Voorplanting & Seksualiteit

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nsaadeh
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125824
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Voorplanting & Seksualiteit
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2012-01-04 23:15:06
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Voorplanting Seksualiteit
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Blok over Voorplanting & Seksualiteit LUMC
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  1. Number of births per year in Holland
    180,000
  2. Perinatal mortality in Holland
    1 per 100 (from 22nd week on)
  3. Maternal mortality in Holland
    8 per 100,000
  4. Percentage using midwives, gynocologists
    • 75% midwives
    • 25% gynocologists
  5. Percentage giving birth at home, in hospital
    • 75% birth at home
    • 25% birth at hospital
  6. Percentage seeing both midwives and gynocologists
    86%
  7. Average age of pregnancy in Holland
    31
  8. Average number of visits with midwive during pregnancy
    13
  9. Latest non-emergency point for abortion
    24 weeks
  10. Ensure the egg does not implant in the fallopian tubes
    Zona pellucida
  11. Viruses which can penetrate the placenta
    • Cytomegalovirus
    • Rubella
    • VZV
    • Coxsackievirus
    • HIV
    • Teponema Pallidum (syfilis)
  12. Chance of twins
    1 in 80
  13. Type of twinning which is hereditary
    Dizygotic
  14. Quintero stages of TTS
    • I: Polyhydramion + Anhydramnion
    • II: No bladder filling in one twin
    • III: Asymmetric doppler
    • IV: Hydrops
    • V: Dead twin
  15. Dyspareunie
    Painful sexual intercourse
  16. Differentiate Dyspareunia with Vaginismus
    Dyspareunia is pain during sexual intercourse while Vaginismus is an involuntary contraction of the Pubococcygeus (PC) muscle - thus Vaginismus is one cause of Dyspareunia
  17. The risks for which congenital defects increase with age? Which do not?
    • All the trisomy's increase with age (13, 18, 21)
    • Turner (45, X) and Triploid Syndrome do not
  18. Testing for Down Syndrome
    • 10 weeks - plasma levels of PAPPA and B-hCG. Low PAPPA & high B-hCG indicate risk of Down.
    • NB Triple test for Down is low AFP, low E3, high hCG
    • Echo btwn 11-14 wks - neck fold > 3.5mm indicates risk
    • If risk > 1/200, amniocenthesis done
    • At 20 wks, a SEO (Strucureel Echospopisch Onderzoek) can be done
  19. Defect accompanying 60% of Down victims
    VSD
  20. Uterine growth pattern
    • 0-10 wks: Hyperplasia
    • 10-20 wks: Hypertrophy
    • 20+ wks: stretching of tissue
  21. When does luteo-placental shift occur?
    7th week
  22. When can you feel a baby move?
    16-18 weeks (18-20 if nulliparous)
  23. When can you feel/see the uterus?
    • Feel: 11-12 wks
    • See: 16 wks
  24. When can you hear the fetal hearbeat?
    6 wks (though usually not searched for until 12 wks using doptone - can be heard with stethescope at 22 wks)
  25. Calculation of due date
    Date of last menstruation + 9 months + 1 week then round to day of week of last menstruation
  26. Foods to avoid during pregnancy and why
    • Raw meat, unwashed vegetables, cat litter - Toxoplasmosis
    • Raw milk - Listeria
  27. Three maneuvers during 1st trimester
    • Chadwick: pigmentation
    • Hegar: soft cervix
    • Piscazek: asymmetric uterus
  28. Fetal heart rates
    170 b/m at 10 wks, down to 120 b/m at birth
  29. Normal pregnancy length
    • 39 weeks
    • Less than 37 is premature
    • More than 42 is Serotiene
  30. Percentage of premature births
    ~5%
  31. Most important risk factor for premature birth
    Previous premature birth (unless was twins!!!)
  32. Cause of bacterial vaginosis
    Gardnerella Vaginalis
  33. What is a tocolytic
    Anti-contraction medication
  34. Tx of early membrane rupture
    Erythromycin
  35. Clinical presentations of placenta praevia vs. abruptio placentae
    • Placenta praevia - painless bloodloss
    • Abruptio placenta - painfull bloodloss
  36. Classic abruptio placentae vs. Partial abruptio placentae
    • Classic: Severe abdominal pain, hard uterine contraction which kills the fetus and releases a few hours later
    • Partial: Light abdominal pain with slight vaginal bleeding - fetus tends to live
  37. Normal length of umbilical cord
    ~55cm
  38. What kind of decelerations does an umbilical cord wrapped around the neck cause?
    Variable
  39. Normal amount of amniotic fluid
    500 - 1000mL
  40. Medicines leading to oligohydramnion
    NSAIDS/ACE inhibitors
  41. Beginning of labour definition
    Regular contractions 3-5 mins apart
  42. Four phases of birth and the hormones responsible for them
    • Inhibition: progesterone, NO
    • Activation: estrogen
    • Stimulation: prostaglandins, oxytocin
    • Involution: oxytocin
  43. Hodge's planes
    • H1: Top of symphyse
    • H2: Bottom of symphyse
    • H3: Spinae ischiadicae (most important - indicates vaginal delivery can take place)
    • H4: Coccyx
  44. Normal birthing position
    • A.a.v. (Achterhooft diepste, achterhooft voor)
    • 95% of births
  45. Autonomic system most responsible for contractions
    Parasympathetic (rest, digest and give birth, apparently)
  46. Grading of birthing rupture
    • Graad 1: Skin & vaginal wall torn
    • Graad 2: Underlying tissue & muscles torn
    • Graad 3: Rupture reaches sphincter ani
    • Graad 4: Rectal mucosa torn
  47. McRobert's maneouver
    Birthing of the arm first
  48. Handgreep van Küstner
    Used to deliver placenta
  49. Against which grades of vaginal rupture does an episiotomy protect
    1 & 2 only!
  50. Define controlled DM
    • Blood glucose 3-7
    • HbA1x < 8
  51. Risk factors for endometrial carcinoma
    • Long duration estrogen therapy (Tamoxifen)
    • HNPCC
  52. Causes of priapism
    • Sickle Cell Disease
    • Thalassemia Major
    • Leukemia
  53. Peyronie's disease
    Fibrosis in penis - leads to pain and abnormal curvature
  54. Breastfeeding helps/hurts sexual interest
    Helps
  55. WHO criteria for fertile man
    >2mL ejaculate with more than 20 million sperm/mL
  56. What is OFO
    Oriënterend FertiliteitOnderzoek
  57. What is OHSS?
    Ovarian HyperStimulation Syndrome - response to artificial insemination.
  58. Mayer-Rokitansky-Küster syndrome
    No uterus
  59. Asherman's syndrome
    Adhesions (fibrosis) within uterus
  60. Turner's syndrome
    45,X - primary amenorrhea
  61. Swyer syndrome
    46,XY but streak gonads - primary amennorhea. Tx is hormone therapy.
  62. Resistant ovary syndrome
    Hypergonadotrop, Hypoestrogen - hormone therapy
  63. Premature ovarian degeneration
    Hormone therayp
  64. Hyperprolactinemia
    Dopamine-agonist
  65. Sheehan syndrome
    Hypogonatotrop, hypoestrogen post partum - hormone therapy
  66. Kallmann's syndrome
    Hypogonadism and anosmia (inability to smell) - hormone therapy
  67. Polycystic Ovarian Syndrome
    Androgens too high, thus hirsutism, acne and insulin resistance - Tx is with GnRH, Dopamine agonist and anti-estrogen
  68. Menorragie
    Heavy bleeding for more than 7 days
  69. Hypermenorroe
    Heavy bleeding for less than 7 days
  70. Metrorragie
    Irregular break-through bleeding
  71. Oligomenorroe
    Cycle lasts more than 35 days
  72. Polymenorroe
    Cycle lasts less than 21 days
  73. Hypomenorrhoe
    Light bleeding

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