Repro Flashcards
(176 cards)
1
Q
what is an ovulation
A
ovaries don’t release an oocyte during a menstrual cycle
2
Q
menstruation phase when
prolif phase when what is secreted
secretory phase when what is secreted
when is the max reception ability for blastocyte
A
d1-4
d4-14 oestrogen
d14-28 progesterone
secretory phase
3
Q
HCG during pregnancy pattern
HCS during preg pattern
A
increased peaks then falls
increases from week 5 (not right from beginning tho)
4
Q
IVF conditions
A
unexplained infertility > 2years pelvic disease anovulatory infertility other pre implantation genetic disease male factor infertility >1x106 motile sperm
5
Q
steps of IVF
A
down regulation with synthetic GnRH analogue baseline scan ovarian stimulation GnRH with LH or FSH action scan sperm sample oocyte collection embryologist transfer
6
Q
risks of buseralin
A
hot flushes
mood swings
nasal irritation
headaches
7
Q
treatment for OHSS
A
before transfer - coasting, stop GNT, freeze, single embryo transfer
after transfer - moniter, anti thrombin, analgesia, admite
8
Q
ART before treatment for females
A
alcohol down to 4 units/ week weight 19-29 stop smoking FA 0.4g/day cervical smear, rubella immunity, Hep B and C, HIV, assess ovarian reserve
9
Q
IUI
A
increase the number of sperm reaching the fallopian tube
unexplained infertility, mild/mod endometriosis, mild male factor infertility
10
Q
ICSI
A
severe male infertility, prev failed IVF, preimplantation genetic disease
11
Q
Aspiration
A
azoospermia
sperm aspirated surgically then ICSI
95% success rate of obtaining sperm if obstructive - epididymis
50% in non
12
Q
obstructive causes of male infertility
non obstructive
A
CF vasectomy, infection
crytochordism, mumps, orchis, chemo/radio, tumours, klinfelters, semen abnormality, systemic, endocrine
13
Q
donor insemination
A
azoospermia or very low sperm count
genetic/infective disease
14
Q
crytochordism treatment
A
<14s orchidopexy
adults orchidectomy
15
Q
androgen insensitivity syndrome
A
46XY
primary amen. lack of pubic hair
no uterus no ovaries, short vagina
16
Q
klinfelters
A
47XXY
gynacamastia, infertility, decreased facial and body hair, small testes
testosterone replacement therapy
17
Q
liomyoma
A
can increased in response to oestrogen (pregnancy)
commoner in afrocarribean populations
18
Q
liomyosarcoma
A
spindle cell morphology
aggressive tumour
surgical resection
19
Q
endometritis
A
cervical mucous plug protects endometrium from ascending infection and so does cyclic shedding
20
Q
chronic plasmocytic endometrium
A
associated with PID
21
Q
adenomyosis
A
endometrial glands and stroma within the myometrium
mennorhagia/dysmennorhea
22
Q
anovulatory causes of DUB
ovulatory
A
obese. extremes of repro life. PCOS, thyroid, prolactin, irregular cycle
35-45, regular heavy periods, inadequate progesterone production, abnormal follicles
23
Q
treatment of DUB
A
progesterone, COCP, GnRH, NSAIDs, antifibrinolytics, capillary wall stabilisation, mirena
ablation/resection or hysterectomy
24
Q
TVUS
A
> 16mm in pre meno
4mm in post meno
do biopsy
25
phamacokinetic changes in pregnancy
```
increased volume of distribution
decreased absorption (vom)
decreased protein binding - increased free drug
increased liver metab of phenytoin
increased GFR
```
26
period of greatest teratogenic risk
4-11 weeks
27
ACEi/ARBs
renal hyperplasia
28
andogenr
virisliation of females
29
antiepileptics
cardiac, facial, NT defects
30
cytotoxic drugs
multiple defects, IUD
31
lithium
CVD
32
retinoids
ear, CVD, skeletal
33
warfarin and opiates at labour
warfarin - bleed
| opitaed - resp depression, premature close of DA
34
stilbestrol
1940-1971
vaginal adenocarcinoma in females aged now 15-20
urological malignancies in boys
35
foremilk
| hindmilk
rich in protein
high fat content
longer feeds - high amount of fat soluble drugs
36
why might drugs accumulate
immature metabolism
37
```
BF drugs:
phenobarbitone
amiodarone
cytotoxic
BZDs
bromecriptine
```
```
suckling difficulties
neonatal hypothyroid - amiodarone
cyto-bone marrow suppression
BZD - drowsiness
brom-suprresses lactation
```
38
N and vom in preg
UTI
pain
heartburn
cyclizine
N and cefalaxin (3rd trim - trimethoprim)
paracetamol
antacids
39
tetra
phenytoin
valproate
staining of bones and teeth
cleft lip and palate
NT defects - SB and amencephaly
40
why is there an increase in seizures during preg
decreased compliance
| changes in plasma concentration - vom, increased clearance
41
SU in preg
not safe
42
why does preg have a high increase in VTE
decreased levels of factors 7, 9, 10 and fibrinogen
43
epilepsy treatment
FA from 3 months before conception
| Vit K 10-20mg PO from 34-36 weeks
44
risk of child developing epilepsy
5% if mum/dad
15-20% if both
10% if sibling and mum/dad
45
during preg and epilepsy
scan at 18-20 weeks
cardiac scan at 22 weeks
LCSC is recurrent generalised seizures in late preg/labour
46
post partum and epilepsy
neonates given Img IM vit K
47
BM and HbA1c in preg
LCSC if
growth scans
BG 4-6, <6%
if macrosomin and EFW >4kg
serial growth scans at 28, 32, 36 w
48
risks of DM
```
fetal macrosomnia - shoulder dystonia C5-C6
polyhydraminoas
polycythaemia
neonatal hypoglycaemia
hypocalcaemia
```
49
LMWH for DVT
1mg/kg once or twice daily till 3m after delivery of 6m after treatment
50
hypothyroid
increase levothyroxine by 25-50mcg in first trim
TFTS every trim
51
hyperthyroid
gets worse due to HCG in first trim
improves in 2nd and 3rd
propylthiouracil, propranolol (IUGR)
TFTS every trim
52
APH
bleeding after 24 weeks
53
placental abruption
painful
blood loss
uterine wooden
difficult to feel fetal parts
clinical dx
steroids, deliver if compromised
54
major PP
| minor PP
=<2cm from os/covering CS
| >2cm from os - vaginal delivery
55
painless bleeding during third trim
| uterus soft and non tender
PP
56
placenta praevia
dont perform vaginal exam till excluded
57
placenta accreta
severe bleeding, PPH
| c sections
58
vasa praevia
fetal distress, bleeding
| can be dx antenatally
59
uterine rupture
prev c sec/uterine repair
| obstructed labour, fetal distress/IUD
60
local causes of APH
small volume
uterus soft non tender
no fetal distress
placenta placed normally
61
acute bleeding 23-32w
recurrent bleed after 28w
any bleed after 32w
24 hour bleed free then discharge
min stay 72 hours
min stay 72 hours
62
PPH cause
tone - uterine atony, distended bladder
trauma
tissue - placenta, clots
thrombin - pre existing or acquired coag
63
PPH treatment
uterine massage
5 units IV syntocin
40 units sync in 500mls
64
persistent PPH
```
confirm placenta and membrane complete
urinary catheter
500mcg ergometrine IV (not in heart disease, htn)
arterial embolisation
surgery
```
65
os closed
| os open
threatened
| inevitable
66
implantation bleeding
10 days post ovulation
| mistaken for period
67
chorionic haematoma
pooling of blood between endometrium and embryo due to separation
bleeding cramps threatened miscarriage
large - infection, irritability, cramps, miscarriage
self limiting, reassure and surveillance
68
type of pain relief for labour
```
enter
water immersion
morphine
IV remifentanil PCA
epidural anaethesia
pudendal nerve block
```
69
epidural anaethesthetic
v effective
does not impair uterine activity
may inhibit progress during stage 2
70
risks of epidural anae
```
hypotension
headache
back pain
atonic bladder - empty bladder
dural puncture - severe headaches and photophobia due to CSF leak
```
71
stage 1 delay
nulliparous <2cm in 4 hours
| parous <2cm in 4 hours or slowing in progress
72
stage 2 delay
prim 2 hours 3 with epi
| multi 1 hours 2 with epidural
73
doppler auscultation
stage 1 done every 15 mins and at beginning and end of every contraction
stage 2 every 5-10 mins
74
treatment of fetal distress
```
change maternal position
IV fluids
sop syntocin
terbutaline 250mcg - stop contractions
maternal assessment
fetal blood sampling
op delivery
```
75
fetal blood sampling
>7.25 pH normal
7.2-7.25 repeat
<7.2 deliver hypoxic
76
induction of labour
vaginal prostaglandin
mechanical
amniotomy - rupture of membrane
IV I syntocin
77
observations during first stage of labour
hourly pulse
4 hourly temp and BP
freq of PU
VE 4 hourly
78
preg induced htn
>=140/90 DBP>110 or SBP>160
| dx in second half week of pregnancy. resolves 6 weeks post natally
79
treatment of preg
labetalol (asthma) - can BF
nifedipine - can BF
hydralazine IV
methyldopa (depression)
80
PET
proteinuria >=0.3g/24 hour
oedema
htn >30 systolic >14 diastolic compared to booking
81
check for PET
maternal artery doppler done at 20-24 weeks to check if placentation has occured
82
refer to daycare unit
>=140/90, proteinuria, oedema, symptoms like persistent headache
83
admit
```
BP>170/110 or 140/90 with lots of proteinuria, headaches/visual symp/abd pain
abnormal biochem
proteinuria
need antihypertensives
signs of fetal comprimise
```
84
MAP>= 150
risk of cerebral haemorrhage
85
aim with htn
<150/80-100
86
eclampsia
tonic clonic seizure occurring with features of PET
| over 1/3 will have seizure before onset of htn/protein
87
when are most seizures in ec
in labour or after
| assoc with ischaemia/cererbral vasospasm
88
treatment of ec
```
control BP, labetalol hydrazine
Mg sulphate 4g IV over 5mins IV infusion 1g/hour
further seizures mg sul 2g
further diazepam IV
fluid balance run px dry 80ml/hour
syntocin
```
89
why should ergometrine be avoided during ec
can cause htn
90
risk factors for PET
75mg aspirin
91
steroids
betamethasone 12mg IM twice 24 hours apart up to 36 weeks
92
wedge shaped nipple
pain after feeding
baby may vom blood
sore/cracked nipples
93
treatment for sore/cracked nipples
breast feeding technique
express milk
scabs - lansinon cream
94
engorgement treatment
| cx
express before feeding
warm baths/press before feeding. cold press between feeds
mild analgesia
good attachment and emptying
cx mastitis
95
treatment for mastitis
continue BF
anti inflam
AB if no improvement or worse after 12-14h
flucoxacillin 1g qds (PA clindamycin 450mg tds) for 7-10 days
96
breast abscess
untreated mastitis
send pus for culture
same treatment as mastitis
97
breast thrush when is it rare
candida albicans
| <6w
98
treatment for breast thrush
superficial miconazole cream 2% 7 days
| deep fluconazole 300g loading dose 150mg daily for 10 days
99
infant treatment fro breast thrush
nappy rash, oral
<4m nystatin suspension 1week
>4m miconzole oral gel 24mg/ml 4 times daily for a week
100
resp congenital shit
trachea-oesophagus fistula
| diaphragmatic hernia
101
preterm
tem
post term
24-36(+6)
37-42
>42
102
retinopathy of immaturity
6-8 weeks post
103
gestational age 32-36 w old
| <32 w
continued for 1 yr
| 2 yrs
104
intraventricular haemorrhage
happens in premature infants
| bleeding in germinal matrix 80% -> intraventrivular bleed
105
RF for intravenctricular haemorrhage
RDS, prem
106
grades 1 and 2
| 3 and 4
neurodevelopment delay 20% mortality 10%
| delay 80% mortality 50%
107
apnoea of prem
cessation of breathing for >20 seconds accompanied by hypoxia or bradycardia
108
bronchopulmonary dysplasia
complication of prolonged ventilation to treat RDS
109
early onset neonatal sepsis
| late onset
bacteria before and during delivery
| after delivery
110
NEC
most common neonatal surgery
| necrosis in small and large intestine
111
NEC when
when recovering from RDS
112
lethargy and gastric residuals, bloody stools, demo instability, apnoea and brady
NEC
113
meconium ileus
not keen to feed, not emptying bowels, slightly distended abdomen, no menonium or little bits
114
when should meconium be passed
within 48 hours
115
meconium ileus
gets stuck in terminal ileus
| 1/3 of CF children present with it
116
treatment of meconium ileus
contrast enema - if not laprotomy
117
fairy liquid vom
malrotation
118
cx of malrotation
SMA supplies midgut can be pinched
119
atresia
absence of connective tube
vom, green stools, distended abd, doesn't want to feed vom
can be seen on antenatal screens
120
hernia
commonest inguinal
121
```
booking visit
booking scan
anomaly scan
monthly visits till
anti D
fortnight visits
weekly visits
```
```
8-12 weeks
11-12 week
20w
till 28 weeks
28 and 36 weeks
28-36 weeks
37 weeks onwards
```
122
booking visit
FBC, hb, ABO-rheuss, rubella, syphillis, HIV, Hep B and C, urinalysis, VDRL, random BG, BP
123
term normal baby weight
2.5-4kg
124
male weight at 28 weeks
at term
daily weight gain
1150g
3550g
24g
125
transplacental transfer
iron, vitamins, calcium, phosphate and ABs
126
screening of child
Hep C, Hep B, HIV, TB-BCG, group B strep, syphilis, gonococilis, hearing, hip screening
gurthrie - hypothyroid, CF, MCCAD, PKU, haemaglobinopathies
127
combined test
USS at 11+3 nuckal thickening
| HCG and PAPPA
128
quadruple test
14-20 weeks
| bHCG, AFP, inhibin A, unconjugated oestrogen
129
diagnostic tests for downs
chorionic villous sampling 12 weeks 2% risk of miscarriage
amniocentesis 15 weeks 1% risk
130
dx of GTT
screened for GTT at booking and at 28 weeks
| dx at 28 weeks fasting >5.1 2 hour >8.5
131
aim for diabetes
3.5-5.9 fasting
| 1 hr post prandial <7.8
132
regular monitering in diabates
for PET
| growth 2-4 weekly FATs from 28 weeks or dx
133
IUGR assym
| sym
placental insufficeicney
| baby just small
134
risks of IUGR
hypoxia, hypoglycaemia, hypothermia, polycythaemia, abnormal neural development
135
treatment of stress incontinance
physio
lose weight
caffeine
smoking
136
treatment of urge incontincence
avoid caffeine
bladder retraining
oxybutinin
137
overflow incontinance
assess renal function
| catheter
138
menopause av
early
prem
late
51
45
40
54
139
HRT
oral or combined transdermal coestradiol and prog
| if no uterus then just oestrogen
140
prem manopause
urogenital
vaginal dryness
sexual dysf
steroid and HRT or CoC
vaginal oestrogens if atrophy
moisturise, lubrincants, vaginal oestrogen
prog off licence
141
benefits of HRT
| risks
decrease fragility fractures, decrease bowel cancer, effect on muscle mass and strength
VTE (oral>transdermal), increased risk of breast cancer, CHD and stroke
142
anterior cystocele
middle/apical - enterocoele
retrocede - posterior
complete eversion
prolapse of bladder into vagina
herniation of pouch of douglas into vagina
prolapse of rectum into vagina
uterine procidentra
143
RF for prolapse
age
vaginal deliveries
increased parity
increased BMI
144
staging for prolapse
```
0 no
1 >1cm above hymen (pos)
2 within 1cm
3 1-2cm below (neg)
4 eversion
```
145
when can't breast feed
8 units of alcohol
cocaine
HIV
146
baby blues when
days 3-10
| self limiting
147
post natal depression when
2-6 weeks
lasts weeks to months. 1/3 up to a year
70% lifetime risk of depression
25% recurrance
148
drugs for depression in preg
sertalline safe in BF
| TCAs amitrip, nortryp safe in preg and ok in BF
149
venlafaxine
paroxetine
citalopram and fluoexetine
htn
cardiac abnormalities
high levels in breast milk
150
purpueral psychosis when
| RF
2 weeks
BPD, prev, first relative with history
5% suicide risk 4% infantcide risk
80% 10 yr recurrence 25% develop BPD
151
BPD which drug is the safest
lamotrigene
152
risk of baby developing BPD
1/7
153
risk of schiz to child
10%
154
whats safe in schiz
| whats unsafe
typical
| atypicals gestational GM, IUGR
155
clozapine
| olanzapein
contraindicated in BF
| can induce extrapyramidal reactions in BF babies
156
avoid what in anxiety
benzos- cleft lip and neonatal withdrawal
157
RF for cervical cancer
HPV (lots of sexual partners), age at first intercourse, long term use of PO contraceptives, no use of barrier contraception, smoking, immunosuppression
158
cervical cancer staging
```
1AI depth 3mm length 7mm
1AII depth 5mm length 7mm low risk of LN mets
1B confined to cervix
2a vaginal involvement
2b parametrial involvement
3 lower vagina/pelvic wall
4 bladder/rectum/mets
```
159
cervical local spread
lymph
heam
uterine body, vagina, bladder, ureters, rectum
pelvic and para aortic early
liver, lungs, bones late
160
cervical screening
25-64
| every 3 years up to 49 then 5 yearly
161
HPV vaccine
against 16 18 6 and 11
| girls aged 11-13, MSM, HIV px
162
cervical erosion
exposure of endocervical epithelium to acid of vagina - physio
squamous metaplasia v common
163
nabothian follicles
endocervical glands that have expanded into mucous cysts
| can form masses or polyps
164
follicular cervitis
subepithelial reactive lymphoid follicles present in cervix
165
endometrial adeno
```
worse prognosis
high SE status
later onset of sexual activity
smoking
HPV esp 18
```
166
vulval intraepithelial neoplasia young women
| elderly women
multifocal, recurrent or persisten causing treatment problems
greater risk of progression to invasive squamous
167
spread to what is an important prognostic factor in vulvar squamous carcinoma
inguinal nodes
168
pagets of vulvar is what
crusting rash. rumour cells in epidermis. contain mucin. pain itching
tumour arises from sweat glands in skin
excise
169
type 1 endometrial cancer
endometroid and mucinous (always low grade)
unopposed oestrogen
precursor is atypical hyperplasia
170
type 2 endometrial cancer
serous
clear cell
both high grade
precursor serous intraepithelial carcinoma
171
obesity is a risk factor for endom cancer how
adipocytes contain aromatise that converts ovarian androgens to oestrogens which induce endometrial proliferation
172
grading of endometriod
I 5% or less solid growth
II 6-50%
III >50%
173
staging of endometrial cancer
IA <50% mymoetrial invasion
IB =>50%
2 cervical stroma
3 local and or regional spread
3A serosa of uterus and or adnexae
3B vaginal and or parametrial involvement
3C mets to pelvic and or para aortic nodes
4 bladder and or bowel mucosa and or distant mets
174
endometrial stromal sarcoma
rare soft fleshy usually polypod masses
high grade
abnormal uterine bleeding but can present with lung/ovarian mets
175
carcinosarcoma
mullerian
| mixed epithelial and stromal
176
presence of what worsens prognosis of mullerian
rhabdomyosarcomatrus
