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Conditions + definitions > Repro wk3 > Flashcards

Repro wk3 Flashcards

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1
Q

What is infertility?

A

Infertility is the inability to conceive with active intercourse (with no contraception) for a period of at least 12 months

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2
Q

What is primary infertility?

A

Being infertile without having had a previous pregnancy

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3
Q

What are irregular periods?

A

Where the time between the first day of each period changes between cycles

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4
Q

How do you diagnose PCOS?

A 
2 of the following 3:
Androgen access (Clinical vs biochemical)
Infrequent periods (anovulation)
Polycystic ovaries

When no other cause can be identified!

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5
Q

How do polycystic ovaries (PCO) and polycystic ovary syndrome (PCOS) differ?

A

PCOS is a diagnosis of exclusion over set criteria.
There are 3 criteria with PCO being one, 2 are needed for a diagnosis of PCOS

PCO is a common occurance in many women

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6
Q

What are the biochemical investigations into androgen access?

A

Testosterone
DHEAS (If over 700 CT adrenal to check for ovarian vs adrenal cause)
17-OH progesterone

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7
Q

What is pre-eclampsia?

A

New hypertension developed at or over 20 weeks with significant proteinuria

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8
Q

What is significant proteinuria?

A

Regent strip urinalysis 1+
Spot Urinary Protein: Creatinine Ratio > 30 mg/mmol
24 hours urine protein collection > 300mg/ day

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9
Q

What are the different types of fibroids?

A

Submucosal
Subserosal
Intermural

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10
Q

What are you looking for in a pelvic exam for infertility?

A 
Masses
Pelvic distortition
Tenderness
Vaginal septum
Cervical abnormalities
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11
Q

What are teh baseline investigations into infertility?

A 
Rubella immunity
Chlamydia
TSH
Biochemical tests
Male semen analysis
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12
Q

What biochemical tests are used to investigate regular periods?

A

Mid-luteal progesterone

Taken 7 days before expected periods

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13
Q

What biochemical tests are used to investigate irregular periods?

A 
Day 1-5:
FSH
LH
PRL
TSH
Testosterone
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14
Q

How do you investigate suspected tubual and uterine abnormalities?

A

Hysterosalpinogram (falling out of favour)
HyCoSy (becoming more prevelant

Laparoscopy if indicated by test above

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15
Q

What are the important questions for fertility in a male history?

A

Development -
Testicular descent
Change in shaving frequency? (change in T levels)
Loss of body hair

Infections - Mumps/STIs
Surgical - variocele repair? Vasectomy
Drugs (smoking.alcohol etc)
Sexual history (libido, fertility)

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16
Q

What side is a variocele more common on?

A

Left side, due to drainage into renal vein

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17
Q

What is klinefelter syndrome?

A 
Primary hypergonadism (small testis) caused by XXY
Impaired spermiogensis (azoospermia)
Testosterone deficiency
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18
Q

What is congenital bilateral absence of vas deferens associated with?

A

Cystic fibrosis

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19
Q

What are the types of ovulatory disorders?

A

3 types

1: Hypothalamic pituitary failure
2: Hypothalamic pituitary ovarian failure
3: ovarian failure

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20
Q

How do you manage type 1 ovulatory disorders?

A 
Encourage to have BMI of 19-29
Treat underlying cause
Potentially HRT to modulate ovulation:
>Clomifene
>Gonadotrophins
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21
Q

What is clomifene?

A

Selective oestrogen receptor modulator
Taken as lowest dose first, and graudally increase if ineffective
Usuable for 6 cycles

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22
Q

What are the side-effects of clomifene?

A

Vaso-motor
Visual disturbances
Multiple pregnancies

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23
Q

When do you use gonadotrophins?

A

No ovulation with clomifene
Ovulation but no pregnancy
FSH used

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24
Q

How do you treat hydrosalpinges?

A

Surgery - salpingectomy

BEFORE IVF

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25
What are the causes of azzospermia?
``` Testicular (hormones levels off) Post testicular (congeinital, ineffective) ```
26
How do you investigate azoospermia?
History/examination FSH/LH/Testosterone Karyotype CF screen
27
What are the classifications of azzospermia?
Transportation problem | Production problem
28
How do you manage transportation problems of azoospermia?
Surgical sperm retreival
29
How do you manage unexplained fertility?
No ovarian stimulation agents | 2 years of unprotected sex before IVF
30
What is the difference between IVF and intracytoplasmic sperm injection?
IVF sperm is placed with eggs to fertilise | ICSI injection of eggs with sperm - individual
31
What is gestational hypertension?
New hypertension develped at or over 20 weeks
32
What is pre-eclampsia?
New hypertension developed at or over 20 weeks with significant proteinuria
33
What is significant proteinuria?
Regent strip urinalysis 1+ Spot Urinary Protein: Creatinine Ratio > 30 mg/mmol 24 hours urine protein collection > 300mg/ day
34
What can cause spontaneous miscarriages?
``` Abnormal conception (genetic, structural, chromosomal) Uterine abnormality (fibroids/genetic) Cervical incompetence Maternal (age/diabetes) Unkown factors ```
35
How do you manage an inevitable miscarriage?
If bleeding is very heavy consider evacuation
36
How do yu manage a threatened miscarriage?
Conservatively
37
How do you manage a missed miscarriage?
Conservatively Medically - prostaglandins Surgical management of miscarriage
38
How do you manage a septic miscarriage?
Antibiotics and evacuate uterus
39
How common are ectopic pregnancies?
1 in 90
40
What are the risk factors of an ectopic pregnancy?
Pelvic inflammatory disease Previous tubual surgery Previous ectopic Assisted conception
41
How does an ectopic pregnancy present?
``` Period of ammenorhea with positive pregnancy test +/- the following Vaginal bleeding Abdominal pain GI/urinary symptoms ```
42
How do you investigate an ectopic pregnnacy?
US (no intrauterine signs Serum beta HCG levels (do not rise as steeply as normal) Serum progesterone levels
43
How do you manage an ectopic pregnancy?
Medially - methotrexate Surgical - laparosciopical Conservatively (sit and wait to see if it solves itself)
44
What is an antepartum haemorrhage?
Haemorrhage from genital tract after 24th week of pregnancy but before birth of baby Obstetric emergency - high mortality and morbidity for mother and child
45
What can cause atepartum haemotrrhage?
``` Placenta praevia Placental abruption Unkown origin Local lesions of genital tract Vasa praevia (rare) ```
46
What is placenta praevia?
Where placenta is attached to lower segment of uterus (all or part)
47
What is placenta abruption?
Where placenta has started to separate from uterine wall before birth of baby
48
Who is likely to get placenta praevia?
Multiparous women Multiple pregnancies Previous C section
49
What is the incidence of placenta praevia?
1/200
50
What are the classifications of placenta praevia?
1: placenta encroaching on lower segment, but not in internal cervical os 2: placenta reaches internal os 3: placenta eccentrically covers internal os 4: central placenta praevia
51
How does placentae praveia present?
Painless PV bleeding Soft, non tender uterus +/- Malpresentation of foetus Incidental
52
How do you diagnose placenta praevia?
Ultra sound MRI if inconclusive DO NOT do a vaginal exam
53
How do you manage placenta praevia?
Depends on gestation + severity | Although C section most common - post partum haemorrhage common
54
How do you manage a post partum haemorrhage?
Medically - ocytocin, egometrine, carbaprost, tranexemic acid Balloon tamponade Surgical - B lynch cutre, ligation of uterine/illiac vessels Hysterectomy (in increaseing order)
55
What factors are assocated with placental abruption?
``` Pre-eclampsia/chronic hypertension Multiple pregnancies Polyhydramnios Smoking Increasing age Parity Previous abortion Cocaine use ```
56
What are teh types of placental abruption?
Revealed (apparent externally as escapes through cervical os) Concealed (between uterine wal and placenta) >Increased uterine contents + larger fundal height than would otherwise be expected for gestation >Uterus may appear bruised Mixed (both of above)
57
What is the presentation of placental abruption?
Pain (abdominal) Vaginal pleeding Increased uteruine activity (tone + contractions)
58
How do you manage APH?
Depends on: Amount of bleeding General condition of mother/baby Gestation Expectant treatment Vaginal delivery Immediate C section
59
What are the complications of placental abruption?
Maternal shock/collapse Foetal death Maternal DIC, renal failure Postpartum haemorrhage
60
What is preterm labour?
Onset of labour before 37 weeks of gestation Can be spontaneous of induced Varies in severity - from 24 weeks being extremely to mild at 32 weeks
61
How common is preterm labour?
5-7% of singletons | 30-40 in multipl pregnancnies
62
What are the predisposing factors of preterm labour?
``` Multiple pregnancues Polyhydramnios APH Pre-eclampsia Infection Prelabour premature rupture of membranes ```
63
How do you manage a preterm delivery?
All cases variable In 24-26 weeks prognosis poor and discuss with parents/neonatologists Consider toclyosis to allow steroids/transfer Steroids unless contraindicated Transfer to unit with neonate intensive care Aim for vaginal delivery
64
What are the risks of a severe preterm labour?
Poor mortality rates | High chance of disability in newborn, increasing the earlier preterm they are
65
What are the morbiditys resulting from being preterm??
``` Respiratory distress syndrome Intraventicular haemorrhage Cerebral palsy Nutrition Temperature control Jaundice Infections Visual impairment Hearing loss ```
66
In patients with chronic hypertension, what is the ideal pre-pregnancy care?
Change ACEI/ARBs to beta blockers (labetolol), CCB (nifedipine) or metyldopa Lower dietary sodium Aim to keep BP below 150/100 Monitor during pregnancy + foetal growth
67
How do you diagnose pre-eclampsia?
Mild hypertension on 2 occasions (more than 4 hrs apart) Or one instance of moderate - severe hypertension PLUS significant proteinuria
68
What is the pathophysiology preeclampsia?
Immunological Genetic predisposition Due to either secondary invasion of maternal spiral arterioles being impaired leading to poor perfusion Or inbalance of vasodilators/constrictors in pregnancy
69
What are the risk factors of pre-eclampsia?
``` First pregnancy Extremes of maternal age Pre-eclampsia in previous pregnancy BMI Family history of PET Multiple pregnancy Underlying medical disorders (HT, renal, diabetes, autoimmune) Long interval between last pregnancy ```
70
What are the complications of PET?
Eclampsia (seizures) Severe hypertension - leads to haemorrhage (cerebral)/stroke HELLP (haemolysis, elevated liver enzymes, low platlets) Disseminated intravascular coagulation Renal failure Pulmonary oedem/cardiac failure Can also impair foetal placental perfusion leading to distress or prematurity
71
What are the clinical features of severe PET?
``` Headache/visual disturbances Epigastric pain/ pain below ribs Vomitting Sudden swelling of hands/face Severe hypertension Clonus/brisk reflexes Reduced urine output Convulsions (eclampsia) ```
72
What are the biochemical abnormalities in preeclampsia?
Raised liver enzymes Raised billirubin if HELLP present Raised urea + creatinine + urate
73
What are the haemtological abnormalities of PET?
Low platlets Low haemoglobin Signs of haemolysis Features of disseminated intravascular coagulation
74
How do you manage PET?
Only "cure" is delivery Manage conservatively - diet etc to bring blood pressure down Then drugs Monitor closely with BP + urine protein + symptoms Check with blood tests + check for distress in baby Consider induction if starting to get severe Continue to monitor post delivery
75
How do you treat PET seizures /impending seizures?
Magnesium suphate bolus + IV infusion Control blood pressure Avoid fluid overload (perihperal oedema often already present)
76
What is the prophylaxis for PET?
Aspirin low dose from 12 weeks until delivery
77
What is gestational diabetes?
Carboydrate intolerance with onset in pregnancy Abnormal glucose tolerance returns to normal after delivery More at risk of type 2 later in life
78
What happens in pre-existing diabetes and pregnancy?
Insulin requirements of mother increases (hormones from diabetes have anti-insulin action) Foetal hyper-insulinaemia occurs (maternal glucose crosses placenta and increases insulin production. Causes macrosomina, polhydramnios
79
What are the potential risks with children born to mothers with preexisting diabetes?
``` Higher risk of neonatal hypoglycaemia Increased risk of respiratory distress Foetal congeital abnormalities (cardiac abnormalities, sacral agenesis) Impaired lung matuiry Jaundice ```
80
What are the risks to the mother in preexisting diabetes?
``` Increased risk of preeclamsia Worsening of maternal neprhopathy, retinopathy + hypoglycaemia Decreasesd awareness of hypoglycaemia Infections Can result in miscarriage/still birth ```
81
How do you manage diabetes pre-conception?
Try to encourage better glycaemic control Give folic acid Dietary advice Retinal + renal assessment
82
How do you manage preexisting diabetes during pregnancy?
Optimise glucose control as insulin requirements increase Continue most dugs, but stop sulfonureas Give glucose solution/glucagon injections and school on risk of hypos Watch for infection Watch foetal growth Retinal assessments Observe for PET
83
How do you manage labour in those with preexisting diabetes?
Usually induce it at 38-40, although maybe earlier depending on concerns C section if significant macrosmnia Give mother insulin/dextrose infusion during labour Foetal monitoring in labour CTG continous Feed baby early to reduce hypoglycaemia
84
What are the risk factors of gestational diabetes?
BMI > 30 Previous macromic baby Previous gestation diabetes FH of dibates Women at high risk of diabetes Polyhydramnios or macrosmnia in current pregnancy Recurrent glycosuria in current pregnancy
85
How do you screen for gestational diabetes?
Offer HbA1C if risk factors present >6% then do an oral glucose tolerance test Repeat at 24-48 (OGTT)
86
How do you manage gestational diabetes?
Control blood sugars - det often enough, metformin if remain high Gect oral glucose test post term Yearly check as higher risk of diabeties
87
Why are pregnant women at greater risk of thromboembolism?
``` Hypercoaguable state >Increased fibrinogen + clotting factors + platlets >Increase in fibrinolysis >Decrease in natural anticoagulants Increased stasis ```
88
Who is at increased risk of thromboembolism in pregnancy?
``` Older mothers/high parity Increased BMI Smoking/IV drugs/alcohol PET Dehydration Decreased mobility Infections Operative delay or prolonged labour Haemorrhage Sickle cell disease ```
89
What are the signs of VTE /symptoms?
Calf pain Increased girth in one leg Calf muscle tenderness ``` Breathlessness/pain on breathing Cough Tachycardia Hypoxic Pleural rub ```
90
What is Duchenne muscular dystrophy?
X linked disease Fatal in early adult life Characterised by way boys get up onto their feet
91
What are the symptoms of sickle cell disorders?
``` Pain (lots) Cold Dehydration Infections Jaundice Stroke Leg ulcers Anaethestia issues ```
92
What is tay-sachs disease?
Progressive lyosomal storage disease Deficency in an enzyme leads to build up of lipids in cells, especially nerve cells of brain Neurological deteriation Usually fatal by 3-5 years
93
What is pehynlketonuria?
Recessive condition unable to break down phenylalanine Untreated babies develp serious mental disability Early treatment with dtrict diet prevents disability
94
What is congenital hypothyroidism?
Not enough thyroixine produced Untreated babies develop serious physical + mental disability Treatment by 21 days with thyroxine tablets prevents disability
95
What is mediam change Acytl-COA dehydogenase deficency
Recessive condition Cannot break down fat to make energy fr baby Life threatening Mean age of presentation 14 months Treatment - avoid fasting + monitor frequency of meals to prevent metabolic crisis In imergency give IV dextrose
96
What are the common sexually transmitted organisms in the UK?
Bacteria Chlamydia trachomatis Klebsiella granulomatis Mycoplasma genitalium ``` Viruses HSV HIV HPV Molluscum contagiosum virus ``` parasites Pthrius pubis Sarcoptes scabei Trichomonas vaginalis
97
What conditions only need genital contact?
Pubic lice (pthirus pubis) Scabies (sarcoptes scabeii) Warts (HPV 6 + 11) Herpes (HSV 1/2)
98
What are the systemic symptoms from STIs?
``` Fever Rash Lymphadenopathy Malaise Infertility ```
99
What are the important questions in STI management?
``` When did you last have sexual contact? Was it casual or with a regular partner (how long with regular?) Male/female? Nature of sex? Condoms? Contraception? Nationality ```
100
What are the questions for risk assessment for a man?
``` Ever had sex with a man? Ever injected drugs? Ever had sexual contact with someone from outside of UK/injected drugs Medical treatment outside of UK? Involvement with sex industry? ```
101
What is the process of STI testing?
History/consultation Test + offer further testing - always think HIV Partner notification Promote health - condoms
102
What STIs are condoms good at preventing + bad?
Good - HIV, chlamydia, gonorrhoea Bad - herpes/warts
103
What are the presenting complaints of genital symptoms?
``` Discharge from orifice Pain Rashes Lumps/swellings Cuts, sores, ulcers Itching Change in appearance Vague sense of something not being right ```
104
What microbial conditions are not regarded as STDs?
``` Vulvovaginal candidosis Bacterial vaginosis Balanopothitis Tinea cruris Erythrasma Infected sebacous gland Impetigo Cellulitis ```
105
What is vulvovaginal candiosis?
``` Very common and usually trivial Usually acquired from bowel Often asymptomatic "Thrush" is symptomatic Itchy with discharge ```
106
What bacteria causes thrush/vulvovaginal candidosis?
90% candida albicans
107
Who is at risk of vulvovaginal candidosis?
Diabetes/oral steroids Immune suprresion Pregnancy Reproductive age group (oestrogen leading to glycogen)
108
How do you diagnose vulvovaginal candidosis?
``` Characteristic history Examination: >Fissuring >Erythema with satellite lesions >Characteristic discharge Investigations - not very sensitive >gram stain - low sensitivity >Culture - low specificity ```
109
How do you treat thrush?
``` Azole antifungals >clotrimazole 500mg >Fluconazole 150mg If recurrent - reinfection or reistance? Other management - maintain skin + aoid irritants ```
110
What is bacterial vaginosis?
Most common cause of abnormal vaginal discharge Symptoms: >Most asymptomatic >Watery grey/yellow "fishy" discharge (worse after sex) >Sometimes sore/itch from dampness Due to imbalance of bacteria rather than infection with biofilm
111
What are the problems associated with bacterial vaginosis?
Endometritis if uterine instrumentation/delivery Premature labour Increased HIV acquistion
112
How do you diagnose bacterial vaginosis?
``` Characteristic history Examination findings (not normally done) Would find thin, homogenous discharge ``` Gram stained smear of vaginal discharge
113
How do you treat bacterial vaginosis?
Metronidazole (oral - avoid alcohol) >Vaginal gel Clindamycin
114
What is zoons balanitis?
Chronic inflammation secondary to overgrowth of commensal organisms + foreskin malfunctiojn Not pathogenic

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