Repro basis Flashcards
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 ___
10
9–10
20–22 weeks
Fn of HCG
1
2
3
• 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
DDx for high HCG
twin pregnancy, hydatidiform mole, choriocarcinoma, embryonal
carcinoma.
DDx for low HCG
ectopic pregnancy, threatened abortion, missed abortion
Chemically it is similar to anterior pituitary growth hormone and prolactin.
HPL
Fn of HPL
It antagonizes the cellular action of insulin, decreasing insulin utilization, thereby
contributing to the predisposition of pregnancy to glucose intolerance and diabete
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
Progesterone
Progesterone:
It is initially produced exclusively by the corpus luteum up to_____ menstrual weeks.
6–7
Between 7 and 9 weeks, both the_____ and _____ produce progesterone
corpus luteum and the placenta
After 9 weeks the corpus luteum declines, and progesterone production is exclusively by the _______
placenta.
Fn of progesteron in early pregnancy
In early pregnancy it induces endometrial secretory changes favorable for blastocyst
implantation
Fn of progesteron in late pregnancy
In later pregnancy its function is to induce immune tolerance for the pregnancy and
prevent myometrial contractions
Seen in Nonpregnant reproductive years
Produced by the Follicle Granulosa
Estradiol
Important enzyme used to produce estradiol
aromatase enzyme that completes the transformation into estradiol
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
Dehydroepiandrosterone-sulfate (DHEAS)
sulfatase
___ is the main form during menopause. Postmenopausally, adrenal androstenedione is
converted in peripheral adipose tissue to estrone
Estrone
reason for Spider angiomata and palmer erythema during pregnancy
From increased skin vascularity.
Bluish or purplish discoloration of the vagina and cervix as a result of
increased vascularity during pregancy
Chadwick sign—
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
24–28
T or F
Arterial blood pressure is never normally elevated in pregnancy.
T
Central venous pressure (CVP) is ____with pregnancy, but femoral venous pressure (FVP) increases two- to threefold by 30 weeks’ gestation.
unchanged
Plasma volume increases up to ____ with a significant increase by the first trimester. Maximum increase is by___ weeks
50%
30
CO increases up to 50% with the major increase by ____ weeks.
20
CO is dependent on maternal position. CO is the highest in the ______
left lateral position.
A _______ murmur along the left sternal border is normal in pregnancy
owing to increased CO passing through the aortic and pulmonary valves
systolic ejection
RBC mass increases by _____ in pregnancy; thus, oxygen-carrying capacity increases.
30%
WBC count increases progressively during pregnancy with a mean value of up to ______ in the third trimester
16,000/mm3
ESR increases in pregnancy because of the increase_________
in gamma globulins.
Platelet count normal reference range is _______ in pregnancy.
unchanged
___________ increase progressively
in pregnancy, leading to a hypercoagulable state
Factors V, VII, VIII, IX, XII, and von Willebrand Factor
Gastric motility decreases and emptying time increases from the ________
effect on smooth muscle.
progesterone
_______increases with pregnancy to 40%. It is the only lung volume that does not decrease with pregnancy.
TV
_______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)—
the volume of air trapped in the lungs after deepest expiration.
It decreases up to 20% by the third trimester
Residual volume
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
The kidneys increase in size because of the increase in renal blood flow. This
hypertrophy doesn’t reverse until ____months postpartum
3
Ureteral diameter increases owing to the progesterone effect on smooth muscle.
The _____ side dilates more than the left in 90% of patients.
right
Urine glucose normally increases. Glucose is freely filtered and actively reabsorbed.
However, the tubal reabsorption threshold falls from_______
195 to 155 mg/dL.
Proteinuria—Urine protein remains _____
unchanged
Adrenal gland size is unchanged, but production of______ increases two- to
threefold
cortisol
_____ increases, resulting in increased total T3 and T4, although free T3 and free T4 remain unchanged.
Thyroid binding globulin
TBG
Fetal Circulation
Three in utero shunts exist within the fetus.
- The _____ carries blood from the umbilical
vein to the inferior vena cava. - The _____ carries blood from the right to the left atrium, and
- the ______s shunts blood from the pulmonary artery to the descending aorta.
ductus venosus
foramen ovale
ductus arterioss
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
On average, there are _______lobes in
each breast, arranged roughly in a wheel-spoke pattern emanating from the nipple area
15 to 20
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
