A 22-year-old woman and her 24-year-old partner have been attempting to conceive for 12 months. They have sexual intercourse two to three times per week and use no contraception or coital lubricants. She has never been pregnant and her husband has fathered no pregnancies. She has no history to suggest damage to her Fallopian tubes and her menses occur at 28- to 31-day intervals.The statistic in question 166 is fecundability. Fecundity is defined as the probability of having a liveborn child per ovulation. What is the fecundity of normally fertile couples?
Answer(s): B
While the probability of conception per ovulation is approximately 20%, about 50% of all conceptions in humans end as a pregnancy loss. Of this percentage, 35% of pregnancies end so early that women never realize they conceived. The remaining 15% are recognized pregnancy losses, most in the first trimester.Stated otherwise, only 10% of women who conceive will have a liveborn child (50% of the 20% conception rate per ovulation). Fecundity in the future (probability of having a liveborn child) is not reduced after a single pregnancy loss.
A 46-year-old G3P3 woman has had postcoital spotting for 6 months. On pelvic examination, she has a fungating, exophytic lesion arising from her cervix that is approximately 2 cm in diameter. Biopsy of this lesion is interpreted as invasive squamous cell carcinoma of the cervix. There is no evidence of extension of the cancer onto the vagina. The parametria are indurated on bimanual examination, though not to the pelvic sidewall. CT scan of her pelvis and abdomen discloses enlarged paraaortic lymph nodes and metastatic lesions in the parenchyma of her liver.Which of the following is the FIGO stage of her cancer?
Answer(s): C
Cervical cancer is currently the only female reproductive tract cancer staged clinically according to FIGO standards. FIGO also requires that the clinical staging be based on technologies generally available worldwide, including third world countries. For this reason, lymphangiography, angiography, CT or MRI scans, laparoscopy, or hysteroscopy are not permitted to stage cervical cancer. Stage I cancer is confined to the cervix. Stage IA is microscopic cancer without a visible lesion. Stage IB is macroscopic cancer visible to the eye. Stage IB is further subdivided into stage IB1 (clinically visible lesion 4.0 cm or less in greatest dimension) and stage IB2 (clinically visible lesion more than 4.0 cm in greatest dimension). Stages IIIV have spread beyond the cervix. Stage IIB is lateral spread into the parametria, but not extending to the pelvic sidewall. Because of the presence of abnormal paraaortic lymph nodes and hepatic changes consistent with metastases, she is actually a stage IVB.
A 46-year-old G3P3 woman has had postcoital spotting for 6 months. On pelvic examination, she has a fungating, exophytic lesion arising from her cervix that is approximately 2 cm in diameter. Biopsy of this lesion is interpreted as invasive squamous cell carcinoma of the cervix. There is no evidence of extension of the cancer onto the vagina. The parametria are indurated on bimanual examination, though not to the pelvic sidewall. CT scan of her pelvis and abdomen discloses enlarged paraaortic lymph nodes and metastatic lesions in the parenchyma of her liver. This woman's childbearing is complete. She is a healthy woman who is close to ideal body weight, exercises regularly, and does not smoke. Which of the following is the most appropriate treatment of this woman?
Answer(s): E
Although this 46-year-old woman is staged as a IIB, she should be treated as a stage IVBbecause of the findings on CT scan. Methods of staging that are similar allow institutions to compare results of treatment without having to account for different staging procedures and criteria. Asimple TAH-BSO is appropriate therapy only for women with carcinoma in situ of the cervix (CIN III, stage 0). Women with stage I or IIA may be treated with radical hysterectomy or with radiation therapy. Beyond stage IIA, only radiation therapy is acceptable. A pelvic exenteration is indicated when there is a central recurrence after maximal dose radiation therapy. Platinum-based chemotherapy has been used for women with metastases or recurrence after radiation therapy. It is considered palliative. Also, some suggest that a lymphadenectomy be performed before the start of radiation. Recently, several have used chemotherapy as primary therapy for bulk disease. There are no randomized-controlled trials to document that chemotherapy is superior to surgery or radiation.
A pregnant woman has been taking phenytoin (Dilantin) for a seizure disorder. She is concerned that the drug will cause fetal abnormalities. Which of the following defects is the most common anomaly associated with phenytoin?
As many as 30% of fetuses exposed to phenytoin had minor craniofacial and digital anomalies. Cleft lip/ palate, hypertelorism, broad nasal bridge, and epicanthal folds are the craniofacial anomalies observed.Hypoplasia of the distal phalanges and nails are the digital anomalies. In addition, these infants may have growth and cognitive deficiencies. Trimethadione, another anticonvulsant, causes similar anomalies. Spina bifida occurs in 12% of infants whose mothers took valproic acid during pregnancy.
When counseling pregnant women about the dangers of drug use during pregnancy, they should be told that the rate of spontaneous major malformations in newborns is what?
Approximately 3% of live born infants have a major congenital anomaly detected at birth.The incidence increases to 67% later in childhood. Chromosomal and single-gene defects account for 10 25% of human malformations. Fetal infections (35%), maternal disease (4%), and drugs and medications (<1%) account for the remaining recognized causes of human malformations. Sixty-five to seventy-five percent of malformations have an unknown or multifactorial etiology
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