Clin Wk 1 Flashcards
Why is the pre-conception consult important for both mother and child?
- Periconceptional period can influence intrauterine, childhood, and adult development of offspring
- Associated with lower infant mortality, and increased positive health behaviours in mother (e.g. inc smoking cessation, taking folic acid etc)
Describe/elaborate on the components of a preconception history
- Reproductive hx (past pregnancies? baby complications [LBW, miscarriage, birth defects] or mother complications [gestational diabetes]?)
- Medical hx (any conditions - diabetes? past c-section? neuromuscular disorders? iron deficiency? autoimmune? renal? vacciantoion? medications?)
- Fhx (ethnicity [black ~ sickle cell, asian ~ thalassaemia], genetic disorders, disability)
- Social hx (smoking, alcohol, drugs, STI risk, ?vegetarian, exercise, ?environmental toxins)
Components of pre-conception physical exam
- BMI calc (?macrosomia risk)
- Oral cavity check (can affect outcomes)
- Cardiac (BP, pulse, auscultation)
- Resp auscultation
- Breast exam
- Abdo palpation
What 4 nutrients should be considered in pre-conception planning (including one that’s only really considered in vegetarians/vegans)? Why?
- Folate (prevent neural tube defect)
- B12 (in vegetarians/vegans)
- Calcium (for pre-eclampsia prevention; may be met by diet alone)
- Iodine (maternal thyroid/fetal CNS development)
What foods should be avoided during pregnancy?
- Vitamin A (increased miscarriage risk; link this to an Rx)
- Caffeine (limit 2-3 coffees a day)
- Mercury (can be found in fish)
Weight and exercise recommendations during pregnancy (which types of exercise are okay?)
- Obesity linked to macrosomia, gestational HTN etc
- Obese women should lose 5-10% of bodyweight before trying to be pregnant
- Maintain normal exercise, but avoid contact sports/scuba
Components of infertility Hx
- Sexual history (freq/timing relative to menstrual cycle)
- Past pregnancies? Complications?
- Menstrual history (freq/duration? abnormal bleeding? dysmenorrhoea?)
- Other medical conditions (which are important?) Past surgeries?
- Medications/allergies?
- Heritable conditions (e.g. POI)
- Smoking/alcohol?
What’s a useful way to categorise anovulation, and some corresponding differentials?
- Hypogonadotrophic (hypothalamic amenorrhoa, pituitary disease, congenital gonadotrophin deficiency, hyperprolactinaemia [why?])
- Normogonadotrophic (PCOS, CAH)
- Hypergonadotrophic (POI)
What bloods do we order to assess infertility?
- Blood group
- FBC
- IgG for varicella and rubella
- Serology for Hep B/C, HIV, syphilis
How do we test for ovulation in infertility presentation?
- Mid-luteal progesterone (why?)
- FSH, LH, and Oestrogen if oligo/amenorrhoea
- Test for hyperandrogenism (free T, free androgen, bioavailable T)
- 17-hydroxyprogesterone for CAH
Most common blood test to measure ovarian reserve
Anti-Mullerian Hormone (AMH)
Anatomical investigations for female infertility
- Transvaginal ultrasound (?endo, ?polyps/fibroids)
- Hysterosalpingography
How do we exam/assess for male infertility?
- Exam: 2° characteristics (facial hair, broad shoulders), penile/scrotal exam
- Endocrine (morning T levels)
