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Flashcards in Weeks 1, 2 Deck (133):
1

Diagrams

Lots in powerpoints

2

Production of milk is stimulated by

Prolactin mainly, also from estrogens and progesterone

3

Ejection of milk stimulated by

Oxytocin from pituitary gland, in response to suckling (let down reflex)

4

Semen is

Sperm + seminal fluid

5

Average amount of ejaculation

2.5-5mL with 50-150mil sperm/mL

6

pH of semen

7.2-7.7. Provides transport medium for sperm, plus nutrients and antibiotics

7

Pathway of sperm

Seminiferous tubules to epididymis to vas deferens to ejaculatory ducts to urethra

8

What gets snipped in vasectomy

Vas deferens

9

Hypothalamus releases

GnRH

10

Anterior pituitary releases

FSH, LH, prolactin

11

Posterior pituitary is

Oxytocin

12

Ovaries release

Estrogens, progesterone, inhibin, relaxin

13

GnRH is responsible for

Controlling ovarian and uterine cycle, stimulates release of FSH and LH

14

FSH is responsible for

Initiating follicle development, secretions of estrogens

15

LH is responsible for

Stimulating further development of ovarian follicles, also secretion of ovarian hormones (estro, proges, inhibin, relaxin)

16

Prolactin is responsible for

Boobie juice

17

Oxytocin is responsible for

Stimulating secretion of breast milk and uterine contractions, released as a result of the sucking action (let down reflex)

18

Estrogens!

Six different types, only 3 in significant quantities.
In order of potency
E2, E1, E3
E2 and E1 from ovaries
E3 from placenta

19

Estrogen functions

Includes reproductive and structural/physiological

20

Estrogen reproductive functions

Increase uterine growth, stimulate endometrial growth, increase vag lube, thicken vag wall

21

Estrogen development of secondary sex characteristics

Voice pitch, broad pelvis, hair patterns, fat distribution (hips, abd, mons pubis, breasts)
Also develops functional components of breasts

22

Estrogen structural and physiological effects

Decelerate height growth (ossification of epiphyseal plates)
Reduce bone resorption, increase bone formation
Reduced muscle mass
Increases protein anabolism
Increase HDL, decrease LDL, fat deposition (accelerate metabolism, burns fat)
Angiogenesis, increased coagulation

23

Estrogen effects on clotting

Increase circulating level of 4 clotting factors including plasminogen, decrease antithrombin III, increase platelet adhesiveness

24

More estrogen effects

Na+ and therefore water retention
Increase cortisol
GI tract (reduce bowel motility, increase cholesterol in bile)
Increase pheomelanin, reduce eumelanin
Support certain breast CA
Sexual desire based on androgen levels rather than estrogen

25

Progesterone functions

Negative feedback on GnRH
Works with estrogen to prepare endometrium for implantation
Prepares mammary glands to secrete milk

26

Inhibin functions

Secreted by corpus luteum of ovary
Decreases FSH, GnRH, and to a lesser extent LH
It is important to decrease LH and FSH at the end of the uterine cycle

27

Relaxin

Produced by corpus luteum and placenta during last trimester
Relaxes symphysis pubis, loosens CT, dilate the cervix for delivery

28

Development of follicles

Initially developed by FSH, furthered by LH, LH also stimulates corpus luteum

29

Estrogens

Increase protein anabolism, lower blood cholesterol, moderates GnRH, FSH, LH

30

Progesterone

Works with estrogens to prepare endometrium for implantation, prepares boobies to secrete, inhibits GnRH and LH

31

Relaxin

Inhibits contractions of uterine smooth muscle.
During labor, it increases flexibility of pubic symphysis and dilates uterine cervix

32

Testes produce

Testosterone and inhibin

33

FSH men

Initiates spermatogenesis

34

LH

Stimulates testosterone secretion

35

Testosterone function

Controls male pattern of development prior to birth -reproductive organs and descent of testes
Development and enlargement of sex organs
Secondary sex characteristics
Anabolism (protein synthesis)

36

Inhibin in men

Secreted by (sustentacular) sertoli cells in seminferous tubules
In response to when spermatogenesis has reached an adequate level
Acts on PT to stop secretion f FSH and LH - negative feedback loops

37

Female reproductive cycle

24-35 days (average 28)
Two cycles, ovarian cycle and uterine (mesntrual) cycle

38

Ovarian cycle

Menstruation, preovulatory, ovulation, postovulator

39

Uterine (menstrual) cycle

Average 28 days. Cycle duration is calculated from first day menses up till first day of next menses

40

Phases of menstrual cycle

Menstrual, proliferation, secretory, regressive (premenstrual)

41

Conception requirements

Intercourse (in vivo) over 3 mil sperm are deposited at time of ejac or in vitro

42

Fertilization

Union of ovum and single sperm become a ZYGOTE
Can occur anywhere in uterus or fallopian tubes
Ova can live max 48 hours
Spermatoza can maintain their fertilizing ability for 2-4 days
When one sperm has entered the ova, the ova wall changes to not allow any more in

43

X and XXY

XXY is klinefelter (sterile) and just X is turner syndrome (also sterile)

44

Zygote

Fertilized ova with sperm, cleavage of zygote (two-cell stage) day 1
Cleavage to four cell stage (day 2)

45

Morula (day 3-4)

The zygote spends 6-8 days traveling to the uterus, and develops into the morula 96 hours after fertilization
Morula divides to form a solid mass of cells (increases number of cells but not mass)

46

Blastocyte (day 4.5-6)

Trophoblast - will develop into the placenta and the outer chorionic membrane
Embryoblast (inner mass) will develop into embryo, cord and inner chorionic membrane
Internal fluid filled cavity (blastocele) blastocyte cavity

47

Implantation (day 6-10)

Day 6 grabs on, day 8 starts to get up into the endometrium of uterus
Day 10 all the way in (if successful = pregnanananancy)

48

Trophoblast cells

Absorb nutrients from uterus
Secrete HCG
HCG maintains corpus luteum

49

S/S of pregnancy classified into

Presumptive (presumed but not proven)
Probably - likely but not definite
Positive - positive

50

Presumptive signs of pregnancy

Cessation of menses (amenorrhea)
Morning sickness
Change in the breasts
Increase in frequency of urination (micturition)

51

Probably signs of pregnancy

Uterine enlargement (changes in abd)
Pigmentation changes
Hegar's sign
Goodell's sign
Chadwick sign
Ballottement
Braxton-Hicks
Hormone tests pregnancy tests

52

Hegar's sign

Non sensitive indication of pregnancy (absence does not exclude)
It is a softening in consistency of the uterus and the uterus and cervix seem to separate into two separate regions

53

Goodell's sign

Significant softening of vaginal section of cervix from increased vascularization

54

Chadwick's sign

Bluish discoloration of the cervix, vagina, and labia resulting from increasted blood flow. 6-8 weeks after pregnancy

55

Ballottement sign

Sharp upward pushing against the uterine wall with a finger inserted into the vagina for diagnosing pregnancy by feeling for return impact of displaced fetus
Similar procedure for detecting a floating kidney

56

Braxton hicks

Start as early as 6 weeks into pregnancy. Not usually felt until second or third trimester
Often infrequent, irregular, only mild cramping

57

Gravida

Number of times a female has been pregnant
Multi gravida is multiple times being pregnant
Primigravida is first time being pregnant
Nulligravida is never been pregnant

58

Para

Number of times pregnancy has progressed to viability

59

Abortus

Number of times pregnancy was terminated before fetus was viable

60

Primipara

First time giving birth

61

GTPALM

Gravida
Term pregnancy
Preterm births
Number of living children
Abortions
Multiple gestation and births

62

4 Ms pertaining to pregnancy

Maturity (gestational age, estimate date of confinement (due date))
Multipara (number of fetus)
Meconium (presence of )
Medication - whats being used

63

Viability

Legal definition - 20 weeks in Canada
Medically viable - 22 weeks or 400 g (WHO)
At 26 weeks the lungs of the fetus have developed to the point that it can support the fetus if delievered

64

Embryo

Product of conception, week 3 to end of 7th week

65

Fetus

Week 8 to delivery

66

Ante partum

Occurs before pregnancy

67

Prenatal

Occurring during pregnancy

68

Postpartum

Occurring after pregnancy

69

Definition of term

Infant born 38-42 weeks gestation regardless of gestational weight

70

Pre term definition

Before 37 weeks regardless of weight

71

Postterm

42 weeks

72

Premature

Old term, not used today, applied to prior to 37 weeks or less than 2500 gms regardless of age

73

Weight and size

SGA - 10th percentile for babies of same gestational age
RGA - right
LGA - 90th percentile for same gestational age
GA - for gestational age

74

Mucus plug

Operculum
Plug of mucus formed from the secretions of the cervical glands
Formed by week 8

75

Chorionic villi

Blood attachements of placenta to uterine wall

76

Amniotic fluid

Pale, clear liquid secreted by cells of amniotic membrane
99% water with mineral salts and small amount of fetal urine

77

Function of amniotic fluid

Temp regulation in utero
Enable free movement of fetal parts
Shock absorber
Flushes out lower genital tract when membranes rupture

78

Placenta developement

Trophoblasts develop villi into chorionic villi which penetrate into capillaries of endometrium, where blood vessels form
The placenta will develop from tissues found at site of implantation, the material tissue and the ovum's chorionic villi

79

More on placenta development

Develops completely at 3 months
Will weight 1/6th of bebe
20cm in diameter and 2-3cm thick

80

Functions of placenta

Respiration, nutrition, excretion (very little excreted by fetus) exchange of nutrients and oxygen across membrane
Protection

81

Placenta protection

Chemical and physical
Enzymes detoxify many compounds
Placental membrane act as a physical barrier for protecting the fetus
No exchange of blood between mother and baby

82

Hormones placenta produces

hCG, relaxin, hCS, corticotropin-releasing hormone

83

hCG from placenta

Rescues corpus luteum from degeneration until 3rd of 4th month of pregnancy

84

Corpus luteum

Produces progesterone and estrogen to maintain endometrium during pregnancy, prepares mammary glands for lactation, prepares mothers body for baby

85

Relaxin

From placenta, increases flexibility of pubic symphysis
Helps dilate uterine cervix during labor

86

hCS

Human chorionic somatomammotropin
Prepares mammary glands for lactation
Enhances growth by increasing protein synthesis
Decreases glucose us and increases fatty acid use for ATP production

87

Corticotropin-releasing hormone

Establishes timing of birth, increases secretion of cortisol

88

Umbilical cord

Two arteries one vein
Arteries carry unoxygenated blood from fetus
Vessels are surrounded by a thick gelatinous substance called Wharton's jelly which prevents vessels from being bent or compressed

89

Vernix caseosa

Cheese like, greasy substance secreted by sebaceous glands which act as a protective barrier to skin of the fetus

90

Meconium

Fetus bowel contents, presence is indication of fetal distress

91

Hormonal changes in pregnancy

hCG, more estrogen, more aldosterone, hCS (placental lactogenic hormone)
Melanocyte stimulating hormone
relaxin
Prolactin

92

Estrogen in pregnancy

Promotes uterine growth, increases breast growth, increases water and salt retention, influences pituitary hormone release, increases blood coagulation

93

Progesterone in pregnancy

Relaxation of smooth muscle, CT
Elevates body temp
Develops lactiferous ducts and alveoli
Secretory changes within breast
ALSO increases water and salt

94

Aldosterone in pregnancy

Increases at 15 weeks, party from increase in renin and party to counteracts effect of progesterone (has antialdosterone effect)
An imbalance creates hypertension

95

hCS in pregnancy

Prepares mammary glands
Increases protein production
Decreases glucose use
Increases fatty acid usage for ATP production (can create a diabetic effect on mom)

96

Uterine changes

Muscle fibers multiply, grow large and stretch because of estrogen, progesterone, and mechanical pressure from fetus, placenta, and amniotic fluid
Uterine walls get thinner and softer as uterus enlargers
Hegars signm goodell's sign

97

Ovaries

Stop producing ova

98

Vagina in pregnancy

External structures and vagina become blue in color - chadwick's sign
Increase in venous dilation
Normal acididc secretions increase significantly

99

Breast changes in pregnancy

Proliferation of breast tissue, dilation of the blood vessels and secretory changes, they get bigger and veins become visible at 8 weeks

100

Nipples in pregnancy

Get larger, darker, erect with more prominent sebaceous glands, increased sensation and tingling (more common in primigravida) clear fluid by 4th week colostrum can be expressed by week 16

101

Muscoskeletal system in pregnancies

Change in center of gravity and contour of body, lordosis develops towards latter part of pregnancy
CT relaxes
Pelvic joints loosen and pelvis widens
Creates back pain, hip pain, trouble walking

102

Heart changes

Myocardial hypertrophy due to increase in stroke volume, position is higher towards second half of pregnancy which may cause L axis deviation and creates louder heart sounds

103

Cardiac output during pregnancy

Increases by 30-50% due to demands of fetus and placenta, pulse goes up 10-15%

104

Physiological anemia

Blood volume increases 40-50%, plasma volume increases more than RBCS (hemoglobin lowered to 80%)
Causes increased fatigue and fainting in pregnant women

105

BP in preggos

Lowered by 5-15mmHG from progesterone which relaxes smooth muscle and causes vasodilation
Orthostatic hypotension becomes more prominent, venous return decreases
Supine hypotension syndrome possible

106

Femoral venous pressure during pregnacny

Increased due to uterus putting pressure on the vein of the lower ext, pregnant females are asked not to sit or stand too long

107

Blood coagulability

Increased to prevent severe hemorrhage at delivery, is caused by increased estrogen, higher incidence of venous thrombosis during pregnancy

108

Leukocytosis

Mild levels during pregnancy, unclear etiology

109

Respiratory changes during pregnancy

Rate increases, SOB is common, uterus pushes against diaphragm BUT lung volume NOT decreased, shape of thoracic cavity is altered

110

Epistaxis during pregnancy

More common, possibly due to increased vasculature from elevated estrogen.

111

Voice changes

May get a deeper voice from progesterone increasing vocal cord size

112

Alimentary canal

Also called digestive tract

113

Alimentary changes

Morning sickness, gastic reflux, constipation, other changes

114

Morning sickness

Early months, possibly from hormones and sugar-glycogen levels
Abnormal if over 8-12 weeks and or hyperemesis

115

Gastric reflux

From hormonal and mechanical changes
Progesterone relaxes cardiac splinter and decreases gastic mobility
Also physical pressure from uterus as it rises
More common later on

116

Constipation

Decreased intestinal mobility (progesterone) and crowding of intestines
Getting all farty is common

117

Oral changes

Increase thirst and appetite
Gums bleed from increased vasculature from estrogen *when brushing
Saliva production increased

118

Urinary tract problems

Urinary problems from hormonal and physical
Decreased smooth muscle function, movement of urine to bladder from kidneys is slowed

119

Stress incontinence

Muscle tone in pelvic floor decreased due to hormones and pressure from uterus
Any sudden increase in ABD pressure will cause some discharge (sneezing or laughing)

120

Weight gain

Main increase in second half, if mother weight is normal a 25% increase is expected

121

Skin changes

Estrogen stimulates melanocyte stimulating hormone to create darker nipples and areola, linea nigra

122

Spider naevi

Red skin lesions with red center and tiny radiating branches most prominent on face and upper chest, fades after pregnancy

123

Metabolism during pregnancy

Increased by 15-25%, blood sugars are elevated

124

Calculation of due dates

Average duration is 280 days (base on 28 day cycle and 10 lunar months)
Can also figure it out from McDonald's rule (fundal height)
OR
LMP plus 280 days OR 40 weeks OR 9 months and 7 days

125

Nagele's rule

Calculating due date
First day of LMP, subtract 3 months and add 7 days

126

McDonald's rule

Fundus at umbilicus at 20 weeks, factors such as hydramnios, multuple gestation, giant babies, and obesity affect measurement accuracy

127

Trimesters

1st is 0-12 weeks, ovum to 3 weeks embryo to 8 weeks fetus at 8 and beyond
2nd is 13-27 weeks
third is 27-40

128

Teratogens

Greatest affect in weeks 2-12

129

Second trimester

Maturation of structures become function except CNS, eyes, and external genitals
WK 24 most organs able to function
WK 26 lungs

130

Third trimester

Maturation of remaining structures (CNS, eyes, external genitals)
Increase in mass of strucutres that have occured

131

Differentiation of body structures

Main event in first trimester, none in second or third

132

Maturation (becoming functional)

none in first trimester, everything in 2nd except in the 3rd is CNS, eyes, external genitals

133

Increase in mass (bulking up)

All in 3rd trimester