Repro 13 - Pregnancy Part 3

Question 1

What is the time required to be infertile?

Answer 1

No pregnancy after 12 months of trying. Treatment can be started at 6 months if older than 35.

Question 2

What are the four general causes of 90% of infertility?

Answer 2

Anovulation (PCOS). Female anatomic defects (congenital defects or tubal scarring). Sperm abnormalities. Cervical factors.

Question 3

What are four possible treatments of infertility?

Answer 3

Ovulation induction (clomiphene, metformin in PCOS). Intrauterine insemination (IUI). In vitro fertilization (IVF). Intra-cytoplasmic sperm injection (ICSI).

Question 4

What are the five categories of OB Safe Medication?

Answer 4

Category A: Safety established in human studies. B: Presumed safety based on animal studies. C: No human or anima studies show an adverse effect/uncertain safety. D: Human risk, but benefit may outweight risk. X: Contraindicated, risk clearly outweights benefit.

Question 5

What are three medications that can be used to treat Hypertension in pregnancy?

Answer 5

Hydralazine. Methyldopa. Labetalol.

Question 6

What is the gold standard medication can be used to treat Diabetes in pregnancy?

Answer 6

Insulin.

Question 7

What medications can be used to treat Epilepsy in pregnancy?

Answer 7

Any antiepileptic that best controls patient’s seizure. However, avoid valproic acid. Supplement w/ increased folic acid.

Question 8

What medications can be used to treat Hypethyroidism in pregnancy?

Answer 8

Propylthiouracil (1st trimester). Methimazole (2nd and 3rd trimester).

Question 9

What two anticoagulant agents can be used in pregnancy?

Answer 9

Heparin. Enoxaparin (Lovenox). Avoid warfarin (Coumadin) because it causes birth defects.

Question 10

What is Tocolysis?

Answer 10

Trying to stop labor.

Question 11

What are the physiologic changes in the uterus to prepare it for uniform contractions during labor?

Answer 11

During pregnancy, the uterus is quiescent because of inhibitors (progesterone, prostacyclin (PGI2). Uterus becomes activated by estrogen and other markers; this leads to increase in receptors for stimulatory prostaglandins (PGE2, PGF2alpha) and oxytocin and also increase the formation of gap junctions.

Question 12

What are some tocolytics?

Answer 12

Indomethacin. Nifedipine. Terbutaline. Magnesium sulfate.

Question 13

Why is Nifedipine a tocolytic?

Answer 13

Calcium channel blocker. Decreases intracellular Ca2+ leading to myometrial relaxation. Calcium is needed for uterine contraction.

Question 14

Why is Terbutaline a tocolytic?

Answer 14

It is a beta-adrenergic receptor agonist. It binds beta2 receptors on uterus, causing myometrial relaxation.

Question 15

What are two prostaglandins used to promote uterine contraction?

Answer 15

Dinoprostone (PGE2 analog). Misoprostol (PGE1 analog). It is off label but they are used mainstream because they cause cervical dilation and contractions.

Question 16

What is the contraindication of using prostaglandins to cause uterine contractions?

Answer 16

If the mother has had scarring in the uterus, it can cause uterine rupture.

Question 17

What are the side effects of prostaglandin use to promote uterine contractions?

Answer 17

Tachysystole. Uterine rupture. Fever. Vomiting. Diarrhea.

Question 18

What medication can we use for medical abortion?

Answer 18

Mifepristone (RU-486) + misoprostol. It is approved up to 49 days of pregnancy.

Question 19

What is the mechanism of action of Mifepristone (RU-486).

Answer 19

It is a synthetic steroid: a competitive inhibitor at progesterone receptors (progesterone is a our pro-gestational hormone; if we lose the progesterone stimulation, the pregnancy is lost).

Question 20

What teratogenic effect might ACE inhibitors have?

Answer 20

Renal malformation.

Question 21

What teratogenic effect might aminoglycosides have?

Answer 21

Ototoxicity.

Question 22

What teratogenic effect might Fluoroquinolones have?

Answer 22

Cartilage damage.

Question 23

What teratogenic effect might Tetracyclines have?

Answer 23

Discolored teeth.

Question 24

What teratogenic effect might Chloramphenicol have?

Answer 24

Gray baby syndrome.

Question 25

What teratogenic effect might Valproic acid have?

Answer 25

Neural tube defects.

Question 26

What teratogenic effect might Lithium have?

Answer 26

Ebstein anomaly.

Question 27

What teratogenic effect might Isotretinoin (vitamin A derivative) have?

Answer 27

Spontaneous abortion. Birth defects.

Question 28

What teratogenic effect might Diethylstilbestrol (DES) have?

Answer 28

Vaginal clear cell adenocarcinoma. Mullerian anomalies.

Question 29

What teratogenic effect might Statins have?

Answer 29

CNS and limb abnormalities.

Question 30

What teratogenic effect might Thalidomide have?

Answer 30

Limb defects.

Question 31

A patient comes in w/ her husband for the eval of infertility. She has regular cyclic menses. She has a history of PID that was treated. Semen analysis within normal limits. What diagnostic study should be performed?

Answer 31

Hysterosalpingogram: evaluates the patency of the fallopian tubes.