Fertility & Reproduction Flashcards
(33 cards)
What is the most common identifiable abnormality associated with infertility in men?
Varicocele
(Present in ~ 16% of men, but 40% of those with primary infertility and 80% of those with secondary infertility)
Which 2 supplements are the only routinely recommended supplements in otherwise healthy pregnancies?
Vitamin D (400 IU / 10 mcg) and Folic Acid (0.4mg as standard, 5mg if high risk)
Which are the only evidence based complimentary interventions for N&V in pregnancy?
Ginger
Acupressure
Acupuncture
At what time during the pregnancy does contracting rubella infection confer the greatest risk of congenital rubella syndrome?
< 11 weeks - 90% will be adversely affected
(infection > 20 weeks unlikely to affect baby)
What are the symptoms of congenital rubella syndrome
Congenital deafness
Microcephaly
IUGR
Congenital cataracts / retinopathy/ glaucoma
Heart defects
What tests make up the combined screening test for Down’s, Edward’s and Pateau and what is the latest gestation that it can be tested for?
Nuchal translucency on USS
HCG
PAPP-A
Can be performed between 10 - 14 weeks gestations
What is considered a ‘high’ and ‘low’ risk result on the combined screening?
High risk = between 1 in 2 to 1 in 150
Low risk = 1 in 151 or higher
What is the quadruple screening test and when can it be performed?
Quadruple screening test screens oNLY for Down’s and can be done if combined screening is missed.
Quadruple screening = 14 - 20 weeks
= HCG, inhibin A, unconjugated oestriol and alpha fetoprotein
What is the typical presentation of intrahepatic cholestasis of pregnancy and what management options are available?
Intrahepatic cholestasis of pregnancy is due to elevated bile acids from the liver - normally occurs in the 3rd trimester
Causes diffuse itch, often affecting palms of hands, often worse at night but no rash (other than perhaps excoriation marks)
Mild ICP no increased risk of stillbirth
Moderate ICP increased risk of stillbirth after 38 weeks
Severe ICP significantly increased risk of stillbirth
Management
Topical emollients with menthol
Loose clothing
Ursodeoxycholic acid (slightly reduces itching and reduces the risk of premature delivery but doesn’t reduce stillbirth risk)
Should have LFTs and bile levels checked at 6 week postnatal check and check that itching resolved - if remain abnormal, refer to liver specialist
What are the first line anti-hypertensives for hypertension in the postpartum period if the woman if breast-feeding
1st line = Enalapril
(unless black in which case 1st line is Nifedipine, or Amlodipine if previously had good BP control with this)
Which anti-hypertensive, commonly used in pregnancy, should be stopped within 2 days of giving birth due to the increased risk of postpartum depression?
Methyldopa
What percentage of pregnancies in the uK are affected by gestational diabetes?
5%
What are the rules for missed COCP pills according to FSRH
Extending HFI (9+ completed days since last pill was taken) = emergency contraception if UPSI in the HFI, extra precautions needed for 7/7
Consider F/U pregnancy test
< 72 hours since last active pill taken (at any time during the pack, providing that Day 1 pill was taken on time after the HFI) = no extra precautions needed, take the last missed pill ASAP
> 72 hours since last active pill taken (2+ pills missed)
- If in week 1, needs emergency contraception if UPSI in the HFI or in week 1 and additional precautions for 7 days
- If in week 2 or 3 - EC NOT needed, need extra precautions for 7 days and if in week 3, skip the HFI
If 7 pills missed at any point in the pack, consider PT and EC. Can consider quick starting the pill again with F/U PT in 21 days
When is postnatal depression most likely to occur after delivery?
In the first 5 weeks postpartum is the highest risk time
What is the first line laxative for idiopathic constipation in pregnancy?
A bulk-forming laxative is 1st line in pregnancy e.g Ispaghula Husk
If doesn’t work then add-in an osmotic laxative e.g macrogol
What are the diagnostic values for GDM for fasting glucose and post glucose challenge?
Fasting blood glucose - 5.6 mmol+
2-hr glucose - 7.8 mmol+
For how long should patients with antiphospholipid patients take 75mg OD aspirin and 40mg OD enoxaprin?
From first positive pregnancy test to 34 weeks gestation
Which women are recommended to take 75-150mg aspirin daily from 12 weeks until term to reduce their risk of pre-eclampsia?
1 HIGH risk factor (Type I or Type II DM, HTN disorder in previous pregnancy, CKD, chronic hypertension, SLE, antiphospholipid syndrome)
or
2+ MODERATE risk factors (nulliparity, interpregnancy interval of 10+ years, age > 40, BMI > 35, family history of pre-eclampsia, multiple pregnancy)
NOTE ASPIRIN DOES NOT HAVE A LICENCE FOR THIS USE IN REDUCING PRE-ECLAMPSIA RISK THEREFORE PHARMACIES CANNOT LEGALLY SUPPLY IT WITHOUT IT BEING PRESCRIBED
For women with clinical suspicion of pre-eclampsia, urine dipstick should be checked for proteinuria, if protein 1+ on dipstick either protein: creatinine ratio (P:Cr) or albumin:creatinine ratio is recommended to quantify the proteinuria. Which values of P:Cr / A:Cr are diagnostic of significant proteinuria?
A:Cr 8 mg/mmol+
or
P:Cr of 30 mg/mmol+
Which antihypertensives have EVIDENCE to suggest they increase the risk of congenital malformations?
ACEi / ARB
Thiazide diuretics
What are 1st, 2nd and 3rd line treatments for hypertension in pregnancy and what is the target BP?
Target = 135 / 85
1st line = Labetalol
2nd line = Nifedipine
3rd line = Methyldopa
What test is available to help you diagnose pre-eclampsia in a woman with pre-existent chronic hypertension?
Placental growth factor (can be tested between 20 - 37 weeks)
What value is considered ‘severe’ hypertension in pregnancy above which the woman should be admitted for close BP monitoring?
Above 160/110mmHg
For women with pre-eclampsia who are treated with antihypertensives postnatally, when should you consider reducing their antihypertensive regime?
Consider if BP < 140 / 90 and definitely reduce once BP < 130/80
