Dr. Cosmina Brümmer Le Roux

PAP Bethesda System CIN Histological classification ------------------------------------------------------ Class I Normal Normal Normal ------------------------------------------------------ Class II AS…

Cauterizarea este o metoda chirurgicala prin care se urmareste distrugerea prin mijloace fizice sau chimice a anumitor tesuturi. Exista mai multe tipuri de cauterizare: -prin caldura:termocauterizare; -folosind curent electric:electrocauterizarea; -prin frig:criocauterizare…

BABY ESSENTIALS: -4-6 vests; -4-6 body vests; -3-6 x sleepsuits; -2 x rompers; -4-6 x 2 piece sets socks; -1 x pair of slippers; -1x pair of sneakers/shoes; FEEDING: -breast pump; -breast pads; -bottle warmer; -4x feeding bottles; -4x teats; -bottle and teat brush…

O importanta deosebita in nutritia gravidei este aportul combinat de proteine,glucide,lipide,vitamine si minerale.Dietele alimentare trebuie evitate , gravidele urmand sa respecte un regim alimentar echilibrat care sa asigure bebelusului toate principiile nutritive necesare crest…

-Can reduce myoma size and uterine volume as well as bleeding; -Goal is to temporarily reduce symptoms and myoma size; -May be sufficient for women nearing menopause; -Side effects and expense limit long-term use; None shown to improve fertility; -Myomas regain pretreatment …

-hypertonia ; -prominent occiput ; -small mouth ; -micrognathia ; -short sternum ; -horseshoe kidney ; -ectopic pancreatic tissue ; -small pelvis ; -increased arch patterns on fingertips flexed fingers ; -overriding index fingers or third fingers ; -ventricular septal d…

-holoprosencephaly ; -absence of the olfactory nerve or bulb ; -severe eye defects (microphtalmia , coboloma , cyclopism) ; -deafness ; -cleft lip/palate ; -omphalocele , umbilical hernia ; -genitourinary abnormalities ; -polydactyly ; -superficial hemangiomas ; -club fe…

Analize OBLIGATORII , care se repeta: -RBW (VDRL,TPHA):saptamanile 29-32; -dozare anticorpi antiRh ; -Ht,Hb,trombocite (hemoleucograma completa); -glicemie; -sumar de urina (albumina,glucoza,corpi cetonici,sediment); -urocultura; -examen bacteriologic secretie vaginala; -…

Toxoplasmosis , other viruses , rubella , cytomegalovirus and herpes simplex virus . Toxoplasmosis is seen in 1/3 of females exposed by undercooked meat or cat feces . So , avoid contaminated meat , unwashed fruit/vegetables , unpasteurized cheese , cat feces . Risks : US de…

Human papillomavirus HPV is the cause of the most common sexually transmitted diseases STDs of viral etiology worldwide. High-risk HPVs are the etiological agents of cervical and other anogenital malignancies and low-risk HPVs induce only benign genital warts. Since high-risk HPV…

The crown-rump length is 32 to 54 mm . The fetus aquires human shape and the fetal body comes longer .The head is still disproportionally large . The forehead prominent and the occiput is flat . The cerebel hemispheres can be seen at 9 weeks . Ossification starts from the occipi…

Several ultrasound studies using mainly the transvaginal approach at 4 to 12 weeks of gestation describe the developent of the normal fetus as fallows : The 4th Week: The gestational sac is visible from about 4 weeks and 3 days as a hypoechoic , ring-like2 to 3 mm structure s…

1. Estrogen-progesterone challenge test in amenorrhea; 2. DUB ; 3. Endometriosis; 4. Dysmenorrhea; 5. Postponement of periods; 6. Premenstrual syndrome and cyclical mastalgia; 7. Idiopatic hirsutism; 8. Hormone replacement therapy; 9. Lower incidence of …

Absolute: 1.Thomboembolic disease; 2.Acute and chronic disease of liver; 3.Cancer of breast or genitals; 4.Pregnancy known or suspected; 5.Focal migraine. Relative: 1.Hypertension; 2.Valvular heart disease; 3.Epilepsy; 4.Smokers over 35 years; 5.Nursing mothers; 6.S…

Acestea pot fi folosite in timpul travaliului pentru a te relaxa , sa-ti conserve energia , sa-ti controlezi corpul si durerea , sa te calmezi si sa iti alungi frica. 1.Respiratia profunda Cand respiri , trebuie sa simti cum partea inferioara a plamanilor se umple cu aer si c…

Acesta reprezinta cea mai importanta complicatie a tratamentelor de stimulare ovariana utilizate in cadrul tehnicilor de stimulare ovariana.El se caracterizeaza prin cresterea in dimensiuni a ovarelor datorita cresterii permeabilitatii vasculare. Gradul I (hiperstimulare usoara)…

1.Semne de alarma la aparitia carora gravida trebuie sa mearga la spital sau medicul de familie va trimite femeia gravida de urgenta la spital : -sangerare vaginala sau pierderi de lichid amniotic ; -CUD (contractii uterine dureroase )+/- hipertonie uterine ; -dureri abdomin…

To rule out antiphospholipid syndrome: 1.Anticardiolipin antibodies a. Ig G (0-15 GPL) - better predictor of fetal outcome; b. Ig M (0-15 MPL) ; c. Ig A ; Positive in medium or higher titer or >= 2 occasions six weeks apart; 2.Lupus anticoagulant ; Sample must be taken uncu…

-Is a unique opportunity to impove future health of your family; -Process is simple and noninvasive, takes about 3 minutes and do not represent any risk to mother or fetus; -Rich blood is bet on stem cells extracted from one gram of umbilical cord blood contains 10 times more t…

Hyperprolactinemia Prolactin - The Hormone Prolactin is a protein (197-199 amino acids) product of the anterior pituitary . Chemically similar to growth hormone and human placental lactogen . A single gene located on chromosome 5 encodes it for prolactin synthesis and funct…

Pe parcurs ce sarcina avanseaza , abdomenul se mareste iar statul pe scaun sau pozitiile care erau pana nu demult confortabile vor deveni incomode . Nu este recomandat sa stai intinsa pe spate , chiar si pentru scurt timp , intrucat greutatea uterului gravid apasa vasele sanguine…

In an anovulatory cycle , ultrasound imaging of the ovaries will reveal either a lack of any follicular development , particularly in the hypogonadotropic hypogonadal patient with type I or a few non ovulatory (less than 11mm) follicles . A dominant follicle larger than 16mm in d…

Routine Investigations : 1.Hemogram , Blood group; 2.Liver function tests; 3.Kidney function tests; 4.Fasting and postprandial blood sugars; 5.Urine - routine/microscopy; 6.X-Ray chest (PA view); 7.ECG. Specific Investigations: 1.Tumor markers CA-125 >35 UI/l in e…

It is the most important complication of ovarian stimulation treatments used in the ovariana.El stimulation techniques are characterized by the ovaries increase in size due to increased vascular permeability. Grade I (mild hyperstimulation) , Abdominal discomfort; -Increase in…

-Maintain healthy weight ; -Nutrition variety of food in moderate protions ; -Exercise , stay fit , keep muscle tone ( Kegel exercise , posture exercise ) ; -Regular sexual activity is important to patients ; -Moisturizers and lubricants as needed for vaginal and sexual comfo…

Genetic abnormalities may cause infertility by affecting sperm production and/or transport.The three most common genetic factors known to be related to male infertility are cystic fibrosis gene mutations associated with CBAVD , chromosomial abnormalities resulting in impaired tes…

Repetarea investigatiilor anterioare (din trimestrul I de sarcina) ale caror rezultate sunt in afara valorilor normale sau exista simptomatologie relevanta. Teste de laborator care SE REPETA la nevoie: -hemoglobina/hematocrit; -glicemie (+/- HGP); -sumar de urina/urocultura…

I.Evaluation of female partner : Physical parameters : Anthropometric : -weight (kg); -height (m); -body mass index (BMI); -normal range : (BMI 19-25); -waist girth (cm); -hip girth (cm); -W:H ratio ; -normal value for W:H ratio

Conform World Health Organisation o spermograma normala arata astfel: -volum: 2 ml; -concentratia spermatozoizilor 20 milioane/ml; -motilitate min 50% cu progresie rapida; -morfologie >30% forme normale; -leucocite

-cerere tip; -copie BI/CI solicitant; -copie certificat nastere copil/ceilalti copii; -copie certificat handicap copii; -adeverinta-tip eliberata de angajator dic care sa rezulte: -ca persoana a realizat venituri profesionale supuse impozitului pe venit conform Codulu…

Antigenul D sau factorul Rh determină clasificarea eritrocitelor È‹n două tipuri : -eritrocitele care prezintă factor Rh sunt eritrocite Rh pozitive și -eritrocite care nu prezintă factor Rh sunt Rh negative . în timpul sarcinii , este obligatorie determinarea grupului sa…

Sperm preparation technique is a very crucial step in the success of IUI.It separates highly motile functional sperm with normal morphology in high percentage and removes seminal plasma that contains prostaglandins and cytokines and antigenic or infectious matter along with defe…

Must weigh several factors : risk of exposure , maternal risk , fetal risk , risk from vaccine / toxoid . Rule of thumb : No live vaccines unless : 1. Susceptibility / exposure probable and 2. Disease threat to woman / fetus - vaccine risk Only routinely administrated immu…

Description: Hypertension existing prior to the onset of pregnancy,hypertension diagnosed prior to 20 weeks estimated gestational age, or persistent postpartum hypertension (>12 weeks postpartum).Hypertension diagnosed during pregnancy may be : -mild: >140/90mm Hg; -severe: >…

Human papillomaviruses (HPVs) are a group of host-specific DNA viruses, with a remarkable epithelial cell specificity: they have been reported principally in the ano-genital tract, urethra, skin, larynx, tracheo-bronchial and oral mucosa. More than 100 different HPV types have be…

Only a minority of women with human papillomavirus (HPV) infection eventually develop cervical cancer, which suggests that host immune mechanisms play a role in the disease. HLA polymorphisms have been linked to the risk of cervical cancer, but very little is known about the role…

Asigura-te ca nu sunt contraindicate in cazul tau . Este obligatoriu sa ai acordul medicului daca : -ai o sarcina cu risc ; -ai hipertensiune indusa de sarcina ; -ai risc de nastere prematura ; -daca ai antecedente de nastere prematura . Exercitii pentru muschii fesieri…

Analize uzuale : - HLG ; -Creatinina ; -Ag HBs ; -Grup ABO ; -Acid uric ; -Ag HCV ; -Grup Rh - gravidă ; -VSH ; -Examen citologic Babeș- Papanicolaou ; -Grup Rh - soț ; -Fibrinogen ; -Examen secreție vagi…

Fetal heart rate is a relative marker for fetal aneuploidy . It is also related to some chromosomal abnormalities. At 5 weeks the embyo’s heart rate is around 110 bpm and increases up to 170 bpm at 9 weeks . It decreases to 150 bpm at 14 weeks. Turner’s syndrome and trisomy…

- Placental sonografic findings : placental degeneration , increased thickness , cystic images and the tendency toward increased volume and echogenicity as pregnancy progresses. - Single umbilical artery is a sonographic sign associated with a wide range of syndromes , perinatal…

1.Factorii de risc pentru cancerul mamar sunt : -varsta intre 45-50 ani ; -pubertatea precoce si menopauza tardiva ; -sterilitate si infertilitatea ; -aparitia tardiva (dupa 27 ani) a primei sarcini dusa la termen , lipsa alaptarii sau alaptare de scurta durata ; -debut tard…

Complete physical: every 5 years; Screening examinations: -blood pressure annualy; -breast every:1-3 years; -pelvis every :1-3 years; Screening tests: -Pap smear every 1-3 years; -serum cholesterol:every 5 years; -rubella titer at age 20; -mammog…

Complete physical: initial visit need not include pelvic; Screening examination: -blood pressure, weight,body image; Screening tests:informational and introductory; Immunizations: HPV vaccine if not already done 8-12; My South Africa

Morula:2-3 days after fertilization; Blastocyst:4-5 days after fertilization; Fertilized ovum reaches uterus in:5-6 days; Implantation:6-7 days; Trophoblastic venous sinuses form : 9-11 days; Cardiovascular system begin to form : 21 days; Earliest morphological indicator of…

H&P , serial hCG levels , decreased progesterone levels , decreasing estradiol levels , increasing MSAFP , C-reactive protein and CA-125 levels , vaginal US , cureyyage , culdocentesis (+if ruptured but in 2 days --> a non-viable pregnancy should be assumed. hCG abnormal pregna…

1.In cazul sarcinii cu factori de risc cunoscuti sau detectati pe parcurs , indicatiile clinice ale ecografiei sunt urmatoarele : -antecedentele obstetricale personale sau familiale; -determinarea varstei gestationale in cazul incertitudinii datei ultimei menstruatii,a menstrua…

1.Head and neck : -brachycephaly ; -epicanthic folds ; -flat nasal bridge ; -folded or dysplastic ears ; -small ears ; -open mouth ; -protruding tongue ; -narrow palate ; -abnormal teeth ; -short neck ; -excessive skin at nape of the neck ; 2.Extremities: -short br…

SA 5 ; Stadii Carnegie 6,7 ; Ecografie : implantare SA 6 ; Stadii Carnagie 8,9,10 ; Eco: inceputul circulatiei fetale ; SA 7 ; Stadii Carnagie 11,12,13,14 : Eco: separarea de sacul Yolk; SA 8 ; Stadii Carnagie 15,16,17,18 ; Eco: dominanta dezv. creierului ; SA 9 ; Stadii Carn…

In the first trimester , the most common ovarian cyst associated with pregnancy is the CLP. The CLP secrets both estrogen and progesterone to support the pregnancy until the placenta can take over this hormonal function near the end of the first trimester . The CLP forms after o…

Sonography does appear to be very reliable in confirming ovulation once ovulation has occurred . Disappearance of the follicle is noted in 91 % of cases after ovulation and a decrease in follicle size occurs in another 9% . Other signs suggesting that ovulation has occurred are t…

-Caused by HPV infection of sexually transmitted double-stranded DNA viruses , typically by low-risk types 6 , 11 ; -Incubation period after exposure ranges from 3 weeks to 8 months ; -Most infections are transiet and cleared within 2 years ; -Viral strains that cause condylom…

Infertility is presumably underestimated because diagnostic involves a specialist. A review of the literature reveals that 60 to 80 million couples experience infertility worldwide and by 2 million couples (15%) in the United States wherein infection is the major cause. Annual r…

Female: 1.Ovulatory dysfunction factors : -Polycystic ovarian syndrome (PCOS) ; -Age greater than 35 (increases the chance of decreased ovulation) ; -Hyperprolactinemia ; -Excessive exercise or dieting; -Drug or alcohol abuse; -Obesity ; 2.Tubal or pelvic pathology fact…

Choroid Plexus Cysts are a well-known ultrasound aneuploidy marker and are easily detectable at second-trimester ultrasound examination , showing an incidence in euploid fetus close to 1 percent and a positive predictive value of 1 to 6 percent . The association with other fetal …

Risks/Benefits: 1.Risks: -infection; -injury to maternal tissues and internal organs; -injury to fetus at delivery; -need for application of vacuum or forceps to expedite delivery in cesarean section; -10% of patients undergoing emergent CD require transfusion due to severe…

Risks/Benefits: 1.Risks: -infection; -injury to maternal tissues and internal organs; -injury to fetus at delivery; -need for application of vacuum or forceps to expedite delivery in cesarean section; -10% of patients undergoing emergent CD require transfusion due to severe…

1.-Annual Paps to begin after first sexual activity and/or after age 18. 2.-Test every 1-2 years until age 30.(Some recommend that after three normal Paps,screening can be every 2-3 years after age of 30 as the squamous metaplasia are - the substrate for neoplasia- is diminished…

HPV vaccine is available.The quadrivalent vaccine targets HPV types 6 and 11 , which cause 90% of genital warts.Primary target for the vaccine will be children prior to sexual activity.Women who are already sexually active can also receive the vaccine.The quadrivalent vaccine pro…

Durata ciclului menstrual:21zile ; ziua cand incepem determinarea ovulatiei:5; Durata ciclului menstrual:22zile ; ziua cand incepem determinarea ovulatiei:6; Durata ciclului menstrual:23zile ; ziua cand incepem determinarea ovulatiei:7; Durata ciclului menstrual:24zile ; ziua …

Durata ciclului menstrual:21zile ; ziua cand incepem determinarea ovulatiei:5; Durata ciclului menstrual:22zile ; ziua cand incepem determinarea ovulatiei:6; Durata ciclului menstrual:23zile ; ziua cand incepem determinarea ovulatiei:7; Durata ciclului menstrual:24zile ; ziua …

Actele necesare : -cartea de identitate / buletin ( original si copie ) ; -carnetul de sanatate ; -adeverinta de la serviciu ; -dosarul de analize din timpul sarcinii ; -carnetul gravidei . Bagajul graviduței : -periuța și pasta de dinți ; -săpun ; -deodorant ; -proso…

The antisperm antibodies in the female possibly adversely affects fertilization , embryo quality and pregnancy rates . Cervical hostility includes a variety of disorders including anatomical , hormonal and immunological conditions . In most cases it is diagnosed by the PCT (Post…

Clinical Criteria One or more episodes of arterial , venous or small vessel thrombosis , occurring in any tissue or organ . Complications of pregnancy : one or more unexplained deaths of a morphologically normal fetus more than 10 weeks of gestation documented by ultrasound o…

PCOS (polycystic ovarian syndrome) is present in up 25 per cent of normal women.The diagnosis of PCOS is made on any combination of characteristic clinical,biochemical and ultrasound features.It is a morphological description of enlarged ovaries with an increased number of follic…

Analize/investigatii OBLIGATORII in trimestrul I de sarcina (sau la luarea in evidenta): -hemoleucograma ; -grupa sanguina si Rh ; -glicemia ; -examen sumar de urina (albumina,glucoza,corpi cetonici,sediment urinar) ; -RBW (VDRL , THPA) ; -test HIV ; -examen bacteriologic …

Acidul folic, sau vitamina B9, este o vitamină importantă din grupa B. Organismul are nevoie de acid folic, una dintre vitaminele B, pentru a produce globulele rosii ale sangelui. Organismul uman nu poate produce suficient acid folic, astfel ca, dieta trebuie sa contina alimente…

1)Necrozoospermia:patients who occasionally may present 100% immotile sperms.Causes:infections (E.coli chronic prostatitis or immobilizing antisperm antibodies). Absolute necrozoospermia (when all sperms are dead) : in case of axonemel defects such as immotile cilia syndrome.…

Embryonic phase: Week 1 : the average crown length is 0.5mm; Week 2 : the average crown length is 2 mm ; Week 3 : the average crown length is 3 mm ; Week 4 : the average crown length is 4 mm and the average weight of foetus is 0.4 g ; Seven days after ovulation, the fertiliz…

-Risk profile ; -Height/weight ; -OB H&P ; -Blood preasure ; -Breast exam.; -PAP smear ; -Hemoglobin/hematocrit ; -Rubella/varicella; -HBV S Ag/RPR ; -HIV; -ABO/Rh/Ab; -Urine culture; -Domestic abuse screening . Dr.Cosmina Brümmer Johannesburg,South Africa