Reproductive Gynaecology Tutorial

Question 1

what is the gold standard to exclude an ectopic pregnancy

Answer 1

transvaginal ultrasound (better to visualise uterus, tubes and ovaries and to see blood in peritoneum)

Question 2

what is crown rump length

Answer 2

from head to tail bone

measurement done until 12 weeks gestation, after this head diameter done

Question 3

what is an imcomplete miscarriage

Answer 3

a miscarriage that has happened in the past, can see small materials of conception on USS

Question 4

what is a threatened miscarriage

Answer 4

vaginal bleeding within 20 weeks gestation
unable to diagnose as foetal pole under 7mm
follow up TVUSS in 7-10 days

Question 5

is pain normal in early pregnancy

Answer 5

no

Question 6

what can you see in pregnancy on USS at 5, 6 and 7 weeks

Answer 6

5- gestational sac
6- yolk sac
7- foetal heart

Question 7

what is needed to diagnose an ectopic pregnancy

Answer 7

suboptimal rise of hCG

Question 8

how are ectopic pregnancies treated

Answer 8

methotrexate or surgery (laproscopy, salpingesctomy)

Question 9

what are the four management options for miscarriage

Answer 9

conservative- pass materials naturally, can take few days- 6 weeks, can take 2 weeks for bleeding to stop, dont use tampons, pregnancy test 2 weeks after miscarriage

medical - mifepristone orally (can take paracetamol for any cramp pains), 2 days lateral 4 misoprostol tablets vaginally, antibiotics and pain relief also given

surgical under general anaesthesia

manual vacuum aspiration

Question 10

when should a period return after a miscarriage

Answer 10

4-6 weeks

Question 11

what are the pros and cons of conservative miscarriage management

Answer 11

pros- avoids risks of surgery/ medical, can be at home, low risk of infection

cons- may need surgery/ medical management, bleeding and pain, may need transfusion/ emergency surgery for heavier bleeding

Question 12

what are the pros and cons of medical miscarriage management

Answer 12

pros- avoids risks of surgery/ anaesthesia

cons- infection, bleeding, incomplete procedure, may need emergency surgery, pain, GI side effects,

Question 13

what are the pros and cons of surgery under general anaesthesia miscarriage management

Answer 13

pros- definitive Tx, reduced heavy bleeding risk

cons- surgery and anaesthesia risk, imcomplete procedure, infection

Question 14

what are the pros and cons of manual vacuum aspiration miscarriage management

Answer 14

pros- quick, can go home quickly, than surgery, definitive

cons- pain, may not tolerate, risks of surgery (less risk of perforation), incomplete procedure, infection

Question 15

what creates anti D antibodies

Answer 15

feto maternal haemorrhage in women who are rhesus D (RhD) negative but are carrying a RhD positive fetus

Question 16

what can anti D antibodies cause in later pregnancy

Answer 16

can cross placenta and cause rhesus haemolytic disease

Question 17

when should anti D immunoglobulin be given

Answer 17

to all RhD -ve women in third trimester
or
within 72 hours of a sensitising event (invasive prenatal diagnosis, haemorrhage, ectopic pregnancy, IU death/ stillbirth, miscarriage, IU procedures, evacuation of a molar pregnancy, abortion, delivery)

Question 18

when is anti D Ig indicated in <12 weeks gestation

Answer 18

not for spontaenous miscarriage unless instrumentation/ medical evacuation

only indication <12 weeks for ectopic pregnancy, molar pregnancy, theraputic termination

Question 19

what determines the sex of a person

Answer 19

short arm of y chromosome- SRY transcription

Question 20

what pulls the testis in the scrotum

Answer 20

the gubernaculums

Question 21

what axis is disrupted in cryoptorchidism

Answer 21

the fetal hypothalamic pituitary testicular axis

Question 22

what is azoospermia

Answer 22

no spermatozoa

Question 23

what is the most common cause of male infertility

Answer 23

idiopathic

Question 24

what lifestyle factors can cause male infertility

Answer 24

drugs, obesity, smoking, alcohol, radiation, overheating

Question 25

what is the normal size of testes in adults

Answer 25

15-25 mls

Question 26

what can cause reduced testes size

Answer 26

spermatogenesis failure (cancer treatment), varicoele, klinefelters, undescended testes

Question 27

what would you expect an increase in in low testosterone

Answer 27

FSH

Question 28

what is the treatment for testicular failure

Answer 28

surgical sperm retrieval. Testosterone replacement. Screen for CF, chromosomal analysis for kleinfielters

Question 29

what are the phases of embryo development

Answer 29

zygote 
cell stage (days 1-3)
morula 
early blastocyst 
mid blastocyst 
late blastocyst (day 4)

Question 30

what are the success rates for sperm retrieval

Answer 30

if obstructive 95%, if non obtrusive then 33%

Question 31

when is menarche usually

Answer 31

12-13 years

Question 32

define primary amenorrhoea

Answer 32

failure of menses by 16

Question 33

what is the fourchette

Answer 33

rear rim of vulva

Question 34

what is an imperforate hymen

Answer 34

Congenital disorder, normal secondary sexual characteristics but primary amenorrhoea due to failure of hymen to perforate during development

Question 35

what is the treatment for a perforate hymen

Answer 35

COC back to back until hymenotomy surgery

Question 36

what are the possible long term complications of an imperforate hymen

Answer 36

vaginal infection, endometriosis, urine infection, peritonitis, gynaecological problems

Question 37

what are the physiological causes of amenorrhoea

Answer 37

low weight, excessive exercise, stress, pregnancy, menopause, breast feeding

Question 38

what are the most common causes of pathological amenorrhoea

Answer 38

hypothalamic dysfunction, ovarian failure, pituitary tumour

Question 39

what are the risks of ectopic pregnancy surgery

Answer 39

bleeding, infection, injury to bladder, bowel, blood vessels, ureter, uterine perforation, clots, hernias, pain / shoulder pain, brusing, wound gaping

Question 40

what are the pros and cons of blood transfusion

Answer 40

prompt Tx of Hb and symptoms, quicker recovery

risks- infection (bacterial and BBV), transfusion reaction, immunisation with antibodies (risk for future pregnancies/ transfusions), transfusion relates acute lunge injury