OBG-female physiology Flashcards
the endometrium and ovaries respond to ______ and ______ levels in the blood
estrogen and progesterone
blood levels are controlled by a ______ between the ovaries and the hypothalamus
feed back mechanism
when serum estradiol falls below a certain serum concentration, the hypothalamus produces ______
Gn RH = gonadotropin releasing hormone
the pituitary gland is then stimulated to produce ______ and ______
FSH = follicle stimulating hormone and LH = leuteniting hormone
as follicles grow, increasing estradiol levels within follicles help them ______ to the LH, with eventual ovulation
respond
the bleeding and shedding of the endometrial lining that occurs at approximately monthly intervals from menarche to menopause
menstruation
the onset of menses, usually at 11-14 years
menarche
termination of regular menses, usually between 45-55 years old
menopause
termination of regular menses prior to age 40
premature menopause
the bladder is adequately full for transabdominal pelvic US, when the dome of the bladder extends above the ______
uterine fundus
transabdominal followed by transvaginal US is the ______ for pelvic US
standard of care
what are the 3 contradictions to transvaginal US?
virginity, 3rd trimester bleeding, and postmenopausal vaginal stenosis (due to lack of estrogen)
what are the 3 ovarian phases?
follicular phase, ovulation, and luteal phase
in this ovarian phase the egg is surrounded by a fluid, FSH stimulating dominate egg (follicle), the dominate follicle (graffian follicle) moves to the surface (cortex) of the ovary
Follicular phase (day 1-14)
several follicles develop each month, the dominate follicle is identified about day ______ when it measures 10mm, size is larger than others
8
the dominate follicle grows linearly, approximately ______ per day, max diameter varies between ______
2-3mm, 15-30mm
any follicle greater than ______ will likely ovulate, a line of decreased reflectivity (hypoechoic) around the follicle suggest that ovulation will occur in ______
11mm, 24 hours
presents of cumulus oophorus (mural nodule in the follicle) suggest ovulation will within ______ hours
36
in this ovarian phase there is a surge of LH, then rupture of follicular membrane within 24-36 hours of the LH surge
ovulation (day 14)
what are the sonographic findings indicating that ovulation has occurred?
sudden decrease in follicular size and free fluid in pouch of douglas or adnexa
at this ovarian phase there is a crater left by the expulsion of the ovum, the crater is filled with a fatty, yellowish cell type (corpus luteum or “yellop body”)
luteal phase (day 15-28)
______ secretes progesterone and smaller amounts of estrogen to prepare and maintain the endometrium for implantation
corpus luteum
if there is a pregnancy, the pregnancy produces ______ (positive preg test), which stimulates the corpus luteum to produce progesterone. If not pregnant, drop in progesterone and menstruation begins
BhC6
what are the sonographic findings in luteal phase?
replacement of dominate follicle with an echogenic structure representing thrombus, small irregular cystic masses with irregular borders and low level echoes (the blood inside), its hypervascular with low resistance flow
what are the 3 uterine phase?
menstrual phase, proliferative phase, and secretory phase
______ is a catabolic process in which the ends is shed if implantation does not occur
menstruation (day 1-5)
______ phase is desquanation and sloughing of the superficial layer of endometrium and blood cells, expelled in the form of menses
menstrual
what is the sonographic findings of the menstrual cycle?
thick, echogenic prior to onset of menses complex at beginning of menses very thin (2mm) after menses
______ phase- regeneration and proliferation of endometrium, stimulates by estrogen which is secreted by the development of follicles
proliferative
what are the sonographic findings in proliferative phase?
“triple stripe” or tri layered endometrium, hypoechoic area around prominent midline echo
______ phase- at ovulation, the endometrium prepares for possible implantation of a fertilized ovum, progesterone from corpus luteum causes edematous, spongy endometrium
secretory (day 15-28)
without BhC6 from a fertile egg, the progesterone production from corpus luteum ______, causing menses
falls
what are the sonographic findings in secretory phase?
thick, echogenic endometrium, 14-16 mm, no triple stripe
______ pills contain both estrogen and progesterone, taken everyday for 20-21 days to prevent ovulation, no dominate follicle. the endometrium growth often is suppressed, so endometrium measurements will not be observed
oral contraceptive pills
______ can lest 5-10 years depending on the type, seen as an echogenic line with posterior shadow.
IUD (intra uterine contraceptive device)
______ is the inability of a man and women to achieve a pregnancy after at least 1 year of regular sexual intercourse without birth control
infertility (1 in 7 american couples affected)
what can cause infertility in females?
no ovulation or abnormal ovulation, transport/tubal factors (adhesion from infection), endometrioris, uterine factors like leiomyomas (fiborials), polycystic ovarial disease, and cervical mucus non alkaline
pelvic ultrasound is first line evaluation for fertility workup, ultrasound is also used in fertility clinics to ______ and ______ follicles
count and evaluate
what are the drugs for ovulation induction?
clonyphane citrate (clomid), stimulate released FSH or LH (gonadotropens), metformin (glucophoge), and porlodel
with ______ ovaries are stimulated to produce follicles, transvaginal ultrasound is preformed daily to monitor follicles
invitrofertilization (IVF)
which invitrofertilization, oocytes are aspirated and incubated with sperm, ______ fertilized eggs are transferred to uterine cavity
2-4
with ______ embryo (zygote or ferilized egg) is placed in the fallopian tube instead of the uterus
Zygote Intrafallopian tube transfer (ZifT)
with ______ sperm and ova is placed in fallopian tube
Gamete intrafallopian tube transfer (GIFT)
with ______ sperm it placed into uterus
intrauterine insemination (IUI)
what are the two complications of fertility treatment?
ovarian hyper stimulated syndrome and multiple gestations
______ is large simple cysts with a diameter grater than 5 cm, bilateral, and may have acites and pleural effusion
ovarian hyper stimulated syndrome (OHSS)
mild cases of OHSS usually resolve spontaneously following the next menstrual cycle, sever cases are associated with a mortality rate up to ______, may require hospitalization for connection of fluid/electrolyte imbalances
50%
with ______ there is higher risks to mother and high premature delivery
multiple gestations
excessive volume during cyclic menstrual bleeding
hypermenorrhea
an abnormally small amount of menstrual bleeding
hypomenorrhea
frequent menstrual bleeding occurring less than 21 days apart
polymenorrhea
menstrual bleeding occurring more than 35 days apart
oligomenorrhea
irregular, frequent bleeding
metrorrhagia
bleeding that is irregular in both frequency and volume
menometrorrhagia
bleeding that occurs between normal cycles
intermenstrual bleeding
intermenstrual bleeding is OC or HRT
breakthrough bleeding
bleeding after vaginal intercourse
postcoital bleeding
painful bleeding
dysmenorrhea
absence of menstrual flow; may be primary- patient has never had a period or secondary - patient had period but they stopped
amenorrhea
bleeding occurring 1 year after menopause
post menopausal bleeding
abnormal bleeding from an essentially normal uterus
dysfunctional uterine bleeding (DUB)
