By Andrew Sokol MD, Eric Sokol MD
The standards in Obstetrics and Gynecology is a chain of volumes that provides a concise review of the sector of obstetrics and gynecology within the following components: excessive chance Obstetrics, common Gynecology, Gynecologic Oncology, and Reproductive Endocrinology and Infertility. every one quantity includes the center fabric that's primary to every zone and contains a presentation that enables the consumer to take in the knowledge speedy and carefully. This quantity is dedicated to normal Gynecology, which covers care of the feminine sufferer outdoor of being pregnant or throughout the preliminary weeks of being pregnant. issues comprise gynecologic imaging, kin making plans, congenital and developmental abnormalities, irregular uterine bleeding, and pelvic flooring issues.
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Extra resources for General Gynecology: The Requisites (Requisites in Ob Gyn)
6%). 7%), with virtually no change in the amount of free progesterone or progesterone bound to SHBG (Table 2-1). Androgens Estrogens Ovarian interstitial cells located in the stroma and hilus of the ovary secrete testosterone and androstenedione. The major pathway for androstenedione synthesis from cholesterol is through dehydroepiandrosterone, produced predominantly by the adrenal gland. 17-Hydroxyprogesterone can also act as a precursor for androstenedione, especially when this precursor is produced in excess as in the case of 21-hydroxylase deficiency, the most common form of congenital adrenal hyperplasia.
Levels of SHBG are increased by estrogens and thyroid hormones and decreased by androgens. 30 THE MENSTRUAL CYCLE The menstrual cycle is driven by pulsatile GnRH release from the hypothalamus and, in the absence of this pulse generator, the pituitary-ovarian axis remains dormant. Coordination of the hypothalamic-pituitaryovarian axis is via blood-borne signals, and the ovaries synchronize ovulation and the stimulatory and inhibitory feedback loops to the hypothalamus and pituitary. The duration of the menstrual cycle and the timing of ovulation appear to be determined by the ovary itself.
During each menstrual cycle, a cohort of many follicles begin their developmental course; however, typically all but one will undergo atresia via apoptotic programmed cell death. The number of follicles that begin growing in each cohort appears to be dependent on the size of the residual pool of inactive primordial follicles. Follicular development is characterized by an increase in the size of the oocyte, which becomes surrounded by a membrane called the zona pellucida. The granulosa cells surrounding the oocyte also proliferate and transition from squamous to cuboidal shaped.