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O bstetrics, G ynecology and G enetic C ounseling

C ompiling a M edical I nterpreter's G lossary:. O bstetrics, G ynecology and G enetic C ounseling. UMTIA Elma Johnson 4/14/2012. Female Reproductive System. Functions To produce the ovum or egg cell necessary for reproduction, To hold the pregnancy after conception,

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O bstetrics, G ynecology and G enetic C ounseling

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  1. Compiling a Medical Interpreter's Glossary: Obstetrics, Gynecology and Genetic Counseling UMTIA Elma Johnson 4/14/2012

  2. Female Reproductive System Functions • To produce the ovum or egg cell necessary for reproduction, • To hold the pregnancy after conception, • To menstruate if the conception does not take place, • To produce female sex hormones required for reproduction, • Lactating breasts provide nutrition. Parts: hypothalamus, pituitary gland and genitalia Menstrual Cycle • Definition & hormones (FSH,LH, estrogen and progesterone) • Irregularities (PCOS, fibroids, endometriosis, PID, extreme weight changes, pregnancy, premature ovarian failure, breastfeeding)

  3. Female Reproductive AnatomyExternal Female Genitalia: Vulva note: Bartholin glands not represented

  4. Female Reproductive AnatomyInternal Female Genitalia

  5. Reproductive system problems • Cancer (breast, uterine, endometrial, ovarian) • Uterine fibroids (leiomyomas, heavy periods and irregular bleeding) • Ovarian cysts and PCOS-polycystic ovary syndrome • Uterine prolapse • Vaginitis (bacterial vaginosis, yeast infection, vaginal atrophy…) • Sexually Transmitted Infections (Gonorrhea, Chlamydia, syphilis, genital herpes, HIV/AIDS, trichomonas, HPV) • HPV and genital warts • HSV and genital herpes • PID-pelvic inflammatory disease • POF-Premature ovarian failure • Endometriosis • Infertility

  6. Reproductive System Procedures • Papanicolaou Test • Colposcopy (cervix and vagina) • Hysteroscopy (cervix and uterus) • Pelvic Laparoscopy • Dilation and Curettage (D&C) • Endometrial ablation • Hysterectomy • Hysterosalpingography • LEEP (Loop Electrosurgical Excision Procedure) • Cervical cerclage

  7. Infertility (1) • Definition • Statistics: 10% to 15% of couple in the US • Causes of female infertility • Damage or blockage of fallopian tubes • Endometriosis • Cervical narrowing or blockage: cervical stenosis • Uterine causes • Ovulation disorders (POF, PCOS, lutealfase defect, abnormal FSH and LH secretion) • Other unknown causes

  8. Infertility (2) Testing • Basal Body Temperature • Ovulation testing (progesterone or LH) • Ovarian reserve testing (FSH and clomiphene citrate challenge test) • HSG (hysterosalpingography) • Laparoscopy • Hormone blood testing

  9. Restoring fertility (1) Medicines • Ovulation stimulating medicine (FSH and LH) through pituitary gland: Clomid (Clomiphene citrate) • Gonadotropins stimulate egg development in the ovaries • Possible complications: multiple pregnancy or OHSS • Other: Metformin, Femara (Letrozole) Surgery Remove growths, fibroids, scar tissue or treat endometriosis, tubal restoration after ligation Reproductive Assistance Assisted Reproductive Technologies (ART) - ICSI and IVF Intrauterine Insemination (IUI)

  10. Restoring fertility (2) Reproductive Assistance • Assisted Reproductive Technologies (ART) : ICSI • In-Vitro Fertilization (ICSI-intracytoplasmic sperm injection) • Intrafallopian transfer when condition of cervix are present • GIFT (Gamete Intrafallopian Transfer) • ZIFT (Zygote Intrafallopian Transfer) • Intrauterine Insemination (IUI)

  11. Fertilization and Pregnancy Pregnancy path: ovary releases egg-fertilization usually in falopian tube-implantation of embrio in endometrium). Pregnancy dating: 40 weeks, first day of last menstrual period or US Testing during pregnancy

  12. Pregnancy milestones week by week… • 0-10 • Pregnancy dating: LMP or Ultrasound • Office visit: new OB screening, labs, pap test, gonorrhea and chlamydia, physical exam, family history, prenatal vitamins, depression screening • 10-14 • 1st Trimester Screening: US+1st blood test • CVS (Chorionic Villus Sampling)

  13. Pregnancy milestones week by week… (Cont.) • 15-20 • Quad screen • 2nd Trimester Screening (2nd blood test) • Amniocentesis • Chordocentesis (Fetal blood sampling) • 17-20 • Anatomy ultrasound • 25-28 • Gestational diabetes screening • Anemia • Tubal ligation discussion • Depression screening

  14. Pregnancy milestones week by week… (Cont.) • 35 • GBS (Group B strep) • Gonorrhea and Chlamydia • 37 or less: pre-term labor • 40vaginal delivery or C-section • 40+ • Non-stress test (NST) • US to measure amniotic fluid

  15. Complications during pregnancy • Anemia (PNV and iron) • Pregnancy or postpartum depression • Ectopic pregnancy • Molar pregnancy • Fetal problems (decreased movement, size, chromosomes) • Gestational diabetes • High blood pressure (after 20th week) • Morning sickness and “hyperemesis gravidarum”(dehydration, hospitalization) • Miscarriage and stillbirth • Placenta previa (C-section in pre-term labor) • Placental abruption (after 20th week) • Preeclampsia (HBP and kidney problems) • Preterm labor (before wk 37, medicines, bed rest),…

  16. Genetic Counseling andprenatal testing • Reasons for testing: • Routine screening (2007, ACOG) • Advanced maternal age • Family history • Requested by patient • Previous children with birth defects • Multiple miscarriages or stillbirths,…

  17. Prenatal testing for birth defects • Carrier testing • Screening tests • Diagnostic tests • Amniocentesis • CVS • Fetal blood sampling

  18. Screening tests • First Trimester Screening • Second Trimester Screening • Integrated Screen • Quad Screen (Alpha-fetoprotein, Estriol, Human chorionic gonadotropin + Inhibin A)

  19. Diagnostic Tests • Amniocentesis • CVS • Fetal blood sampling or chordocentesis

  20. The role of the Genetic Counselor • Family history • Screening and Testing • Outcome and results • What does the patient want from this?

  21. Resources • www.mayoclinic.com • www.nlm.nih.gov/medlineplus/ency/article/001191.htm • www.nsgc.org

  22. Questions And Discussion…

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