Exam 2- early pregnancy bleeding, dyfunctional uterine bleeding Flashcards
What is dysfunctional uterine bleeding and what are the two subtypes?
Heavy and/or abnormal bleeding in the absence of known pathology
Ovulatory (luteal phase deficiency)
Anovulatory- occurs at the extremes of reproductive life
Systemic organic causes of menorrhagia (2)
Hypothyroidism
Coagulation defects
Medical therapy for dysfunction uterine bleeding (5)
Mirena COC Antifibrinolytics (e.g. tranexamic acid) Antiprostaglandins (e.g. mefanamic acid) GnRH analogues e.g. Buserelin
Definition of miscarriage
Expulsion of the products of conception before 24 weeks pregnancy
Commonest aetiology of miscarriage
Chromosomal abnormalities
Management of inevitable/incomplete miscarriage (5)
Allow evacuation Pain relief Blood transfusion if shocked Misoprostol (prostaglandin analogue) Mifepristone (antiprogestogen)
Definition of recurrent miscarriage
Miscarriage on 3 or more consecutive occasions
Factors which predispose to ectopic pregnancy (4)
Salpingitis
Previous tubal surgery
Endometriosis
Cu-ICD
Clinical features of ectopic pregnancy (3)
Amenorrheoa
Vaginal bleeding
Pain (lower abdo, shoulder tip)
Signs on examination which suggest ectopic pregnancy (3)
Peritonism
Adnexal mass
Cervival excitation
Investigation of a suspected ectopic pregnancy (4)
Pregnancy test
Paired hCCG (should double every day, suboptimal in ectopic)
Ultrasound
Diagnostic/treatment laparoscopy
Systemic drug given in ectopic pregnancy
Methotrexate
What kind of cancer can hydatidiform moles develop into?
Choriocarcinoma
Clinical features suggesting hydatidiform mole (3)
Vaginal bleeding after period of amenorrheoa
Large for dates uterus
Hyperemesis
Investigations and findings suggesting molar pregnancy (2)
Markedly elevated urinary/serum hCG
Ultrasound- “snowstorm” appearance, theca lutein cysts
Management of molar pregnancy (2)
Suction curettage
Follow-up monitoring of hCG
Rationale for screening for chlamydia prior to abortion?
Carries risk of post-op salpingitis
Two stages involved in medical abortion
Oral mifeprostone (antiprogestogen) Vaginal/oral misoprostol (PG analogue)
Surgical methods of abortion and weeks gestation they are used up until
Vacuum aspiration (up to 14 weeks) Dilatation and evacuation (14-24 weeks)
How does the late medical abortion procedure differ from early?
Late- second stage takes place at home and repeated doses of prostaglandin may be required
What do Leydig cells produce?
Testosterone
What do Sertoli cells produce?
Androgen-binding globulin
Roles of FSH and LH within the testicle
FSH stimulates spermatogenesis, LH stimulates testosterone release
Role of the a) seminal vesicles and b) prostate gland
a) fructose, prostaglandins, finbrinogen
b) alkaline fluid, clotting enzymes
Recommendations prior to starting assisted conception therapy:
a) BMI
a) alcohol
c) folic acid
a) 19-29
b) fewer than 4 units/week
c) 0.4mg/day
Assisted conception options (3)
In vitro fertilization
Intracytoplasmic sperm injection
Intrauterine insemination
Basic timeline of IVF treatment schedule (7)
Downreg. with Buserelin (starting day 21 of cycle) 2-3 weeks of downreg. then baseline scan FSH injections- 8/9 days Action scan hCG injection Egg collection 36 hours after hCG Fertilization and implantation Cyclogest pessary for two weeks
Abdominal pain, nausea and vomiting after FSH stimulation
Ovarian hyperstimulation syndrome
