Repro basis Flashcards
1
Q
HCG
It is produced by the placental syncytiotrophoblast, first appearing in maternal
blood _____ days after fertilization, peaking at ____ weeks, and then gradually falling to a plateau level at ___
A
10
9–10
20–22 weeks
2
Q
Fn of HCG
1
2
3
A
• Maintain corpus luteum production of progesterone until the placenta can take over
maintenance of the pregnancy.
• Regulate steroid biosynthesis in the placenta and fetal adrenal gland as well.
• Stimulate testosterone production in the fetal male testes
3
Q
DDx for high HCG
A
twin pregnancy, hydatidiform mole, choriocarcinoma, embryonal
carcinoma.
4
Q
DDx for low HCG
A
ectopic pregnancy, threatened abortion, missed abortion
5
Q
Chemically it is similar to anterior pituitary growth hormone and prolactin.
A
HPL
6
Q
Fn of HPL
A
It antagonizes the cellular action of insulin, decreasing insulin utilization, thereby
contributing to the predisposition of pregnancy to glucose intolerance and diabete
7
Q
This is a steroid hormone produced after ovulation by the luteal cells of the corpus
luteum to induce endometrial secretory changes favorable for blastocyst implantation
A
Progesterone
8
Q
Progesterone:
It is initially produced exclusively by the corpus luteum up to_____ menstrual weeks.
A
6–7
9
Q
Between 7 and 9 weeks, both the_____ and _____ produce progesterone
A
corpus luteum and the placenta
10
Q
After 9 weeks the corpus luteum declines, and progesterone production is exclusively by the _______
A
placenta.
11
Q
Fn of progesteron in early pregnancy
A
In early pregnancy it induces endometrial secretory changes favorable for blastocyst
implantation
12
Q
Fn of progesteron in late pregnancy
A
In later pregnancy its function is to induce immune tolerance for the pregnancy and
prevent myometrial contractions
13
Q
Seen in Nonpregnant reproductive years
Produced by the Follicle Granulosa
A
Estradiol
14
Q
Important enzyme used to produce estradiol
A
aromatase enzyme that completes the transformation into estradiol
15
Q
Estriol is the main estrogen during pregnancy. ________
from the fetal adrenal gland is the precursor for 90% of estriol converted by _____
enzyme in the placenta
A
Dehydroepiandrosterone-sulfate (DHEAS)
sulfatase
16
Q
___ is the main form during menopause. Postmenopausally, adrenal androstenedione is
converted in peripheral adipose tissue to estrone
A
Estrone
17
Q
reason for Spider angiomata and palmer erythema during pregnancy
A
From increased skin vascularity.
18
Q
Bluish or purplish discoloration of the vagina and cervix as a result of
increased vascularity during pregancy
A
Chadwick sign—
19
Q
Pregancy changes
Systolic and diastolic values both decline early in the first trimester, reaching a nadir by _____weeks, then they gradually rise toward term but never return quite
to prepregnancy baseline
A
24–28
20
Q
T or F
Arterial blood pressure is never normally elevated in pregnancy.
A
T
21
Q
Central venous pressure (CVP) is ____with pregnancy, but femoral venous pressure (FVP) increases two- to threefold by 30 weeks’ gestation.
A
unchanged
22
Q
Plasma volume increases up to ____ with a significant increase by the first trimester. Maximum increase is by___ weeks
A
50%
30
23
Q
CO increases up to 50% with the major increase by ____ weeks.
A
20
24
Q
CO is dependent on maternal position. CO is the highest in the ______
A
left lateral position.
25
A _______ murmur along the left sternal border is normal in pregnancy
owing to increased CO passing through the aortic and pulmonary valves
systolic ejection
26
RBC mass increases by _____ in pregnancy; thus, oxygen-carrying capacity increases.
30%
27
WBC count increases progressively during pregnancy with a mean value of up to ______ in the third trimester
16,000/mm3
28
ESR increases in pregnancy because of the increase_________
in gamma globulins.
29
Platelet count normal reference range is _______ in pregnancy.
unchanged
30
___________ increase progressively
| in pregnancy, leading to a hypercoagulable state
Factors V, VII, VIII, IX, XII, and von Willebrand Factor
31
Gastric motility decreases and emptying time increases from the ________
effect on smooth muscle.
progesterone
32
_______increases with pregnancy to 40%. It is the only lung volume that does not decrease with pregnancy.
TV
33
_______increases up to 40% with the major increase by 20 weeks.
This is also the product of respiratory rate (RR) and Vt
Minute ventilation (V • e)—
34
the volume of air trapped in the lungs after deepest expiration.
It decreases up to 20% by the third trimester
Residual volume
35
The rise in Vt produces a ______with a decrease in Pco2 from 40–30 mm Hg and an increase in pH from 7.40 to 7.45.
respiratory alkalosis
36
The kidneys increase in size because of the increase in renal blood flow. This
hypertrophy doesn’t reverse until ____months postpartum
3
37
Ureteral diameter increases owing to the progesterone effect on smooth muscle.
The _____ side dilates more than the left in 90% of patients.
right
38
Urine glucose normally increases. Glucose is freely filtered and actively reabsorbed.
However, the tubal reabsorption threshold falls from_______
195 to 155 mg/dL.
39
Proteinuria—Urine protein remains _____
unchanged
40
Adrenal gland size is unchanged, but production of______ increases two- to
threefold
cortisol
41
_____ increases, resulting in increased total T3 and T4, although free T3 and free T4 remain unchanged.
Thyroid binding globulin
| TBG
42
Fetal Circulation
Three in utero shunts exist within the fetus.
1. The _____ carries blood from the umbilical
vein to the inferior vena cava.
2. The _____ carries blood from the right to the left atrium, and
3. the ______s shunts blood from the pulmonary artery to the descending aorta.
ductus venosus
foramen ovale
ductus arterioss
43
What causes the breasts to undergo dramatic changes which culminate in the
fully mature form
With the beginning of female puberty, however, the release of estrogen—at first
alone, and then in combination with progesterone when the ovaries functionally
mature
44
On average, there are _______lobes in
| each breast, arranged roughly in a wheel-spoke pattern emanating from the nipple area
15 to 20
45
There is a preponderance of glandular tissue in the ________of the breast.
This is responsible for the tenderness in this region that many women experience
prior to their menstrual cycle.
upper outer portion
46
Ligaments called ________ which keep the breasts in their characteristic
shape and position, support breast tissue. I
Cooper’s ligaments,
47
Hormones for breast development
* Estrogen, released from the ovarian follicle, promotes the ______.
* Progesterone, released from the corpus luteum, stimulates the development of ________
growth ducts
milkproducing alveolar cells.
48
Hormones for breast development
* Prolactin, released from the anterior pituitary gland, stimulates ______
* Oxytocin, released from the posterior pituitary in response to suckling, causes______
milk production.
milk ejection from the lactating breast.
49
_____ Ducts, nipples, fat
_____Lobules, alveoli
_____Milk production
_____Milk ejection
Estrogen
Progesterone
Prolactin
Oxytocin
50
It contains more protein and less fat than subsequent milk, and contains IgA antibodies that impart some passive immunity to the infant.
colostrum
51
The ______ at delivery initiates milk production and causes the drop
in circulating estrogens and progesterone.
_____ antagonizes the positive effect of
prolactin on milk production
expulsion of the placenta
Estrogen
52
The most significant event of week 1 is the _______
implantation of the blastocyst on the endometrium
53
Fertilization usually occurs in the distal part of the oviduct.
The egg is capable of being fertilized for ____
The sperm is capable of fertilizing for ___
hours.
12–24 hours.
24–48
54
2 phases of Postconception Week 1
intratubal
intrauterine
55
What phase during week 1 post concepction
It begins at conception (day 0) and ends with the entry of the morula into the uterine cavity (day 3).
The conceptus is traveling down the oviduct as it passes through the 2-cell, 4-cell, and
8-cell stages.
56
What happens in the intrauterine phase
During this time the morula differentiates into a hollow ball of cells. The outer layer will
become the trophoblast or placenta, and the inner cell mass will become the embryo
57
Post-Conception Week 2. What are the 3 most important events?
* Starts with implantation
* Ends with 2-layer embryo
* Yields bi-laminar germ disk
58
What week?
b-hCG pregnancy test now can be positive for the first time.
Postconception Week 2
59
Post-Conception Week 3. What are the 3 most important events?
* Starts with 2-layer embryo
* Ends with 3-layer embryo
* Yields tri-laminar germ disk
60
During this time the major organs and organ systems are being formed. This is the period of major teratogenic risk.
Postconception Weeks 4–8
61
What develops from the Ectoderm—
central and peripheral nervous systems; sensory organs of seeing and
hearing; integument layers (skin, hair, and nails).
62
What develops from the Mesoderm—
muscles, cartilage, cardiovascular system, urogenital system.
63
What develops from the Endoderm—
lining of the gastrointestinal and respiratory tracts.
64
This duct is present in all early embryos and is the primordium of the female internal reproductive system. No hormonal stimulation is required
Paramesonephric (Müllerian) Duct
65
In males the Y chromosome induces gonadal secretion of _____, which causes the müllerian duct to involute.
müllerian inhibitory factor (MIF)
66
T or F
No hormonal stimulation is needed for differentiation of the external genitalia into labia majora, labia minora, clitoris, and distal vagina.
T
67
This duct is also present in all early embryos and is the primordium of the male internal reproductive system.
Testosterone stimulation is required for development to continue to form the vas
deferens, seminal vesicles, epididymis, and efferent ducts.
Mesonephric (Wolffian) Duct
68
In females, without androgen stimulation, the Wolffian duct undergoes______
regression
69
_____stimulation is needed for differentiation of the external genitalia
into a penis and scrotum.
If a genetic male has an absence of androgen receptors, external
genitalia will differentiate in a female direction
Dihydrotestosterone (DHT)
70
_______---> Anti-Müllerian hormone
| Inhibits Müllerian duct development
Sertoli cell
71
_______--->Testosterone-->Maintains Wolffian duct development
Leydig cell
72
A _____ is any agent that disturbs normal fetal development and affects subsequent
function.
teratogen
73
Teratogenesis
What are the effects:
From conception to end of second week—
The embryo will either survive intact or
| die because the 3 germ layers have not yet been formed
74
Teratogenesis
What are the effects:
Postconception weeks 3–8—
This is the period of greatest teratogenic risk from formation
of the 3 germ layers to completion of organogenesis.
75
Teratogenesis
What are the effects:
After week 9 of postconception—
During this time teratogenicity is low, but adverse effects may include diminished organ hypertrophy and hyperplasia
76
Chemotherapy: Risk is predominantly a_________
first-trimester phenomenon.
77
______ is associated with intrauterine growth restriction (IUGR) and preterm
delivery, but no specific syndrome
Tobacco
78
_____ is associated with placental abruption, preterm delivery, intraventricular
hemorrhage, and IUGR.
_____is associated with preterm delivery but not with any syndrome.
Cocaine
Marijuana
79
What are Category A drugs
Controlled studies show no risk. Adequate studies show no risk to the fetus in any pregnancy trimester.
80
Examples of CatA
This includes acetaminophen, thyroxine, folic acid,
| and magnesium sulfate.
81
Examples of Cat B
Category B—No evidence of risk in animals but human studies have not been done
penicillins, cephalosporins, methyldopa, insulin, Pepcid, Reglan, Tagamet, Vistaril, Paxil, Prozac, Benadryl, and Dramamine
82
Examples of Category C—Risk cannot be ruled out. Risk is present in animals but controlled studies
are lacking in humans
This includes codeine, Decadron, methadone, Bactrim, Cipro, AZT, b-blockers, Prilosec, heparin, Protamine, Thorazine, Alupent, Robitussin, and Sudafed
83
Category D—Positive evidence of risk. Studies demonstrate fetal risk, but potential
benefits of the drug may outweigh the risk.
This includes aspirin, Valium, tetracycline,
| Dilantin, Depakote, and Lithium.
84
Examples of Cat X
This includes Accutane (isotretinoin), Danocrine,
| Pravachol, Coumadin, and Cafergot.
85
What syndrome
IUGR, midfacial hypoplasia, developmental delay, short
palpebral fissures, long philtrum, multiple joint anomalies, cardiac defects.
Alcohol. Fetal alcohol syndrome
86
What syndrome
T-shaped uterus, vaginal adenosis (with predisposition
to vaginal clear cell carcinoma), cervical hood, incompetent cervix, preterm delivery
Diethylstilbestrol. DES syndrome
87
What syndrome
IUGR, craniofacial dysmorphism (epicanthal folds,
depressed nasal bridge, oral clefts), mental retardation, microcephaly, nail hypoplasia, heart
defects.
Dilantin. Fetal hydantoin syndrome
88
What syndrome?
Congenital deafness, microtia, CNS defects, congenital heart defects.
Isotretinoin (Accutane
89
Ebstein’s anomaly (right heart defect).
Li
90
VIII nerve damage, hearing loss.
Strep
91
After fourth month, deciduous teeth discoloration
Tet
92
Phocomelia, limb reduction defects, ear/nasal anomalies, cardiac defects, pyloric or duodenal stenosis.
Thalidomide.
93
Facial dysmorphism (short upturned nose, slanted eyebrows), cardiac defects, IUGR, mental retardation.
Trimethadione.
94
Neural tube defects (spina bifida), cleft lip, renal defects.
Valproic acid (Depakote).
95
Chondrodysplasia (stippled epiphysis), microcephaly, mental retardation, optic atrophy.
Warfarin (Coumadin).
96
Advanced maternal age: women ≥35 years of age at increased risk of_________
fetal nondisjunction trisomies (e.g., trisomies 21 and 18)
97
This refers to numeric chromosome abnormalities in which cells do not contain 2 complete sets of 23 chromosomes. This usually occurs because of nondisjunction.
Aneuploidy
98
MC Aneuploidy
trisomy,
99
The most common trisomy in first-trimester losses is ______
| The most common trisomy at term is ______
trisomy 16.
trisomy 21.
100
This refers to numeric chromosome abnormalities in which cells contain complete sets of extra chromosomes
Polyploidy
101
The most common polyploidy is ______
triploidy with 69 chromosomes, followed
| by tetraploidy with 92 chromosomes
102
An example of triploidy is _______
| pregnancies, which occurs from fertilization of an egg by two sperm
incomplete molar
103
An example of a chromosomal deletion is del
| (5p) or ______, which is a deletion of the short arm of chromosome 5.
cri du chat syndrome
104
This refers to the presence of >2 cytogenetically distinct cell lines in the same individual
Mosaicism
105
Gonadal mosaicism can result in ______
premature
| ovarian failure and predispose the gonad to malignancy.
106
This involves any two or more nonhomologous chromosomes, and occurs when there is
a breakage and reunion of portions of the involved chromosomes to yield new products.
Reciprocal translocation
107
This always involves the acrocentric chromosomes, and is caused by centric fusion after loss
of the satellite region of the short arms of the original acrosomic chromosome
Robertsonian translocation
108
Robertsonian translocation consequences
The karyotype
of a balanced Robertsonian translocation will appear to have only 45 chromosomes;
however, the full complement of genetic material is present, and there are no clinical effects
109
Robertsonian translocation consequences if produces offspring
The offspring may have 46 chromosomes but have double the genetic material of a particular
chromosome.
110
The 2 most common aneuploidies in miscarriages are ______ and _____
trisomy 16 and monosomy X.
111
The majority of birth defects (70%) are _____ or _____ in origin, which means there is an interaction of multiple genes with environmental factors
multifactorial or polygenic
112
The overall recurrence rate of multifactorial inheritance is ________
The overall recurrence rate is 2–3%.
113
Pathophysio of NTD
These anomalies result from failure of neural
| tube closure by day 22–28 postconception.
