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Placenta Flashcards

(61 cards)

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1
Q

Explain follicular phase

A

dec luteal prod. of progesterone & inhibin A
inc FSH
growth & selection of antral follicles
LH surge inc progesterone & prostaglandin
LH induce theca cell to prod more androstenedione then converted to estrogen in granulosa
as estrogen rise, negative feedback to hypothalamus & ant. pituitary, dec FSH & LH
inc prod inhibin B further dec FSH

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2
Q

Explain ovulation

A 
devt of corpus luteum
dec FSH & LH
granulosa enhance estrogen & progesterone prod
NO fertilization:
       - luteolysis (9-11 d)
       - dec steroid hormone
       - repeat cycle
fertilization:
       - HCG prevent luteolysis
       - maintain progesterone
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3
Q

Explain proliferative phase

A 
estrogen phase
toward end of mens
proliferation of SM & inc vascularity
endometrial glands are elongated with narrow lumen
utz: trilaminar appearance
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4
Q

Explain early secretory phase

A

secrete mucus & glycogen
glands are tortuous and spiral arteries extends to superficial layers
utz: thickest endometrial layer

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5
Q

Explain late secretory phase

A

dec progesterone & estrogen

lots of glycogen lots of vacuole

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6
Q

Explain menstrual phase

A

spiral arteries rupture

endometrium sloughed off

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7
Q

when is the best time to get an endometrial sample?

A

1-4 days prior to menstruation

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8
Q

what happens to endometrium if the woman becomes pregnant?

A

endometrium transform into decidua

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9
Q

3 parts of decidua

A 
decidua basalis
       - between embryo & myometrium
       - passageway of nutrition
decidua capsularis
       - bet. embryo & uterine lumen
decidua parietalis
       - side of uterus away from embryo
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10
Q

functions of decidua

A

nutritional support & excretion
protein & steroid synthesis
controls trophoblastic invasion

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11
Q

implantation

A

6-7 days after fertilization

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12
Q

stages of implantation

A 
apposition
       -  most common site is the upper and posterior wall in mid-sagittal plane
adhesion
       - d20-21
invasion
       - spiral arteries reconstruction
decidualization
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13
Q

day 8

A

trophoblast differentiation into cytotrophoblast & syncytiotrophoblast
embryoblast differentiation into hypoblast & epiblast

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14
Q

day 9

A

first vacuole
lacunar stage
primitive yolk sac

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15
Q

day 11-12

A

primary villi formation
sinusoids
extraembryonic mesoderm

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16
Q

day 13

A

secondary villi formation

chorionic cavity

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17
Q

by 2nd wk of life, what supplies the implanted ovum in uterus?

A

lacunar system

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18
Q

3rd wk of gestation

A

vascularization
chorionic villin into extravillous trophoblast
tertiary villus or definitive placental villus

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19
Q

4th wk of gestation

A

CVS formation, true circulation is established
remodelling of spiral arteries
cytotrophoblast invade spiral arteries and replace maternal endothelium

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20
Q

5th wk of gestation

A

capillary network dominates villi (V>C)

drainage into sinus venosus

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21
Q

what is the main functional component of placenta?

A

trophoblast

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22
Q

week 7

A

trophoblast proliferated into villi

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23
Q

week 8

A

villus chorion or chorion frondosum

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24
Q

what is the maternal and fetal side of placenta?

A

M: decidua basalis, uterine vessel & glands
F: chorionic plate (amnion & trophoblast)

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25
placental growth w/c trimester is more rapid? what wk, placental and fetal wt is equal? what is the placental wt at term?
1st trim. more rapid 17th wk placenta = fetal 1/6 fetal weight at term
26
placental maturation what wk does it calcified? grading base from week
end of 42nd wk: placenta gets calcified Gr 0: immature (<18wks) Gr 1: indentations of chorionic plate (18-29wks) Gr 2: comma like densities (30-38wks) Gr 3: severely calcified; ring-like structure (>39wks)
27
what is responsible for proliferation and devt of placenta?
leptin or adiponectin
28
what is the fetal macrophages?
hofbauer cells
29
week 6
chorion laeve
30
2 placental plates
chorionic plate: internal; lined by amniotic membrane; umbilical cord lies to this plate basal plate: maternal
31
differentiate vasculogenesis & angiogenesis
V: de novo formation of BV from mesodermally derived precursor cells A: expansion of preexisting vessel bed & creation of new vessel branches from preexisting ones
32
angiogenesis category
branching: 0-24wks; primitive capillary network; VEGF nonbranching: 24wks; mature intermediate villi & later terminal villi; PIGF
33
explain the 3 placental hypoxia
preplacenta: mother, placenta & fetus are hypoxic; inc peripheral branching uteroplacenta: placenta & fetus are hypoxic, normoxic mother; d/t VEGF upregulation postplacenta: normoxic mother, hyperoxic placenta, hypoxic fetus; terminal villi capillary branching almost absent
34
physiologic changes in uteroplacental arteries
trophoblastic invasion loss of elasticity dilatation loss of vasomotor control
35
explain circulation in intervillous space
uterine contraction: vein is occluded, arterial blood forced into intervillous space uterine relaxation: venous drainage spiral arteries are perpendicular & veins are parallel to uterine wall
36
explain fetoplacental circulation
umbilical arteries are deoxygenated from fetus to IVS | umbilical vein are oxygenated from IVS to fetus
37
differentiate thin zone & thick zone in placental barrier
thin alpha zone: gas exchange | thick beta zone: hormone synthesis
38
hormones synthesized by placenta
``` hCG hPL ACTH hCG-V PTHP-rP calcitonin relaxin inhibin, activins, cytokines, ANP TRH GnRH CRH GHRH ```
39
what is the major site of steroid & CHON production in placenta?
syncytiotrophoblast
40
source of placenta in progesterone biosynthesis
maternal LDL-C
41
source of placenta in estrogen synthesis
C19 steroids from maternal & fetal adrenal glands
42
what maintains corpus luteum in pregnant women? in nonpregnant women?
P: hCG NP: LH
43
explain hCG levels in pregnancy
detected: 8 d doubles q48h max: 10 wks min: 16 wks
44
explain hPL levels in pregnancy
detected: 3 wks max: 36 wks
45
fx of hCG
``` maintains corpus luteum stim leydig to prod testosterone immunosuppressive action stim maternal thyroid growth of umbilical cord ```
46
fx of hPL
``` promotes maternal lipolysis insulin resistance glucose spared to fetus promotes growth of breast marker for placental functioning ```
47
explain hGH-V levels in pregnancy
present: 21-26 wks max: 36 wks
48
fx hPL
growth promoting & anti-lipogenic fx
49
explain activin & inhibin levels in pregnancy
peak at term
50
fx of activin & inhibin
A: stim placental hormone production I: opposes activin
51
fx of placental ACTH
imp for controlling fetal lung maturation & parturition timing CRH stim prostaglandin prod & ACTH secretion
52
describe decidual NK cells
lacks cytotoxic fx dampen Th17 cells express IL-8 & interferon 10 (invasion) prod VEGF & PIGF
53
describe decidual macrophages
inhibit typical NK cells spiral artery remodelling engulf apoptotic cells
54
describe T cell apoptosis (FasL)
clonal deletion of immune cells that recognize paternal Ags
55
describe regulatory T cells
prevent immunological rejection of fetus CCR4 modify fx of APC thru CTLA4-B7 w/c upregulates IDO
56
describe PDL 1
regulates T cell homeostasis imp in peripheral tolerance & prevention of autoimmunity dec PDL1 results in dec fetal survival
57
3 mechanisms of fetomaternal tolerance
lack MHC molecules on trophoblast trophoblast HLAs T-cell apoptosis
58
px with frequent hx of abortion, what can be given (2-3 days postfertlization)?
progesterone
59
G1P0 w/ hypogastric cramps, amenorrheic for 6wks, positive PT. Utz 8cm right adnexal mass cystic w/ solid component. approach?
observe then remove mass after 10 wks
60
milestones per week
1st wk: blastocyst, cytotrophoblast, syncytiotrophoblast, disappearance of zona pellucida 2nd wk: implantation (apposition), lacuna to tertiary villi 3rd-4th wk: septation
61
starved pregnant women, IUGR or maldevt of brain?
mental retardation

obstetrics (11 decks)

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