Reproductive Health II

fibrocystic breast changes

• thickening of normal breast tissue

• most common benign breast issue

fibrocystic breast etiology

probably estrogen and progesterone imbalance

fibrocystic breast symptoms

cyclic pain, tenderness, swelling right before menses

fibrocystic breast diagnosis

mammography MRI or fine needle aspiration

fibrocystic breast treatment

limit caffeine, decrease sodium, use oral contraceptives

endometriosis

presence of endometrial tissue outside of uterine cavity

endometriosis etiology

unknown, maybe due to backflow of menstrual flow, inflammation of endometrium, immune defect

endometriosis symptoms and diagnosis

• pelvic pain usually at menses

• confirmed by laparoscopy

endometriosis treatement

surgical removal endometrial tissue, NSAIDs, oral contraceptives

PCOS

• ovaries enlarged and contain numerous small cysts along outer edge of ovaries

• cause unknown

PCOS symptoms

• irregular to absent menses

• elevated testosterone + androgen levels (acne, hirsutism, muscle mass, alopecia)

• obesity

• insulin resistance

• infertility

PCOS diagnosis

H+P, labs, vaginal US to evaluate uterus and ovaries

PCOS treatment

oral contraceptives, glucophage, spironolactone, metformin

TSS (toxic shock syndrome)

• disease of women in their reproductive years around menses or postpartum

• cause: toxin released by Staph A

• risk r/t tampons

TSS symptoms

fever, rash on trunk that resembles a sunburn, vomiting, hypotension, inflamed mucus membranes

TSS diagnosis

elevated BUN, AST, ALT, Bili, low platelets

TSS treatment

hospitalization, IVF to maintain BP, antibiotics

bacterial vaginosis (BV)

• decrease in normal vaginal flora

• etiology: overgrowth of bacteria probably due to douching or frequent sex

BV symptoms

increased amt of thin, watery, whitish/grey fluid with fishy smell

BV diagnosis

vaginal pH greater than 4.5, slide prep

BV treatment

Flagyl (metronidazole), clindamycin vaginal cream

vaginal candidiasis (VC)

• yeast infection

• caused by: antibiotics, oral contraceptives, immunosuppressants, diabetes

VC symptoms

thick, curdy vaginal discharge, severe itching, rash

VC diagnosis

vaginal discharge will show spores under microscope

VC treatment

Diflucan (Fluconazole), Nystatin

trichomoniasis

• STI

• caused by Trichomoniasis Vaginalis

trichomoniasis symptoms

yellow/green discharge, inflammation, itching, dysuria

trichomoniasis diagnosis

visualization of organism on microscope slide

trichomoniasis treatment

Flagyl (metronidazole) vs. non-treatment

chlamydia

• most common bacterial STD

• caused by chlamydia trachomatis

chlamydia symptoms

thin, purulent discharge, dysuria, lower abd. pain

chlamydia diagnosis and treatment

• lab culture

• azithromycin

chlamydia can lead to ____ in infant

blindness

gonorrhea

• STD increasing risk for PID

• bacteria neisseria gonorrhoeae

gonorrhea symptoms

purulent, greenish/yellow discharge, dysuria, vulva swelling

gonorrhea diagnosis and treatment

• lab culture

• Rocephin (ceftriaxone) + azithromycin

gonococcal ophthalmia neonatorum

• untreated mom = infection for baby in eyes

herpes genitalis

• HSV-1 (cold sore) + HSV 2 (genital infection)

• caused by herpes simplex virus

herpes symptoms

single, blister-like vesivce in genital area, if active lesion don’t deliver vaginally

herpes genitalis diagnosis and treatment

• culture of lesion

• no cure, acyclovir to help keep virus dormant

syphilis

• chronic infection from contact with open wound or acquired congenitally

• spirochete treponema pallidum

syphilis symptoms

chancre the later wart-like plaque vulva, fever, weight loss, malaise

syphilis diagnosis and treatment

• blood test VDRL or RPR

• penicillin

• risk for still-birth or pre-term

HPV

• sexually transmitted through vaginal, oral or anal sex, usual cause of cervical cancer

• human papillomavirus

HPV symptoms and diagnosis

• genital warts

• biopsy lesion

HPV treatment

cryotherapy, shave excision, acid removal

PID (pelvic inflammatory disease)

• inflammatory disorder of upper female genitalia, can cause tubal damage + infertility

PID etiology

women with multiple sexual partners, use of IUD, untreated gonorrhea + chlamydia

PID symptoms

bilateral, sharp cramping pain, fever, chills, purulent vaginal drainage

some asymptomatic

PID diagnosis and treatment

• cultures, CBC, VDRL, RPR

• multiple antibiotics combos

lower UTI (cystitis)

• etiology: E.coli, enterococcus or staph

• symptoms: low grade temp, hematuria, painful urination

• diagnosis: urine specimen, labs

• treatment: antibiotics

upper UTI (pyelonephritis)

• etiology: preceded by lower infection

• symptoms: high temp, chills, flank pain

• diagnosis: urine specimen, labs

• treatment: IVF, IV antibiotics, pain meds

primary infertility

unprotected sexual intercourse over 12 month time period where conception does not occur

secondary infertility

unable to conceive or sustain a pregnancy after 1 or more successful pregnancies

essential female fertility components

• favorable cervical mucus

• patent tubes with normal motility

• ovaries that produce and release normal ova

• no obstruction b/t ovary and uterus

• favorable endometrium

• adequate reproductive hormones

essential male fertility components

• normal quality, quantity and motility of sperm

• unobstructed genital tract

• normal genital tract secretions

• ejaculated sperm able to reach cervix

ways to improve fertility

• no douching or artificial lubricants

• retain and avoid leaking sperm for at least 20-30 min after aftercourse

• sex every other day during fertile period

• decrease anxiety + stress

• adequate nutrition

women with ovulatory problems infertility workup

• BBT (basal body temp - temp increase with increased progesterone)

• cervical mucus changes (clearer + thinner)

• hormonal assessment (LH surge)

• endometrial biopsy

• transvaginal US

male infertility workup

ductal obstruction or abnormal sperm/sperm production

infertility tx/options

• meds

• therapeutic insemination

• IVF

• gamete intrafallopian transfer

infertility meds

Clomid (clomiphene citrate), progesterone, gonadotropins (FSH, LH), Parlodel (bromocriptine)

therapeutic insemination

donor or husband’s sperm deposited at cervical os or uterus mechanically

in vitro fertilization

egg collected from ovary, fertilized in lab and palced in uterus after embryo development starts

gamete intrafallopian transfer

egg removed by laparoscopy and placed with sperm, fertilization occurs in fallopian tube, then egg travels to uterus to implant

zygote intrafallopian transfer

eggs retrieved and incubated with sperm and placed back into fallopian tubes once fertilization occurs

karyotype

pictorial view of chromosomes

phenotype

observable expression of trait, brown eyes + skin color

abnormal chromosomal number

Down syndrome - trisomy 21

chromosomal abnormalities

• translocation of the chromosome - 14, 21, and a 14/21 chromosome

• additions or deletions of chromosomal material

• sex chromosome defects

• difficulty achieving pregnancy

autosomal dominant inheritance

• affected individual has affected parent

• affected individuals have 50% chance of passing defect onto children

• parent can have mild form, child can have sever form

autosomal recessive inheritance

• affected individual has clinically normal parents, but both are carriers

• when both are carriers, both have 25% chance of passing defect onto any children

• with 2 carriers, 50% chance child will be carrier

prenatal dx tests

• genetic ultrasound

• genetic amniocentesis

• chorionic villus sampling

• alpha fetoprotein - blood test for possibly neuro tube defect or down syndrome

• noninvasive prenatal testing with cell-free fetal DNA