Repro Flashcards
What is the grafian follicle?
A mature fluid filled cavity in the ovary which contains the female gamete/ovum.
A fully mature grafian follicle ruptures and releases the ovum mid menstrual cycle
What does the grafian follicle become after ovulation?
Corpus luteum
What does the corpus luteum do?
Secrete progesterone for two weeks after ovulation, required for the maintenance of pregnancy
What does the corpus luteum become if there is no fertilisation?
Corpus albicans- scar on surface of ovary
What layer do the urogenital and reproductive systems arise?
Mesoderm
What week does sexual differentiation occur?
Week 7
What does the paramesonephric duct give rise too?
Uterine tubes, uterus and superior vagina
What does the caudal portion of the paramesonephric duct give form?
Fuses with the paramesonephric duct on the other side to form the uterovaginal canal (becomes uterus and superior vagina)
What does the mesonephric duct become in males?
The ductus deferens and epididymis and opening into urogenital sinus
What are granulosa cells?
A type of cell in the ovary that produces oestrogen and progesterone
What does presence of the SRY protein cause?
Stimulates formation of somatic support cells which become sertoli cells
What causes degeneration of the paramesonephric ducts?
Sertoli cells secreting anti-mullerian hormone
What do leydig cells do?
Produce testosterone to induce formation of epididymis, vas deferens and seminal vesicles
What is a hydrosalpinx?
Condition where the fallopian tube becomes blocked and fills with serous fluid near the ovary. Gives rise to distension
What type of cell tumours are ovarian tumours?
Epithelial Cell tumours
Treatment for pelvic inflammatory disease?
Ceftrixaone for gonnorhoea
Doxycycline for chlamydia
Metronidazole for anerobic
What emergency contraception can be taken 72 hours after unprotected sex?
Levorgestrel
What emergency contraception can be taken 120 hours (5 days) after unprotected sex?
Ulipristal acetate
What is uterine fibroid degeneration?
Blood supply to the fibroid is compromised leading to ischaemia and necrosis -> causes severe pain and vaginal bleeding
What is myomectomy and when is it used?
Surgery that removes fibroids when fertility is still desired
What is the pattern of hormones in premature ovarian failure?
High gonadotrophins (LH and FSH) with low oestrogen production due to lack of negative feedback on the pituatary gland.
What cells line the ectocervix (part of vagina continuous with cervix)
stratified squamous epithelium
What is the endocervix lined with?
Columnar epithelium
Describe an inevitable misscarriage?
-Spontaneous loss of pregnancy before 24 weeks
- Abdo pain, vaginal bleeding without evidence of products of conception
-Cervical os open
- fetus may be alive by miscarriage in inevitable
Describe a missed miscarriage
- abdo pain, bleeding, passage of products of conception
- cervical os closed
- US showing non-viable foetus
Describe an incomplete miscarriage
- abdo pain, vaginal bleeding, passage of products of conception
-cervical os open so process is incomplete and foetal tissue will continue to pass
What hormonal treatments can be given for endometriosis
Combined oral contraceptive- suppressing ovulation can cause atrophy of endometrium
What is a complete mole?
One or two sperm fertilise an egg with no chromosomal content. Therefore a placenta is formed with no embryo
What is a partial mole?
Two sperm fertilise a normal egg and instead of forming twins causes an abnormal proliferation of embryonic tissue with no viable pregnancy.
What is the first stage of labour?
Cervical effacement and dilatation progressing from 0 to 10cm
What is HELLP syndrome
Haemolysis, Elevated liver enzymes, low platelets
What is given to initiate termination of pregnancy
Mifepristone- blocks the action of progesterone
Which ovarian tumours are most common in post-menopausal women?
Epithelial ovarian tumours
Which ovarian tumours are most common in younger women
Germ cells ovarian tumour
What is the first line tx of dysmenorrhoea?
Intra-uterine system
What is placenta increta?
Abnormal placentation where placenta infiltrates into myometrium and into the muscle. Not confined to decidual layer of the endometrium
What is placenta praevia?
The placenta lies over the cervical os. Results in bleeding of the placenta when stretched.
Classic painless bleeding after 20 weeks gestation
What is vasa praevia?
The foetal vessels lie over the internal os partially or completely. High risk of haemorrhage and premature rupture of membranes
What days of the menstrual cycle is the proliferative phase?
Day 5-13
What days of the menstrual cycle is ovulation?
Day 14
What days of the menstrual cycle is the secretory/luteal phase?
15-28
What are happens to FSH, LH and oestrogen during menopause?
High FSH + LH (due to decreased -ve feedback), low oestrogen
When should Anti-D be administered during pregnancy?
28 + 34 weeks
What is a cystocele and its symptoms?
Herniation of bladder into vagina
Stress incontinence symptoms and anterior wall prolapse
What is an enterocele and its symptoms?
Prolapse of small bowel into vagina.
Presents typically with posterior wall bulge and lower back pain
What is an rectocele and its symptoms?
Rectum prolapse into vagina. Posterior wall bulge with pain on defecation
What can toxoplasma gondii infection lead to in a baby?
chorioretinitis, hydrocephalus, seizures, visual and hearing impairment
What is classified as primary amenorrhoea?
-Failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development),
-or by 13 years of age in girls with no secondary sexual characteristics
What is the combined test and when is it used?
Recommended test for Down Syndrome. Carried out from 11-13 weeks
Nuchal translucency using ultrasound scan
PAPP-A hormone (level reduced in pregnancy affected with Down’s syndrome)
Beta-hCG hormone (raised in pregnancy affected by Down’s syndrome)
When is the triple test used and what does it measure?
Used after 13 weeks gestation
- Beta HcG
- AFP
-Ue3
At what gestation does pre-eclampsia usually present?
34 weeks gestation
What does rubella infection in pregnancy lead to in the child?
Cararacts, microphthalmia, microcephaly and heart defects
What can using folic acid anatagonists such as methotrexate do to your baby?
Birth defects such as anacephaly, hydrocephalus, cleft lip/palate, skull defects
BMI over what is considered for prophylactic VTE treatment?
30
What are the LAMBAST drugs to avoid in pregnancy?
Lithium, amiodarone, methotrexate, benzos, aspirin, sulfonamides, tetracyclines
Definition of placental abruption?
Separation of normally implanted placenta from uterine wall
Signs and symptoms of placental abruption?
Severe, continous abdo pain
Bleeding (can be concealed)
Woody, hard uterus
Can present in collapse
Prophylactic treatment for chickenpox?
Acyclovir
Initial treatment for uterine atony?
Uterine massage
What is the diagnostic glucose values for gestational diabetes?
a fasting plasma glucose level of 5.6 mmol/litre or above or
a 2‑hour plasma glucose level of 7.8 mmol/litre or above
When is insulin used in gestational diabetes?
In a fasting plasma glucose level of 7.0mmol or above
Which HRT is required in women with a uterus?
Oestrogen combined with progesterone for endometrial protection
Which HRT should women with periods go on?
Cyclical HRT, cyclical progesterone and regular breakthrough bleeds
Which HRT should post-menopausal women with a uterus go on?
Continuous combined HRT
What is the COOP protective against?
Ovarian cancer
What abdo surgical incision is usually performed for a C-section?
Suprapubic incision
Describe the broad ligament of the uterus?
Extends between uterus and lateral walls of pelvis
Helps maintain the uterus in correct midline position
Contains the uterine tubes and proximal part of round ligament
Describe the round ligament of the uterus?
Embryological remanant
Attaches to lateral aspect of uterus
Passes through deep inguinal ring and attaches to superficial tissue of female perineum
Describe the levator ani
3 skeletal muscle under voluntary control- puborectalis, pubococcygeus, iliococcygeus
Forms the majority of the pelvic diaphragm
Provides support to pelvic organs- tonic contraction and in situations of increased abdominal pressure
Supplied by nerve to levator ani eg S3,4,5
Where does lymph from the breast drain?
-most drains from ipsilateral axillary lymph nodes to supraclavicular lymph nodes
-Lymph from inner breast quadrants can drain into parasternal lymph nodes
-Lymph from lower can also drain into abdo lymph nodes
1st line ix for breast cancer in a patient under 35 with a lump
US
1st line ix for breast cancer in patient over 35 with lump?
Mammogram
Which medication is most effective against oestrogen positive breast cancer?
Tamoxifen
Which medication is indicated in HER2 +ve breast cancers?
Trastruzumab
A bishops score of what suggests the cervix is ripe and favourable?
7
Tx for urge incontinence?
1st line- anticholingerics eg oxybutinin
2nd line- desmopressin- synthetic analogue of ADH
What are the two antenatal scans pregnant women are offered and when?
Booking visit- 8-12 weeks
Anomaly scan/detailed ultrasound scan- 18-21 weeks
What is assessed at the booking visit?
Haemoglobinopathies, Hep B&C, HIV, Syphilis, red cell antibodies, anaemia, number fetuses, viability, PMH, PSH, Obstetric hx, meds, allergies, SH, FH, past mental health history, FGM, BMI (& trisomy screening offered)
What is assessed at the anomaly scan?
Cleft, heart, NTD, limb defects, placental site, diaphragmic hernia, abdominal wall defects, lungs abnormalities, brain abnormalities, urinary tract abnormalities
What testing is offered if there is a high chance of trisomy?
NIPT testing
Tx for baby in placenta praevia
Steroids if 24-35+6
MgSO4 <32w
Mx for vasa praevia
Elective C-secton 35-36 before labour
What is twin to twin tranfusion syndrome
Occurs in monochorionic twins due to anastamoses of umbilical vessels
What are both twins at risk of developing in twin transfusion syndrome?
Heart failure and hydrops (oedema)
In twin transfusion syndrome what is most likely to happen to the donor twin?
High output cardiac failure due to severe oedema
In twin transfusion syndrome what is most likely to happen to the recipient twin?
Fluid overload due to excess blood volume
When is a dating scan performed?
10-13 weeks
Complications of CMV in pregnancy
Hearing loss, visual impairment, learning disability
Which antibiotic is used in PPROM to reduce chances of infection
Erythromycin or clarithromycin
Mx of preterm labour?
Dexamethasone x2 12 hours apart-> stimulate surfactant production from 33weeks +6
Magnesium sulphate for neuroprotection
When is the COCP absolutely contraindicated in breastfeeding women?
Up to 6 weeks postpartum
What mx is used in stress incontinence if pelvic floor exercises aren’t working?
Duloxetine- SNRI
Time of effectiveness of all contraceptions if not taken on first day of period?
2 days: POP
7 days: COC, injection, implant, IUS
What do progesterones increase the risk of?
Breast cancer
When should a trial of diet and exercise changes be offered for 1-2 weeks in gestational diabetes?
If fasting plasma glucose less than 7mmol/L
What does Erb’s palsy result in?
Adduction and internal rotation of the arm with pronation of the forearm: waiter’s tip (C5,C6)
Tx for lichen sclerosus?
Clobetasol propionate- potent topical steroid
Risk factors for placenta praevia?
c-section, previous termination, age >40, multiparity, assisted conception, multiple pregnancy, smoking
Risk factors for placental abruption?
Pre-eclampsia/hypertension, trauma, smoking, cocaine, Medical thrombophilias, renal disease, diabetes, Polyhydramnios, Multiple pregnancy, Preterm, Abnormal placenta, Previous abruption
Risk factors for placenta accreta?
- Placenta praevia and prior caesarean delivery
- Increased risk with multiple c/sections
Risk factors for uterine rupture?
- Previous caesarean section/uterine surgery
- Multiparity and use of prostaglandins/syntocinon
- Obstructed labour
Tx of placental abruption
If mother haemodynamically stable then steroids
If not then emergency c-section
A bCHG of greater than what should suggest there is a pregnancy somewhere?
> 1500 beta hcg
What are the three categories of ovarian tumours?
-Surface epithelial cells
-Germ cell
-Sex cord/stromal
Medical mx of a missed miscarriage?
Oral mifepristone then misoprostolol 48 hours later unless gestational sac passed
Tx for CIN?
Large loop excision of transformation zone- electrical current to remove affected area of cervix
Medical mx of an incomplete miscarriage?
Single dose of misoprostol
What antibiotics are used in the different stages of pregnancy for UTIs?
1st and 2nd sem- nitrofurantoin
3rd- trimeprothin
Which antibiotic is contraindicated in pregnancy
Doxycycline
Presentation of mammary duct ectasia?
Thick, green, yellow dishcharge
Presentation of intraductal papilloma
Bloody discharge
When can the copper coil be used as contraception?
Within 5 days of the earliest expected date of ovulation
