Repro - 1-4 Endocrine Of Pregnancy

Front 1

Mother's role

Back 1

Maternal endocrine glands produce all the hormones involved in preg.

Mainly the hypothal, pituitary and ovary and involved in preg maintenance.

Front 2

Placenta's role

Back 2

Syncytiotrophoblast produces mainly progesterone and estrogen.

Other hormones too.

Front 3

Fetus' role

Back 3

HPA develops in the fetus that influences fetal adrenals and fetal testes (in the male)

Fetal adrenals don't need to prod steroids essential for normal pregnancy.

Front 4

Three stages of pregnancy and parturition

Back 4

Implantation and establishment of pregnancy
Maint of pregnancy
Parturition (the process of giving birth)

Front 5

What hormones prepare uterus for implantation?

Back 5

Estrogen and progesterone.

Front 6

Blastocyst secretes...

Back 6

estrogen and human chorionic gonadotropin (hCG)

Front 7

Corpus luteum

Back 7

Forms from ruptured follicle after ovulation.

Produces progesterone to maintain uterine endometrium.

hCG secreted by implanting blastocyst maintains the CL.

Front 8

CL can be removed as early as...

Back 8

28 days after last period without certain abortion.

but usually it is main progesterone producer until week 7 (placenta takes over after that)

Front 9

Women who previously had a preterm birth

Back 9

Giving extra progesterone to them will decrease the chance of that happening again.

Front 10

Progesterone synthesis

Back 10

LDL chol. passes into placental syncytiotrophoblast.

Cholesterol is liberated which serves as a precursor for progesterone.

In late preg - small amt of it converted from maternal prognenolone.

Front 11

Where does placental progesterone go?

Back 11

85% to mom. Rest to fetus.

Front 12

Effects of progesterone on endometrium

Back 12

Increased secretory activity.
Preparation for implantation
Decidual rxn (cellular/vasc cahnges in endometrium at time of implantation)
supp of PG synthesis.

Front 13

progesterone effect on myometrium

Back 13

decrease in contractility
decrease in uterine irritability
facil relaxation and dilation of uterus letting it stretch.

Front 14

Estrogen synth

Back 14

Complex. Good summ on pg 3 of notes.

Front 15

Estrogen and blood flow

Back 15

increases blood flow to organs (incl uterus)

Front 16

Effects of estrogen on uterus in general

Back 16

generally opposite of progesterone

Front 17

Effects of estrogen on endometrium

Back 17

inc in tissue edema
inc in plasma vol
hypertrophy
hyperplasia
increase in PG synth

Front 18

Effects of estrogen on myometrium

Back 18

destabilization
inc contractility
inc in # of oxytocin receptors.

Front 19

hCG structure

Back 19

Similar to LH - alpha is identical, beta subunit is different.

Front 20

Serum levels of hCG

Back 20

increase to 10th week of preg then drop.

Front 21

role of hCG

Back 21

maintains corpus luteum,

stimulates fetal adrenal and aids its steroidgenic function.

promotes androgen production by the fetal testis

Front 22

high levels of hCG associated with..

Back 22

multiple pregnancy

Front 23

low rise in hCG suggests...

Back 23

ectopic preg or spont abortion.

Front 24

Human placental lactogen struct and levels

Back 24

similar to prolactin

Appears early in first trimester, increases steadily until 36th week.

Front 25

High levels of hPL found in...

Back 25

multiple preg.

Front 26

Function of hPL

Back 26

glucose metab.

with low maternal gluc - increase in placental hpl leading to increase in lipolysis and ketone production.

But ketons move freely to fetus and can cause fetal brain damage.

hPL antagonizes effects of insulin and can thus exagg diabetic disorders in late preg.

Front 27

2 Placental hormones

Back 27

human chorionic thyrotropin (hct) - similar to pituitary TSH

placental chorionic adrenocorticotropic hormone (placental ACTH)

Front 28

Hypothalamic release hormones of the placenta

Back 28

GnRH and TRH - produced locally by the placenta.

Front 29

Endorphins made by the placenta

Back 29

beta endorphin and beta lipotropin.

Front 30

PG effect on myometriumn

Back 30

PGE2 and PGF2alpha are the main ones.

Stimulate contractility.

They increase myometrial muscle tone and increase cyclic uterine contractions.

Augment uterine responsiveness to oxytocin

Play a role in cervical ripening and init of labor.

Front 31

Effect of PGs on fetus

Back 31

Changes intermittent breathing pattern to contin breathing.

Vasodilation and dilation of pulm vasc bed.

Induces cervical ripening.

Prevents closure of the ductus arteriosus. (and inhibitors induce early closure)

Front 32

Clinical uses of PGs

Back 32

Induce mid-trimester abortion.
Induce labor in case of fetal demise
Induce cervical ripening
PG inhibitors during pregnancy SHUOLD NOT BE USED because it can close ductus arteriosus.

Front 33

Substances that increase uterine irritability and contractility during parturition

Back 33

Estrogen, oxytocin, PGF2alpha

Front 34

Substances that decreased uterine irrit

Back 34

Progesterone and relaxin.

Front 35

Cervical ripening

Back 35

Must be done prior to labor.

Breakdown of collagen surrounding the cervical muscle and replacing it with hyaluronic acid and water.

Front 36

Hormones responsible for cervical ripening

Back 36

PGE2 - produced by extraembryonic membranes (amnion and chorion)

relaxin

Front 37

Molecular mech of contractions of labor

Back 37

From muscular action of myometrium

Liberation of Ca++ --> phos of myosin light chain by MLC kinase --> formation of phosphorylated-actomyosin accompanied by conversion of ATP to ADP.

Front 38

Gap junctions

Back 38

Contractions develop over the length of the uterus due to them.

Absent in preg until term.

Estrogen and PGs stimulate their formation. Progesterone inhibits their formation. Oxytocin has no effect on them.

Front 39

PGs - molecular mechanism of them to cause contraction

Back 39

inhibit the atp-dependent sequestration of ca++ and this increases cytosolic ca++ and thus causes contractions.

They also increase gap junctions in the myometrium and help ripen the cervix.

Front 40

Progesterone withdrawal

Back 40

Hypothesis of labor induction

Not true bc labor will commence prior to progesterone drop. But elev progesterone will maintain pregnancy

Front 41

oxytocin

Back 41

Hypothesis of labor induction

Stimulation near term can induce uterine contractions. But this isn't the first natural event stimulating labor onset.

Front 42

Protaglandins increase

Back 42

Hypothesis of labor induction

PG prod by extraembryonic membranes (amnion and chorion) and by uterine tissue surrounding the chorion.

Rupture of fetal membranes which increases PGs in amniotic fluid can promote onset of labor.

Front 43

Cortisol and CRH release

Back 43

Hypothesis of labor induction

Most favored hypothesis.

CRH produced by placenta at term. It leads to an increase in fetal adrenal DHEA-sulfate which moves to the placenta and is converted to estrogen.

This increases the estrogen/progesterone ratio and destabilizes the myometrium.

CRH also increases fetal cortisol and thus increases placental CRH (positive feedback)

CRH may facilitate cervical ripening and contractile response to oxytocin.

Cortisol may have direct effects on fetal lung maturation.

Front 44

Quad screen

Back 44

Offered during second trimester at 15-22 weeks.

Alpha fetoprotein
hCG
estriol
dimeric inhibin A (DIA)

Front 45

Down's will have the following lab results

Back 45

Low estriol, high DIA, high HCG, low AFP

Front 46

Neural tube defect will have the following results...

Back 46

high AFP

Front 47

2 components of placenta

Back 47

syncytiotrophoblast - single cell with many nuclei
cytotrophoblast - many cells

Front 48

LH and FSH spike

Back 48

PLan to have sex around this time.

It is immediately before ovulation.

Front 49

Hcg examples

Mrs. Q has quantitative hCGs drawn every other day starting at week 4 from LMP. She has values of (mIU):

Back 49

30, 60, 150, 400 - normal
30, 120, 390, 900 - normal
30, 33, 38, 31 - might be a miscarriage of ectopic
30, 31, 200 - worry about ectopic
hCG of 25,000 with no intrauterine sac - molar pregnancy where there is tons of abnormal placental tissue.

Front 50

hcg increase

Back 50

should inc by at least 66% every 48 hours in first 7-8 weeks of preg.

Front 51

RU486

Back 51

A progesterone inhibitor to terminate pregnancies

You must ripen the cervix first with prostaglandins

Front 52

Uterus relationship with the cervix

Back 52

"uterus is a bag of relaxed SM cells closed by a ring of cervix. at term, you want it to be connected SM cells that can open up the cervix."