Layers of the endometrium
Functional layer - which changes in response to hormones and is shed in menstruation Basal layer - thin, not shed.
length of luteal and follicular phase
14 days each. Luteal phase can vary in length (accounting for variations in cycle length), but follicular phase is always 14 days.
Why does the body only ovulate one egg?
Negative feedback - After period, early follicular phase, follicles are forming the the one that develops the most FSH receptors makes the most estrogen. Rise in estrogen provides negative feedback, which dampens development of other follicles.
Positive feedback in menstrual cycle?
As estrogen levels reach a critical point (coming from dominant follicle) you get positive feedback that supports the LH surge for ovulation.
long or infrequent cycles
Of trichomonas, chlamydia, and gonorrhea, which are reportable?
Chalmydia and gonorrhea are reportable. Trichomonas is not.
How common is Trichomonas?
The most common non-viral STI. 3.1% of reproductive aged women (US).
pain with urination
Reiter Syndrome (5)
A possible consequence of chlamydia. A post-inflammatory autoimmune disease; May present with conjunctivitis, urethritis, oligoarthritis, and skin lesions occurring 3-6 weeks after infection. Occurs more often in men.
Pelvic Inflammatory Disease - What is it? (3) - Causes (2) - Prevalence (1)
Infection/inflammation of... - endometrium - uterine tubes - pelvic peritoneum - surrounding structures Caused by chlamydia and gonorrhea as well as numerous non-STI pathogens in the vagina. Prevalence unknown because it isn't reportable and it's difficult to diagnose. Risk factors include, young age and sexually active, cervicitis, prior PID, IUD (within 21 days of insertion), surgery, vaginal douching
Fitz-Hugh-Curtis Syndrome (4)
- cause, symptoms
Mostly occurs as a sequela of chlamydia infections;
Perihepatitis - inflammation of the liver capsule.
Characterized by R upper quadrant pain, nausea, vomiting, and fever, which are generally accompanied by evidence of pID on physical exam. 'bow-string sign'
Follow up for chlamydia treatment
Abstain from unprotected itnercourse until after multiple dose therapy or 7 days after single dose. Test of cure at 6 mos after infection and 3-4 weeks if pregnant. Screen for other STIs, screen partners, reportable to public health.
Follow up for gonorrhea treatment
- treat partners - all those with contact within 60 days
STI infections that pose risk for developing PID?
Chlamydia and gonorrhea
Possible outcomes of PID (6)
May lead to tubo-ovarian abscess, sepsis, Fitz-Hugh Curtis syndrome, ectopic pregnancy, infertility (increases with n# of PID occurrences), chronic pelvic pain, increased risk of recurrent PID.
How to diagnose PID
A syndrome that is mostly diagnosed by exclusion. Symptoms of note: - lower abdominal pain*** - deep dyspareunia - UTI symptoms - increased vaginal discharge Signs: - cervical motion tenderness*** - adnexal tenderness on bimanual exam (uterine tenderness)***
Treatment for PID
Cefixime OR ceftriaxone WITH doxycycline OR azithromycin WITH OR WITHOUT Metronidazole
When to admit a pt with PID? (6)
Possible surgical emergency (appy not ruled out)
Not responding to oral antibiotics
Non-compliant with treatment
Severe illness, fever
Recommendations for wt gain in pregnancy
BMI < 18.5 gain 28-40 lbs
BMI 18.5-24.9 gain 25-30 lbs
BMI 25-30 gain 15-25 lbs
Obese BMI>30 consult healthcare provider
Gain more wt in 2nd and 3rd trimesters. Some populations are at risk for gaining too much wt in first trimester
- reinforce twice as healthy not twice as much.
Complications of obesity in pregnancy (4)
Macroscopic baby - increased rates c-section, unable to fit through vaginal canal;
Hemorrhage, pre-eclampsia; (From CBL)
Recommendations for exercise in pregnancy
Moderate exercise is safe and recommend because it decreases risk of HTN and length of labour. - generally 30 mins each day at a level where they can still talk For people who weren’t exercising already - start at 15 mins and work up. Exercise at an intensity when you are still able to talk normally. Generally, 150 mins a week spread over at least 3 days. Both aerobic and resistance and stretching if it feels good. Stop impact exercises once uterus moves out of pelvis (after 1st trimester?). Avoid initiating the valsalva manoeuvre (increases abdominal pressure). Stay hydrated, avoid overeating, avoid sauna/hot tub. (CBL)
What is the recommended schedule of visits for a low risk pregnancy? What are the recommended investigations (lab & ultrasound), when are these performed, and for whom are they recommended? ****return and fill out
Weeks 0-28: visits every 4 wks. Initial Visit: Reconfirm with pregnancy test. Detailed history and physical. (Confirm blood type and Rh status. Test HIV, chlamydia, gonorrhoea, TSH, Hep B and C, zika, MMR, HSV (pap smear), urine (proteinuria), toxoplasmosis. SIPS, dating ultrasound (wk 7-14), detailed ultrasound Weeks 28-36: visits every 2 wks. Start anti-Rh factors wk 28 if necessary. Weeks 36-term: visits weekly. SIPS: Wk 13-15
3 ways to estimate due date
1) Last menstrual period (time since first day of the last period; LMP + 7 days + 1 year - 3 months) 2) Dating ultrasound 3) Measuring symphyseal-fundal length
Compare and contrast first trimester dating US and a second trimester detailed an atomic scan
7-14 (recommended to do it at 10 wks onwards; only if available); gold standard to determine when pregnancy is due. 19-20 wks: for everyone in BC; make sure fetus is growing properly, check for congenital anomalies.
BC guidelines for genetic screening
Everyone should be offered SIPS - screening for aneuploidy and NTD. If it’s positive, getting IPS is covered. The genetic screening in SIPS; 2 blood tests for PAPPA (pregnancy-associated plasma protein A) and the other for a quad screen (levels of components indicate various risks). Can check for trisomy 13, 18, 21
When are fetal movements first felt in pregnancy?
Typically, 18-22 wks
(At 26 weeks we expect to feel 6 movements in 2 hours?)
What produces hCG?
syncytiotrophoblasts. Its role is to maintain corpus luteum until placenta takes over.
Progesterone produced by...?
Produced by corpus loteum until 10 wks and placenta takes over
CV changes in pregnancy
- Most early, peak in 2nd semester and then plateau - increased blood volume, RBC mass (due to increased EPO; calls for more iron) - Increased CO due to increased SV and HR. HR increases most in 3rd trimester by 10-15 bpm. - Decreased SVR due to placenta. Placenta opens spiral arteries to establish high flow low resistance system. Response to angiotensin II and estrogen-mediated vasodilation.
plasma volume increases faster than increase in RBC mass, leading to anemia. If Hg gets less than 105, this may actually be pathological and not just dilutional anemia. This is why we consider iron supplementation in almost all women.