CASES BLOCK 2.2
Growth and Development II
19 DECEMBER 2016
MARIEKE DE JONG
ITM
,Case 1: Look Before You Leap .................................................................................................................4
Anatomy of the Female Reproductive System ....................................................................................4
What is Preconceptional Advice? ........................................................................................................7
Getting Pregnant after Birth Control ...................................................................................................8
Ethics ....................................................................................................................................................8
Inheritance ...........................................................................................................................................8
Case 2: Overdue Again, Pregnant This Time ........................................................................................10
Embryonic Development ...................................................................................................................10
Pregnancy Diagnosis ..........................................................................................................................11
What To Do When You’re Pregnant? ................................................................................................11
Physiological Changes ........................................................................................................................11
Multiple Pregnancy ............................................................................................................................12
8 Week Ultrasound ............................................................................................................................12
Miscarriage ........................................................................................................................................13
Case 3: Is Everything Okay This Time? .................................................................................................14
Chromosomal Abnormalities .............................................................................................................14
Numerical Abnormalities ...............................................................................................................14
Structural Abnormalities ................................................................................................................14
Prenatal Testing for Chromosomal Abnormalities ............................................................................15
Down Syndrome ................................................................................................................................15
Ethical and Legal Aspects of Abortion ...............................................................................................16
United States of America ...............................................................................................................16
The Netherlands ............................................................................................................................16
United Kingdom .............................................................................................................................16
China ..............................................................................................................................................16
Case 4: Joys and Burdens ......................................................................................................................17
Physiological Changes in Pregnancy ..................................................................................................17
Reproductive Tract ........................................................................................................................17
Breasts ...........................................................................................................................................17
Skin .................................................................................................................................................17
Blood ..............................................................................................................................................17
Cardiovascular System ...................................................................................................................18
Respiratory System ........................................................................................................................18
Urinary System ...............................................................................................................................18
Gastrointestinal Tract ....................................................................................................................19
Musculoskeletal System ................................................................................................................19
1
, Nervous System .............................................................................................................................19
Metabolic Changes ............................................................................................................................19
Placental Circulation, Anatomy and Physiology. ...............................................................................20
Case 5: A Tender Abdomen ..................................................................................................................21
Preeclampsia ......................................................................................................................................21
HELLP Syndrome ................................................................................................................................22
Consequences for Mother .................................................................................................................22
Case 6: Giving Birth and Being Born .....................................................................................................23
Stages of Delivery ..............................................................................................................................23
Postpartum Complications ................................................................................................................25
Breast Anatomy and Lactation ..........................................................................................................25
Heel Prick ...........................................................................................................................................27
Case 7: Being Born: A Risky Start..........................................................................................................28
Complications ....................................................................................................................................28
Newborn Care ....................................................................................................................................29
Newborn Circulation ..........................................................................................................................30
Case 8: What is Normal? .......................................................................................................................32
Child Development ............................................................................................................................32
Special Education ...............................................................................................................................33
Case 9: Not Letting the Grass Grow Under their Feet .........................................................................34
Brain Development ............................................................................................................................34
Alcohol Use in Adolescents ............................................................................................................34
STDs....................................................................................................................................................35
Case 10: Prevention is Better than Cure ..............................................................................................36
HPV Virus ...........................................................................................................................................36
Pre-stages for HPV .............................................................................................................................36
Carcinogenic Stages ...........................................................................................................................36
Screening for HPV ..............................................................................................................................37
Prevention..........................................................................................................................................37
Case 11: Out of Control .........................................................................................................................38
Leukaemia ..........................................................................................................................................38
Oncogenes vs. Tumour Suppressor Genes ........................................................................................38
Hallmarks of Cancer ...........................................................................................................................39
Genomic Instability ............................................................................................................................39
Case 12: Status Matters ........................................................................................................................40
Breast Cancer .....................................................................................................................................40
2
, Types ..............................................................................................................................................40
Staging ...........................................................................................................................................40
Symptoms ......................................................................................................................................41
Treatment ......................................................................................................................................41
Pathogenesis ..................................................................................................................................42
Risk Factors ....................................................................................................................................42
Hereditary Cancers ............................................................................................................................42
Breast Cancer Screening ....................................................................................................................43
Case 13: It’s Coming Back .....................................................................................................................44
Pathological Background of Metastasis.............................................................................................44
Angiogenesis ..................................................................................................................................45
Imaging and Treatment .....................................................................................................................45
Bibliography ..........................................................................................................................................46
3
, Case 1: Look Before You Leap
Anatomy of the Female Reproductive System
The vulva describes the exterior female genitalia, including everything between the pubic symphysis
and perineal body. The pubic symphysis is covered by a collection of fat called the mons pubis. From
puberty, this is covered by the escutcheon (a downward facing triangle of pubic hair).
The labia majora are located laterally, close to the thighs. They contain fat, and the amount varies
between individuals. They are 7-8 cm long, 2-3 cm deep and 1-1.5 cm thick. They originate on the
mons pubis and merge over the perineal body to form the posterior commissure between the vagina
and the anus.
There is barely any muscle tissue in the labia majora. However, there is a lot of elastic and adipose
tissue, and it has many apocrine, eccrine and sebaceous glands.
The labia minora lie medially to the labia majora. Superiorly, they both split into two lamellae. The
lower lamellae form the frenulum of the clitoris, the upper form the prepuce. Posteriorly they join to
form the fourcette, which lies anteriorly to the posterior commissure.
The labia minora are richly innervated and vascularised. They have abundant elastin fibres. They
have no hair follicles, eccrine glands or apocrine glands, but they do have sebaceous glands.
The clitoris is located beneath the frenulum and prepuce. It is over 2 cm long and consists of a glans,
a corpus and two crura. The glans is most richly innervated.
The vestibule is an area between the labia minora. It is enclosed by the Hart line laterally, the
frenulum anteriorly and the fourcette posteriorly. It is pierced by the urethra, two Bartholin gland
ducts, two Skene gland ducts and the vagina. The Skene glands open next to the urethra, the
Bartholin glands lateroposteriorly to the vagina.
The part between the fourcette and vagina is the fossa navicularis. It is only found in nulliparous
women.
The Bartholin glands are also called the greater vestibular glands. The minor vestibular glands lie
along the Hart line. The urethral opening lies in the middle of the vestibule.
The hymen is a membrane that surrounds the vaginal opening. It can be torn many different ways,
not just through intercourse. Some women have a fully closed hymen, but even if it is not torn there
is mostly a gap, which has a great range in diameter.
Figure 1
4
Growth and Development II
19 DECEMBER 2016
MARIEKE DE JONG
ITM
,Case 1: Look Before You Leap .................................................................................................................4
Anatomy of the Female Reproductive System ....................................................................................4
What is Preconceptional Advice? ........................................................................................................7
Getting Pregnant after Birth Control ...................................................................................................8
Ethics ....................................................................................................................................................8
Inheritance ...........................................................................................................................................8
Case 2: Overdue Again, Pregnant This Time ........................................................................................10
Embryonic Development ...................................................................................................................10
Pregnancy Diagnosis ..........................................................................................................................11
What To Do When You’re Pregnant? ................................................................................................11
Physiological Changes ........................................................................................................................11
Multiple Pregnancy ............................................................................................................................12
8 Week Ultrasound ............................................................................................................................12
Miscarriage ........................................................................................................................................13
Case 3: Is Everything Okay This Time? .................................................................................................14
Chromosomal Abnormalities .............................................................................................................14
Numerical Abnormalities ...............................................................................................................14
Structural Abnormalities ................................................................................................................14
Prenatal Testing for Chromosomal Abnormalities ............................................................................15
Down Syndrome ................................................................................................................................15
Ethical and Legal Aspects of Abortion ...............................................................................................16
United States of America ...............................................................................................................16
The Netherlands ............................................................................................................................16
United Kingdom .............................................................................................................................16
China ..............................................................................................................................................16
Case 4: Joys and Burdens ......................................................................................................................17
Physiological Changes in Pregnancy ..................................................................................................17
Reproductive Tract ........................................................................................................................17
Breasts ...........................................................................................................................................17
Skin .................................................................................................................................................17
Blood ..............................................................................................................................................17
Cardiovascular System ...................................................................................................................18
Respiratory System ........................................................................................................................18
Urinary System ...............................................................................................................................18
Gastrointestinal Tract ....................................................................................................................19
Musculoskeletal System ................................................................................................................19
1
, Nervous System .............................................................................................................................19
Metabolic Changes ............................................................................................................................19
Placental Circulation, Anatomy and Physiology. ...............................................................................20
Case 5: A Tender Abdomen ..................................................................................................................21
Preeclampsia ......................................................................................................................................21
HELLP Syndrome ................................................................................................................................22
Consequences for Mother .................................................................................................................22
Case 6: Giving Birth and Being Born .....................................................................................................23
Stages of Delivery ..............................................................................................................................23
Postpartum Complications ................................................................................................................25
Breast Anatomy and Lactation ..........................................................................................................25
Heel Prick ...........................................................................................................................................27
Case 7: Being Born: A Risky Start..........................................................................................................28
Complications ....................................................................................................................................28
Newborn Care ....................................................................................................................................29
Newborn Circulation ..........................................................................................................................30
Case 8: What is Normal? .......................................................................................................................32
Child Development ............................................................................................................................32
Special Education ...............................................................................................................................33
Case 9: Not Letting the Grass Grow Under their Feet .........................................................................34
Brain Development ............................................................................................................................34
Alcohol Use in Adolescents ............................................................................................................34
STDs....................................................................................................................................................35
Case 10: Prevention is Better than Cure ..............................................................................................36
HPV Virus ...........................................................................................................................................36
Pre-stages for HPV .............................................................................................................................36
Carcinogenic Stages ...........................................................................................................................36
Screening for HPV ..............................................................................................................................37
Prevention..........................................................................................................................................37
Case 11: Out of Control .........................................................................................................................38
Leukaemia ..........................................................................................................................................38
Oncogenes vs. Tumour Suppressor Genes ........................................................................................38
Hallmarks of Cancer ...........................................................................................................................39
Genomic Instability ............................................................................................................................39
Case 12: Status Matters ........................................................................................................................40
Breast Cancer .....................................................................................................................................40
2
, Types ..............................................................................................................................................40
Staging ...........................................................................................................................................40
Symptoms ......................................................................................................................................41
Treatment ......................................................................................................................................41
Pathogenesis ..................................................................................................................................42
Risk Factors ....................................................................................................................................42
Hereditary Cancers ............................................................................................................................42
Breast Cancer Screening ....................................................................................................................43
Case 13: It’s Coming Back .....................................................................................................................44
Pathological Background of Metastasis.............................................................................................44
Angiogenesis ..................................................................................................................................45
Imaging and Treatment .....................................................................................................................45
Bibliography ..........................................................................................................................................46
3
, Case 1: Look Before You Leap
Anatomy of the Female Reproductive System
The vulva describes the exterior female genitalia, including everything between the pubic symphysis
and perineal body. The pubic symphysis is covered by a collection of fat called the mons pubis. From
puberty, this is covered by the escutcheon (a downward facing triangle of pubic hair).
The labia majora are located laterally, close to the thighs. They contain fat, and the amount varies
between individuals. They are 7-8 cm long, 2-3 cm deep and 1-1.5 cm thick. They originate on the
mons pubis and merge over the perineal body to form the posterior commissure between the vagina
and the anus.
There is barely any muscle tissue in the labia majora. However, there is a lot of elastic and adipose
tissue, and it has many apocrine, eccrine and sebaceous glands.
The labia minora lie medially to the labia majora. Superiorly, they both split into two lamellae. The
lower lamellae form the frenulum of the clitoris, the upper form the prepuce. Posteriorly they join to
form the fourcette, which lies anteriorly to the posterior commissure.
The labia minora are richly innervated and vascularised. They have abundant elastin fibres. They
have no hair follicles, eccrine glands or apocrine glands, but they do have sebaceous glands.
The clitoris is located beneath the frenulum and prepuce. It is over 2 cm long and consists of a glans,
a corpus and two crura. The glans is most richly innervated.
The vestibule is an area between the labia minora. It is enclosed by the Hart line laterally, the
frenulum anteriorly and the fourcette posteriorly. It is pierced by the urethra, two Bartholin gland
ducts, two Skene gland ducts and the vagina. The Skene glands open next to the urethra, the
Bartholin glands lateroposteriorly to the vagina.
The part between the fourcette and vagina is the fossa navicularis. It is only found in nulliparous
women.
The Bartholin glands are also called the greater vestibular glands. The minor vestibular glands lie
along the Hart line. The urethral opening lies in the middle of the vestibule.
The hymen is a membrane that surrounds the vaginal opening. It can be torn many different ways,
not just through intercourse. Some women have a fully closed hymen, but even if it is not torn there
is mostly a gap, which has a great range in diameter.
Figure 1
4
