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Medicine Year 2 > Repro Topic 3 - General Reproduction > Flashcards

Repro Topic 3 - General Reproduction Flashcards

1
Q

What causes stillbirth?

A
  • Maternal
    • Haemorrhage, diabetes mellitus, hypertensive pregnancy disorders, uterine rupture, advanced age, heavy smoking
  • Foetal/placental
    • Intrauterine growth retardation (placental insufficiency), placental abruption, infection, chromosomal abnormalities, congenital abnormalities, placental/umbilical complications, foetal hydrops
  • Miscellaneous
    • Unknown (50%), environmental factors
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2
Q

Describe the cause and presentation of dihydrotestosterone

A
  • Occurs in small population in Dominican Republic
  • No 5 alpha reductase gene (needed in the conversion of testosterone to dihydrotestosterone)
  • XY children appear female - have blind vaginal pouch, enlarged clitoris and internal testes
  • At puberty - testosterone wave, secondary sex characteristics develop (penis etc.)
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3
Q

Describe the cause and presentation of Turner’s syndrome

A
  • XO genotype
  • Primordial germ cells degenerate after arrival at genital ridge
  • Causes failure of gonadal development - infantile genitalia, mesonephric duct regression, large hands, webbed neck
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4
Q

Define early pregnancy loss/early miscarriage

A

Loss of pregnancy in the first 12 weeks

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5
Q

Describe hormone therapy for transwomen

A
  • Oestradiol valerate 1-2mg daily or oesdradiol 50meg/day transdermal patch
  • Increase to 4-6mg daily or 100-200meg patch
  • Anti-androgens
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6
Q

Describe the formation of the male urethra

A
  • Androgens from testes cause genital tubercle to elongate into phallus
  • Pulls urethral folds forwards, form lateral walls of urethral groove, close over urethral plate to form penile urethra
  • Terminal part of male urethra (external urethral meatus) from surface ectoderm
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7
Q

What are the consequences of Klinefelter’s syndrome?

A
  • Leydig cells have low testosterone production, so low sperm production
  • Causes infertility, gynaecomastia, impaired sexual maturation
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8
Q

What complications can arise from the treatment of cryptorchidism?

A
  • Haematoma
  • Pain
  • Wound infection
  • Testicular atrophy
  • Recurrent cryptorchidism - infertility
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9
Q

What questions should be asked when taking the history of an infertile couple?

A
  • Age
  • Personal and family history, congenital abnormalities
  • Male
    • Occupation
    • Previous children
    • Injuries
  • Female
    • Previous births/termination/miscarriages and complications
    • Smears
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10
Q

Define miscarriage/spontaneous abortion

A

Loss of pregnancy in first 24 weeks

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11
Q

How may disorder of sex development present in a newborn?

A
  • Overt genital ambiguity
  • Apparent female genitalia - enlarged clitoris, posterior labial fusion, inguinal/labial mass
  • Apparent male genitalia - bilateral undescended testes, micropenis, hypospadias
  • Family history of DSD
  • Discordance between genital appearance and prenatal karyotype
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12
Q
A
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13
Q

What structures develop from the paramesonephric (Mullerian) duct? How?

A
  • Form the uterine tubes, uterus, vaginal canal
  • Develop lateral to the gonads and mesonephric duct
  • Responds to oestrogen
  • Funnel-shaped cranial ends open into peritoneal cavity = infundibulum of uterine tubes
  • Migrate caudally, parallel to mesonephric ducts
  • Approach each other at midline - cranial = uterine tubes, caudal = uterovaginal primordium
  • Males - degenerate due to anti-Mullerian hormone produced by Sertoli cells
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14
Q

List the ways in which missed/incomplete miscarriages are managed?

A
  • Expectant management
  • Medical management e.g. misoprostol
  • Surgical management
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15
Q

When is chromosomal/genetic sex determined?

A

At fertilisation - XX is female, XY is male

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16
Q

What are the effects of oestrogen on transwomen?

A
  • Breast growth
  • Softer skin
  • Less facial/body hair
  • Fat redistribution to hips
  • More emotional
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17
Q

What is a missed miscarriage?

A
  • Unrecognised intrauterine death of the embryo or foetus without loss of the pregnancy from the body
  • 15% of clinically diagnosed pregnancies
  • Women may have no self awareness due to lack of obvious symptoms - may still experience sickness, tender breasts, tiredness (typical of pregnancy)
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18
Q

Which structures contribute to the developing bladder?

A

Anterior urogenital sinus and the caudal parts of the mesonephric duct

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19
Q

When is sex determined?

A
  • Genetic sex is determined at fertilisation
  • Gonads differentiate into male or female at week 7
  1. Genital duct development
  2. Gonadal development
  3. External genitalia development
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20
Q

What preventative measures should be taken in those who have undergone gender reassignment?

A
  • Smears - FTM if cervix still present
  • Prostate cancer screening
    • MTF less risk due to oestrogen and anti-androgen, screen as for non-trans males
  • Breast cancer screening
    • FTM still some breast tissue - self-examination, refer breast lumps as usual
    • MTF - offer breast screening
  • General health monitoring - blood pressure, LFTs, hormone levels etc.
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21
Q

What are transvaginal scans used for?

A
  • Antral follicle count
  • Normal = 6-8
  • More - polycystic ovaries
  • Less - older/infertility
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22
Q

List the features of testicular dysgenesis syndrome

A
  • Hypospadias
  • Micropenis
  • Low semen quality
  • Testicular cancer
  • Cryptorchidism
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23
Q

What is the cause of hypospadias?

A

Usually no specific underlying cause - associated with testicular dysgenesis syndrome, gives higher risk of cryptorchidism/inguinal hernias etc.

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24
Q

What are the complications of ectopic pregnancy?

A
  • Main risk = rupture of uterine tube
    • Sharp, sudden and intense pain in abdomen
    • Dizziness
    • Nausea
    • Pallor
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25
Q

What is a hydrocoele and how can it be identified?

A

Excess fluid in the tunica vaginalis

Transluminate - red colour

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26
Q

When do the genital ducts develop?

A

Week 5-6

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27
Q

Define cryptorchidism

A

Impalpable or undescended (can be felt in abdominal cavity) testes (bilateral or unilateral)

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28
Q

When does the mesonephros become the metanephros?

A

Metanephros appears at week 5, becomes functional at week 11

Definitive kidney - produces small amounts of urine

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29
Q

How is HPO dysfunction treated?

A

Clomid/letrozole/metformin/gonadotrophins

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30
Q

Describe the somatic cells of the developing male gonads

A
  • Somatic cells - Leydig (testosterone producing) and Sertoli (anti-mullerian hormone producing) cells
  • Sertoli cells are present antenatally then disappear until puberty
  • Leydig cells disappear after week 17/18 - don’t reappear until puberty
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31
Q

How is termination of pregnancy for foetal anomaly carried out?

A
  • Medical (early gestation) - mifepristone and misoprostol
  • Surgical - dilation of cervix and removal of foetus and placenta (safer in 2nd trimester than medical)
  • Induction of labour and delivery of the foetus and placenta
  • Should be offered choice wherever possible
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32
Q

Describe the classification of cryptorchidism

A
  • Position (abdominal, inguinal, prescrotal)
  • Position over time
  • Aetiological factors
  • Rectractile? - not usually a problem, can become fully retracted and need treatment
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33
Q

What surgery is available for transwomen?

A
  • Thyroid chondroplasty (Adam’s apple)
  • Penectomy, orchidectomy, clitoroplasty, vulvoplasty and penile inversion vaginoplasty
  • Colovaginoplasty
  • Breast augmentation
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34
Q

What are the male and female genital ducts?

A

Paramesonephric (Mullerian) ducts = female

Mesonephric (Wolffian) ducts = male

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35
Q

How does the indifferent embryo become female?

A
  • No SRY (XX)
  • Active signals e.g. Wnt (silenced in males)
  • Primordial germ cells migrate to genital ridge, surface epithelium develops and proliferations (not as tough as males as gonads are internal so require less protection)
  • Primordial germ cells develop into a pool of oogonia via mitosis, enter mitotic arrest at 4th month as oocytes (Prophase II)
  • Oocytes become associated with follicular cells - primordial follicles
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36
Q

How do the external genitalia form?

A
  • 2 cloacal folds develop around the cloacal membrane - join cranially to form the genital tubercle
    • Genital tubercle = phallus in males, clitoris in females
  • Caudally stay divided
    • Urethral folds in front - labia minora in females
    • Anal folds behind
    • Genital swellings around urethral folds - form scrotal swellings in male, labia majora in females
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37
Q

How is an endometrial scratch used to treat infertility?

A
  • Offerred if recurrent implantation failure
  • Scratch endometrium to help implantation
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38
Q

How is testicular cancer identified?

A

Hard lump on testes

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39
Q

What is epididymitis?

A

Inflammation of epididymis due to infection, can lead to orchitis

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40
Q

Describe the WHO criteria for normal semen

A
  • Volume = 1.5ml
  • pH 7.2
  • Sperm concentration = 15 million per ml
  • Total count = 39 million per ejaculate
  • Motility = 40% progressive and non-progressive movement, 32% progressive
  • Viability = 58% live spermatozoa
  • Morphology = 4% normal forms
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41
Q

When does external genitalia in males and females occur?

A

Week 3

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42
Q

Describe the development of the gonads before differentiation into male and female

A
  • Pair of longitudinal ridges (week 5 - indifferent) - urogenital/gonadal ridges
  • Mesoderm projects into coelonic cavity
  • Primordial germ cells originate from yolk sac, move to genital ridge via dorsal mesentery - forms primitive gonad
  • Need to move by week 6, if not will be infertile
  • Gonad indifferent until week 7
  • Primordial germ cells form primitive sex cord
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43
Q

List the kidney precursors which arise during development

A
  • 3 sets of kidney structures during development - formed cranial to caudal
  1. Pronephros - cervical
  2. Mesonephros - abdominal
  3. Metanephros - pelvic
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44
Q

What investigations should be done in men experiencing infertility?

A
  • Semen analysis
  • Urology examination to look for blockage in epididymis
  • CF screening
  • Y chromosome deletion diagnosis
  • Karyotyping
  • Baseline FSH - are sperm being produced?
  • Surgical sperm removal from testes/epididymis - used in ISCI
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45
Q

Describe medical management of incomplete/missed miscarriages

A
  • Administer misoprostol vaginally/orally
    • Side effects - pain, fever, diarrhoa and vomiting
  • Give information/support about length/extent of bleeding to expect
  • Offer pain relief and anti-emetics
  • If bleeding doesn’t occur within 24 hours further treatment required
  • Less invasive, more autonomous and feels more natural than surgical intervention
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46
Q

Define transgender

A

Alteration in perception of ones gender from that assigned at birth

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47
Q

What is a complete miscarriage?

A

All pregnancy tissue has left body

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48
Q

What is the ureteric bud?

A

Protrusion of the mesonephric duct, allows drainage of urine

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49
Q

Define dual role transvestism

A

Wearing clothes of opposite sex for part of the individual’s existence to enjoy the temporary experiecne of membership of the opposite sex, without desire for more permanent sex change of associated surgical reassignment, and without sexual excitement accompanying the cross-dressing

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50
Q

Describe the hormonal therapy regime for transmen

A
  • Sustanon 125mg IM injection 3x weekly
  • Testosterone gel 20-25mg daily
  • Nebido 1000mg 12 weekly
  • Dose increased with time
  • Suppress menstruation:
    • GnRH analogues
    • Contraception - progesterone only e.g. Depo provera or implant
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51
Q

How is HPO failure treated?

A

Pulsatile GnRH or gonadotrophins with LH

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52
Q

What structures develop from the mesonephric (Wolffian) ducts? How are these structures formed?

A
  • Forms the ductus deferens, ejaculatory ducts and the epididymis under the influence of testosterone
  • Testosterone produced under influence of male genes
  • Females - low testosterone levels, mesonephric duct disappears
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53
Q

What is the cause and presentation of testicular feminising syndrome?

A
  • XY genotype - mutation on X causes deficiency in androgen receptors
  • Testes produce testosterone but it can’t act on target tissues
  • Female external phenotype, internal testes
  • Uterus and upper vagina degenerate due to the presence of AMH
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54
Q

What are the differences between direct and indirect inguinal hernias?

A
  • Inguinal hernia indicated by a lump you can’t get above
  • Indirect - in infancy, inguinal ring fails to close in utero
  • Direct - adulthood, occurs when wall of abdominal wall become weak
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55
Q

How is ectopic pregnancy treated?

A
  • Dependent on symptoms, size of pregnancy and level of HCG
  • Expectant - close monitoring, chance pregnancy will end itself
  • Medical - methotrexate
    • Interferes with folate levels, stops development of the foetus which is then reabsorbed by the body
    • Used when HCG levels are low - no risk of rupture
    • Must avoid pregnancy for next 3 months to allow folate levels to return to normal
  • Surgery - removal or pregnancy, usually along with affected ovarian tube, keyhole
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56
Q

How many pregnancies/infants are lost?

A

1 in 4

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57
Q

How does the indifferent embyro become male?

A
  • Male embryo - Y chromosome codes for testis (SRY gene) and SOX-9
  • SRY acts on somatic cells to produce hormones, determine gonadal development and proliferation of sex cords
  • Sex cords become horseshoe shaped, made of primitive germ cells and somatic cells, break up into tubercles
  • Dense connective tissue (tunica albuginea) forms
  • Also under control of steroidogenic factor 1 (SF-1) and Wilms tumour (WT1) genes
58
Q

Describe the classifications of anovulation

A
  • Group 1 - HPO failure
  • Group 2 - HPO dysfunction (e.g. polycystic ovaries)
  • Group 3 - ovarian failure (e.g. Turner’s syndrome)
59
Q

List the types of miscarriage

A
  • Threatened
  • Complete
  • Missed
  • Incompletel
60
Q

Describe expectant management of missed/incomplete miscarriages

A
  • For up to 4 weeks - wait for full miscarriage to occur
  • Can cause uncertainty/anxiety
  • Some prefer as it allows a more natural conclusion
61
Q

How are hypospadias treated?

A
  • Surgery - use tissue from foreskin
  • Hormonal treatment prior
  • Side effects - scarring, curvature, strictures, fistulas
62
Q

How is a missed miscarriage diagnosed?

A
  • Often not picked up until 1st ultrasound scan
    • Empty amniotic sac - anembryonic pregnancy
    • No heartbeat
63
Q

When is gonadal sex determined?

A

When undifferentiated structures become the ovary or testis, occurs 9-16 weeks after fertilisation

64
Q

Define transsexual

A

Undergoing treatment/alteration to align body image/sense of self with physical form

65
Q

Where are the male accessory glands derived from?

A

Prostate and bulbourethral glands from the penile urethra

66
Q

List the patient signs/symptoms which indicate stillbirth

A
  • Decrease in foetal movements or a change in pattern of movements (hard to ascertain in early pregnancy)
  • Leaking fluid from vagina or unusual discharge - infection or waters have broken early
  • Symptoms of pre-eclampsia -
    • Severe headaches
    • Vision problems
    • Sudden swelling of feet, ankles, hands and face
    • Pain below ribs
  • Vaginal bleeding - problem with placenta
  • Severe pain or contractions, may indicate early labour or placental problem
67
Q

Describe the aftercare required following medical management of an incomplete/missed miscarriage

A
  • Take urine pregnancy test 3 weeks after medical management of miscarriage unless they experience worsening symptoms - return to early pregnancy unit
    • Positive test - return for reveiw to ensure there is no molar/ectopic pregnancy
68
Q

How does the cloaca develop?

A
  • Weeks 4-7, urorectal septum divides the cloaca by fusion with the cloaca membrane to form:
    • Anterior urogenital sinus - becomes bladder
    • Posterior rectal/anal canal
69
Q

List the causes of miscarriage

A
  • Foetoplacental - chromosomal/congenital abnormalities
  • Abnormalities of the reproductive organs - septate uterus, uterine leiomyomas, uterine adhesions, cervical imcompetence
  • Systemic disease - diabetes mellitus, hypo/hyperthyroidism, genetic disorders, infections, hypercoagulability
  • Miscellaneous - trauma, amniocentesis/CVS, environmental factors, unknown
70
Q

What investigations should be carried out on a woman experiencing infertility?

A
  • In those with regulatory cycles take mid-luteal progesterone (day 21)
  • Ultrasound to check antral follicle count
  • Anti-Mullerian hormone
  • FSH (day 1-3), LH (day 1-3), prolactin, sex hormone binding globulin (SHBG), testosterone
    • FSH should be 1.5x LH, if LH>FSH polycystic ovaries
71
Q

When does the developing kidney become functional?

A

Begins partially functioning as the mesonephros in week 5 (no urine production), becomes fully functional as the metanephros in week 11

72
Q

Define stillbirth/intrauterine foetal demise

A

Death after 24 weeks of pregnancy, before or during birth

73
Q

From where is the urethra derived?

A

From middle pelvic part of ureogenital sinus

74
Q

What causes cryptorchidism?

A

Cause unclear - environmental e.g. phthalates?

75
Q

What is a varicocoele?

A
  • Enlargement of the veins in the scrotum
  • Infertility, failure of development of testes, testes shrink
  • Feels like bag of worms on posterior testes
76
Q

Describe the structure of the metanephros

A

2 parts:

  1. Ureteric bud
  2. Metanephric cap - mesenchyme
77
Q

Describe the prevalence of cryptorchidism

A

Normal birthweight 2-8%

78
Q

Define hypospadias

A
  • Most common penile anomaly
  • Ectopically positioned urethral meatus - proximal or ventral, if severe opens onto scrotum
79
Q

Define recurrent pregnancy loss

A

3+ consecutive pregnancy losses

80
Q

What is gender identity and when is it established?

A

The development of strong feelings of being male or female, occurs in childhood (or earlier?)

81
Q

At what age can transgender patients consent to surgery?

A

18

82
Q

Describe the abnormal morphologies of sperm

A
  • Giant
  • Microsperm
  • Double head/body
  • Long head
  • Rough head
  • Abnormal midpiece
83
Q

How common is infertility?

A

1 in 7 heterosexual couples have problems

84
Q

What structural abnormalities are often seen with hypospadias?

A

Penile chordae (bend) and hooded foreskin are common

85
Q

What investigations are done to diagnose cryptorchidism?

A
  • Ultrasound
  • CT/MRI
  • Laparoscopy
  • Biochemical tests - testosterone secretion
  • Karyotype? (may be due to a genetic disorder)
86
Q

What is the effect of cystic fibrosis on reproduction?

A
  • Men
    • Infertiliy - aspermia, absences of vas deferens
  • Women
    • Amenorrhoea
    • Delayed puberty
87
Q

Describe the transabdominal phase of testicular descent

A
  • Testes enlarge as mesonephric kidney regresses
  • Anchored above by cranial suspensory ligament, below by gubernaculum (derived from urogenital mesentery)
  • Gubernaculum swells under control of insulin-like peptide 3 and receptor LGR8 produced by Leydig cells
  • Serotoli cells produces AMH causing mullerian duct atrophy, allows testes to move transabdominally to deep inguinal ring
88
Q

List the lifestyle factors which can affect fertility

A
  • Smoking
  • Alcohol
  • Recreational durgs - not eligible for NHS treatment
  • STIs - chlamydia, gonorrhoea are common
  • Driving - long distance reduces sperm quality
  • Toxins, radiation
  • Tight garments
  • Drugs - antipsychotics, aspirin, caffeine
89
Q

List pregnancy loss support organisations

A

Miscarriage association

Tommy’s

SANDS

90
Q

What germ layer is the urogenital tract derived from?

A

Intermediate mesoderm

91
Q

How is a complete miscarriage managed?

A
  • No treatment required - pain relief recommended
  • May not report to GP/healthcare provider, especially if early in pregnancy
  • Ultrasound to confirm - uterus should be smaller than expected for gestational age
  • Check cervix is closed
  • Support given, signposting to support agencies
92
Q

List common disorders of sex development

A
  • Klinefelter’s syndrome
  • Testicular feminising syndrome
  • Turner’s syndrome
  • Dihydrotestosterone (DHT)
93
Q

What is required for conception to occur?

A
  • Holy triad - healthy/correct anatomy of ovary, uterine tubes and sperm
  • Healthy uterus and peritoneum
  • Functional HPO axis hormone production and other glands e.g. thyroid, pancreas
94
Q

Describe the descent of the testes

A
  • Begin high in abdomen - beside mesonephros (urogenital ridge), descend to scrotum
  • Begins in 8-10th week
  • 2 phases - transabdominal and inguinoscrotal
95
Q

What investigations should be done in infertility?

A
  • Rubella status
  • Chlamydia/gonorrhoea
  • BMI - has to be 18.5-30 for NHS treatment
  • Cervical smear
96
Q

How is IUI carried out?

A
  • If using donor sperm - aspermia or same sex couple
  • Sperm washed
  • Best quality inserted into uterus
97
Q

Describe the formation of the lower part of the vagina

A

2 outgrowths from urogenital sinus - sinovaginal bulbs, fuse to form vaginal plate, hollows to form cavity

98
Q

When is phenotypic sex determined?

A
  • Development of external and internal reproductive structures continues as male or female in response to hormones
  • Occurs 8 weeks after fertilisation
99
Q

How can fertility be preserved when a transgender person undergoes hormonal treatment?

A
  • FTM - collection and storage of oocytes, storage of embryo
  • MTF - collection and storage of semen
100
Q

What is done if the uterine tubes are blocked causing infertility?

A

IVF

101
Q

When does the pronephros becomes the mesonephros?

A

Pronephros regresses by week 4, replaced by the mesonephros in week 4 and 5

102
Q

Describe surgical management of an incomplete/missed miscarriage

A
  • If patient has significant maternal disease/heavy bleeding/septic then preferred option
  • When clinically appropriate, choice of
    • Manual vacuum aspiration under local anaesthetic in an outpatient/clinic setting
    • Surgical management in a theatre under general anaesthetic
  • Involves dilation of cervix, insertion of suction tube into uterus/instrumental removal of the pregnancy - tissue samples can be sent for pathology
103
Q

Describe the criteria for hormone therapy in transgender patients

A
  • Persistent, well-documented gender dysphoria
  • Capacity to make fully informed decision and consent for treatment
  • Appropriate age - if younger follow standards of care
    • Suspend puberty?
  • If significant medical/mental health concerns they must be well controlled
104
Q

In what circumstances can a GP prescribe a bridging prescription to a transpatient?

A
  • Patient is already self prescribing with hormones from an unregulated source
  • The blocking prescription is intended to mitigate a risk of self-harm or suicide
  • Doctor has sought the advice of a gender specialist and prescribes the lowest acceptable dose in the circumstances
105
Q

How is the function of the uterine tubes tested?

A
  • Laparoscopy
  • Histocontrast contrast sonography - dye and scan
  • Histrosal pingogram - X-ray with dye
106
Q

List the types of hypospadias

A
  1. Glanular
  2. Coronal
  3. Mid-shaft
  4. Penoscrotal
  5. Scrotal
  6. Perineal - most severe
107
Q

How is stillbirth diagnosed clinically?

A
  • Check for foetal heartbeat - not always diagnostic
  • Ultrasound
108
Q

What are the consequences of cryptorchidism?

A
  • Long term consequences on testicular function - low sperm count
109
Q

Define infertility

A

Inability to conceive after 1 year of unprotected sex

Unexplained infertility (25%) - inability to conceive after 1 year of unprotected sex in the absence of known causes of infertility in women of reproductive age

110
Q

How is the mesonephros formed?

A
  • Intermediate mesoderm from the upper thoracic and lumbar segments
  • Contributes to supporting cells to the genital ridge and ducts (develop into excretory ducts)
111
Q

What problems can be faced after gender reassignment surgery?

A
  • FTM
    • Urinary
      • Neo-urethral stenosis
      • Urethral fistula
    • Dislodgement of erectile cylinders
    • Mechanical failure of erectile mechanism - may need 10 yearly replacement
  • MTF
    • Urinary
      • Urinary spraying
      • Increased risk of UTI due to shortened urethra
    • Granulation tissue - silver nitrate cautery
    • Neovaginal hair growth
    • Vascular occlusion of arterial supply to neo-clitoris
    • Neovaginal stricture
    • Ongoing need for dilation
112
Q

Describe the inguinoscrotal phase of testicular descent

A
  • Controlled by androgens and calcitonin gene related peptide (CGRP) - from sensory nucleus of genitofemoral nerve (spermatic cord and round ligament)
  • Gubernaculum shortens and migrates
  • Testes in scrotum a few weeks before birth, slide down behind processus vaginalis through the inguinal canal
  • 28-35 weeks - gubernaculum moves upwards, allows further descent of the testes
  • May not have fully descended in premature babies
113
Q

How are disorders of sex development managed?

A
  • All newborn infants recieve male or female sex assignment
    • Avoid hasty decisions
    • Need multidisciplinary team
    • Strict confidence
    • Open communication
  • Management
    • Surgical
    • Sex steroid hormone replacement
    • Psychosocial management
114
Q

What is ectopic pregnancy?

A
  • Fertilised egg implants at location other than uterus - also known as pregnancy of unknown location
  • Risk to maternal life, pregnancy cannot be saved
115
Q

How is the HCG stimulation test carried out? What are the side effects?

A
  • Inject HCG - acts on the pituitary to produce LH, which increases testosterone secretion by Leydig cells
  • Helps testes descend spontaneously
  • Up to 25% reascend
  • Side effects
    • Pain
    • Penile growth
    • Behavioural problems
    • Low testicular volume in adulthood
116
Q

List the risk factors for cryptorchidism

A
  • Small birthweight (<2.5kg)
  • Prematurity
  • Maternal diabetes including gestational
  • Environmental factors e.g. smoking
117
Q

What are the risks of oestrogen hormone therapy?

A
  • Increased risk for venous thromboembolism (VTE)
  • Weight gain
  • Increased BP
  • Increased breast cancer risk
  • Migraines
  • Bone problems - osteoporosis
118
Q

Describe the process of IVF

A
  1. Give high dose of FSH and LH to woman - stimulates ovaries to produce eggs
  2. Carry out minor operation through vagina to collect aggs from ovaries
  3. Partner gives semen sample
  4. 25 sperm to each egg in test tube (or in ISCI - sperm injected into egg)
  5. When embryos form, 1/2 inserted and remainder frozen
119
Q

What might be the cause of lumps in the groin?

A
  • Inguinal hernia - direct or indirect
  • Femoral hernia
  • Varicocoele
  • Testicular cancer
  • Orchitis
  • Epididymitis
  • Hydrocoele
120
Q

How is the pronephros formed?

A

Intermediate mesoderm differentiates, divides, proliferates, arranged into 7-10 segments

121
Q

Describe the mechanism of action of misoprostol

A
  • Synthetic prostaglandin analogue
  • Induces cervical softening and uterine contractions
  • Potency depends on gestational age, cumulative dose and route of administration
122
Q

How is a threatened miscarriage managed?

A
  • Expectant management
  • If symptoms resolve - pregnancy continues
  • If symptoms progress - incomplete/complete miscarriage
    • Advise avoidance of strong physical activity
    • Weekly ultrasounds
    • Rule out treatable causes of vaginal bleeding
    • Watch and wait
123
Q

What are the risks of testosterone hormone therapy?

A
  • Polycythaemia
  • Liver dysfunction
  • Increased risk for cardiovascular disease
  • Weight gain
  • Diabetes
  • Mental health disturbance
124
Q

What causes Klinefelter’s syndrome?

A

XXY or XXXY genotype

125
Q

What is a threatened miscarriage?

A
  • Abnormal bleeding and abdominal pain while pregnancy continues
  • Vaginal bleeding common during early pregnancy, anything more than spotting during 1st trimester may be considered a threated miscarriage
126
Q

Who sets the guidelines for standard of care of transgender patients?

A

World professional association for transgender health

127
Q

What uterine/peritoneal disorders can cause infertility?

A
  • Endometriosis
  • Uterine anomalies - problems with conception or miscarriage
  • Endometrial deficits
128
Q

What is an incomplete miscarriage?

A

Loss of pregnancy tissue has occurred with bleeding and the cervix is dilated, but some of the tissue from the pregnancy still remains in the uterus

129
Q

What is the effect of testosterone on FTM transgender patients

A
  • Lower voice
  • Facial and body hair growth
  • Increased muscle bulk
  • Amenorrhoea
  • Clitoromegaly
  • Increased libido
  • Tendency to be more aggressive
130
Q

How is cryptorchidism treated?

A
  • Any undescended testes after 6 months should be referred for orchidopexy (surgery to bring testes into scrotum)
    • Done in several stages
    • 75-95% success
    • Ideally done at 6-18 months
    • Follow up 12 months later
  • Hormonal treatment - human chorionic gonadotrophin (HCG) stimulation test
131
Q

List the symptoms of ectopic pregnancy

A
  • Sometimes asymptomatic
  • Symptoms usually show at 4-12 weeks
  • Abdominal pain, low on one side
  • Vaginal bleeding or brown watery discharge
  • Pain in tip of shoulder - referred
  • Discomfort when urinating/defecating
132
Q

How are those on oestrogen hormone therapy screened for bone problems?

A
  • Osteoporosis screening if high risk for oesteoporotic fracture or prolonged periods of hypogonadism
  • Dexa scanning if no sex steriod for more than 12 months
  • Young people on hormone blockers have regular Dexa scanning and calcium/phosphate monitoring
133
Q

What is the cloaca?

A
  • Early intestinal, reproductive and urinary tract opening - formed from hindgut swelling
  • Contributes to future development of bladder
  • Starts with ectoderm/endoderm membrane covering
  • Endodermal lining
134
Q

How is stillbirth managed?

A
  • Delivery shouldn’t be rushed unless maternal health is at risk (pre-eclampsia/infection)
  • Spontaneous labour usually occurs within 2 weeks of foetal death
  • Most patients choose induction - length of time waited will impact condition of baby when delivered
  • Vaginal delivery safer than cesaerian section
  • Privacy and emotional support, acknowledgement of parental grief - cold cots, bereavement suite/midwife
  • Post mortem/examination of placenta to determine cause of death
135
Q

How is low sperm count treated?

A

Intracytoplasmic sperm injection

If no sperm - intrauterine insemination with donor sperm

136
Q

Describe the criteria for IVF treatment

A
  • Max 3 embryos ages 40-43
  • Max 2 embryos under age 40
  • Hepatits B/C and HIV testing done
    • Positive - can still be offered treatment, have to go to specialist unit
  • Have had no children previously - current or past relationships
  • Healthy weight - BMI of 18.5-30
  • Don’t smoking
  • Trying to get pregnant for 2 years
  • Haven’t got pregnant through 12 cycles of artificial insemination
137
Q

How is an incomplete miscarriage diagnosed?

A

Ultrasound to confirm presence of pregnancy tissue within uterus or cervix

138
Q

What are the differences between femoral and inguinal hernias?

A
  • Femoral
    • Bowel/fatty tissue through weak point in abdominal walls to femoral canal
    • More common in women
    • Lump on inner thigh/groin
  • Inguinal
    • Protrusion of abdominal cavity contents through inguinal canal
139
Q

What surgery is available for transmen?

A
  • Bilateral masectomy and male chest reconstruction
  • Hysterectomy and oophorectomy
  • Metoidioplasty - hypertrophied clitoris released and urethra redirected through
  • Phalloplasty - radial artery/pubic/thigh
140
Q

How is ectopic pregnancy diagnosed?

A
  • Vaginal ultrasound scan
  • HCG levels - often lower and slower to rise than in uterine pregnancy
  • If no location can be determined, exploratory surgery may be required
141
Q

How is ovarian failure treated?

A

Oocyte donation

Medicine Year 2 (41 decks)

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