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Flashcards in Repro Deck (39):
1

Complete mole

46 XX or 46 XY - 1 sperm divides and fertilizes empty egg
- VERY high beta-hCG
- increased uterine size
- NO fetal parts

Risk: 2% choriocarcinoma, 15-20% malignant trophoblastic disease (invades through uterine wall)
- Monitor beta-hCG after evacuation

Tx: dilation currettage, methotrexate

2

Partial mole

69 XXX, 69 XXY, 69 XYY
- 2 sperm and 1 egg
- slight increase in beta-hCG
- Fetal parts

Risk: low risk of malignancy (<5%)

Tx: dilation currettage, methotrexate

3

Preeclampsia

Preeclampsia= HTN, proteinuria, edema
- Occurs in 7% women from 20 weeks gestation to 6 weeks postpartum
- Before 20 weeks= molar pregnancy likely

Eclampsia= preeclampsia + seizures

Etiology:
- Increased incidence in pre-existing HTN, diabetes, chronic renal disease, autoimmune disorders
- Defect in uterine vasculature--> increased vascular tone

HELLP syndrome= Hemolysis, Elevated Liver enzymes, Low Platelets

Mortality: cerebral hemorrhage, adult respiratory distress syndrome

Treatment:
- IV magnesium sulfate: prevention and treatment for seizures

4

Abruptio placentae

Premature detachment of placenta
- Associated with DIC?
- Increased risk with smoking, HTN, cocaine

Symptoms:
- Painful bleeding in 3rd trimester (Abrupt detachment)--> life threatening to fetus and mother

5

Placenta accreta

Scar tissue in myometrium--> defects in decidual layer--> allows placenta to adhere to tissue
- increased bleeding risk after delivery

** Retained placental tissue: increased risk of infection
- Bacteroides= most commonly isolated (mixed flora infection)

6

Placenta previa

Placenta attaches to lower uterine segment
- Increased risk with multiparity, C-section

Symptoms:
- PainLESS bleeding in any trimester

7

Ectopic pregnancy

** Lower than expected beta-hCG

8

Polyhydramnios

> 1.5-2 L amniotic fluid-->
Due to:
- esophageal/duodenal atresia: Can't swallow amniotic fluid
- Anencephaly (can't swallow w/o brain

9

Cervical dysplasia/CIN

HPV 16--> E6--> inhibit p53
HPV 18--> E7--> inhibit Rb

* Increased risk with multiple sexual partners (#1), smoking, early debut, HIV infection

10

Gynecologic tumor epidemiology

Worldwide: Cervical cancer most common

Incidence (US):
1. endometrial
2. ovarian
3. cervical

Highest mortality:
1. ovarian
2. Cervical
3. Endometrial

11

Clear cell adenocarcinoma of vagina

DES exposure in utero--> seen in adulthood

12

Sarcoma botyoides

Rhabdomyosarcoma
- girls < 4 years of age
- Spindle-shaped tumor cells= desmin positive

13

CA-125

Cancer antigen elevated in serous, endometrioid, clear cell carcinoma of ovary
- Used to monitor therapeutic response

14

Malignant breast cancer

Common post-menopause
Usually arise from terminal duct lobular unit

Overexpression of:
- Estrogen/progesterone receptors
- c-erbB2 (HER-2= EGF receptor)

15

Leuprolide

GnRH analog:
- Agonist when used in pulsatile dosing (infertility drug)
- Antagonist when used continuously (prostate cancer, uterine fibroids, precocious puberty treatment)

Tox:
- Antiandrogen, N/V

16

Testosterone

MOA: Agonist at androgen receptors

Use: Treats hypogonadism
- Promotes secondary sex characteristics
- Anabolic steroid- burn or injury recovery

Tox:
- Masculinization in famles
- Inhibits LH release (negative feedback)--> gonadal atrophy
- Premature epiphyseal plate closure
- Increased LDL, decreased HDL

17

Finasteride

MOA: 5-alpha-reductase inhibitor
- Decreases conversion of T--> DHT

Use:
- BPH
- Male-pattern baldness

18

Flutamide

MOA: nonsteroidal inhibtor of androgens at testosterone receptor

Use: prostate cancer

19

Ketoconazole

MOA: inhibits steroid synthesis (inhibits 17,20-desmolase)

Use:
- PCOS (prevent hisutism)

Tox: gynecomastia, amenorrhea

20

Spironolactone

MOA: inhibits steroid binding

Use:
- PCOS (prevent hisutism)

Tox: gynecomastia, amenorrhea

21

Ethinyl estradiol, DES, Mestranol

MOA: bind estrogen receptors

Use:
- Hypogonadism, ovarian failure
- Menstrual abnormalities
- HRT in post-menopauseal women
- Androgen-dependent prostate cancer

Tox:
- Increased endometrial cancer risk
- Bleeding in post-menopausal women
- DES in utero exposure--> clear cell adenocarcinoma of vagina
- Thrombosus
** Avoid in ER-positive breast cancer, previous history of DVT

22

Clomiphene

MOA: SERM
- Partial agonist at estrogen receptors in hypothalamus (prevents normal feeback inhibition)
- Increases LH, FSH release

Use: infertility, PCOS

Tox:
- Hot flashes
- Ovarian enlargement
- Multiple simultaneous pregnancies
- Visual disturbances (enlarged pituitary)

23

Tamoxifen

MOA: SERM
- Antagonist on breast tissue, agonist of endometrium

Use: treat, prevent recurrence of ER-positive breast cancer

24

Raloxifene

MOA: SERM
- Agonist on bone--> reduces resorption

Use: Osteoporosis

25

Anastrozole, Exemestane

Aromatase inhibitors

Use: postmenopausal breast cancer (estrogen-sensitive cancer)

26

Progestin

MOA: bind progesterone-R, reducing growth and decreasing vascularization of endometrium

Use:
- oral contraceptives
- Endometrial cancer
- AbnL uterine bleeding

27

Mifepristone (RU-486)

MOA: competitive inhibitor of progestins at progesterone-R

Use: terminate pregnancy (administered with misoprostol= PGE1)

Tox: Heavy bleeding, GI effects (N/V/A), abdominal pain

28

Oral contraceptives (progestin + estrogen)

MOA: inhibit LH/FSH release--> prevent estrogen surge--> no LH surge--> no ovulation
- Progestins= thicken cervical mucus (barrier); inhibit endometrial proliferation (no implantation)

29

Terbutaline

MOA: beta-2 agonist, relaxes uterus

Use: reduce premature contractions

30

Tamulosin

MOA: alpha-1 antagonist, inhibits smooth m. contraction (selective for alpha 1A,D receptors in prostate vs alpha 1B in vasculature)

Use: BPH

31

Sildenafil, Vardenafil

MOA: inhibit PDE-5--> increased cGMP--> smooth muscle relaxation in corpus cavernosum (increased blood flow--> erection)

Use: Treat ED

Tox: H/A, flusing, dyspepsia, impaired blue-green color vision
- Avoid in patients taking nitrates--> hypotension

32

Danazol

MOA: synthetic androgen; partial agonist at androgen receptors

Use: endometriosis, hereditary angioedema

Tox:
- Weight gain, edema
- Acne, hirsutism, masculinization
- Decreased HDL, hepatotoxic

33

Sources of estrogen in female

Ovary (17-beta estradiol), placenta (estriol), adipose tissue (estrone via aromatization)

- GnRH--> LH--> desmolase in Theca cell
--> Cholesterol converted to androstenedione
- GnRH--> FSH--> aromatase in Granulosa cell
---> Androstenedione converted to astrogen

Estrogen--> increased transport proteins, SHBG; increased HDL, lowered LDL; causes LH surge--> ovulation

** Potency: estradiol > Estrone > estriol

34

Oogenesis

Meiosis I= prophase I; primary oocyte (until ovulation)
Meiosis II= Metaphase II; secondary oocyte (until fertilization)

35

Lactation

Progesterone decreases at birth--> lactation begins
- Prolactin= binds JAK-STAT pathway--> induce and maintain lactation, prevent ovulation
- Oxytocin= milk letdown

36

hPL

Human placental lactogen
- Secreted from syncytiotrophoblast
- Similar to prolactin, GH
- Increases maternal insulin resistance, decreases maternal glucose utilization, increases blood glucose
--> increased lipolysis, proteolysis (energy for mom as baby uses glucose)

** Maternal insulin resistance d/t: hPL, GH, estrogens, progesterone, glucocorticoids
- Gestational diabetes= unable to overcome insulin resistance

37

Alpha-fetoprotein (AFP)

Synthesized in liver, GI tract, yolk sac
- Serum AFP low in: Down's syndrome, increased gestational age
- Elevated AFP: dating error (most common cause), neural tube defects, gastro wall defects, multiple gestations

38

Endometritis

Inflammation of endometrium d/t:
- Retained products of conception following delivery
- Miscarriage/abortion
- Foreign body (IUD)

Bacteroides= common infection

Treatment:
- Gentamycin + Clindamycin
+/- Ampicillin

39

Fibrocystic change in breast

Most common cause of breast lumps from 25- menopause
- Premenstrual breast pain, bilateral, multiple lesions
- Fluctate in size, mass
- Does NOT indicate increased risk of carcinoma

Fibrosis= hyperplasia of stroma

Cystic= fluid-filled blue dome (ductal dilation)

Sclerosing adenosis= increased acini, intralobular fibrosis; associated with calcifications (confused with cancer)

Epithelial hyperplasia= increased epithelial cells in terminal duct lobule (increased risk of cancer if atypical cells)