TOP & Infertility Flashcards
What is the upper gestational limit?
24weeks
Who needs to sign an abortion certificate?
2 registered medical practitioners
On a TOP form what is the most common reason?
The pregnancy has not exceeded 24weeks and the continuance would involve risk greater than if the pregnancy were terminated of injury to the physical/mental health of the pregnant woman
What does section 4 of the abortion act exempt doctors from if they wish?
Not to participate in administering treatment
Not sign the abortion act certificate
What does section 4 of the abortion act not exempt doctors from?
Giving advice
Facilitating a referral
Preparing steps for a TOP
How soon after a termination can contraception be initiated?
Apart from sterilisation all can be done the same day
What are the methods of TOP?
- Early medical
- Late early medical
- Mid-trimester medical
- Manual vacuum aspiration
- Surgical evacuation under GA
- Dilatation/evacuation under GA
- Surgical evacuation without fetocide
- Surgical evacuation with fetocide
What medication is used for an early medical TOP?
Mifepristone 200mg PO wait 36-48hours then Misoprostol 800mcg PO/PV
What are the main causes of infertility?
Unexplained
Male factors
Ovulatory disorders
What are the types of ovulatory disorders?
Type I: Hypothalamic pituitary failure usually BMI<19, high exercise
Type II: Hypothalamic pituitary ovarian dysfunction- PCOS
Type III: Ovarian failure/Premature ovarian insufficiency (Fragile X, Turners)
What is the process of IVF?
1) Egg production stimulated by hormone therapy
2) Egg retrieved
3) Sperm sample provided (naturally swarms the egg and one implants)
4) Inserted into the uterus
What is the difference between IVF & ICIS?
In ICIS one sperm is injected into the egg
How is female fertility preserved?
Ovarian suppression
Freezing eggs
How is ovarian suppression achieved?
GnRH analogues only used for 6months usually only for chemo patients, takes 2weeks
Can frozen eggs be used in IVF or ICIS?
If eggs are frozen then it makes the outer shell harder therefore ICIS must be used IVF won’t work
What are the causes of female infertility?
Tubal disease Infection: TB, Chlamydia, Gonorrhoea Cervical/uterine abnormalities Ovulatory dysfunction* Unexplained PCOS
How does ovulatory dysfunction lead to infertility?
Hypo-gonadotrophic anovulation occurs as a result of hypothalamic or pituitary abnormalities. Hyper-gonadotrophic anovulation occurs as a result of ovarian failure.
How does tubal disease lead to infertility?
Most often caused by infection. High anti-chlamydial antibody titres highly correlate to abnormal tubal pathology.
How is infertility diagnosed?
Failure to conceive after 2years of regular unprotected sex in the face of normal investigations
How is female infertility investigated?
Luteal phase: <9.5 anovulatory
Urinary LH: +Ve = ovulation
TVUS: PCOS cysts, abnormal structure
HyCosY: Blocked fallopian tubes
How is female infertility managed?
Weight gain/loss Moderate exercise Pulsatile administration of GnRH-induce ovulation Clomifene Citrate (<6months) Ovarian drilling Tubal microsurgery/cannulation
What are the causes of infertility in men?
Abnormal spermatogenesis* Reproductive tract anomalies Obstruction Impaired sperm motility Sexual/ejaculatory dysfunction Hypogonadism
Which cells produce testosterone & which support spermatogenesis? What are they influenced by?
Testosterone: Leydig cells
LH
Spermatogenesis: Sertoli cells
Testosterone & FSH
How is infertility in men investigated?
Semen analysis: >1.5ml pH >7.2 Sperm morphology: >4% normal Conc: >15mill spermatozoa/ml Total no. :>39mill/ejaculation Motility: >40% or >32% progressive motility Vitality: >58% alive
How is infertility in men managed?
Gonadotrophin
Surgical correction of epididymal bloackge
What is a molar pregnancy?
moles are chromosomally abnormal pregnancies that have the potential to become malignant (gestational trophoblastic neoplasia or GTN).
Hydatidiform- Arise from placental abnormalities
What causes a molar pregnancy?
AKA Hydatidiform moles Excess paternal chromosomes
Abberant mitochondrial DNA
Certain oncogenes (p53, EGFR5)
What are the 2 types of molar pregnancy?
Complete: 46XX/46XY karyotype entirely from paternal DNA
Partial: 69XXX/69XXY karyotype with maternal & paternal DNA
How does a complete molar pregnancy occur?
The result of fertilisation of a chromosomally empty egg with a haploid sperm that then duplicates. Malignant transformation set apart by failure of serum beta hCG to return to normal levels after treatment of the mole.
How does a partial molar pregnancy occur?
This arises from fertilisation of a haploid ovum by a single sperm, and duplication of paternal haploid chromosomes.
Partial can contain components of a fetus, complete moles do not.
What are the RFs for a molar pregnancy?
Extremes of maternal age
Prior GTD
How is a molar pregnancy investigated?
beta-hCG: >100,000
FBC: anaemia
Serum PT, PTT: prolonged
Serum metabolic panel: renal/hepatic dysfunction
Pelvic USS: Abormal with uterine enlargement, ovarian cysts
CXR: Pulmonary nodules in malignant disease
Hist exam of placental tissue: Placental villi with irregular architecture, oedema with true villous cavitation, and trophoblast hyperplasia
How is a molar pregnancy managed?
Dilation & evacuation (hysterectomy if not desiring fertility)
Supportive care
Oral/intrauterine contraception
What are the complications of a molar pregnancy?
Pre-eclampsia
Asherman’s Syndrome
Invasive GT neoplasia (complete>partial)
What are the signs & symptoms of premature ovarian failure?
<40yrs old
Amenorrhoea
Menopause symptoms
Bloods: LH & FSH ↑, Estradiol ↓/n
What are the causes of premature ovarian failure?
Idiopathic Chromosomal: Down's, Turner's, Fragile X Enzyme deficiencies Autoimmune RT & chemo
How is premature ovarian failure managed?
Pregnancy: IVF w/donor eggs
HRT- oestrogen deficiency (protect against osteoporosis)
