OB Exam #1

Gravida: the ________ of _____________ a woman has had, regardless of outcome, including current.

number of pregnancies

Spermatogenesis = the process of sperm formation, begins during __________ (age 13) in males. It occurs in the seminiferous tubules of the ________. __________ is the replication of cells to keep the same number of chromosomes (46), then through the maturation process the cells undergo _________ with division to decrease the chromosomal number from diploid (46 chromosomes) to haploid (23 chromosomes). The final product is 4 mature, motile sperm - either 22X or 22Y. During ejaculation, 40-250 million sperm are released and usually only survive 24 hrs (although may survive up to 5 days).

puberty testes Mitosis meiosis

Gametogenesis = formation of male or female germ cells (gametes) called _______ or _______

sperm or ovum

SAB

spontaneous abortion (miscarriage)

Antepartum: _______ of pregnancy

term

Secretory Phase (Days __-__) -"__________ ________ ___ _____________"

15-25 Perfect Time for Pregnancy

Abortion: Pregnancy delivered between conception and ____ weeks gestation

20

Preterm: Pregnancy delivered between ____ & ____ weeks gestation

20 & 37

Ischemia Phase (Days __-__) "____________ _________"

26-28 Endometrium Receeds

Neonate: refers to a newborn baby during the first _____ days of life

28 days

Average length of menstruation cycle = _____ days (____-____ range)

28 days 25-32 range

Term: Pregnancy delivered between ____ & ____ weeks gestation

37 & 42

51 years - 13 years = ___ years of reproductive life.

38 years

Average duration of flow = ____ days (____-____ range)

5 days 2-8 range

Average blood loss = ____mL (____-____ range)

50mL 20-80mL range

Proliferative Phase (Days __-__) -"__________ __________"

6-14 Develop Follicles

Postpartum: refers to the ___th week period of time after childbirth when a women's body is returning to its non-pregnant physiology state

6th week

AMNIOTIC FLUID pH = _____-_____, slightly _________, so it turns nitrazine paper _______

7.0-7.25 alkaline blue

AMNIOTIC FLUID Amount = 1. Normal at 40 wks gestation (term) ______-______mL 2. Oligohydramnios <_____% expected amount 3. Hydramnios (polyhydramnios) >________mL

700-800mL <50% >2,000mL

Amnion = __________ Membrane (closest to baby), and two membranes are partially fused 1. Thin, tough, translucent, avascular membrane which is filled with amniotic fluid. The amnion covers the chorion on the fetal side of the placenta, and covers the umbilical cord.

Inner

Last 14 Days = __________ Phase _______________ is the dominant hormone.

Luteal Phase Progesterone

Other multiple gestations: triplets, quadruplets, etc. May be a combination of _____________ and ____________.

Monozygotic and Dizygotic

_________ = a solid ball of 12-16 cells by about day 3 after conception

Morula

Nulligravida

Never been pregnant

Nullipara

None delivered at viability

DIZYGOTIC TWINS = Twins are __________. May be same or opposite ________. 1. Always two ______, two _____, and two ______________ 2. Multiple ___________ (resulting in dizygotic twins) is an autosomal recessive trait, so it tends to repeat in families. 3. There are two implantations, two placentas (which may fuse), two chorions (may fuse), two amnions.

fraternal sex ovum, sperm, fertilizations ovulation

The Graafian follicle becomes a ________ __________ which produces both __________ and ______________ until the placenta is established to do so.

corpus luteum estrogen and progesterone

Oogensis = the process of egg (ova) formation in the female begins in ______ ______. The female has all her ova by ____ weeks gestation as a fetus. The first meiotic divisions are complete starting at ________ with one primary oocyte maturing _________. This is when ovulation occurs, usually day ____ of a 28 day cycle, and releases the ovum. It cannot move by itself, but is carried along by cilia which line the _________ toward the uterus. The ovum may only survive 24 hrs after its release at ovulation. The ruptured follicle (that contained the maturing ovum) is called the _______ ________, and it secretes ___________ and ______________ to maintain pregnancy until the placenta is established.

fetal life 30 weeks puberty monthly 14 fallopian tube corpus luteum estrogen and progesterone

First day of menstrual bleeding is designated as day _____ of cycle.

1

Infant: refers to a baby from _____ month to _____ year

1 month to 1 year

Menstrual Phase (Days __-__) -"____________ ____________"

1-5 Shedding Endometrium

Single Gene Disorders: 1. Autosomal dominant (_______________ _________ - adult onset, neurodegenerative) 2. Autosomal recessive (_______ _____ _______, & _______ ________) 3. X-Linked (____________, _________ ________ ________, & ____________ ____)

1. Huntington's Disease 2. Sickle Cell Disease & Cystic Fibrosis 3. Colorblindness, Duchenne Muscular Dystrophy, & Hemophilia A

Chromosonal Abnormalities: 1. Numerical Abnormalities (most common - ________ ___/_________ ___________) 2. Structural Abnormalities (________ ___ _________)

1. Trisomy 21/Down's Syndrome 2. Fragile X Syndrome

Luteinizing Hormone peaks ___-___hrs BEFORE ovulation

10-12hrs

Ovulation occurs on day ____ of a 28-day cycle, or ____ days BEFORE next menstruation.

14 14

UMBILICAL CORD (well established by __-__ wks) 1. Extends from the umbilicus to placenta and is slightly longer than baby -Less than ____cm is considered abnormally short; minimal cord length for vaginal delivery is ____cm 2. Contains ____ vessels; ___ arteries that carry ______________ blood from baby to placenta; and ____ vein which carries _____________ blood from placenta to baby 3. Contains no ________ receptors 4. _________ _______: soft substance that cushions the entire cord and prevents kinking or obstruction. It has a high water content causing the cord to shrink after birth. It also contains protaglandins which have a vasoconstriction effect after the cord is cut. 5. ________ _______ in the cord (as opposed to kinks or folds) are life-threatening to the fetus

8-9 wks 30cm 32cm 3 2 deoxygenated 1 oxygenated pain Wharton's Jelly True Knot

AMNIOTIC FLUID Composition = (___-___% Water) 1. Early in gestation, composition is the same as the baby's ___________ 2. Fetus breathes fluid in and out of lungs, so amniotic fluid contains _________ and ___________ which are present in fetal lung field 3. Fetus urinates in-utero, so amniotic fluid contains ______, __________, _________, etc. 4. Other: skin cells, lanugo, vernix, albumin, leukocytes, glucose, electrolytes, and hormones.

98-99% water serum lecithin and sphingomyelin urea, creatinine, bilirubin

AMNIOTIC FLUID Diagnostic Testing = _______________ 1. ________ studies may be done on cells in the amniotic fluid 2. L/S ratio may be performed to determine fetal ______ ___________

Amniocentesis Genetic lung maturity

___________ Fluid: Protects the growing fetus and promotes normal prenatal development

Amniotic

___________ = the cells continue to divide and then divides into two distinct layers 1. The inner cell mass (embryoblast) becomes the _________ and the _________. 2. The outer cell mass (trophoblast) develops the ________ and ______ ___________.

Blastocyst embryo and fetus placenta and fetal membranes

___________ = "born with"; acquired in-utero

Congenital

AMNIOTIC FLUID Purpose = 1. __________ the baby to protect it 2. Maintains a stable ______________ 3. Allows freedom of __________ for musculoskeletal development 4. Source of oral _______ for baby 5. Prevent the membranes from _________ to the developing fetal parts

Cushions temperature movement fluids adhering

_____ = the building blocks of genes and chromosomes

DNA

During menstruation, the CNS sends a message to the hypothalamus that _____________ levels are low.

Estrogen

MENARCHE = Onset of ________ menstruation 1. Usually occurs around age ____yrs (range 8-16yrs) 2. For 1+ yrs, cycles are irregular, unpredictable, painless, and ________________

First 12.5yrs Anovulatory

Primigravida

First/One pregnancy

The ovary responds to the FSH by selecting a ___________ for maturation. The chosen follicle that begins to mature is called the ____________ follicle.

Follicle Graafian Follicle

The anterior pituitary responds by sending ___________ _______________ ____________ (___) and then _______________ ____________ (__) to the ovary.

Follicle Stimulating Hormone (FSH) Luteinizing Hormone (LH)

First 14 Days = ______________ Phase (pre-ovulatory) ____________ is the dominant hormone.

Follicular Phase Estrogen

The hypothalamus responds by sending ______________-___________ __________ to the Anterior Pituitary.

Gonadotropin-Releasing Hormone

Complete OB History includes (in order) _________ _________ __________ _________ ___________

Gravida Term Preterm Abortion Living

Short OB History includes __________ and ___________

Gravida and Para

GYN = ____________: referring to _________/__________

Gynecology woman/female

Genetic information is stored on chromosomes in the cell ___________. Chromosomes contain thousands of genes lined up in a specific pattern. All normal body cells contain ___ chromosomes (___ matched pairs). ___ autosomes and __ pair of sex chromosomes (___ = female; ___ = male)

Nucleus 46 chromosomes 23 matched pairs 22 autosomes 1 pair of sex chromosomes XX = female XY = male

OB = ______________: health care of a women _________ pregnancy, childbirth, and postpartum

Obstetrics during

Primipara

One delivered at viability

MENOPAUSE = Menstruation has ceased for at least ___ year. 1. Usually occurs around age _____ 2. ___________________: The period of time just before and after menopause when hormone transitions are occurring

One year 51 Perimenopause

Chorion = _________ Membrane 1. One portion of the chorion covers the placenta on the fetal side and contains the umbilical vessels that branch out over the surface of the placenta 2. The other portion surrounds the amnion and is smooth with no blood vessels

Outer

Primary hormone which maintains pregnancy = ______________ (prevents ____________)

Progesterone (prevents contractions)

TRANSFER: 1. Gas Exchange - oxygen and carbon dioxide diffuse across the membrane. ____________ is one of the key functions of the placenta. Fetal blood gas levels are different than an adult. Oxygen levels are ________, but fetal hemoglobin is usually at a ________ level than an adult and it binds oxygen more readily to aid with oxygen transfer. This allows the fetus to survive in the lower oxygen state. 2. Nutrition - Water, proteins, carbs, fats, vitamins, minerals, electrolytes, pass from maternal to fetal blood. ________ is the major energy source for fetal growth and metabolic activities. 3. Waste Removal - Besides the removal of carbon dioxide, other metabolic waste products leave the fetal blood and enter maternal blood for disposal 4. Antibody Transfer - Immunoglobin G (IgG) provides passive (temporary) protection against some diseases. Transfer occurs primarily in the last ____wks of pregnancy. Preterm and small for gestational age babies are at a higher risk

Respiration lower higher Glucose 4 wks

______ Cells = obtained from the embryoblast

Stem Cells

ENVIRONMENTAL DISORDERS -___________ - anything that adversely affects the fetus -Causative agents: maternal infection, drugs, pollutants, radiation

Teratogens

Multipara

Two or More delivered at viability

Multigravida

Two or More pregnancies

Conception = the union of a single egg and sperm forming a ____________

Zygote

Fertilization = when sperm enter ovum 1. Fertilization usually takes place in the _________ of the fallopian tube (closer to the ovary). 2. When a sperm enter the ovum a ______ _________ occurs, which changes the zona pellucida surrounding the ovum and prevents other sperm from entering. 3. The nucleus of the sperm containing 23 chromosomes merges with the nucleus of the ovum also containing 23 chromosomes. This restores the diploid number to ____ chromosomes. Through this process the DNA of the chromosomes combine, forming the new person. *Conception, the formation of a zygote, is now _____________. 4. The combination of the female 22X with a male 22Y = a ______ baby & the combination of the female 22X with a male 22X = a ______ baby 5. The fertilized ovum (zygote) travels to the uterus in ___-___ days, while cell division is rapidly occurring

ampula zona reaction 46 chromosomes complete male female 3-4 days

IMPLANTATION: 1. The endometrium (lining of the uterus) is now called the ________ and is in the __________ phase of the reproductive cycle. This provides the richest environment for implantation. 2. The blastocyst goes through a gradual process of implantation between days ___-___ 3. Most implantation occurs in the ______ or top of the uterus. The trophoblast cells secrete enzymes which lyse endometrial cells and erode maternal blood vessels to create lacunae (small blood lakes) which provide nutrition and oxygen for the blastocyst. 4. Implantation __________ may occur resulting in some spotting. 5. Fingerlike vascular projections called _______ _____ develop out of the trophoblast and extend into the endometrium (decidua). They form the ______ portion of the placenta, and fetal blood circulates through them, allowing for exchange of oxygen/carbon dioxide, nutrient, and wastes. 6. Throughout this process, the embryo continues to develop. 7. Implantation should occur in the uterus, resulting in a ______________ pregnancy. If implantation occurs outside the uterus, such as the fallopian tube or abdomen, it is called an ______________ (__________) pregnancy, and is ____-viable

decidua secretory 6-10 fundus bleeding chorionic villi fetal intrauterine pregnancy extrauterine (ectopic) pregnancy non-viable

Para: the number of pregnancies ___________ at viability, regardless of whether the baby lives or dies

delivered

PLACENTA: sustain pregnancy and permit normal prenatal development 1. Shape/Size - large in comparison to fetus ________ in development, but by the end of full-term pregnancy the placenta is <__lb, about ___in in diameter, and ___in thick -Maternal portion is ______ where it attaches to the uterus -Fetal portion is ________ vessels covering the membrane covered surface 2. Function - Metabolic: -The placenta is an organ, and produces some nutrients needed by the embryo and for the functions of the placenta -Effective function depends on adequate __________ ____________ -Adequate perfusion depends on ... *Maternal ____; avoid hypertension and hypotension *Avoid strenuous ___________ which diverts blood away from uterus to muscles *Maternal position; avoid _________ position which compresses vena cava *Uterine Tone: excessive contractions curtail flow of maternal blood, decreasing _____ and _________ to baby *Healthy placental tissue: an aging placenta begins to ___________ *_____________ contractions can cause problems

early 1lb 6in 1in rough smooth maternal circulation BP exercise supine O2 and nutrients calcify Premature

EAB/TAB

elective/therapeutic abortion

High levels of ________ and _____________ are present. If conception does not occur, levels of both gradually __________ as the corpus luteum disintegrates. When estrogen levels are low again, ____________ begins and the cycle repeats.

estrogen and progesterone decrease menstruation

MULTIFACTORAL DISORDERS -Interactions between ________ susceptibility and ______________ -Present and detectable at _________ -Examples: ______ defects, _______ _____ defects, ______ ____/______

genetic and environment birth heart defects, neural tube defects, cleft lip/palate

MONOZYGOTIC TWINS = Twins are ___________ twins, and are always the same _______. 1. Always one ________, one _______, and one _______________ 2. They may divide very early, resulting in 2 separate implantations, placentas, membranes 3. They may divide later so that there is one implantation, one fused placenta, and one chorion with separate amnions 4. They may divide even later, so that both babies are inside the same ___________ _______

identical sex ovum, sperm, fertilization amniotic sac

If conception occurs: 1. Levels of estrogen and progesterone _____________ 2. CNS sends message to hypothalamus that estrogen levels are _______ 3. Hypothalamus stops sending ____________-____________ ____________ to the anterior pituitary 4. Anterior Pituitary stops sending _____ and ___ to the ovary 5. There is no ____________ selected for ripening 6. Menstrual period stop and ________ levels of estrogen and progesterone throughout pregnancy prevent menstruation from occurring

increase high Gonadotropin-Releasing Hormone FSH and LH follicle high

Intrapartum: term for __________ and __________

labor and childbirth

AMNIOTIC FLUID Color = -Normal - clear or pale straw color -Green = __________ present (babies 1st bowel movement)

meconium

Luteinizing Hormone stimulates the follicle to release the _________, and _______________ occurs.

ovum ovulation

Mittelschmerz = mid-cycle _______ associated with ovulation

pain

Gestation: length of ____________ from the first day of the last menstrual period (LMP) to delivery = ____ wks

pregnancy 40 weeks

Menstruation: periodic __________ bleeding that begins approximately ____ days after ovulation

uterine 14 days