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Reproductive Endocrinology

Twin to Twin Transfusion: same placenta, identical because stealing blood from each other;
monochorionic, mono amniotic.
-Estriol is made only by the LIVING fetus.
A wall between mom and the baby- cannot immunologically recognize the baby or else, the mom would
attack the baby and cross react with self, therefore the baby must come out stillborn because the
protective wall comes down within 24 hours die from heart failure.
-Autoimmune disease during pregancy is BETTER b/c the mom's immne system is shut down. The
exception is LUPUS.
-SGA hypertension- MCC- vasoconstriction. Symmetrical-chromosomal abnormalities = monosomy.
assymmetrical: HTN, head sparing, head circumferences is normal.
-LGA: diabetes, steroids, Cushings. IDM: infant of diabetic mom macrosomia mom's glucose
increases, but not the baby's insulin. Day #1: hypoglycemia due to transient hyperinsulinemia. Day#2:
Hypocalcemia- a vasculitis involving the parathyroid arteries. PTH decreases Ca and P increases
more likely to depolarizes. Tx. Day 1 and Day2 fluid. More distal places are affected by vasculitis
sacral agenesis= dimple in the lumbar area.
-Short left column syndrome: splenic flexture (watershed area) is ischemia constipation.
-Shoulder dystocia: middle 1/2 breaks. L side is asymmetrical, more reflex. Ortho consult. Examine not
to rip subclavian artttery before it clots off- or else you have to amputate the baby's arm- if bruit is
heard immediate vascular surgery.
-Cephalo pelvic disproportion: shoulder gets stuck C section or clavicle, Erbs, Klunky plasy
-Erb's paralysis: C5C6 nerve root; fully extended and internal rotation; waiter's tip; (peripheral nerves
regenerate 1mm/day); hemidiaphragmatic paralysis respiratory distress.
- Klumpke's Palsy: C8-T1; ulnar nerve is lesioned; median nerve still workds
Tx. Orthopedic consult, OT
@42 weeks pregnancy: Dry Wharton's Jelly: in umbilical cord cut off bloody supply; pineal gland
regulate this process.
E1: estrone
E2: estridiol
Precocious puberty: too early; 10 yo girls and 11 yo boys; due to either the hypothalamus or the ec