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10 Cards in this Set

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define ectopic preg (Ocj #1)
tubal pregnancy
factors assoc w/ectopic preg
-maternal age, gravidity, parity, and infertility
-delayed ovulation & fert

-IUD use
-OCP's
-tubal sterilization
-PID
Dx of ectopic preg
1. hCG:
*nl- hCG should rise at least 66% in 48 hrs and double in 72 hrs
*ectopics-falling or abnormally rising hCG

2. Progesterone:
low levels (<15 ng/ml)

3. Ultrasound: mass on one side, no nl pregnancy structures in uterus; conclusive Dx=fetus outside the uterus
Tx ectopic preg (Obj #2)
1. Surgical:
a. Salpingotomy (surgical incision of fallopian tube)
b. Salpingostomy (make a hole in fallopian tube)
c. Segmental resection
d. Manual expression of fetus
e. Laparoscopic tx
*for unruptured tubal preg < 3 cm

2. Non-surgical:
a. expectant managment
b. medical management
how Tx distal implantations undergoing spontaneous extrustion thru abdominal tubal ostium
remove by suction, followed by repeated rinsing and electrocautery of bleeding sites til homeostasis achieved
how Tx tubal pregnancy located in isthmic or proximal ampulla, < 3cm, and tube is mobile
electrosurgically remove
how Tx unruptured ampullary pregnancy <3 cm diameter
linear salpingotomy (surgical incision of fallop tube)
indications for IVF (Obj 3)
1. Tubal factor (MC)
-absent fallop tubes==>IVF is the only option
-best prognosis for this group

2. Endometriosis
3. Male Factor
Sperm:
-low concentration (oligospermia)
-decr motility (asthenospermia)
-abnl morphology (teratospermia)

4. idiopathic infertility
5. Immunologic infertility
-confirmed by ID of antisperm Ig
-Diethylstilbestrol (DES) Exposure:
~DES-exposed women have incr risk of infert
Major steps of IVF (Obj 4)
1. Ovarian Stimulation
a.down-regulate the pt's pituitary by giving GnRH analog
b.then stimulate ovaries with gonadotropin for 7-10 d.
c.when follicular dev has reached stage where optimum # mature follicles present, administer hCG (looks like LH)to trigger ovulation

D. Oocyte retrieval:
retrieve oocyte via ultrasound-directed transvaginal needle aspiration

3. Fert & Embryo Transfer
a. Fert
-incubate sperm & oocytes together
-fert confirmed by presence of 2 pronuclei (male & female)

b. Assess embryo quality (viability)

c. Embryo transfer (into cervix via catheter inserted into cervix thru endometrial cavity)
variations of IVF embryo transfer
1. GIFT: transfer oocytes & spermatozoa directly into fallop tube, thus eliminating many steps

2. ZIFT: transfer pronuclear-stage Zygotes into fallop tube

3. Gamete, Embryo micromanipulation:
-inject a single sperm into oocyte (in severe male factor infertility)
-"assisted hatching": zona pellucida partially opened using microneedles
-cryopreseveration