Quiz 4

Question 1

What percentage of pregnancies are unplanned?

Answer 1

51%

Question 2

What percentage of pregnancies end in miscarriage?

Answer 2

25%

Question 3

How do Progesterone only pills Block Ovulation?

Answer 3

-high levels of progesterone inhibit both the hypothalamus and there anterior pituitary
-low levels of GnRH slow the development of the follicles
-there is no ovulation because the LH surge is prevented
-all follicles enter atresia

Question 4

How do Combination pills block Ovulation?

Answer 4

-progesterone only pills reduce GnRH and LH, Estrogen also reduces FSH, arresting follicles earlier in their development
-the reduction in mature follicles reduces the circulating estrogen levels, which prevents the uterine lining from developing as fully

Question 5

How does Levonorgestrel block ovulation?

Answer 5

Plan B or levonorgestrel delivers a large dose of synthetic progesterone that prevents ovulation by blocking LH
Plan B is effective for up to 72 hours after sex, preventing or delaying ovulation throughout the duration of sperm lifespan in the females reproductive tract

Question 6

What are the versions of longer-lasting combination hormone delivery (not pill)

Answer 6

Combination injection, vaginal ring, combination patch

Question 7

What is tubal ligation and what are the three methods?

Answer 7

Obstruction of the uterine tubes, making fertilization impossible. It is considered permanent.

Cauterization, Tie/Cut, and Banded are the three ways. Banded is considered the only “reversible” route

Question 8

What is spermicide and how does it function?

Answer 8

Spermicide contains Nonoxynol-9 which interacts with sperm specific membrane components. This causes the acrosome to rupture, making fertilization impossible. Spermicide is applied to the women and is effective for up to 1hr.

Question 9

How does coitus interruptus work?

Answer 9

this is the pull out method. Because the glands are not perfectly synced and sperm can reside anywhere within the ductus deferens, there is a 27% failure rate.

Question 10

How does Phexxi work?

Answer 10

Phexxi lowers the pH of the vagina, making it inhospitable to sperm. 86-93% effective, only effective for 1 hour.

Question 11

How does a Plastic IUD work?

Answer 11

Plastic imbedded with progesterone.
-presence of an IUD triggers an inflammatory response, WBCs present in the uterus attack and destroy sperm + ovum
- low dose progesterone changes the consistency of the uterine fluid and vaginal mucus, making it less likely that sperm can swim through

Question 12

How do Copper IUDs work?

Answer 12

Copper acts as an additional spermicide (preventing capacitation) and can even be effective at killing sperm when inserted as emergency contraception

Question 13

What are the two most effective emergency contraceptives?

Answer 13

Ella and Copper IUD

Question 14

How does Ella disrupt uterine prep and prevent zygote from implanting?

Answer 14

-ulipristal acetate
-progesterone receptor modulator
-inhibits progesterone-mediated uterine gland activity
-taken during the secretory phase, prevents endometrial prep
-can be taken up to 5 days after sex

Question 15

How is a medical abortion carried out?

Answer 15

Medical abortion is a series of two medications.
-Mifepristone, progesterone receptor antagonist that will induce contractions
- Misoprostol, exogenous prostaglandins that bring about more contractions and cramps
-Medical abortion can be performed up until 9 weeks of pregnancy

Question 16

What are the initial changes of the uterine wall after implantation?

Answer 16

the endometrium proliferates in the areas surrounding the implanting embryo
-the endometrium will then envelope the embryo; the embryo now resides within the uterine wall

Question 17

What are the three decidua?

Answer 17

Once the embryo resides within the uterine wall, the endometrium is now known as the decidua
Decidua Basalis: endometrium deep to the embryo
Decidua Capsularis: endometrium covering the embryo
Decidua Parietalis: endometrium on other surfaces of the uterus

Question 18

What are the two most common immune cell types in the decidua?

Answer 18

most common- Natural Killer (NK) cells: function to kill off foreign or virally infected cells
second most common-Macrophages (activating or regulating)

Question 19

When are activating and regulating macrophages higher?

Answer 19

regulating type is higher in successful pregnancies. Regulating macrophages are calming signals that stop NK cells from targeting fetus.
activating type is higher in preeclampsia and spontaneous miscarriage

Question 20

What is the shift in the maternal immune system regarding B and T cells?

Answer 20

The shift favors antibody production (B Cells) and slightly diminish cells mediated immunity (T cells).
Because of this shift, some pregnant individuals experience a relief of autoimmune symptoms (rheumatoid arthritis) and some individuals experience an exacerbation (lupus)

Question 21

What is the Amnion?

Answer 21

Amnion grows to surround fetus. As organs develop, fetus urinates into amnion and fills it with amniotic fluid.

Question 22

What is the Yolk Sac?

Answer 22

site of early hematopoiesis (blood cell creation). It is absorbed by the fetus

Question 23

What is the Chorion?

Answer 23

becomes placenta and outer surface of amniotic sac

Question 24

What percentage of ESTABLISHED pregnancies miscarry?

Answer 24

15% before 15 weeks

Question 25

Why is vasoconstriction during birth important?

Answer 25

vasoconstriction will occur before, during, and after birth to close bloodjets so excessive blood loss does not occur when placenta is removed.

Question 26

What are the four placental transfer mechanisms?

Answer 26

-Diffusion based on molecular properties -Facilitated diffusion (selective) -active transport (selective) -pinocytosis: pinch off piece of membrane to create vesicle to move molecule across, and then fuse back into membrane

Question 27

Maternal Alcohol use

Answer 27

small and lipophilic molecules, readily crosses by diffusion, fetus has less ability to clear due to lack of hepatocytes

Question 28

How does Maternal use of cocaine and amphetamines have an effect?

Answer 28

Norepi and Serotonin transporters are expressed on syncytiotrophoblasts. -these molecules are both stimulators of uterine contractions and act as vasoconstrictors (given to fetus) -cocaine and amphetamines block syncytiotrophoblasts, allowing NE and serotonin to cross. -risks: placental abruption, premature birth, low birth weight, fetal neurological effects

Question 29

Maternal Heroin/opioid use

Answer 29

readily cross the placenta and interact with fetal opioid receptors altering development in the fetal nervous system

Question 30

Maternal nicotine use

Answer 30

readily crosses the placenta and is found 88% higher than maternal blood levels in amniotic fluid, 15% higher in fetal blood risks: low birth weight, preterm birth, altered motor development, biggest risk factor for SIDS.

Question 31

What is SIDS and why is nicotine the biggest risk factor?

Answer 31

SIDS: Sudden Infant Death Syndrome -exposure to nicotine invivo or invitro can cause muscle tension that can stop breathing in an infant

Question 32

What do SARS CoV-2 and Zika Virus infect respectively?

Answer 32

SARS- synctiotrophoblasts, antibodies dont cross placenta at same rates as anti-flu Zika- cytotrophoblasts, microcephaly (small head)

Question 33

How does B cell localization change due to breast feeding?

Answer 33

B cells are called to breast tissue while breast feeding occurs. Will return to original spot after breast feeding is done.

Question 34

What is the pathway for maternal cholesterol?

Answer 34

maternal cholesterol crosses into placenta, placenta converts cholesterol to progesterone, progesterone goes to fetus adrenal glands, converted to DHEA then DHA-> back to placenta -> estroiol

Question 35

What does Human placental lactogen do?

Answer 35

causes maternal blood glucose levels to rise, giving more nutrients to the fetus to grow. -decreases maternal insulin sensitivity in all pregnancies

Question 36

Why can pregnant people smell more?

Answer 36

There is a big burst of neurogenesis in the beginning of pregnancy due to prolactin. This can be seen in the sense of smell that a pregnant person has

Question 37

Hormonally, why are pregnant people more easily stressed?

Answer 37

Corticotropin and thyrotropin - tropic hormones which increase cortisol and TH hormones levels in the pregnant person

Question 38

How does the cardiovascular and respiratory system change during pregnancy?

Answer 38

maternal blood volume increase by 45-50%. RBC increase by 20-30% respiratory rate increase, volumes decrease slightly. Coincide because fetus pushes up and organs push against diaphragm and lungs

Question 39

What are the possible contributors of morning sickness?

Answer 39

changes in vestibulocochlear system (balance) changes in olfactory system (smell)

Question 40

What is meconium and what dangers can it pose?

Answer 40

Meconium is the first feces after birth. If pregnancy goes way past due date, fetus can poop inside sack and the meconium can enter their eyes and mouth; means for an immediate c-section

Question 41

What is the difference between Type I and II diabetes?

Answer 41

Type I: autoimmune, beta cells attacked by immune system; dont take in sugar Type II: genetics and lifestyle; cells become insulin resistant, later beta cells slow insulin production

Question 42

What is Gestational Diabetes?

Answer 42

form of diabetes mellitus that arises during pregnancy, affects 2-10% of US pregnancies -idiopathic, probably genetics or tendency toward insulin insensitivity

Question 43

Pregnancy complications from gestational diabetes

Answer 43

Taxing on maternal kidneys, dehydrating, increase in fetal size, leading to peri- and pos-natal complications

Question 44

What is type II diabetes mellitus?

Answer 44

when gestational diabetes doesnt resolve after birth

Question 45

Ectopic Pregnancies

Answer 45

-pregnancies in which implantation is not in the endometrium (L selectin/ligands somehow stop early) -in all cases the pregnant person is at risk of hemorrhage caused by in the invasion of cytotrophoblasts, 0% of ectopic pregnancies can proceed to term -more common in older women, women with history of PID or endometriosis

Question 46

What is Placenta Previa?

Answer 46

-location of the placenta is an issue (toward cervix) -bleeding during pregnancy and birth -because the vascular lake is at or near the cervix, some of this blood will leak out all of the time -placenta invades too deeply into the uterine wall -no matter when placenta accreta is diagnosed, the uterus will be removed by hysterectomy

Question 47

Preeclampsia complications

Answer 47

7% of all pregnancies in the US -leading cause of maternal and fetal death in the US - most common in primiparous individuals (first pregnancy), risk increases with age -individuals with more than one pregnancy are at lower risk, but if the father of the child changes the risk will be similar to that of a primiparous individual

Question 48

What are the chances of preeclampsia in New Black americans and Black Americans?

Answer 48

8.1%- US average for new black americans 8.8%- US average for Black Americans Black americans are 3-4x more likely to die from preeclampsia

Question 49

Miscarriages in the first 10 weeks and beyond week 10

Answer 49

First 10 weeks - 50% of fertilized eggs either do not implant, or miscarry just after implantation (Unknown miscarriages) -chromosomal/genetic issues cause most miscarriages of established pregnancies in the first trimester -immune system responses Beyond 10 weeks -change over in progesterone manufacturing from corpus luteum to placenta can cause miscarriage in week 10-14 -cervical incompetence

Question 50

How does estrogen enable myometrial contractility ?

Answer 50

-stimulating synthesis of prostaglandins - upregulating oxytocin receptors - increasing the expression of gap junctions, which connect myometrial cells - promotes the breakdown of collagen in the cervix, making it more likely to thin and dilate

Question 51

Explain prostaglandins

Answer 51

-inhibited by progesterone and stimulated by estrogen -prostaglandins are involved in inflammation, pain and fever responses by the immune system -directly induce myometrial contractions -levels rise in the last month of pregnancy and soar during labor -Prostaglandin Synthesis is Paracrine and follows a positive feedback loop

Question 52

Oxytocin in birth

Answer 52

-cause the release of prostaglandins -uterine contractions -follows a positive feedback loop, release of oxytocin is triggered by cervical pressure, nipple/vaginal mechanical stimulation

Question 53

Explain what the Fetal Drop is

Answer 53

-as estrogen and relaxin work to loosen the ligaments of the pelvis -fetal head is able to sink lower into pelvis - 2/3 weeks prior to birth -sometimes called "lightening" bc breathing becomes easier

Question 54

What are the three birth stages?

Answer 54

Stage 1: latent and active phases: dilating Stage 2: pushing stage Stage 3: Placenta release

Question 55

What is effacement and how does it occur?

Answer 55

Early contractions, strong but far apart push the fetal head into the cervix, thinning it=effacement

Question 56

What two steps must occur before the fetus can be dislodged?

Answer 56

Rupture of the decidua capsularis (in most cases complete by month 5) Breaking of the amnion (thrombin cleaves the collagen fibers)

Question 57

What are the steps in birth that separate it from Menstruation after "production of tissue destroying enzymes and vasoconstrictors"

Answer 57

myometrial contractions-> increase in prostaglandins and vasoconstrictors-> intense rapid constriction of uterine arteries-> arrested blood flow to placenta-> detach placenta

Question 58

What is Precipitous labor?

Answer 58

birth less than 3 hours after contractions begin

Question 59

What can occur if labor is too fast?

Answer 59

there might not be time for epidurals, antibiotics, getting to the hospital, and placenta detachment. the increase the risk of infections, bleeding, and incorrect placenta detachment

Question 60

What is cephalopelvic disproportion ?

Answer 60

when fetal head and maternal pelvis are not size matched, can prolong labor

Question 61

Risks of slow labor?

Answer 61

low fetal oxygen because placenta is detaching before fetus is out Meconium is amniotic fluid because fetus is maturing faster than labor is progressing

Question 62

What is prodromal labor?

Answer 62

type of false labor contractions, sensations start and stop over a course of days

Question 63

What is umbilical cord prolapse? How about nuchal cord?

Answer 63

umbilical cord prolapse: the cord comes out before the fetus and is compressed by the head nuchal cord: the fetus becomes entangled in the cord (cuts off circulation to head)

Question 64

What is shoulder dystocia and what are the risks ?

Answer 64

-fetal shoulder gets caught on the pubic symphysis -risks for pregnant person: severe tears, long last pubic symphysis pain -risks for fetus: broken clavicle, brachial plexus injury -push fetus back in, delivery via C-section

Question 65

Details on hemorrhaging during birth

Answer 65

-most common birth complication -strong uterine contractions during placental delivery are required to vasoconstrict the uterine arteries -hemorrhage occurs if contractions are not strong enough to close arteries -medication and massages are used to stop bleeding

Question 66

What is the medication used to treat postpartum hemorrhage?

Answer 66

Oxytocin- increases contraction to stop bleeding

Question 67

Explain Tears during birth

Answer 67

-tears can be spontaneous or due to surgical cuts to the perineum (episiotomy) -can lead to postpartum bleeding but is different from hemorrhage -increases risk of infection

Question 68

Explain Uterine rupture

Answer 68

-bleeding into the abdominal cavity -likely to cause maternal death -typically occurs in individuals with previous C-sections

Question 69

What is a VBAC?

Answer 69

Vaginal Birth After C-section -therefore, vaginal births after C-sections are considered high risk -endometrium after C-section contains scar tissue and is not sufficient for birth

Question 70

Why are children from C-sections more likely to develop skin conditions?

Answer 70

-children born vaginally are coated in microbes during birth which becomes their microbiome - the c-section baby only relies on their skin as the microbiome

Question 71

What is the Apgar score?

Answer 71

test taken at 1 min and 5 min after birth, should trend upwards. 7 and above considered healthy A: appearance of skin color P: pulse, heart rate G: grimace, reflexes A: Activity, muscle tone R: respiration, breathing

Question 72

What is the hormone roster in breast regarding birth and why do women who dont breast feed have a higher risk of breast cancer?

Answer 72

Estrogen: pro-mitotic in breast tissue Oxytocin: milk ejection, triggered by suckling(and bond) Prolactin: milk production -breast cancer is likely to develop in those who are pregnant multiple times without breastfeeding because the mitotic cells are not regulated

Question 73

Explain the transition from pregnancy to lactation

Answer 73

-estrogen and progesterone inhibit the secretion of prolactin the anterior pituitary -once the placenta is expelled, the blood levels of estrogen and progesterone drop precipitously -no milk is produced for the first few days, but 2-3 days after placental expulsion, milk production begins

Question 74

What are the breastfeeding physiological effects?

Answer 74

-inhibition of GnRH (pause on fertility) -increase in metabolism - making enough breastmilk for an infant takes around 700 Kcal

Question 75

What is in breastmilk?

Answer 75

the second highest ingredient-oligosaccharide for microbes IgA (antibodies) and lactoferrin (antimicrobial compound) Leptin (appetite suppressing hormone) in breastmilk leading to lower risk of obesity in children

Question 76

What are breastfeeding advantages and disadvantages for a mom?

Answer 76

-nutritional drain, including significant calcium loss -breastfeeding lowers risk of type II diabetes, high blood pressure (from release of oxytocin), and breast cancer

Question 77

Details on Postpartum: Physiological Return

Answer 77

Blood volume reduction: .5-1L of plasma lost through urination (this results in about 6lbs of weight lost in the first week) Lung capacity increases to pre-pregnancy values Uterus reduces in size through involution (cell shrinkage and some apoptosis) from 2lbs of weight down to 3oz.

Question 78

What does advanced maternal age mean?

Answer 78

AMA is used to describe pregnancies occurring in individuals over the age of 35

Question 79

What does Advanced Paternal age mean?

Answer 79

APA is used to describe paternal age over the of 45 AT TIME of birth

Question 80

Simply define menopause

Answer 80

diagnosis given when a previously menstruating person has not menstruated for over 1 year

Question 81

Simply define Andropause

Answer 81

no official diagnosis, but a gradual decline in testosterone with symptoms of decreasing muscle mass, energy level and libido and bone density. increases in inflammation

Question 82

Why are human females the only mammalian species to undergo menopuase ?

Answer 82

it is evolutionary beneficial to not go through taxing menstruation as one ages.

Question 83

What is Perimenopause ?

Answer 83

period of time preceding menopause where body begins to shift. An individual can have irregular menstrual cycles.

Question 84

What is in a growing follicle?

Answer 84

Growing follicles secrete Anti-Mullerian Hormone (AMH), estrogen and inhibin - as fewer and fewer follicles are available to enter the follicular phase of the menstrual cycle, AMH levels decline and can be measured to test proximity to menopause

Question 85

What is the result of inhibin declining while the body is approaching menopause?

Answer 85

as inhibin declines the feedback on the anterior pituitary changes, FSH levels increase. In the approach to menopause, often more follicles are readied

Question 86

Explain how egg quality changes with age?

Answer 86

the eggs that remain after age 35 may be of lower quality. Miscarriage rates increase after 35. Rate of chromosomal abnormalities increase as well

Question 87

What the physiological and physical changes due to declining estrogen in age?

Answer 87

declining estrogen levels lead to changes in CV function, metabolism, mood and more. Genitals, breast tissue, uterus and vagina decrease in size. pH increase and secretions decrease. Blood androgen levels increase as hormone binding protein level decreases; leading to facial hair, deepening of the voice, abdominal weight gain, enlargement of the clitoris, changes to libido

Question 88

What causes Hot flashes?

Answer 88

they are caused by sudden activation of the sympathetic nervous system, leading to vasodilation of the skin. Estrogen has a regulating effect on temperature and due to increased FSH levels, the system is sensitive to triggers and can fluctuate based on small changes.

Question 89

What is HRT and what are the risks in women?

Answer 89

Hormone replacement therapy reduces hot flashes and other menopausal symptoms. Increased risk of blood clots, breast cancer. Increased risk of breast cancer seen in women that are well into menopause. Cardiovascular risks are only seen in women that have HRT later in life. If taken 2-5 years within 10 years of cessation of menstruation CVD risk decreases.

Question 90

What secondary sex characteristics change in andropause in men

Answer 90

-voices rises in pitch -facial hair growth decreases -genitals shrink

Question 91

What are the risks of APA?

Answer 91

APA is associated with an increased risk of spontaneous mutation. Increase in particular autosomal diseases. APA is also strongly correlated to risk of autism and schizophrenia in children.

Question 92

Explain HRT in men

Answer 92

exogenous testosterone, typically applied as a cream, decreases bone and muscle loss in older men. Increases risk of cardiovascular disease. Anyone taking exogenous testosterone is at an inclined risk for cardiovascular disease.

Question 93

What is colostrum?

Answer 93

the first breast milk the baby consumes. It has antibodies, immune support, and a laxative to encourage baby bowel movements.