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Number of births per year in Holland
180,000
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Perinatal mortality in Holland
1 per 100 (from 22nd week on)
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Maternal mortality in Holland
8 per 100,000
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Percentage using midwives, gynocologists
- 75% midwives
- 25% gynocologists
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Percentage giving birth at home, in hospital
- 75% birth at home
- 25% birth at hospital
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Percentage seeing both midwives and gynocologists
86%
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Average age of pregnancy in Holland
31
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Average number of visits with midwive during pregnancy
13
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Latest non-emergency point for abortion
24 weeks
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Ensure the egg does not implant in the fallopian tubes
Zona pellucida
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Viruses which can penetrate the placenta
- Cytomegalovirus
- Rubella
- VZV
- Coxsackievirus
- HIV
- Teponema Pallidum (syfilis)
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Type of twinning which is hereditary
Dizygotic
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Quintero stages of TTS
- I: Polyhydramion + Anhydramnion
- II: No bladder filling in one twin
- III: Asymmetric doppler
- IV: Hydrops
- V: Dead twin
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Dyspareunie
Painful sexual intercourse
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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
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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
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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
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Defect accompanying 60% of Down victims
VSD
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Uterine growth pattern
- 0-10 wks: Hyperplasia
- 10-20 wks: Hypertrophy
- 20+ wks: stretching of tissue
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When does luteo-placental shift occur?
7th week
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When can you feel a baby move?
16-18 weeks (18-20 if nulliparous)
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When can you feel/see the uterus?
- Feel: 11-12 wks
- See: 16 wks
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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)
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Calculation of due date
Date of last menstruation + 9 months + 1 week then round to day of week of last menstruation
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Foods to avoid during pregnancy and why
- Raw meat, unwashed vegetables, cat litter - Toxoplasmosis
- Raw milk - Listeria
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Three maneuvers during 1st trimester
- Chadwick: pigmentation
- Hegar: soft cervix
- Piscazek: asymmetric uterus
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Fetal heart rates
170 b/m at 10 wks, down to 120 b/m at birth
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Normal pregnancy length
- 39 weeks
- Less than 37 is premature
- More than 42 is Serotiene
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Percentage of premature births
~5%
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Most important risk factor for premature birth
Previous premature birth (unless was twins!!!)
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Cause of bacterial vaginosis
Gardnerella Vaginalis
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What is a tocolytic
Anti-contraction medication
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Tx of early membrane rupture
Erythromycin
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Clinical presentations of placenta praevia vs. abruptio placentae
- Placenta praevia - painless bloodloss
- Abruptio placenta - painfull bloodloss
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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
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Normal length of umbilical cord
~55cm
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What kind of decelerations does an umbilical cord wrapped around the neck cause?
Variable
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Normal amount of amniotic fluid
500 - 1000mL
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Medicines leading to oligohydramnion
NSAIDS/ACE inhibitors
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Beginning of labour definition
Regular contractions 3-5 mins apart
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Four phases of birth and the hormones responsible for them
- Inhibition: progesterone, NO
- Activation: estrogen
- Stimulation: prostaglandins, oxytocin
- Involution: oxytocin
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Hodge's planes
- H1: Top of symphyse
- H2: Bottom of symphyse
- H3: Spinae ischiadicae (most important - indicates vaginal delivery can take place)
- H4: Coccyx
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Normal birthing position
- A.a.v. (Achterhooft diepste, achterhooft voor)
- 95% of births
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Autonomic system most responsible for contractions
Parasympathetic (rest, digest and give birth, apparently)
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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
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McRobert's maneouver
Birthing of the arm first
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Handgreep van Küstner
Used to deliver placenta
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Against which grades of vaginal rupture does an episiotomy protect
1 & 2 only!
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Define controlled DM
- Blood glucose 3-7
- HbA1x < 8
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Risk factors for endometrial carcinoma
- Long duration estrogen therapy (Tamoxifen)
- HNPCC
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Causes of priapism
- Sickle Cell Disease
- Thalassemia Major
- Leukemia
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Peyronie's disease
Fibrosis in penis - leads to pain and abnormal curvature
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Breastfeeding helps/hurts sexual interest
Helps
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WHO criteria for fertile man
>2mL ejaculate with more than 20 million sperm/mL
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What is OFO
Oriënterend FertiliteitOnderzoek
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What is OHSS?
Ovarian HyperStimulation Syndrome - response to artificial insemination.
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Mayer-Rokitansky-Küster syndrome
No uterus
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Asherman's syndrome
Adhesions (fibrosis) within uterus
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Turner's syndrome
45,X - primary amenorrhea
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Swyer syndrome
46,XY but streak gonads - primary amennorhea. Tx is hormone therapy.
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Resistant ovary syndrome
Hypergonadotrop, Hypoestrogen - hormone therapy
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Premature ovarian degeneration
Hormone therayp
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Hyperprolactinemia
Dopamine-agonist
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Sheehan syndrome
Hypogonatotrop, hypoestrogen post partum - hormone therapy
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Kallmann's syndrome
Hypogonadism and anosmia (inability to smell) - hormone therapy
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Polycystic Ovarian Syndrome
Androgens too high, thus hirsutism, acne and insulin resistance - Tx is with GnRH, Dopamine agonist and anti-estrogen
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Menorragie
Heavy bleeding for more than 7 days
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Hypermenorroe
Heavy bleeding for less than 7 days
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Metrorragie
Irregular break-through bleeding
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Oligomenorroe
Cycle lasts more than 35 days
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Polymenorroe
Cycle lasts less than 21 days
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Hypomenorrhoe
Light bleeding
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