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Sex Phys > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

What percentage of pregnancies are unplanned?

A

51%

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2
Q

What percentage of pregnancies end in miscarriage?

A

25%

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3
Q

How do Progesterone only pills Block Ovulation?

A

-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

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4
Q

How do Combination pills block Ovulation?

A

-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

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5
Q

How does Levonorgestrel block ovulation?

A

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

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6
Q

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

A

Combination injection, vaginal ring, combination patch

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7
Q

What is tubal ligation and what are the three methods?

A

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

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8
Q

What is spermicide and how does it function?

A

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.

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9
Q

How does coitus interruptus work?

A

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.

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10
Q

How does Phexxi work?

A

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

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11
Q

How does a Plastic IUD work?

A

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

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12
Q

How do Copper IUDs work?

A

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

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13
Q

What are the two most effective emergency contraceptives?

A

Ella and Copper IUD

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14
Q

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

A

-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

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15
Q

How is a medical abortion carried out?

A

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

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16
Q

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

A

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

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17
Q

What are the three decidua?

A

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

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18
Q

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

A

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

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19
Q

When are activating and regulating macrophages higher?

A

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

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20
Q

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

A

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)

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21
Q

What is the Amnion?

A

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

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22
Q

What is the Yolk Sac?

A

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

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23
Q

What is the Chorion?

A

becomes placenta and outer surface of amniotic sac

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24
Q

What percentage of ESTABLISHED pregnancies miscarry?

A

15% before 15 weeks

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25
Q

Why is vasoconstriction during birth important?

A

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

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26
Q

What are the four placental transfer mechanisms?

A

-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

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27
Q

Maternal Alcohol use

A

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

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28
Q

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

A

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

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29
Q

Maternal Heroin/opioid use

A

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

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30
Q

Maternal nicotine use

A

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.

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31
Q

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

A

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

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32
Q

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

A

SARS- synctiotrophoblasts, antibodies dont cross placenta at same rates as anti-flu

Zika- cytotrophoblasts, microcephaly (small head)

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33
Q

How does B cell localization change due to breast feeding?

A

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

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34
Q

What is the pathway for maternal cholesterol?

A

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

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35
Q

What does Human placental lactogen do?

A

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

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36
Q

Why can pregnant people smell more?

A

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

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37
Q

Hormonally, why are pregnant people more easily stressed?

A

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

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38
Q

How does the cardiovascular and respiratory system change during pregnancy?

A

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

39
Q

What are the possible contributors of morning sickness?

A

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

40
Q

What is meconium and what dangers can it pose?

A

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

41
Q

What is the difference between Type I and II diabetes?

A

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

42
Q

What is Gestational Diabetes?

A

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

43
Q

Pregnancy complications from gestational diabetes

A

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

44
Q

What is type II diabetes mellitus?

A

when gestational diabetes doesnt resolve after birth

45
Q

Ectopic Pregnancies

A

-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

46
Q

What is Placenta Previa?

A

-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

47
Q

Preeclampsia complications

A

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

48
Q

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

A

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

49
Q

Miscarriages in the first 10 weeks and beyond week 10

A

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

50
Q

How does estrogen enable myometrial contractility ?

A

-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

51
Q

Explain prostaglandins

A

-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

52
Q

Oxytocin in birth

A

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

53
Q

Explain what the Fetal Drop is

A

-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

54
Q

What are the three birth stages?

A

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

55
Q

What is effacement and how does it occur?

A

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

56
Q

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

A

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

57
Q

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

A

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

58
Q

What is Precipitous labor?

A

birth less than 3 hours after contractions begin

59
Q

What can occur if labor is too fast?

A

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

60
Q

What is cephalopelvic disproportion ?

A

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

61
Q

Risks of slow labor?

A

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

62
Q

What is prodromal labor?

A

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

63
Q

What is umbilical cord prolapse? How about nuchal cord?

A

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)

64
Q

What is shoulder dystocia and what are the risks ?

A

-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

65
Q

Details on hemorrhaging during birth

A

-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

66
Q

What is the medication used to treat postpartum hemorrhage?

A

Oxytocin- increases contraction to stop bleeding

67
Q

Explain Tears during birth

A

-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

68
Q

Explain Uterine rupture

A

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

69
Q

What is a VBAC?

A

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

70
Q

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

A

-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

71
Q

What is the Apgar score?

A

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

72
Q

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

A

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

73
Q

Explain the transition from pregnancy to lactation

A

-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

74
Q

What are the breastfeeding physiological effects?

A

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

75
Q

What is in breastmilk?

A

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

76
Q

What are breastfeeding advantages and disadvantages for a mom?

A

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

77
Q

Details on Postpartum: Physiological Return

A

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.

78
Q

What does advanced maternal age mean?

A

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

79
Q

What does Advanced Paternal age mean?

A

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

80
Q

Simply define menopause

A

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

81
Q

Simply define Andropause

A

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

82
Q

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

A

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

83
Q

What is Perimenopause ?

A

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

84
Q

What is in a growing follicle?

A

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

85
Q

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

A

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

86
Q

Explain how egg quality changes with age?

A

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

87
Q

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

A

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

88
Q

What causes Hot flashes?

A

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.

89
Q

What is HRT and what are the risks in women?

A

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.

90
Q

What secondary sex characteristics change in andropause in men

A

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

91
Q

What are the risks of APA?

A

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.

92
Q

Explain HRT in men

A

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.

93
Q

What is colostrum?

A

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

Sex Phys (4 decks)

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