Definitions unable to conceive >12 months but epidemiologist tend to define as >24 months
Fertility depends on frequency of intercourse
Ovulation induction kit decreases the fertility
Use of lubricants decreases the sperm motility
Risk of Infertility
PID * 1 7
PID*3 19
Semen analysis if poor repeat in 72 days
Chlamydia antibodies
Basal body temperature not recommended.Marital dysharmony
Friday 23 January 2009
Female genital mutilation
WHO definitions whole or part
Type 1-4
Type 3 partial closing of vagina
Type 4 corrosives
Africa Asia not faith related Christian Muslim
Immediate complications
Infection
Bleeding
Urinary retention
Death
Post op positioning leg finding
Longterm consequences
Obstetrics
Type 2 &3
PPH
Obstetrics labour
UK
Shock amongst carers
Painful examinations
Analgesia regional
Episiotomy anteriorly not laterally
Female Genital Multilation Act 2003
Type 1-4
Type 3 partial closing of vagina
Type 4 corrosives
Africa Asia not faith related Christian Muslim
Immediate complications
Infection
Bleeding
Urinary retention
Death
Post op positioning leg finding
Longterm consequences
Obstetrics
Type 2 &3
PPH
Obstetrics labour
UK
Shock amongst carers
Painful examinations
Analgesia regional
Episiotomy anteriorly not laterally
Female Genital Multilation Act 2003
Reproductive Medicine
Learning points from regional teaching
Hypothalamus-GnRH that acts on anterior pitutitary
Pitutitary FSH/LH act on granulosa
Ovary granulosa cells secretes inhibin
3types of oestrogen :17b estradiol oestriol oestrone
Oestrogen helps in development of secondary sexual charecteristics and preserves bone density.
Ovary's dimension 4*1.5*1.5 cm
PCOS
2003 ESHRE/ASRM
USS-ovarian volume >10ml
2-12 mm cysts 10 or more
Polygenic disorder of steroid biosynthesis or insulin metabolism.
LH acts theca cell
2 cell theory
SHBG reduced by androgen & insulin.SHBG produced in liver .
Free androgen index =total testerone*100/SHBG. Normal <4.5
Impact of Obesity insulin resistance and increase in insulin like growth factors
Leptin
Endocannabiods regulate multiple endocrine system including HPO axis.
Intrauterine life has an impact
Follistatin
Anovulation with PCOS
Group 2 Anovulation
Consensus on infertility treatments ESRE
1-preconceptual-weight loss
2-ovulation induction
Multiple pregnancy clomiphene 10%
Hyperstimulation
Clomiphene
Tamoxifen less trials
Clomiphene + Dexamethasone is one option
Metformin Doses 500. mg or 850 mg bd
ESRE only indicated glucose intolerance or type 2 DM
Gonadotropins cumulative success rate 40-50%
1-2% severe OHSS. Possible tx
Rotterdam crieteria
Ovarian adhesion
Laparoscopic diathermy free of risk multiple
Pregnancy , no ovarian HSS
LOMNI new technique.
Hypothalamus-GnRH that acts on anterior pitutitary
Pitutitary FSH/LH act on granulosa
Ovary granulosa cells secretes inhibin
3types of oestrogen :17b estradiol oestriol oestrone
Oestrogen helps in development of secondary sexual charecteristics and preserves bone density.
Ovary's dimension 4*1.5*1.5 cm
PCOS
2003 ESHRE/ASRM
USS-ovarian volume >10ml
2-12 mm cysts 10 or more
Polygenic disorder of steroid biosynthesis or insulin metabolism.
LH acts theca cell
2 cell theory
SHBG reduced by androgen & insulin.SHBG produced in liver .
Free androgen index =total testerone*100/SHBG. Normal <4.5
Impact of Obesity insulin resistance and increase in insulin like growth factors
Leptin
Endocannabiods regulate multiple endocrine system including HPO axis.
Intrauterine life has an impact
Follistatin
Anovulation with PCOS
Group 2 Anovulation
Consensus on infertility treatments ESRE
1-preconceptual-weight loss
2-ovulation induction
Multiple pregnancy clomiphene 10%
Hyperstimulation
Clomiphene
Tamoxifen less trials
Clomiphene + Dexamethasone is one option
Metformin Doses 500. mg or 850 mg bd
ESRE only indicated glucose intolerance or type 2 DM
Gonadotropins cumulative success rate 40-50%
1-2% severe OHSS. Possible tx
Rotterdam crieteria
Ovarian adhesion
Laparoscopic diathermy free of risk multiple
Pregnancy , no ovarian HSS
LOMNI new technique.
Wednesday 14 January 2009
Learning points from Audit meeting
Obstetrics Cholestasis
If LFT is elevated needs
1.USS
2.Hepatitis B serology
3.CMV/EBV
4.Autoimmune Screen
Do we have to fasting bile acids?
Postnatal care
1.contraception-avoids Combined Oral Contraceptive pills.
2.ensure resolution of LFT
1000 lives campaign
Mechanical compression Elective LSCS (TEDS)/Emergency section(Flowtron)
Elective Gynaesurgey Prophylactic antibiotic one hour prior to surgical incision
Debriefing after EmLSCS especially after EmLSCS,third degree tear is important.
If LFT is elevated needs
1.USS
2.Hepatitis B serology
3.CMV/EBV
4.Autoimmune Screen
Do we have to fasting bile acids?
Postnatal care
1.contraception-avoids Combined Oral Contraceptive pills.
2.ensure resolution of LFT
1000 lives campaign
Mechanical compression Elective LSCS (TEDS)/Emergency section(Flowtron)
Elective Gynaesurgey Prophylactic antibiotic one hour prior to surgical incision
Debriefing after EmLSCS especially after EmLSCS,third degree tear is important.
Thursday 8 January 2009
Flashcards for Obstetrics & Gynaecology
Flash cards are used as memory aid.One writes question on one side & answer overleaf.
Here are some resources.
My web site
Thursday 1 January 2009
Guidelines in Obstetrics & Gynaecology
- Green top guide lines from RCOG
- NICE guidelines
- Collection of 96 guidelines from various resources(from e-meducation)
- Clinical knowledge summaries
- SIGN guidelines on Women's health
- Society of Obstetricians and Gynaecologists of Canada (SOGC)
- Guidelines from North America(from TRIP)
- Guidelines from Europe(from TRIP)
- Systematic reviews in Obstetrics & Gynaecology from TRIP
- Cochrane Library-Pregnancy & Childbirth group
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