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GOSH > TOP & Infertility > Flashcards

TOP & Infertility Flashcards

1
Q

What is the upper gestational limit?

A

24weeks

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2
Q

Who needs to sign an abortion certificate?

A

2 registered medical practitioners

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3
Q

On a TOP form what is the most common reason?

A

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

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4
Q

What does section 4 of the abortion act exempt doctors from if they wish?

A

Not to participate in administering treatment

Not sign the abortion act certificate

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5
Q

What does section 4 of the abortion act not exempt doctors from?

A

Giving advice
Facilitating a referral
Preparing steps for a TOP

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6
Q

How soon after a termination can contraception be initiated?

A

Apart from sterilisation all can be done the same day

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7
Q

What are the methods of TOP?

A
  • 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
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8
Q

What medication is used for an early medical TOP?

A

Mifepristone 200mg PO wait 36-48hours then Misoprostol 800mcg PO/PV

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9
Q

What are the main causes of infertility?

A

Unexplained
Male factors
Ovulatory disorders

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10
Q

What are the types of ovulatory disorders?

A

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)

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11
Q

What is the process of IVF?

A

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

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12
Q

What is the difference between IVF & ICIS?

A

In ICIS one sperm is injected into the egg

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13
Q

How is female fertility preserved?

A

Ovarian suppression

Freezing eggs

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14
Q

How is ovarian suppression achieved?

A

GnRH analogues only used for 6months usually only for chemo patients, takes 2weeks

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15
Q

Can frozen eggs be used in IVF or ICIS?

A

If eggs are frozen then it makes the outer shell harder therefore ICIS must be used IVF won’t work

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16
Q

What are the causes of female infertility?

A 
Tubal disease
Infection: TB, Chlamydia, Gonorrhoea
Cervical/uterine abnormalities
Ovulatory dysfunction*
Unexplained
PCOS
17
Q

How does ovulatory dysfunction lead to infertility?

A

Hypo-gonadotrophic anovulation occurs as a result of hypothalamic or pituitary abnormalities. Hyper-gonadotrophic anovulation occurs as a result of ovarian failure.

18
Q

How does tubal disease lead to infertility?

A

Most often caused by infection. High anti-chlamydial antibody titres highly correlate to abnormal tubal pathology.

19
Q

How is infertility diagnosed?

A

Failure to conceive after 2years of regular unprotected sex in the face of normal investigations

20
Q

How is female infertility investigated?

A

Luteal phase: <9.5 anovulatory
Urinary LH: +Ve = ovulation
TVUS: PCOS cysts, abnormal structure
HyCosY: Blocked fallopian tubes

21
Q

How is female infertility managed?

A 
Weight gain/loss
Moderate exercise
Pulsatile administration of GnRH-induce ovulation
Clomifene Citrate (<6months)
Ovarian drilling
Tubal microsurgery/cannulation
22
Q

What are the causes of infertility in men?

A 
Abnormal spermatogenesis*
Reproductive tract anomalies
Obstruction
Impaired sperm motility
Sexual/ejaculatory dysfunction
Hypogonadism
23
Q

Which cells produce testosterone & which support spermatogenesis? What are they influenced by?

A

Testosterone: Leydig cells
LH
Spermatogenesis: Sertoli cells
Testosterone & FSH

24
Q

How is infertility in men investigated?

A 
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
25
Q

How is infertility in men managed?

A

Gonadotrophin

Surgical correction of epididymal bloackge

26
Q

What is a molar pregnancy?

A

moles are chromosomally abnormal pregnancies that have the potential to become malignant (gestational trophoblastic neoplasia or GTN).
Hydatidiform- Arise from placental abnormalities

27
Q

What causes a molar pregnancy?

A

AKA Hydatidiform moles Excess paternal chromosomes
Abberant mitochondrial DNA
Certain oncogenes (p53, EGFR5)

28
Q

What are the 2 types of molar pregnancy?

A

Complete: 46XX/46XY karyotype entirely from paternal DNA
Partial: 69XXX/69XXY karyotype with maternal & paternal DNA

29
Q

How does a complete molar pregnancy occur?

A

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.

30
Q

How does a partial molar pregnancy occur?

A

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.

31
Q

What are the RFs for a molar pregnancy?

A

Extremes of maternal age

Prior GTD

32
Q

How is a molar pregnancy investigated?

A

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

33
Q

How is a molar pregnancy managed?

A

Dilation & evacuation (hysterectomy if not desiring fertility)
Supportive care
Oral/intrauterine contraception

34
Q

What are the complications of a molar pregnancy?

A

Pre-eclampsia
Asherman’s Syndrome
Invasive GT neoplasia (complete>partial)

35
Q

What are the signs & symptoms of premature ovarian failure?

A

<40yrs old
Amenorrhoea
Menopause symptoms
Bloods: LH & FSH ↑, Estradiol ↓/n

36
Q

What are the causes of premature ovarian failure?

A 
Idiopathic
Chromosomal: Down's, Turner's, Fragile X
Enzyme deficiencies
Autoimmune
RT &amp; chemo
37
Q

How is premature ovarian failure managed?

A

Pregnancy: IVF w/donor eggs

HRT- oestrogen deficiency (protect against osteoporosis)

GOSH (17 decks)

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