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PBL SEM 1 > Case 1 - Normal Pregnancy > Flashcards

Case 1 - Normal Pregnancy Flashcards

1
Q

what are the two cycles in female reproduction

A

menstrual (changes to uterus) and ovarian

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2
Q

what is a primordial follicle

A

ovum surrounded by one layer of granulose cells

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3
Q

what do GC do through childhood

A

provide nourishment to ovum and secrete oocyte maturation inhibiting factor to keep ovum suspended in primordial state in prophase of meiosis 1

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4
Q

what causes follicles to develop

A

stimulation of FSH

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5
Q

process of developing follicles

A
  1. FSH stimulation
  2. Only one follicle reaches maturity
  3. FSH = proliferation of GC = layers
  4. theca cells collect = primary follicle
  5. secrete androstenedione bc of LH. taken up by GC, converted to oestrogen via aromatase
  6. antrum formed = secondary follicle
  7. GC secrete oest filled fluid - TERTIARY
  8. oest released - inhibits FSH and LH
  9. also acts on GC = proliferation and sensitivity to FSH
  10. LH receptors promoted on gC cells, LH and FSH stimulation
  11. increase in secretion of rest
  12. positive feedback = increase in LH also = proliferation of theca cells = GRAAFIAN FOLLICLE
  13. increase in lH - completion of meiosis 1
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6
Q

what are the products of meiosis 1

A

oocyte and polar body

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7
Q

what is the theca externa

A

vascular connective tissue capsule that becomes capsule of developing follicle

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8
Q

process of ovulation

A
  • theca externa releases proteolytic enzymes = dissolution of capsular wall
  • growth of new BV into wall and prostaglandins secreted into follicular tissue
  • plasma transudation = follicle swelling
  • degeneration of stigma and ovum discharges
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9
Q

menstrual phase

A

1-5 days

  • degeneration of endometrial lining of uterus bc of constriction of spiral arteries. reduces blood flow to endometrium = no oxygen or nutrients and it erupts and blood fills cavity
  • 50 ml blood lost
  • FSH - GC secretes estradiol, stimulates LH receptors on theca cells = prepares them for prog synthesis after ovulation
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10
Q

what causes cramps

A

liberation of prostaglandins from endometrium

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11
Q

proliferative/follicular phase

A
  • single follicle becomes dominant. reduces FSH
  • atresia for others = reabsorbed into follicular phase
  • dominant: bulge forms bc of increasing pressure of filling antrum
  • LH levels rise, prog released before ovulation
  • oest stimulates repair of ends, cells of stratum basalis undergo mitosis = stratum functionalis
  • endo thickens
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12
Q

ovulation phase

A
  • rise in west, positive feedback so surge of FSH and LH
  • if rising oest = no ovulation yet
  • follicular rupture: 36h after LH surge
  • oocyte expelled into fallopian tube
  • during lH surge = LHG receptor binds to LH and GC produce progesterone
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13
Q

what happens to remaining follicle

A

converted to corpus lute to facilitate prog secretion

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14
Q

secretory/luteal

A

15-28
-uterine wall grows bc prog
if no fertilisation = CL degenerates, prog decreases

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15
Q

why is it called the secretory phase

A

endometrium becomes glandular under influence of prog

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16
Q

what is the CL cyst

A

after ovulation, cl MAY fill with blood or fluid instead of breaking down. harmless

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17
Q

stratum basalis

A

deepest layer

undergoes little change, not shed

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18
Q

stratum spongiosum

A

stroma w spongy appearance, middle layer

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19
Q

stratum compactum

A

compact stromal appearance

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20
Q

stratum functionalis

A

shed during menstruation

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21
Q

what are straight and spiral arteries in SF

A

straight - short, supply SB. not responsive to hormonal changes of MC

spiral - long, coiled and thick. to surface of endo, capillary plexus around glands and SC. responsive to hormonal changes. at end of cycle, less prog = ischaemic phase

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22
Q

impact of oest and prog on SF

A

oest - highly proliferative

prog - vascular and glandular

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23
Q

process of fertilisation

A
  • in isthmus or ampulla
  • infundibulum moves to site of follicle rupture - fijmbraie envelop and direct ovum into tube
  • movement: peristaltic action due to long and circular SM layers of oviduct wall
  • contractions of uterine muscles - accelerates sperm
  • stimulated by prostaglandins in semen and oxytocin during orgasm
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24
Q

acrosome reaction

A
  • many sperm penetrate CR
    -hyaluronidase breaks bonds between adj follicle cells
    acrosome head ruptures when spermatozoon binds to ZP
  • acrosin penetrates ZP
    sperm fuses to vitelline membrane
  • sperm absorbed into oocyte
    -inactivation of sperm receptors
    -ZP hardens to prevent polyspermy.
  • meiosis 2 continues from metaphase in puberty
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25
Q

process of cleavage

A 
subdivides cytoplasm of zygote
asynchronous division
initial division - 2 cells, then 4 etc
morula (8 blasters w in ZP, 32 cell stage)
morula to blastula
then blastocyst
trophoblast gives rise to placenta
ICM gives rise to embryo
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26
Q

what is a blastula

A

hollow sphere of blastomeres surrounding inner fluid filled cavity called blastoceole

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27
Q

what is a blastocyst

A

blastula but w ICM called embryo blast - pluripotent SC which will form embryp

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28
Q

what is a trophoblast

A

insulator and supplier of nutrients

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29
Q

what are cytotrophoblasts

A

trophoblast cells closest ti interior

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30
Q

what are syncytiotrophoblasts

A

CT that have lost membranes and cytoplasms have been fused to make multinucleate cells

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31
Q

process of implantation

A

1 blastocyst exposed to glycol rich fluid secreted by endometrium n enlarges
2 blastocyst contacts endo
3 trophoblasts cells divide
4 CT remain intact
5 CT differentiate into SCT
6 SCT break down SF by secreting hyaluronidase (eroding path through endometrium)
7 SCT produces hug - goes to ovaries, binds to receptors on CL to sustain prod of O & P
8 prog = uterine more glandular n vascular
9 enlarged cells in endo
10 blastocyst burrows into SF - development occurs here
11 SCT expand and erode glands w in endo = nutrients released
12 ICM n trophoblasts use nutrients to develop embryo blast
13 trophoblastic extensions penetrate endometrial blood supply and increases it around day 9

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32
Q

where is implantation normally

A

posterior wall of fundus

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33
Q

how is the amniotic cavity formed

A

sep between ICM and trophoblast increasing

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34
Q

what happens at day 12

A

gastrulation

cells move to primitive streak

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35
Q

what are the three germ layers

A

endoderm
mesoderm
ectoderm

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36
Q

what does mesoderm form

A

CVS and renal system, musculoskeletal

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37
Q

ectoderm forms?

A

nervous system, hair skin and nails

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38
Q

endoderm forms?

A

respiratory, GI and urinary tracts

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39
Q

what is a yolk sac

A

first site of blood cell formation

40
Q

amnion?

A

surrounds embryo, makes cavity filled w amniotic fluid

41
Q

chorion

A

becomes principle part of placenta

42
Q

what is the allantois

A

becomes vascular connection between embryo n placenta

43
Q

what type of SC are embryonic

A

pluripotent (can give rise to any embryonic cell except placental)

44
Q

process of placentation

A

1 blastocyst surrounded by chorionic villi and chorion enlarges
2. 4th week - embryo, amnion and yolk sac suspended in fluid
3 body stalk contains distal portions of allantois and BV that carry blood to n from placenta

45
Q

what is a yolk stalk

A

narrow connection between endoderm n yolk sac

46
Q

decidua capsularis?

A

thin portion of endo, not used in nutrient exchange or chorionic villi disappears

47
Q

decidua basalis?

A

placental functions conc in deeper region

48
Q

decidua parietalis?

A

rest of endometrium

49
Q

development of NS

A 
19-21 days after gastrulation
cephalic region=  brain
caudal regoion = spinal cord
neural tube closure  - neural plate rolls up to form tube
neural plate - groove - fold - tube
failure to close = spina bifida
50
Q

somite development

A

19-21 days
alongside neural tube in pairs
anterior to posterior
muscle, vertebral and rib bones

51
Q

ear development

A

week 4 visible, w5 not visible on surface = forms component of inner ear
from placodes - ectoderm thickening visible on surface

52
Q

eye development

A

optic placed - end of w4 visible

forms lens

53
Q

limb development

A 
external structures vis from w4
buds that go outward
forelimb then hindlimb
week 7: hands and feet visible
week 8: sep of digits by apoptosis
54
Q

development of heart

A

from tube
beats on day 22, circ on day 27
first organ to function

55
Q

lung development

A

branching morphogenesis
endoderm and mesoderm supply most of alveoli
ectoderm = neural innervation
mesoderm = musculoskeletal support

56
Q

kidney developemnt

A

pronephros d18, mesonephros d24, metanephros d35

57
Q

GI development

A

week 2-3
foregut: oral cavity, oesophagus, trachea, stomach
midgut: SI, pancreas develops through herniation
hindgut: colon
will enter body wall as they become finely packed

58
Q

what is the CR length at w11 and at full term

A

6-8cm

30-40cm

59
Q

FSH origin, function, regulation

A

APG
target: testes n ovaries
to promote follicle development n stimulate secretion of oest. stimulates sustentacular cells in M
reg: stopped by inhibin, reg by GnRH

60
Q

LH

A

APG, to testes n ovaries

induces ovulation, promotes secretion of prog n oest in F, stimulates prod of sex hormones by interstitial testes cells

61
Q

prog

A

ovary/placenta

prepares uterus for preg, maintenance of preg, development of alveolar system in mammary glands

62
Q

oest

A

ovary, testes, placenta
tim bone n muscle growth, sex charac. affects CNS (sex drive in HT)
growth n repair of endo
reg: FSH and LH

63
Q

inhibin

A

sustentacular cells, follicler cells
targets APG
inhibits FSH
stimulated by FSH from APG

64
Q

HCG

A

origin: SCT in CL
maintains integrity of CL n promotes continued secretion of prog
appears in blood after implantation

65
Q

relaxin

A

origin: CL and placenta
incr flexibility of PS, pelvis expands during delivery. dilation of cervis, suppresses oxytocin by HT, delays onset of labour contractions

66
Q

what is the ductus arteriosus

A

connects right V and aorta

67
Q

ductus venosus

A

first point of contact from placenta

blood then goes to RA

68
Q

foramen ovale

A

embryo, connects right and left A together

69
Q

what is folic acid and what is its function

A

synthetic form of vitamin b9

maintain and produce new cells, prevent DNA damage, reduce spina bifida risk

70
Q

what should prenatal vitamins include

A

calcium
iodine
iron

71
Q

how does a pregnancy (immunoassay) test work?

A

dip stick in urine in morning
stick has mobile mAB with blue latex particle attached
hcg acts as an antigen and moves up stick
binds to mAB bc complementary
complex binds to immobilised mAB in first window
marker molecule accumulates and forms coloured line to show pregnancy
2nd window: uncombined mAB continue to move up dipstick to 2nd line = bind and show test is working

72
Q

what are the two types of USS

A 
transvaginal  = time of missed period
transabdominal = 5 weeks
73
Q

what do uSS at 12 and 20 weeks check

A 
12 = viable and number of fetuses, date of pregnancy, CVS defects
20 = sex and structural defects
74
Q

what are the CVS maternal changes during pregnancy

A 
hypertrophy
plasma volume increases
hypercoagubility
vasodilation
pre-eclampsia
raised cardiac output and rbc volume
75
Q

what is pre-eclampsia

A

rapid rise in arterial blood pressure in last few months of pregnancy
proteins in urine
water and salt retention
gfr and renal BF too low
trophoblasts change arterioles of endometrium into larger bv with low resistance = doesn’t happen in PE

76
Q

resp changes in mother?

A

relative hyperventilation = po2 and pco2

tidal volume increases = prog relaxed ligaments attaching sternum to ribs

77
Q

musculoskeletal changes?

A

sciatica
stretch marks
carpal tunnel syndrome
lordosis

78
Q

renal changes?

A

increased BF
increased GFR rate = more urination
bigger kidneys and ureter

79
Q

GI changes?

A

prog causes relaxed valves = heartburn

soft ligaments = abdominal pain

80
Q

other symptoms of pregnancy

A

sore breast
nausea
constipation
tiredness

81
Q

what is the process of labour

A

cervical dilation = 10cm, takes 6-12 hours
positive feedback
uterine contractions stretch cervix = dilates
stretching = reflexive contractions = dilates
dilation = oxytocin = powerful contractions

82
Q

how is fetus adapted at birth

A

blood from placenta to DV
moves to RA, through FO to LA
moves from RV to aorta via DA
LV: blood to body and internal iliac artery to UC and placenta

83
Q

what are changes to infants lungs when it is born

A

more o2 in lungs = less BF resistance to lungs
fluid drains
lungs inflate and move o2 into blood and co2 out

84
Q

what is surfactant and what does it do

A

substance that lines alveoli

prevents collapsing when breathing

85
Q

what happens if baby has no surfactant

A

alveoli collapse
more force to breathe
tire out diaphragm
tear lung tissue

86
Q

how can low surfactant levels be treated

A

steroid injections

87
Q

how long do you take combined pill for

A

21 days, 7 free

88
Q

what does oestrogen in combined pill do?

A

inhibits FSH = no follicle development

89
Q

what does prog in combined and mini pill do?

A

prevent ovulation, hinder implantation, thicken cervical mucus and inhibits endometrial proliferation

90
Q

how long do you take mini pill for?

A

daily

91
Q

why do some people take mini pill instead?

A

older, breastfeeding or overweight women

92
Q

why is age of first pregnancy increasing

A

high divorce rates
marrying later bc careers
waiting till financially stable
don;t know about fertility ages and rates

93
Q

how many appointments should you have when pregnanr

A

10 for nulliparous, 7 for others

94
Q

what is the criteria for a c-section

A 
baby in breech position
low lying placenta
pre-eclampsia
baby not getting enough nutrients
untreated HIV
choice = non medical reasons
95
Q

what is the process of gastrulation

A

cells move towards the primitive streak on the surface of the epiblast, which is base of amniotic cavity
they slip beneath it
invagination = leads to formation of 3 germ layers
more cells move and migrate, extend beyond margin and come into contact with extra-embryonic mesoderm covering amnion and yolk sac

PBL SEM 1 (4 decks)

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