OBGYN Block 1 Flashcards
The perineum is also AKA the ?
What is the anterior triangle called?
What is the posterior triangle called?
Inferior boundary of the pelvis
Urogenital
Anal
The urogenital and anal triangle is separated arbitrarily by ?
What makes up the urogenital diaphragm?
Transverse perineal muscles
Perineal body
Levator ani
Coccygus muscles
Vulva is AKA the ?
The labia majora, minora and clitoris are homologous to what male structures
Pudenda
Majora: scrotum
Minora: ventral shaft
Clitoris: erectile homologue
Labia majora taper posteriorly to form the ?
Labia minora fuse superiorly to form ? and infer/posterior to form the ?
Posterior commissure
Sup: clitoris/prepuce
Inf/Post: Fourchette
Define Hart Line
What do the outer and medial lines indicate?
Demarcation line in labia minora between skin and mucous membranes
Outer- Kerat Strat Squam epithelium
Medial: Non-kerat Squam Epithelium
? is the principle female erogenous zone
Define Vestibule
Vestibule runs from ? to ? and ? to ?
Glans of clitoris
Embryonic urogenital membrane derivative
Hart line to hymen
Clitoral frenulum to fourchette
Vestibule contains ? 4 structures
Define Hymen
Urethra
Vagina
Bartholin glands x 2
Skene gland ducts x 2
Elastic/collagen CT around vaginal orifice
Where are the Bartholin and Skene glands located
What type of hymen is of concern?
B: below hymen ring
S: largest paraurethral glands, near urethral meatus on anterior wall of vagina
Imperforate- retains all menses
What lubricates the inside of the vagina?
Why is this important to know?
Subepithelial capillaries Permeable epithelium
Inc secretions due to increase transudate from increased vascularity
Where is the fornix?
Why do post-menopause females complain of painful intercourse?
Recesses around cervix creating arch
Loss of rugae/transverse ridges due to atrophy
What are the three points of the fornix
Why is one of those landmarks important?
Lateral Anterior Posterior
Posterior fornix- access for culdocentesis: needle drainage of fluid from pouch of douglas
Pouch of Douglas is AKA ?
Fluid accumulation here can indicate ?
Retrouterine pouch between rectum and uterus
Ectopic pregnancy
What are the upper and lower boundaries of the cervix?
Define the Portio Supravaginalis
Upper- internal os, into uterus
Lower- external os, into vagina
Upper segment above the vagina’s attachment to the cervix
Define Nulliparous os
Define Parous os
Small, oval opening= no vaginal birth
Transverse slit= vaginal delivery
What are 3 signs/changes seen on the cervix during pregnancy
Chadwick: early blue tint from increased vascularity
Goodell: cervical softening due to edema
Hegar: Isthmus and uterus softening
Define Ectocervix
Define Endocervix
Cervix covered by stratified squamous epithelium
Cervical canal covered by columnar epithelium
Define the SCJunction
Define the T-Zone
Columnar cells meet squamous cells w/ position depending on age/hormone status
Transformation zone; area between original and new SCJ where 95% of cervical neoplasia occur
What is the sequence of cells and metaplasial changes at the cervical T-zone
Birth:
Columnar cells- endocervical
Squamous cells- cervix/vag
Puberty:
Columnar proliferate onto ectocervix, transforms back to squamous
What hormone affects the cell type and amount at the T-zone?
Define Corpus
Define Isthmus
Estrogen
Muscular upper portion of uterus
Joins corpus to cervix, forms lower uterine segment during pregnancy
Where is the visceral periotenum in the uterus?
What is the MC site of implantation of a fertilized egg within the uterus?
Posterior wall
Upper posterior wall
Uterus has ? general/normal position?
Define Myometrium and why is it useful
Anteroverted
Upper uterus smooth muscles and CT used for homeostasis during 3rd stage of labor
Who has a bigger uterus, 4y/o of newborn?
Why?
Newborn
Mother estrogen
Uterus and ovary are not connected but are both nested within ?
What is the most common site in the fallopian tube for fertilization and for extopic pregnancy
Mesosalpinx of broad ligament
Ampulla
What are the 4 parts of the fallopian tube
Ovaries secrete ? and are supplied w/ blood by ?
Infundibulum
Ampulla
Isthmus
Interstitial?intramural
Estrogen/Progesterone
Ovarian and uterine arteries
What is the MC site of ovarian cancers?
Where do ovaries drain blood into?
Epithelium, outer layer
L- L renal vein
R- R IVC
Ovarian ligament attaches ovary to and the suspensory ligament attaches ovary to ?
Difference between True and False pelvis
O: lateral uterus
S: wall of pelvis
True: immobile, constrains delivery of fetus
False: above linea terminalis, supports pregnant uterus
The two innominate bones of the pelvis are the fusion sites of ? 3 bones and join to sacrum at ?
The two innominate bones meet at ?
Ilium
Ischium
Pubis
SI joint
Symphysis pubis
What is the name of the preferred baby head position during delivery?
What are the 3 head positions seen during delivery
Occiput anterior- back of head facing maternal anterior in nose down position
Vertex
Sinciput
Brow- usually seen microcephaly fetus
What are the 3 important pelvic landmarks
What are the two pelvic types preferred for vaginal delivery and two that are least favorable
Interspinous diameters
Transverse inlet
Obstetrical conjugate- cant/not measured on living PT
+ Gynecoid, anthropoid
- Android, platypelloid
What maternal delivery position may be used to increase the pelvic outlet diameter?
What are the vessels that run diagonally toward umbillicus
Dorsal lithotomy inc by 1.5-2cm
Superficial epigastric
All superficial vessels of the abdominal wall arise from the ?
All inferior/deep vessels are branches of ? vessels and supply ?
Femoral artery below inguinal ligament in femoral triangle
External iliac
Muscle/fascia of abdominal wall
Maylard incisions may lacerate ? vessel and where
Why are vertical incisions avoided when possible?
Inferior epigastric artery lateral to rectus belly
High tension, wider scar
Low transverse incisions for delivery are AKA ? and follow ? dermatological line
What are the risks of performing an incision here?
Pfannenstiel
Langer lines
Damage to Iliohypogastric nerve- loss of sensation over lateral glute/hypogastric region
What are the 4 parts of the HPO axis that compile the menstrual cycle and the hormones released by each
Hypothalamus- GnRH
AntPit- PRL LH/FSH ACTH TSH GH
Ovaries
Endometrium
What effects do estrogen/progesterone have on the endometrium
What is the only female reproductive organ that remains unchanged during pregnancy
E: proliferative, grow
P: secretory
Ovary
What are the 3 sources of gonad tissues in females?
What is the progression of development into an ovary?
Mesothelium- posterior abdominal wall
Mesenchyme- embryonic CT
Primordial germ cells- earliest undifferentiated germ cells
Mesothelium Gonad ridge Gonad cord Indifferent gonad Ovary
Primordial germ cells take ? days for gestation, migrate along ? to ? and are incorporated into the ? by week 6 of gestation
24d
Dorsal mesentery to gonadla ridges
Gonad cord
Testes grow from ?
Ovaries grow from ?
What causes the distinguishing development
Mesonephric (Wolffian) duct
Paramesonephic (Mullerian) duct
Y chromosome releasing TDF= testes
No TDF= ovary
Feetal ovaries grow in response to ? and not ?
What causes these ovaries to not develop from paramesonephric/Mullerian ducts?
Lack of Y chromosome
No estrogen effect
Y chromosome and TDF
During fetal development oogonia undergo ? to replicate from their ? state
After completing this development and replication, what stage of replication do they sit in until puberty?
Mitosis
Diploid- 46XX
Meiosis I
? peaks between 8-12wks of development and stimulates testosterone development
? other glycoprotein is produced, where and what does it do
Hcg
AMH
Sertoli cells
Suppresses paramesonephric/Mullerian ducts
Define Didelphys
Define Bicornuate Uterus
Double uterus from failed fusion of inferior paramesonephric ducts
Duplicated superior portion of uterus
Define Bicornuate Uterus w/ Rudimentary horn
Define Septate Uterus
Slowed growth of one paramesonephric duct that fails to fuse
Internally divided uterus by thing septum due to failure of resorption
Define Unicornuate Uterus
One paramesonephric duct fails to develop
PT is fertile but w/ inc risk of preterm delivery/loss
Define Ovotesticular DSD
Chromatin pos nuclei
PT has ovotestis
M or F phenotype and ambiguous external genitals
Define 46XX DSD
What can this lead to?
+ normal ovaries
Clitoral hypertrophy, partial fusion of labia, urogenital sinus
Both Worlffian and Mullerian present
Congenital adrenal hyperplasia- deficient 21 hydroxylase
Define 46XY DSD
Poor virilization of male fetus deu to defect enzyme synthesis of testosterone causing d/o of testicular development
Chromatin negative nucli
Caused by low testosterone production and MIS
Define AIS
Androgen Insensitivity Syndrome
Externally female w/ testes and 46XY
Blind pouch vagina
Define Kallmann syndrome
2* hypogonadism due to Gnrh failure
Hypo Hypo
Anosmia
Low FSH LH and estrogen
Define Klinefelter
Primary Hypo
Lot T, Elevated FSH, LH
Define Turner Syndrome
Primary hypogonad 45XO Hyper Hypo Inc FSH LH, low estrogen Streak gonads/gonadal dysgenesis
Teen female PT w/ amenorrhea, absent uterus confirmed by US and genetically 46XX, what is the diagnosis
Define Gametogenesis
Mullerian dysgenesis
AKA MRKH Syndrome
Formation and development of ova/sperm precursors into gametes, ooctye/spermatozoa
What type of duplication occurs in gametogenesis
Where are premordial germ sperm cells stored until puberty
Meiosis I: diploid 46XY to haploid 23X and 23Y
Meiosis II: 2 haploid 23X and 23Y
Spermatogonia lie dormant in seminiferous tubules of testes until stimulated replication by GnRH
What are the two types of Spermatocytes
One primary spermatocyte develops into ? mature/mobile sperm
Primary: largest, diploid
Secondary: smaller, haploid
Four 23 chromosome sperm
What is the last phase of spermatogenesis
What is the use/function of an Acrosome
Spermiogenesis
Enzymatic digestion of egg zona pellucida
What is the function and location of Sertoli cells?
These also allow for passive transport from ? to ?
Seminiferous tubules
Develop/regulate spermatogenesis
Seminiferous tubule to Epididymis
How long does it take for sperm to mature?
What are the components of sperm?
What are found in each section
Spermiogenesis= 2mon + 1mon of maturation in seminiferous tubules
Head/Tail
Head: Acrosome, Nucleus
Tail: 3 segments- middle, principle, end
Mitochondria in middle
Define Sperm Capacitation
What is the function of the prostaglandins found in the semen?
Physiological process after ejaculation where sperm acquire ability to fertilize ova by readying acrosomal reaction
Stimulate uterine motility
Aids w/ movement to ampulla for fertilization
What are the 4 sub-cycles of the menstrual cycle
A normal cycle can last how long?
Hypothalamus- GnRH
Ant Pituitary- LH, FSH
Ovaries- estrogen, progestin androgen for folliculr, ovulatory and luteal phases
Endomtrium- mentrual, proliferative and secretory phases
28 +/- 7= 21-35 days
What immediately proceeds ovulation?
What controls the whole menstrual cycle
Estrogen surge then,
LH surge
Gonadotropin from hypothalamus
Endometrium responds to ? 3 and what 3 phases occur
What happens in the Proliferative and Secretory phases
Progestin Estrogen Androgen
Menstrual Proliferative Secretory
Pro: estrogen proliferates, spiral arteries lengthen, endometrial growth is max, straight glands, narrow lumen
Sec: progesterone from corpus luteum (after ovulation) stims glycogen secretion, glands dilate,
High estrogen at ovulation also causes ? changes at the cervix
What pattern would be seen under a microscope
Inc quantity of more alkaline mucus
Ferning test- no progesterone to inhibit estrogen induced pattern
What change occurs after oocyte is contacted by sperm?
What are the phases of fertilization?
Completes meiosis 2 via diploid event
Sperm passes through Corona Radiata Acrosoma reaction penetrates pellucida, changes permeability to other sperm Fusion Completion of meiosis 2 OOtid= zygote
What are estrogen, progesterone and prostaglandin effects on zygote implantation?
By implantation, what is the name of the form of the thing that implants
Estro: + sticking
Pro: - sticking
Prosta E: relaxes tube
Prosta F: stims tube motility
Blastocyst
What are the two layers of the blastocyst
What layer produces hCG
Embryoblast- embryo, amnion and cord
Trophoblast- chorion; forms placenta
Trophoblast produces hCG
What are the 3 phases of implantation
What is the name of the fertilized egg as it leaves the fallopian tubes and enters the uterus
Apposition
Adhesion
Invasion
Morula-Blastocyte-Implant
What are the two layers of implantation
Define Decidua and what does it do
Decidua may be AKA
Syncotiotrophoblast- outter
Cytotrophoblast- inner
Maternal component of placenta, establishes implantation of embryo
Endometrium of pregnancy- functional layer of pregnancy that separates from uterus after birth
What are the 3 different regions of the decidua
What parts separates conceptus from the uterine cavity
Basalis
Capsularis
Parietalis
Capsularis
By day _ the trophoblast differentiate into ? two layers
Upon implantation, it further develops into ?
8
Cytotropho/Cyncytiotrophoblast
Villous trophobloasts- become chorionic villi, fetal aspect of placenta, for transport funtions
Extravillous trophoblasts- migrate into maternal vasculature/decidua, anchor chorionic villi to uterus
What are the two types of extravillous trophoblasts that migrate into the decidua and myometrum
When chromosomal testing is done on babies, what is being tested?
Interstitial: penetrate myometrium, surrounds spiral arteries
Endovascular: penetrate spiral artery lumen, allows placenta blood flow to be low resistance
Chorionic villi
How many vessels are in the umbilical cord?
What is the name of the maternal surface of the placenta
What is the name of the fetal surface?
3- AAV (artery carry deoxygenated blood)
Vein: oxygenated and higher press
Basal plate- cleft/lobules called cotyledon
Chorionic plate- umbilical cord inserts at center
Where do vessels travel to after the cord?
Define Nitabuch Layer
Chorionic plate
Stem villi of platenal parenchyma
Maintains maternal/placental separation and zone of degeneration in decidua
Prevent placental invasion into uterus
What are the 3 abnormal variants to nitabuch layer
What are the risk factors for these to occur
P accreta- adheres to myometrium
P increta- invades myometrium
P percreta- perforates myometrium
Prior uterine surgery/C-section delivery
How long after conception does maternal blood enter the intervillous space from spiral arteries
Upon pushing through and being released, what structure does the blood bathe?
1mon
Synchytiotophoblast
What are the functional units of placental architecture and what do they contain
At what point in development are placenta and fetus the same weight
Cotyledon- one vein to enhance o2/nutrient exchange w/ maternal blood
17 wk
1st trimester, placenta grows faster than fetus
? maintains the corpus luteum
What makes this maintainer
Hcg
Synchtiotrophoblast during the 1st trimester
When does Hcg level peak?
What happens after the peak and what could a low or high amount mean
Doubles q2days, peaks by 60-70 days, plateau for pregnancy
Low- ectopic, spot abortion
High- gestational trophoblastic neoplasia
What hormone causes the n/v of morning sickness of pregnancy
What other issue can it cause
Hcg
Hyperemesis gravidarum
What is the purpose of the abrupt rise of hcg
What are the 3 advantages of fetal gas exchange?
Maintain corpus luteum and progesterone
Fetal Hgb higher affinity for o2
Bohr effect lowers o2 affinity w/ lower pH
Fetus has higher Hgb
Chorionic villi drain nutrients/o2 from maternal blood using ?
Define Nuchal cord
Bohr effect
Umbilical cord around fetal neck
What are the 3 parts of fetal cardiology that allow for R to L shunting
D Arteriosus- connects A and PA, diverts blood to brain, heart and away from lungs
F Ovale- shunts blood from RA to systemic circulation
D Venosus- bypasses hepatic circulation, remnant of ligamentum venosum
What is the Tanner Staging for breasts
1: elevation of papilla
2: buds and areola enlargement
3: breast tissue growth
4: projection of areola/papilla and secondary mound formation
5: adult type contours
What is the Tanner staging for pubic hiar
1: villus only
2: sparse hair along labia
3: coarse pigmented hair
4: adult hair but doesn’t spread to thighs
5: adult hair spreads to thighs
Define Thelarche
Define Adrenarche
Breast development due to estrogen
Pubic hair growth due to androgens
What is the sequence of event changes for female PTs
What is usually the first sign?
TAPP Me
Thelarche Adrenarche Pubarche Peak growth Menarche
Pubarche
Earlier onset of puberty can be due to ? body type
? hormone is proposed as the initiator hormone
Obesity
Leptin from adipocytes
What is the critical weight in order for females to begin menarche
What hormone sequence starts puberty
106lbs (48kg)
Inc Gnrh from hypothalamus causes AntPit to release FSH/LH
FSH/LH stimulate production of testosterone/estradiole/progesterone
What is the first sign of secondary sexual characteristics
Define Precocious Puberty
Thelarche
Appearance of secondary sex characteristics <8y/o
How is Precocious Puberty classified
Early + of HPO axis
Central- gonadotropin dependent; isosexual- 2* characteristic same for phenotype
Peripheral: gonadotropin independent; iso/heterosexual
Can lead to tumors, CAH, Cushings
