Infertility Flashcards
Ectopic preg is preg located outside ___ of the ___
Leading cause of preg related death in 1st trimester
RF T Previous \_\_\_ Hx of \_\_\_ Infertility tx w
Risk of ectopic preg inc w
endometrial cavity, uterus
hemorrage due to ectopic preg
tubal damage from PID
tubal surgery
ectopic preg
ART
earlier ectopic preg
Contraception ___ risk of ectopic preg
some failed contraceptives ___ risk of preg
including __ and ___ (esp by bipolar coagulation)
Sx Ab \_\_\_ A Vaginal Shoulder pain may suggest \_\_\_ A H
Initial work up includes __ and ___
discriminatory zone beta level is ___
above this, should see IUP by
dec
inc, IUD, BTL
ab pain amenorrhea spotting hemoperitoneum acute abdomen hemodynamic instab
Beta HCG, CBC
1500-2000
TVUS
Visualization of ___ rules out ___
Ectopic preg confirmed if US shows ___
mc finding is complex, heterogeneous mass separate from ___
pseudo gestational sac may be present ___ in the uterus and is ___
Sites of Ec Preg (in order) A I F O Interstitial or A
IUP, ectopic preg
extra uterine gestational sac
ovary
centrally, irregularly shaped
ampulla isthmus fimbrial ovarian cornual ab
Tx ectopic preg
med management w
__/__ management
Dx of ___ must be certain before tx w ___
Favorable indicators of success Absent or \_\_\_ Beta HCG < No \_\_\_\_ ectopic gestational mass
methotrexate
surgical/expectant
ectopic preg, methotrexate
mild sx
5000
fetal cardiac activity
4cm
Contraindications to MTX H Evidence of \_\_\_ follow up \_\_ diseases
Surgical tx of choice if pt hemodynamically stable
Consider salpinogstomy if
H
Patient desires
Recurrent EP can occur in
All other pts need
Expectant management if baseline BHCG < __ and declining
No signs of ___
Follow BHCG is ___
hemodynamically unstable
acute bleeding
unreliable
liver/renal
laparoscopy
hemodynamically stable
fertilityy
same tube
salpingectomy
200
acute ab
neg
Spontaneous abortion defined as preg loss prior to
MC reason is ___
MC abnormal karyotype
mc single chromosome abnormality
maternal RF A hx of \_\_ and \_\_\_ Over/under \_\_ \_\_\_ /\_\_/\_\_\_ use \_\_ abnorm infections such as C. P, R, L, T
Dx based on
__ and ___ if dx uncertain
20wks gestation
genetic abnorm
autosomal trisomy
45x
age SAB, radiation T/A/D uterine CMV, Parvo B19, Rubella, Listeria, Toxo
clinical presentation
Pelvic US, BHCG
Threatened abortion defined as uterine bleeding w/out ___ or ___
usually ____
___ tx
if live fetus present, preg ___
Inevitable abortion defined as uterine bleeding and ___ w/out __ of tissue
inevitable bc ___ is open
Tx via ___/__/___ management
cervical dilation, effacement
painless
no effective
continues
cervical dilation, expulsion
cervix
expectant/medical/surgical
Incomplete abortion
___ w partial expulsion of products of ___
tx via _/__/__ management
Complete abortion Pt has passed \_\_ of conception cervix is \_\_ \_\_ and \_\_\_ stopped Empty \_\_\_ on US No \_\_\_ needed
cervix open, conception
expectant, med, surg
all products closed bleeding/cramping uterus tx
Missed abortion
Dead fetus seen in __ on __
No signs of __ such as ___ or ___
may be a ___ coag if preg > ___
Tx via __/___/___ management
uterus on US
abortion, bleeding/cramping
consumptive, 5wks
expectant, med, surg
Med management of SAB
most commonly used med is
__ and __ can be given __/__ or ___
SE
Expectant management
Success rate depends on __ of expectant management
Pt returns to clinic ___ until spontaneous passage of ___
high success for __
mod for ___
less for ____
misoprostol
safe/effective, vag/oral/sublingual
DNV, low grade fever
length
1x wk, tissue
incomplete abortion
missed abortion
embryonic preg
Surgical Mx
Trad/effective tx for ___ failure
Comps Uterine \_\_ I Cervical \_\_\_ Risk of \_\_\_
early preg
perforation
infection
laceration
anesthesia
Recurrent pregnancy loss
defined as __ or more consecutive ___ losses
Workup
Systemic eval w __ and __ for med causes
Uterine eval to look for __ causes
Coag eval, looking for ___ if 3+ preg loss
Karyotyping: screen both partners for _____
2, pregnancy
TSH/FSH
anatomic causes
APS
balanced translocations
Elective abortion
__ or __ disruption of preg
Infertility defined as inability to conceive after __ of unprot intercourse
women over __ known to have __ or ___, consider early eval
most common causes
T
M
U
Types infertility O/T/C/M factor U E U
surgical/med
1yr
35, ovulatory/pelvic do
tubal dz
male factor
unexplained
ovarian/tubal/cervical/male factor
uterine defect
endometriosis
unexplained
Most causes of infertility determined based on
Elicit partners hx, such as __ or ___ to groin
Search for ____ problems such as T. H. W. G. P
Elicit ___ hx esp P/A, E
Social history including T/A/D, D&E. s
history/physical
previous kids/radiation to groin
maternal med, Thyroid dz, HTN, weight change, galactorrhea, PID
surgical hx, Pelvic/ab, endometriosis ablation
T/A/D use, diet and exercise, stress
Labs for infertility T P B A C R HH
Pelvic US may detect __ anomaly ( such as ___)
No other causes of infertility, MC testing is S__
Tests for ___ including day 21 ___ level and ___ kit
H__ to evaluate tubes
TSH, prolactin, blood type, antibody screen, CF screen, RPR
HIV/HBV/HCV
uterine, fibroids/septum
semen analysis
ovulation, P, ovulation kit
hysterosalpingogram
