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year 1 flash cards > Reproductive Strand > Flashcards

Reproductive Strand Flashcards

1
Q

What is the primary role of follicle stimulating hormone?

A

Stimulates the oocytes to develop

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2
Q

What is the primary role of luteinising hormone?

A

Triggers ovulation

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3
Q

What is the primary role of oestrogens?

A

Thicken the endometrium

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4
Q

What is the primary role of progesterone?

A

Maintains the endometrium

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5
Q

What makes up the hypothalamic-pituitary- gondola (HPG) axis?

A

Hypothalamus
Anterior pituitary
Posterior pituitary

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6
Q

How does the hypothalamus stimulate the pituitary?

A
  • proteins pass through the artery from the hypothalamus to the anterior pituitary
  • the posterior pituitary stimulated by nervous stimulation
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7
Q

What hormones are released from the posterior pituitary?

A

ADDH

Oxytocin

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8
Q

What hormones are released from the anterior pituitary?

A 
GH
ACTH
TSH
FSH
LH
Prolactin
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9
Q

What is the primary role of oxytocin?

A
  • uterine contractions

- lactation

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10
Q

What is gonadotrophin hormone (GnRH)?

A
  • decapeptide
  • released in pulses every 90-120 mins
  • released by hypothalamus
  • stimulated related of LH and FSH from the anterior pituitary
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11
Q

How many oocytes to females have throughout their lifetime?

A
  • born with 1-2 million
  • by puberty 300,000-400,000 are left
  • after puberty, women loose about 1000 oocytes a month
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12
Q

When do oocytes start meiosis?

A

During fatal life

- then pause as primordial follicles

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13
Q

What are the stages of maturation of a oocyte follicle?

A
  1. Primordial follicle
  2. Primary/preantral follicle
  3. Secondary/antral follicle
  4. Preovulatory follicle
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14
Q

How long does it take for a follicle to develop to the stage where it is ready for ovulation?

A

Almost a year

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15
Q

Describe the structure of a developed oocyte

A

From outer layer to inner layer

  1. Theca externa - fibrous outer surface
  2. Thece interna - produces androgens
  3. Granulosa cells - convert the androgens to estradiol
  4. Antrum - fluid-filled cavity
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16
Q

What is the role of the theca external?

A

Fibrous outer surface

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17
Q

What is the role of the theca interna?

A

produces androgens

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18
Q

What is the role of the granulose cells?

A

Converts androgens to estradiol

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19
Q

What is the role of the antrum?

A

fluid filled cavity

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20
Q

What happens to the theca interna and granulosa cella after ovulation?

A

They undergo lutenisation

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21
Q

What results from lutenisation?

A

The corpus luteum

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22
Q

What is the role of the corpus luteum

A

To produce progesterone and estradiol

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23
Q

What is day one of the menstural cycle?

A

The first day of the menstrual period

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24
Q

Describe the hormone levels on day 1 of the menstrual cycle

A
  • LH levels are low
  • FSH levels are starting to rise
  • The dominant follicle starts the final stages of development
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25
Q

Describe the hormone levels in the follicular phase of the menstrual cycle

A
  • FSH stimulates follicular development
  • The granulose cells produce more oestrogens
  • Oestrogens provide
    negative feedback to
    the hypothalamus and
    pituitary
  • FSH levels start to fall
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26
Q

Describe the hormone levels around ovulation

A 
- oestrogen
levels continue to rise
so the negative feedback
switches to positive
feedback
- The resulting LH surge
triggers ovulation
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27
Q

Describe the hormone levels in the literal phase of the menstrual cycle

A 
-  The corpus luteum
produces progesterone
and estradiol
- These give negative
feedback to the
hypothalamus and
pituitary, so FSH and LH
levels are low
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28
Q

What are the 2 phases of the hormonal and follicular cycle called?

A
  1. Follicular phase

2. Luteal phase

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29
Q

What is the endometrium?

A
  • uterine lining
  • endometrial glands and supporting storm
  • very vascular
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30
Q

Describe what happens to the endometrium in the proliferative phase of the menstrual cycle

A
  • the menstrual cycle starts with the endometrium being shed

- the estradiol causes the endometrium to proliferate

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31
Q

What are the two phases of the endometrium cycle of the menstrual cycle?

A
  1. proliferative phase

2. secretory phase

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32
Q

Describe what happens to the endometrium in the secretory phase

A 
- Progesterone readies the
endometrium for
implantation:
• Glands become convoluted 
• Glycogen stores increase
- It also causes cervical mucus to thicken
- In the absence of
implantation, falling
progesterone causes the
endometrium to start
breaking down
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33
Q

When does menarche occur?

A

(start of menstruation)

12-13, but can be as young as 8

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34
Q

When does menopause occur?

A

around 51

between 45 and 55

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35
Q

How long is a normal menstrual cycle?

A

21-40 days

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36
Q

What does the day of ovulation depend on?

A

The length of the luteal phase
- ie when there is variation in cycle length, thi sis due to variation in the length of the follicular phase. The luteal phase is fixed at 14 days

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37
Q

What is menorrhagia?

A

Heavy menstrual bleeding

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38
Q

Describe heavy menstrual bleeding

A
  • Most women loose 30-40ml blood / period
  • Menorrhagia >80ml +/or patient perception
  • Affects up to 1:5 women
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39
Q

What are the consequences of menorrhagia?

A
  • Anaemia
  • Interference with daily activities
  • Anxiety and depression
  • Estimated cost to economy >£500 million/year
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40
Q

What is the treatment for menorrhagia?

A

Continuous progesterone treatment or combination with oestrogen

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41
Q

How does continuous progesterone treat menorrhagia?

A

Continuous progesterone thins the endometrium and inhibits release of GnRH, FSH and LH

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42
Q

What is endometriosis?

A

• Presence of endometrial tissue
outside of the uterine cavity
• Causes pain with periods and
intercourse and subfertility

43
Q

How can endometriosis be treated?

A
  • Can treat with progestogen +/-
    oestrogen
  • Can also use a GnRH agonist as without GnRH pulsatility FSH and LH
    release is suppressed
44
Q

what date does implantation occur

A

day 12 post conception

45
Q

what is needed to achieve a pregancny

A
  • plentiful supply of eggs
  • functioning menstrual cycle
  • regular release of an egg (ovultion)
  • patent fallopian tubes
  • healthy sperm
  • receptive endometrium
46
Q

what conditions may effect the supply of eggs

A
  • age
  • menopuase
  • premature ovarian failure (menopause before 40)
  • previous cancer treatment
  • PCOS
47
Q

how does PCOS effect the ovaries ? how does this condition effect the periods of a women

A

you get tiny little cysts on the ovaries so the ovaries cannot produce good quality eggs

in PCOS a lot of follicles start to develop but non finish this stage so ovulation is often irregular or absent = leading to irregular or absent periods

48
Q

what is the average age for menopause

A

51

49
Q

what conditions can effect the patency of the fallopian tubes

A
  • pelvic inflammatory disease
  • hydrosalpinx
  • endometriosis
50
Q

what is pelvic inflammatory disease. whats the mian risk factor for this

A

scarring and damage to the fallopian tubes

STI’s are the main risk factor for this - especially chalyidyma

51
Q

whats hydrosalphinx

A

fluid accumulation in the fallopian tubes

52
Q

what conditions effect the production of healthy sperm

A
  • varicocele (increase temperature can effect sperm production)
  • klinefelter’s syndrome ( XXY: effects the production of sperm and ejactulation)
  • orchitis (inflammation, damage and scarring of tissue scrotum)
  • CBAVD (thickened secretions - from CF)
  • testicular torsion (surgical emergency)
  • anabolic steroids (lead to hypogonadism and decreased testicualr size)
  • vasectomy
53
Q

what can effect the receptiveness of the endometrium

A
  • fibrosis
  • septum
  • polyps
  • intrauterine adhesions
54
Q

what is the difference between sub-fertility and absolute fertility

A

sub-fertility is the reduced chance of conception (never say never vibes), whereas absolute fertility - can never get pregnant

55
Q

whats the most common factor of inferility

A

male factor

56
Q

what are the investigations of inferility

A 
MOTU
M- male factor 
O- ovulation and ovarian reserve 
T- tubal patency 
U- uterine cavity
57
Q

how would you investigate for male factor in a fertility investigation ? what abnormalities would you look for

A

a semen analysis:

  • no sperm
  • quantity of sperm
  • sperm motions
  • sperm shape
58
Q

what is required for a good semen analysis

A

fresh sample and a period of absentence before

59
Q

how would you test for ovulation and ovarian reserve for in a fertility investigation

A
  • ovualtion: mid-luteal progesterone (meausre 7 days before period- day 21/28 of cycle)
  • ovarian reseve: FSH, AMG,AFC (antral follicle count)
60
Q

how would you test for tubual patency for in a fertility investigation

A

put fluid through tubes look with ultrasound or X ray

under general anaesthetic

61
Q

how would you test for uterine cavity for in a fertility investigation

A 
ultrasound 
hysteroscopy (camera into womb)
62
Q

what is the treatment for inferility

A
  • stop smoking
  • reduce/stop alchohl
  • healthy diet
  • excersise
  • healthy BMI
  • no recretional drugs
  • men advised to avoid high tempreture
  • treat underlying condition
63
Q

steps involved in IVF

A
  • pre treatment (the pill)
  • down regulation to prevent premature LH surge (GnRH agnosit or antagonist)
  • controlled ovarian stimualtion (gonadotrophins)
  • trigger injection to encourage final oocyte maturation (hCG or GnRH agnosit)
  • transvaginal oocyte reterval
  • fertlisation using iVF
  • embryo culture
  • select embyos
  • embyo tranfer
  • luteal phase support (progesterone)
64
Q

what is screening

A

process to identify apparently healthy people who might be at an increased risk for a disease or condition

65
Q

when do we screen in antenatal care

A

1- booking: 8-12 weeks
2- dating scan: 10-14 weeks
3- anomaly scan: 18-21 weeks

66
Q

what does a booking scan consist of

A

blood tests for:

infectious diseases:

  • HIV
  • hep B
  • syphilis
  • Rubella

Haemoglobinopathies:

  • sickle cell
  • thalassemia

mothers blood group Rhesus status

  • note need to also test partner*
67
Q

explain the contraction of Rh disease ? what are the consequnces of this

A

1- RH+ father
2- Rh- mother carrying her first Rh+ foetus
3- Rh antigens from developing foetus enter mothers blood during delivery
3- mother produces anti-Rh antibodies
4- if women becomes pregnant with another Rh+ foetus her anti-Rh antibodies will cross placenta and damage/attack foetal RBC
5- causes haemolytic anaemia and jaundice in newborn

68
Q

how do we prevent Rhesus disease

A

mother receives IM anti-D at 28-30 weeks :

neutralises foetal Rh+ antigens which have entered maternal blood = prevents creation of antibodies

69
Q

do we just give the IM anti-D medication to the mother during the pregnancy

A

no another dose of anti-D is given after delivery if the baby is RH+ - cord blood tests are done at birth

70
Q

what is a combined scan (in terms of results) and when is it performed?

A

combined scan is performed at the same time as a dating scan

Gives 2 results:

  • chance of baby having trisomy 21
  • chance of baby having trisomy 13/18 (Patau’s or Edwards syndromes)
71
Q

what investigations are done in combined screening

A
  • nuchal Translucency scan

- blood test: hCG, PAPP-A (pregnancy associated plasma protein A)

72
Q

if there is a chance of trisomy 21/13/18 what is offered?

A

more invasive testing

73
Q

what does a nuchal translucency scan measure

A

sonographic appearance of a collection of fluid under the skin behind the fetal neck in the first-trimester of pregnancy- increased in cases of possible disease

74
Q

what is chronic villus sampling? when is it performed ad what are the risks

A

sample of cells from the placenta is taken and analysed
11-14 weeks
1% risk of miscarriage

75
Q

what is amniocentesis? when is it performed ad what are the risks

A

sample of amniotic fluid (containing fetal cells) taken and analysed
15-20 weeks
risk of miscarriage = 0.8%

76
Q

what can we get from an anomaly scan, an anomaly scan, when is ti performed, what does it check

A
  • between 18-21 weeks
  • check physical development baby
  • examine physcial abnormaliites
  • screens 11 main/rare conditions: baby bones. heart, brain, spinal chord, face, kidneys, abdomen
77
Q

what is antenatal care ? what is the aim of this

A

care women receive from healthcare individuals (midwives, obstetricians) during pregnancy

aims to bring mother and child to labour in the bst possible condition

78
Q

what does antenatal care involve

A
  • detects subgroups most at risk
  • diagnostic procedures to see who is really at risk
  • provision of appropriate managemnt for those highest risk
  • education for health pregnancy - childbirth and having new baby
79
Q

what are the principles of good antenatal care

A
  • information given in the form easiest to undrestand and accesible
  • based on current available evidence
  • respect women’s wishes
80
Q

what is the estimated due date based on

A

women’s last menstrual period

81
Q

what risks does a booking visit with a midwife determine

A
  • complications of previous pregnancies: pre-eclampsia, pre term birth, gestational diabetes
  • has chronic disease: diabetets, high bp, thyroid problems
  • has had a baby with previous abnormalities: spina bifida, downs syndrome
  • family history of inherited disorders: sickle cell, CF
82
Q

how is the labour plan for an individual who has been identified as high risk in antenatal care changed

A
  • hospital recommended as place of birth and baby may be delivered prior to 40 weeks gestation via induction of labour or a planned cesarian
83
Q

what treatment/ advice is given to a pregnant mother who has been identified as ‘high risk’ during antenatal care?

A
  • may include high dose of folic acid (reducing the risk of spina bifida)
  • stop smoking
  • check if regualr meds are safe in the pregancny
84
Q

when is it important to increase the dose of folic acid for pregnancy

A

prior to conception

85
Q

what are the babies of high risk women at risk of

A

higher risk of still birth

86
Q

whats the differnece between a still birth and a misscarage

A

baby born without signs of life after 24 weeks of completed pregancy = stillbirth

baby born without signs of life before 24 weeks of pregnancy = miscarrage

87
Q

whats the most common cause of a miscarrge

A

unexplained

88
Q

what are the symptoms which diagnose pregancy

A
  • amenorrhoea
  • nausea and vomitting
  • breast symptoms
89
Q

why do we amenorrhoea in preganncy

A
  • endomertrium shedding prevented by progesterone made by the corpus lutem
90
Q

why do we THINK we get vommiting and nausea symtoms in preganncy

A

increased levels of hCG

91
Q

what breast symptoms do we get in pregnancy

A
  • increased in size
  • feels warm
  • areolae darken
  • montgomery’s tubecles develop and skins viens dilate
92
Q

when can pregnancy first be seen on an ulttrasound scan

A

5 weeks

93
Q

how can we diagnose a preganacy

A
  • pregnancy test: hCG (urine tests)

- ultrasound

94
Q

when is the fetal heart rate visible on an ultrasound

A

6 weeks

95
Q

when is the feotal pole visible on an ultrasound

A

7 weeks

96
Q

what basic investigations are done on a booking visit fir a normal pregancny

A
  • urine for protein, glucose and signs of infection
  • blood for anemia
  • blood fro screening tests (HIV, thalasemia, hep B, syphilis, sickle cell)
97
Q

how do we estimate the esitmated due date

A

take first day of last normal period, take away 3 months and add one year, add 7 days

98
Q

what history is taken on a booking visit for a normal preganacy

A
  • maternal disease
  • family history (of father too)
  • past obstetric history (gravida 3, parity 2)
  • drug history
  • social history (smoking, alcohol, martial staus, living conditions)
99
Q

what does gravida 3 mean

A

number of times a women has been preganant

100
Q

what does parity 2 mean

A

number of children women has given birth to

101
Q

how many midwife appointments do first time mothers get in comparisison to women who have had preganacies before

A

first time = 10 weeks

otherwise- 7 weeks

102
Q

after 34 weeks which 3 positions can the babys be in? which one of these are best?

A
  • cephalic (best one- head down)
  • breech (head up)
  • transverse like (baby horizontal0
103
Q

what do we measure in order to measure babys growth

A

fundal height is measured in cm from the pubic symphysis to the top portion of the uterus

year 1 flash cards (23 decks)

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