Repro Flashcards
what is an ovulation
ovaries don’t release an oocyte during a menstrual cycle
menstruation phase when
prolif phase when what is secreted
secretory phase when what is secreted
when is the max reception ability for blastocyte
d1-4
d4-14 oestrogen
d14-28 progesterone
secretory phase
HCG during pregnancy pattern
HCS during preg pattern
increased peaks then falls
increases from week 5 (not right from beginning tho)
IVF conditions
unexplained infertility > 2years pelvic disease anovulatory infertility other pre implantation genetic disease male factor infertility >1x106 motile sperm
steps of IVF
down regulation with synthetic GnRH analogue baseline scan ovarian stimulation GnRH with LH or FSH action scan sperm sample oocyte collection embryologist transfer
risks of buseralin
hot flushes
mood swings
nasal irritation
headaches
treatment for OHSS
before transfer - coasting, stop GNT, freeze, single embryo transfer
after transfer - moniter, anti thrombin, analgesia, admite
ART before treatment for females
alcohol down to 4 units/ week weight 19-29 stop smoking FA 0.4g/day cervical smear, rubella immunity, Hep B and C, HIV, assess ovarian reserve
IUI
increase the number of sperm reaching the fallopian tube
unexplained infertility, mild/mod endometriosis, mild male factor infertility
ICSI
severe male infertility, prev failed IVF, preimplantation genetic disease
Aspiration
azoospermia
sperm aspirated surgically then ICSI
95% success rate of obtaining sperm if obstructive - epididymis
50% in non
obstructive causes of male infertility
non obstructive
CF vasectomy, infection
crytochordism, mumps, orchis, chemo/radio, tumours, klinfelters, semen abnormality, systemic, endocrine
donor insemination
azoospermia or very low sperm count
genetic/infective disease
crytochordism treatment
<14s orchidopexy
adults orchidectomy
androgen insensitivity syndrome
46XY
primary amen. lack of pubic hair
no uterus no ovaries, short vagina
klinfelters
47XXY
gynacamastia, infertility, decreased facial and body hair, small testes
testosterone replacement therapy
liomyoma
can increased in response to oestrogen (pregnancy)
commoner in afrocarribean populations
liomyosarcoma
spindle cell morphology
aggressive tumour
surgical resection
endometritis
cervical mucous plug protects endometrium from ascending infection and so does cyclic shedding
chronic plasmocytic endometrium
associated with PID
adenomyosis
endometrial glands and stroma within the myometrium
mennorhagia/dysmennorhea
anovulatory causes of DUB
ovulatory
obese. extremes of repro life. PCOS, thyroid, prolactin, irregular cycle
35-45, regular heavy periods, inadequate progesterone production, abnormal follicles
treatment of DUB
progesterone, COCP, GnRH, NSAIDs, antifibrinolytics, capillary wall stabilisation, mirena
ablation/resection or hysterectomy
TVUS
> 16mm in pre meno
4mm in post meno
do biopsy
phamacokinetic changes in pregnancy
increased volume of distribution decreased absorption (vom) decreased protein binding - increased free drug increased liver metab of phenytoin increased GFR
period of greatest teratogenic risk
4-11 weeks
ACEi/ARBs
renal hyperplasia
andogenr
virisliation of females
antiepileptics
cardiac, facial, NT defects
cytotoxic drugs
multiple defects, IUD
lithium
CVD
retinoids
ear, CVD, skeletal
warfarin and opiates at labour
warfarin - bleed
opitaed - resp depression, premature close of DA
stilbestrol
1940-1971
vaginal adenocarcinoma in females aged now 15-20
urological malignancies in boys
foremilk
hindmilk
rich in protein
high fat content
longer feeds - high amount of fat soluble drugs
why might drugs accumulate
immature metabolism
BF drugs: phenobarbitone amiodarone cytotoxic BZDs bromecriptine
suckling difficulties neonatal hypothyroid - amiodarone cyto-bone marrow suppression BZD - drowsiness brom-suprresses lactation
N and vom in preg
UTI
pain
heartburn
cyclizine
N and cefalaxin (3rd trim - trimethoprim)
paracetamol
antacids
tetra
phenytoin
valproate
staining of bones and teeth
cleft lip and palate
NT defects - SB and amencephaly
why is there an increase in seizures during preg
decreased compliance
changes in plasma concentration - vom, increased clearance
SU in preg
not safe
why does preg have a high increase in VTE
decreased levels of factors 7, 9, 10 and fibrinogen
epilepsy treatment
FA from 3 months before conception
Vit K 10-20mg PO from 34-36 weeks
risk of child developing epilepsy
5% if mum/dad
15-20% if both
10% if sibling and mum/dad
during preg and epilepsy
scan at 18-20 weeks
cardiac scan at 22 weeks
LCSC is recurrent generalised seizures in late preg/labour
post partum and epilepsy
neonates given Img IM vit K
BM and HbA1c in preg
LCSC if
growth scans
BG 4-6, <6%
if macrosomin and EFW >4kg
serial growth scans at 28, 32, 36 w
risks of DM
fetal macrosomnia - shoulder dystonia C5-C6 polyhydraminoas polycythaemia neonatal hypoglycaemia hypocalcaemia
LMWH for DVT
1mg/kg once or twice daily till 3m after delivery of 6m after treatment
hypothyroid
increase levothyroxine by 25-50mcg in first trim
TFTS every trim
hyperthyroid
gets worse due to HCG in first trim
improves in 2nd and 3rd
propylthiouracil, propranolol (IUGR)
TFTS every trim
APH
bleeding after 24 weeks
placental abruption
painful
blood loss
uterine wooden
difficult to feel fetal parts
clinical dx
steroids, deliver if compromised
major PP
minor PP
=<2cm from os/covering CS
>2cm from os - vaginal delivery
painless bleeding during third trim
uterus soft and non tender
PP
placenta praevia
dont perform vaginal exam till excluded
placenta accreta
severe bleeding, PPH
c sections
vasa praevia
fetal distress, bleeding
can be dx antenatally
uterine rupture
prev c sec/uterine repair
obstructed labour, fetal distress/IUD
local causes of APH
small volume
uterus soft non tender
no fetal distress
placenta placed normally
acute bleeding 23-32w
recurrent bleed after 28w
any bleed after 32w
24 hour bleed free then discharge
min stay 72 hours
min stay 72 hours
PPH cause
tone - uterine atony, distended bladder
trauma
tissue - placenta, clots
thrombin - pre existing or acquired coag
PPH treatment
uterine massage
5 units IV syntocin
40 units sync in 500mls
persistent PPH
confirm placenta and membrane complete urinary catheter 500mcg ergometrine IV (not in heart disease, htn) arterial embolisation surgery
os closed
os open
threatened
inevitable
implantation bleeding
10 days post ovulation
mistaken for period
chorionic haematoma
pooling of blood between endometrium and embryo due to separation
bleeding cramps threatened miscarriage
large - infection, irritability, cramps, miscarriage
self limiting, reassure and surveillance
type of pain relief for labour
enter water immersion morphine IV remifentanil PCA epidural anaethesia pudendal nerve block
epidural anaethesthetic
v effective
does not impair uterine activity
may inhibit progress during stage 2
risks of epidural anae
hypotension headache back pain atonic bladder - empty bladder dural puncture - severe headaches and photophobia due to CSF leak
stage 1 delay
nulliparous <2cm in 4 hours
parous <2cm in 4 hours or slowing in progress
stage 2 delay
prim 2 hours 3 with epi
multi 1 hours 2 with epidural
doppler auscultation
stage 1 done every 15 mins and at beginning and end of every contraction
stage 2 every 5-10 mins
treatment of fetal distress
change maternal position IV fluids sop syntocin terbutaline 250mcg - stop contractions maternal assessment fetal blood sampling op delivery
fetal blood sampling
> 7.25 pH normal
7.2-7.25 repeat
<7.2 deliver hypoxic
induction of labour
vaginal prostaglandin
mechanical
amniotomy - rupture of membrane
IV I syntocin
observations during first stage of labour
hourly pulse
4 hourly temp and BP
freq of PU
VE 4 hourly
preg induced htn
> =140/90 DBP>110 or SBP>160
dx in second half week of pregnancy. resolves 6 weeks post natally
treatment of preg
labetalol (asthma) - can BF
nifedipine - can BF
hydralazine IV
methyldopa (depression)
PET
proteinuria >=0.3g/24 hour
oedema
htn >30 systolic >14 diastolic compared to booking
check for PET
maternal artery doppler done at 20-24 weeks to check if placentation has occured
refer to daycare unit
> =140/90, proteinuria, oedema, symptoms like persistent headache
admit
BP>170/110 or 140/90 with lots of proteinuria, headaches/visual symp/abd pain abnormal biochem proteinuria need antihypertensives signs of fetal comprimise
MAP>= 150
risk of cerebral haemorrhage
aim with htn
<150/80-100
eclampsia
tonic clonic seizure occurring with features of PET
over 1/3 will have seizure before onset of htn/protein
when are most seizures in ec
in labour or after
assoc with ischaemia/cererbral vasospasm
treatment of ec
control BP, labetalol hydrazine Mg sulphate 4g IV over 5mins IV infusion 1g/hour further seizures mg sul 2g further diazepam IV fluid balance run px dry 80ml/hour syntocin
why should ergometrine be avoided during ec
can cause htn
risk factors for PET
75mg aspirin
steroids
betamethasone 12mg IM twice 24 hours apart up to 36 weeks
wedge shaped nipple
pain after feeding
baby may vom blood
sore/cracked nipples
treatment for sore/cracked nipples
breast feeding technique
express milk
scabs - lansinon cream
engorgement treatment
cx
express before feeding
warm baths/press before feeding. cold press between feeds
mild analgesia
good attachment and emptying
cx mastitis
treatment for mastitis
continue BF
anti inflam
AB if no improvement or worse after 12-14h
flucoxacillin 1g qds (PA clindamycin 450mg tds) for 7-10 days
breast abscess
untreated mastitis
send pus for culture
same treatment as mastitis
breast thrush when is it rare
candida albicans
<6w
treatment for breast thrush
superficial miconazole cream 2% 7 days
deep fluconazole 300g loading dose 150mg daily for 10 days
infant treatment fro breast thrush
nappy rash, oral
<4m nystatin suspension 1week
>4m miconzole oral gel 24mg/ml 4 times daily for a week
resp congenital shit
trachea-oesophagus fistula
diaphragmatic hernia
preterm
tem
post term
24-36(+6)
37-42
>42
retinopathy of immaturity
6-8 weeks post
gestational age 32-36 w old
<32 w
continued for 1 yr
2 yrs
intraventricular haemorrhage
happens in premature infants
bleeding in germinal matrix 80% -> intraventrivular bleed
RF for intravenctricular haemorrhage
RDS, prem
grades 1 and 2
3 and 4
neurodevelopment delay 20% mortality 10%
delay 80% mortality 50%
apnoea of prem
cessation of breathing for >20 seconds accompanied by hypoxia or bradycardia
bronchopulmonary dysplasia
complication of prolonged ventilation to treat RDS
early onset neonatal sepsis
late onset
bacteria before and during delivery
after delivery
NEC
most common neonatal surgery
necrosis in small and large intestine
NEC when
when recovering from RDS
lethargy and gastric residuals, bloody stools, demo instability, apnoea and brady
NEC
meconium ileus
not keen to feed, not emptying bowels, slightly distended abdomen, no menonium or little bits
when should meconium be passed
within 48 hours
meconium ileus
gets stuck in terminal ileus
1/3 of CF children present with it
treatment of meconium ileus
contrast enema - if not laprotomy
fairy liquid vom
malrotation
cx of malrotation
SMA supplies midgut can be pinched
atresia
absence of connective tube
vom, green stools, distended abd, doesn’t want to feed vom
can be seen on antenatal screens
hernia
commonest inguinal
booking visit booking scan anomaly scan monthly visits till anti D fortnight visits weekly visits
8-12 weeks 11-12 week 20w till 28 weeks 28 and 36 weeks 28-36 weeks 37 weeks onwards
booking visit
FBC, hb, ABO-rheuss, rubella, syphillis, HIV, Hep B and C, urinalysis, VDRL, random BG, BP
term normal baby weight
2.5-4kg
male weight at 28 weeks
at term
daily weight gain
1150g
3550g
24g
transplacental transfer
iron, vitamins, calcium, phosphate and ABs
screening of child
Hep C, Hep B, HIV, TB-BCG, group B strep, syphilis, gonococilis, hearing, hip screening
gurthrie - hypothyroid, CF, MCCAD, PKU, haemaglobinopathies
combined test
USS at 11+3 nuckal thickening
HCG and PAPPA
quadruple test
14-20 weeks
bHCG, AFP, inhibin A, unconjugated oestrogen
diagnostic tests for downs
chorionic villous sampling 12 weeks 2% risk of miscarriage
amniocentesis 15 weeks 1% risk
dx of GTT
screened for GTT at booking and at 28 weeks
dx at 28 weeks fasting >5.1 2 hour >8.5
aim for diabetes
3.5-5.9 fasting
1 hr post prandial <7.8
regular monitering in diabates
for PET
growth 2-4 weekly FATs from 28 weeks or dx
IUGR assym
sym
placental insufficeicney
baby just small
risks of IUGR
hypoxia, hypoglycaemia, hypothermia, polycythaemia, abnormal neural development
treatment of stress incontinance
physio
lose weight
caffeine
smoking
treatment of urge incontincence
avoid caffeine
bladder retraining
oxybutinin
overflow incontinance
assess renal function
catheter
menopause av
early
prem
late
51
45
40
54
HRT
oral or combined transdermal coestradiol and prog
if no uterus then just oestrogen
prem manopause
urogenital
vaginal dryness
sexual dysf
steroid and HRT or CoC
vaginal oestrogens if atrophy
moisturise, lubrincants, vaginal oestrogen
prog off licence
benefits of HRT
risks
decrease fragility fractures, decrease bowel cancer, effect on muscle mass and strength
VTE (oral>transdermal), increased risk of breast cancer, CHD and stroke
anterior cystocele
middle/apical - enterocoele
retrocede - posterior
complete eversion
prolapse of bladder into vagina
herniation of pouch of douglas into vagina
prolapse of rectum into vagina
uterine procidentra
RF for prolapse
age
vaginal deliveries
increased parity
increased BMI
staging for prolapse
0 no 1 >1cm above hymen (pos) 2 within 1cm 3 1-2cm below (neg) 4 eversion
when can’t breast feed
8 units of alcohol
cocaine
HIV
baby blues when
days 3-10
self limiting
post natal depression when
2-6 weeks
lasts weeks to months. 1/3 up to a year
70% lifetime risk of depression
25% recurrance
drugs for depression in preg
sertalline safe in BF
TCAs amitrip, nortryp safe in preg and ok in BF
venlafaxine
paroxetine
citalopram and fluoexetine
htn
cardiac abnormalities
high levels in breast milk
purpueral psychosis when
RF
2 weeks
BPD, prev, first relative with history
5% suicide risk 4% infantcide risk
80% 10 yr recurrence 25% develop BPD
BPD which drug is the safest
lamotrigene
risk of baby developing BPD
1/7
risk of schiz to child
10%
whats safe in schiz
whats unsafe
typical
atypicals gestational GM, IUGR
clozapine
olanzapein
contraindicated in BF
can induce extrapyramidal reactions in BF babies
avoid what in anxiety
benzos- cleft lip and neonatal withdrawal
RF for cervical cancer
HPV (lots of sexual partners), age at first intercourse, long term use of PO contraceptives, no use of barrier contraception, smoking, immunosuppression
cervical cancer staging
1AI depth 3mm length 7mm 1AII depth 5mm length 7mm low risk of LN mets 1B confined to cervix 2a vaginal involvement 2b parametrial involvement 3 lower vagina/pelvic wall 4 bladder/rectum/mets
cervical local spread
lymph
heam
uterine body, vagina, bladder, ureters, rectum
pelvic and para aortic early
liver, lungs, bones late
cervical screening
25-64
every 3 years up to 49 then 5 yearly
HPV vaccine
against 16 18 6 and 11
girls aged 11-13, MSM, HIV px
cervical erosion
exposure of endocervical epithelium to acid of vagina - physio
squamous metaplasia v common
nabothian follicles
endocervical glands that have expanded into mucous cysts
can form masses or polyps
follicular cervitis
subepithelial reactive lymphoid follicles present in cervix
endometrial adeno
worse prognosis high SE status later onset of sexual activity smoking HPV esp 18
vulval intraepithelial neoplasia young women
elderly women
multifocal, recurrent or persisten causing treatment problems
greater risk of progression to invasive squamous
spread to what is an important prognostic factor in vulvar squamous carcinoma
inguinal nodes
pagets of vulvar is what
crusting rash. rumour cells in epidermis. contain mucin. pain itching
tumour arises from sweat glands in skin
excise
type 1 endometrial cancer
endometroid and mucinous (always low grade)
unopposed oestrogen
precursor is atypical hyperplasia
type 2 endometrial cancer
serous
clear cell
both high grade
precursor serous intraepithelial carcinoma
obesity is a risk factor for endom cancer how
adipocytes contain aromatise that converts ovarian androgens to oestrogens which induce endometrial proliferation
grading of endometriod
I 5% or less solid growth
II 6-50%
III >50%
staging of endometrial cancer
IA <50% mymoetrial invasion
IB =>50%
2 cervical stroma
3 local and or regional spread
3A serosa of uterus and or adnexae
3B vaginal and or parametrial involvement
3C mets to pelvic and or para aortic nodes
4 bladder and or bowel mucosa and or distant mets
endometrial stromal sarcoma
rare soft fleshy usually polypod masses
high grade
abnormal uterine bleeding but can present with lung/ovarian mets
carcinosarcoma
mullerian
mixed epithelial and stromal
presence of what worsens prognosis of mullerian
rhabdomyosarcomatrus
