Reproduction Flashcards
Phenytoin Teratogen Defects
- Fetal hydantoin syndrome = cleft palate, cardiac defects, phalanx/fingernail hypoplasia
Autonomic innervation of the male sexual response
Erection = PSNS = Pelvic Splanchnic Emission = (testes-->urethra) = Sympathetic Nervsous system = Hypogastric nerves Ejaculation = visceral and somatic nerves = Pudendal nerve (urethra --> outside)
Lymphatic Drainage
- Ovarian/testes –> para-aortic lymph nodes
- lower 2/3 vagina/vulva/scrotum –> superficial inguinal nodes (easily palpable)
- upper 1/3 vagina/uterus –> obturator, external iliac, and Hypogastric nodes (not palpable)
Sertoli Cells
- create tight junctions that help to form the blood test is barrier to isolate gametes from autoimmune attack
Diethylstilbestrol (DES)
In Utero exposure
- Clear cell adenocarcinoma of vagina
- Anatomic abnormalities of genital tract
Occurs in children of mothers that used DES
Medroxyprogesterone (Depo-Provera)
- IM injection that is good for 3 months
- reliable
- long term great for non-compliant people
- can induce amenorrhea
Side Effects
- associated with bone internal density loss especially if long term therefore not ideal for >2 year of use
- weight gain
- irregular bleeding = due to no estrogen
Progestins
Implanon and Nexplanon (filled with progesterone)
- stick that is put into the arm
- progesterone is released at the same amount every day
Intrauterine Devices
- Copper (paragard) –> 10 years
- Progesterone (Mirena) –> 5 years, decreases menstruation by reducing endometrial growth used as treatment for menorrhagia
Side Effects
- small risk of uterine perforation when placed (usually used with ultrasound)
- contraindicated for patients high risk of STD = can push infection into the uterus during placement
Menopause Hot Flashes
- occur in 75% of menopausal women
- Presentation: starts in face/chest then generalizes, lasts 2-4 min, associated with diaphoresis, and palpitations, followed by chills and shivering, may cause sleep disturbances
Treatment: estrogen replacement > SSRI or SNRI (venlafaxine) > Clonidine or gabapentin
Herbal Treatment: soy isoflavones, red clover, black cohosh, vitamin E ( = potential estrogenic effect on the breast, much like estrogen replacement)
Vaginal Pain
- Trauma
- infections
- muscular spasm
- mucosal allodynia (pain from a stimulus that doesn’t usually cause pain)
- hyperalgesia (ramped up pain pathway responses due to nerve damage or some kind of psychological issue)
- vaginismus = spasm of pelvic floor muscles that causes pain when touched
- vestibulitis - burning sensation at opening of vagina = pain when touching the glands (Bartholin or skene glands)
Treatment = desensitization
- remove painful stimuli
Benign Vulvar Cysts
Bartholin gland and Skenes gland = normally important for vaginal lubrication
Bartholyn gland cyst
- problem with the duct of the bartholyn gland or Skenes gland causing obstruction
- making the gland to swell
Treatment = excision and drainage and make a new exit point for the duct to drain into the vagina
Any bacteria can be a cause of this (more associated with Chlamydia and gonorrhea) must drain before giving antibiotic
Risk Factors for Endometrial Cancer
Hyperplasia Hypertension Obesity Nulliparity Diabetes Anovulatory state
HHONDA
Treatment = hysterectomy, removal of lymph nodes, chemotherapy
Classic Locations for Fibroids
Subserosal = outside of uterus
Intramural = inside the wall of the myometrium (most common)
Sub mucosal = under the mucosa inside the uterine cavity
Menorhhagia with no pelvic pain but enlarged uterus
Leiomyoma
Most common tumor in women
Leiomyoma
Most common gynecological malignancy in the US
Endometrial Carcinoma
- world wide = Cervical Cancer
Medications for Pregnancy Termination
Misoprostol = Prostaglandin E1 agonist = causing uterine contractions
Mifepristone = progesterone and glucocorticoid antagonist
Methotrexate = folic acid antagonist
Mentropin
- human menopausal gonadotropin
- mimics FSH and triggers formation of a dominant ovarian follicle
- anovulation is a common cause of infertility
- ovulation is then induced by administration of HCG which mimics the LH surge
Amniocentesis Indications
- abnormal maternal serum triple or quadruple screen
- high risk for trisomy or other genetic defects (>35 yo; carrier of AR disease)
- Evaluation of fetal lung maturity (lecithin:sphingomyelin ratio >2.0)
- In Rh-sensitized pregnancy to detect fetal blood type or fetal hemolysis
- Testing for infection
Timing
- can’t be earlier than 15-17 weeks for genetic evaluation
- performed in 3rd trimester for fetal lung maturity evaluation
Risks
- 1-2% of fetal/maternal hemorrhage, 0.5% fetal loss
Chorionic Villus Sampling (CVS)
- Performed at 10-12 weeks
- needle biopsy of placenta
Risks
- 1% fetal loss, inability to diagnose NTD, limb defects if done
Sleep Patterns in the Elderly
- decreased REM sleep
- decreased slow wave sleep
- increased Sleep latency
- increased nighttime awakenings
Causes of Intellectual Disability
Most common cause overall = Fetal Alcohol Syndrome
1st most common when it comes to genetics = Down Syndrome
2nd most common when it comes to genetics = Fragile X syndrome
Horseshoe Kidney, congenital heart defects, streak ovaries, and cystic hygroma
Turner Syndrome
Most common cause of congenital retardation in men
Fragile X syndrome
Ovulation
- Peak levels of estrogen in the late follicular phase has a positive feedback effect on LH production which causes the LH surge
- This LH surge causes the rupture of the follicle leading to extrusion of the secondary locate (ovulation)
- FSH levels are highest just before ovultation
Teratogens
Warfarin = causes nasal hypoplasia, stipples epiphysis
Vitamin A = Microcephaly, they mic hypoplasia, small ears, hydrocephalus
Lithium = hypothyroidism and Epstein anomaly
Phenytoin = causes fetal hydantoin syndrome ==>orofacial clefts, Microcephaly, digit or nail hypoplasia, cardiac defects, and dysmorphic facial features
Kleinfelter Syndrome
- primary hypogondadism
- increased long bone length
- gynecomastia
- learning and socialization difficulties
Decreased testosterone
LH and FSH are increased due to loss of feedback inhibition
Increased Estradiol
Vaginal Candidiasis
Normally gram + lactobacilli comprise a major part of the normal vaginal flora and exist in balance with other colonizers at a normal vaginal pH of 3.8-4.5
- changes in vaginal flora and epithelial injury can lead to overgrowth of yeast, most commonly candida
- Common triggers for candida vaginitis include: antibiotic use, high estrogen levels, systemic corticosteroid therapy, uncontrolled diabetes mellitus, and any other cause of immunosuppression including HIV
Menopause vagina
- decreased thickness of the vaginal epithelium and decreased amounts of glycogen in epithelial cells are characteristic in postmenopausal and lactating women
- these changes are caused by low estrogen levels and lead to atrophic vaginitis
Alpha Fetal Protein
- synthesized by the fetal liver, GI tract, and yolk sac (early gestation only)
- levels increase with gestation age
- this is why accurate dating is crucial in performing the calculations involved in ddetermining risk status
- Patients with a history of irregular menses are at risk for inaccurate pregnancy dating
Increased AFP
- Open neural tube defects
- Ventral wall defects = omphalocele, gastroschisis
- multiple gestational
Gap junction stimulation
Immediately before delivery, estrogen stimulates up regulation of gap unctions between individual myometrial smooth muscle cells
- An increase in gap junction density at delivery heightens myometrial excitability
- Gap junctions consist of aggregated Connexxion proteins that allow passage of ions between myometrial cells
- Estrogen also increases expression of oxytocin receptors that help mediate calcium transport through ligand-activated calcium channels
- the combo of an increase in gap junction density and uterotonic receptors results in coordinated synchronous labor contractions
ED
- if the patient has morning erections then the erectile dysfunction is due to psychogenic impotence
Endometriosis vs. Adenomyosis
Adenomyosis = uterus is uniformly enlarged
Endometriosis = no enlarged uterus
Fibroids = irregularly enlarged uterus
Transverse Vaginal Septum
- failed vertical fusion of the paramesonephric ducts with the urogenital sinus
- the obstructive septum causes primary amenorrhea with cyclic pelvic pain from hematometra (menses retained in the uterus) and an HSG cannot be performed on these patients
Virilazation in Pregnant mother and born child
- This is due to aromatase deficiency in the placenta
- there will be no conversion to testosterone which will increase the androgen levels in the mom and baby
- Can’t be any of the congenital hyperplasia deficiencies because it won’t affect the mom due to aromatase being intact in the placenta
Aromatase converts androgens in the ovaries, testes, placenta, and other peripheral tissues
