Infertility, Genetics, Prenatal Assessment, and Labor Induction

Comprehensive practice flashcards detailing etiology and treatments of infertility, genetic disorders, prenatal screening and diagnostic assessments, and pharmacological and mechanical methods for labor induction and augmentation.

How is infertility clinically defined based on maternal age?

Infertility is defined as the inability to achieve pregnancy after $1\,\text{year}$ of regular, unprotected intercourse when the woman is less than $35\,\text{years}$ of age, or after $6\,\text{months}$ when the woman is older than $35\,\text{years}$ of age.

What percentage of couples are affected by infertility?

Infertility affects $10\text{--}15\%$ of couples.

Before age $35$, what is a couple's monthly chance of conception, and what percentage conceive within $6\,\text{months}$?

Before age $35$, there is a $25\text{--}30\%$ chance of conceiving each month, and $80\%$ of couples conceive within $6\,\text{months}$.

Based on the provided etiology chart, what percentage of infertility cases are attributed to female factors, male factors, and unknown factors?

Female factors account for $40.0\%$, male factors account for $40.0\%$, and unknown factors account for $20.0\%$.

What are the four primary categories of female infertility risk factors?

Hormonal and ovulatory factors, tubal and peritoneal factors, uterine factors, and vaginal-cervical factors.

What are the four recognized categories of male infertility risk factors?

Hormonal disorders, testicular factors, sperm transport abnormalities, and idiopathic factors.

What sequence of assessments is recommended when initiating fertility testing?

Testing should begin with a thorough history and physical examination, lab work, and semen analysis, proceeding from the least to most invasive tests.

Which medications are commonly used in medical therapy for infertility?

Clomid, progesterone, gonadotropins and FSH supplements, and Metformin.

What is endometriosis and what complications does it cause?

Endometriosis is an inflammatory condition where endometrial tissue that normally lines the uterine cavity appears in abnormal ectopic locations, causing pelvic pain, dysmenorrhea, painful intercourse, scar tissue formation, and infertility.

What medical and surgical treatment options exist for endometriosis?

NSAIDs during menstruation, oral contraceptives, GnRH agonists (inducing medically induced menopause), laparoscopy, and total abdominal hysterectomy (TAH).

What ethical, clinical, and financial considerations accompany Assisted Reproductive Technology (ART)?

Preimplantation Genetic Diagnosis (PGD), embryo storage, selective reduction, high cost, multiples and high-risk pregnancy, insurance coverage limitations, legal issues, and ethical dilemmas obscured by pressure for IVF success.

What four main categories of risk factors complicate the development, growth, and sustainability of pregnancy?

Biophysical factors (originating within mother or fetus), psychosocial factors (maternal behaviors and adverse lifestyles), sociodemographic factors (maternal and family characteristics), and environmental factors (exposure to hazards).

At what gestational age do fetal kick counts begin, and what result warrants further investigation?

Fetal kick counts begin at $28\,\text{weeks}$ gestation; feeling fewer than $10$ movements in $2\,\text{hours}$ warrants further investigation.

What criteria define a reactive Non-Stress Test (NST) for a fetus greater than $32\,\text{weeks}$ gestation?

At least $2$ accelerations of the fetal heart rate of at least $15\,\text{bpm}$ above baseline lasting at least $15\,\text{seconds}$ within a $20\,\text{minute}$ window.

What finding classifies a Non-Stress Test (NST) as non-reactive?

The criteria of $2$ qualifying accelerations are not met within a $40\,\text{minute}$ monitoring period, requiring further evaluation.

What five parameters are evaluated in an ultrasound Biophysical Profile (BPP)?

Fetal breathing movements, gross body movements, fetal tone, amniotic fluid volume, and the Non-Stress Test (NST).

How are Biophysical Profile (BPP) scores interpreted and clinically managed?

A score of $8\text{--}10$ is normal (repeat as indicated); $4\text{--}6$ indicates suspected chronic asphyxia (consider delivery if $> 36\,\text{weeks}$, or repeat in $4\text{--}6\,\text{hours}$); $0\text{--}2$ strongly suspects chronic asphyxia (deliver regardless of gestational age).

What is the clinical purpose of a Contraction Stress Test (CST), and when is it performed?

To evaluate fetal heart rate response and respiratory functioning under the stress of uterine contractions after $34\,\text{weeks}$ gestation.

Why is this Contraction Stress Test (CST) tracing interpreted as positive?

Repetitive late decelerations occur with each contraction (present with $50\%$ or more of contractions) without fetal heart rate accelerations during fetal movements.

What conditions represent absolute contraindications to performing a Contraction Stress Test (CST)?

Any condition where vaginal delivery is contraindicated, including placenta previa, prior classical cesarean section, and high risk for preterm labor (multiple gestation, PPROM).

What are the primary clinical indications for ultrasound in each trimester of pregnancy?

First trimester: confirm pregnancy, viability, and uterine abnormalities; second trimester: confirm due date, $20\,\text{week}$ anatomy scan, detect anomalies, measure growth, locate placenta; third trimester: fetal growth, placental functioning and location, presenting part, Doppler flow studies.

What are the chromosomal basis, incidence, and average life expectancy of Down syndrome?

Down syndrome is caused by an extra chromosome at position $21$ (Trisomy 21), has an incidence of $1\text{ in }700$ live births (increased with advanced maternal age), and carries an average life expectancy of $47\,\text{years}$.

What physical characteristics are typically observed in an infant with Down syndrome?

Almond-shaped eyes with an upward slant, small or low-set ears, flat nasal bridge, single palmar crease, hypotonia, and tongue protrusion.

What are the genetic requirements and inheritance probabilities for Autosomal Dominant disorders?

Only $1$ abnormal gene is required to exhibit the disorder; an affected parent has a $50\%$ chance of passing the condition to each offspring (e.g., Huntington's disease, Marfan syndrome).

What are the genetic requirements and inheritance probabilities for Autosomal Recessive disorders?

Both genes must be abnormal to have the disorder; if both parents are carriers, offspring have a $25\%$ chance of being affected, a $50\%$ chance of being carriers, and a $25\%$ chance of being unaffected (e.g., Sickle Cell Anemia, Cystic Fibrosis, Tay-Sachs disease).

What gestational window applies to Cell-Free DNA (cfDNA) screening, what does it detect, and when is it contraindicated?

Performed at $10\text{--}12\,\text{weeks}$ gestation using maternal plasma to screen for Trisomies 13, 18, and 21; it is not recommended for multifetal pregnancies.

What gestational age and measurement threshold define an abnormal Fetal Nuchal Translucency (FNT) screening?

Performed at $10\text{--}14\,\text{weeks}$ gestation via ultrasound; a fluid pocket greater than $3\,\text{mm}$ at the nape of the fetal neck is abnormal, indicating Down syndrome, trisomy 18, or cardiac defects.

What four serum markers comprise the Quad Screen, and how do they shift in Down syndrome?

Drawn at $16\text{--}18\,\text{weeks}$: Alpha-fetoprotein (AFP, decreased), human chorionic gonadotropin (hCG, increased), Inhibin A (increased), and unconjugated estriol (decreased).

What diagnostic procedure and sampling route are depicted in this illustration?

Transcervical Chorionic Villus Sampling (CVS), performed under ultrasound guidance to aspirate chorionic villi from the placenta between $10\text{--}13\,\text{weeks}$ gestation.

What clinical analyses are performed on the cellular components and supernatant obtained during amniocentesis?

Cellular components are used for chromosome analysis, biochemical analysis, enzyme studies, and sex chromatin; the supernatant is evaluated for Rh antibodies, chemical analysis, and intrauterine infection.

At what gestational ages is amniocentesis performed for genetic concerns versus fetal lung maturity?

It is performed at $14\text{--}18\,\text{weeks}$ gestation for genetic testing, and during the third trimester to assess fetal lung maturity via the L/S ratio and surfactant presence.

How is Induction of Labor (IOL) defined?

The chemical or mechanical initiation of uterine contractions before their spontaneous onset.

What is the primary goal of labor induction according to ACOG?

To artificially stimulate uterine contractions so that pregnant women can deliver vaginally, weighing procedure risks against benefits to woman and fetus.

What are major maternal medical indications for induction of labor?

Hypertensive Disorders of Pregnancy (HDP), Intrauterine Fetal Demise (IUFD), chorioamnionitis, diabetes, and cholestasis.

What are major fetal medical indications for induction of labor?

Postterm pregnancy (especially with oligohydramnios), Hypertensive Disorders of Pregnancy (HDP), Intrauterine Growth Restriction (IUGR), isoimmunization, chorioamnionitis, and Premature Rupture of Membranes (PROM) with established fetal maturity.

According to ACOG guidelines, what is the earliest gestational age at which elective induction may occur?

Elective induction should not occur prior to $39\,\text{weeks}$ of gestation.

According to March of Dimes educational data, how does fetal brain weight at $35\,\text{weeks}$ compare to term?

A baby's brain at $35\,\text{weeks}$ weighs only two-thirds of what it will weigh at $39\text{ to }40\,\text{weeks}$.

What obstetric conditions represent absolute contraindications to induction of labor?

Acute severe fetal distress, shoulder presentation (transverse lie), breech presentation, floating fetal presenting part, uncontrolled hemorrhage, placenta previa, previous vertical uterine incision or uterine surgeries, and active genital HSV.

How is Augmentation of Labor defined, and what uterine abnormality commonly triggers it?

The stimulation of uterine contractions after labor has started spontaneously but progress is unsatisfactory, commonly caused by hypotonic uterine dysfunction.

What are the four clinical stages of labor?

Stage 1: onset of regular contractions to complete dilation ($0\text{--}10\,\text{cm}$); Stage 2: $10\,\text{cm}$ dilation to birth of baby (includes pushing); Stage 3: delivery of placenta; Stage 4: immediate postpartum recovery period (up to $4\,\text{hours}$).

What cervical dilation measurements correspond to the Early, Active, and Transition phases of Stage 1 labor?

Early phase: $0\text{ to }5\,\text{cm}$; Active phase: $6\text{ to }8\,\text{cm}$; Transition phase: $8\text{ to }10\,\text{cm}$.

What behavioral and physical manifestations are characteristic of the Transition phase ($8\text{--}10\,\text{cm}$) of labor?

Loss of emotional control, irritability, declaring "I can't do this anymore," copious bloody show, nausea, vomiting, perspiration, shaking, and intense rectal pressure with an urge to push.

What did the research by Zhang et al. (2010) conclude regarding contemporary labor curves compared to Friedman's Curve?

Contemporary labor progresses more slowly than Friedman's curve originally suggested, and avoiding cesarean delivery before the active phase of labor is established can reduce primary and repeat cesarean rates.

Based on the Bishop's Score scoring table, what five cervical parameters are evaluated?

Dilation ($\text{cm}$), Effacement ($\%$), Station, Cervical Consistency (firm, medium, soft), and Cervical Position (posterior, midposition, anterior).

What Bishop's Score threshold indicates a likelihood of vaginal birth equal to that of spontaneous labor?

A Bishop's Score of $8$ or more on the $13$-point scale.

What medication, dosing schedule, and route are shown here for cervical ripening, and what is its primary contraindication?

Cytotec (misoprostol), administered buccally, sublingually, or placed near the cervix at $25\text{--}50\,\mu\text{g}$ every $4\,\text{hours}$; it is strictly contraindicated in patients attempting a Vaginal Birth After Cesarean (VBAC).

What medication, dose, and administration guidelines apply to the vaginal insert shown here?

Cervidil (dinoprostone) $10\,\text{mg}$ vaginal insert, placed near the cervix for gradual release, removed at $12\,\text{hours}$ or at active labor onset; oxytocin may only be started $30\,\text{minutes}$ after removal.

How does the mechanical cervical ripening device shown in this diagram facilitate cervical dilation?

It uses balloons (placed in the uterus and/or against the cervix) that inflate to simulate pressure from the fetal head, mechanically dilating the cervix.

What instrument is shown here, and what nursing considerations are required when it is used?

An Amnihook for amniotomy (AROM); the nurse must confirm no active genital HSV, assess FHR immediately post-rupture, document amniotic fluid TACO, and assess maternal temperature every $2\,\text{hours}$.

What severe maternal and fetal risks classify intravenous oxytocin (Pitocin) as a high-alert medication?

Placental abruption, uterine rupture, unnecessary cesarean birth, postpartum hemorrhage, infection, fetal hypoxemia, and fetal acidemia.