Reproductive Gynaecology Tutorial Flashcards
what is the gold standard to exclude an ectopic pregnancy
transvaginal ultrasound (better to visualise uterus, tubes and ovaries and to see blood in peritoneum)
what is crown rump length
from head to tail bone
measurement done until 12 weeks gestation, after this head diameter done
what is an imcomplete miscarriage
a miscarriage that has happened in the past, can see small materials of conception on USS
what is a threatened miscarriage
vaginal bleeding within 20 weeks gestation
unable to diagnose as foetal pole under 7mm
follow up TVUSS in 7-10 days
is pain normal in early pregnancy
no
what can you see in pregnancy on USS at 5, 6 and 7 weeks
5- gestational sac
6- yolk sac
7- foetal heart
what is needed to diagnose an ectopic pregnancy
suboptimal rise of hCG
how are ectopic pregnancies treated
methotrexate or surgery (laproscopy, salpingesctomy)
what are the four management options for miscarriage
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
when should a period return after a miscarriage
4-6 weeks
what are the pros and cons of conservative miscarriage management
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
what are the pros and cons of medical miscarriage management
pros- avoids risks of surgery/ anaesthesia
cons- infection, bleeding, incomplete procedure, may need emergency surgery, pain, GI side effects,
what are the pros and cons of surgery under general anaesthesia miscarriage management
pros- definitive Tx, reduced heavy bleeding risk
cons- surgery and anaesthesia risk, imcomplete procedure, infection
what are the pros and cons of manual vacuum aspiration miscarriage management
pros- quick, can go home quickly, than surgery, definitive
cons- pain, may not tolerate, risks of surgery (less risk of perforation), incomplete procedure, infection
what creates anti D antibodies
feto maternal haemorrhage in women who are rhesus D (RhD) negative but are carrying a RhD positive fetus
what can anti D antibodies cause in later pregnancy
can cross placenta and cause rhesus haemolytic disease
when should anti D immunoglobulin be given
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)
when is anti D Ig indicated in <12 weeks gestation
not for spontaenous miscarriage unless instrumentation/ medical evacuation
only indication <12 weeks for ectopic pregnancy, molar pregnancy, theraputic termination
what determines the sex of a person
short arm of y chromosome- SRY transcription
what pulls the testis in the scrotum
the gubernaculums
what axis is disrupted in cryoptorchidism
the fetal hypothalamic pituitary testicular axis
what is azoospermia
no spermatozoa
what is the most common cause of male infertility
idiopathic
what lifestyle factors can cause male infertility
drugs, obesity, smoking, alcohol, radiation, overheating
what is the normal size of testes in adults
15-25 mls
what can cause reduced testes size
spermatogenesis failure (cancer treatment), varicoele, klinefelters, undescended testes
what would you expect an increase in in low testosterone
FSH
what is the treatment for testicular failure
surgical sperm retrieval. Testosterone replacement. Screen for CF, chromosomal analysis for kleinfielters
what are the phases of embryo development
zygote cell stage (days 1-3) morula early blastocyst mid blastocyst late blastocyst (day 4)
what are the success rates for sperm retrieval
if obstructive 95%, if non obtrusive then 33%
when is menarche usually
12-13 years
define primary amenorrhoea
failure of menses by 16
what is the fourchette
rear rim of vulva
what is an imperforate hymen
Congenital disorder, normal secondary sexual characteristics but primary amenorrhoea due to failure of hymen to perforate during development
what is the treatment for a perforate hymen
COC back to back until hymenotomy surgery
what are the possible long term complications of an imperforate hymen
vaginal infection, endometriosis, urine infection, peritonitis, gynaecological problems
what are the physiological causes of amenorrhoea
low weight, excessive exercise, stress, pregnancy, menopause, breast feeding
what are the most common causes of pathological amenorrhoea
hypothalamic dysfunction, ovarian failure, pituitary tumour
what are the risks of ectopic pregnancy surgery
bleeding, infection, injury to bladder, bowel, blood vessels, ureter, uterine perforation, clots, hernias, pain / shoulder pain, brusing, wound gaping
what are the pros and cons of blood transfusion
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
