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Women's Health 2 > Phys - OB > Flashcards

Phys - OB Flashcards

1
Q

what timing must coitus occur around ovulation for fertilization to be possible

A

72 hours before

24 hours after

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2
Q

How long are sperm and oocytes viable

A
  • ovulated oocyte: 12-24 hrs

- sperm 12-48 hours

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3
Q

Journey of sperm to the egg

A
  • 250 m sperm per ejaculate
  • millions don’t make it to the vagina, millions die in acidic environment, and millions don’t make it through the cervical canal
  • uterine contractions act against sperm’s upward course
  • half go into the wrong uterine tube
  • only a few hundred make it to the ovum
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4
Q

Capacitation

A
  • changes sperm go through in order to penetrate and fertilize an egg
  • cholesterol stabilizes the acrosome
  • it depletes along the female reproductive path
  • takes 6-8 hours
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5
Q

Acrosomal reaction of sperm

  • chemical release
  • numbers
  • function
A
  • hyaluronidase, acrosin, other proteases to break down the cells around the egg
  • hundreds of acrosomal reactions needed (one sperm is not enough to fertilize an egg)
  • function is to breach the corona radiate and zona pellucida
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6
Q

How does monospermy occur?

A
  • sperm binds oocyte membrane
  • Na and Ca channels open
  • fast and slow blocks
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7
Q

Fast block to polyspermy

A
  • Na influx depolarizes the membrane

- prevents further penetration

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8
Q

Slow block to polyspermy

A
  • Ca influx causes cortical granule exocytosis
  • Contents are released into the ECF under the zona pellucida
  • binds water and swells to create a gel-like border around the egg
  • detaches sperm from the membrane
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9
Q

Once sperm is in, what occurs to complete fertilization

A
  • sperm nucleus is phagocytize by oocyte
  • Ca influx triggers completion of meiosis from metaphase II
  • sperm and oocyte pronuclei membranes rupture
  • fertilization is accomplished when chromosomes from egg and sperm combine and a diploid zygote is formed
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10
Q

First stages of cells after fertilization

A

early mitotic divisions of zygote increase cell number but not size:

  • 2 cells (36 hours after fertilization, in the uterine tube)
  • 4 cells
  • 8 cells etc
  • morula (100 cells, 72 hours, is in the uterus)
  • blastocyst
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11
Q

Blastocyst

  • describe
  • two main types of cells
A
  • fluid filled ball of cells
  • inside called blastocoel
  • Trophoblasts: single cell outer layer that become the placenta
  • Inner cell mass: becomes the embryonic disc
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12
Q

Implantation

  • When
  • describe process
A
  • D6
  • trophoblasts bind to endometrial cells and secrete digestive enzymes against endometrium
  • endometrium proliferates and covers the blastocyst
  • entire process occurs from approx D7 to D14
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13
Q

What happens to the blastocyst during implantation

A
  • Differentiates into two layers
  • Synctiotrophoblasts: multinucleate outer layer which continue to secrete digestive enzymes
  • Cytotrophoblast: inner cell layer
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14
Q

What hormone is released after implantation

A

HCG - human chorionic gonadotropin

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15
Q

HCG

  • secreted by what
  • target
  • action
  • timing
  • when detected in blood
A
  • secreted by synctiotrophoblasts
  • targets corpus luteum
  • stimulates secretion of P and E
  • starts W4, spikes W8
  • blood at W3
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16
Q

What secretes HCG after synctiotrophoblasts

A

Chorion

- develops from trophoblasts

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17
Q

When does the placenta take over E and P secretion?

A

W12

- corpus luteum no longer

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18
Q

Placentation

  • formed from what
  • timing
A
  • formed from embryonic and maternal tissues
  • Corionic villi of the embryo and decidua basalis (basal layer of uterine lining)
  • completed by W12
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19
Q

Describe the formation of the placenta

A
  • Chorionic villi projections formed by trophoblasts fill with embryonic vasculature and invade the functionalis.
  • The decidua basalis forms from endometrium between the stratum basalis and chorionic villi and fills with maternal vasculature
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20
Q

Describe the amnion

A
  • membranous sac
  • surrounds embryo
  • broken only by umbilical cord
  • filled with amniotic fluid: maternal fluid and fetal urine
  • allows free fetal movement
  • is turned over every 2 hours
  • provides thermostasis
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21
Q

What are three extra-embryonic membranes?

A
  1. yolk sac
  2. chorion
  3. allantois
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22
Q

Yolk sac

  • formed from what
  • function
A
  • forms from embryonic disc cells
  • produces fetal blood (no liver or bone marrow yet)
  • germ cells seed gonads
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23
Q

Chorion

  • forms what
  • function
A
  • forms placenta

- later fuses with amnion to form amniochorionic membrane

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24
Q

Allantois

  • location
  • forms what
A
  • out pocket of yolk sac
  • forms base for umbilical cord
  • becomes part of urinary bladder
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25
Q

Gastrulation

  • describe
  • when
A
  • formation of three layered embryo from two layered inner cell mass
  • Forms three primary germ layers: ectoderm, endoderm, mesoderm
  • Primitive streak develops: establishes bilateral symmetry and orientation
  • Days 14-21
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26
Q

What do the ectoderm, endoderm, and mesoderm become?

A
  • Ectoderm: skin and nervous system
  • Endoderm: epithelial linings
  • Mesoderm: notochord and everything else
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27
Q

Notocord formation

A
  • first organ to form
  • derived from mesoderm
  • gives signal for neurulation
  • forms axial support
  • replaced later by vertebral column
  • persists as nucleus pulposus of intervertebral discs
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28
Q

Neurulation

A
  • from ectoderm
  • surrounds notocord
  • detaches once neural tube is formed
  • Anterior end forms brain and posterior end forms spinal cord
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29
Q

Timing of important phases of neurulation

A
  • forms neural plate D7
  • forms neural folds D21
  • forms neural tube D23
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30
Q

What does the neural crest give rise to?

A
  • cranial, spinal, sympathetic ganglia

- adrenal medulla

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31
Q

Endoderm organogenesis

A
  • folds laterally, anteriorly, and posteriorly
  • edges fuse to form gut lining
  • oral and anal opening perforate lining
  • outpockets form mucosal linings and glands of respiratory and GU systems
32
Q

Mesoderm organogenesis

A
  • once notochord is formed, somites form
  • somites are 40 pairs of mesodermal blocks
  • complete at end of W4
33
Q

three portions of mesoderm organogenesis and what do they form?

A
  1. Sclerotome: vertebrae
  2. Myotome: skeletal muscle
  3. Dermatome: dermis of skin
34
Q

Fetal circulation

A
  • yolk sac and mesoderm form blood cells
  • mesoderm spreads to form vascular network
  • End of W3 2 vessels have fused and bent to form rudimentary heart
  • fetal circulation bypasses the liver and lungs
35
Q
  • When does the rudimentary heart start pumping?

- when is the CVS functional?

A
  • W4

- W8

36
Q

List the 5 fetal vascular modifications and what happens after birth

A
  1. umbilical vein: constricts/fibroses into ligamentum teres of round ligament of liver
  2. Ductus venosus: collapses, ligamentum venosum on undersurface of liver
  3. Foramen ovale: flap closes due to high L side pressure, fuses into fossa ovalis
  4. Ductus arteriosus: constricts and remains a fibrous connection between pulmonary artery and aorta
  5. Umbilical arteries: constrict/fibrose, persist as superior vesical arteries that supply the bladder and as umbilical ligaments
37
Q

Umbilical vein

A

Carries freshly oxygenated blood and nutrient rich blood from placenta to embryo

38
Q

Ductus venosus

A

sends blood from umbilical vein to IVC (nutrients skip gut/liver)

39
Q

Foramen ovale

A

oval opening in interatrial septum

40
Q

Ductus arteriosus

A

Between pulmonary artery and aorta

41
Q

Umbilical arteries

A

bilateral branches from internal iliac arteries, deliver blood to placenta

42
Q

Sexual determination

A
  • genetic gender determined at moment of fertilization

- XX vs. XY

43
Q

Sexually indifferent stage

  • when
  • describe
A
  • W 5-6
  • gonadal ridges of mesodermal derivation are the pre-gonads, become seeded with gametogonia from yolk sac (can be either sex, destined to go through meiosis)
  • 2 ducts form: paramesonephric (Mullerian) and mesonephric (Wolffian)
44
Q

Male sex differentiation

A
  • gonadal ridges develop into gonads
  • If have Y chromosome, around W7 gonads become testes and secrete testosterone
  • Seminiferous tubules develop from gonadal ridges
  • Gonads merge with mesonephric tubes (Wolffian) to develop into male anatomy
  • mesonephric ducts form remaining duct system
  • paramesonephric (Müllerin) ducts degenerate
45
Q

Female sex differentiation

A
  • “default”
  • Around W8 if no testosterone gonads develop into ovaries
  • cortical portion forms follicles
  • paramesonephric ducts develop into female duct system
  • mesonephric ducts degenerate
46
Q

Sexual differentiation

- what three structures develop into male or female sexual organs

A
  • genital tubercle
  • urethral folds
  • labioscrotal swellings
47
Q

Sexual differentiation: male

  • when is it a “male” embryo
  • describe formation of genitalia/organs
A
  • XY embryo at W8
  • genital tubercle: enlarges, become penis
  • Urethral folds: fuse to enclose urethral groove, form penile urethra and meatus
  • Labioscrotal swellings fuse to become scrotum
48
Q

Sexual differentiation: female

  • when is it a “female” embryo
  • describe formation of genitalia/organs
A
  • XX embryo at W8
  • genital tubercle: becomes clitoris
  • Urethral folds: form labia minora
  • Labioscrotal form labia majora
49
Q

Descent of testes

  • when
  • describe
A
  • about W32
  • migrate through inguinal canal into scrotum, drag blood and nerve supply
  • gubernaculum cord assists and becomes part of spermatic cord
  • tunica vaginalis is parietal peritoneum
50
Q

Descent of ovaries

  • when
  • describe
A
  • about W32
  • descend a short distance
  • gubernaculum splits to become ovarian and round ligaments
51
Q

6 Anatomical changes in pregnant body

A
  1. increase in vascular network and engorgement of blood in reproductive organs
  2. Chadwick’s sign - blue vagina
  3. Breasts enlarge and areolas darken
  4. Melasma
  5. Hypertrophy of myometrium
  6. Amniotic fluid increases
52
Q

Timing in pregnancy

  • when does uterus occupy the pelvic cavity
  • When is the fungus above the umbilicus
  • when is the fundus at the xiphoidal process
A
  • 16 weeks
  • 7 months
  • 9 months
53
Q

What is approx pregnancy weight gain?

A

30 lbs

54
Q

Gi physiologic changes during pregnancy

A
  • increased salivation
  • n/v
  • GERD
  • constipation
55
Q

urinary physiologic changes during pregnancy

A
  • fetal metabolic waste
  • increased volume load
  • increased frequency of urination
56
Q

respiratory system physiologic changes during pregnancy

A
  • nasal mucosa congestion
  • nosebleeds
  • increased respiration rate and vital capacity
  • dyspnea
57
Q

Cardio physiologic changes during pregnancy

A
  • increased blood volume 25-40%
  • increased bp
  • increased hr
  • decreased venous return
  • varicosities
  • increased CO by 20-40%
58
Q

7 placental hormones

A
  • Human placental lactogen
  • Human chorionic thyrotropin
  • Relaxin
  • HCG
  • Progesterone
  • Estrogen
  • Oxytocin
59
Q

Human placental lactogen

A
  • Enhances E and P effect on mammary tissue
  • glucose sparing effect for female (need to keep blood glucose appropriately high to support fetus)
  • promotes fetal growth
60
Q

Human chorionic thyrotropin

A
  • similar to TSH

- stimulates thyroid and increases metabolism

61
Q

Relaxin

A
  • produced by corpus luteum, placenta, and mammary glands
  • relaxes pubic symphysis and other joints
  • softens and dilates cervix
62
Q

HCG

A
  • produced by corpus luteum and placenta

- induces progesterone production

63
Q

Progesterone

A
  • maintains uterine lining
  • quiets uterus
  • thickens cervical mucus
  • inhibits lactation during pregnancy
64
Q

Estrogen

A
  • steadily increases during pregnancy
  • overwhelms progesterone near term (need uterine contracts to deliver!)
  • stimulates oxytocin receptors on myometrium
65
Q

Oxytocin

A
  • produced by fetal cells and hypothalamus (posterior pituitary)
  • acts on placenta
  • stimulates release of prostaglandins
  • causes uterine contractions
  • positive feedback with hypothalamus
  • creates strong rhythmic uterine contractions of labor
66
Q

Three stages of labor

A
  • dilation stage
  • expulsion
  • placental stage
67
Q

Dilation stage

A
  • cervix effaces and thins
  • contractions at fundus (later whole uterus)
  • engagement
68
Q

Expulsion stage

A
  • full dilation
  • contractions Q2-3 min, last 1 min
  • urge to push
  • crowning
  • birth
69
Q

Placental stage

A
  • uterine contractions compress blood vessels to limit bleeding
  • allows detachment
  • delivered about 15 min after expulsion
  • inspect to ensure all parts have been delivered, none retained
70
Q

First breath

A
  • CO2 accumulates
  • acidosis occurs: respiratory centers in brain stem are stimulated and cause first inspiration
  • surfactant reduces alveolar surface tension
  • Rate is 45+ for first two weeks
71
Q

Normal rr for children

A
  • newborn to 6 months: 30-60
  • 6-12 months: 24-30
  • 1-5 years: 20-30
  • 6-12 years: 12-20
72
Q

Prolactin-releaseing hormone (PRH)

A
  • released from hypothalamus
  • in response to elevated E, P, lactogen and suckling
  • target is anterior pituitary
  • stimulates release of prolactin
73
Q

Prolactin

A
  • anterior pituitary in response to PRH
  • targes mammary glands
  • stimulates milk production
  • initiates lactation post birth, takes a few days
74
Q

What is initial milk called? describe it

A
  • Colostrum
  • high in protein, vitamin A, sodium chloride
  • lower CHO, lipids, potassium than mature milk
75
Q

Oxytocin and lactation

A
  • released from posterior pituitary
  • response to cervical and nipple stretch and infant suckling
  • targets uterus and alveolar glands
  • stimulates release of milk and duct contractions
  • let down reflex

Women's Health 2 (9 decks)

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