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Placentation and lactation

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What role does aldosterone play in maintaining blood pressure?

Promoting the retention of sodium

What is the consequence of aldosterone deficiency in CAH?

Life-threatening dehydration

Which hormone deficiency can result in symptoms like weakness, fatigue, and nausea?

Cortisol

What consequences can excessive androgens have in CAH?

Early growth spurt and short stature in adulthood

In CAH, what is the most common form that affects cortisol and aldosterone production?

Involving enzyme deficiencies in adrenal hormone synthesis

Which enzyme is essential for cortisol and aldosterone synthesis in 17-Alpha Hydroxylase Deficiency CAH?

17-alpha hydroxylase

Which gene mutation is responsible for causing 11-Beta Hydroxylase Deficiency CAH?

CYP11B1

What is a common symptom seen in individuals affected by 3-Beta-Hydroxysteroid Dehydrogenase Deficiency CAH?

Ambiguous genitalia

Which type of CAH is associated with reduced libido and erectile dysfunction in adolescents and adults?

17-Alpha Hydroxylase Deficiency CAH

Which enzyme deficiency leads to increased cortisol precursors and the accumulation of 11-deoxycorticosterone (DOC) in 11-Beta Hydroxylase Deficiency CAH?

11-beta hydroxylase

Which hormone produced by the placenta is responsible for the preparation of the mother's body for lactation and contributing to the growth and development of the fetus?

Estrogen

Which hormone aids in loosening the ligaments around the pelvis, facilitating childbirth during delivery?

Relaxin

During early pregnancy, which hormone is responsible for maintaining the corpus luteum and producing essential progesterone for pregnancy maintenance?

Human Chorionic Gonadotropin (hCG)

What is the role of uterine secretions in the earliest stages of life?

Nourishing the embryo and supporting its development

How is the production of uterine milk and uterine secretions regulated?

By both the oviduct and the uterus

Why is uterine milk considered essential for the growth and development of the embryo?

To support implantation and embryo growth

What is the role of oxytocin during implantation?

Maintaining proper uterine contractions

Which hormone is responsible for inhibiting uterine contractions during implantation?

Progesterone

What are common signs of successful implantation?

Light implantation bleeding and mild uterine contractions

When does the zona pellucida degenerate?

implantation (day 6)

Which of the following correctly matches blood supply to the endometrial layers?

functionalis layer: spiral arteries, basalts arteries: straight arteries

What role does the decidua basalis primarily play in pregnancy?

Immune and hormonal functions

During early pregnancy, which type of decidua thickens to prepare for implantation?

Decidua vera

What is the significance of the decidua parietalis in pregnancy?

Providing structural support to the uterus

Which trimesters are crucial for the decidua in maintaining a healthy pregnancy?

Second and third trimesters

What distinguishes decidua vera from decidua basalis and decidua parietalis?

Temporary presence only during early pregnancy

What is the primary role of trophoblast invasion in the intermediate trophoblastic phase of pregnancy?

Development of the placental villi for nutrient exchange

During which phase of fetal nutrition does the trophoblast invasion and consumption of the uterine decidua significantly contribute?

Second trimester

What is the key function of the placental villi in pregnancy?

Exchange of nutrients and waste products between the mother and the fetus

What is the primary function of syncytiotrophoblast cells in pregnancy?

Replacing shed syncytiotrophoblast cells to maintain placental function

What is the significance of trophoblast differentiation from cytotrophoblast to syncytiotrophoblast cells?

Maintaining the placenta's function throughout pregnancy

How do trophoblast cells contribute to immune tolerance during pregnancy?

Expressing inhibitory immune checkpoint molecules like PD-L1

What can abnormally high levels of hCG during pregnancy indicate?

Molar pregnancy

How do low hCG levels in early pregnancy potentially signal a problem?

Signal an ectopic pregnancy

In terms of doubling patterns, when do hCG levels typically begin to slow down during early pregnancy?

Around the 8th week

Which of the following could lead to higher than normal hCG?

All of the above

What is a potential limitation of using methotrexate for treating ectopic pregnancy?

Risk of side effects like bone marrow suppression

In what scenario would laparoscopic surgery be preferred over methotrexate for treating ectopic pregnancy?

When the ectopic pregnancy is too advanced

What makes laparoscopic surgery more invasive compared to methotrexate for treating ectopic pregnancy?

Requires general anesthesia

What is one of the most common ultrasound findings in molar pregnancies?

Empty fetal sac

What is a classic sign of a hydatidiform mole on ultrasound imaging?

Cluster of hyperechoic areas resembling grapes

What is the primary purpose of surgical removal in the management of hydatidiform moles?

Addressing complications and potential risks

What is a unique characteristic of choriocarcinoma related to metastases?

Displaying as round masses known as cannonball metastases

How can choriocarcinoma metastases affect the lung's surface?

Manifest as round masses called cannonball metastases

What can cause cannonball metastases in choriocarcinoma?

Invasion of blood vessels

Which symptom of ectopic pregnancy can be indicative of low blood pressure due to internal bleeding?

Lightheadedness

What imaging technique is commonly used to visualize the location of an ectopic pregnancy?

Transvaginal ultrasound

Which treatment option for ectopic pregnancies involves dissolving tissue and preventing further bleeding?

Methotrexate

What is a potential risk of ectopic pregnancy related to damage to the fallopian tubes?

Reduced fertility

How can the risk of ectopic pregnancy be reduced through preventive measures?

Regular sexual health check-ups

A 25-year-old woman (AFAB) presents for evaluation of amenorrhea. She has not had a menstrual period for 2 months. On physical examination, her uterus is enlarged. Serum levels of human chorionic gonadotropin are elevated. This hormone most likely derives from which of the following locations?

syntiotrophoblast

What is one of the primary roles of amniotic fluid in fetal development?

Promoting fetal movement and positioning

How does the composition of amniotic fluid change during pregnancy?

It adapts to the fetus' needs by constantly changing

Why is monitoring the volume and composition of amniotic fluid important during pregnancy?

To identify potential issues like low or excess amniotic fluid

What is the primary function of the chorionic membrane in protecting the developing fetus?

Shielding the fetus from the immune system

Which hormone is primarily secreted by the chorionic membrane to maintain the early stages of pregnancy?

Progesterone

How do chorionic villi contribute to the establishment of the placental connection between the mother and the fetus?

By increasing nutrient exchange efficiency

What is a potential complication often seen in monochorionic diamniotic (MCDA) twins?

Preterm birth

Why is close monitoring crucial in monochorionic monoamniotic (MoMA) twin pregnancies?

To reduce the risk of cord entanglement

What distinguishes dichorionic diamniotic (DCDA) twins from MCDA twins?

Lower risk of preterm birth

Which complication is commonly associated with monochorionic twins but not dichorionic twins?

TTTS

Why is delivery often performed by cesarean section in monochorionic twins?

To reduce the risk of umbilical cord compression

How does hPL contribute to fetal growth and development?

By promoting fetal growth directly affecting fetal tissues

What is one of the implications of hPL-induced insulin resistance in the mother?

Increasing the risk of gestational diabetes

Which factor influences the regulation of hPL secretion in addition to placental and maternal hormones?

Fetal growth and development

What role does human chorionic gonadotropin (hCG) play during the luteal-placental transition in pregnancy?

Stimulates corpus luteum growth

Which hormone undergoes a reduction during the luteal-placental transition as the placenta takes over its production?

Progesterone

What is the significance of the luteal-placental transition for successful pregnancy continuation?

Supports embryo development

How does progesterone (P4) contribute to maintaining a safe environment for the growing fetus?

By inhibiting the production of pro-inflammatory cytokines

Which of the following statements about progesterone (P4) during pregnancy is true?

It suppresses natural killer cell activity

In the context of pregnancy, what is a key role of maintaining immune tolerance between the mother and the fetus?

Preventing rejection of the fetus by the mother's immune system

How does progesterone (P4) aid in minimizing the risk of preterm labor?

By inhibiting uterine contractility

What is the effect of progesterone (P4) on endometrial decidualization in pregnancy?

It promotes endometrial decidualization

Which phenomenon describes the mother's immune system becoming less responsive to foreign antigens during pregnancy?

Immunologic tolerance

What is the primary role of the placenta in promoting an immune-tolerant environment during pregnancy?

Secreting anti-inflammatory factors

How do maternal B-cells contribute to the maternal immune system during pregnancy?

Producing antibodies specific to fetal antigens

What is the main method used to diagnose preeclampsia?

Blood pressure readings and protein in urine analysis

Which complication of preeclampsia is characterized by seizures and coma?

Eclampsia

What can occur if the placenta detaches from the uterine wall prematurely?

Placental abruption

What is a key factor contributing to the development of preeclampsia as described in the text?

Endothelial dysfunction

Which aspect is essential for early detection of preeclampsia according to the information provided?

Blood pressure monitoring

How does oxidative stress contribute to the development of preeclampsia based on the text?

By causing damage to blood vessels

What is a key consideration for deciding when to proceed with delivery for women with HELLP syndrome?

The mother's condition worsens or complications arise.

What is a critical aspect of emergency management for HELLP syndrome regarding blood products?

Transfusing platelets and fresh-frozen plasma to correct coagulopathy.

Which of the following is NOT a part of the emergency management strategy for HELLP syndrome according to the text?

Close monitoring of maternal health only.

Why is pre-conception counseling recommended for women at risk of PAS?

To weigh the risks and benefits of pregnancy

What is a potential consequence of severe PAS?

Chronic pain and long-term sequelae

Why is emergency preparedness important in cases of severe PAS?

To minimize risks for both mother and baby

Which factor significantly increases the risk of abruptio placentae in pregnant women over the age of 35?

Advanced maternal age

How can placental abnormalities contribute to the development of abruptio placentae?

By affecting placental function and blood flow

Which condition is commonly associated with an increased risk of abruptio placentae due to its effect on blood pressure and blood flow?

High blood pressure

What is the most common symptom of placenta previa, often leading to the diagnosis?

Painless vaginal bleeding

Which is a key aspect of placenta previa management according to the text?

Regular ultrasounds and non-stress tests

Why is a C-section delivery often necessary in cases of placenta previa?

To prevent complications during delivery

Where is milk synthesized and stored within the mammary gland?

Alveoli

Which component of the mammary gland is responsible for carrying milk from the alveoli to the nipple?

Ducts

What is the main function of lobules in the mammary gland?

Synthesize and store milk

Which part of the mammary gland forms a honeycomb-like structure in breast tissue?

Alveoli

What is the role of collecting ducts in the mammary gland?

Bring milk from alveoli to lactiferous sinuses

Match the following placental hormones with their role in breast development

estrogen = milk duct growth Progesterone = alveoli and lobe growth; Inhibits milk production during pregnancy Human placental lactogen = Produced by syncytiotrophoblast; Augments growth of breasts, nipples, and areolae -- = --

Match the following hormones with their role in the negative feedback on GnRH:

Prolactin = Suppresses LH secretion Estrogen = Inhibits prolactin release Progesterone = Inhibits prolactin release Dopamine = Regulates prolactin secretion

Match the hormone with its effect on the suppression of FSH secretion:

Prolactin = Suppresses FSH secretion Estrogen = Can inhibit prolactin release Progesterone = Can inhibit prolactin release Dopamine = Regulates prolactin secretion

Match the hormone/chemical with its role in prolactin regulation in females:

Dopamine = Primary regulator of prolactin secretion CRH = Stimulates prolactin secretion TSH = Can inhibit prolactin release Thyroid-stimulating hormone = Can inhibit prolactin release

Match the following terms with their descriptions:

Milk ejection reflex = Coordinated series of events transferring milk from alveoli to milk ducts Oxytocin release = Produced in hypothalamus, released into bloodstream by nipple stimulation during breastfeeding Effects of oxytocin on breast tissue = Promotes growth of milk-producing glands, facilitates myoepithelial cell contraction Oxytocin and bonding with the baby = Influences bond between mother and baby beyond fostering social connections

Match the following scenarios with their effects on oxytocin production:

Stress during breastfeeding = Negatively impacts oxytocin production and milk ejection reflex Skin-to-skin contact with baby = Promotes oxytocin release and enhances bonding Breastfeeding difficulties = May hinder oxytocin release and affect milk flow Regular breastfeeding schedule = Helps maintain oxytocin levels for efficient milk ejection

Match the following statements with their relation to breast milk production:

Oxytocin contraction of myoepithelial cells = Essential for efficient milk removal during breastfeeding Oxytocin effect on lactating breast = Prompts smooth muscle contractions facilitating milk ejection reflex Breastfeeding frequency and oxytocin release = Linked to maintaining adequate milk supply for the baby Oxytocin's role in breast development = Promotes growth and development of milk-producing glands ensuring sufficient milk supply

Match the following effects of oxytocin with their descriptions:

Fostering social bonds = Encouraging the formation of emotional connections based on trust and empathy Regulating anxiety = Having a calming effect on the nervous system, reducing stress and anxiety Supporting childbirth = Playing a pivotal role in the process of giving birth Enhancing sexual activity = Helping couples deepen their relationship and enjoy more satisfying sexual encounters

Match the following benefits of oxytocin with their implications:

Building and maintaining relationships effectively = Helping individuals with social anxiety connect better with others Treating PTSD and depression = Showing promise in improving emotional well-being and mental health Improving overall emotional well-being = Suggesting potential help for individuals struggling with mental health or social connections Reducing stress and anxiety = Indicating exciting possibilities for managing mental health issues

Match the following oxytocin effects with their significance:

Deepening relationships = Enhancing emotional connections based on trust and empathy Improving social connections = Supporting individuals who struggle with building and maintaining relationships Alleviating PTSD and depression symptoms = Showing promise in enhancing emotional well-being and mental health Regulating anxiety and stress = Offering potential help to those facing social or mental health challenges

Study Notes

Congenital Adrenal Hyperplasia: A Deep Dive into Genetics, Hormones, and Their Impact

Congenital Adrenal Hyperplasia, or CAH, is a genetic disorder that affects the adrenal glands, which play a vital role in producing essential hormones. Despite its name, this condition is not exclusively hyperactive but rather a result of enzyme deficiencies, primarily impacting the production of cortisol and, to a lesser extent, aldosterone. Regardless, understanding the genetics, hormones involved, and their interconnected roles provides a clearer perspective on this complex disorder.

Genetics

CAH is caused by mutations in genes responsible for producing enzymes involved in the synthesis of adrenal hormones. The most common form of CAH is due to deficiencies in the 21-hydroxylase enzyme, which affects approximately 90-95% of cases. Other, less common forms include deficiencies in 11-beta hydroxylase, 17-alpha hydroxylase, and 3-beta hydroxysteroid dehydrogenase type 2.

The responsible genes, CYP21A2 for 21-hydroxylase, CYP11B1 for 11-beta hydroxylase, and CYP17A1 for 17-alpha hydroxylase, are all part of the steroidogenic acute regulatory (STAR) protein-dependent pathway. Mutations in these genes result in a multitude of potential defects and severities, from classical CAH to non-classical CAH.

Mineralocorticoids

Aldosterone, a mineralocorticoid hormone, helps regulate water and electrolyte balance. It maintains blood pressure by promoting the retention of sodium and the excretion of potassium. In CAH, aldosterone deficiency can lead to a condition called salt-wasting crisis, characterized by life-threatening dehydration and electrolyte imbalances.

Glucocorticoids

Cortisol, the primary glucocorticoid hormone, plays a fundamental role in stress management, maintaining blood sugar levels, and regulating immune responses. Cortisol deficiency can result in adrenal insufficiency, causing symptoms such as low blood sugar, weakness, fatigue, and nausea.

Androgens

CAH leads to overproduction of androgens, such as testosterone, which contribute to the development of ambiguous genitalia in females and premature pubarche in both males and females. Excessive androgens can also result in an early growth spurt, accelerated bone maturation, and unnecessarily rapid closure of growth plates, potentially leading to short stature in adulthood.

In summary, CAH is a genetic disorder involving enzyme deficiencies in adrenal hormone synthesis. The most common form of CAH affects cortisol and aldosterone production, leading to mineralocorticoid and glucocorticoid deficiencies. Overproduction of androgens is another significant consequence of CAH, which can result in a broad range of symptoms. Understanding the complex interplay between genetics, hormones, and their roles in CAH helps medical professionals develop appropriate treatments and management strategies for affected individuals.

H Burkin Block 3 Week 7

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