USMLE Step 1 Web Prep Female Reproductive System: Part 2

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PREGNANCY
Ovum Pick-up and Fe !i"i#a!ion Fertilization occurs in the upper end of the oviduct within $-%& 'ou ( af!e ovu"a!ion Low sperm counts ! 20 million"ml of e#aculate$ are associated with reduced fertilit% &'s: women to famil% doctor( with normal c%cle( 2 wee)s late menstruation( pre*nant+ how man% wee)s is pre*nant, - wee)s 2 wee)s of luteal and 2 wee)s of not menstruatin*$ &'s: %oun* couple( famil% doctor( una.le to pre*nant( sperm count should .e first chec)ed. Imp"an!a!ion /t the time of implantation0 which occurs a.out & da)( af!e fe !i"i#a!ion0 the ! op'o*"a(!ic cells of the fetus .e*in to secrete a peptide hormone into the maternal circulation0 human chorionic *onadotropin 'CG$ Fetal h12 possesses a - su.unit (imi"a to that of L+0 and therefore it has considera.le L3 activit% 4he presence of h12 in the urine can .e detected .% a variet% of 5 !e(! ki!(6 for the detection of pre*nanc% detected in the urine in 2 wee)s0 and in 1 wee)s in .lood screen$
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+o mona" ,ain!enance of !'e -!e ine Endome! ium

1 part( "u!ea" p'a(e lar*e pro*esterone and some estro*en estradiol that is comin* from ovar%( estro*en of menstrual c%cle$ luteal cell diminishes their response to L3( pro*esterone decreases af!e imp"an!a!ion: developin* fetus secretes h12( it stimulate luteal cells0 and then continue to secrete pro*esterone and estro*en estradiol from ovar%$. 2 part 7 ea ") p e.nanc)( first 2(3 months( estradiol. h12( re8uired to secrete pro*esterone and estro*en &'s: if %ou *ive .loc)er to h12 in earl% pre*nanc% 2-3months$( plasma pro*esterone decreases( a.ort development of fetus0 if in last 6 months of pre*nanc%( nothin*( .ecause luteal cells and this hormone not re8uired for the later part &'s: remove ovaries durin* 2-3 months: luteal cells produce pro*esterone0 no ovaries( pro*esterone decreases0 a.ort to develop fetus remove ovaries durin* last 6 months 7 %es0 placenta ta)es over production of secretion of pro*esterone and estro*en. 9ro*esterone secretion is .ased upon size and availa.ilit% of su.strate( uncontrolled( more su.strates and lar*er placenta( the *reater production of pro*esterone 3 part ( the "a(! / mon!'( of pre*nanc% Fetal 9ituitar% *land( fetal adrenal in size of )idne%$( lar*e amounts of andro*ens( ver% wea) and water(solu.le andro*ens0 even in female fetus creates no pro.lem with this andro*en :n most cases andro*en *oes to the liver and structures modified sli*htl%

( placenta andro*en$( aromatase of placenta e(! io"( since andro*en modified$( main estro*en of last 6 months of pre*nanc%(estriol. ;o placenta also secrete estradiol and estron0 .ut estriol( is dominate

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Pe ip'e a" effec!( of 'o mona" c'an.e(

4he estro*en and pro*esterone secreted .% the placenta durin* pre*nanc% stimulates the followin*: =assive *rowth of the uterus0 especiall% the m%ometrium :ncreased *rowth of all components *lands0 stroma0 and fat$ of the .reasts
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Addi!iona" +o mona" C'an.e(

:ncreased p o"ac!in secretion .% the pituitar% in response to e"eva!ed e(! o.en(. 2enerall%( estro*en stimulate release of prolactin not onl% durin* pre*nanc%$ ;ecretion of human chorionic somatomammotropin h1;$0 also referred to as human placental lacto*en h9L$0 .% the p"acen!a pronounced durin* the "a!!e 'a"f of the pre*nanc%$ 'CS 2'PL3 3as considera.le amino acid se8uence(homolo*% (imi"a $ with . o4!' 'o mone .ut has ver% little *rowth(stimulatin* activit% no ana.olic activit%$ 3as similar meta.olic actions ca!a*o"ic ac!ion((stress$ to *rowth hormone0 i.e.0 it increases maternal "ipo")(i( and )eto*enesis and dec ea(e( maternal ."uco(e u!i"i#a!ion0 there.% ma)in* maternal ener*% stores more availa.le for

the fetus more free fatt% acids and *lucose for fetus$ 3owever0 these an!i-in(u"in actions ma% also account for the 5.e(!a!iona" dia*e!e(6 that develops in some pre*nant women h1; is secreted proptionate to the size of the placenta and is an inde> of placental well(.ein*. E(! io" is an inde5 of fe!a" 4e""-*ein. secreted in the later part of pre*nanc%$

h1;( to suppl% su.strates in the later part of pre*nanc%. &'s: compare luteal phase and later part of pre*nanc%: *lucose tolerance test: in luteal phase and pre*nanc% h1; decreases *lucose upta)e .% peripheral tissues0 so tolerance test in the later part of pre*nanc%( .cz of anti(insulin effect higher plasma level of glucose than in the luteal phase and therefore0 greater insulin secretion durin* that test in the later part of pregnancy
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G ap'ica" Rep e(en!a!ion of +o mona" Leve"( Du in. P e.nanc)

pro*esterone and estro*en pro*ressivel% increase pea) of them (at term #ust .efore deliver$ h12( re8uired for earl% 3 months0 pea) in 3 months0 and then decreased .ut still secreted prolactin 9@L$( driven .% risin* estro*en0 so it's increased alon* pre*nanc% and has pea) at term as estro*en h1;( secreted in the later part of pre*nanc% anti(insulin$
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Fema"e Se5 S!e oid ,e!a*o"i(m and E5c e!ion

Astradiol can .e e>creted as a con#u*ate of estradiol0 .ut most is first converted to estrone or estriol 9ro*esterone is converted in the liver to pre*nanediol and is e>creted as pre*nanediol *lucuronide 4he amount of se> steroids in the urine can .e used to monitor the menstrual c%cle. For e>ample: Low pro*esterone meta.olites and low .ut slowl% risin* estro*en meta.olites characterize the earl% follicular phase Low pro*estone meta.olites and rapidl% risin* estro*en meta.olites characterize the latter part of the follicular phase #ust .efore ovulation Alevated levels of pro*esterone meta.olites characterize the luteal phase and pre*nanc%
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C'an.e( Induced Nea !'e End of P e.nanc)

4he pu.ic s%mph%sis0 cervi> and va*ina .ecome more distendi.le 4he peptide hormone0 e"a5in0 which is secreted .% the ovar% also promotes these chan*es :n response to elevated plasma estro*ens0 o>%tocin receptors appeared in the later part of pre*nanc%$ increase in the m%ometrium Bvaries( not re8uired in last 6 months0 so rela>in is not re8uired for deliver%

Pa !u i!ion
/lthou*h o>%tocin can .e administered to induce uterine contractions once o>%tocin receptors appeared$0 .ut a rise in plasma o>%tocin is not the natural si*nal that induces la.or natural is un)nown$
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LAC7A7ION
=ammar% *land *rowth and secretion is influenced .% most hormones 2rowth of mammar% tissue is stimulated .% the female se> steroids0 e(! o.en and p o.e(!e one. 3owever0 for these steroids to stimulate ma>imum *rowth0 p o"ac!in0 *rowth hormone0 and cortisol must .e present Durin* pre*nanc%0 the hi*h levels of plasma estro*en *reatl% increase prolactin secretion .ut mil) s%nthesis does not occur .ecause the hi*h level of estro*en and pro*esterone$ .loc) mil) s%nthesis /t parturition0 plasma estro*en drops lose placenta$0 withdrawin* the .loc) on mil) s%nthesis. /s a result0 the num.er of prolactin receptors in mammar% tissue increases several fold and mil) s%nthesis .e*ins &'s: after deliver%0 what initiates mil) s%nthesis,( drop in estro*en. ;uc)lin* is re8uired to maintain mil) s%nthesis0 otherwise prolactin level decreases to the prepre*nanc% level
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Ne4 c)c"e 4he len*th of the follicular phase tends to .e more varia.le than the len*th of the luteal phase Bnce ovulation has occurred0 menses *enerall% follows in a.out 1- da%s 4he len*th of the menstrual c%cle in da%s minus 1- *ives the most li)el% da% of

ovulation E(! o.en 7e mino"o.) Astro*en 4erminolo*% Astro*en: / *eneric term 1< Astradiol: =a#or hormone secreted .% the ovarian follicle. Astrone Astriol: =a#or estro*en secreted .% the placenta. 9otenc%: Astradiol > estrone > estriol
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Suck"in. i( e9ui ed !o main!ain "ac!a!ion

;uc)lin*( causes stimulation of neuron receptors in the nipple0 does not cause ne*ative pressure :ncrease afferent activit% to the 1E;: 1. post pituitar% ( o>%tocin ( deliver to the .reast( contraction of m%oepithelial cell( mil) e#ection( ne vou(-'o mona" ef"e5 fast refle>$ 2. decrease in release prolactin( inhi.itin* factor form h%pothalamus( continur prolactin secretion 3. decrease of 2n@3 from h%pothalamus( decrease F;3 and L3 ( woman should not has menstrual c%cle as lon* new.orn is suc)lin* and lactation ta)es place( in most individuals it ta)es ?(1- wee)s. :t's not a *ood method of .irth control