Reproduction medicine Flashcards
Rate of fetal anomalies is 2-5%
F (3-5%)
1/5 to 1/4 of women have miscarriage
T
1/10 of women develop pre-eclampsia
T
Full term (40 weeks gestation) is not inclusive of the 2 weeks after LMP
F (40 weeks gestation = 2 week post LMP + 38 weeks)
Very early preterm is 24-28 weeks & late preterm is 35-37 weeks
F (late preterm is 34-37 weeks)
It is common to feel excitement, tiredness and nausea in the 1st trimester
T
2nd trimester is from week 12-24
F (13-24)
During pregnancy, patient will have increased uterine blood flow (50mls/min to 500mls/min), constipation and higher risk of clotting.
T
In the 1st trimester, we need to do US scans ensure there is no physical deformity
F (anatomy scan is done in the 2nd trimester)
During the 3rd trimester, it is compulsory to have US scan to observe the placenta growth and location.
F (it is not compulsory)
Folic acid is best taken when the pregnancy test comes back positive.
F (neural tube is formed by 28 day, by then it may be too late.)
It is normal to gain >10kg during pregnancy especially if your BMI prior was >30
F (>30 BMI usually gain only 5-9kg)
For a smoker, switch to nicotine replacement therapy during pregnancy.
F (should quit, NRT is harmful)
Second to the baby, most weight gain is contributed to increase stores of fat, protein and other nutrients.
T (baby ~3.4kg, stores ~3.2kg)
The difference between DOMINO and ETH is the time difference required post delivery in hospital before heading home.
T (DOMINO - go home 6 hours postnatal while ETH - go home 1-2 days postnatal)
A moderate contraction last 30-60seconds.
T
The third stage of labour is the delivery of foetus only.
F (delivery of foetus to delivery of placenta)
The first vaccine is at 6 weeks.
F (8 week)
Puerperium is the period immediately after childbirth, when the womb is returning to its normal size, lasting approximately 8 weeks.
F (6 weeks)
Kegel exercise is recommended for woman postnatally.
T
After birth, the uterus shrinks from 1000g to a mere 350g by 6 weeks.
F (shrinks to 100-200g)
Immediately after delivery, uterus shrinks to level of umbilicus, then midway between umbilicus and symphysis by week 2 and finally to pelvis by week 4.
T
After birth, there will be constant volume of lochia up to 6 weeks.
F (lochia is reducing over 6 weeks)
Breast feeding acts as a contraceptive.
F (can still get pregnant)
Ovulation may return within 6-8 weeks in breastfeeding mothers.
F (in non-breastfeeding. breastfeeding preggos take longer time)
Oestrogen promotes lactation.
F (prolactin)
The AB in breast milk is only IgG
F (IgA and IgG)
Mother will produce colostrum for 48-72 hours
T
almost 50% of medicines taken during pregnancy is over the counter
T
Vitamins are not considered medication.
F
Thalidomide was marketed as an anti-emetic, anti-histamine and hypnotic. The critical period for exposure is 36-50 days menstrual age.
F (35-50)
25% of exposed children are affected
F (20%)
The mean age of diagnosis from DES syndrome is 18.9yo.
T
In females with DES syndrome, they have adenocarcinoma of ovaries, and structural genital tract anomalies
F (cancer is cervix/vagina, not ovaries)
Patients with hyperemesis gravidarum can be prescribe anti-psychotics.
T (anti-dopaminergic effect)
Anti-emetics are first line in treating morning sickness.
F (Give cariban. Only give anti-emetics if cariban doesn’t work)
Cariban is comprised of pyridoxine and doxylamine.
T (pyridoxine = Vitamin B6) (Doxylamine = histamine)
Conservative treatment of reflux includes drinking milk, gasvicon and ranitidine.
F (ranitidine H2 blocker and omeprazole PPI are medicinal approach)
Constipation in pregnant women should be treated with a stimulant, followed by a bulking agent.
F (do not give Senna!)
You can give Ca2+ and Fe2+ supplement to alleviate leg cramps.
T
In anaemic patients, give vitamin D and Ca2+
F (vitamin C helps iron absorption) (Ca2+ prevents iron from being absorbed)
Iron tablets work almost immediately to manage anaemia.
F (takes few weeks to work)
Iron infusion is the first choice for anaemia.
F (reserved for those with low iron stores and unable to tolerate PO iron)
Labetalol is safe for pregnant women.
T
What are the medication for epilepsy in a pregnant women?
Lamotrigine, Levetiracetam
What medication for epilepsy should be avoided?
Phenytoin, sodium valproate - causes foetal defect
In the ovarian cycle, how many primary follicles develop and on which day will there be a dominant follicle?
15-20
day 9
FSH surge promotes ovulation
F (LH surge)
What causes LH surge?
A rise in oestrogen in week prior to ovulation
Basal body temperature falls during ovulation and rise during menstruation
F (opposite)
What is the follicular and luteal phase?
Follicular phase = onset of menses till next LH surge
Luteal phase = LH surge till onset of next menses
Follicular phase is variable but luteal phase is constant (12-16 days)
T
Before ovulation, granulosa cells produce androgens and theca cells converts these androgens to oestradiol.
F (theca produce androgen, granulosa converts)
What happens when there is no implantation
Decrease in progesterone due to corpus luteum regression. Increase thromboxane and endothelin results in vasoconstriction. Decrease blood flow results in ischaemia/apoptosis of endothelium and sloughing and rupturing of spiral arteries (menstruation).
Ovaries and testes are formed from primordial germ cells that migrated from the yolk sac to gonadal ridge
T
Primordial follicle in a primary oocyte halted at prophase 2, surrounded by a single layer of flatted granulosa cell
F (prophase 1)
How many days does it take for spermatogenesis
70-75 days
how many days does it take to transport the sperm from epididymis to ejaculatory duct?
10-21 days
What are the layers a sperm has to penetrate?
corona radiate
zona pellucida
perivitelline space
vitelline membrane
Most eggs are fertilized in the fallopian tube
T
What are the 2 cell type of a fertilised eggs and what is their function
- inner cell mass “embryonic disc” - endoderm, mesoderm, ectoderm which will go on to form the baby
- Trophoblast - invades endometrium and form maternal venous sinuses to promote gas exchange, nutrient transfer, waste elimination
also secretes hormones (HCG, oestrogen, progesterone)
What are the 6 sites that an ectopic pregnancy can occur?
ovarian infundibular ampullar isthmic transmural cervical
the umbilical cord contains 2 veins and 1 artery
F (1 vein and 2 arteries)
The umbilical artery transport O2 and nutrients to the baby
F (transport CO2, waste etc, away from baby to placenta)
what ages does girl and boys have puberty?
8-14 girls
9-14 boys
What is the timing of puberty dependent on?
- genetics (50-80%)
- environment E.g. nutritional status (starved = later age)
- Leptin - regulates appetite and metabolism through hypothalamus
What causes the formation of adrenarche?
rise in adrenal and androgens
what are the stage in Marshal Tanner for both females and males?
too long…..
After menarche, we only increase 6% of final height.
F (4%)
Prepuberty, ovaries are what volume?
0.3-0.9cm3
What volume of ovaries indicates puberty has begun?
> 1 cm3
What volume are ovaries post-puberty?
4 cm3
Delayed puberty can only be caused by hypogonadism.
F (hypergonadism can also cause delayed puberty)
GH peaks at night.
T
What effects does GH has on male sex organ?
delay of puberty
diminished Leydig cell function
Decrease response to gonadotrophins
Precocious puberty is more common in males and usually benign.
F (less common, and mostly pathological)
What does menarche, adrenarche, thelarche, pubarche mean?
menarche - first menses
adrenarche - androgen dependent body change
thelarche - reast development
pubarche - first sign of pubic hair
Most follicles due to ovulation
F (from atresia, which accelerates with age, esp after 37)
High pearl index = more safe (less accidental pregnancy)
F (pearl index = number of unintended pregnancies per 100 women per year)
how does the COCP works?
it blocks FSH surge early in the cycle, hence no follicles become mature. Progesterone also makes cervical mucus more viscous)
What are CI of COCP?
Smoker (15 or more cigs/day for >35yrs) <6 weeks postpartum (if breastfeeding) >160/100bpm IHD Cirrhosis, liver failure Diabetes w complication Breast cancer
Benefits of COCP?
reduce ovarian, endometrial and colonic cancer
reduce benign breast disease
Chloasma will be reversed by stopping COCP
F (not always reversible)
If I miss 2 pills in the 3rd week, what should I do?
do not have 7 day break, start new pack
If I missed 3 pills, what should I do?
take emergency contraception
What is the more common flora of genital tract
lactobacilli
the normal vaginal pH is 3-5
F (3.5-4.6)
How does lactobacilli protects female genitalia?
It metabolises glucose to lactic acid and create a vaginal pH of 3.5-4.6. It also produce hydrogen peroxide that is bactericidal.
What are clue cells?
bacteria overwhelming vaginal epithelial cells till the point you cannot see the outline.
What are features in trichomonas vaginalis?
tail behind the cell
