Reproductive Strand Flashcards
What is the primary role of follicle stimulating hormone?
Stimulates the oocytes to develop
What is the primary role of luteinising hormone?
Triggers ovulation
What is the primary role of oestrogens?
Thicken the endometrium
What is the primary role of progesterone?
Maintains the endometrium
What makes up the hypothalamic-pituitary- gondola (HPG) axis?
Hypothalamus
Anterior pituitary
Posterior pituitary
How does the hypothalamus stimulate the pituitary?
- proteins pass through the artery from the hypothalamus to the anterior pituitary
- the posterior pituitary stimulated by nervous stimulation
What hormones are released from the posterior pituitary?
ADDH
Oxytocin
What hormones are released from the anterior pituitary?
GH ACTH TSH FSH LH Prolactin
What is the primary role of oxytocin?
- uterine contractions
- lactation
What is gonadotrophin hormone (GnRH)?
- decapeptide
- released in pulses every 90-120 mins
- released by hypothalamus
- stimulated related of LH and FSH from the anterior pituitary
How many oocytes to females have throughout their lifetime?
- born with 1-2 million
- by puberty 300,000-400,000 are left
- after puberty, women loose about 1000 oocytes a month
When do oocytes start meiosis?
During fatal life
- then pause as primordial follicles
What are the stages of maturation of a oocyte follicle?
- Primordial follicle
- Primary/preantral follicle
- Secondary/antral follicle
- Preovulatory follicle
How long does it take for a follicle to develop to the stage where it is ready for ovulation?
Almost a year
Describe the structure of a developed oocyte
From outer layer to inner layer
- Theca externa - fibrous outer surface
- Thece interna - produces androgens
- Granulosa cells - convert the androgens to estradiol
- Antrum - fluid-filled cavity
What is the role of the theca external?
Fibrous outer surface
What is the role of the theca interna?
produces androgens
What is the role of the granulose cells?
Converts androgens to estradiol
What is the role of the antrum?
fluid filled cavity
What happens to the theca interna and granulosa cella after ovulation?
They undergo lutenisation
What results from lutenisation?
The corpus luteum
What is the role of the corpus luteum
To produce progesterone and estradiol
What is day one of the menstural cycle?
The first day of the menstrual period
Describe the hormone levels on day 1 of the menstrual cycle
- LH levels are low
- FSH levels are starting to rise
- The dominant follicle starts the final stages of development
Describe the hormone levels in the follicular phase of the menstrual cycle
- FSH stimulates follicular development
- The granulose cells produce more oestrogens
- Oestrogens provide
negative feedback to
the hypothalamus and
pituitary - FSH levels start to fall
Describe the hormone levels around ovulation
- oestrogen levels continue to rise so the negative feedback switches to positive feedback - The resulting LH surge triggers ovulation
Describe the hormone levels in the literal phase of the menstrual cycle
- The corpus luteum produces progesterone and estradiol - These give negative feedback to the hypothalamus and pituitary, so FSH and LH levels are low
What are the 2 phases of the hormonal and follicular cycle called?
- Follicular phase
2. Luteal phase
What is the endometrium?
- uterine lining
- endometrial glands and supporting storm
- very vascular
Describe what happens to the endometrium in the proliferative phase of the menstrual cycle
- the menstrual cycle starts with the endometrium being shed
- the estradiol causes the endometrium to proliferate
What are the two phases of the endometrium cycle of the menstrual cycle?
- proliferative phase
2. secretory phase
Describe what happens to the endometrium in the secretory phase
- 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
When does menarche occur?
(start of menstruation)
12-13, but can be as young as 8
When does menopause occur?
around 51
between 45 and 55
How long is a normal menstrual cycle?
21-40 days
What does the day of ovulation depend on?
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
What is menorrhagia?
Heavy menstrual bleeding
Describe heavy menstrual bleeding
- Most women loose 30-40ml blood / period
- Menorrhagia >80ml +/or patient perception
- Affects up to 1:5 women
What are the consequences of menorrhagia?
- Anaemia
- Interference with daily activities
- Anxiety and depression
- Estimated cost to economy >£500 million/year
What is the treatment for menorrhagia?
Continuous progesterone treatment or combination with oestrogen
How does continuous progesterone treat menorrhagia?
Continuous progesterone thins the endometrium and inhibits release of GnRH, FSH and LH
What is endometriosis?
• Presence of endometrial tissue
outside of the uterine cavity
• Causes pain with periods and
intercourse and subfertility
How can endometriosis be treated?
- Can treat with progestogen +/-
oestrogen - Can also use a GnRH agonist as without GnRH pulsatility FSH and LH
release is suppressed
what date does implantation occur
day 12 post conception
what is needed to achieve a pregancny
- plentiful supply of eggs
- functioning menstrual cycle
- regular release of an egg (ovultion)
- patent fallopian tubes
- healthy sperm
- receptive endometrium
what conditions may effect the supply of eggs
- age
- menopuase
- premature ovarian failure (menopause before 40)
- previous cancer treatment
- PCOS
how does PCOS effect the ovaries ? how does this condition effect the periods of a women
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
what is the average age for menopause
51
what conditions can effect the patency of the fallopian tubes
- pelvic inflammatory disease
- hydrosalpinx
- endometriosis
what is pelvic inflammatory disease. whats the mian risk factor for this
scarring and damage to the fallopian tubes
STI’s are the main risk factor for this - especially chalyidyma
whats hydrosalphinx
fluid accumulation in the fallopian tubes
what conditions effect the production of healthy sperm
- 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
what can effect the receptiveness of the endometrium
- fibrosis
- septum
- polyps
- intrauterine adhesions
what is the difference between sub-fertility and absolute fertility
sub-fertility is the reduced chance of conception (never say never vibes), whereas absolute fertility - can never get pregnant
whats the most common factor of inferility
male factor
what are the investigations of inferility
MOTU M- male factor O- ovulation and ovarian reserve T- tubal patency U- uterine cavity
how would you investigate for male factor in a fertility investigation ? what abnormalities would you look for
a semen analysis:
- no sperm
- quantity of sperm
- sperm motions
- sperm shape
what is required for a good semen analysis
fresh sample and a period of absentence before
how would you test for ovulation and ovarian reserve for in a fertility investigation
- ovualtion: mid-luteal progesterone (meausre 7 days before period- day 21/28 of cycle)
- ovarian reseve: FSH, AMG,AFC (antral follicle count)
how would you test for tubual patency for in a fertility investigation
put fluid through tubes look with ultrasound or X ray
under general anaesthetic
how would you test for uterine cavity for in a fertility investigation
ultrasound hysteroscopy (camera into womb)
what is the treatment for inferility
- stop smoking
- reduce/stop alchohl
- healthy diet
- excersise
- healthy BMI
- no recretional drugs
- men advised to avoid high tempreture
- treat underlying condition
steps involved in IVF
- 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)
what is screening
process to identify apparently healthy people who might be at an increased risk for a disease or condition
when do we screen in antenatal care
1- booking: 8-12 weeks
2- dating scan: 10-14 weeks
3- anomaly scan: 18-21 weeks
what does a booking scan consist of
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*
explain the contraction of Rh disease ? what are the consequnces of this
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
how do we prevent Rhesus disease
mother receives IM anti-D at 28-30 weeks :
neutralises foetal Rh+ antigens which have entered maternal blood = prevents creation of antibodies
do we just give the IM anti-D medication to the mother during the pregnancy
no another dose of anti-D is given after delivery if the baby is RH+ - cord blood tests are done at birth
what is a combined scan (in terms of results) and when is it performed?
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)
what investigations are done in combined screening
- nuchal Translucency scan
- blood test: hCG, PAPP-A (pregnancy associated plasma protein A)
if there is a chance of trisomy 21/13/18 what is offered?
more invasive testing
what does a nuchal translucency scan measure
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
what is chronic villus sampling? when is it performed ad what are the risks
sample of cells from the placenta is taken and analysed
11-14 weeks
1% risk of miscarriage
what is amniocentesis? when is it performed ad what are the risks
sample of amniotic fluid (containing fetal cells) taken and analysed
15-20 weeks
risk of miscarriage = 0.8%
what can we get from an anomaly scan, an anomaly scan, when is ti performed, what does it check
- 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
what is antenatal care ? what is the aim of this
care women receive from healthcare individuals (midwives, obstetricians) during pregnancy
aims to bring mother and child to labour in the bst possible condition
what does antenatal care involve
- 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
what are the principles of good antenatal care
- information given in the form easiest to undrestand and accesible
- based on current available evidence
- respect women’s wishes
what is the estimated due date based on
women’s last menstrual period
what risks does a booking visit with a midwife determine
- 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
how is the labour plan for an individual who has been identified as high risk in antenatal care changed
- hospital recommended as place of birth and baby may be delivered prior to 40 weeks gestation via induction of labour or a planned cesarian
what treatment/ advice is given to a pregnant mother who has been identified as ‘high risk’ during antenatal care?
- may include high dose of folic acid (reducing the risk of spina bifida)
- stop smoking
- check if regualr meds are safe in the pregancny
when is it important to increase the dose of folic acid for pregnancy
prior to conception
what are the babies of high risk women at risk of
higher risk of still birth
whats the differnece between a still birth and a misscarage
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
whats the most common cause of a miscarrge
unexplained
what are the symptoms which diagnose pregancy
- amenorrhoea
- nausea and vomitting
- breast symptoms
why do we amenorrhoea in preganncy
- endomertrium shedding prevented by progesterone made by the corpus lutem
why do we THINK we get vommiting and nausea symtoms in preganncy
increased levels of hCG
what breast symptoms do we get in pregnancy
- increased in size
- feels warm
- areolae darken
- montgomery’s tubecles develop and skins viens dilate
when can pregnancy first be seen on an ulttrasound scan
5 weeks
how can we diagnose a preganacy
- pregnancy test: hCG (urine tests)
- ultrasound
when is the fetal heart rate visible on an ultrasound
6 weeks
when is the feotal pole visible on an ultrasound
7 weeks
what basic investigations are done on a booking visit fir a normal pregancny
- urine for protein, glucose and signs of infection
- blood for anemia
- blood fro screening tests (HIV, thalasemia, hep B, syphilis, sickle cell)
how do we estimate the esitmated due date
take first day of last normal period, take away 3 months and add one year, add 7 days
what history is taken on a booking visit for a normal preganacy
- maternal disease
- family history (of father too)
- past obstetric history (gravida 3, parity 2)
- drug history
- social history (smoking, alcohol, martial staus, living conditions)
what does gravida 3 mean
number of times a women has been preganant
what does parity 2 mean
number of children women has given birth to
how many midwife appointments do first time mothers get in comparisison to women who have had preganacies before
first time = 10 weeks
otherwise- 7 weeks
after 34 weeks which 3 positions can the babys be in? which one of these are best?
- cephalic (best one- head down)
- breech (head up)
- transverse like (baby horizontal0
what do we measure in order to measure babys growth
fundal height is measured in cm from the pubic symphysis to the top portion of the uterus
