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Pregnant at Last, include, include, reveal, include, include, include,…

- - - - high LH/ low FSH #
        
        more androstenedione production by theca cells
        
        estrone
        
        low FSH
        
        anovulation
        
        follicular cysts
        
        low progesterone
        
        testosterone
        
        hirsutism/ acne #
  - - - grey white with smooth surface= anovulation
  - - - follicular atresia
      - increases storm with luteinized cells (hyperthecosis)
      - absent corpora kutea & corpora albicantiae
- - - - passive
        
        fetus not in direct contact with mother
        
        Layering of cells from fetal blood to maternal blood
        
        Action of extravillous and column cytotrophoblast
      - active
        
        trophoblast cells
        
        Fas ligand
        
        more HLA-G
        
        complement inhibition at placenta
        
        MCP,DAF,CD59
        
        C3b
        
        progression of alternative pathway
        
        T regulatory cells
        
        IDO expression by fetal and placental tissue
        
        inhibit cytotoxic T lymphocytes expansion
        
        decidual macrophages
        
        inhibitory macrophages
        
        apoptotic fetal cells
    - - first trimester
        
        Implantation is pro-inflammatory
      - second trimester
        
        Th2-type response
      - third trimester
        
        Th1-type response
        towards end
    - - progesterone
        
        Th1 response
  - - - Dilutional anemia
    - - Postpartum bleeding
    - - Mild Respiratory alkalosis
    - - due human placental lactogen
  - - - Materal components (1st trimester)
      - Fetal urine (after 1st trimester)
    - - Cushions the fetus
        
        Injury
      - Immunological protection
      - Fetal growth and development
    - - Water, electrolytes, urea, creatinine
- - - - posture of a fetus during labor
    - - Longitudinal
      - transverse
      - oblique
    - - cephalic presentation
      - Breech
      - shoulder
      - brow
      - face
  - - - the uterine muscles to contract
    - - increase intracellular calcium levels
        
        contraction of myometrial muscle
  - - - regular uterine contractions
      - complete cervical dilatation at 10 cm
      - latent phase
      - active phase
    - - complete cervical dilatation
      - delivery of the fetus
    - - period between delivery of fetus & delivery of placenta & fetal membranes
- - - - Uterine horn with labia majora
    - - Ovary to pelvic wall
    - - Uterus with pelvic wall
    - - Cervix to sacrum
  - - - Genital ridge
      - Coelomic epithelium
      - Primordial germ cells
    - - Paramesonephric duct
        
        Uterine tubes
        
        Uterus
        
        Superior 1/3 of vagina
      - Mesonephric duct
        
        Gartner's duct
    - - Genital tubercle
        
        Glans clitoris
      - Urethral folds
        
        Labia minora
      - Urogenital groove
        
        Vagina and vestibule
      - Labioscrotal swellings
        
        Labia majora
- - - - an Increase in GnRH frequency
        
        increase in FSH levels and estradiol
        
        negative feedback
    - - switch from negative to positive feedback
        
        increase frequency of GnRH
        
        LH surge
        
        follicular hypermia
        
        ovulation occur
    - - corpus luteum
        
        progesterone and some estradiol
        
        negative feedback
        
        decrease in progesterone #
        
        menstruation happens
  - - - endometrial proliferation takes place
        
        estrogen
    - - progesterone
        
        proliferation of endometrium
        
        vessels growth and coil arteries
        
        implantation
  - - - sperm binds to zona pellucida
        
        acrosomal enzyme
        
        penetrates zona pellucida
        
        membrane of the ovum
- - - - Pregnancy
      - Spironolactone
        
        blocking androgen receptor
        
        Side effects
        
        gynecomastia
        
        oligospermia
        
        decreased libido
      - Finasteride
        
        Inhibiting 5 alpha reductase
        
        Teratogenic
    - - Progesterone
        
        thickens cervical mucus
        
        Sperm transport
      - Estrogen
        
        suppressing LH
        
        Androgen production
        
        Increases production of SHBP
        
        Androgen excess
      - Side effects
        
        Irregular bleeding
        
        Increased risk of venous thromboembolism
  - - - antagonist of Estrogen receptor
        
        Inhibit negative feedback of estrogen on hypothalamus and pituitary
        
        Increase FSH\LH secretion
        
        Induce ovulation #
    - - Side effects
        
        Vitamin B12 deficiency
        
        GI disturbance
        
        Lactic acidosis
      - Insulin sensitizer
        
        Increase glucose uptake by tissues #
      - renal or hepatic diseases
- - - - Galactorrhea
      - Signs of androgen excess
      - Thyroid gland
      - Pelvic Exam
    - - Ovarian Reserve Assessment
        
        Day 3 FSH
        
        Anti-müllerian hormone
      - Structural Assessment
        
        Hysterosalpingo-contrast sonography
      - Serum progesterone level
    - - Sexual history
      - Past medical history
      - Menstrual history
- - - - 0 > to 1
        
        positive correlation
      - 0
        
        no correlation
      - -1 to < 0
        
        negative correlation