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BMS250 > wk 13, lec 2 > Flashcards

wk 13, lec 2 Flashcards

1
Q

theca cell vs granulosa cell

A

Theca:
-respond to LH
-make progesterone and androgens from cholesterol
-dont make estrogen (no aromatase enzyme)

the androgens diffuse across cell

granulosa:
-respond to FSH
-dont make androgens, take them from theca cell and turn them into estrogens
-later in cycle respond to LH and make progesterone

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2
Q

spiral arteries in the uterus are sensitive to

A

progesterone

Progesterone withdrawal
at the end of the cycle →
constriction and ischemia
of the functional layer of
the endometrium

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3
Q

when is the period of endometrial receptivity for implantation of the embryo? (6-10 days after fertilization of oocyte)

A

fertilize at day 14
implant day 20-24

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4
Q

endometrial factors that aid implantation

A

pinopods (protrusion near gland openings to absorb fluid, depend on elevated progesterone in midluteal)

secretion of ECM proteins for attachment/implantation (laminin, fibronectin, glycoproteins)

secrete proteases to help blastocysts to hatch out of zona pellucida

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5
Q

pinopods need which homrone and what is their function

A

progesterone; absorb fluidsecretion of ECM proteins for attachment/implantation (laminin, fibronectin, glycoproteins)

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6
Q

secretion of ECM proteins for attachment/implantation - what are they

A

laminin, fibronectin, glycoproteins

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7
Q

predicualization

A

changes to stromal cells in endometrium in response to progesterone

happens 3-5days after ovulation

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8
Q

changes in predicidualization

A

enlarge stromal cells

develop eosinophilic cytoplasm to secrete glycogen

develop prominent Golgi and ER

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9
Q

stromal cells differentiate into decidual cells and then function?

A
  • secrete laminin, fibronectin, heparin sulfate, and type IV collagen
  • Store glycogen to nourish the blastocyst
  • Form a dense layer called the zona compacta
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10
Q

blastocysts secrete something to complete process of decidualization

A

increased by integrins and fibronectins –> contact each other –> implantation

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11
Q

capacitation of sperm

A

after sperm are ejaculate in fallopian tubes; sperm mature; then can fertilize oocyte

increased membrane fluidity

Surface glycoproteins removed from the head of the sperm cell,
increased motility, and increased cholesterol is inserted into the
plasma membrane → increased membrane fluidity

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12
Q

what increases membrane fluidity of sperm for capacitation

A

Surface glycoproteins removed from the head of the sperm cell,
increased motility, and increased cholesterol is inserted into the
plasma membrane → increased membrane fluidity

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13
Q

sperm getting to ampulla of fallopian tube?

A

many lost from acidic pH of vagina

muscular contraction help propel them there and so does ciliary movement and peristalsis

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14
Q

steps of fertilization

A
  1. sperm bind zona pellucida
  2. acrosome rxn
  3. sperm penetrates zona pellucida
  4. fusion of egg and sperm membranes
  5. egg cortical rxn triggered by entry of sperm nucleus
  6. female pronucleus
  7. male pronucleus
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15
Q

fertilize egg from ampulla –> implanted in uterus endometrium

A

usually 8 days; day 20-24

lots of fluid; pinopods absorb to bring embryo and endometrium closer

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16
Q

decidualization

A

storage of glycogen in endometrial cells to feed the blastocyst

(get ready for implantation)

increase integrals and fibronectins –> implantation in endometrium

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17
Q

implantation (embryo invades the endometrium)

when?

what does blastocyst become?

A

blastocysts forms and attaches to uterine lining at day 5 after fertilization

hatches out of ZP

trophoblast –> cytotrophoblast –> synctiotrophoblast when adhesion occurs

invasion of blastocyst (synctiotrophoblast) completes decidualization

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18
Q

when does blastocyst bind to adhere to endometrium

A

CAM

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19
Q

what does blastocyst turn into when binds endometrium

A

trophoblast differentiates into the
syncytiotrophoblast and cytotrophoblast.

then can invade uterine stroma

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20
Q

implantation: syncytiotrophoblast becomes ?

A

multinuclear cell mass

invades endometrial stroma

forms villi; via proteinases and adhesion molecules

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21
Q

what does syncytiotrophoblast secrete when implantation occurs

A

human chorionic gonadotropin
(hCG)

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22
Q

hCG function

A

prevents the shedding of the endometrium (and loss of the embryo) by
maintaining ovarian secretion of steroid hormones (i.e. progesterone)

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23
Q

Why is fetal Hb able to
obtain oxygen from
maternal Hb?

A

fHb has higher oxygen affinity than adult Hb

left shift to oxygen dissociation curve

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24
Q

what can cross mother fetal placental barrier

A

IgG

otherssss i.e. oxygen, carbs, hormones, drugs, viruses

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25
what does fetal hemoglobin have lower affinity for (compared to adult hemoglobin)
2,3-diphosphoglycerate (2,3-DPG) ((is a molecule that binds to hemoglobin and reduces its affinity for oxygen)) so fHb is less effected by 2,3DPG
26
structural different in fetal vs adult hemoglobin
* Fetal hemoglobin is composed of two α-globin chains and two γ-globin chains * Adult hemoglobin (HbA) is composed of two α-globin chains and two β- globin chains
27
what is hCG secreted by and its function
synctiotrophoblasts to maintain corpus luteum (so it can secrete progesterone and prevent spasm of spiral arteries, death of endometrial lining and uterine contractions)
28
hCG binds TSH receptor weakly to cause what in mom
mild hyperthyroid
29
Human placental lactogen (hPL) function? what is it the antagonist of? promotes development of?
Helps the fetus take up glucose and store/convert it into fatty acids and ketones ▪ Antagonizes insulin – may contribute to gestational diabetes ▪ Promotes development of mammary glands
30
after wk 8 what is the major site of progesterone and estrogen production in mom
trophoblast cells in the placenta
31
how do placental trophoblast cells make progesterone
from maternal LDL cholesterol The placenta lacks 17α-hydroxylase and, therefore, cannot convert progesterone to androgen
32
progesterone from placenta goes to maternal circulation and some is converted into and then goes back into placenta as what
DHEAS (sulphation to reduce biological activity) by maternal adrenal gland DHEAS reenters placenta, gets de-sulfated to DHEA and then converted into androstenedione and testosterone
33
placenta has what enzyme to turn testosterone into estradiol and estrone
aromatase for the estrogens to go back into maternal circulation and help with pregnancy
34
path for hormones between mom and baby
placenta trophoblast makes progesterone from LDL (no 17a hydroxyls to turn it into androgen) progesterone goes into mom and becomes DHEAS DHEAS back into baby --> DHEA --> androstenedione and testosterone --> estradiol and estrone (via aromatase) --> back to maternal circualtion
35
fetus converts pregnenlonone and progesterone to
cortisol --> goes into placenta and becomes corticosterone (seperate from moms cortisol) ((progesterone could also could go back to move become DHEAS then back to baby and become androgens then estrogen))
36
estrogens impact in pregnnacy
increase uteroplacental blood flow enhance LDL receptor expression in synctiotrophoblast (makes progesterone) induce things for parturition (prostaglandins, oxytocin receptors) help breast growth
37
relaxin impacts in pregnancy
▪ Prevents contraction of myometrium to prevent premature labour ▪ During labour, however, it may soften the cervix ▪ Produced by corpus luteum, decidua, and later the placenta
38
cardiovascular changes in pregnancy
increase blood volume increase stroke volume, HR, cardiac output decrease peripheral resisntacen increase erythropoeisis (which eats up iron and could cause anemia) but blood volume increases more so 'dilutional' anemia
39
what causes increase blood volume and decreased peripheral resistnace in pregnancy
increase BV: estrogen and aldosterone decrease PR: vasodilate via estrogen and progesterone
40
pulmonary changes in pregnancy
bronchodilation and increased tidal volume --> increased ventilation (progesterone increase, drop in pCO2, mild respiratory alkalosis) expand uterus --> compress diaphragm (minor decrease in FRC and RV)
41
renal changes in prengnacy
increase GFR increase aldosterone --> increase H20 and Na+ retention --> edema no increase in K+
42
what hormones/ things make labour happen
prostaglandins= smooth muscle contractions (soften, thin and dilate cervix) estrogen increases oxytocin receptors oxytocine cause uterine contractions; positive feedback
43
stages of labout
frist stage -latent phase: infrequent and irregular contraction; slow cervical dilation -active phase: cervical fully dilated, painful regular contractions second stage -full dilation to deliver of baby -urge to bear down w contractions third stage -seperate and expulsion of placenta fourth stage -1st postpartum hour
44
during pregnancy how do mammary glands develop
estrogen causes ductile system progesterone stimulates alveolar glands placental lactogen develops breasts prolactin made throughout pregnancy but inhibited by progesterone and placental lactogen
45
what happens to mammary glands after childbirth
placental hormonal [ ] decline and no longer inhibit prolactin breast produce milk mechanical stimulate (suckle) to release oxytocin from posterior pituitary stimulate milk release nipple needs to be stimulated regularly to keep making milk
46
mammogenesis lactogenesis galactokinesis galactopoiesis
mammogenesis= breast development --> estrogen, IGF1, cortsiol, prolactin lactogenesis= milk prodcution --> prolactin, hPL, cortsiol, IGF1, thyroid galactokineses= milk ejection/ letdown reflex (via myopethelial contraction) --> OT, AVP galactopoeises= maintain milk production --> prolactin, cortsiol
47
prolactin important for which stage of lactation
▪ Mammogenic, lactogenic, and **galactopoeitic** ▪ Primary hormone for maintaining milk production once it is initiated (galactopoeisis)
48
prolactin suppresses
GnRH most women breastfeeding are anovulatory
49
strongest stimuli for prolactin release
suckling also estrogen and TRH
50
oxytocin for which part of lactation
galactokinesis (milk ejection/letdown reflex) Initiates contraction of not only uterine muscle, but myoepithelial cells surrounding the alveoli
51
oxytocin is stimulated by
suckling psychogenic associated with suckling (i.e. hear infant cry) suppressed by stress and anger
52
steps in milk!
1. suckling stimuli --> hypothalamus 2. inhibit dopamine (which usually inhibits lactotrophs in anterior pituitary) --> prolactin release 3. release oxytocin 4. inhibit GnRH
53
ectopic pregnancy sites
Ampullary (70%) >> isthmal (12%) > fimbrial (11%) > ovarian (3%) > interstitial (2%) > abdominal (1%) fallopian tube most commone
54
risk factors for ectopic pregnancy
PID, previous ectopic, tubal damage, endometriosis, IVF, smoking (dose dependent- affects tubal motility and function)
55
signs and sx of ectopic prgnnacy
amenorrhea (missed period) vaginal bleeding/ spotting ab pain breast tender, nausea syncope
56
diagnose and treat ectopic pregnancy
dx: beta-hCG, ultrasound if severe ab pain then treat surgically or medically via high dose methotrexate
57
placenta previa
placenta over or near the cervix (lower part of uterus) frequent (1/200) esp if have fibroids/leiomyomas and multiple pregnancies may resolve by itself possible c section
58
sx of placenta previa
painless vaginl bleeding after wk 30
59
dx and therapy for placenta previa
dx: ultrasound if too much bleeding do transfusion deliver via c section
60
placental abruption
premature detachment of placenta from uterus idiopathic but predisposed byL: cocaine, hypertension, trauma, chorioamnionitis usually in 3rd trimester
61
sx of placental abruption
vaginal bleeding with crampy ab and back pain, ab tender
62
hypertensive disorders of pregnancy
eclampsia and pre-eclampsia
63
ecampsia vs pre-elcampsia
pre eclampsia: hypertension, edema, proteinuria (after 20 weeks gestation) eclampsia: pre-eclampsia plus convulsions (seizures)
64
complications of exlampsia
DIC, renal failure, hypercoagulability, pulmonary edema HELLP – hemolysis, elevated liver enzymes, low platelets (complication of pre-eclampsia)
65
pre eclampsia
decidual blood vessels remain constricted and narrowed placenta is ishemic secrete anti-angiogenic factors than impair vasodilation, cause decreased PGI2 and hypercoagulatbility
66
sx of pre-eclampsia
headaches, visual disturbances (blurred vision, scotomas), hyper-reflexia * more severe cases involve edema, changes in urine colour (indicating hematuria), abdominal pain
67
impacts on baby of hypertesnion (eclampsia) in pregnancy
IUGR (intrauterine growth restriction), placental abruption, premature delivery
68
gestational diabetes
oral glucose tolerance test in late 2nd trimester treat w insulin complication: hypertesnion, pre-eclampsia, ketoacidosis, retinopathy, pyelonephritis, macrosomnia, congenital anomalies, preterm labour, hypoglycemia etccc
69
Gestational Trophoblastic Disease
abnormal growth on placenta benign (molar) or malignant
70
hydatidiform mole (gestational trophoblastic disease)
abrnomal grrwoth * Trophoblastic proliferation and degeneration of chorionic villi * Complete mole – fetus is not identified; partial mole – has some fetal parts attached from abnormal fertilization (all chromosomes are paternal; 2 sperm fertilize 1 egg) could become malignant if placenta not removed no baby
71
choriocarcinoma (gestational trophoblastic disease)
malignant cancer from placenta cells usually from molar pregnancy
72
post partum hemorrhage
Loss of > 500 mL of blood with vaginal delivery or > 1000 mL with C-section from: trauma (i.e uterine rupture), coagulopathy, tissue (ie. gestatonal trophoblastic neoplasia), tone (fibroids) etcccc

BMS250 (52 decks)

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