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Obstetrics and Gynaecology > Reproductive system - done > Flashcards

Reproductive system - done Flashcards

1
Q

Label the following:

A
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2
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5
Q

What hormones are involved in the hypothalamic-pituitary-gonadal axis?

A

Hypothalamus = GnRH

Anterior pituitaty = LH and FSH (stimulate development of follicles)

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6
Q

What part of the follicles secrete oestrogen?

A

Theca granulosa cells

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7
Q

What effect does oestrogen have on the hypothalamus and anterior pituitary?

A

Negative feedback effect

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8
Q

What kind of hormone is oestrogen?

A

Steroid sex hormone

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9
Q

What is the most active version of oestrogen?

A

17-beta oestradiol

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10
Q

Where does oestrogen work?

A

On tissues with oestrogen receptors to promote female secondary sexual characteristics

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11
Q

What changes does oestrogen stimulate?

A
  • Breast tissue development
  • Development of female sex organs at puberty
  • Blood vessel development in the uterus
  • Development of the endometrium
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12
Q

What kind of hormone is progesterone?

A

Steroid sex hormone

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13
Q

Where and when is progesterone formed?

A

Corpus luteum after ovulation

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14
Q

After pregnancy where is progesterone mainly formed?

A

Placenta from 10 weeks gestation onwards

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15
Q

What does progesterone do?

A

Acts on tissues which have previously been stimulated by oestrogen

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16
Q

What does progesterone do?

A

Thickens and maintains the endometrium

Thickens the cervical mucus

Increases the body temperature

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17
Q

What age does puberty begin in girls and boys respectively?

A

Girls = 8-14

Boys = 9-15

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18
Q

What enzyme is found in adipose tissue which is important in the creation of oestrogen?

A

Aromatase

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19
Q

When may puberty be delayed?

A
  • Low birth weight
  • Chronic disease
  • Eating disorders
  • Athletes
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20
Q

What is the order of puberty in girls?

A
  • Breast buds
  • Pubic hair
  • Menarche (first episode of mensturation)
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21
Q

What scale can be used to stage pubertal development?

A

Tanner scale

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22
Q

What hormone initially rises during puberty?

A

Growth hormone

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23
Q

In puberty what is released after GH and what is its function?

A

GnRH stimulates the release of FSH and LH

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24
Q

What does FSH and LH stimuate in the woman?

A

Production of oestrogen and progesterone

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25
Q

How does FSH and LH change just before menarche?

A

FSH levels plateau a year before

LH continues to rise and spike just before menarche

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26
Q

What suppresses GH in women?

A

Oestrogen

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27
Q

What are the two phases to the menstural cycle?

A

Follicular phase (start of mensturation to moment of ovulation)

Luteal phase (final 14 days of cycle)

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28
Q

Which cells have the potential to develop into eggs?

A

Oocytes

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29
Q

Which cells surround the oocytes?

A

Granulosa cells (forming follicles)

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30
Q

What are the 4 key stages of development of the follicles?

A

Primordial follicles

Primary follicles

Secondary follicles

Antral follicles (aka Graafian follicles)

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31
Q

When do primordial follicles mature into primary and secondary follicles?

A

Always occuring, independent of the menstural cycle

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32
Q

At what point do the follicles develop the receptors for FSH?

A

Secondary follicle stage (further development requires FSH)

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33
Q

At the start of the menstural cycle, what stimulates further development of the secondary follicles?

A

FSH

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34
Q

What secretes oestradiol in the woman?

A

Granulosa cells

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35
Q

What effect does this oestradiol have on the pituitary gland?

A

Negative feedback (reducing LH and FSH)

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36
Q

What effect does the rising oestrogen have on the cervical mucus?

A

Makes it more permeable allowing sperm to penetrate the cervix

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37
Q

What hormone spikes just before ovulation, causing the dominant follicle to release the ovum (an unfertilised egg)

A

Luteinising hormone

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38
Q

What happens to the follicle that releases the ovum?

A

Collapses and becomes the corpus luteum

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39
Q

What hormone does the corpus luteum secrete?

A

Progesterone

(and a little oestrogen)

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40
Q

What effect does the progesterone from the corpus luteum have?

A

Maintains endometrial lining

Causes cervical mucus to become thick and no longer penetrable

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41
Q

Where does human chorionic gonadotrophin (HCG) come from?

A

Syncytiotrophoblast of the embryo

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42
Q

What is the purpose of HCG?

A

Maintains the corpus luteum

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43
Q

What causes mensturation?

A

No production of hCG = corpus luteum degenerates = production of oestrogen and progesterone stops = endometrium breaks down and mensturation occurs

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44
Q

During mensturation where does prostalandins come from?

A

Stromal cells of the endometrium

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45
Q

What is the purpose of prostaglandins?

A

Encourages the endometrium to break down and uterus contracts

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46
Q

What day of the menstural cycle does mensturation occur on?

A

Day 1

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47
Q

Why does LH and FSH begin to rise at the beginning of the menstural cycle?

A

Due to negative feedback from the corpus luteum stopping (so progesterone and oestrogen decreases)

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48
Q

What layers of the endometrium are lost during mensturation?

A

Superficial and middle

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49
Q

What layer of the endometrium is kept during mensturation?

A

Basal layer

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50
Q

What type of cells are oocytes?

A

Germ cells - undergo meiosis to become mature ovum (ready for fertilisation)

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51
Q

How many chromosomes do ovum contain?

A

46

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52
Q

What layers surround the primary oocyte?

A

Pregranulosa cells

Surrounded by outer basal lamina layer

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53
Q

What are the three layers to the primary follicle?

A
  • Primary oocyte in centre
  • Zona pellucida
  • Cuboidal shaped granulosa cells
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54
Q

Where does the zona pellucida come from in the primary follicles?

A

Secreted by the granulosa cells (they also secrete oestrogen)

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55
Q

What layer develops on top of the granulosa layer?

A

Theca folliculi

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56
Q

What are the two layers of the theca folliculi?

A

Theca interna and theca externa

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57
Q

What does the theca interna secrete?

A

Androgen hormones

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58
Q

What is the theca externa made up of?

A

Connective tissue containing smooth muscle and collagen

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59
Q

What is the difference between primary and secondary follicles?

A

Secondary are larger with small fluid-filled gaps between granulosa cells

Receptors for FSH

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60
Q

What is required for the further development of the secondary follicle?

A

Stimulation from FSH

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61
Q

What develops in the secondary follicle and what is this called?

A

Single large fluid-filled area in the granulosa called the antrum

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62
Q

Once the antrum is formed, what surrounds the oocyte now?

A

Corona radiata - made of granulosa cells (surrounding the zona pellucida and oocyte)

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63
Q

What causes the follicle to burst during ovulation?

A

LH surge (causes the smooth muscle of the theca externa to burst)

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64
Q

What sweeps along the oocyte?

A

Fimbriae of the fallopian tubes

65
Q

Once ovulation occurs what happens to the cells of the follicle?

A

Become luteal cells

66
Q

At what point do the 46 chromosomes split to become 23 in the oocyte?

A

Just before ovulation the primary oocyte undergoes meiosis creating a haploid cell (the other 23 chromosomes float off to the side and become a polar body) it is then a secondary oocyte

67
Q

When the sperm enters the egg what happen to the chromosomes of the egg?

A

They multiply into two sets and only one set combines with the 23 chromosomes from the sperm to form a diploid set of 46 chromosomes

68
Q

What happens to the other set of 23 chromosomes?

A

Float off to the side to create the second polar body

69
Q

What is the fertilised egg called?

A

Zygote

70
Q

After rapid divison what is the zygote then called?

A

Morula

71
Q

How does the morula change?

A

A fluid filled cavity gathers within the group of cells and it becomes a blastocyst

72
Q

What are the components of the blastocyst?

A

- Embryoblast: main group of cells in the middle

- Blastocele: fluid filled cavity

- Trophoblast: outer layer of cells

(gradually losing the corona radiata and zona pellucida)

73
Q

When does the blastocyst arrive in the uterus?

A

8-10 days after ovulation

74
Q

Which cells of the blastocyst implant on the endometrium?

A

Cells of the trophoblast undergo adhesion to the stroma (supportive outer tissue) of the endometrium

75
Q

What is the outer layer of the trophoblast called?

A

Syncytiotrophoblast (this layer forms projections into the stroma)

76
Q

What do the cells of the stroma (supportive outer tissue of the endometrium) convert into?

A

Decidua

77
Q

What is the role of the decidua?

A

Provides nutrients to the trophoblast

78
Q

After implantation of the blastocyst, what starts producing HCG?

A

Human chorionic gonadotrophin

79
Q

What is the purpose of HCG?

A

Maintains the corpus luteum in the ovary, allowing it to continue producing progesterone and oestrogen

80
Q

After implantation when does the blastocyst start to differentiate?

A

A week after fertilisation

81
Q

What does the embryoblast differentiate into?

A

Yolk sac

Amniotic cavity

Divided by the embryonic disc

82
Q

What does the embryonic disc divide into?

A

Fetal pole into the fetus

83
Q

What surrounds the yolk sac and amniotic cavity?

A

The chorion (two layer: cytotrophoblast, syncytiotrophoblast)

84
Q

Label the following:

A
85
Q

What does the connecting stalk eventually become?

A

Connecting stalk

86
Q

When does the embryonic disc become the fetal pole?

A

5 weeks gestation

87
Q

What are the three laters of the fetal pole?

A

Ectoderm (outer layer)

Mesoderm (middle layer)

Endoderm (inner layer)

88
Q

Name some derivatives of the three germ cell layers?

A
89
Q

At what point gestation have all the major organs developed?

A

8 weeks gestation, from this point the fetus matures and grows until birth

90
Q

What are the spiral arteries?

A

Artery branches in the endometrium from the myometrium

91
Q

What is the chorionic villi?

A

Finger-like projections from the syncytiotrophoblast into the endometrium containing foetal blood vessels

92
Q

Where is the chorionic villi most vascular?

A

Chorion Frondosum: nearest the connecting stalk - these contain mesoderm

93
Q

What cells become the placenta?

A

Cells of the chorion frondosum

94
Q

When is placental development complete by?

A

10 weeks gestation

95
Q

What signal reduces vascular resistance of the spiral arteries?

A

Signals from the trophoblast invasion of the endometrium make the spiral arteries more fragile

96
Q

When the spiral arteries break down, what is left?

A

Lacunae = pools of blood

97
Q

What does the maternal blood flow through?

A

From uterine arteries into lacunae and back out through uterine veins

98
Q

What point in gestation does lacunae form?

A

20 weeks gestation

99
Q

What separates the lacunae from the chorionic villi?

A

Placental membrane

100
Q

What can result if the process forming lacunae is inadequate?

A

Pre-eclampsia

101
Q

What is pre-eclampsia caused by?

A

High vascular resistance in the spiral arteries

102
Q

What are the functions of the placenta?

A

Respiration

Nutrition

Excretion

Endocrine

Immunity

103
Q

Where does the foetus’ oxygen come from?

A

Placenta

104
Q

How does foetal Hb differ from adult Hb?

A

Foetal Hb has a higher affinity for oxygen

105
Q

What is exchanged in the placenta which helps with acid-base balance?

A

Carbon dioxide

Hydrogen ions

Bicarbonate

Lactic acid

106
Q

What is the main form of nutrition for the foetus?

A

Glucose used for energy and growth

107
Q

What substances can a mother consume which will harm a foetus?

A

Medications

Alcohol

Caffeine

Cigarette smoke

108
Q

What are the waste products from a foetus?

A

Urea

Creatinine

109
Q

Where does hCG come from and what is its purpose?

A

Syncytiotrophoblast (increasing in early pregnancy and then plateauing)

110
Q

What is the purpose of hCG?

A

Maintains the corpus luteum until the placenta can take over the production of oestrogen and progesterone

111
Q

What is a side effect of hCG production?

A

Nausea and vomiting in early pregnancy

112
Q

When are there higher levels of hCG?

A

Twins

Molar pregnancies

113
Q

The placenta produces oestrogen, what is it’s purpose?

A

- Allows expansion of the muscles and ligaments of the uterus and pelvis

  • Softens the cervix, ready for birth
  • Enlarges the breast and nipples for breastfeeding
114
Q

The placenta produces progesterone, what is it’s purpose?

A

Maintain the pregnancy

Relaxes the uterine muscles

Maintains the endometrium

115
Q

Progesterone can relax other muscles, what are the side effects of this?

A
  • GORD due to relaxation of the LOS
  • Constipation due to relaxation of the bowel
  • Hypotension due to relaxation of the blood vessels (causing hypotension, headaches and skin flushing)
116
Q

How much does body tempterature increase during pregnancy?

A

0.5 to 1 degree celsius

117
Q

What carries oxygenated blood to the fetus?

A

Umbilical vein

118
Q

What is produced in excess in pregnancy?

A

ACTH

Prolactin

Melanocyte stimulating hormone

119
Q

What does the rise in ACTH cause?

A

Rise in steroid hormones: cortisol and aldosterone

120
Q

What does the higher steroid levels cause in pregnancy?

A
  • Improvement in autoimmune conditions
  • Susceptibility to diabetes and infections
121
Q

What does the increase in prolactin during pregnancy cause?

A

Suppression of FSH and LH

122
Q

What does the increase in melanocyte stimulating hormone cause in pregnancy?

A

Increased pigmentation of the skin during pregnancy

123
Q

What does the increase in skin pigmentation during pregnancy cause?

A

Linea nigra

Melasma

124
Q

How do thyroid hormones change during pregnancy?

A

TSH remains normal

T3 and T4 levels rise

125
Q

When do hCG levels fall during pregnancy?

A

Around 8-12 weeks

126
Q

What is the role of progesterone in pregnancy?

A

Maintains the pregnancy

Prevents contractions

Supress the mother’s immune system

127
Q

How does the uterus change in size during pregnancy?

A

Increases from 100g to 1.1kg

128
Q

How does the myometrium change during pregnancy?

A

Hypertrophy of the myometrium and the blood vessels

129
Q

How may the cervix change during pregnancy?

A

Cervical ectropion

Increased cervical discharge

130
Q

What causes increased vaginal discharge in pregnancy?

A

Increase in oestrogen (also causes hypertrophy of the vaginal muscles as it increases throughout pregnancy)

131
Q

How does the cervix change before delivery?

A
132
Q

What are the cardiovascular changes in pregnancy?

A

Increased: blood volume, plasma volume, cardiac output

Decreased: preipheral vascular resistance, blood pressure

Varicos veins (peripheral vasodilation and obstruction of the IVC), peripheral vasodilation causing flushing and hot sweats

133
Q

What are the renal changes in pregnancy?

A

Increased GFR

Increased aldosterone = increased salt and water reabsorption

Increased protein excretion from the kidneys

Dilation of the ureters leading to physiological hydronephrosis

134
Q

What are the haematological changes in pregnancy?

A

Increased RBCs

Increased plasma volume

135
Q

What nutritional demands do the increase in RBCs cause?

A

Higher iron, folate and B12

136
Q

Why is there a lower concentration of RBCs in pregnancy?

A

As plasma volume increases more than RBC volume

137
Q

Why does anaemia occur in pregnancy?

A

High plasma volume means the haemoglobin concentration and red cell concentration fall in pregnancy

138
Q

What clotting factors increase in pregnancy?

A

Fibrinogen

Factor VII, VIII and X

139
Q

What is a result of the increase in clotting factors in pregnancy?

A

Increased risk of VTE

140
Q

What are the other blood changes during pregnancy?

A

Increased white blood cells, ALP (from the placenta), ESR, D-dimer,

Decreased platelet count and reduced albumin

141
Q

What are the skin changes in pregnancy?

A
  • Pigmentation (due to increase in MSH = linea nigra and melasma)
  • Striae gravidarum (stretch marks on the abdomen)
  • Pruritus (normal / obstetric cholestatsis)
  • Spider naevi
  • Palmar erythma
142
Q

What are the hair changes in preganancy?

A

Postpartum hair loss (normal and usually improves in 6 months)

143
Q

When does labour usually occur?

A

Between 37 and 42 weeks gestation

144
Q

What are the 3 stages of labour?

A

First stage = onset of labour to 10cm cervical dilation

Second stage = from 10cm dilatation to delivery of baby

Third stage = from delivery of the baby to delivery of the placenta

145
Q

What role do prostaglandins have in pregnancy?

A
  • Stimulate contraction of the uterine muscles
  • Ripening the cervix before delivery
146
Q

What is in the pessaries which induce labour?

A

Prostaglandin E2 (dinoprostone)

147
Q

What are Braxton-Hicks contractions?

A

Occasional and irregular contractions of uterus - don’t progress and become regular - not true contractions (staying hydrated and relaxing can help reduce)

148
Q

What are the components of the first stage of labour?

A

Cervical dilation (opening up)

Effacement (getting thinner)

149
Q

What is the purpose of “the show” - the mucus plug in the cervix?

A
  • Prevents bacteria from entering / falling out
150
Q

What are the 3 phases of the first stage of pregnancy?

A

Latent phase = 0 to 3cm dilation of cervix, irregular contractions (0.5cm per hour)

Active phase = 3 to 7cm dilation, regular contractions (1cm per hour)

Transition phase = 7 to 10cm dilation, strong and regular contractions (1cm per hour)

151
Q

What are the 3 Ps of the second stage of labour?

A

Power

Passenger

Passage

152
Q

What does power depend on?

A

Strength of uterine contractions

153
Q

How can the passenger be described?

A

Size (of head)

Attitude (posture of the fetus - how back is rounded /head and limbs are flexed)

Lie (longitudinal/transverse/oblique)

Presentation (part of fetus closest to cervix = cephalic / shoulder / breech)

154
Q

What are the 3 different types of breech

A

Complete (hips and knees flexed)

Frank (bottom first - hips flexed and knees extended)

Footling (foot hanging through cervix)

155
Q

What does Passage stand for?

A

Size and shape of the passageway, mainly pelvis

156
Q

What are the seven cardinal movements of labour?

A

Engagement

Descent

Flexion

Internal rotation

Extension

Restitution and external rotation

Expulsion

157
Q

How is the babies head position described during delivery?

A

In relation to the mother’s ischial spines during the descent phase:

-5cm

0

5cm

158
Q

What are the different management options for the 3rd stage of labour?

A

Physiological management (placenta is delivered by maternal effort only)

Active management (midwife/dr helps with delivery of the placenta, shortens phase and reduces risk of bleeding) - haemorrhage or 60 min delay should prompt active management - associated with N&V

Intramuscular oxytocin can be given to help the uterus contract and expel the placenta (careful traction is applied to the umbilical cord to guide the placenta out of the uterus)

Obstetrics and Gynaecology (10 decks)

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