Reproductive Strand Flashcards
1
Q
What is the primary role of follicle stimulating hormone?
A
Stimulates the oocytes to develop
2
Q
What is the primary role of luteinising hormone?
A
Triggers ovulation
3
Q
What is the primary role of oestrogens?
A
Thicken the endometrium
4
Q
What is the primary role of progesterone?
A
Maintains the endometrium
5
Q
What makes up the hypothalamic-pituitary- gondola (HPG) axis?
A
Hypothalamus
Anterior pituitary
Posterior pituitary
6
Q
How does the hypothalamus stimulate the pituitary?
A
- proteins pass through the artery from the hypothalamus to the anterior pituitary
- the posterior pituitary stimulated by nervous stimulation
7
Q
What hormones are released from the posterior pituitary?
A
ADDH
Oxytocin
8
Q
What hormones are released from the anterior pituitary?
A
GH ACTH TSH FSH LH Prolactin
9
Q
What is the primary role of oxytocin?
A
- uterine contractions
- lactation
10
Q
What is gonadotrophin hormone (GnRH)?
A
- decapeptide
- released in pulses every 90-120 mins
- released by hypothalamus
- stimulated related of LH and FSH from the anterior pituitary
11
Q
How many oocytes to females have throughout their lifetime?
A
- born with 1-2 million
- by puberty 300,000-400,000 are left
- after puberty, women loose about 1000 oocytes a month
12
Q
When do oocytes start meiosis?
A
During fatal life
- then pause as primordial follicles
13
Q
What are the stages of maturation of a oocyte follicle?
A
- Primordial follicle
- Primary/preantral follicle
- Secondary/antral follicle
- Preovulatory follicle
14
Q
How long does it take for a follicle to develop to the stage where it is ready for ovulation?
A
Almost a year
15
Q
Describe the structure of a developed oocyte
A
From outer layer to inner layer
- Theca externa - fibrous outer surface
- Thece interna - produces androgens
- Granulosa cells - convert the androgens to estradiol
- Antrum - fluid-filled cavity
16
Q
What is the role of the theca external?
A
Fibrous outer surface
17
Q
What is the role of the theca interna?
A
produces androgens
18
Q
What is the role of the granulose cells?
A
Converts androgens to estradiol
19
Q
What is the role of the antrum?
A
fluid filled cavity
20
Q
What happens to the theca interna and granulosa cella after ovulation?
A
They undergo lutenisation
21
Q
What results from lutenisation?
A
The corpus luteum
22
Q
What is the role of the corpus luteum
A
To produce progesterone and estradiol
23
Q
What is day one of the menstural cycle?
A
The first day of the menstrual period
24
Q
Describe the hormone levels on day 1 of the menstrual cycle
A
- LH levels are low
- FSH levels are starting to rise
- The dominant follicle starts the final stages of development
25
Describe the hormone levels in the follicular phase of the menstrual cycle
- FSH stimulates follicular development
- The granulose cells produce more oestrogens
- Oestrogens provide
negative feedback to
the hypothalamus and
pituitary
- FSH levels start to fall
26
Describe the hormone levels around ovulation
```
- oestrogen
levels continue to rise
so the negative feedback
switches to positive
feedback
- The resulting LH surge
triggers ovulation
```
27
Describe the hormone levels in the literal phase of the menstrual cycle
```
- The corpus luteum
produces progesterone
and estradiol
- These give negative
feedback to the
hypothalamus and
pituitary, so FSH and LH
levels are low
```
28
What are the 2 phases of the hormonal and follicular cycle called?
1. Follicular phase
| 2. Luteal phase
29
What is the endometrium?
- uterine lining
- endometrial glands and supporting storm
- very vascular
30
Describe what happens to the endometrium in the proliferative phase of the menstrual cycle
- the menstrual cycle starts with the endometrium being shed
| - the estradiol causes the endometrium to proliferate
31
What are the two phases of the endometrium cycle of the menstrual cycle?
1. proliferative phase
| 2. secretory phase
32
Describe what happens to the endometrium in the secretory phase
```
- Progesterone readies the
endometrium for
implantation:
• Glands become convoluted
• Glycogen stores increase
- It also causes cervical mucus to thicken
- In the absence of
implantation, falling
progesterone causes the
endometrium to start
breaking down
```
33
When does menarche occur?
(start of menstruation)
| 12-13, but can be as young as 8
34
When does menopause occur?
around 51
| between 45 and 55
35
How long is a normal menstrual cycle?
21-40 days
36
What does the day of ovulation depend on?
The length of the luteal phase
- ie when there is variation in cycle length, thi sis due to variation in the length of the follicular phase. The luteal phase is fixed at 14 days
37
What is menorrhagia?
Heavy menstrual bleeding
38
Describe heavy menstrual bleeding
- Most women loose 30-40ml blood / period
- Menorrhagia >80ml +/or patient perception
- Affects up to 1:5 women
39
What are the consequences of menorrhagia?
* Anaemia
* Interference with daily activities
* Anxiety and depression
* Estimated cost to economy >£500 million/year
40
What is the treatment for menorrhagia?
Continuous progesterone treatment or combination with oestrogen
41
How does continuous progesterone treat menorrhagia?
Continuous progesterone thins the endometrium and inhibits release of GnRH, FSH and LH
42
What is endometriosis?
• Presence of endometrial tissue
outside of the uterine cavity
• Causes pain with periods and
intercourse and subfertility
43
How can endometriosis be treated?
- Can treat with progestogen +/-
oestrogen
- Can also use a GnRH agonist as without GnRH pulsatility FSH and LH
release is suppressed
44
what date does implantation occur
day 12 post conception
45
what is needed to achieve a pregancny
- plentiful supply of eggs
- functioning menstrual cycle
- regular release of an egg (ovultion)
- patent fallopian tubes
- healthy sperm
- receptive endometrium
46
what conditions may effect the supply of eggs
- age
- menopuase
- premature ovarian failure (menopause before 40)
- previous cancer treatment
- PCOS
47
how does PCOS effect the ovaries ? how does this condition effect the periods of a women
you get tiny little cysts on the ovaries so the ovaries cannot produce good quality eggs
in PCOS a lot of follicles start to develop but non finish this stage so ovulation is often irregular or absent = leading to irregular or absent periods
48
what is the average age for menopause
51
49
what conditions can effect the patency of the fallopian tubes
- pelvic inflammatory disease
- hydrosalpinx
- endometriosis
50
what is pelvic inflammatory disease. whats the mian risk factor for this
scarring and damage to the fallopian tubes
STI's are the main risk factor for this - especially chalyidyma
51
whats hydrosalphinx
fluid accumulation in the fallopian tubes
52
what conditions effect the production of healthy sperm
- varicocele (increase temperature can effect sperm production)
- klinefelter's syndrome ( XXY: effects the production of sperm and ejactulation)
- orchitis (inflammation, damage and scarring of tissue scrotum)
- CBAVD (thickened secretions - from CF)
- testicular torsion (surgical emergency)
- anabolic steroids (lead to hypogonadism and decreased testicualr size)
- vasectomy
53
what can effect the receptiveness of the endometrium
- fibrosis
- septum
- polyps
- intrauterine adhesions
54
what is the difference between sub-fertility and absolute fertility
sub-fertility is the reduced chance of conception (never say never vibes), whereas absolute fertility - can never get pregnant
55
whats the most common factor of inferility
male factor
56
what are the investigations of inferility
```
MOTU
M- male factor
O- ovulation and ovarian reserve
T- tubal patency
U- uterine cavity
```
57
how would you investigate for male factor in a fertility investigation ? what abnormalities would you look for
a semen analysis:
- no sperm
- quantity of sperm
- sperm motions
- sperm shape
58
what is required for a good semen analysis
fresh sample and a period of absentence before
59
how would you test for ovulation and ovarian reserve for in a fertility investigation
- ovualtion: mid-luteal progesterone (meausre 7 days before period- day 21/28 of cycle)
- ovarian reseve: FSH, AMG,AFC (antral follicle count)
60
how would you test for tubual patency for in a fertility investigation
put fluid through tubes look with ultrasound or X ray
| under general anaesthetic
61
how would you test for uterine cavity for in a fertility investigation
```
ultrasound
hysteroscopy (camera into womb)
```
62
what is the treatment for inferility
- stop smoking
- reduce/stop alchohl
- healthy diet
- excersise
- healthy BMI
- no recretional drugs
- men advised to avoid high tempreture
- treat underlying condition
63
steps involved in IVF
- pre treatment (the pill)
- down regulation to prevent premature LH surge (GnRH agnosit or antagonist)
- controlled ovarian stimualtion (gonadotrophins)
- trigger injection to encourage final oocyte maturation (hCG or GnRH agnosit)
- transvaginal oocyte reterval
- fertlisation using iVF
- embryo culture
- select embyos
- embyo tranfer
- luteal phase support (progesterone)
64
what is screening
process to identify apparently healthy people who might be at an increased risk for a disease or condition
65
when do we screen in antenatal care
1- booking: 8-12 weeks
2- dating scan: 10-14 weeks
3- anomaly scan: 18-21 weeks
66
what does a booking scan consist of
blood tests for:
infectious diseases:
- HIV
- hep B
- syphilis
- Rubella
Haemoglobinopathies:
- sickle cell
- thalassemia
mothers blood group Rhesus status
* note need to also test partner*
67
explain the contraction of Rh disease ? what are the consequnces of this
1- RH+ father
2- Rh- mother carrying her first Rh+ foetus
3- Rh antigens from developing foetus enter mothers blood during delivery
3- mother produces anti-Rh antibodies
4- if women becomes pregnant with another Rh+ foetus her anti-Rh antibodies will cross placenta and damage/attack foetal RBC
5- causes haemolytic anaemia and jaundice in newborn
68
how do we prevent Rhesus disease
mother receives IM anti-D at 28-30 weeks :
| neutralises foetal Rh+ antigens which have entered maternal blood = prevents creation of antibodies
69
do we just give the IM anti-D medication to the mother during the pregnancy
no another dose of anti-D is given after delivery if the baby is RH+ - cord blood tests are done at birth
70
what is a combined scan (in terms of results) and when is it performed?
combined scan is performed at the same time as a dating scan
Gives 2 results:
- chance of baby having trisomy 21
- chance of baby having trisomy 13/18 (Patau's or Edwards syndromes)
71
what investigations are done in combined screening
- nuchal Translucency scan
| - blood test: hCG, PAPP-A (pregnancy associated plasma protein A)
72
if there is a chance of trisomy 21/13/18 what is offered?
more invasive testing
73
what does a nuchal translucency scan measure
sonographic appearance of a collection of fluid under the skin behind the fetal neck in the first-trimester of pregnancy- increased in cases of possible disease
74
what is chronic villus sampling? when is it performed ad what are the risks
sample of cells from the placenta is taken and analysed
11-14 weeks
1% risk of miscarriage
75
what is amniocentesis? when is it performed ad what are the risks
sample of amniotic fluid (containing fetal cells) taken and analysed
15-20 weeks
risk of miscarriage = 0.8%
76
what can we get from an anomaly scan, an anomaly scan, when is ti performed, what does it check
- between 18-21 weeks
- check physical development baby
- examine physcial abnormaliites
- screens 11 main/rare conditions: baby bones. heart, brain, spinal chord, face, kidneys, abdomen
77
what is antenatal care ? what is the aim of this
care women receive from healthcare individuals (midwives, obstetricians) during pregnancy
aims to bring mother and child to labour in the bst possible condition
78
what does antenatal care involve
- detects subgroups most at risk
- diagnostic procedures to see who is really at risk
- provision of appropriate managemnt for those highest risk
- education for health pregnancy - childbirth and having new baby
79
what are the principles of good antenatal care
- information given in the form easiest to undrestand and accesible
- based on current available evidence
- respect women's wishes
80
what is the estimated due date based on
women's last menstrual period
81
what risks does a booking visit with a midwife determine
- complications of previous pregnancies: pre-eclampsia, pre term birth, gestational diabetes
- has chronic disease: diabetets, high bp, thyroid problems
- has had a baby with previous abnormalities: spina bifida, downs syndrome
- family history of inherited disorders: sickle cell, CF
82
how is the labour plan for an individual who has been identified as high risk in antenatal care changed
- hospital recommended as place of birth and baby may be delivered prior to 40 weeks gestation via induction of labour or a planned cesarian
83
what treatment/ advice is given to a pregnant mother who has been identified as 'high risk' during antenatal care?
- may include high dose of folic acid (reducing the risk of spina bifida)
- stop smoking
- check if regualr meds are safe in the pregancny
84
when is it important to increase the dose of folic acid for pregnancy
prior to conception
85
what are the babies of high risk women at risk of
higher risk of still birth
86
whats the differnece between a still birth and a misscarage
baby born without signs of life after 24 weeks of completed pregancy = stillbirth
baby born without signs of life before 24 weeks of pregnancy = miscarrage
87
whats the most common cause of a miscarrge
unexplained
88
what are the symptoms which diagnose pregancy
- amenorrhoea
- nausea and vomitting
- breast symptoms
89
why do we amenorrhoea in preganncy
- endomertrium shedding prevented by progesterone made by the corpus lutem
90
why do we THINK we get vommiting and nausea symtoms in preganncy
increased levels of hCG
91
what breast symptoms do we get in pregnancy
- increased in size
- feels warm
- areolae darken
- montgomery's tubecles develop and skins viens dilate
92
when can pregnancy first be seen on an ulttrasound scan
5 weeks
93
how can we diagnose a preganacy
- pregnancy test: hCG (urine tests)
| - ultrasound
94
when is the fetal heart rate visible on an ultrasound
6 weeks
95
when is the feotal pole visible on an ultrasound
7 weeks
96
what basic investigations are done on a booking visit fir a normal pregancny
- urine for protein, glucose and signs of infection
- blood for anemia
- blood fro screening tests (HIV, thalasemia, hep B, syphilis, sickle cell)
97
how do we estimate the esitmated due date
take first day of last normal period, take away 3 months and add one year, add 7 days
98
what history is taken on a booking visit for a normal preganacy
- maternal disease
- family history (of father too)
- past obstetric history (gravida 3, parity 2)
- drug history
- social history (smoking, alcohol, martial staus, living conditions)
99
what does gravida 3 mean
number of times a women has been preganant
100
what does parity 2 mean
number of children women has given birth to
101
how many midwife appointments do first time mothers get in comparisison to women who have had preganacies before
first time = 10 weeks
| otherwise- 7 weeks
102
after 34 weeks which 3 positions can the babys be in? which one of these are best?
- cephalic (best one- head down)
- breech (head up)
- transverse like (baby horizontal0
103
what do we measure in order to measure babys growth
fundal height is measured in cm from the pubic symphysis to the top portion of the uterus
