Repro Flashcards
Complete mole
46 XX or 46 XY - 1 sperm divides and fertilizes empty egg
- VERY high beta-hCG
- increased uterine size
- NO fetal parts
Risk: 2% choriocarcinoma, 15-20% malignant trophoblastic disease (invades through uterine wall)
- Monitor beta-hCG after evacuation
Tx: dilation currettage, methotrexate
Partial mole
69 XXX, 69 XXY, 69 XYY
- 2 sperm and 1 egg
- slight increase in beta-hCG
- Fetal parts
Risk: low risk of malignancy (<5%)
Tx: dilation currettage, methotrexate
Preeclampsia
Preeclampsia= HTN, proteinuria, edema
- Occurs in 7% women from 20 weeks gestation to 6 weeks postpartum
- Before 20 weeks= molar pregnancy likely
Eclampsia= preeclampsia + seizures
Etiology:
- Increased incidence in pre-existing HTN, diabetes, chronic renal disease, autoimmune disorders
- Defect in uterine vasculature–> increased vascular tone
HELLP syndrome= Hemolysis, Elevated Liver enzymes, Low Platelets
Mortality: cerebral hemorrhage, adult respiratory distress syndrome
Treatment:
- IV magnesium sulfate: prevention and treatment for seizures
Abruptio placentae
Premature detachment of placenta
- Associated with DIC?
- Increased risk with smoking, HTN, cocaine
Symptoms:
- Painful bleeding in 3rd trimester (Abrupt detachment)–> life threatening to fetus and mother
Placenta accreta
Scar tissue in myometrium–> defects in decidual layer–> allows placenta to adhere to tissue
- increased bleeding risk after delivery
- Retained placental tissue: increased risk of infection
- Bacteroides= most commonly isolated (mixed flora infection)
Placenta previa
Placenta attaches to lower uterine segment
- Increased risk with multiparity, C-section
Symptoms:
- PainLESS bleeding in any trimester
Ectopic pregnancy
** Lower than expected beta-hCG
Polyhydramnios
> 1.5-2 L amniotic fluid–>
Due to:
- esophageal/duodenal atresia: Can’t swallow amniotic fluid
- Anencephaly (can’t swallow w/o brain
Cervical dysplasia/CIN
HPV 16–> E6–> inhibit p53
HPV 18–> E7–> inhibit Rb
- Increased risk with multiple sexual partners (#1), smoking, early debut, HIV infection
Gynecologic tumor epidemiology
Worldwide: Cervical cancer most common
Incidence (US):
- endometrial
- ovarian
- cervical
Highest mortality:
- ovarian
- Cervical
- Endometrial
Clear cell adenocarcinoma of vagina
DES exposure in utero–> seen in adulthood
Sarcoma botyoides
Rhabdomyosarcoma
- girls < 4 years of age
- Spindle-shaped tumor cells= desmin positive
CA-125
Cancer antigen elevated in serous, endometrioid, clear cell carcinoma of ovary
- Used to monitor therapeutic response
Malignant breast cancer
Common post-menopause
Usually arise from terminal duct lobular unit
Overexpression of:
- Estrogen/progesterone receptors
- c-erbB2 (HER-2= EGF receptor)
Leuprolide
GnRH analog:
- Agonist when used in pulsatile dosing (infertility drug)
- Antagonist when used continuously (prostate cancer, uterine fibroids, precocious puberty treatment)
Tox:
- Antiandrogen, N/V
Testosterone
MOA: Agonist at androgen receptors
Use: Treats hypogonadism
- Promotes secondary sex characteristics
- Anabolic steroid- burn or injury recovery
Tox:
- Masculinization in famles
- Inhibits LH release (negative feedback)–> gonadal atrophy
- Premature epiphyseal plate closure
- Increased LDL, decreased HDL
Finasteride
MOA: 5-alpha-reductase inhibitor
- Decreases conversion of T–> DHT
Use:
- BPH
- Male-pattern baldness
Flutamide
MOA: nonsteroidal inhibtor of androgens at testosterone receptor
Use: prostate cancer
Ketoconazole
MOA: inhibits steroid synthesis (inhibits 17,20-desmolase)
Use:
- PCOS (prevent hisutism)
Tox: gynecomastia, amenorrhea
Spironolactone
MOA: inhibits steroid binding
Use:
- PCOS (prevent hisutism)
Tox: gynecomastia, amenorrhea
Ethinyl estradiol, DES, Mestranol
MOA: bind estrogen receptors
Use:
- Hypogonadism, ovarian failure
- Menstrual abnormalities
- HRT in post-menopauseal women
- Androgen-dependent prostate cancer
Tox:
- Increased endometrial cancer risk
- Bleeding in post-menopausal women
- DES in utero exposure–> clear cell adenocarcinoma of vagina
- Thrombosus
- Avoid in ER-positive breast cancer, previous history of DVT
Clomiphene
MOA: SERM
- Partial agonist at estrogen receptors in hypothalamus (prevents normal feeback inhibition)
- Increases LH, FSH release
Use: infertility, PCOS
Tox:
- Hot flashes
- Ovarian enlargement
- Multiple simultaneous pregnancies
- Visual disturbances (enlarged pituitary)
Tamoxifen
MOA: SERM
- Antagonist on breast tissue, agonist of endometrium
Use: treat, prevent recurrence of ER-positive breast cancer
Raloxifene
MOA: SERM
- Agonist on bone–> reduces resorption
Use: Osteoporosis
Anastrozole, Exemestane
Aromatase inhibitors
Use: postmenopausal breast cancer (estrogen-sensitive cancer)
Progestin
MOA: bind progesterone-R, reducing growth and decreasing vascularization of endometrium
Use:
- oral contraceptives
- Endometrial cancer
- AbnL uterine bleeding
Mifepristone (RU-486)
MOA: competitive inhibitor of progestins at progesterone-R
Use: terminate pregnancy (administered with misoprostol= PGE1)
Tox: Heavy bleeding, GI effects (N/V/A), abdominal pain
Oral contraceptives (progestin + estrogen)
MOA: inhibit LH/FSH release–> prevent estrogen surge–> no LH surge–> no ovulation
- Progestins= thicken cervical mucus (barrier); inhibit endometrial proliferation (no implantation)
Terbutaline
MOA: beta-2 agonist, relaxes uterus
Use: reduce premature contractions
Tamulosin
MOA: alpha-1 antagonist, inhibits smooth m. contraction (selective for alpha 1A,D receptors in prostate vs alpha 1B in vasculature)
Use: BPH
Sildenafil, Vardenafil
MOA: inhibit PDE-5–> increased cGMP–> smooth muscle relaxation in corpus cavernosum (increased blood flow–> erection)
Use: Treat ED
Tox: H/A, flusing, dyspepsia, impaired blue-green color vision
- Avoid in patients taking nitrates–> hypotension
Danazol
MOA: synthetic androgen; partial agonist at androgen receptors
Use: endometriosis, hereditary angioedema
Tox:
- Weight gain, edema
- Acne, hirsutism, masculinization
- Decreased HDL, hepatotoxic
Sources of estrogen in female
Ovary (17-beta estradiol), placenta (estriol), adipose tissue (estrone via aromatization)
- GnRH–> LH–> desmolase in Theca cell
- -> Cholesterol converted to androstenedione
- GnRH–> FSH–> aromatase in Granulosa cell
- –> Androstenedione converted to astrogen
Estrogen–> increased transport proteins, SHBG; increased HDL, lowered LDL; causes LH surge–> ovulation
** Potency: estradiol > Estrone > estriol
Oogenesis
Meiosis I= prophase I; primary oocyte (until ovulation)
Meiosis II= Metaphase II; secondary oocyte (until fertilization)
Lactation
Progesterone decreases at birth–> lactation begins
- Prolactin= binds JAK-STAT pathway–> induce and maintain lactation, prevent ovulation
- Oxytocin= milk letdown
hPL
Human placental lactogen
- Secreted from syncytiotrophoblast
- Similar to prolactin, GH
- Increases maternal insulin resistance, decreases maternal glucose utilization, increases blood glucose
- -> increased lipolysis, proteolysis (energy for mom as baby uses glucose)
- Maternal insulin resistance d/t: hPL, GH, estrogens, progesterone, glucocorticoids
- Gestational diabetes= unable to overcome insulin resistance
Alpha-fetoprotein (AFP)
Synthesized in liver, GI tract, yolk sac
- Serum AFP low in: Down’s syndrome, increased gestational age
- Elevated AFP: dating error (most common cause), neural tube defects, gastro wall defects, multiple gestations
Endometritis
Inflammation of endometrium d/t:
- Retained products of conception following delivery
- Miscarriage/abortion
- Foreign body (IUD)
Bacteroides= common infection
Treatment:
- Gentamycin + Clindamycin
+/- Ampicillin
Fibrocystic change in breast
Most common cause of breast lumps from 25- menopause
- Premenstrual breast pain, bilateral, multiple lesions
- Fluctate in size, mass
- Does NOT indicate increased risk of carcinoma
Fibrosis= hyperplasia of stroma
Cystic= fluid-filled blue dome (ductal dilation)
Sclerosing adenosis= increased acini, intralobular fibrosis; associated with calcifications (confused with cancer)
Epithelial hyperplasia= increased epithelial cells in terminal duct lobule (increased risk of cancer if atypical cells)
