Friday, 23 January 2009


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

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

Urinary retention

Post op positioning leg finding

Longterm consequences

Type 2 &3
Obstetrics labour


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



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


Endocannabiods regulate multiple endocrine system including HPO axis.

Intrauterine life has an impact


Anovulation with PCOS

Group 2 Anovulation

Consensus on infertility treatments ESRE
1-preconceptual-weight loss
2-ovulation induction
Multiple pregnancy clomiphene 10%


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
2.Hepatitis B serology
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.

Flashcard exchange


Basic terms in Obs & Gynae

My web site

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Thursday, 1 January 2009

Guidelines in Obstetrics & Gynaecology

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