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The document discusses treatment of hot flashes. It begins with an introduction that describes the clinical manifestations, pathophysiology, rates, and risk factors of hot flashes. It then covers assessment methods and scoring systems used to evaluate hot flash severity. The majority of the document discusses treatment options, including both hormonal therapies like estrogen, progestin, and tibolone, as well as non-hormonal options such as SSRIs, gabapentin, and lifestyle changes. Estrogen, specifically, is described as the most effective treatment for reducing the frequency and severity of hot flashes.
Infertility above 40
The document discusses infertility issues for women over 40. It notes that 15% of women now delay childbearing until after age 40. Ovarian aging leads to a decline in both egg quantity and quality with increasing female age. After age 40, evaluation should include tests of ovarian reserve like AMH, AFC, and FSH. IVF is the best treatment option for these women, though success rates decline sharply after age 43. Oocyte donation is the only effective treatment for infertility caused by declining egg quality due to age.
Us in infertility
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The document discusses the tension-free vaginal tape (TVT) procedure for stress urinary incontinence. It provides details on TVT techniques, outcomes, and complications from various studies. TVT was found to have high success rates of 80-90% in curing or improving stress urinary incontinence, including in recurrent cases and those with intrinsic sphincter deficiency. Complication rates for TVT were low, with bladder perforation being the most common issue. TVT was also found to improve urge incontinence symptoms in some mixed incontinence cases. The results indicate TVT is an effective and lasting minimally invasive treatment for stress urinary incontinence.
OOCYTE RETRIEVAL Prof. Aboubakr Elnashar
Oocyte retrieval involves three key steps:
1) Anesthetizing the patient using either conscious sedation with a paracervical block or general anesthesia. 2) Guiding an ultrasound-monitored needle into each follicle to aspirate the follicular fluid and oocyte. 3) Using a suction pump set to 90-120 mmHg for mature follicles and 40-60 mmHg for immature follicles to aspirate the fluid and oocyte without damaging the cumulus-oocyte complex. Precautions like antibiotics and monitoring for bleeding are important to minimize risks of complications.
Transobturator tape
The document discusses different surgical procedures for treating female stress urinary incontinence (SUI), including tension-free vaginal tape (TVT) and transobturator tape (TOT). It summarizes studies comparing the two procedures, finding that TOT has fewer complications than TVT, as it does not require penetrating the retropubic space. However, both procedures are shown to be safe and effective treatments for SUI, with high patient satisfaction and cure rates.
Management of Overactive Bladder For Gynecologist
The document discusses the management of overactive bladder for gynecologists. It defines overactive bladder based on symptoms of urgency, with or without urge incontinence, usually with frequency and nocturia. It notes that overactive bladder significantly impacts quality of life through physical, psychological, social, sexual, and occupational problems. Treatment options include lifestyle changes, behavioral therapy, medications, minimally invasive procedures, and surgery. Common medications used are anticholinergic agents like trospium chloride, oxybutynin, tolterodine, solifenacin, and darifenacin.
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Infertility above 40
The document discusses infertility issues for women over 40. It notes that 15% of women now delay childbearing until after age 40. Ovarian aging leads to a decline in both egg quantity and quality with increasing female age. After age 40, evaluation should include tests of ovarian reserve like AMH, AFC, and FSH. IVF is the best treatment option for these women, though success rates decline sharply after age 43. Oocyte donation is the only effective treatment for infertility caused by declining egg quality due to age.
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This document discusses transvaginal ultrasound assessment of the female reproductive system for infertility diagnosis and treatment. It covers evaluation of the uterus, including endometrial thickness, uterine anomalies, fibroids, adenomyosis, and other abnormalities. It also discusses ovarian assessment including volume, antral follicle count, polycystic ovary syndrome, cysts, and diminished ovarian reserve. Key diagnostic features of structures like the corpus luteum are also summarized. The document provides guidance on using ultrasound to evaluate infertility and monitor treatment.
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TVT: Long term results
The document discusses the tension-free vaginal tape (TVT) procedure for stress urinary incontinence. It provides details on TVT techniques, outcomes, and complications from various studies. TVT was found to have high success rates of 80-90% in curing or improving stress urinary incontinence, including in recurrent cases and those with intrinsic sphincter deficiency. Complication rates for TVT were low, with bladder perforation being the most common issue. TVT was also found to improve urge incontinence symptoms in some mixed incontinence cases. The results indicate TVT is an effective and lasting minimally invasive treatment for stress urinary incontinence.
OOCYTE RETRIEVAL Prof. Aboubakr Elnashar
Oocyte retrieval involves three key steps:
1) Anesthetizing the patient using either conscious sedation with a paracervical block or general anesthesia. 2) Guiding an ultrasound-monitored needle into each follicle to aspirate the follicular fluid and oocyte. 3) Using a suction pump set to 90-120 mmHg for mature follicles and 40-60 mmHg for immature follicles to aspirate the fluid and oocyte without damaging the cumulus-oocyte complex. Precautions like antibiotics and monitoring for bleeding are important to minimize risks of complications.
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The document discusses different surgical procedures for treating female stress urinary incontinence (SUI), including tension-free vaginal tape (TVT) and transobturator tape (TOT). It summarizes studies comparing the two procedures, finding that TOT has fewer complications than TVT, as it does not require penetrating the retropubic space. However, both procedures are shown to be safe and effective treatments for SUI, with high patient satisfaction and cure rates.
Management of Overactive Bladder For Gynecologist
The document discusses the management of overactive bladder for gynecologists. It defines overactive bladder based on symptoms of urgency, with or without urge incontinence, usually with frequency and nocturia. It notes that overactive bladder significantly impacts quality of life through physical, psychological, social, sexual, and occupational problems. Treatment options include lifestyle changes, behavioral therapy, medications, minimally invasive procedures, and surgery. Common medications used are anticholinergic agents like trospium chloride, oxybutynin, tolterodine, solifenacin, and darifenacin.
Ultrasonography of the uterus
This document provides an overview of ultrasonography of the normal and abnormal uterus. It describes the techniques, anatomy, measurements, and appearances of the uterus throughout the menstrual cycle. Common abnormalities such as fibroids, adenomyosis, endometrial polyps and cancers are outlined. Details on evaluating the endometrium, myometrium, cervical abnormalities and intrauterine devices are provided. Ultrasonography is an important tool for assessing the uterus but has limitations and often requires correlation with clinical history and other imaging modalities.
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50% of women ovulate using clomiphene citrate (CC) at a dosage of 50 mg/day, while another 25% ovulate if the dosage is increased to 100 mg/day. Most CC-induced pregnancies occur within the first 3 cycles. There is no benefit to increasing the dosage once ovulation occurs or continuing CC for more than 6 months. CC should be discontinued if a patient remains anovulatory after the dosage has been increased to 100 mg over 3 consecutive cycles. Metformin, aromatase inhibitors like letrozole, and adjuvants including N-acetyl cysteine and corticosteroids can be considered as alternatives or adjuvants to CC for ovulation induction in women who do not respond to
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This document discusses monitoring of the ART (assisted reproductive technology) cycle. It describes various methods for monitoring, including ultrasound to measure follicle growth and endometrial thickness, as well as using ultrasound combined with serum estradiol levels. The key objectives of monitoring are outlined, such as predicting ovarian response, monitoring pituitary suppression, evaluating gonadotropin dose, preventing OHSS, determining the optimal time for hCG administration, and avoiding cycle cancellation. Indicators for when to adjust gonadotropin dosage or cancel the cycle are provided. Ultrasound is identified as the most practical monitoring method and combining it with estradiol is particularly useful for high-risk patients.
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1) Embryo transfer is the final step in IVF where embryos are placed in the uterus. Careful technique is important for success.
2) Factors that can affect the success of embryo transfer include embryo selection, the timing of the transfer, cervical infections, endometrial thickness and pattern, and experience of the provider.
3) During the procedure, gentle technique, ultrasound guidance, and depositing embryos slightly below the uterine fundus can help maximize the chances of implantation and pregnancy. Meticulous attention to factors before, during, and after embryo transfer is crucial.
Treatment of hot flushes
This document discusses the treatment of hot flashes. It begins by describing the clinical manifestations, pathophysiology, prevalence, and risk factors of hot flashes. It then discusses methods of assessing hot flash severity, including hot flash scores, the Greene Climacteric Score, and the Modified Kupperman Index. The main treatment approaches covered are hormonal therapies like estrogen, progestin, and tibolone, and non-hormonal options such as SSRIs, SNRIs, and complementary therapies. Hormonal therapies are generally the most effective treatment but have risks, so non-hormonal alternatives are considered when hormones are not appropriate.
Umblical & uterine artery Doppler
This document discusses umbilical and uterine artery Doppler ultrasound. It notes that umbilical artery Doppler is useful for predicting abnormal fetal outcomes, with a resistance index above 0.72 outside normal limits after 26 weeks. Absent or reversed end diastolic flow in the umbilical artery indicates fetal distress and need for monitoring or delivery. Uterine artery Doppler has limited use in predicting fetal growth restriction but can suggest maternal versus fetal causes. An abnormal uterine Doppler with decreased diastolic flow or persistence of a diastolic notch after 24 weeks can help predict preeclampsia. Fortnightly umbilical artery Doppler scans are recommended when growth is not maintained or abdominal circumference is below the third percentile.
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
This document discusses different methods for endometrial preparation in frozen embryo transfer (FET) cycles. It describes natural cycle FET, which can be done through a true natural cycle or modified natural cycle with an HCG trigger. It also outlines artificial/hormone replacement cycle FET, where estrogen and progesterone are administered without GnRH agonists in patients with remaining ovarian function. The key points are that the endometrium must be adequately prepared prior to embryo transfer, and the age of the embryos after thawing should correspond to the developmental age of the endometrium. The best method varies between patients and there is no clear consensus.
Controlled ovarian stimulation in IVF
This document discusses different types of ovarian stimulation protocols used in IVF. It begins by describing 4 main types of stimulation: natural/modified natural cycles involving little to no medication; mild stimulation involving low dose FSH/HMG; conventional stimulation using standard FSH/HMG doses; and high stimulation. It then covers the drugs used for ovarian stimulation, including gonadotropins and GnRH analogues. The rest of the document discusses specific GnRH agonist and antagonist protocols, methods of triggering ovulation including hCG and GnRH agonists, and criteria for cycle cancellation.
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Luteal phase support in ART
The document discusses luteal phase support (LPS) in assisted reproductive technology (ART) cycles. It notes that abnormal luteal function can occur after controlled ovarian stimulation, necessitating LPS. It reviews various LPS options including human chorionic gonadotropin and progesterone administered via different routes. Vaginal progesterone is found to effectively increase endometrial levels while intramuscular progesterone yields the highest serum levels. The document concludes that LPS is necessary to optimize ART outcomes and that intramuscular or vaginal progesterone are equally effective options.
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This document discusses clinical utility of sperm DNA fragmentation tests. It first reviews the origins and etiology of sperm DNA fragmentation, including factors during spermatogenesis and transport that can lead to increased oxidative stress and DNA damage. It then examines several methods for assessing sperm DNA fragmentation and finds an inverse correlation between fragmentation and conventional semen quality parameters. Higher fragmentation is also correlated with lower fertility rates, poorer embryo development and quality, lower implantation, pregnancy and higher abortion rates. While several studies link fragmentation to outcomes, evidence is still insufficient to recommend routine clinical use of tests to predict fertility or ART success.
Assessment and treatment of people with fertility problem NICE guideline, 2013
This document discusses guidelines for assessing and treating fertility problems from 2013. It covers:
- Common causes of fertility issues including unexplained infertility and male/female factors
- Terms used in fertility treatment like infertility and full IVF cycle
- Recommendations for treatments like not offering oral drugs for unexplained infertility and IUI, and criteria for IVF referral
- Principles of care like providing information to couples and counseling on chances of conception
- Investigations for fertility problems and how to interpret results
- Medical and surgical treatment options for issues like ovulation disorders, tubal problems, endometriosis, and male factor infertility
- Procedures used in IVF treatment including controlled ovarian stimulation protocols
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This document discusses vulvodynia, specifically vulvar vestibulitis syndrome (VVS). It defines VVS as a chronic condition characterized by severe pain on vestibular touch or attempted vaginal entry. The causes are unclear but may be multifactorial, and treatments include reassurance, medical options like topical creams or antidepressants, behavioral therapies, and surgery like vestibulectomy in some cases. Diagnosis involves assessing for tenderness localized within the vestibule using a cotton swab test.
ART: Factors affecting success: ABOUBAKR ELNASHAR
The document discusses factors that affect success rates of assisted reproductive technology (ART). It identifies several factors related to the couple, treatment techniques, and IVF centers. Key factors discussed include age, ovarian reserve, number of previous treatment cycles, cause of infertility, and lifestyle factors like smoking. The document also examines stimulation protocols, oocyte retrieval techniques, and the role of the laboratory in contributing to ART success rates.
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The document discusses maternal mortality in Egypt. It outlines the causes of maternal mortality as direct or indirect complications from pregnancy. Trends show a significant decline in maternal mortality over 20 years, though challenges remain in meeting MDG5 targets. Private health clinics are a particular challenge due to issues like lack of adherence to protocols, managing high-risk cases unsuitably, and refusal of training. Regional disparities also threaten national goals. The MCH acceleration plan aims to close inequity gaps and reach vulnerable populations to achieve the MDG5 target.
Safe prevention of the primary cesarean delivery
The document discusses strategies for safely reducing the rate of primary cesarean deliveries. It finds that the most common indications for primary c-sections are labor dystocia, abnormal fetal heart rate tracings, fetal malpresentation, multiple gestation, and suspected macrosomia. Safe reduction of c-section rates will require different approaches tailored to each of these indications. Some strategies discussed include revising the definition of labor dystocia, improving interpretation of fetal heart rate monitoring, increasing access to support during labor, attempting external cephalic version for breech babies, and allowing trial of labor for some twin pregnancies. The document emphasizes using evidence-based guidelines and a multifaceted approach at the organizational and regional levels,
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
The document summarizes key information from the ESHRE 2022 and FIGO 2022 conferences. It discusses several topics including:
- The ESHRE conference included 97 sessions with 317 oral and 801 poster presentations.
- The FIGO classification system for ovulatory disorders was updated, categorizing disorders into 4 types based on their hypothalamic, pituitary, ovarian, or PCOS origin.
- Subtle distal fallopian tube abnormalities may be treated with laparoscopy, leading to a 46.58% natural pregnancy rate.
- Children born after frozen embryo transfer have a higher risk of childhood cancer than those born after fresh embryo transfer or spontaneously.
hepatitis B.pdf
1. Hepatitis B in pregnancy can impact both mother and child. Vertical transmission from mother to child is a major risk, occurring in 30% of cases without intervention.
2. Diagnosis involves screening all pregnant women for HBsAg. For HBsAg positive mothers, further testing of HBV DNA viral load, HBeAg status, and liver enzymes can assess risk of transmission.
3. Prevention of mother-to-child transmission focuses on antiviral therapy starting at 28 weeks for mothers with high viral load, administration of HBIG and HBV vaccines within 12 hours of birth, and completion of the vaccine series for the infant.
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Clomiphene citrate adjunctives & alternatives
50% of women ovulate using clomiphene citrate (CC) at a dosage of 50 mg/day, while another 25% ovulate if the dosage is increased to 100 mg/day. Most CC-induced pregnancies occur within the first 3 cycles. There is no benefit to increasing the dosage once ovulation occurs or continuing CC for more than 6 months. CC should be discontinued if a patient remains anovulatory after the dosage has been increased to 100 mg over 3 consecutive cycles. Metformin, aromatase inhibitors like letrozole, and adjuvants including N-acetyl cysteine and corticosteroids can be considered as alternatives or adjuvants to CC for ovulation induction in women who do not respond to
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Clomiphene citrate or aromatase inhibitors for
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undergoing intrauterine insemination:
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This document discusses monitoring of the ART (assisted reproductive technology) cycle. It describes various methods for monitoring, including ultrasound to measure follicle growth and endometrial thickness, as well as using ultrasound combined with serum estradiol levels. The key objectives of monitoring are outlined, such as predicting ovarian response, monitoring pituitary suppression, evaluating gonadotropin dose, preventing OHSS, determining the optimal time for hCG administration, and avoiding cycle cancellation. Indicators for when to adjust gonadotropin dosage or cancel the cycle are provided. Ultrasound is identified as the most practical monitoring method and combining it with estradiol is particularly useful for high-risk patients.
SEXUAL FUNCTION AFTER HYSTERECTOMY
1. The document reviews the impact of hysterectomy on sexual function based on various studies.
2. While hysterectomy was historically thought to impair sexuality, most studies found sexual function was unchanged or improved after hysterectomy.
3. Subtotal hysterectomy was associated with less impairment of sexual response than total hysterectomy and a reduction in dyspareunia.
OHSS: Prediction and prevention in non IVF cycles
This document discusses prediction and prevention of ovarian hyperstimulation syndrome (OHSS) in non-IVF cycles. It defines OHSS and describes its degrees of severity. Risk factors for OHSS include polycystic ovary syndrome (PCOS) history and high antral follicle count (AFC) or anti-Müllerian hormone (AMH) levels. Prevention strategies discussed include using a low-dose gonadotropin protocol, monitoring estrogen levels and ultrasound findings closely, triggering with a gonadotropin-releasing hormone agonist instead of hCG, and administering hydroxyethyl starch or cabergoline. The document emphasizes that primary prevention through risk assessment and modified stimulation protocols is crucial to avoiding
Embryo transfer: Aboubakr Elnashar
1) Embryo transfer is the final step in IVF where embryos are placed in the uterus. Careful technique is important for success.
2) Factors that can affect the success of embryo transfer include embryo selection, the timing of the transfer, cervical infections, endometrial thickness and pattern, and experience of the provider.
3) During the procedure, gentle technique, ultrasound guidance, and depositing embryos slightly below the uterine fundus can help maximize the chances of implantation and pregnancy. Meticulous attention to factors before, during, and after embryo transfer is crucial.
Treatment of hot flushes
This document discusses the treatment of hot flashes. It begins by describing the clinical manifestations, pathophysiology, prevalence, and risk factors of hot flashes. It then discusses methods of assessing hot flash severity, including hot flash scores, the Greene Climacteric Score, and the Modified Kupperman Index. The main treatment approaches covered are hormonal therapies like estrogen, progestin, and tibolone, and non-hormonal options such as SSRIs, SNRIs, and complementary therapies. Hormonal therapies are generally the most effective treatment but have risks, so non-hormonal alternatives are considered when hormones are not appropriate.
Umblical & uterine artery Doppler
This document discusses umbilical and uterine artery Doppler ultrasound. It notes that umbilical artery Doppler is useful for predicting abnormal fetal outcomes, with a resistance index above 0.72 outside normal limits after 26 weeks. Absent or reversed end diastolic flow in the umbilical artery indicates fetal distress and need for monitoring or delivery. Uterine artery Doppler has limited use in predicting fetal growth restriction but can suggest maternal versus fetal causes. An abnormal uterine Doppler with decreased diastolic flow or persistence of a diastolic notch after 24 weeks can help predict preeclampsia. Fortnightly umbilical artery Doppler scans are recommended when growth is not maintained or abdominal circumference is below the third percentile.
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
This document discusses different methods for endometrial preparation in frozen embryo transfer (FET) cycles. It describes natural cycle FET, which can be done through a true natural cycle or modified natural cycle with an HCG trigger. It also outlines artificial/hormone replacement cycle FET, where estrogen and progesterone are administered without GnRH agonists in patients with remaining ovarian function. The key points are that the endometrium must be adequately prepared prior to embryo transfer, and the age of the embryos after thawing should correspond to the developmental age of the endometrium. The best method varies between patients and there is no clear consensus.
Controlled ovarian stimulation in IVF
This document discusses different types of ovarian stimulation protocols used in IVF. It begins by describing 4 main types of stimulation: natural/modified natural cycles involving little to no medication; mild stimulation involving low dose FSH/HMG; conventional stimulation using standard FSH/HMG doses; and high stimulation. It then covers the drugs used for ovarian stimulation, including gonadotropins and GnRH analogues. The rest of the document discusses specific GnRH agonist and antagonist protocols, methods of triggering ovulation including hCG and GnRH agonists, and criteria for cycle cancellation.
Hepatitis B in Pregnancy
Hepatitis B in Pregnancy discusses the epidemiology, natural history, transmission, impact on pregnancy, and management of HBV infection during pregnancy. It notes that perinatal transmission is the primary mode of HBV transmission in many areas. The document recommends immunoprophylaxis for infants using HBIG and vaccination to reduce transmission risk from 70-90% to 5-10%. For HBV-infected women, antiviral therapy late in pregnancy can further lower transmission risk, though does not ensure prevention. Correct infant immunization allows for breastfeeding.
Luteal phase support in ART
The document discusses luteal phase support (LPS) in assisted reproductive technology (ART) cycles. It notes that abnormal luteal function can occur after controlled ovarian stimulation, necessitating LPS. It reviews various LPS options including human chorionic gonadotropin and progesterone administered via different routes. Vaginal progesterone is found to effectively increase endometrial levels while intramuscular progesterone yields the highest serum levels. The document concludes that LPS is necessary to optimize ART outcomes and that intramuscular or vaginal progesterone are equally effective options.
Ivf in pcos
This document discusses IVF treatment for polycystic ovary syndrome (PCOS). It begins with an overview of PCOS prevalence, definitions, and diagnostic criteria. IVF is indicated for PCOS patients who fail to conceive after ovulation induction or have other fertility factors. Patient preparation, gonadotropin protocols and monitoring, triggering ovulation, embryo transfer, and luteal phase support are discussed. Outcomes are better with GnRH antagonist protocols for PCOS patients due to lower gonadotropin doses and risk of ovarian hyperstimulation syndrome (OHSS). Primary and secondary prevention of OHSS includes metformin use, coasting, cryopreservation of embryos, and GnRH agonist triggering of ovulation.
Clinical utility of sperm DNA fragmentation tests
This document discusses clinical utility of sperm DNA fragmentation tests. It first reviews the origins and etiology of sperm DNA fragmentation, including factors during spermatogenesis and transport that can lead to increased oxidative stress and DNA damage. It then examines several methods for assessing sperm DNA fragmentation and finds an inverse correlation between fragmentation and conventional semen quality parameters. Higher fragmentation is also correlated with lower fertility rates, poorer embryo development and quality, lower implantation, pregnancy and higher abortion rates. While several studies link fragmentation to outcomes, evidence is still insufficient to recommend routine clinical use of tests to predict fertility or ART success.
Assessment and treatment of people with fertility problem NICE guideline, 2013
This document discusses guidelines for assessing and treating fertility problems from 2013. It covers:
- Common causes of fertility issues including unexplained infertility and male/female factors
- Terms used in fertility treatment like infertility and full IVF cycle
- Recommendations for treatments like not offering oral drugs for unexplained infertility and IUI, and criteria for IVF referral
- Principles of care like providing information to couples and counseling on chances of conception
- Investigations for fertility problems and how to interpret results
- Medical and surgical treatment options for issues like ovulation disorders, tubal problems, endometriosis, and male factor infertility
- Procedures used in IVF treatment including controlled ovarian stimulation protocols
Vulvodynia
This document discusses vulvodynia, specifically vulvar vestibulitis syndrome (VVS). It defines VVS as a chronic condition characterized by severe pain on vestibular touch or attempted vaginal entry. The causes are unclear but may be multifactorial, and treatments include reassurance, medical options like topical creams or antidepressants, behavioral therapies, and surgery like vestibulectomy in some cases. Diagnosis involves assessing for tenderness localized within the vestibule using a cotton swab test.
ART: Factors affecting success: ABOUBAKR ELNASHAR
The document discusses factors that affect success rates of assisted reproductive technology (ART). It identifies several factors related to the couple, treatment techniques, and IVF centers. Key factors discussed include age, ovarian reserve, number of previous treatment cycles, cause of infertility, and lifestyle factors like smoking. The document also examines stimulation protocols, oocyte retrieval techniques, and the role of the laboratory in contributing to ART success rates.
Maternal mortality in egypt
The document discusses maternal mortality in Egypt. It outlines the causes of maternal mortality as direct or indirect complications from pregnancy. Trends show a significant decline in maternal mortality over 20 years, though challenges remain in meeting MDG5 targets. Private health clinics are a particular challenge due to issues like lack of adherence to protocols, managing high-risk cases unsuitably, and refusal of training. Regional disparities also threaten national goals. The MCH acceleration plan aims to close inequity gaps and reach vulnerable populations to achieve the MDG5 target.
Safe prevention of the primary cesarean delivery
The document discusses strategies for safely reducing the rate of primary cesarean deliveries. It finds that the most common indications for primary c-sections are labor dystocia, abnormal fetal heart rate tracings, fetal malpresentation, multiple gestation, and suspected macrosomia. Safe reduction of c-section rates will require different approaches tailored to each of these indications. Some strategies discussed include revising the definition of labor dystocia, improving interpretation of fetal heart rate monitoring, increasing access to support during labor, attempting external cephalic version for breech babies, and allowing trial of labor for some twin pregnancies. The document emphasizes using evidence-based guidelines and a multifaceted approach at the organizational and regional levels,
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Assessment and treatment of people with fertility problem NICE guideline, 2013
Assessment and treatment of people with fertility problem NICE guideline, 2013
More from Aboubakr Elnashar
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
The document summarizes key information from the ESHRE 2022 and FIGO 2022 conferences. It discusses several topics including:
- The ESHRE conference included 97 sessions with 317 oral and 801 poster presentations.
- The FIGO classification system for ovulatory disorders was updated, categorizing disorders into 4 types based on their hypothalamic, pituitary, ovarian, or PCOS origin.
- Subtle distal fallopian tube abnormalities may be treated with laparoscopy, leading to a 46.58% natural pregnancy rate.
- Children born after frozen embryo transfer have a higher risk of childhood cancer than those born after fresh embryo transfer or spontaneously.
hepatitis B.pdf
1. Hepatitis B in pregnancy can impact both mother and child. Vertical transmission from mother to child is a major risk, occurring in 30% of cases without intervention.
2. Diagnosis involves screening all pregnant women for HBsAg. For HBsAg positive mothers, further testing of HBV DNA viral load, HBeAg status, and liver enzymes can assess risk of transmission.
3. Prevention of mother-to-child transmission focuses on antiviral therapy starting at 28 weeks for mothers with high viral load, administration of HBIG and HBV vaccines within 12 hours of birth, and completion of the vaccine series for the infant.
hepatitis c2022.pdf
Hepatitis C and pregnancy can affect both mother and fetus. While pregnancy does not typically affect the course of HCV infection, HCV can increase maternal risks like gestational diabetes and postpartum hemorrhage. It may also increase fetal risks such as preterm delivery and low birthweight. Management includes screening all pregnant women for HCV, treating the mother if needed to reduce viral load and risk of transmission, and monitoring the fetus for complications. Delivery by cesarean is not routinely recommended, and breastfeeding is considered safe if nipples are intact.
Adenomyosis associated infertility
A 32-year-old woman presented with primary infertility of 1.5 years. Ultrasound and MRI findings indicated adenomyosis. Adenomyosis can be associated with infertility by decreasing chances of conception and increasing risk of miscarriage. The patient underwent failed ovulation induction and IUI cycles. The document discusses recommended treatment protocols including IVF with a long agonist or antagonist protocol, as well as potential surgical options like conservative surgery if additional IVF cycles fail. Conservative surgery may improve fertility in women under 40 who desire future pregnancy.
Endometriosis associated infertility: ESHRE2022
The document is a lecture on the treatment of endometriosis-associated infertility according to 2022 ESHRE guidelines. It discusses various treatment options including medical treatment with hormonal therapies, surgery, assisted reproductive technologies (ART), and fertility preservation. Key recommendations include that ovarian suppression should not be used to improve fertility. Surgery and ART may be considered depending on the stage of endometriosis and patient factors. Extensive counseling is recommended when discussing fertility preservation options.
Adenxal mass guidelines2020
This document summarizes guidelines for managing adnexal masses from the SOGC in 2020. It discusses examining patients with adnexal masses through history, physical exam, investigations including ultrasound, lab tests, cancer antigen 125 levels, and the risk of malignancy index. Ultrasound is emphasized for distinguishing benign from malignant features, with IOTA criteria outperforming RMI. Referral to a gynecologic oncologist is recommended for suspected malignancy based on sonographic features, family history, clinical findings or indeterminate ultrasound results.
Aesthetic gynecology controversy
This document discusses controversies in aesthetic gynecology procedures. It begins by defining aesthetic gynecology as procedures that alter female genital appearance or structure for non-medical reasons. The document then outlines the increasing popularity of these procedures in recent years. It notes both opponents and proponents of these procedures and their differing views on issues like patient autonomy and lack of evidence. The document concludes by summarizing various medical organizations' ethical guidelines, which state that the safety and effectiveness of many aesthetic gynecology procedures have not been established and caution is warranted.
Hormonal assay in clinical gyn
This document discusses a lecture on hormonal assays in clinical gynecology given by Prof. Aboubakr Elnashar. It provides information on various hormones including prolactin, TSH, AMH, FSH, LH, estrogens, progesterone, and androgens. For each hormone, the document discusses their source, reference ranges, clinical uses, and conditions they may be associated with. It also provides summaries of key points about each hormone test and their roles in evaluating endocrine conditions like infertility, menstrual disorders, and menopause.
FIRST TRIMESTER ANC OF IVF
1. The document discusses the routine care and special considerations for antenatal care (ANC) of pregnancies achieved through in vitro fertilization (IVF).
2. Special considerations for IVF pregnancies include increased risk of complications like ovarian hyperstimulation syndrome, multiple pregnancies, and genetic abnormalities which require specialized counseling and screening.
3. ANC for IVF pregnancies should be provided by specialists familiar with both obstetrics and IVF in order to monitor for pregnancy complications and provide psychosocial support related to fertility treatments.
Unnecessary investigations in reproductive medicine
The document discusses unnecessary investigations in reproductive medicine. It provides examples of tests that should not be routinely performed when evaluating infertility, during IVF treatment, in cases of recurrent implantation failure, and recurrent pregnancy loss. Specific tests that are deemed unnecessary include post-coital testing, thrombophilia testing without a clinical indication, immunological testing, and advanced sperm function tests for initial infertility evaluations. The document also recommends limiting hormonal assessments during IVF cycle monitoring.
Infertility prevention
This document discusses prevention of female infertility and contains information on several topics:
1. Age-associated infertility and the decline of fertility with increasing female age. Early childbearing and egg freezing are recommended.
2. Tubal factor infertility caused by infections like pelvic inflammatory disease which can be prevented by screening and treating STDs. Adhesions from surgery can also be prevented using techniques that minimize trauma.
3. Other causes of infertility like endometriosis, ovarian issues, and uterine factors are discussed along with prevention strategies.
Individualisation of controlled ovarian stimulation
This document discusses individualizing controlled ovarian stimulation (COS) protocols based on a patient's ovarian reserve. It describes various ovarian reserve tests (ORTs) like AMH and AFC levels that can categorize patients' responses. Prediction models incorporating multiple factors are presented to anticipate poor or high responses and tailor gonadotropin starting doses. Treatment strategies for different POSEIDON patient groups aim to maximize oocyte yield, including increasing gonadotropin doses or adding medications like recombinant LH. Dual stimulation protocols within one cycle are also proposed.
Female infertility
This document discusses female infertility, including causes like endometriosis, ovarian factors, tubal factors, and uterine factors. It provides guidelines for evaluating infertility, including taking a history, physical exam, and testing. For ovarian factor infertility, it discusses assessing ovulation through symptoms, ultrasound, and progesterone testing. Causes of anovulation like PCOS are explained. Ovarian reserve can be assessed through age, antral follicle count, and AMH levels.
Maternal near miss
This document discusses maternal near miss (MNM), which refers to women who survive severe life-threatening complications during pregnancy, childbirth, or postpartum. MNM is presented as an important tool for evaluating obstetric healthcare beyond just maternal mortality. The document outlines criteria for identifying MNM cases, indicators for assessing healthcare quality using MNM data, advantages of MNM reviews for reducing maternal mortality, and findings from studies on MNM in various hospitals that identified leading complications and opportunities for improvement. MNM reviews are described as complementary to maternal death reviews for gaining insights to reduce preventable morbidity and mortality.
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
The document provides guidelines for the management of severe preeclampsia and eclampsia. It defines preeclampsia and eclampsia and describes criteria for severe disease. It recommends close maternal monitoring of blood pressure, labs, urine output and fetal wellbeing. It provides guidance on controlling blood pressure with antihypertensive drugs like labetalol, nifedipine and hydralazine. The goal is to prolong the pregnancy and deliver at the optimal time while preventing maternal and fetal complications.
cesarean birth: procedural aspects: NICE2021
This document provides guidelines for procedural aspects of caesarean sections (CS). It discusses topics such as: timing of planned CS to reduce neonatal risks; classification and timeframes for emergency CS categories; preoperative testing and preparation; regional anesthesia preferences; techniques to reduce infection risks and prevent transmission; surgical techniques for skin incision, uterine closure, and more; and thromboprophylaxis and accommodating women's preferences.
CAESAREAN SCAR DEFECT
The document discusses caesarean scar defects, also known as uterine niches. It provides information on the prevalence, risk factors, clinical presentation, diagnosis, and management of this condition. Uterine niches are common, affecting up to 70% of those with a prior c-section, and are usually asymptomatic but can sometimes cause bleeding, pain, or infertility. Diagnosis involves ultrasound imaging to identify a triangular defect in the uterine scar with decreased or absent underlying muscle. Larger niches with less residual muscle are more likely to be symptomatic.
Management of pregnancy of unknown location
This document provides guidelines for managing pregnancies of unknown location (PUL). It defines PUL as a positive beta-hCG result but no pregnancy located on ultrasound. PULs have several potential outcomes including intrauterine pregnancy (IUP), ectopic pregnancy, or persistent PUL. The M6 regression model can help stratify PULs as high or low risk for ectopic pregnancy to guide treatment. Management of PUL requires close follow-up with repeated testing until a definitive diagnosis is made.
Aerobic Vaginitis
1. Aerobic vaginitis (AV), also known as desquamative inflammatory vaginitis (DIV), is an underdiagnosed vaginal discharge syndrome caused by an imbalance of the vaginal microbiota and an inflammatory response.
2. It is characterized by a lack of lactobacilli bacteria and overgrowth of aerobic bacteria like E. coli, streptococci, and staphylococci. Women present with yellowish foul-smelling discharge, irritation, and vaginal inflammation.
3. The diagnosis of AV is made through microscopic examination showing lack of lactobacilli, presence of inflammatory cells and parabasal cells, and a vaginal pH over 4.
COVID 19 infection and pregnancy RCOG2021
This document provides guidelines for caring for pregnant women with COVID-19. It discusses that vertical transmission of COVID-19 from mother to baby is uncommon. It recommends continuing antenatal care with safety modifications and advises vaccination for pregnant women when risk of exposure is high. For pregnant women with COVID-19, it suggests treatments and monitoring based on symptoms and managing clinical deterioration. Guidelines are provided for intrapartum and postpartum care as well, including thromboprophylaxis. The overall goal is to provide care for both the health of the pregnant woman and baby while mitigating risk of COVID-19 transmission.
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WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
Unnecessary investigations in reproductive medicine
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Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
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Gastritis and Gastric Health
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Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
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9. Integrate the respiratory regulatory mechanisms
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