Exam 1 Flashcards
(121 cards)
1
Q
Female reproductive cycle (FRC)
A
ovarian cycle (ovulation) Menstrual cycle (menstruation) The two cycles take place simultaneously
2
Q
Major target organs for female hormones
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ovary, vagina, uterus, fallopian tubes
3
Q
What hormones are the ovaries sensitive to?
A
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
4
Q
What hormones is the uterus sensitive to?
A
Estrogen and progesterone.
5
Q
Estrogens
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hormones associated with characteristics contributing to “femaleness.”
6
Q
3 types of estrogen
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Estrone (ovaries-major, adrenal cortex-minute, fat cells-secondary estrogen)
B-estradiol
Estradiol
7
Q
Major estrogen
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B-estradiol
8
Q
Progesterone
A
is secreted by the corpus luteum and is found in greatest amounts during the secretory phase of the menstrual cycle.
9
Q
Prostaglandins (PGs)
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oxygenated fatty acids that are produced by the cells of the endometrium and are also classified as hormones. They have varied action in the body.
10
Q
Two primary types of prostaglandins
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Group E and F.
11
Q
PGE
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Relaxes smooth muscles and is a potent vasodilator.
12
Q
PGF
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A potent vasoconstrictor and increases the contractility of muscles and arteries.
13
Q
Hypothalamus
A
secretes ganodotropin-releasing hormone (GnRH) to the pituitary gland in response to signals received from the CNS.
14
Q
In response to GnRH, the anterior pituitary secretes the gonadotropic hormones:
A
FHS and LH
15
Q
FSH
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is primarily responsible for the maturation of the ovarian follicle.
16
Q
Ovulation
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takes place following the very rapid growth of the follicle, as the sustained high level of estrogen diminishes and progesterone secretion begins.
17
Q
Corpus luteum
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The mass of cells that the ruptured follicle becomes following luteinization.
18
Q
Ovarian Cycle
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has two phases: the follicular phase (days 1-14) and the luteal phase (days 15-28 in a 28-day cycle)
19
Q
Follicular phase
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the immature follicle matures as a result of FSH. within the follicle, the oocyte grows.
20
Q
Mittelschmerz
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Midcycle pain with ovulation.
21
Q
Human chorionic gonadotropin (hCG)
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needed to maintain the corpus luteum.
22
Q
Corpus albicans
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If fertilization doesn’t take place, within about a week after ovulation the corpus luteum begins to degenerate and eventually becomes a connective tissue scar called the corpus albicans.
23
Q
Menstruation
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Cyclic uterine bleeding in response to cyclic hormonal changes. Begins 14 days after ovulation, in the absence of pregnancy.
24
Q
Menstrual discharge/menses/menstrual flow
A
is composed blood mixed with fluid, cervical and vaginal secretions, bacteria, mucus, leukocytes, and other cellular debris. It is dark red and has a distinctive odor.
25
Factors that can alter cycle intervals:
Emotional and physical such as illness, excessive fatigue, stress or anxiety, and vigorous exercise programs can alter the cycle interval.
Environmental factors: temperature and altitude
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Menstrual cycle has four phases:
Days 1-6 Menstrual, proliferative, secretory, and ischemic. Menstration occurs during the menstrual phase.
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Proliferative Phase
Days 7-14 begins when the endometrial glands enlarge, becoming twisted and longer in response to increasing amounts of estrogen. Endometrium thickens 6 to 8-fold.
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Spinnbarkeit
as ovulation nears, the cervical mucosa shows increased elasticity (Ferning pattern)
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Secretory phase
Days 15-26, follows ovulation. The endometrium under estrogenic influence, undergoes slight cellular growth.
30
Ischemic phase
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Days 27-28
Estrogen and progesterone levels drop
Spiral arteries undergo vasoconstriction
Endometrium becomes pale
Blood vessels rupture
Blood escapes into uterine stromal cells, gets ready to be shed.
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31
Fertilization
The process by which a sperm fuses with an ovum to form a new diploid cell, or zygote.
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Zygote
Begins life as a single cell with a complete set of genetic material, 23 chromosomes from the mother's ovum and 23 chromosomes from the father's sperm for a total of 46 chromosomes.
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Capacitation
the removal of the plasma membrane overlying the spermatozoa's acrosomal area and the loss of seminal plasma proteins. Takes about 7 hours.
34
Sperm that undergo capacitation take on three characteristics:
1. ability to undergo the acrosomal reaction
2. ability to bind to the zona pellucida
3. the acquisition of hypermotility
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Acrosomal reaction
Follows capacitation, whereby the acrosomes of the sperms surrounding the ovum release their enzymes and break down the hyaluronic acid in the ovum's corona radiate.
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Block to polyspermy
At the moment of penetration by a fertilizing sperm, the zona pellucida undergoes a reaction that prevents additional sperm from entering a single ovum. AKA the cortical reaction.
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Sex chromosomes
X - female
Y - male
XX - female
XY - male
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Preembryonic Development
The first 14 days of development, starting the day the ovum is fertilized. Also called the stage of the ovum.
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Development after fertilization can be divided into two phases:
Cellular multiplication and cellular differentiation
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Cleavage
When zygote enters a period of rapid mitotic divisions during which it divides into two cells, four cells, eight cells, and so on.
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Blastomeres
Cells so small that the developing cell mass is only slightly larger than the original zygote. Blastomeres are held together by the zona pellucida, which is under the corona radiate.
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Morula
Solid ball of 12 to 16 cells developed from blastomeres.
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Primary germ layers
10th to 14th days after conception, the homogeneous mass of blastocyst cells differentiates into the primary germ layers. These layers are the ectoderm, mesoderm, and endoderm.
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Ectoderm
Sensory epithelium of internal and external ear, nasal cavity, sinuses, moth, anal canal
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Mesoderm
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Skeleton
Muscles (all types)
Cardiovascular system (heart, arteries, veins, blood, bone marrow)
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46
Endoderm
Respiratory tract epithelium
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Chorion
Thick membrane that developes from the trophoblast, and has many fingerlike projections called chorionic villi on its surface. These villi form the fetal portion of the placenta.
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Amnion
Originates from the ectoderm. It is a thin protective membrane that contains amniotic fluid.
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Primary Functions of amniotic fluid:
- Act as a cushion to protect the embryo against mechanical injury
- Help control the embryos temperature
- Permit symmetrical external growth and development
- Prevent adherence of the embryo/fetus to the amnion
- Allow freedom of movement
- Allow the umbilical cord to be relatively free of compression
- Act as an extension of fetal extracellular space
- Act as a wedge during labor
- Provide fluid analysis to determine fetal health and maturity.
50
Amniotic Fluid
is slightly alkaline and contains albumin, uric acid, creatinine, lecithin, sphingomyelin, bilirubin, vernix, leukocytes, epithelial cells, enzymes, and fine hair called lanugo.
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The fetus influences the volume of amniotic fluid by:
Swallowing the fluid
Excreting lung fluid
Excreting urine
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Oligohydramnios
Less than 400 mL of amniotic fluid
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Hydramnios
More than 2000 mL of amniotic fluid
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Yolk sac
is small and functions early in embryonic life. It develops as a second cavity in the blastocyst on about day 8 or 9 after conception. It forms primitive red blood cells during the first 6 weeks of development, until the embryo's liver takes over the process. As the embryo develops, the yolk sac is incorporated into the umbilical cord, where it can be seen as a degenerated structure after birth.
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Body stalk
Attaches the embryo to the yolk sac.
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Wharton's jelly
Specialized connective tissue that surrounds the blood vessels in the umbilical cord.
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Placenta
is the means of metabolic and nutrient exchange between the embryonic and maternal circulations.
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Syncytium
- is in direct contact with the maternal blood in the intervillous spaces.
- it is the functional layer of the placenta and secretes the placental hormones of pregnancy.
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Braxton Hicks contractions
Intermittent painless uterine contractions that may occur every 10 to 20 minutes and occur more frequently near the end of pregnancy.
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Placental functions
fetal respiration
nutrition
excretion
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Progesterone
- is an essential hormone for pregnancy
- it increases the secretions of the fallopian tubes and uterus to provide appropriate nutritive matter for the developing morula and blastocyst.
- must be present in high levels for implantation to occur
- decreases the contractility of the uterus
- production peaks about 7 to 10 days after ovulation
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Estrogens
- serve mainly a proliferative purpose
- cause enlargement of the uterus, breasts, and breast glandular tissue.
- increase vascularity and vasodilation
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Estriol
primary estrogen secreted by the placenta
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Estradiol
estrogen secreted by the ovaries
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Human placental lactogen (hPL)
referred to as human chorionic somatomammotropin (hCS), is similar to human pituitary growth hormone; hPL stimulates certain changes in the mother's metabolic processes. These changes ensure that more protein, glucose, and minerals are available for the fetus.
-Secretion of hPL can be detected by about 4 weeks.
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Fetal Circulation
Blood in placenta --> enters fetus via umbilical vein --> small amount of blood to liver; the rest flows through the ductus venosus into fetal inferior vena cava --> R atrium --> foramen ovale to L atrium --> L ventricle --> aorta.
Some blood returning from the head and upper extremities by way of the SVC is empties into the R atrium --> tricuspid valve --> R ventricle --> pulmonary artery --> ductus arteriosus --> descending aorta --> 2 umbilical arteries --> placenta.
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The changes that occur in the pregnant woman's body may result from:
Hormonal influences, the growth of the fetus, or the mother's physiologic adaptation to the pregnancy.
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Cervix
-estrogen stimulates the glandular tissue of the cervix, which increases in cell number and becomes hyperactive
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Goodell's sign
Softening of the cervix
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Chadwick's sign
bluish discoloration of the cervix
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Vagina
-estrogen causes a thickening of the vaginal mucosa, a loosening of the connective e tissue, and an increase in vaginal secretions
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Breasts
-Estrogen and progesterone cause many changes in the mammary glands.
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Colostrum
an antibody-rich yellow secretion, may leak or be expressed from the breasts during the last trimester. Colostrum gradually converts to mature milk during the first few days after childbirth.
74
Respiratory system
Progesterone decreases airway resistance, permitting a 15 to 20% increase in oxygen consumption. Volume of air breathed each minute increases 30 to 40%.
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Cardiovascular system
- Blood flow increases to the uterus, placenta, and breasts.
- Hepatic and cerebral flow remains unchanged.
- Cardiac output begins to increase early in pregnancy and peaks at 25 to 30 weeks gestation at 30 to 50% above pre-pregnant levels.
- Pulse may increase by as many as 10 to 15 BPM.
76
GI System
- Elevated progesterone levels cause smooth muscle relaxation, resulting in delayed gastric emptying and decreased peristalsis.
- Bloating/constipation is common.
- Heartburn (pyrosis) common
- Hemorrhoids common from constipation and from pressure on vessels below the level of the uterus.
- Gallstone formation not uncommon due to delayed emptying of gallbladder due to progesterone.
77
Urinary Tract
1st trimester: urinary frequency because uterus is still a pelvic organ and presses against the bladder.
2nd trimester: more normal
3rd trimester: reappears when the presenting part descends into the pelvis and again presses on the bladder.
78
Skin and Hair
Linea nigra: extends from the umbilicus or above to the pubic area.
Facial chloasma or melisma gravidarum: mask of pregnancy.
Sweat and sebaceous glands are often hyperactive during pregnancy and may cause heavy perspiration, night sweats, and acne.
Striaestretch marks
Increased hair loss for 1 to 4 months after birth is common.
79
Musculoskeletal System
Diastasis recti: rectus abdominis muscle separates.
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Central Nervous System
"Pregnancy brain."
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Eyes
During pregnancy intraocular pressure decreases and the cornea thickens slightly because of fluid retention.
These changes usually disappear by 6 weeks postpartum.
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Metabolism
Most metabolic functions increase during pregnancy because of the increased demands of the growing fetus and its support system.
83
Weight Gain
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Normal weight gain 11.5-16kg/ 25-35 lbs
Overweight gain 6.8-11.5kg/ 15-25 lbs
Obese gain 5-9 kg/ 11-20 lbs
Underweight 12.7-18.1 kg/ 28-40 lbs
Normal weight gain pattern is .5-2 kg/ 1.1-4.4 lbs during the 1st trimester with an average gain of about 0.45kg/1 lb per week during the last 2 trimesters.
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84
Thyroid gland
- often enlarges slightly during pregnancy because of increased vascularity and hyperplasia of glandular tissue.
- influenced by estrogen
- basal metabolic rate increases by as much as 20 to 25% during pregnancy.
85
Pituitary
Pregnancy is made possible by the hypothalamic stimulation of the anterior pituitary gland. The anterior pituitary produces FSH, which stimulates ovum growth, and LH, which brings about ovulation.
Prolactin, another anterior pituitary hormone, is responsible for lactation.
86
Relaxin
- is detectable in the serum by time of first missed menstrual period.
- inhibits uterine activity, diminishes the strength of uterine contractions, aids in the softening of the cervix, and has the long-term effect of remodeling collagen.
- Primary source is the corpus lutem, but small amounts are believed to be produced by the placenta and uterine decidua.
87
Subjective (Presumptive) Changes of pregnancy
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Amenorrhea
N&V
Excessive fatigue
Urinary frequency
Changes in the breasts
Quickening
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Objective (Probably) Changes of pregnancy
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Changes in pelvis organs
Enlargement of the abdomen
Braxton Hicks contractions
uterine soufflé
Changes in pigmentation of the skin
Fetal outline
Pregnancy tests
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Diagnostic (Positive) Changes of pregnancy
Fetal heartbeat
Fetal movement
Visualization of the fetus
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Abortion
birth that occurs before the end of 20 weeks gestation or the birth of a fetus/newborn who weights less than 500g.
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Term
the normal duration of pregnancy, 38 to 42 weeks.
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Preterm labor
Labor that occurs after 20 weeks but before completion of 37 weeks gestation.
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Gravida
any pregnancy, regardless of duration, including current pregnancy
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Nulligravida
a woman who has never been pregnant
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Primigravida
a woman who is pregnant for the first time
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Multigravida
a woman who is in her second or any subsequent pregnancy.
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Para
birth after 20 weeks gestation
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stillbirth
an infant born dead after 20 weeks gestation
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GTPAL
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Gravida
Term
Preterm
Abortion
Living
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Risk factors
any findings that suggest the pregnancy may have a negative outcome, for either the woman or her unborn child.
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Estimated due date
Nagele's rule: subtract 3 months, add 7 days.
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Fundal height
McDonald's method: Pubic bone to top of the uterine fundus. Fundal height in centimeters correlates well with weeks of gestation between 22 and 34 weeks.
Void within 30 minutes prior to measurement.
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Fetal heartbeat
Heard starting at 8-10 weeks gestation
| Normal ranges is 110 to 160.
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Recommended antepartum visits
Q4wks for 24 weeks
Q2wks to 36 weeks
Qwk to birth
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N/V Self-care measures
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carbonated beverages
avoid odors or causative factors
dry crackers or toast before getting up in AM
Small, frequent meals
avoid greasy, highly seasoned foods
take dry meals with fluids between meals
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106
Urinary frequency self-care
void when urge is felt
increases fluid intake during the day
decrease fluid intake only in the evening to decrease nocturia
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Fatigue self-care
plant time for a nap or rest period
go to bed earlier
seek family support and assistance
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Breast tenderness self-care
wear well0fitting, supportive bra
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Increased vaginal discharge self-care
Bath daily
avoid douching, nylon underpants and pantyhose
wear cotton underpants
use powder but don't allow it to cake
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Category A
No associated fetal risk
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Category B
animal studies show no risk, but there are no controlled studies in women, or animal studies indicate a risk, but controlled human studies fail to demonstrate a risk. (PCNs)
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Category C
Human studies not available or animal studies show risk.
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Category D
Evidence of human fetal risk exists but benefit may outweigh the risk.
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Category X
Demonstrated fetal risk clearly outweigh any possible benefit.
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Fetal Alcohol Syndrome (FAS)
Characterized by growth retardation, facial anomalies, and CNS dysfunction of varying severity.
Currently the most common preventable cause of intellectual disability in the U.S.
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Maternal weight BMI
underweight: BMI less than 18
Normal-weight: BMI 18.5-24.9
Overweight: BMI 25-29.9
Obese: BMI over 30
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Iron
- requirements increase during pregnancy
- Anemia in pregnancy is mainly caused by low iron stores, although it may also be caused by inadequate intake of other nutrients.
- Iron deficiency anemia is defined as a decrease in the O2 carrying capacity of the blood.
- IDA in pregnancy is associated with an increased incidence of low birth weight infants and preterm birth.
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High iron foods
Lean meats, dark green leafy vegetables, eggs, and whole-grain and enriched breads and cereals
Also
dried-fruits, legumes, shellfish, and molasses.
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RDA for iron in pregnancy
27 mg per day
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Folic Acid
- Folate
- required for normal growth, reproduction and lactation
- prevents the macrocytic, megaloblastic anemia of pregnancy.
- inadequate intake....neural tube defects
121
Folic Acid containing foods
fresh green leafy vegetables, liver, peanuts, and whole-grain breads and cereal.
