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UPNS 337 OB Exam #1 Study Guide part 1.
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OB Exam #1 Study Guide part 1. 1OB Exam #1
Assessment and Health Promotion (4 questions)
• Describe the menstrual cycle in relation to hormonal, ovarian, and endometrial responses.
o Menstrual cycle controlled by feedback of 3 following systems
o Hypothalamic-pituitary cycle
▪ Low estrogen and progesterone levels at end of cycle stimulate hypothalamus to release
Gonadotropin- releasing hormone (GnRH)
▪ GnRH stimulates anterior pituitary to secrete
▪ FSH - stimulates development of ovarian follicles and their production of estrogen
▪ LH – release of LH and small peak of estrogen (day 12) precede expulsion of ovum by
follicles, levels peak at day 13,14
• If no implantation, regression of corpus luteum = estrogen and progesterone decrease and
again stimulate hypothalamus to release GnRH
• Ovarian cycle
• Pre-ovulation phase
▪ Before ovulation, 1-30 follicles begin to mature under influence of FSH and estrogen
▪ Surge of LH affects selected follicle and oocyte matures, ovulation occurs, empty
follicle transforms into corpus luteum
• Ovulation Phase
▪ Estrogen levels decrease, 90% of women experience small amount of withdrawal bleeding
• Luteal Phase
▪ Begins immediately after ovulation, ends with start of period
▪ Corpus luteum reaches peak functioinality 8 days after ovulation – secreting estrogen and
progesterone
▪ Fertilized ovum implanted simultaneously as peak luteal functioning
• Endometrial cycle
• Menstrual phase
▪ Shedding of function 2/3 of endometrium initiated by vasoconstriction of upper layers
of endometrium
▪ Basal layer always retained
▪ Regeneration beings near end of cycle
• Proliferative phase
▪ Rapid growth from day 5 to ovulation
▪ Endometrial surface restored in about 4 days, then 8-10 fold thickening – levels off at ovulation
▪ Depends on estrogen stimulation from ovarian follicles
• Secretory phase
▪ From ovulation to 3 days before next period
▪ After ovulation, large amounts of progesterone produced
▪ Fully matured secretory endometrium reaches full thickness
• Ischemic phase
▪ Blood supply to functional endometrium is blocked, necrosis develops
▪ Functional lays separate from basal layer and period begins – marking day 1 of next cycle
• Review the four phases of the sexual response cycle.
• Excitement
• Heart rate and BP increase
• Nipples become erect
• Myotonia beings
• Plateau
• Heart rate and BP continue to increase
• Respirations increase
• Myotonia becomes pronounced
• Grimacing occurs
• Orgasmic
• HR, BP, respirations increase to max levels
• Involuntary muscle spasms occur
• External rectal sphincter contracts
• Resolution
• HR, BP, respirations return to normal
1
, 2
• Nipple erection subsides
• Myotonia subsides
• Outline health-screening and immunization recommendations for women across the life span.
• Preconception Counseling and care
• Pregnancy
• Well-woman care
• Fertility control and infertility
• Menstrual problems
• Perimenopause
Structural Disorders and Neoplasms of the Reproductive System (2 questions)
• Discuss the pathophysiology of selected benign and malignant neoplasms of the female reproductive tract.
o Benign Neoplasms
▪ Ovarian Cysts
▪ follicular, corpus luteum, theca-lutein, polycystic ovary syndrome, dermoid cysts,
ovarian fibromas
▪ dependent on hormonal influences associated with menstrual cycle
▪ Treatment
▪ Oral contraceptives – suppress ovulation
▪ Cystectomy
▪ Pain management
▪ Theca-lutein cysts treated conservatively – they usually regress – or by removal
of hydatidiform mole
▪ PCOS – lifestyle modifications, management of s/s - oral contraceptives,
GnRH, metformin, etc
▪ Fibromas and dermoid cysts removed
• Uterine polyps
• Endometrial or cervical in origin
• Tumors on pedicles arising from mucosa
• Rarely recur after removal
• Most common in multiparous women over 40
• Treatment
▪ Removal – can be done in MD office
• Leiomyomas
• Aka fibroid tumors, fibromas, myomas, fibromyomas
• Slow growing, benign tumors arising from muscle tissue of uterus
• Rarely become malignant
• Growth influenced by ovarian hormones
• Spontaneously shrink after menopause
• Most women asymptomatic
• Classified by location on uterine wall – subserous, intramural, submucosal,
cervic, pedunculated
• Medical management
▪ Medications – NSAIDs, oral contraceptives, GnRH agonists, Depo Shot, selective
estrogen receptor modulators
▪ uterine artery embolization – polyvinyl ETOH pellets injected into selected blood
vessels to block blood supply to fibroid = shrinkage and resolution os s/s
▪ can be done under local anesthesia and conscious sedation as outpatient
• Surgical management
• laser sx – electrocauterization, destroys small fibroids laparoscopically,
usually outpatient procedure
• myomectomy – removal of tumor if its on outer wall of uterus and symptoms
are significant, laparoscopically done during proliferative phase of cycle
• hysterectomy – treatment of choice if bleeding is severe or fibroid is obstructing
normal function of other organs
• Vulvar Problems
• Bartholin cysts
• Most common lesions of vulva (external genitalia structures)
• Cause by obstruction of Bartholin duct – enlarges
2
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