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Repro and Sexual Health > Week 1 > Flashcards

Week 1 Flashcards

1
Q

Abortion is certified under a specific indication (5 clauses A-E), which clause are most abortions in the UK certified under?

A

Clause C

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2
Q

Describe clause C

A

Clause C: continuing the pregnancy would involve risk of injury to the physical or mental health of the pregnant women, or her existing children/family.
Gestational limit of 24 weeks

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3
Q

Describe clause E

A

There is a substantial risk that if the child were born it would suffer from physical or mental abnormalities aa to be seriously handicapped
There is no gestational limit

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4
Q

Describe a medical abortion

A

Mifepristone then misoprostol. A second dose of misoprostol can be given 24-48hrs later if expulsion has not occurred

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5
Q

What are the classifications of miscarriages?

A

Threatened miscarriage
Inevitable miscarriage
Incomplete miscarriage
Complete miscarriage
Missed miscarriage
Early fetal demise or NCP
Anembryonic pregnancy

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6
Q

What is the latest a spontaneous loss of a pregnancy is classed an early pregnancy loss?

A

before 13 weeks

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7
Q

In what classification of miscarriage is the os closed?

A

Threatened miscarriage

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8
Q

What is seen on speculum examination of an inevitable miscarriage?

A

Products are sited at the open os

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9
Q

What is seen on speculum examination of a complete miscarriage?

A

Products sited in the vagina and the os is closed

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10
Q

A patient presents with heavy vaginal bleeding. The internal os is open, and a fetus is seen on ultrasound. What type of miscarriage is this?

A

Inevitable miscarriage

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11
Q

What is the aetiology of a complete molar pregnancy?

A

In a complete molar pregnancy, a sperm fertilises an egg with no DNA

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12
Q

What is the aetiology of an incomplete molar pregnancy?

A

In an incomplete molar pregnancy, two sperms fertilise an egg

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13
Q

Define infertile

A

Inability to conceive after 12 months of regular intercourse without contraception

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14
Q

How common is infertility?

A

Infertility affects 1 in 6 couples

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15
Q

What is day 1 of the menstrual cycle?

A

The first day of bleeding

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16
Q

Which phase of the menstrual cycle is always 14 days long?

A

Luteal phase

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17
Q

When is the follicular phase?

A

From the first day of bleeding until she ovulates

18
Q

When is the luteal phase?

A

The 14 days after ovulation

19
Q

How does an ovulation prediction kit work?

A

It detects the LH surge

20
Q

Describe type 1 ovulatory disorders

A

Hypothalamic pituitary failure
- low levels of FSH and/or LH causing amenorrhoea
- can be caused by stress; excessive exercise; anorexia/low BMI; brain/pituitary trauma; head trauma; Kallman’s syndrome; drugs

21
Q

Describe type 2 ovulatory disorders

A
22
Q

Describe type 3 ovulatory disorders

A

Hyper-gonadotropic, hypoestrogenic anovulation
Caused by ovarian failure
Around 5% of women with ovulation disorders have a group III ovulation disorder

23
Q

What is the commonest reason for ovulatpry problems and what type of ovulatory disorder is it?

A

PCOS
type 2

24
Q

How do we induce ovulation?

A
  1. Clomifene citrate
    alternatively Letrozole/Tamoxifen
  2. Gonoadotrophin injections
  3. Laparoscopic ovarian diathermy
25
Q

What is the revised Rotterdam diagnostic criteria?

A

Must have 2 of 3:
1. Oligo/amenorrhoea
2. Polycystic ovaries (on USS)
3. Clinical and/or biochemical signs of
hyperandrogenism e.g. acne, hirsutism

26
Q

Why do cysts form on the ovaries in PCOS?

A

Underproduction of estrogen and overproduction of androgens by the ovaries can result in tiny cysts on the surface of the ovaries

27
Q

What produces gonadotrophins (LH and FSH)?

A

The anterior pituitary gland

28
Q

What part of the menstrual cycle has the main impact on cycle length?

A

Follicular phase

29
Q

When taking combined oral contraceptives to manage Pre-menstrual disorders, which form of progesterone should they include?

A

Drospirenone

30
Q

How do Pre-menstrual disorders differ from premenstrual symptoms?

A

Premenstrual disorders must impact daily living

31
Q

What is the pharmacoogical management of heavy menstrual bleeding?

A
  1. IUS (mirena coil)
  2. a. Tranexamic acid
    b. COC
  3. a. Norethisterone
    b. DMPA (Depo injection)
32
Q

What is the management of pre-menstrual disorders?

A

ALL WORK BY OVULATION SUPPRESSION
1. Combined Oral Contraceptive (COCs)
2. GnRH agonists
3. Bilateral oophrectomy and hysterectomy with add back oestrogen only

33
Q

Define post-menopausal bleeding

A

Abnormal bleeding greater than 1 year after cessation of menstruation

34
Q

How is the definitive diagnosis of a miscarriage made?

A

Transvaginal USS

35
Q

In what types of miscarriage management is anti-D required?

A

any mother who is rhesus -ve and (beyond 12 weeks and/or having a surgical miscarriage)

36
Q

What are the 2 main risk factors for miscarriages

A
  • previous miscarriages
  • increased maternal age
37
Q

How is a missed miscarriage usually diagnosed?

A

On TVUS:
- crown rump length is >7mm and no fetal heart pulsation
- mean gestation sac diameter is ≥25 mm with no obvious yolk sac

38
Q

What is the most common aetiology of miscarriages?

A

First trimester: Chromosomal abnormalities
Second trimester: incompetent cervix

39
Q

When is an HSA1 form used? AND how many doctors have to sign it?

A

An HSA1 form is used for clause E for abortions
2 doctors have to sign it

40
Q

When is an HSA1 form used? AND how many doctors have to sign it?

A

An HSA1 form is used in an emergency abortion
1 doctor has to sign it

41
Q

Why does increasing maternal age increase the rates of miscarriage?

A

As you get older oocytes have more genetic abnormalities
increase in poor-quality oocytes leads to chromo-
somally abnormal conceptions.

42
Q

How is infertility initially investigated?

A

Progesterone is measured on day 21 of a woman’s cycle

Repro and Sexual Health (7 decks)

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