7th week: SRY gene activated -> TDF
8th week: MIH and Testosterone
9th-12th week: DHT secretion begins
5
Q
Male Development: Primary sex cords: Rete testes + mesonephric remnants: Mesenchymal thickening: Mesothelial cells:
A
Primary sex cords: Testis cords (middle) + rete testis (end)
Rete testes + mesonephric remnants: Efferent ductules
Mesenchymal thickening: Tunica albuginea
Mesothelial cells: Sertoli and Leydig Cells
6
Q
Disorders of Sex Development:
Primordial germs cells do not form/migratePatient is female
A
Gonadal agenesis
7
Q
Disorders of Sex Development:
One testis, one ovary, external genitalia of both sexes
A
True hermaphroditism
8
Q
Disorders of Sex Development:
46XY
Ambiguous external genitalia until puberty
Deficiency of DHT
A
5a-reductase type 2 deficiency
9
Q
Adult Derivatives of the Mesonephric Ducts, Male
A
SEED Seminal vesicles Epipdydymis Ejaculatory Duct Ductus Deferens
10
Q
Adult Derivatives of the Mesonephric Ducts, Female
A
Appendix of vesiculosis
Gartner’s Duct
12
Q
Adult Derivatives of the Paramesonephric Ducts, Female
A
FUUH Fallopian tubes Uterus and Cervix Upper 1/4 of vagina Hydatid of Morgagni
13
Q
Congenital Malformations
Diagnosis of Cryptorchidism is made after how many months of undescended testis
A
3-6 months
14
Q
Congenital Malformations
Most common penile anomaly
Pathogenesis?
A
Hypospadias
Failure of the closure of the urogenital sinus
15
Q
OOgonia
What phase from before birth until puberty?
Until ovulation?
At fertilization?
A
Meiosis 1 prophase
Meiosis 2 metaphase with formation of 1st polar body
Completion of Meiotic division with formation of 2nd polar body
16
Q
Female Pelvic Ligaments
Suspensory ovarian ligaments
A
Connects ovary to lateral wall
Contains ovarian vessels
17
Q
Female Pelvic Ligaments
Ovarian round ligament
A
Ovary to uterus
18
Q
Female Pelvic Ligaments
Broad ligament
A
Uterus, fallopian tubes, and ovaries to lateral pelvic wall
19
Q
Female Pelvic Ligaments
Cardinal ligament of Mackenrodt
A
Connects cervix to lateral pelvic wall
Major support to uterus and cervix
20
Q
Female Pelvic Ligaments
Uterine round ligament
A
Uterus to labia majora via the inguinal canal
Contains the artery of Sampson
Maintains anteversion during pregnancy
21
Q
Congenital Malformations
Mayer-Rokitansky-Kuster-Hauser Syndrome
A
Mullerian agenesis
2nd most common cause of primary amenorrhea
Tx: Mackendow procedure
22
Q
Congenital Malformations
Uterus Didelphys
A
2 hemiuterus, 2 cervix
23
Q
Congenital Malformations
Most common Mullerian duct abnormality
A
Septate uterus
Most common cause of 2nd trimester abortion
24
Q
Female Anatomy:
Define vulva
A
All structures visible externally from the pubis to the perineal body
25
Q
Female Anatomy:
What are the contents of the vestibule?
A
HymenVaginal openingUrethral openingPeriurethral glands (Skenes glands)Vulvovaginal glands (Bartholin glands)
26
Female Anatomy:
| Differentiate labia majora and minora
Majora: KSSE (outer), NKSSE (inner) (+) hair follicles, sweat glands, Montgomery glands
Minora: NKSSE, (-) hair follicles, sweat glands
27
Pathology of the Skenes glands (particularly if menopausal)
Urethral diverticulum
Sx: recurrent UTI
Tx: Treat UTI and resect
28
Pathology of the Bartholins glands
Bartholin's cyst / Abscess
| Tx: marsupialization
29
Female Anatomy:
| Area of paucity in the vagina
Upper & middle third
| Area where tampons can be forgotten
30
Female Anatomy:
| Vaginal length
Ant: 6-8 cm
| Post 7-10 cm
31
Female Anatomy:
| Blood supply of the Vagina?
Upper: Cervico-vaginal branch of the uterine art
Middle: Inferior vesical arteries
Lower: Middle rectal & Int. Pudendal art
Venous drainage: Vaginal plexus drains into int. iliac vein.
32
Fallopian Tube:
| What are the 4 segments?
Intramural: within uterus muscular wall
Isthmus: narrowest portion
Ampulla: widest and most tortous
Infundibulum: (+) fimbriae
33
Adult Derivatives of the Paramesonephric Ducts, Male
Appendix of the testes
34
Ectopic pregnancy rates within the Fallopian tubes
80% ampulla
12% isthmus
~5% intramural
~1-2% interstitial
35
Ovary: Attaches the ovary to the broad ligament
Mesovarium
| Note: the ovary is not covered by peritoneum
36
Ovary: Layers of the ovary
Cortex:
Germinal Epithelium of Waldeyer / Surface epithelium
Tunica albuginea
Primordial and Graafian follicles
```
Medulla:
Loose connective tissue
Smooth muscles
Stroma and blood vessels
Few to No follicles
```
37
Nerve injuries during obstetric procedures
| Radical hysterectomy
Genitofemoral nerve & obturator nerve
38
Nerve injuries during obstetric procedures
| Improper dorsal lithotomy position
Peroneal nerve
39
Fallopian tube:Longest fimbriae
Fimbria ovarica
40
Nerve injuries during obstetric procedures
| Inguinal node dissection
Femoral nerve
41
Complication during node dissection of the obturator fossa
Ext. iliac artery
42
Bony Pelvis:
| Boundaries
Superior: pelvic inletInferior: pelvic outletAnt: Pubic bones, ascending rami, obturator foraminaLat: ischial bones and sacrosciatic notch
43
Complication due to straddle / anesthesia for the second stage of labor
Pudendal artery damage
44
```
Diameters of the Pelvic Inlet
Transverse:
Oblique:
Post Sagittal:
AP:
```
```
Transverse: 13 cm
Oblique: 13 cm
Post. Sagittal: 4 cm
True conjugate: 11 cm
Obstetrical conjugate: 10 cm
Diagonal conjugate: >11.5 cm - only one measured clinically.
```
45
Signs of a contracted midpelvis
Prominent ischial spine
Convergent sidewalls
Shallow sacrum
Narrow sacroiliac notch
46
Laxity of the pelvic joints
Due to hormonal changes during pregnancyEsp. affects the symphysis pubisIncreases mobility of sacroiliac joint
47
How is the midpelvis measured? Pelvic outlet?
Midpelvis: at the level of the ischial spines
Outlet: intertuberous diameter
48
Ischial spines as a landmark:
1) Plane of least pelvic dimensions
2) Levator ani muscle at this level
3) Engagement at this level
4) IR of head when occiput
5) Mid forceps, low if beyond this
6) Pudendal nerve block
7) Normal external cervical os
8) Location for ring pessary for pelvic organ prolapse
49
Pelvis types:
| Most to least common type
Gynecoid
Anthropoid
Android
Platypelloid
50
Pelvis type:
| Prone to Deep transverse arrest
Android (with worst prognosis)
51
Pelvis type:
| Prone to face delivery
Anthropoid
52
Pelvis type:
| Poor prognosis for vaginal delivery
Android
| Platypelloid
53
Pelvis typesMost to least common type
Gynecoid
Anthropoid
Android
Platypelloid
54
Pelvis type:Prone to face delivery
Anthropoid
55
Follicular Phase Goal
Restore endometrium, prepare for pregnancy
56
Follicular Phase
| Theca Cell
LH stimulation
Desmolase active (cholesterol to pregnenolone)
Androgens produced
57
Follicular Phase
| Granulosa Cell
FSH stimulation
| Converts androgens to estrogen
58
Follicular Phase
| Estrogen
Inhibits FSH and LH release
Increases Granulosa cell sensitivity to FSH
Initiate release of inhibin - allowing only 1 secondary follicle to develop
Uterine cells to increase rate of mitotic division
Cervical mucous : ferning (7th-18th day crystal arborization)
59
LH Surge
Triggers ovulation and follicular rupture in 12-24 hours
Cumulus-oocyte complex
Luteinization of Granulosa Cells
Resumption of oocyte maturation
60
Ovulation
~Day 14 of the cycle
| Spinnbarkeit formation
61
What is Spinnbarkeit?
Egg white cervical mucous, stretches 6cm.
62
Post-Ovulatory Phase
Corpus Luteum?
Corpus Hemorrhagicum?
Luteum: granulosa + theca cells
Hemorrhagicum: mittelschmerz
63
Post-Ovulatory Phase
| Progesterone
**Table in First Aid
64
Menstruation:
| Most striking and constant event:
Period of vasoconstriction preceding menstruation.
65
Menstruation:
| By what day has the endometrium been restored?
5th.
66
Urine Metabolites during the Menstrual cycle
Early follicular: low pro, inc est
Late follicular: low pro, rapid inc est
Luteal phase / pregnancy: progesterone
67
Preovulatory or Postovulatory?
| Constant (14 days)
Postovulatory
68
Preovulatory or Postovulatory?
| Low basal temp
Preovulatory
69
Preovulatory or Postovulatory?
| Thin and watery cervical mucous
Preovulatory
70
Preovulatory or Postovulatory?
| Dominant hormone: estrogen
Preovulatory
71
Endometrium of pregnancy?
| What are its layers?
Decidua Basalis, Capsularis, Parietalis
| Later, the capsularis and parietalis fuse to become the Decidua vera
72
Decidua Basalis
Implantation site
73
Decidua capsularis
Overlies the enlarging blastocyst
| More prominent during the 2nd month of pregnancy, eventually fuses with parietalis
74
Decidua parietalis
Remainder of the uterus
75
Key event in fertilization allowing the sperm to penetrate the zona pellucida
Acrosome reaction
76
Cycle day: 22-24
Predecidual reaction (ready for zygote implantation)
77
Earliest histologic sign of progesterone action
Basal vacuolation
78
Postconception: Week 1
Cleavage
Blastocyst
Implantation
79
Postconception: Week 2
Embryoblast differentiated
| Trophoblast differentiated
80
Differences between syncytiotrophoblast and cytotrophoblast?
Cytotrophoblast: divides mitotically
Syncytiotrophoblast: produces HCG
81
Postconception: Weeks 3-8
Gastrulation
| Period of high susceptibility to teratogens
82
Formation of Organs/Limbs
CNS: first to develop, continues postnatally
Heart: completed by 8 weeks
Upper limb: completed by 8 weeks
Lower limb: completed by 8 weeks
Ext. Genitalia: differentiated by 12 weeks
83
Amniotic fluid, by the numbers
12 weeks: 60 mL
34-36 weeks: 1 L
Term: 840 mL
42 weeks: 540 mL
84
Production and Regulation of Amniotic fluid
Production: amniotic epithelium, fetal kidneys
Regulation: fetal swallowing, fetal aspiration, exchange between skin and fetal membranes
85
Placenta at Term, by the numbers
450-500g
| 15-20 irregularly shaped and sized cotyledons
86
Fetal Development:
| Embryonic period
3rd week after ovulation until 8th week AOG
87
Fetal Development:
| Abortus
20 weeks or less
| Birth weight < 500g
88
Fetal Development:
| Week 12
Uterus becomes an abdominal organ
| (+) breathing movements
89
Fetal Development:
| Week 14
Gender can be identified by experienced examiners
90
Fetal Development:
| Week 16
(+) quickening
91
Fetal Development:
| Week 20
(+) vernix caseosa
| Lanugo covers the whole body
92
Fetal Development:
| Week 28
Starts eye opening
| 90% chance of survival
93
Fetal Development:
| Week 32
Testis descend
94
Fetal Development:
| Week 34
Mature hair appears
95
Fetal Development:
| Week 36
More rotund body, (+) fat deposition
96
Fetal Development:
| Week 40
Testes in inguinal canal / scrotum
97
Determining Fetal Age by UTZ
1st trim: CRL
2nd trim: BPD / FL
3rd trim: BPD
98
Head Circumference
Smallest?
Greatest?
Smallest: sub-occipitobregmatic (32 cm)
Greatest: Occipitofrontal (34.5 cm)
99
Head Diameters
| Greatest transverse
Bitemporal (8.0 cm)
BPD (9.5 cm) - greatest transverse
Occipitomental (12.5 cm)
100
Fetal circulatory shunts
Ductus venosus -> ligamentum venosum
Foramen ovale -> closes
Ductus arteriosus -> fxn closed 10-12 hours post birth, anat closed 2-3 weeks
101
Fetal Hematopoeisis
Embryonic period: yolk sac
2nd trim: Liver & spleen = Hemoglobin F
3rd trim: Bone marrow (starts at 4months AOG) persists until adulthood.
102
Test for fetomaternal hemorrhage
Kleihauer-Betke Test
| Fetal RBCs are resistant to denaturing effects of alkali - adult RBCs become ghosts.
103
Surfactant
Produced by type 2 pneumoncytes
| As early as 28 weeks but a sufficient amount is present only at 34-36 weeks.
104
When does alveolar development complete?
8 years of age
105
Hormones of Pregnancy:
| HCG
Produced by syncytiotrophoblast
Plasma within 7-9 days of fertilization
Doubles every 1.4-2 days, max level around 8-10 weeks
Nadir at 18-20 weeks
106
Hormone of pregnancy that:
Rescues the corpus luteum
promotes male sexual differentiation
Promotes secretion of relaxin (vascular vasodilation and myometrial smooth muscle relaxation)
HCG
107
Hormone of pregnancy that:
Prolactin and growth hormone like activity
Diabetogenic
HPL / Chorionic somatomammotropin
108
Hormone of pregnancy that:
Ensures uterine quiesence during pregnancy
Inhibits T-lymphocyte mediated tissue rejection
Progesterone
109
Hormone of pregnancy that:
| Is produced from the fetal adrenals
DHEAS - processed into estriol
110
Hormone of pregnancy that:
| Dominates during week 1- week 6 of gestation
Estradiol
111
Maternal Adaptation to Pregnancy
| Softening of and compressibility of the isthmus occurring in the 6th-8th week AOG.
Hegar's sign
112
Maternal Adaptation to Pregnancy
| Softening of the cervix from 6th-8th week AOG
Goodell's sign
113
Maternal Adaptation to Pregnancy
| Edema and engorgement of vasculature: bluish discoloration at 6 weeks AOG
Chadwick's sign
114
Maternal Adaptation to Pregnancy
| Changes in Skin
MSH: linea nigra, chloasma
Hyperestrogenemia: spider nevi
Corticosteroids: striae
115
Maternal Adaptation to Pregnancy
| Cardiac Changes
HR: Inc 10bpm
Volume: Inc 40-45%
CO: significant increase 30-40% (if patient is supine, decreased by 20%)
BP: no change in systolic, decreased diastolic
Heart displaced upwards and to the left
116
Maternal Adaptation to Pregnancy
| Genito-urinary changes
Urinary stasis due to increased peristalsis
Asymptomatic bacteruria
Nocturia
117
Maternal Adaptation to Pregnancy
| Renal changes
Kidneys hypertrophy
GFR inc by 50%
Inc: GRF, RPF, Crea Cl.
Dec. BUN, Crea, Uric acid
118
Maternal Adaptation to Pregnancy
| Physiologic Hydroureter
Estrogen: hypertrophy and muscle elongation
Progesterone: atony
Right > Left
119
Maternal Adaptation to Pregnancy
| GI Changes
Appendix displaced upward and viscerally
Dec: GIT motility, LES tone, CCK (gallbladder stasis)
Inc: Water absorption
Inhibited intraductal transmission of bile acid = Pruritus gravidarum, Intrahepatic cholestasis
120
Maternal Adaptation to Pregnancy
| Hematologic
Hemoglobin: 12.5, Anemia: 11
Hematocrit: decreased
Decreased platelet count
Slightly hypercoagulable
All coag factors increased except 11 and 13
121
Maternal Adaptation to Pregnancy
| Endocrine
Pituitary gland enlarges 135% (-) increase in blood supply
Adrenal hyperplasia,
Inc: cortisol (most bound to transcortin), aldosterone, deoxycorticosterone, testosterone
Thyroid: increased production (40-100%), but still euthyroid
Parathyroid: PTH: Decrease 1st trim, increase during the rest; Calcitonin: increased
Ovaries at rest
122
Maternal Adaptation to Pregnancy
| Pulmo
RR unchanged
Inc: TV and resting minute ventilation
Dec: FRC and RV (Diaphragm elevates ~4cm during pregnancy)
123
Maternal Adaptation to Pregnancy
| Weight gain
```
12.5kg or 27.5lbs
BMR inc 10-20%
"convention"
1st trim: 2lbs
2nd: 11lbs
3rd: 11 lbs
```
124
Maternal Adaptation to Pregnancy
| Immunologic
```
Suppressed T helper Cells (Th4)
Increased Th8
PMN leukocyte chemotaxis decreased
Increased leukocytes
Increase in cervical IgA and IgG
```
125
Maternal Adaptation to Pregnancy
| Eyes
Decreased IOP
| Corneal sensitivity
126
Maternal Adaptation to Pregnancy
| CNS
Attention, concentration and memory problems
127
Maternal Adaptation to Pregnancy
| Skeletal
Progressive lordosis
| Increased pelvic joint mobility
128
FDA Classification of Drugs for Pregnancy
```
A: Ayos sa fetus!
B: Bad sa hayop
C: Culang [sic] sa pag-aaral
D: Desperate measures (benefit>risk)
X: X_X
```
