Repro 13 - Pregnancy Part 3 Flashcards
What is the time required to be infertile?
No pregnancy after 12 months of trying. Treatment can be started at 6 months if older than 35.
What are the four general causes of 90% of infertility?
Anovulation (PCOS). Female anatomic defects (congenital defects or tubal scarring). Sperm abnormalities. Cervical factors.
What are four possible treatments of infertility?
Ovulation induction (clomiphene, metformin in PCOS). Intrauterine insemination (IUI). In vitro fertilization (IVF). Intra-cytoplasmic sperm injection (ICSI).
What are the five categories of OB Safe Medication?
Category A: Safety established in human studies. B: Presumed safety based on animal studies. C: No human or anima studies show an adverse effect/uncertain safety. D: Human risk, but benefit may outweight risk. X: Contraindicated, risk clearly outweights benefit.
What are three medications that can be used to treat Hypertension in pregnancy?
Hydralazine. Methyldopa. Labetalol.
What is the gold standard medication can be used to treat Diabetes in pregnancy?
Insulin.
What medications can be used to treat Epilepsy in pregnancy?
Any antiepileptic that best controls patient’s seizure. However, avoid valproic acid. Supplement w/ increased folic acid.
What medications can be used to treat Hypethyroidism in pregnancy?
Propylthiouracil (1st trimester). Methimazole (2nd and 3rd trimester).
What two anticoagulant agents can be used in pregnancy?
Heparin. Enoxaparin (Lovenox). Avoid warfarin (Coumadin) because it causes birth defects.
What is Tocolysis?
Trying to stop labor.
What are the physiologic changes in the uterus to prepare it for uniform contractions during labor?
During pregnancy, the uterus is quiescent because of inhibitors (progesterone, prostacyclin (PGI2). Uterus becomes activated by estrogen and other markers; this leads to increase in receptors for stimulatory prostaglandins (PGE2, PGF2alpha) and oxytocin and also increase the formation of gap junctions.
What are some tocolytics?
Indomethacin. Nifedipine. Terbutaline. Magnesium sulfate.
Why is Nifedipine a tocolytic?
Calcium channel blocker. Decreases intracellular Ca2+ leading to myometrial relaxation. Calcium is needed for uterine contraction.
Why is Terbutaline a tocolytic?
It is a beta-adrenergic receptor agonist. It binds beta2 receptors on uterus, causing myometrial relaxation.
What are two prostaglandins used to promote uterine contraction?
Dinoprostone (PGE2 analog). Misoprostol (PGE1 analog). It is off label but they are used mainstream because they cause cervical dilation and contractions.
What is the contraindication of using prostaglandins to cause uterine contractions?
If the mother has had scarring in the uterus, it can cause uterine rupture.
What are the side effects of prostaglandin use to promote uterine contractions?
Tachysystole. Uterine rupture. Fever. Vomiting. Diarrhea.
What medication can we use for medical abortion?
Mifepristone (RU-486) + misoprostol. It is approved up to 49 days of pregnancy.
What is the mechanism of action of Mifepristone (RU-486).
It is a synthetic steroid: a competitive inhibitor at progesterone receptors (progesterone is a our pro-gestational hormone; if we lose the progesterone stimulation, the pregnancy is lost).
What teratogenic effect might ACE inhibitors have?
Renal malformation.
What teratogenic effect might aminoglycosides have?
Ototoxicity.
What teratogenic effect might Fluoroquinolones have?
Cartilage damage.
What teratogenic effect might Tetracyclines have?
Discolored teeth.
What teratogenic effect might Chloramphenicol have?
Gray baby syndrome.
