WEEK 4 - Female Reproductive/Genitourinary
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Define infertility
The inability to conceive after at least one year of regular, unprotected sex
What are some male causes of infertility? (x4)
• Disorders of the hypothalamic-pituitary system • Disorders of the testes • Abnormalities of ejaculation • Physical causes
What are some female factors of infertility? (x3)
• Problems with ovulation • Tubal obstruction of dysfunction • Uterine or cervical factors
What are some of the diagnostic tests for fertility in females?
• Review of gynaecological and menstrual hx • Assessment of possible STIs • PAP test • Pelvic US • Test for levels of LH, FSH, Prl • Post coilital test • Genetic testing • Ovulation studies • Tubal patency studies
What are some of the diagnostic tests for fertility in males?
• Physical exam for varicocoele/Peyronie disease • Semen analysis • Plasma testosterone and serum LH and FSH • Medications/lifestyle changes/corrective surgery
Name the three assisted reproductive technologies
• IVF • GIFT - gamete intra-fallopian transfer • ZIFT - zygote intra-fallopian transfer
Define abortion
The loss or termination of pregnancy before the foetus has reached a state of viability May be spontaneous or induced.
What is a spontaneous abortion?
The natural loss of pregnancy before 20 week’s gestation.
What are the causes of spontaneous abortion?
Foetal chromosomal abnormalities Endocrine abnormalities Acquired abnormalities Immunological factors Environmental factors
Signs and symptoms of spontaneous abortion?
Uterine cramping coupled with vaginal bleeding
Examinations required for spontaneous abortion?
• Beta-HCG testing (more than one measurement) - Vaginal ultrasound (examination of the pelvis)
Treatment for spontaneous abortion? Are these useful?
Treatment = bed rest, avoidance of vaginal intercourse No - most women progress to abortion anyway
Define induced abortion
Intentional or elective termination of pregnancy (for personal or medical reasons)
What are the four methods of induced abortion for an early termination?
• Menstrual extraction • Suction aspiration • Mifepristone with misoprostol • Methotrexate with misoprostol
What are the three methods of induced abortion for a late termination?
• Hypertonic saline solution • Prostaglandins • Hysterectomy • First two for 16+ weeks, last for 20+ weeks
Abnormal vaginal bleeding is common in which gynaecological conditions?
• Oligomenorrhea (for 35+ days) • Amenorrhea (primary and secondary) • Metrorrhagia ( irregular spotting) • Menorrhagia (more than 80mLs per day for 7 days)
Diagnostic studies and management for abnormal vaginal bleeding?
• Health hx and physical exam • OCP for amenorrhea • Hysterectomy • Myomectomy • Balloon thermotherapy • Hormones oestrogen and progesterone
Define ectopic pregnancy
Any blockage of the fallopian tubes or reduction of tubal peristalsis that impedes or delays the zygote passing to the uterine cavity, leading to tubal implantation
What can an ectopic pregnancy cause?
Tubal rupture
Risk factors for ectopic pregnancy?
PID Previous ectopic pregnancy Progestin-releasing IUD Progesterone-only birth control Prior pelvic or tubal pregnancy IVF embryo transfer Ovulation induction
Signs and symptoms of ectopic pregnancy?
Abdominal pain Shoulder tip pain (referred pain) Missed menses Irregular vaginal bleeding Morning sickness Breast tenderness Hypovolaemic shock, syncope GI upset
How far into an ectopic pregnancy do signs and symptoms arise?
6-8 weeks
What tools are used to diagnose a ectopic pregnancy?
• Serum pregnancy test immunoassay - Ultrasound
Medical and surgical management of an ectopic pregnancy?
• Medical - methotrexate for masses less than 3cm • Surgical - laparoscopic removal of the foetus from the uterine tube or emergency removal of the tube and fluid resuscitation