INFERTILITY
- It is the inability to conceive a child or
sustain a pregnancy to birth.
- A couple is infertile if the woman has not
become pregnant after at least 1 year of
unprotected sex/ a woman keeps having
miscarriages.
Subfertility
- Delay in conceiving
- Possibility of conceiving naturally exist but
takes longer than average
Types of Infertility
1. Primary infertility- patients who has never
conceived
2. Secondary infertility- indicated previous
pregnancy but failure to conceive
subsequently
Anovulation
- When an egg does not release or ovulate
from a woman’s ovaries.
- Chronic anovulation: common cause of
infertility.
- Turner’s syndrome: no ovaries to produce
ova
Endometriosis
- Implantation of uterine endometrium or
nodules that spread from the interior up to
the outside of the uterus
Types of Endometriosis
1. Superficial Peritoneal Lesion- most
common, present in the peritoneum
2. Endometrioma- dark, fluid filled cysts.
3. Deeply infiltrating endometriosis- develops
under peritoneum, may involve other
organ near the uterus
Tubal Occlusion
- Female sterilization by tubal occlusion is a
permanent procedure where a micro-insert
which work with the body to form a barrier
that keeps sperm from reaching the eggs,
preventing pregnancy. It is placed into
each of the fallopian tubes.
- It is similar to tubal ligation. This involves a
surgical incision in the abdominal wall to
find the fallopian tubes
2 Types of Surgeries
1. Laparoscopy- a small cut near the belly
button.
2. Salpingectomy- if blocking of the fallopian
tubes has not worked, the tubes may be
completely removed.
Hyperemesis Gravidarum
Abortion
- A medical term for any interruption of
pregnancy before a fetus is viable (20-24
weeks)
- Sometimes known as a termination of
pregnancy
2 Types of Abortion
1. Spontaneous abortion- pregnancy loss at
less than 20 weeks in the absence of
elective medical/surgical measures to
terminated the pregnancy
 Threatened miscarriage- vaginal
bleeding that occurs during the first
20 weeks. The cervix will remain closed
 Imminent miscarriage- When uterine
contractions and cervical dilation
occur
 Complete miscarriage- entire products
of conception are expelled
spontaneously without any assistance
 Incomplete miscarriage- when some
but not all of the pregnancy tissue is
passed
 Missed miscarriage- the fetus dies in
the utero but is not expelled
 Recurrent miscarriage- a history of
repeated miscarriage
2. Induced abortion- intentional
medical/surgical termination of pregnancy
 Elective abortion- voluntary
termination of pregnancy
 Therapeutic abortion- the ending of
pregnancy on purpose
Medical management:
Oral mifepristion (Mifeprex) & Oral
misoprostol (Cytotec)- most common
type of medical abortion
Mifepristone- blocks the hormone
progesterone
 Misoprostol- contracts the uterus and
expel the embryo
Methotrexate- rarely used for elective/
unwanted pregnancies
Surgical management:
In clinic abortion- surgery to end
pregnancy
Vacuum aspiration- most common type
of surgical abortion done in 1st trimester
Ectopic pregnancy
- The fertilized egg from the ovary does not
implant itself normally in the uterus, the
egg develops somewhere else in the
abdomen
- Usually found in first 5 to 10 weeks
Types of ectopic pregnancy
1. Interstitial- develops in the uterine part of
fallopian tube
2. Isthmic- differs from one in the ampulla or
infundibulum because the narrow tube
cannot expand
3. Ampullary- growth of pregnancy in the
ampulla beyond the first trimester
4. Abdominal- embryonic implantation in the
peritoneal cavity, exclusive of tubal ovarian
or intraligamentary implantations
5. Cervical- rare implantation of pregnancy in
the endocervix canal
6. Ovarial- occurs by fertilization of an ovum
retained in the peritoneal cavity leading to
implantation in the ovarian surface
7. Fibrial- implantation is at the fimbria of the
fallopian tube
Cerival Incompetence
- Occurs when the cervix opens to early and
silently during the pregnancy
- It can shorten and open in the second or
early in 3rd trimester w/o any symptoms of
labor.
- Can sometimes lead to a late miscarriage
or premature labor
Medical Management
1. Progesterone supplementation
2. Pessary- device to hold the uterus in place
3. Repeated ultrasound
4. Transvaginal cerclage- the cervix is stitched
closed with strong sutures
 Transabdominal-a small,
extremely strong woven synthetic
band stitched high on the cervix
 Mcdonald’s – nylon sutures are
place horizontally and vertically
across the cervix
 Shirodkar- sterile tape is used
where it is threaded in a purse-
string manner under the
submucous layer of the cervix
Oligohydramnios
- A condition that causes to have a little
amniotic fluid during pregnancy
- It happens anytime during pregnancy, but
it is common in the 3rd trimester
Types of Oligohydramnios
1. Low- between 5.1 cm – 7.9 cm
2. Moderate- between 3.1 cm – 5.0 cm
3. Severe- less than or equal to 3.0 cm
Medical Management
1. Supplementation- L arginine can help by
increasing amniotic fluids
2. Early delivery
3. Amnioinfusion- procedure to inject fluid
into the womb
Polyhydramnios
- Excess of amniotic fluid
- Fluid volume at 2,000 ml
Types of Polyhydramnios
(On degree)
1. Mild- 8-11 cm up to 25-30 cm
2. Moderate- 12-15cm up to 30-35 cm
3. Severe- >15 cm up to >35 cm
(On concept)
1. Acute- fluid volume starts increasing in the
early trimester to the early weeks of 2nd tri
2. Chronic- begins to develop late in the 2nd
or third trimester of pregnancy
Medical Management
1. For mild: Biophysical profile test and non-
stress test
 2. For moderate: Amnioreduction (draining - Abnormal attachment of placenta in the
large amount of amniotic fluid) and uterus near or covering the opening
Indomethacin (to decrease production of
Abruptio Placenta
amniotic fluid by reducing the urine
output) - Premature separation of placenta from

Hydatidiform Mole uterus

- Delivery is the treatment of choice if the
- Type of benign gestational thropblastic fetus is at term gestation/ the mother or
disease fetus is jeopardy
- Abnormal proliferation and degeneration
3 types
of thropoblastic villi
- 2 types: Complete & Partial 1. Subchorionic- bleeding between
myometrium and placental membranes
Common medicine used:
2. Retroplacental- bleeding between
1. Methotrexate- attacks rapidly growing cells myometrium and placenta
2. Dactinomycin- ordered once metastasis 3. Preplacental- bleeding between placenta
occurs and amniotic fluid

Surgical Management: Cord Prolapse

1. Dilation and currretage/evacuation - Unborn baby’s umbilical cord slips through

2. Hysterectomy
Anemia (Folic acid deficiency)
- Lack of folic acid in the blood
- Megalolastic anemia- babies who are
unable to absorb folic acid
the cervix and into the vagina after a
mother’s water breaks and before the baby
descends into the birth canal
- It is rare, 1 put of every 300 births
- C-section for funic cord prolapse to avoid
injury

Medical Management Types of cord prolapse

1. Nutritional supplements 1. Overt- the cord is prolapsed thru the OS

2. Blood transfusion into the vaginal canal
3. IV fluids 2. Occult- cord is below or next to a fetal
presenting part and may not be visible or
Urinary Tract Infection (UTI) palpated in the cervix or vagina
- Infection in any part of person’s urinary 3. Funic- loop of umbilical cord lies bet fetal
tract system presenting part and still intact fetal
- If UTI cannot be treated promptly it can membranes covering the OS
cause pyelonephritis
Medical Management
Types of UTI
1. Amnioinfusion- addition of sterile fluid into
1. Urethritis- infection of the urethra
the uterus to supplement amniotic fluid
2. Cytitis- Infection of the bladder
2. Fetal blood sampling
3. Pyelonephritis- Infection of the kidneys
4. Vaginitis- Infection of the vagina Human immune deficiency virus (HIV)

- Virus that attacs the immune system

Placenta previa - Maternal HIV: transmission of HIV of a

woman to her child during pregnancy
- Placenta grows in the lowest part of womb
Hepatitis B
(uterus) covers all or part of the opening to
the cervix - Serious liver infection that causes
inflammation and can lead to liver damage
 - An injection of immunoglobulin/ hep B - Women with 20 weeks of pregnancy whose
vaccine may help to protect you blood pressure is higher than the standard
range
Cardiovacular disorder
Medical management
- Refers to disease associated with
cardiovascular and cerebrovascular issues 1. Antihypertensive drug
2. Anticonvulsant (magnesium sulfate)
Gestational Diabetes Mellitus (GDM)
3. Corticosteroids- to promote baby’s lung
- A hormone made by placenta prevents the development before delivery
body from using insulin effectively Eclampsia
- A condition in which your blood sugar
levels become high during pregnancy - Follows pre-eclampsia which is
characterized by high blood pressure
Types of diabetes
occurring in pregnancy, and rarely in
1. Type 1- it stops your body from making postpartum
insulin. You need to take insulin every day Types of eclampsia
to survive
2. Type 2- your body doesn’t use insulin well 1. Antepartum- before birth
and can’t keep blood sugar at a normal 2. Intrapartum- during childbirth
level. It can be prevented 3. Postpartum- after childbirth

Treatment Treatment

1. Dietary modification 1. Induction of labor

2. Exercise 2. Cesarean delivery
3. Insulin therapy
Isoimmunization (RH Incompatibility)
4. Oral hypoglycemic agents (glyburide or
metformin - when a pregnant woman’s blood protein is
incompatible with the baby, causing her
Rheumatic Heart Disease
immune system to react and destroy the
- Complication of rheumatic fever which is a baby’s RBC
delayed multisystem inflammatory
Fetal distress
condition that occurs 1-5 weeks after strep
throat infection - uncommon complication of labor
- A long-term cardiac effect of rheumatic where fetus has not been receiving
fever enough oxygen
- Valves affected: Mitral, tricuspid and
- it occurs when pregnancy lasts too
pulmonary
long or a difficult labor
- Most common heart disease in pregnancy
- Emergency C-section may be ordered
Medical management urgently
1. Strict bed rest Dystocia
2. Hospital admission
3. Antibiotic therapy (penicillin/ - An abnormal or difficult labor
erythromycin) - Most common medication used is oxytocin
4. Anti-inflammatory drug (Aspirin/ Types
Acetaminophen)
5. Anticoagulation therapy (warfarin) 1. Cervical- cervix fail to dilate during labor
2. Shoulder- the infant’s head is usually lies
Pre-eclampsia
to the left and rotates to the occipito-
anterior position
 3. Fetal- abnormal fetal size or position 6. Magnesium sulfate
resulting difficult delivery 7. Blood transfusion

Premature rupture of membranes (PROM) Abnormal placenta types

- Rupture of membranes before labor begins - Placenta previa: placenta covers some or
- Pre-term premature rupture of membrane: all of the cervix
PROM occurs before 37 weeks - Placenta accrete: placenta grows to deeply
- Administer tocolytics to treat infections into the wall of uterus
- Placenta accrete- placenta attaches more
Pre-term labor
firmly to the uterus
- Labor that commences <37 weeks
Uterine prolapse
- Early preterm: 33 6/7 weels
- Late preterm: 34-36 weeks - Bulge within the vagina caused by uterus
dropping downwards
Treatment
- Occurs when pelvic floor muscles and
1. Beta-adrenergenic agonist (ritodrine) ligaments stretch, weaken, and no longer
2. Magnesium sulfate (terbutaline) provide enough support for the uterus
3. Prostaglandin inhibitor (indomethacin)
Stage 1: uterus is in upper half of vagina
4. Calcium channel blocker
Stage 2: uterus has nearly descended to the
5. Atociban
opening of vagina
6. Nitric oxide donor
Stage 3: uterus protrudes out of vagina
Precipitous labor Stage 4: uterus is completely out of vagina

- Being in labor and giving birth in less than Treatment

3 hours after regular contractions start
1. Pelvic floor muscle exercise (kegel)
Disseminated Intravascular Coagulation (DIC) 2. Using vaginal pessary
3. Medication (estrogen)
- Abnormal blood clotting throughout the
4. Vaginal hysterectomy
body’s blood vessels
5. Manchester repair- operation to support
- Also known as consumption coagulophaty
the womb by shortening the cervix
or defibrination syndrome
6. Sacrohysteropexy- to suspend prolapsed
Treatment uterus using strip of synthetic mesh

1. Heparin through IV may be administered Uterine rupture

2. Clotting factor replacement
- Spontaneous tearing of uterus that may
3. Oxygen therapy
result in fetus being expelled in the
4. Plasma transfusion to prevent bleeding
peritoneal cavity
5. Platelet transfusion- quicly raises platelet
- Complete division of all three layers of
HELLP Syndrome uterus

- Hemolysis, Elevated Liver Enzyme and Low Types of uterine rupture

Platelets
1. Complete- full-thickness tear develops
- Variant of pre-eclampsia which occurs later
2. Incomplete- myometrium is disrupted but
in pregnancy or later after birth
serosa is intact
Treatment
Treatment
1. Deliver the baby early
1. Uterine repair on one hand
2. IV fluid administration
2. Uterine repair with bilateral tubal ligation
3. Corticosteroid
3. Hysterectomy
4. Antihypertensive drugs
4. Immediate laparotomy with C-section
5. Anticonvulsant drugs
Uterine inversion
- Happens in 3rd stage of labor (delivery of
placenta)
- With pressure being put to the umbilical
cord, that connects to the placenta which
may still be attached to the uterine wall,
uterine inversion is imminent
- Johnson maneuver: to put back inverted
uterus
- Hydrostatic method treatment: place
mother in reverse trendelenburg Lithotomy
Uterine Atony
- Refers to corpus uteri myometrial cells
inadequate contraction in response to
endogenous oxytocin that is released in
course of delivery
- Massaging the uterus may be effective
- Medications such as oxytocin,
methylergonovine,, misoprostol, or
dinoprostone
Amniotic fluid embolism
- Condition when amniotic fluid is forced
into an open maternal urine blood sinus
through some defects in membrane or
after membrane rupture
Medical management
1. Epinephrine
2. Dopamine/noradrenaline- inotropic
support
3. Phenylephrine
4. Vasopresin
5. Digoxin
Laceration (vaginal tearing)
- Tear in the tissue around vagina and
perineum
- Chromic suturing is used to close the
opening
Classification
First degree- least severe tear. Small injury o the
first layer of tissue
Second degree- most common tear during
childbirth. It extends deeper through skin and
muscular tissue
Third degree- anal sphincter is breached
Fourth degree- most severe, tear is through perineal
area through sphincter and into the rectum
Placenta accrete
- Placenta grows too deeply in the uterine
wall of uterus
- Part of all placenta remains attached
Placental anomalies
1. Placenta accreta- placenta attaches too
deeply in the uterine wall
2. Placenta increta- placenta grows into the
walls of uterus (myometrium)
3. Placenta percreta- Placenta grows through
the wall of the uterus (perimetrium)
In vitro fertilization
- Mature eggs are collected from ovaries
and fertilized by sperm in a lab
- Most effective form of assisted
reproductive technology
Gamete Intrafallopian tube transfer (GIFT)
- Transabdominal or transvaginal collection
of oocytes quality and maturation in a
laboratory
- A technique in which the male and female
germ cells required to begin formation of a
human embryo and injected into a
woman’s fallopian tubes for fertilization
Surrogate Embryo Transfer
- Last part in IVF process
- Approximately 2-5 days after egg retrieval,
one or more eggs have been fertilized and
placed in the woman’s uterus
Assisted vaginal birth
- A vaginal birth performed with the help of
forceps or a vacuum device
Types of assisted vaginal birth
1. Vacuum assisted birth- applying suction to
the fetal head
 Kiwi omni cup- contains a hand-
help vacuum generating pump,
which is attached via flexible
tubing to a rigid plastic
mushroom cup
  Mitysoftbell cup- has a softbell
cup attached by a semirigid shaft
to a handheld pump
2. Forceps assisted birth
 Blades, shanks, lock, or handle is
used
Protection of women against sexual harassment
Sexual harassment- unwelcome sexual advances,
request for sexual favors, other verbal or physical
harassment of a sexual nature
Laws in protecting women against sexual
harassment
 RA 9262 (Anti-violence against women and
their children act (VAWC) of 2004-
 RA 7877: Anti-sexual harassment act of
1995- an ac declaring sexual harassment
unlawful in employment, education or
training environment
 RA 9710 (Magna Carta act for women)- any
gender based violence that may result in
physical, sexual harm or suffering to
women
 RA 11313: Safe spaces act (Bawal bastos
law)
 Anti-catcalling and street harassment law
Protection of women against violence
- Intimate partner abuse is abuse by family
member against other individual living in a
household
- RA 9262: law that seeks to address the
prevalence against women and their
children
Impotence
Dyspaurenia
- Medical term for painful sexual intercourse
- A recurrent or persistent pain before,
during or after sex
There are 2 types:
1. Entry pain (intraorbital) –felt at the
entrance of vagina during initial
penetration
2. Deep pain (collision)- occurs in deep
penetration and can feel worse in certain
sexual position
Sexual dysfunction
- Individual is unable to participate in sexual
relationship as he or she would wish
- Prevents a person from experiencing
satisfaction from sexual activity
Types of sexual dysfunctin
1. Desire disorder- lack of sexual desire or
interest in sex
2. Arousal disorder- inability to become
physically aroused or excited during sexual
activity
3. Orgasm disorder- delay or absence of
orgasm
4. Pain disorder- pain during intercourse
Types of male sexual dysfunction
1. Erectile dysfunction/ impotence- Inability
to achieve and sustain an erection suitable
for sexual intercourse
2. Premature ejaculation- a man ejaculates
sooner during sexual intercourse than his
partner would like
Types of female sexual dysfunction
1. Vaginismus- body’s automatic reaction to
fear with some or all types of penetration
2. Anorgasmia- delayed, infrequent, or
absent of orgasm
3. Dyspareunia- persistent/ recurrent genital
pain during sex
Diagnostic procedures:
Laparoscopy- keyhole surgery in abdomen
Salpingectomy- removal of fallopian tubes
Transvaginal ultrasound- slender transducer
is placed in the vagina to send out sound
waves that generates images in the monitor
Pelvic examination- examining the cervix
Fetal non-stress test- a non-invasive test used
for surveillance of high-risk pregnancis
Pelvic ultrasound- produces images that are
used to assess organs and structures within
the female pelvis
Urine culture- to determine a type of bacteria
in a urine

Color Doppler- to evaluate the umbilical cord

and to study the blood velocity wave forms
within the cord

Electrocardiogram- records the strength and

timing of electrical activity of heart

Echocardiogram- shows damage to valve

flaps, backflow of blood through leaky valves,
heart enlargement

Sonography- to identify asymptomatic

cervical dilation

Hysterectomy- removal of uterus

Urodynamic test- measures urine speed and

volume, amount of urine left in bladder after
urination