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obstetrics > Placenta > Flashcards

Placenta Flashcards

1
Q

Explain follicular phase

A

dec luteal prod. of progesterone & inhibin A
inc FSH
growth & selection of antral follicles
LH surge inc progesterone & prostaglandin
LH induce theca cell to prod more androstenedione then converted to estrogen in granulosa
as estrogen rise, negative feedback to hypothalamus & ant. pituitary, dec FSH & LH
inc prod inhibin B further dec FSH

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2
Q

Explain ovulation

A 
devt of corpus luteum
dec FSH & LH
granulosa enhance estrogen & progesterone prod
NO fertilization:
       - luteolysis (9-11 d)
       - dec steroid hormone
       - repeat cycle
fertilization:
       - HCG prevent luteolysis
       - maintain progesterone
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3
Q

Explain proliferative phase

A 
estrogen phase
toward end of mens
proliferation of SM & inc vascularity
endometrial glands are elongated with narrow lumen
utz: trilaminar appearance
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4
Q

Explain early secretory phase

A

secrete mucus & glycogen
glands are tortuous and spiral arteries extends to superficial layers
utz: thickest endometrial layer

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5
Q

Explain late secretory phase

A

dec progesterone & estrogen

lots of glycogen lots of vacuole

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6
Q

Explain menstrual phase

A

spiral arteries rupture

endometrium sloughed off

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7
Q

when is the best time to get an endometrial sample?

A

1-4 days prior to menstruation

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8
Q

what happens to endometrium if the woman becomes pregnant?

A

endometrium transform into decidua

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9
Q

3 parts of decidua

A 
decidua basalis
       - between embryo & myometrium
       - passageway of nutrition
decidua capsularis
       - bet. embryo & uterine lumen
decidua parietalis
       - side of uterus away from embryo
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10
Q

functions of decidua

A

nutritional support & excretion
protein & steroid synthesis
controls trophoblastic invasion

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11
Q

implantation

A

6-7 days after fertilization

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12
Q

stages of implantation

A 
apposition
       -  most common site is the upper and posterior wall in mid-sagittal plane
adhesion
       - d20-21
invasion
       - spiral arteries reconstruction
decidualization
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13
Q

day 8

A

trophoblast differentiation into cytotrophoblast & syncytiotrophoblast
embryoblast differentiation into hypoblast & epiblast

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14
Q

day 9

A

first vacuole
lacunar stage
primitive yolk sac

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15
Q

day 11-12

A

primary villi formation
sinusoids
extraembryonic mesoderm

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16
Q

day 13

A

secondary villi formation

chorionic cavity

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17
Q

by 2nd wk of life, what supplies the implanted ovum in uterus?

A

lacunar system

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18
Q

3rd wk of gestation

A

vascularization
chorionic villin into extravillous trophoblast
tertiary villus or definitive placental villus

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19
Q

4th wk of gestation

A

CVS formation, true circulation is established
remodelling of spiral arteries
cytotrophoblast invade spiral arteries and replace maternal endothelium

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20
Q

5th wk of gestation

A

capillary network dominates villi (V>C)

drainage into sinus venosus

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21
Q

what is the main functional component of placenta?

A

trophoblast

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22
Q

week 7

A

trophoblast proliferated into villi

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23
Q

week 8

A

villus chorion or chorion frondosum

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24
Q

what is the maternal and fetal side of placenta?

A

M: decidua basalis, uterine vessel & glands
F: chorionic plate (amnion & trophoblast)

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25
Q

placental growth
w/c trimester is more rapid?
what wk, placental and fetal wt is equal?
what is the placental wt at term?

A

1st trim. more rapid
17th wk placenta = fetal
1/6 fetal weight at term

26
Q

placental maturation
what wk does it calcified?
grading base from week

A

end of 42nd wk: placenta gets calcified
Gr 0: immature (<18wks)
Gr 1: indentations of chorionic plate (18-29wks)
Gr 2: comma like densities (30-38wks)
Gr 3: severely calcified; ring-like structure (>39wks)

27
Q

what is responsible for proliferation and devt of placenta?

A

leptin or adiponectin

28
Q

what is the fetal macrophages?

A

hofbauer cells

29
Q

week 6

A

chorion laeve

30
Q

2 placental plates

A

chorionic plate: internal; lined by amniotic membrane; umbilical cord lies to this plate
basal plate: maternal

31
Q

differentiate vasculogenesis & angiogenesis

A

V: de novo formation of BV from mesodermally derived precursor cells
A: expansion of preexisting vessel bed & creation of new vessel branches from preexisting ones

32
Q

angiogenesis category

A

branching: 0-24wks; primitive capillary network; VEGF
nonbranching: 24wks; mature intermediate villi & later terminal villi; PIGF

33
Q

explain the 3 placental hypoxia

A

preplacenta: mother, placenta & fetus are hypoxic; inc peripheral branching
uteroplacenta: placenta & fetus are hypoxic, normoxic mother; d/t VEGF upregulation
postplacenta: normoxic mother, hyperoxic placenta, hypoxic fetus; terminal villi capillary branching almost absent

34
Q

physiologic changes in uteroplacental arteries

A

trophoblastic invasion
loss of elasticity
dilatation
loss of vasomotor control

35
Q

explain circulation in intervillous space

A

uterine contraction: vein is occluded, arterial blood forced into intervillous space
uterine relaxation: venous drainage
spiral arteries are perpendicular & veins are parallel to uterine wall

36
Q

explain fetoplacental circulation

A

umbilical arteries are deoxygenated from fetus to IVS

umbilical vein are oxygenated from IVS to fetus

37
Q

differentiate thin zone & thick zone in placental barrier

A

thin alpha zone: gas exchange

thick beta zone: hormone synthesis

38
Q

hormones synthesized by placenta

A 
hCG
hPL
ACTH
hCG-V
PTHP-rP
calcitonin
relaxin
inhibin, activins, cytokines, ANP
TRH
GnRH
CRH
GHRH
39
Q

what is the major site of steroid & CHON production in placenta?

A

syncytiotrophoblast

40
Q

source of placenta in progesterone biosynthesis

A

maternal LDL-C

41
Q

source of placenta in estrogen synthesis

A

C19 steroids from maternal & fetal adrenal glands

42
Q

what maintains corpus luteum in pregnant women? in nonpregnant women?

A

P: hCG
NP: LH

43
Q

explain hCG levels in pregnancy

A

detected: 8 d
doubles q48h
max: 10 wks
min: 16 wks

44
Q

explain hPL levels in pregnancy

A

detected: 3 wks
max: 36 wks

45
Q

fx of hCG

A 
maintains corpus luteum
stim leydig to prod testosterone
immunosuppressive action
stim maternal thyroid 
growth of umbilical cord
46
Q

fx of hPL

A 
promotes maternal lipolysis
insulin resistance
glucose spared to fetus
promotes growth of breast
marker for placental functioning
47
Q

explain hGH-V levels in pregnancy

A

present: 21-26 wks
max: 36 wks

48
Q

fx hPL

A

growth promoting & anti-lipogenic fx

49
Q

explain activin & inhibin levels in pregnancy

A

peak at term

50
Q

fx of activin & inhibin

A

A: stim placental hormone production
I: opposes activin

51
Q

fx of placental ACTH

A

imp for controlling fetal lung maturation & parturition timing
CRH stim prostaglandin prod & ACTH secretion

52
Q

describe decidual NK cells

A

lacks cytotoxic fx
dampen Th17 cells
express IL-8 & interferon 10 (invasion)
prod VEGF & PIGF

53
Q

describe decidual macrophages

A

inhibit typical NK cells
spiral artery remodelling
engulf apoptotic cells

54
Q

describe T cell apoptosis (FasL)

A

clonal deletion of immune cells that recognize paternal Ags

55
Q

describe regulatory T cells

A

prevent immunological rejection of fetus
CCR4
modify fx of APC thru CTLA4-B7 w/c upregulates IDO

56
Q

describe PDL 1

A

regulates T cell homeostasis
imp in peripheral tolerance & prevention of autoimmunity
dec PDL1 results in dec fetal survival

57
Q

3 mechanisms of fetomaternal tolerance

A

lack MHC molecules on trophoblast
trophoblast HLAs
T-cell apoptosis

58
Q

px with frequent hx of abortion, what can be given (2-3 days postfertlization)?

A

progesterone

59
Q

G1P0 w/ hypogastric cramps, amenorrheic for 6wks, positive PT. Utz 8cm right adnexal mass cystic w/ solid component. approach?

A

observe then remove mass after 10 wks

60
Q

milestones per week

A

1st wk: blastocyst, cytotrophoblast, syncytiotrophoblast, disappearance of zona pellucida
2nd wk: implantation (apposition), lacuna to tertiary villi
3rd-4th wk: septation

61
Q

starved pregnant women, IUGR or maldevt of brain?

A

mental retardation

obstetrics (11 decks)

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