infertility and abortion Flashcards
SAB: no heartbeat
no bleeding
cervix closed
missed abortion
diagnostic workup for spontaneous abortion (SOB)
CBC
Rh type ⇒ give Rhogam if mom is Rh negative!!!
hCG
pelvic and transvag US
what are some causes of recurrent abortion
abnormal karyotype
uterine malformations
antiphospholipid syndrome
chronic medical conditions
insufficient progesterone levels
infertility
vs
subfertility
vs
sterility
- infertility
- diminished capacity to conceive despite frequent sex
- subfertility
- more appropriate description of most infertile couples
- sterility
- complete inability to conceive offspring
- usually ccurs after procedure/ illness/ exposure/ genetic condition
what medications are used for elective abortion and how far along can the patient be to take them
misoprostol
mifepristone
up to 70 days GA
SAB: closed cervical os
bleeding
positive pregnancy test
threatened
most common complication of pregnancy
pregnancy loss which occurs prior to 20 weeks gestation =
spontaneous abortion
aka miscarriage
when do you evaluate for infertility
after 12 months of unprotected sex in women under 35
after 6 months of unprotected sex in women over 35
what are you looking for in a sperm sample
low sperm concentration
absent sperm
motility issues
morphology issues
are they alive
what surgical procedures are used for elective abortion
suction D and C
dilation and evacuation
stimulation of labor
fecundability ____ over time
decreases over time
0.25 for the first 3 cycles
down to 0.15 for the next 9 cycles
main cause of infertility
female factor (37%)
then male factor (8%)
tx of anovulation for PCOS
diet and exercise education
provera cycling
metformin
clomiphene 50 mg PO x 5 days
how do you determine if the cause of infertility is due to a tubal factor (oviduct patency)
hysterosalpingogram (HSG)
not covered by most insurance
painful
does not eval tubal function, just patency
what drug is used for ovulation induction
clomiphene
Selective Estrogen Receptor Modulator
works 60-85% of the time
rate of twin pregnancy is 7-9%
can cause life threatening hyperstimulation
what are the 4 main categories of female infertility
-
ova
- older age/ surgeries
-
ovulation
- PCOS, thyroid dysfunction, hyperprolactinemia (from breast feeding/ breast stimulation/ exercise/ meds like risperidone/ pituitary adenoma)
-
oviduct patency (distal or proximal)
- due to untreated STI/ hydrosalpinx/ mucous/ anatomic anomalies/ salpingectomy/ prior ectopic pregnancy
- uterine anatomic abnormalities
what are the 4 main categories of male infertility
-
enodcrine and systemic disorders
- GnRH deficiency, iron overload, multi-organ disorder, pituitary/ hypothalamic disorder/ tumor, hormonal, drugs (androgens, opiods, psychotrophic, GnRH ag and antag), obesity, nutritional deficiencies
-
primary testicular defects in spermatogenesis
- klinefelter, cryptorchidism, androgen insensitivity syndromes, variocele, drugs (marijuana, ETOH, antiandrogens, ketoconazole, spironolactone)
-
sperm transport disorders
- epidydimal/ vas derferens/ seminal vesicles/ prostate/ ejaculatory ducts disorders
- idiopathic
SAB: open cervical os
bleeding
+ pregnancy test
inevitable
tx of anovulation for hyperprolactinemia
bromocriptine
fecundability
vs
fertility
fecundability- the probability of achieving a pregnancy in one menstrual cycle
vs
fertility- ability to conceive and produce offspring
fecundability is a more accurate descriptor
tx for female infertility due to a tubal factor
usually IVF
surgical tubal repair has high failure rates and increased risk of ectopic pregnancy
SAB: complete pasasge of products of conception
complete
how to obtain a semen analysis
patient is abstinent for 2 to 7 days
2 masterbation samples taken, 1 to 2 weeks apart
SAB: retention of part or all products of conception
incomplete
___ or more consecutive losses prior to 20 weeks are called ___
3 or more consecutive losses prior to 20 weeks are called recurrent abortion
if someone has thyroid problems and is trying to become pregnant, what meds should they take
hyperthyroid- PTU
hypothyroid- levothyroxine
