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52 Cards in this Set
- Front
- Back
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Dyspnea in pregnancy
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due to increased Tidal Volume and MVV
RR is unchanged, but tidal volume increases and MVV (RR*TV) will increase. This leads to elevated P02 both alveolar and arterial. And decreased PCO2 (alveolar and arterial) |
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Cardinal Ligament
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Attaches side walls of cervix to the side wall of the pelvis
Carry the uterine vessels |
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Round Ligament
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derivative of the gubernaculum, travels through the inguinal canal, and attaches to the gubernaculum
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What stimulates androgen synthesis?
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LH (helps in the conversion of cholesterol into androgens/progesterone)
This occurs in the theca interna inside the theca interna is where the granulosa cells reside, which contain aromatase, and FSH will stimulate the androgens to produce estrogen |
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What is the suspensory ligament?
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Attaches the ovaries to the lateral walls of the pelvis, the ureter can be mistaken for the suspensory ligament in surgeries. NO NO!
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Estrogen (sources, functions)
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Source: ovary, placenta, blood (aromization)
Purpose: endometrial proliferation, development of genitalia, growth of the follicle, stromal development of the breast, female fat distribution, hepatic synthesis of transport proteins (increase SHBG), feedback inhibition of FSH & LH, LH surge responsible for ovulation (estrogen negative feedback of LH secretion switches to postive to negative just before LH surge), increased myometrial excitability, increased HDL, decreased LDL |
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Progesterone
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Sources: corpus luteum, placenta, adrenal cortex, testes
elevated progesterone is indicative of ovulation 1. stimulation of endometrial glandular secretions and spiral artery 2. Maintenance of Pregnancy 3. Decreases endometrial excitability 4. produces thick cervical mucus to inhibit sperm entry into the uterus 5. increase body temp 6. inhibit FSH and LH 7. Uterine smooth muscle relaxation |
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How do OCP work?
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Prevent the midcycle GNRH surge to inhibit ovulation
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Mittleschmerz
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Ruptured follicular blood irritates the peritoneum that could mimic appendicitis
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hCG
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syncytiotrophoblast of placenta
Doubles every 2 days, peaking around 10-12 weeks elevated in GTD hcG shares the alpha subunit with TSH, LH and FSH, the beta subunit is different |
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acute and chronic cervicitis
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caused by chlamydia, candida, GC, HSV-2, trich vag
follicular cervicitis: Chlamydia-- see reticulate bodies and elementary bodies cervicitis is the number one cause of pneumonia and conjunctivitis in the newborn |
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pap smear for hormonal status
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estrogen: superficial squamous cells
progesterone: intermediate squamous cells lack of E/P: parabasal cells normal woman: 70% squamous, 30% intermediate preggers: 100% intermediate to the progesterone effect |
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urge incontinence
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feeling the need to go, but can't control it
detrusor muscle is hyperactive, there is an uninhibited contraction of the detrusor muscle--can be diagnosed by foley catheter and syringe |
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stress incontinence
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the peeing when you increase intrabdominal pressure
stress=sneeze generally due to urethral hypermotility, and less than 10% are due to intraurethral sphincter deficiency best tx: retropubic sling procedures |
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overflow incontinence
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diagnose with a PVP> 300 cc
normal is 50-60 cc |
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bHCG levels and Progesterone levels
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bHCG should double in 48 hours up to the peak around 8-11 weeks
to diagnose by US need above 2000 on quantitative progesterone levels ought to be above 25 ng/nl (indicative of a healthy pregnancy) |
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first trimester spotting
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occurs in up 30% of all pregnancies
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diagnosis of ectopic
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1. fetal pole visualized outside the uterus
2. hcG>2000 and no IUP 3. failure of hCG to double/48 hours 4. levels don't fall following D&C |
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indications for MTX treatment
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1. hemodynamically stable
2. Good liver function tests, WBC count 3. Non ruptured mass 4. Mass <4cm w/out HR or <3.5cm w/HR |
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Ruptured Ectopic
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Indication for laparoscopy
signs of hemodynamic instability-- tachycardic, tachypnic, hypotensive etc |
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inevitable abortion
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dilated cervix before 20 weeks, w/out passage of POC
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threatened abortion
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vaginal bleeding before 20 weeks
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incomplete abortion
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passed some but not all POC
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missed abortion
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fetal demise w/out passage and w/out cervical dilation
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Germ Cell Tumors of the Ovary
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Dysgerminoma (MCC malignant germ cell, see elevated LDH, risk factor with streak gonads--> same as the seminoma of the testes)
Cystic Teratoma: usually benign, ectodermal differentiation. Immature malignant types contain mature and immature components (immature is more likely malignant) Yolk Sac Tumor: Schiller-Duval Bodies; malignant tumor, commonly seen in young girls increased alpha fetoprotein |
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Surface Derived Tumors of the Ovary
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Serous: Most common, can be benign or malignant, unilateral or bilateral
Mucinous: Large, seeding can cause pseudomyxoma peritonei may be associated with Brenner's Endometroid: malignant tumors associated with endometrial carcinoma; bilateral commonly Brenner Cell: containts walthard's rests |
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Sex-Cord Stromal Tumors
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Sertoli-Leydig: benign masculinzing tumor (produces androgens); crystals of Reinke
Thecoma-Fibroma: Benign Tumor, associated with Meig's Syndrome (ascites, right sided pleural effusion) Granulosa-Cell: Call Exner Bodies; feminizing tumor (produces estrogen) Gonadoblastoma: malignant tumor that is a mix of germ cell tumor (dysgerminoma) and sex-cord stromal tumor-- often associated with abnorml sexual development |
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Meig's Syndrome
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Seen with Thecoma-Fibroma (sex cord stromal tumor); benign tumor
Ascites, Right sided Pleural Effusion; the effusions regress following removal of the tumor |
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Call Exner Bodies
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seen in granulosa thecal cell tumors, which secrete estrogen and are a sec cord stromal tumor
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Signet Rings
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Gastric Cancer, metastasize to the ovaries via hematogenous spread-- Krukenberg Tumor
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Corpus Luteum Cyst
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most common mass in pregnancy; non neoplastic-- accumulation of fluid in the cyst
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Oophoritis
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may be a complication of Mumps or PID
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Psammoma Bodies in the Ovary
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Serous Tumor
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elevated LDH and an adenexal mass?
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Dysgerminoma
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What forms the umbilical vein?
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the chorionic villlus vessels coalesce to form the umbilical vein
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Umbilical Cord
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Contains 1 vein, 2 arteries
Vein: oxygenated Artery: unoxygenated |
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Most common cause of placental infections
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Group B Strep and increased incidence of PPROM
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Funisitis
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infection of the umbilical cord
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What do you do with a placenta accreta?
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Hysterectomy
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Succenturiate lobes
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accessory lobes of the placenta--located along the margin, risk for hemorrhage if the accessory lobes are detached
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Monochorionic types are associated with what type of twins?
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Identical--> derive from a single fertilized egg
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Dichorionic types are associated with what type of twins?
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Fraternal or Identical
fused amnions and single chorion or two separate chorions and two separate amnions |
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What should you think about when you see preeclampsia in the first trimester?
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molar pregnancies
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Amniotic Fluid Composition
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Fetal Urine
HIgh Salt Content causes ferning when dried on a slide Swallowed and recycled by the fetus |
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Increased maternal alpha fetal protein
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open tube defects
related to folate deficiency neural tube is already formed by the end of the first month of pregnancy |
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decreased maternal alpha fetal protein
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Down Syndrome
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What inhibits surfactant synthesis?
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Insulin
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Where does estriol derived from in pregnancy?
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From the fetal zone of the adrenal cortex, placenta and maternal liver
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DHEA-S
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made in the adrenal gland; elevated with Congential Adrenal Hyperplasia
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Down Syndrome Triad
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decreased urine estradiol
decreased AFP increased beta hCG |
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Ectopic Pregnancies
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Most common cause is PID, then endometriosis, altered tube motility, SIN
Cinically: sudden onset pain, generally 6 weeks after LMP, see AUB, adenexal mass, hypovolemic shock |
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Complications with Ectopics
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Most common is rupture with an intraabdominal bleed-- most common cause of death in early pregnancy; most common cause of hematosalpinx
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