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OB (outcome 2 & 3) Flashcards

1
Q

What 2 phases is the endometrial cycle divided into?

A
  • proliferative/follicular phase

- secretory/luteal phase

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2
Q

Proliferative/Follicular Phase

A
  • 1st half of menstrual cycle
  • gradual thickening of functional layer (proliferation)
  • in response to estrogen
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3
Q

Secretory/Luteal Phase

A
  • 2nd half of menstrual cycle
  • increased vascularity and preparation for implantation (differentiation)
  • in response to progesterone (mostly) and estrogen
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4
Q

What day does menstrual bleeding mark?

A

1

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5
Q

What does menstrual bleeding happen in response to?

A
  • decrease in estrogen and progesterone levels

- endometrium starts to break down and shed

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6
Q

After menses, what do rising levels if estrogen form?

A

-new functional layer of endometrium

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7
Q

How many mm is the endometrium in the later proliferative phase (trilaminar)?

A

11mm

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8
Q

What happens in the secretory phase?

A
  • after ovulation

- levels of estrogen and progesterone prepare endometrium to accept the blastocyst

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9
Q

How do estrogen and progesterone prepare endometrium to accept the blastocyst?

A
  • thickening of endometrium
  • more blood vessels develop
  • uterine glands get bigger
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10
Q

What is the sono appearance of the endometrium in the secretory phase?

A

-hyperechoic

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11
Q

Series of Ovarian Events Involved in Ovulation

A
  • oocyte maturation
  • ovulation
  • release of mature ovum into fallopian tube
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12
Q

3 Phases of Ovarian Cycle

A
  • follicular
  • ovulatory
  • luteal
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13
Q

Follicular Phase (ovarian cycle)

A
  • group of primary follicles begin to develop (FSH)
  • produce estrogen
  • 1 follicle becomes dominant (produces more estrogen and the rest of the follicles undergo atresia)
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14
Q

What does the dominant follicle become?

A
  • graafian follicle

- moves toward ovarian wall

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15
Q

Cyclical Endometrial Changes

A
  • occur at a young age (11 to 13)
  • 1st menstrual period (menarche)
  • absent before puberty
  • absent in post menopausal women
  • can be absent with hormonal imbalances, BCP and hormone therapies
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16
Q

Ovulatory Phase (ovarian cycle)

A
  • LH surge causes follicular and ovarian wall to rupture
  • ovulation occurs
  • mature ovum gets picked up by fimbriae
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17
Q

Mittelschmerz

A
  • mid cycle pain

- symptom of ovulation

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18
Q

Signs of Ovulation

A
  • mittelschmerz (mid cycle pain)

- small amounts of fluid in PCDS

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19
Q

Luteal Phase (ovarian cycle)

A

-graafian cavity collapses and forms into corpus luteum (CL)

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20
Q

What hormones does the corpus luteum secrete?

A
  • progesterone (mostly)

- estrogen (some)

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21
Q

How many days does the corpus luteum last?

A
  • 12 to 14 days

- unless it receives hCG from gestational sac

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22
Q

What happens to the corpus luteum without fertilization?

A
  • corpus luteum degenerates
  • becomes corpus albicans
  • decrease in progesterone
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23
Q

What does the hormonal cycle involve?

A

Interactions of Several Hormones:
-GnRH (gonadotropin releasing hormone)

  • FSH (follicle stimulating hormone)
  • LH (luteinizing hormone)
  • estrogen
  • progesterone
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24
Q

What is the hormonal cycle controlled by?

A

-negative and positive feedback loops

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25
Day 1 to 5 of Menstrual Cycle
- low levels of estrogen and progesterone initiate + feedback to hypothalamus (increase in GnRH, FSH and LH) - FSH stimulates follicles
26
Day 5 to 13 of Hormonal Cycle
- growing follicles produce estrogen (done by Graafian follicle later on) - high levels of estrogen lead to endometrial thickening - FSH causes maturation of dominant follicle into graafian follicle
27
Day 14 (ovulation) of Hormonal Cycle
- high estrogen levels cause LH surge - enzymes released that degrade follicular wall (ovulation) - LH also stimulates formation of CL from collapsed dominant follicle
28
Day 15 to 28 of Hormonal Cycle
- CL produces progesterone and estrogen (endometrium continues to thicken) - high levels of progesterone and estrogen (activate negative feedback to hypothalamus and ant. pituitary gland) - no FSH and LH
29
Amenorrhea (symptom of early pregnancy)
- consistant levels of estrogen and progesterone from corpus luteum and placenta later - results in complete cessation of menstrual cycle
30
Symptoms of Early Pregnancy
- amenorrhea - morning sickness - breast changes - urinary frequency - abd enlargement - quickening
31
Morning Sickness (symptom of early pregnancy)
- high levels of hormones - altered metabolism - physical changes - fluctuating BP
32
Hyperemesis Gravidarum
-severe nausea and vomiting
33
Breast Changes (symptom of early pregnancy)
- sensitive to changes in estrogen | - enlargement may be felt as early as 6 weeks
34
Urinary Frequency
- caused by hCG - blood volume increases, causing more filtration through kidneys - pressure of enlarged uterus on bladder - stress incontinence (caused by coughing, sneezing, laughing or exercise)
35
Abd Enlargement @ 10 to 12 Weeks
-fundus is just above symphysis pubis
36
Abd Enlargement @ 16 Weeks
-half way between symphysis and umbilicus
37
Abd Enlargement @ 20 Weeks
-@ umbilicus
38
Abd Enlargement @ 36 Weeks
-fundus just below xiphoid process
39
Quickening (symptom of early pregnancy)
- perception of movement by mother - 1st pregnancy is let between 18 to 20 weeks - 2nd/3rd pregnancy is felt at 16 weeks
40
B-hCG
- glycoprotein produced during pregnancy | - detected in mothers blood and urine
41
In the initial stages of pregnancy, B-hCG is important in maintaining what?
-corpus luteum (allows continued production of estrogen and progesterone, maintaining the thickened, vascular endometrium)
42
2 Types of Pregnancy Tests
- qualitative | - quantative
43
Qualitative Pregnancy Test
-assess amount of B hCG in urine - will show positive or negative based on amount - if negative, if can be repeated a few days later (hCG rises quickly)
44
Quantitative Pregnancy Test
-assesses amount of B hCG in blood - for singelton pregnancy between 3 to 5 weeks, B hCG will double every 2 to 3 days - after 6 weeks, it slows down and peaks at 8 to 12 weeks
45
Gravida
-# of pregnancies - twins are 1 - miscarriage is 1 - includes current pregnancy
46
Nulli Gravida (G0)
-never pregnant
47
Primi Gravida (G1)
-1st pregnancy or has only been pregnant once
48
Multi Gravida (ex. G3)
-has been pregnant more than once
49
Para/Parity
-# of viable births - twins are 1 - any birth over 20 weeks (including stillbirths) counts
50
Abortus
-# of pregnancies lost for any reason - ex. A# - includes abortions and miscarriages
51
TPAL
-used to provide patient obstetrical history T- term births (after 37 weeks gestation) P- premature births A- abortions/miscarriages L- living children
52
Ho many weeks do most pregnancies last?
- 40 weeks from LMP - 280 dyas - can be +/- 2 weeks
53
A pregnancy before ___ weeks in considered premature.
-37
54
Trimesters
1st- 1 to 13 weeks 2nd- 14 to 26 weeks 3rd- 27 weeks to term
55
Gestational Age (GA)
= conceptual age + 2 weeks | -aka menstrual age
56
How is gestational age measured?
-weeks from last normal menstrual period to the current date
57
Conceptus Period
-3rd to 5th weeks since LMP
58
Embryonic Period
- 6th to end of 10th week since LMP - involves the completion of organogenesis (formation of organs) - after this, it is a fetus
59
EDD
- estimated date of delivery | - expected due date
60
EDC
- estimated date of confinement | - expected date of confinement
61
How is due date calculated?
-wheel or software on US machine
62
Conception
-combining of an oocyte (mature ovum) and a spermatozoon
63
When does conception occur?
- within 24 to 36hours of ovulation | - day 14/15 of cycle
64
Where does conception occur?
-ampullary region of fallopian tube
65
What does conception form?
-single cell zygote
66
How many chromosomes does a zygote have?
- 46 (23 from each parent) | - 22 autosomal pairs, plus 1 pair of sex chromosomes (XY/XX)
67
3 Parts of a Blastocyst/Blastula
1) trophoblast 2) embryo blast/ICM 3) blastocele
68
Trophoblast (blastocyst)
- future placenta (embryonic part) | - produces hCG that supports CL
69
Embryoblast/ICM (blastocyst)
-will develop into embryo
70
Blastocele (blastocyst)
-fluid filled cavity
71
What day does the blastocyst implant?
- 20 to 23 of LMP (5 days after fertilization) | - continues to develop after it burrows
72
What does development of an embryo involve?
- decidua - blastocyst - amniotic cavity - chorion - yolk sac - gastrulation
73
Decidua
-endometrium during pregnancy
74
Blastocyst
-embryo
75
Amniotic Cavity
-houses pregnancy within gestational sac
76
Chorion
-develops into placenta
77
Yolk Sac
-provides nutrients to fetus
78
Gastrulation
-3 germ cell layers
79
Decidual Reaction
- changes that occur in the endometrium - due to estrogen and progesterone from the CL - involves further development and growth of endometrium
80
3 Layers of Decidualized Endometrium
1) decidua basalis 2) decidua capsularis 3) decidua parietali/vera
81
Decidua Basalis
- aka decimal plate - site of blastocyst attachment - develops into maternal part of placenta
82
Decidua Capsularis
-covers blastocyst and separates it from endometrial cavity
83
Decidua Parietalis/Vera
-remainder of endometrium (not directly in contact with blastocyst)
84
How long does implantation of the blastocyst take?
-4 days

Term 2 (19 decks)

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