REPRODUCTIVE SYSTEM

Physiological causes of amenorrhea

Menopause, Pregnancy, Breastfeeding

Causes of infertility in women

Endometriosis, Hx of salpingitis, androgen insensitivity, cushing’s syndrome. Prolactinoma
Polycystic ovarian syndrome

Changes in pregnancy
CVS: hypervolemia ( increase plasma and RBC vol) – physiological anemia
Respi: compensatory increase chest circumference (AP and transverse) due to decrease lung length
Renal: increase in Renal Plasma Flow and GFR
GI: hyperinsulinemia, heart burn( increase intragastric pressure) , nausea vomiting

DM in pregnancy
Placental lactogen alter maternal glucose metabolism and lipolysis  glucose load
hyperinsulinemia peripheral insulin receptor resistance decrease maternal glucose utilization
divert glucose to fetus (big baby)

Why kaussmaul breathing

Increase lipolysis  increase ketone bodies  diabetic ketoacidosis
Arteriolosclerosis and glycosylation of Basement Membrane ( renal function fail)
Hyperventilation to compensate for metabolic acidosis

Basis of Pregnancy test

Human ChorionicGonadotrophin to confirm pregnancy
As HCG elevated during pregnancy

Screening Test
VDRL venereal disease research lab aka cardiolipin
Rapid Plasma Reagin Test RPR
Confirmatory Test
TPHA treponema pallidum hemagglutinin test
Florescence Treponema Antibody Absorption Test

What causes ovarian maturation : FSH, produce by anterior pituitary

Late menarche: 16 – 18 yo
Causes: weight, malnutrition, background illness, genetics

Fecundity: biological ability to have kids

Fertility: actual childbearing, measured by crude birth rate, and total fertility rate

Physiology of menopause
Ovary less responsive to Gonatrophin LH and FSH. Estrogen production decrease, subsequent ovarian
cycle become anovulatory. Period become irregular eventually, ovulation and menses will cease,
normally occur
Menopause – 12 months or longer cessation of menstruation and is associated with decrease
hormonal production.
Phases of changes during the Climateric
phase I: Hypthalamic pituitary hyperactivity. Increase follicular resistant to gonadotrophin
Phase II: ovulation and CL failure  DUB
Phase II: ovarian follicular failure  inadequate estrodiol secretion  menses cease

Androgen Insensitivity Syndrome 46 XY

LH activate Leydig Cell secrete testosterone

Sertoli cell has androgen receptors and supports spermatogenesis. FSH bind to Sertoli cells to facilitate
spermatogenesis.

Estrogen on (proliferative stage)

Cervical mucus : thin, clear, hi spinnbarkeit, ferning effect
Vaginal mucosa: increase mitotic activity in the columnar epi of vagina  cornified

Sexual differentiation on embryo

3rd month

Role of MIH and androgen in sexual differentiation

Fetal testes secrete
1. MIH: Mullerian inhibiting Substance secrete by sertoli cell to inhibit mullerian system
(paramesonephric)
2. Androgen: formation of male external genitalia
a. Testosterone – induce the retention of Wolffian system ( Mesonephric system)
b. Dihydrotestosterone- 4mation of male external genitalia

Basis of Sperm Analysis

morphology, pH, mobility, number

Menstrual History
Menarche, when’s your last time, Cycle, Regular, How heavy, clots

Why measure temp before ovulation

To determine ovulation timing for natural family planning

Testosterone excreted as 17 ketosteroid T

DHT more potent than Testosterone T
DHT form fr aromatization F ( 5 alpha reductase)
Theca androgen are aromatized to form estrogen under aromatase in granulose cells

VDRL: test for Cardiolipin antibodies

Syphillis: effect: still birth,

GSC: Gonorrhea, Streptococcus, Chlamydia will cause
Opthalmia neonatorum

Why no rubella vaccine to mother.

Rubella is a live vaccine. May pass the disease to fetus. Congenital Rubella Syndrome
Patent ductus arteriosus
How fetus affected
Malnutrition : Fe, folate (spina bifida)
Tetratogenic: Drugs, Anti mitotic drugs ( cancer therapy), ectrodactyly (phenytoin)
Lifestyle: alcohol, smoking

Complete hydratidiform mole

Diploid, absent of organs

Incomplete hydratidiform
Triploid, present of organ

If leave the mole alone become choriocarcinoma ( complete more predominant)

4 layers of placental ( fr out to in)

Amnion
Chorionic placenta
Chorion
Basalic placenta
Decidual Basalis

Fetal HR: 120-160

Breast feeding
Advantage to baby: Immunity, nutrition, closer bonding to mom, mother passes normal flora
Advantage to mother: Involution of uterus, contraception, regain pre pregnancy wt faster. Postpartum
hemorrhage, economic

Acute mastitis : staph aureus,

Route of entry: thru cracks and fissure of the nipple

These 2 factors affecting baby

Smoking: refer respi
Alcohol: Tetralogy of Fallot

Cervical cancer
By HPV 16, 18, 31, 33
Condylomata acuminatum
Risk factor: Early first sex, multiple sexual partner, unprotected sex
Dyskaryosis
Abnormal maturation seen in exfoliated cell
Normal cytoplasm but hyperchromatic nuclei
Irregular chromatic distribution
Maybe followed by malignant neoplasm

Breast: AJC
Cervix : FIGO
Hodgkin’s : Ann arbor
Normal flora of vagina
Ecoli, Gp B streptococcus, Staphy, clostridium
Digest the glucose to lactic acid. Keep vagina in acidic condition.
Will the normal flora be affected? Yes I think

Complication:
Ureter involvement ( obstruction, hydroureter, hydronephrosis)
Uremia
Pain in the lumbosacral plexus
Goss edema of the legs ( vascular and lymphatic stasis)
Haemorrhage

2 support of uterus
Round ligament and broad ligament

Polycystic ovarian syndrome (PCOS)

Raised androgen : hirsutism
Decrease FSH/ increase LH
Ratio FSH:LH 1:3
Norm PRL
Multiple
Why test prolactin and androgen : to exclude the cause becos prolactin can inhibit the release of
estrogen and progesterone

In proliferative and secretory phase

Endometrium :
Cervical:

2 Protozoa causing STD trichomonia vaginalis, giardia lambia, entamoeba histolitica

Foul Smelling T vaginalis, fishy foul smelling

Endometriosis
Regurgitation, Metastatic thru coelemic cavity, Vascular dissemination