Lecture 04 AP Female Reproduction Flashcards Preview

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Flashcards in Lecture 04 AP Female Reproduction Deck (60):

Where is the Bartholins Gland located and what does it do?

located on posterior on either side of vagina opening at 4 and 8 o’clock Secretes clear mucous to lubricate


Why is the fourchette important to note?

When we talk about STDs and herpes. Herpes will be lesions and blisters, and may have skin tear regions in that area.


Describe the AP of Vagina and pH level

Fibro-muscular, tubular with rugae( transverse folds allow expansion during childbirth)Few sensory nerve ending with an acidic pH of 4-5


What is the uterus like? What are the 3 layers to the uterine wall?

3 layers to uterine wall
Endometrium: area that sloughs off if woman isn’t pregnant


AP of cervix

cylindrical opening at bottom of uterus made up of fibrous connective & elastic tissue which thins and opens during vaginal delivery (effacement and dilatation)


Describe the fallopian tubes and size.

attached to fundus of uterus, allows passage from ovary to uterus of ovum. (10cm long x 1cm wide)


What does ovaries do? What 3 hormones does it produce? Size of ovaries?

ovulation (release of a mature egg/ova) and hormone (estrogen, progesterone & androgen production). (2.5 – 5 cm long x 1.5 – 3 cm wide)


Menstrual Cycle Terminology

Puberty def:

transitional stage b/w childhood and sexual maturity; marked increase in estrogen production b/w 8~11 weeks


Menstrual Cycle Terminology


First menstruation, typically around age 12, it's dif from puberty


Menstrual Cycle Terminology

end of woman's productive phase; occurs b/w ages 50 & 55


Menstrual Cycle Terminology


beings in late 40s. Irregular menses, sx of menopause beings, gradual decline of estrogen


Menstrual Cycle Terminology


periodic uterine bleeding that begins approx 14 days after ovulation. Complex feedback system that prepares uterus for pregnancy. When pregnancy doesn’t occur, menstruation occurs. Best time to get pregnant is 12,14,16 days before next menses. It’s not advised to have sex twice a day, since it takes a man 36 hours for sperms to really regenerate.


What occurs during ovulation?

Ovulation - Approximately mid-cycle (day 14) the dominant follicle releases an ovum, or egg into the fallopian tube. Divides ovarian cycle from endometrial cycle;
After ovulation, ova live for 24 hours without fertilization; remains of the dominant follicle in the ovary become a corpus luteum;


What does the Corpus luteum do?

Corpus luteum produces large amounts of progesterone which causes the endometrium (uterine lining) to thicken/prepare for potential implantation of an embryo to establish a pregnancy.


What occurs if implantation doesn't happen?

If implantation does not occur within approximately two weeks, the corpus luteum will involute, causing sharp drops in levels of both progesterone and estrogen. These hormone drops cause the uterus to shed its lining and egg in a process termed menstruation. Menstrual bleeding is endometrial tissue, mucous & blood
Cycle is complex interplay between the Hypothalumus-Pituitary gland and Ovaries


What occurs during the endometrial cycle?

menstruation occurs. Stimulated by increasing amounts of estrogen in the follicular phase, endometrium thickens.


Fertilization: Where does it take place in the fallopian tube?
what occurs?

1. Takes place in the distal/outer 1/3 of the fallopian tube (“ampulla’)
2.Cellular replication occurs as the fertilized ovum (zygote) travels the fallopian tube into the uterus. Usually takes 3 – 4 days


Implantation: When does it occur?
Why does ovulation cease during pregnancy?

1. 6~10 days after conception, tophoblast cells embed in the endometrium. Implantation bleeding can occur.
2. Ovulation ceases during pregnancy due to high levels of estrogen and progesterone.


What occurs during an ectopic pregnancy?

1. Fertilized ovum does not implant in endometrium, 95% of ectopic pregnancies occur in the ampulla of the fallopian tube.

Leading cause of 1st trimester pregnancy related death.


What increases the incidences of ectopic pregnancy?

1. Birth control
2. STI
3. Other hormones being taken


What are Sx of ectopic pregnancies?

1. Missed/late menstrual period, dark red/brown vaginal bleeding, unilateral pain, tenderness. Pain escalates from dull to colicky as tube stretches.
2. Bleeding into peritoneal cavity causes referred shoulder pain, acute deep LQ pain.
3. If internal bleeding, symptoms of vertigo, lightheadedness, hypotension


What are Dx (diagnosis) of ectopic pregnancies?

1. High index of suspicion, pregnancy test, transvaginal ultrasound
2. Active bleeding associated with tubal rupture
3. Main concern is rupture and shock


What are two treatment options for ectopic pregnancies?

1. Surgical
2. Medical


What does Surgical treatment of ectopic pregnancies consist of?

Surgical removal of ectopic pregnancy
(salpingostomy) before rupture or
laparoscopic removal


What does the medical treatment of ectopic pregnancies consist of?

Administering single IM dose of methotrexate in unruptured pregnancies.


What is the action of methotrexate?
What must be included in Pt teaching?

Action: Antimetabolite and folic acid antagonist that destroys rapidly dividing cells; immunosuppresant

Pt teaching: Need to advise pt to stop taking prenatal vitamins (with folic acid) because it contraindicate the drug.


What are benefits of methotrexate?

High success rate, low complication rate and good reproductive potential


What are the criteria for admin methotrexate? (4)

1. Unruptured tube
2. B-hCG levels
3. No free fluid in peritoneum
4. Compliance with post treatment monitoring


What are nursing care interventions that must be done after admin of methotrexate?

Monitor BP
Psychological needs r/t loss
Unexpected pregnancy
Prep for surgery if MTX treatment fails
No sun exposure


Which is safer in terms of remaining fertile when using ectopic treatments?

MTX is safer than surgery, since the recurrence of an ectopic pregnancy with the surgical treatment is 10~25%.

For MTX, it's 10~12%


If there's a ruptured ectopic pregnancy, then which treatment would be used?



What are some indications of methotrexate?

ectopic pregnancy (EP), rheumatic conditions, psoriasis, chemotherapy agent (so OTHER pregnant females should not be administering this drug)


What are side effects of methotrexate?

N & N, fever, dizziness, pruritis, thrombocytopenia, neurotoxicity;


What are contraindications of methotrexate?

Tubal rupture, anticoagulant Rx i.e Coumadin, Heparin


What are the hormones involved in pregnancy? (5)

1. HCG
2. Estrogen
3. Progesterone
4. Human placental lactogen
5. Relaxin


Hormones involved in Pregnancy: HCG

1. When is this secreted?
2. What does it stimulate?
3. Why does miscarriage occurs?

1. Secreted by trophoblastic cells during early pregnancy. Can be detected 6~8 after conception, so around time she's suppose to get period.
2. Stimulates the corpus luteum to produce progesterone and estrogen to maintain pregnancy until placenta can assume this func
3. Miscarriage occurs when the corpus stops functioning before the placenta is producing enough estrogen and progesterone


Hormones involved in Pregnancy:

Estrogen, when is it produced and what are the levels throughout pregnancy?

The placenta produces it after the 6th/7th week. Level remains high throughout pregnancy.


Hormones involved in Pregnancy:
Progesterone is produced by what?
What are the levels throughout the pregnancies?
What's its role in pregnancy?

Progesterone is produced by the corpus and then by the placenta.

It's found in high levels during pregnancies.

It's the most important hormone during pregnancy because it maintains the endometrium and prevents abortion by relaxing uterine muscles. It relaxes all smooth muscles and maintains uterine lining.


Hormones involved in Pregnancy:
What is human placental lactogen's role?
what are the levels throughout pregnancies?

1. Increases availability of glucose for the fetus.
2. Level increases steadily throughout pregnancy.


Hormones involved in Pregnancy:
What are the roles (3) of Relaxin?

1. Inhibits uterine activity
2. Softens connective tissue
3. Relaxes pelvic joints

All three gives the ability to widen the pelvis and have the baby slide out. Without it, this leads to less CPD pregnancies and more C sections.


Structures and Functions of Conception:
What's the major func of placenta?

When does it form?

1. Major endocrine organ with purpose of oxygenating and sustaining the growing fetus

2. Placenta forms at the site of embryo implantation in the endometrial lining


Structures and Functions of Conception

When does circulation occur?

Embryonic circulation takes place by day 17 when embryonic heart starts beating.


Structures and Functions of Conception:

When is placental formation completed?

Completed by week 12 of pregnancies. Covers about 1/2 of uterus


Why is smoking bad for pregnancies?

It vasconstricts the vessels and creates less nutrients being delivered to the baby.

High BP and used of drugs would be bad as well.


What are the 2 fetal membranes that surround the embryo form at implantation?

Chorion and Amnion


What does the Chorion consist of? (2)

What is the function of the chorion

1. Contains major umbilical cord vessels
2. Has villi "fingers" that develop from the trophoblast burrow into the endrometruim of the uterus. The fingers faces uterus


Which fetal membrane is the closest to the fetus?

Amnion is the inner membrane. Amni- amniotic fluid.


Where does amnion develop from and what is it's function?

Develops from: interior wall of blastocyst
Func: As embryo grows, it draws this membrane around itself to create a fluid filled sac. It grows to accommodate the growing amniotic fluid (800~1200cc)

Amnion also covers the umbilical cord.


How is AF (Amniotic Fluid) amount an indicator of fetal well being?

It indicates that the baby is buffered well.

If there's not enough AF, there may be renal insufficiency. Maternal diabetes may lead to less fluids as well.


How much AF is presented at term?

800~1200 ml normally at term


What does AF contain? (10)

1. urea
2. albumin
3. creative
4. lecithin
5. sphingomyelin
6. Proteins
7. skin cell
8. enzymes
9. lanugo
10. fructose


What's the AF function?

Function is to help maintain constant fetal temperature, cushions the fetus from trauma, allows for musculoskeletal development, lung development and maturity

AF flows in and out of fetal lungs. The fetus does urinate in to AF, but it's alright since AF is constantly being produced.


What is Oligohydramnios?
What is it associated with?

Less than 300 cc of AF

Associated with congential renal anomalies, growth restriction, fetal distress during labor. Cord compression.


What is hydramnios/polyhydramnios?

What is it associated with?

greater than 2 Litres

Associated with neural tube defects, maternal diabetes


What is AFV (amniotic fluid volume) measured by?

Measured during biophysical profile (BPP); noninvasive assessment. Pockets of fluid are measured.


When is the umbilical cord completely developed?

What does it do? AVA

Completely developed during 5th week

Two arteries carry blood from the embryo to the chorionic villi; one vein returns blood to the embryo


What is the size of the umbilical cord?

2 cm in diameter, 50~90 cm long at term


What does Wharton's jelly do?

Connective tissue that prevents compression and continues nourishment


What is cord compression?

cord sandwiched between fetal head and maternal pelvis or is twisted around the fetus


What is a nuchal cord?

Cord wrapped around fetal neck. Not that big of an issue because of wharton's jelly. The jelly insulates the cord and prevents compression.