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Physiology Flashcards

1
Q

Describe the follicular phase of the ovarian cycle

A

The follicular phase is dominated by FSH released by the pituitary in response to GnRH

This stimulates egg development so that follicles ready to be released

Mid-cycle; rise in oestrogen causes LH surge which causes egg to be released and ovulation to occur

Follicle releases egg and becomes corpus luteum

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2
Q

Describe the Luteal phase of the ovarian cycle

A

Follicle becomes corpus luteum which starts to release hormones; oestrogen and progesterone

Initially following LH surge oestrogen drops (-ve feedback) but then corpus luteum begins to release it

Progesterone makes the endometrium receptive to egg implantation

If this does not happen then a period will occur

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3
Q

Describe the uterine cycle

A

Day 0 = period starts with vasoconstriciton of vessels and breakdown of endometrium

Menses leads into proliferative phase where oestrogen starts to repair endometrium; thickening and development of gland crypts

Ovulation occurs and progesterone released which leads into secretory phase; making endometrium receptive to implantation of fertilised egg

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4
Q

What is the difference between the ovarian cycle and uterine cycle?

A

Ovarian cycle is in terms of hormones and egg production

Uterine cycle is in terms of the endometrium

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5
Q

What is the role of GnRH in female reproductive system?

A

From hypothalamus

Stimulates LH and FSH secretion from anterior pituitary

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6
Q

What is the role of FSH in female reproductive system?

A

From anterior pituitary

Stimulates follicular recruitment and development

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7
Q

What is the role of LH in female reproductive system?

A

From anterior pituitary

Maintain dominant follicle, induce follicular maturation and ovulation, stimulate CL function

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8
Q

What is the role of oestradiol in female reproductive system?

A

One of the oestrogens (strongest of the three)

  • supports female secondary sexual characteristics and repro organs
  • negative feedback control of LH and GnRH
    EXCEPT for late follicular phase (positive control LH surge)
  • Stimulates proliferative endometrium
  • negative control of FSH
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9
Q

What is the role of progesterone in female reproductive system?

A

From corpus luteum

  • maintains secretory endometrium
  • -ve feedback control of HPO
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10
Q

What are the systemic effects of oestrogen?

A
  • protein, carbohydrate and lipid metabolism
  • water and electrolyte balance
  • blood clotting
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11
Q

What are some targets for oestrogen?

A 
CNS
Anterior pituitary 
Fat distribution
Mammary gland
Bone maturation and turnover
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12
Q

Describe oogenesis

A

Oognium are stem cells in ovaries; undergo mitosis to produce primary oocytes shortly or after birth

Meiosis starts but arrested in prophase I

Group primary oocytes hormone responsive each cycle; one completes meiotic division and releases haploid secondary oocyte

Extra genetic material becomes polar body

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13
Q

Describe sperm production

A

Occurs in testis; seminiferous tubule

Germ cells produce sperm

Sertoli cells support sperm producing cell and produce inhibin

Interstitial leydig cells produce testosterone

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14
Q

What does FSH control in males?

A

induces spermatogenesis in seminiferous tubules of testis

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15
Q

Wha does LH control in males?

A

Induces leydig cells to produce testosterone

Testosterone acts on sertli cells to support sperm developing cells

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16
Q

Describe the normal process of ejaculation

A

Sperm created in testis

Travels through vas deferens to urethra

Seminal vesicles and prostate create semen which is carried along with sperm to urethra

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17
Q

Describe the lifespan of spermatozoa

A

Produced from puberty throughout life

About 30million per day

60-75 days for sperm production

10-14 days for transport to epididymis

20-100million released per ml of ejaculate

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18
Q

What factors can affect oogenesis/spermatogenesis?

A

Problem with hormonal control i.e. genetic, tumours, meds, functional

Problem at site of production i.e. genetic, cancer treatment induced, surgery, trauma, infections

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19
Q

What changes occur in the breast during pregnancy?

A

Increased size and vascularity; warm, tense and tender

Increased pigmentation areola and nipple

Secondary areola appears

Montgomery tubercles appear on areola

Colostrum-like fluid can be expressed from end of third month

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20
Q

What are postpartum CV changes?

A

Return to normal by 3 months (mostly)

BV decreases by 10% post-partum

BP initially falls then increases again days 3-7 (pre-preg levels by 6 weeks)

HR returns pre-preg over two weeks

CO increases by up to 80% 1st hr post delivery then continues to fall over next 24hrs

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21
Q

Describe changes in the respiratory system during pregnancy

A

Significant increase in O2 demand

40-50% increase in minute ventilation

Raised TV, relatively normal RR

Decreased functional residual capacity

Reduced PCO2

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22
Q

Describe renal system changes in pregnancy

A

Dramatic dilation urinary collecting system; more pronounced on right

Increased renal plasma flow

Raised GFR

Creatinine clearance raises by up to 50%, so creatinine reduced

Protein excretion raised, glycosuria common

Microscopic haematuria may be present

80% women develop oedema

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23
Q

What haematological changes occur in pregnancy?

A

Plama vol increases

Reduced hg, hcrit,

Increased rcc but this is diluted by plasma

Reduced platelet count

2-3 fold increase in Iron requirement

10-20 fold increase in folate requirement

WCC increases

HYPERcoaguable

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24
Q

What is the definition of normal labour?

A

Process in which foetus, placenta and membranes are expelled via birth canal

Spontaneous, 37-42 weeks gestation

Foetus presenting by vertex

Results in spontaneous vaginal birth (SVD)

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25
Describe the initiation of labour
Triggered by paracrine and autocrine signals generated by maternal, foetal and placental factors
26
What physiological changes must occur to allow expulsion of foetus?
Cervix softens Myometrial tone changes to allow co-ordinated contractions Progesterone decreases whilst oxytocin and prostaglandins increase to allow for labour to initiate
27
Describe stage I of labour
Latent first stage - established first stage - complete when cervix is fully dilated - length of established first stage of labour varies - anticipated progress 0.5-1 cm per hour
28
Describe stage II of labour
From full cervical dilation to birth of baby Passive second stage and active second stage Primagravida birth would be expected within two hours of active second stage Multigravida birth would be expected within one hour of active second stage
29
Describe stage III of labour
Time from birth to expulsion of placenta and membranes Active management of third stage OR Physiological management of third stage Prolonged third stage if it is not completed within 30 mins of birth with active management or 60 mins of birth with physiological managment
30
How do you check progression and monitor labour?
- maternal observations - abdominal palpation - vaginal examination - monitoring of liquor - auscultation of fetal heart - palpation of uterine muscle contractions EXTERNAL SIGNS; rhomboid of Michaelis and anal cleft line
31
Describe the mechanism of labour
- descent - flexion - internal rotation of head - crowning and extension of head - restitution - internal rotation of shoulders - external rotation of h head - lateral flexion
32
What are indications for induction of labour?
- Diabetes - Failure to start labour - Overdue Term + 7 days - maternal health problem necessitating planning of delivery i.e. on DVT treatment - foetal reasons eg. growth concerns
33
What does induction involve?
An attempt to instigate labour artificially using medications and/or devices to "ripen cervix" followed usually by artificial rupture or membranes Vaginal prostaglandin pessaries or balloon can be used to open cervix Bishop's score is used to clinically assess the cervix - score 7 or more means ready for amniotomy Once amniotomy performed, IV oxytocin can be used to achieve adequate contrations
34
What is Bishop's score?
Used to clinically assess the cervix Determined by dilation, length, position, consistence, station
35
What is amniotomy?
Artificial rupture of waters
36
Describe some problems with powers (contractions) in labour
Inadequate progress - cephalopelvic disproportion - malposition - malpresentation - inadequate uterine activity - other reasons for obstruction i.e. ovarian cyst Foetal distress
37
How is progress monitored in labour?
Cervical effacement, cervical dilatation, descent of foetal head through maternal pelvis
38
What is moulding?
Where sutures cross over one another Can occur due to cephalopelvic disproportion
39
Describe position in labour
The position of the baby's head in reference to the mother's symphysis pubis
40
What is a CTG?
Cardiotocography Continuous monitoring of baby's heart beat
41
In what situations should you advise not to labour?
Obstruction to birth canal; major placenta praevia, masses Malpresentations; transverse, shoulder, hand, breech(?) Medical conditions where labour would not be safe for woman Specific previous labour complications; previous uterine rupture Foetal conditions
42
What can be used in assisted/instrumental delivery?
Accounts for around 15% of births Forceps Vacuum extraction
43
What are some 3rd stage complications in labour?
Retained placenta Post-partum haemorrhage; 4 Ts tone trauma tissue thrombin Tears; graze, 1st-4th degree
44
What are some common post-partum problems?
All women 6 week post-natal check at GP - problems with infant feeding - problems with bonding - social issues (partner, other children, financial)
45
What is the "puerperium"
The post partum period from birth - 6 weeks after
46
What hormone do trophoblast cells produce?
B-hCG Beta human Chorionic Gonadotropin
47
What is the target and function of B-hCG?
Target is corpus luteum in ovary Function is to stimulate corpus luteum to produce progestogen which stops decidua from shedding This hormone forms the basis for pregnancy tests
48
Describe analgesia in labour
- breathing, massage, TENS, paracetamol, dihydrocodeine - water - Entonox (inhaled) - Opioids - Remifentanil patient controlled analgesia - Epidural CONSIDER; Maternal position and mobility can also affect pain
49
Define infertility
An inability of a couple to conceive after 12 months of regular intercourse without use of contraception
50
What is the chance of conception?
>80% couples in general population will conceive within 1 year is woman under 40 and do not use contraception whilst having regular intercourse Of those that don't conceive in first year, about half will in second year
51
What is considered at an infertility consultation?
Are eggs available? Are sperm available? Can they meet? Can embryo implant?
52
What female history is considered at infertility consultation?
- duration of infertility - previous contraception - fertility in previous relationships - previous pregnancies and complications - menstrual history - medical and surgical history - sexual history - previous investigations - psychological assessment
53
What female examination is important in an infertility consultation?
- weight - height - BMI - fat and hair distribution - galactorrhoea - abdo exam - pelvic exam
54
What do we look for on pelvic examination?
``` Mases Pelvic distortion Tenderness Vaginal septum Cervical abnormalities ``` Fibroids
55
What baseline investigations are carried out at infertility consultation?
Female partner - rubella immunity - chlamydia - TSH - if period regular; mid luteal progesterone - if period irregular day 1-5 FSH, LH, PRL, TSH, testosterone Male partner - semen analysis
56
How are suspected tubal and uterine abnormalities investigated?
Women without co-morbidities i.e. PID, previous ectopic, endometriosis Offered Hysterosalpingography (HSG) to screen for tubal occlusion Less invasive and more efficient use of resources than laparoscopy
57
What is important to consider in the male history at an infertility consultation?
Developmental - testicular descent - change in shaving freq - loss body hair Infections - mumps - STDs Surgical - varicocele repair - vasectomy Previous fertility
58
What examination of male is considered at infertility consultation?
- weight - height - BMI - fat and hair distribution - abdominal and inguinal exam - genital exam; epididymis, testes, vas def, varicocele
59
Describe varicocele
Dilation of pampiniform plexus of spermatic veins in scrotum Affects semen parameters including low sperm concentration Surgical varicocele treatment will not improve pregnancy rate
60
Describe Klinefelter syndrome
One of most common causes of primary hypogonadism with impaired spermatogenesis and testosterone deficiency Characterised by sex chromosome aneuploidy with extra X being most frequent Often very small testes and almost always azoospermia
61
Describe group I ovulatory disorders
Hypothalamic pituitary failure i.e. hypothalamic amenorrhoea or hypogonadotrophic hypogonadism Can improve chance of pregnancy by raising BMI if <19, moderating exercise levels if do a lot of exercise Offer pulsatile administration of gonadotrophin-releasing hormone or gonadotrophins with LH to induce ovulation
62
Describe group II ovulatory disorders
Hypothalamic-pituitary-ovarian dysfunction Predominantly Polycystic ovary syndrome
63
Describe group III ovulatory disorders
Ovarian failure
64
Describe polycystic ovary syndrome
1. Androgen excess; clinical (hirsutism), biochemical (testosterone) 2. Infrequent periods; anovulation 3. Polycystic ovaries; US
65
How can ovulation be induced?
Clomiphene; blocks oestrogen receptors in AP to increase FSH secretion Gonadotrophins; risk of multifollicular recruitment and thus multiple pregnancy, monitoring scans reduce risk GnRH
66
Describe clinical use of clomifene
Selective oestrogen receptor modulator for inducing ovulation Monitoring; - follicle scanning in 1st cycle - 15% require dose adjustment Side effects - vasomotor - visual
67
What is hydrosalpinx?
When the fallopian tube (salpinx) is blocked by a watery fluid (hydro) Should have surgery for this before IVF treatment as improves chances of live birth Surgery is salpingectomy
68
what are the types of Azoospermia?
Testicular - normogonadotrophic - hypogonadism - hypergonadotrophic Post-testicular - iatrogenic - congenital - infective
69
What is azoospermia?
medical condition where man's semen contains no sperm
70
What investigations are there for azoospermia?
History Examination FSH, LH, testosterone, Karyotype, PRL CF screen
71
What do you do for women with unexplained fertility?
Don't give ovarian stim agents (i.e. clomifene) Advise to try for total of 2 years before IVF will be considered Offer IVF

Reproductive (11 decks)

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