Repro Flashcards
What are the functions of the pelvic floor?
Support pelvic organs
Maintain intra-abdo pressure when coughing, sneezing
Continence
Facilitate childbirth
Which muscles form the lateral walls of the pelvis?
Piriformis
Obturator internus
Which muscles form the pelvic diaphragm/floor?
Coccygeus
Levator Ani
Which muscles comprise levator ani?
Puborectalis
Pubococcygeus
Iliococcygeus
What are the deep perineal muscles?
Deep transverse perineal
Compressor urethrae
External urethral sphincter
What are the superficial perineal muscles?
Superficial perineal pouch
Superficial transverse perineal
External anal sphincter
Which 2 muscles are in the superficial perineal pouch?
Bulbospongiosus
Ischiocavernosus
What is the importance of the perineal body?
Attachment point of pelvic floor muscles
How can pelvic floor function be altered during childbirth?
levator ani muscles stretched
pudendal n. damage
perineal body disrupted
Iatrogenic - episiotomy
What are the consequences of pelvic floor dysfunction?
Prolapse
Incontinence
What are risk factors for prolapse?
Age Parity Vaginal delivery Post-menopause Obesity - raised intra-abdo pressure CT disorders
What is episiotomy?
Surgical incision medic-laterally during childbirth to prevent uncontrolled perineal tear.
What can PID cause?
Endometritis
Salpingitis
Tubo-ovarian abscess
How does tubo-ovarian abscess happen from PID?
Adhesions cause blockage in fallopian tubes, fill with exudate.
What are complications of PID?
Infertility
Ectopic pregnancy
Fitz- Hugh -Curtis syndrome - RUQ pain, peri-hepatitis after chlamydia PID
What reduces oxytocin function prior to labour?
Relaxin
Progesterone
No receptors
How does oestrogen affect myometrium muscle cells?
increases gap junctions - excitability
What is the most common cause of PPH?
Uterine atony
What is normal length of menstrual cycle?
21-35 days
what is the normal position of the uterus?
Anteverted and anteflexed
What is menopause?
No menstrual periods for 12 months
What are the stages of menopause?
Pre-menopause - 40’s, changes in cycles, can still get pregnant
Peri-menopause
Menopause
Post-menopause - after 12 months amenorrhoea
What is pathological menopause?
Before 40 years
What is used to diagnose menopause?
FSH levels high (aromatase enzyme still synthesises oestrogen)
Explain risk of endometrial carcinoma at menopause.
No progesterone but oestrogen still produced in body.
Unopposed oestrogen - endometrial hyperplasia.
What happens to vagina pH at menopause?
Increases - less oestrogen means less glycogen
Explain the increased CVS risk at menopause?
Increase LDL and VLDL, decrease HDL
Increased insulin resistance
Increased BP
Central body fat deposition/weight gain
What are the cardinal movements of labour?
Engage Descend and flex Internal rotation Extension x 2 Restitution Anterior shoulder Posterior shoulder
What hormonal change is repsonsible for the secretion of milk after delivery?
Decreased oestrogen and progesterone
What does increased fetal HR suggest?
Fetal movement
What does decreased fetal HR suggest?
head compression
umbilical cord compression
What is the symphysis-fundal height at 12,16,20 and 36 weeks?
12 - pubic symphysis
16 - mid-way to umbilicus
20 - umbilicus
36 - xiphisternum
What are causes of oligohydramnios?
placental insufficiency
renal impairment
premature membrane rupture
What are causes of polyhydramnios?
inability to swallow - CNS of tracheoesphageal septum
When is surfactant produced?
Terminal sac stage - 26 weeks onwards
What are the vascular changes that lead to erection?
Inhibit sympathetic constriction
Parasympathetic stimulation - dilation
NO released from endothelial cells and nerves (cremasteric)
What is MOA of sildenafil?
Inhibits phosphodiesterase, increase cGMP to increase NO.
What is the order of puberty events in females?
- Thelarche - breast buds
- Pubic hair
- Growth spurt
- Menarche -periods
What is the order of puberty events in males?
- Testicle enlargement
- Pubic hair
- Spermatogenesis
- Growth spurt
- Adult size testicles
What influences puberty onset?
Photoperiod, leptins
Girls - 47kg weight
What is the vagina developed from?
Paramesonephric ducts
Urogenital sinus
What diffuses by active transport across placenta?
Amino acids
Iron
Vitamins
What moves by facilitated diffusion across the placenta?
Glucose
What is the difference between intrauterine device and intrauterine system?
IUD = copper coil IUS = plastic, progesterone secreting
What is the MOA of IUD?
Cu is toxic to sperm and ovary
Inflammation in endometrium inhibits implantation
Thickens cervical mucous
Does IUD or IUS increase bleeding?
IUD - copper coil increases bleeding.
IUS decreases bleeding.
What is the MOA of IUS?
Prevents implantation
Thickens cervical mucous
What are the 2 types of cervical cancer?
Squamous cell carcinoma (most common)
Adenocarcinoma
What is the cancer marker used for colon cancer?
CEA
What is the marker used for ovarian cancer?
CA-125
What is alpha-fetoprotein marker used for?
Hepatocellular carcinoma
Germ cells
Where does uterine leiomyosarcoma spread to?
lungs
What marker is used for germ cell tumours?
AFP
hCG
What is the difference between spermatogenesis and spermiogenesis?
Spermatogenesis - spermatogonia to spermatids
Spermiogenesis- spermatids to spermatozoa
What is the function of cervical gland, how is it controlled?
Secretes mucous
Progesterone - thick, viscous to prevent sperm entry
What are the main histological changes in the placenta from the first to the third trimester?
- Villi increase in SA - primary to tertiary
2. Thinning - decreased diffusion distance.
What is a key sign of PCOS?
High LH:FSH ratio
