Problem Coordinator Dr

Problem Coordinator Dr. Bashair Mussa Unit Coordinators Dr. Eman Abu-Gharbieh, Dr. Jibran Muhamad and Dr. Mohamed El Adl Year 1 Coordinator Prof. Nabil Sulaiman ____________________________________________________________________________ Mini Problem 1 A couple in their late 20s presented at the infertility clinic for evaluation. They have not been using any birth control methods since they got married 2 years ago. Neither has a history of any major illness. Semen analysis of the husband was normal. However, physical examination and imaging investigations of the wife revealed bilateral obstruction of the fallopian tubes (tubal obstruction). The consultant advised them to have In Vitro Fertilization (IVF) as the best alternative treatment for possible conception. QUESTIONS What is infertility Is a condition in which there is an inability of accomplishing pregnancy despite having regular intercourse for more than a year. What is the rational approach to investigate infertility Both the male and female should undergo investigation for the most accurate and beneficial outcomes and treatment plan, such investigations include To check for the male semen quality whether its normal or not, in case of observing an abnormality, a second test should be taken six weeks later. Investigate whether the female ovulates or not, if not, investigate the underlying reasons. Evaluation of the females tubal conditions and the uterine cavity. What are the general causes of tubal obstruction and damage The most widespread cause is infection. However, there are other causes as well which include 1- Endometriosis, 2- Pelvic inflammatory disease (PID), 3- Sexually transmitted disease (STD), 4- ectopic pregnancy, 5- previous surgery in the abdomen or pelvis. What are the imaging investigations that can diagnose the tubal obstruction 1- Hysterosalpingography (HSG), 2- Laparoscopy, 3- Saline infusion sonohysterosalpingography (SIS), 4- hysterosalpingo-contrast sonography (HyCoSy) What is In vitro fertilization ( IVF) In vitro fertilization (IVF) is a procedure by which a womans egg and a mans sperm are combined in a laboratory dish (in vitro outside the body). Why the doctor advised the couple for IVF After seeing that the problem isnt in the males sperm nor the womans egg, in addition to the fact that the blockage is in the fallopian tube, also, IVF is known to have high chances of success. What other assisted reproduction techniques that take place in the lab Gamete intrafallopian Transfer (GIFT), 2- Zygote Intrafallopian Transfer (ZIFT), 3- Tubal Embryo Transfer (TET), 4- Intracystoplasmic sperm injection (ICSI), 5- Frozen embryo transfer (FET). What is the psycho-socio-economic impact of the above treatment method Psychological Effect Although it brings back hope to the couple, it can be stressful at the same time due to the anxiety generated as theyre anticipating the final result of the procedure. Social Effect Due to the elevated family expectations which leads to potential stress among the couple. Economic Effect IVF is known to be a costly procedure which can place the couple under an economic distress. Suggested references Braude, P and Taylor,A. 2004 ABC of subfertility. BMJ publishing group. Verhaak C.M, Smeenk,, J.M.J., Evers ,A.W.M, Kremer, J.A.M. ,Kraaimaat, F.W. and Braat, D.D.M. 2007 Human Reproduction Update, Vol.13, No.1 pp. 2736. (BLACKBOARD). Handbook of the assisted reproduction laboratory / edited by Broaks A. Keel, Jeffrey V. May, Christopher J. De Jonge. Medical Library , Shelf Mark WQ208.H2369 2000 Mini Problem 2 A 28-year-old lady was seen in the antenatal clinic at 32 weeks of her second pregnancy. Her medical history includes hypertension, smoking, and poor dietary habits. Her first baby was delivered by cesarean section for fetal distress. The child is well at home but suffering some difficulty in school education. On physical and ultrasound examination, her fundal height was found of 20 cm, fetal weight was in the ninth percentile for gestational age (lower than expected), and there was marked oligohydramnios (reduction of amniotic fluid). The doctor decided to admit her immediately to hospital. Questions What is your assessment of the fetal well being Justify your answer. The fetus is considered small for its gestational age (SGA) since the fundal height is found to be 20cm at 32 weeks when its supposed to be close to 30cm, also, the weight is lower than normal which leads to the conclusion that the fetus is suffering from intrauterine growth restriction and as a consequence, SGA is resulted. How can the diagnosis of small fetus be made more specific There are several approaches for the diagnosis of such a case, these include Doppler flow which uses sound waves to measure blood flow. Mothers weight gain when the mother gains a small amount of weight during her pregnancy, this may correspond with a small baby. Gestational assessment Infants are weighed within the first few hours after birth. The birthweight is compared with the babys gestational age and recorded in the medical record. Somephysicians use a formula for calculating a babys body mass to diagnose SGA. What are the general causes of such case There are several causes that contribute to this case, mainly an intrauterine growth restriction (IUGR), this condition occurs when the fetus does not receive the sufficient amount of nutrients and oxygen needed for proper growth and development of organs and tissues, which can begin at any time during pregnancy. Early-onset of IUGR is often a result of chromosomal abnormalities such as Downs Syndrome maternal infections such as rubella and syphilis severe problems with the placenta which makes the infant unable to receive the sufficient amount of nutrients and oxygen. Late-onset growth restriction (after 32 weeks) is usually related to other problems. Why the doctor decided to admit her immediately In order to treat the condition by IV rehydration since the doctor noted low levels of amniotic fluid, but in cases of severe oligohydramnios, an early delivery and a cesarean section is performed. What is the term given to the fetal condition that occurs on the opposite extreme of the above case Large for gestational age polyhydramnios References Chamberlain,G. and Morgan, M. (2002) ABC of antenatal care, 4th edition, Chapter 11, pp.71-79. 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