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OBSTETRICS AND FERTILITY-PART 2
Hello and welcome back to InterpreterPrep.com!
Welcome to the second part of our presentation on OBSTETRICS AND FERTILITY. In this second
part we will be talking about CONTRACEPTION, OBSTETRIC INFECTIONS and THE
BREASTS. Quite a handful there! Before going into this lesson you may want to review PART ONE
on OBSTETRICS AND FERTILITY if you haven't already.
CONTRACEPTION
Now, going back to the menstrual cycle which we talked about in part one of Obstetrics, there are
typically some fertile days in every cycle and when we say: “fertile days” I'm referring to those days
in which the probability of PREGNANCY occurring are good, let's put up another image to better
understand this. Here we see a typical menstrual cycle which lasts 28 days. I said “typical” because it
may be longer or shorter. At the top, we see the number 1 which represents the first day of the cycle
and if we count clockwise it goes all the way around ending at day number 28. Now, those days down
at the bottom of this image, in the colors orange, red and purple are the “fertile days” because
ovulation is occurring around this time. The possibility of pregnancy occurring, if you have sex
during those days, is high. Some couples “count days” as a method of birth control. This method has a
high failure rate for those of you considering it! You've been warned!
And talking about BIRTH CONTROL, lets review current :
CONTRACEPTIVE METHODS
1) FEMALE CONDOM : consists of a thin sheath with two flexible rings that is inserted in
the vagina before having intercourse and comes in different sizes. Acts as a physical barrier
to sperm.
2) NATURAL FAMILY PLANNING : under this category we have :
• RHYTHM METHOD : “counting days” and avoiding sex on “fertile days”
• BASAL BODY TEMPERATURE : avoiding sex once basal body temperature
increases and
• BILLING'S METHOD : avoid sex when there is a perceived “slippery” sensation in
the vagina due to increasing cervical mucus (which means “hey you are about to
ovulate!!)
3) INJECTABLES : hormones are injected into muscle in a SUSTAINED RELEASE form
known as “DEPOT INJECTION” . Repeated every 1 to 3 months depending on the
formulation.
4) INTRAUTERINE DEVICES (IUD) : is a device (some of which have a form that resembles a
“T”) which is inserted into the uterus by a gynecologist. They may come with copper which
creates a negative charge in the mucous of the uterus, which sort of like “electrocutes the
sperm” (just a figure of speech I don't want you getting the idea that there's an electric
current!). Some women noticed heavier periods with the IUD so some IUDS come with a little
progesterone to offset this side effect, reducing the bleeding. Since fertilization occurs up in
the Fallopian tubes, the IUD works by preventing the implantation of the fertilized egg
(contragestion). This makes it an unacceptable method for some due to religious or ethical
reasons.
5) ORAL CONTRACEPTIVES : pills contain both estrogen and progesterone or just contain
progesterone (mini-pill). Pill acts by blocking ovulation, thus preventing pregnancy. A
drawback to any birth control method that contains estrogen is an increased risk of blood clots
which may lead to heart attack or a pulmonary embolus a rare but possible side effect and
the reason why if a woman is over 35 y/o, has high blood pressure or smokes it may be wiser
not to use a birth control method that contains estrogen.
6) CONTRACEPTIVE PATCH : patch gives off hormones that are absorbed through the
skin. The patch is changed every week for 3 weeks and then you get a week off.
7) MALE CONDOM : latex sheath placed over the penis before intercourse. The only one of
all these birth control methods that is controlled by the male!
8) VAGINAL RING : the ring contains estrogen and progestin, like a pill. The difference is
instead of taking a pill, a woman gets the hormones that block ovulation by absorbing them
form the ring which remains in the vagina for 3 weeks to then be removed for a week to
permit the period to occur.
9) OTHER METHODS :
• EMERGENCY CONTRACEPTIVE aka the “NEXT DAY” PILL) : taken in the
next few hours after having unprotected sex. Contains a high dose of hormones which
either block ovulation ( contraception) or prevent implantation of the fertilized egg (
contragestion).
• DIAPHRAGM : latex dome applied to the cervix before sex. Acts as a barrier to
sperm blocking it's access to the os of the cervix.
10) SURGICAL BIRTH CONTROL METHODS
- In the woman : BILATERAL TUBAL LIGATION (BTL) : not to be confused with a BLT!
In this procedure the tubes are “tied” as seen in this image and this shuts the tubes down,
blocking the path to the uterus for the ovum.
-In the man : VASECTOMY : as seen there on the right , through a small incision in the
scrotum, the urologist gains access to the vas defrens and seals it off. The sperm is stuck in
the testicles and can't get out!
These two birth control methods are usually permanent and as such are also known as
“ STERILIZATION”.
So all these contraceptive methods are used to prevent pregnancy from happening. Of all these birth
control methods the only ones known to prevent or reduce the risk of getting STDs are the male
and female condoms
CONDOMS PREVENT STDs
PERINATAL INFECTIONS ( TORCH COMPLEX) : “TORCH” is an acronym used to designate a
series of infections that can be transmitted to the fetus by a pregnant woman. The importance of
these infections is that they can cause severe fetal birth defects or even abortion.
They can affect the
• eyes (CHORIORETINITIS) causing reduced vision or blindness and also affect
• the brain causing MENTAL RETARDATION and
• other defects
The following diseases make up the TORCH COMPLEX :
1) TOXPLASMOSIS : parasitic infection transmitted to human beings by cats.
2) OTHER INFECTIONS : like
• SYPHILIS : It can also be transmitted to the newborn causing serious birth defects
( heart, bones, teeth) and
• HIV infection is also included.
3) RUBELLA (aka “GERMAN MEASLES”): viral infection so aggressive that if a mother
should catch it in the first trimester of pregnancy it is almost positive that the baby will be
born with severe birth defects.
4) CYTOMEGALOVIRUS : may cause deafness, retardation and blindness in newborn
5) HERPES VIRUS (GENITAL HERPES) : Can be transmitted to the newborn during birth or
during pregnancy. Baby can develop encephalitis and other conditions.
Although not included in this group, perinatal infections by :
•
CHLAMYDIA can cause miscarriage, blindness, premature birth and pneumonia.
•
GONOCOCCUS infection in mother can be asymptomatic but cause severe eye infection right
after birth so a few drops of silver nitrate are routinely (always) placed in newborn's eyes
right after birth to prevent this.
SOME DIAGNOSTIC PROCEDURES : a blood test can be done on the newborn to determine if
there may be an infection. This blood test is known as a TORCH SCREEN.
SOME TREATMENTS :
1) RUBELLA VACCINE : rubella can be prevented by vaccinating mother to be before she gets
pregnant.
2) Toxoplasmosis and Syphilis respond to ANTIBIOTIC treatment.
3) AZT is given in pregnancy to try to prevent HIV transmission to fetus.
4) In the case of an active Genital Herpes infection a C-SECTION is done.
5) SILVER NITRATE DROPS : to prevent gonococcal conjunctivitis in the newborn.
6) Other TORCH infections may not have a specific treatment.
IF a woman has already had Rubella or Toxoplasmosis before pregnancy then she already has
defenses (antibodies) against these diseases so the fetus is protected.
MAMMARY GLANDS aka THE BREASTS
It is this part of our anatomy that makes human beings “mammals”. Mammals have mammary
glands. Although the breasts do not play a part in the reproductive process, they are considered to be a
part of the female reproductive system because they are responsible for the production of milk
known as LACTATION necessary to feed the offspring.
The breasts are located on the anterior chest wall, over the pectoral muscles. They are composed of
glandular tissue with supporting fatty and connective tissue and are covered with skin. The size and
shape of the breasts vary from person to person depending on the amount of fatty tissue present.
Here in this image we can see that the MAMMARY GLAND is surrounded by yellow FATTY
TISSUE. The gland produces milk which flows down a series of DUCTS known as lactiferous ducts,
All the ducts end at the NIPPLE. The darker pigmented area surrounding the nipple is called the
AREOLA. The infant will LATCH on to the nipple to feed.
SOME SIGNS OF DISEASE :
1)
2)
3)
4)
5)
LUMP : localized hardness in the breast tissue
TENDERNESS : a discomfort in the breast.
REDNESS and SWELLING around nipple or in the breast.
NIPPLE DISCHARGE : especially if it contains blood.
NIPPLE INVERSION : nipple normally sticks out, here it becomes “sucked in”
SOME DISEASES :
1) BREAST CANCER : a malignant tumor of the breast. The most frequent type arises in the
ducts. Although in this image we see a cancerous tumor in the bottom of the image, the upper
and outer quadrant of the breast is the place where most cancers appear. Once a tumor
reaches a certain size it can METASTASIZE (spread) to the LYMPH NODES. The lymph
nodes are found around the breast in groups as we see in this image. Here we see the cancer
in red and the lymphatic vessels and lymph nodes in blue. The lymph node acts as a defense
station, full of defense cells known as : lymphocytes which will try to fight the cancer so that it
doesn't reach the bloodstream. When the cells in the node detect the presence of a potentially
dangerous element like a cancer cell or a bacteria, they react by enlarging. These enlarged
lymph nodes that can be felt like little balls below the skin are known as : ADENOPATHY.
If the cancer is near or behind the nipple, the nipple may flatten down or even get drawn in
as if the cancer were “sucking it in”. The appearance of bloody discharge from the nipple
may also signal cancer. You may run into the term : “carcinoma”
CARCINOMA = CANCER
which also means cancer.
2) FIBROADENOMA : now back to the original image behind the cancerous tumor we see an
image of a benign tumor ( doesn't spread like cancer does) called a fibroadenoma.
3) CYST : in the top part of the image we see a breast cyst which is a benign collection of fluid.
4) ABSCESS aka MASTITIS : right smack in the middle of the image we see an abscess. An
abscess is a collection of pus (infection). Seen almost exclusively in women who are
breastfeeding. The breast becomes, red, tender and warm to the touch. Fever may appear.
SOME DIAGNOSTIC PROCEDURES :
1) BREAST SELF EXAMINATION : women should examine their breasts monthly for changes
like the appearance of a lump and get it checked asap. “Breast exams, once thought essential for
early breast cancer detection, are now considered optional”- Mayo Clinic
2) ASPIRATION BIOPSY: is an INVASIVE PROCEDURE in which a THIN needle is
inserted into the breast to obtain a sample of cells or fluid to be sent for microscopic
examination and diagnosis.
3) CORE BIOPSY : differs from the aspiration biopsy in that a thicker needle is used so that a
tiny sample of tissue called a “core” can be obtained as opposed to only cells or fluid in the
aspiration biopsy.
4) MAMMOGRAM : looking at this picture I would call it a “squishogram” but it is actually an
X-ray study of the breasts ROUTINELY indicated in women over 50 years of age. It is a
screening method (means it's indicated even though the patient is asymptomatic with the hope
of detecting a disease in it's early stages). It is used to detect breast cancer.
5) BREAST ULTRASOUND : gives information on whether a lump is solid or liquid in nature.
Liquid breast lesions are more likely to be BENIGN.
6) BONE SCAN : study used to detect the presence of metastasis in bones.
SOME TREATMENTS :
1) CHEMOTHERAPY : generally an ANTINEOPLASTIC drug cocktail that contains several
cancer drugs like VINCRISTINE, FLUORURACIL, METHOTREXATE, just to mention a
few, is given to kill the cancer cells and reduce the size of the tumor before operating.
2) RADIATION THERAPY : is a form of energy that destroys the cancer cells
3) LUMPECTOMY : a more conservative breast surgery where the tumor (the “lump”) and
some of the good tissues surrounding it are removed. The lymph nodes in the axilla may also
be removed. This sometime causes swelling of the arm (LYMPHEDEMA)
4) MASTECTOMY :
ECTOMY = REMOVE
MAST = BREAST
“ectomy” means to remove, “mast” refers to mammary.
It may be a
• TOTAL MASTECTOMY : removes breast, nipple or a
• MODIFIED RADICAL MASTECTOMY same as before but goes deeper by also
removing part of the lining (fascia) that covers the pectorals and axillary nodes. The
reason it is called a “modified” radical mastectomy is because before they used to also
remove the pectoral muscles themselves. May be followed by BREAST
RECONSTRUCTION using a BREAST IMPLANT.
5) HORMONE THERAPY : many times breast cancer cells thrive on estrogen so an
ANTI-ESTROGEN drug called TAMOXIFEN is given.
6) ANTIBIOTICS : for mastitis
The specialists who deliver babies are called OBSTETRICIANS and their specialty is OBSTETRICS
Most residency programs include training in both OBSTETRICS and GYNECOLOGY reason why
the specialty is known as OB/GYN.
TERMINOLOGY REVIEW. Now it's time for review so let's go over the terminology mentioned in
this presentation in English and in the target language.
1) CONTRACEPTION : anticoncepcion, contracepcion
2) BIRTH CONTROL : control de la natalidad
3) CONTRACEPTIVE METHODS : metodos anticonceptivos
4) FEMALE CONDOM : preservativo femenino; condon femenino
5) PREVENT : prevenir
6) NATURAL FAMILY PLANNING : metodos anticonceptivos naturales
7) RHYTHM METHOD : metodo del ritmo
8) BASAL BODY TEMPERATURE : metodo de la temperatura basal
9) BILLINGS METHOD : metodo de Billings
10) INJECTABLES : inyectables
11) SUSTAINED RELEASE : liberacion prolongada
12) DEPOT INJECTION : inyeccion de deposito
13) INTRAUTERINE DEVICE (IUD): (DIU) dispositivo intrauterino
14) ORAL CONTRACEPTIVES : anticonceptivos orales
15) CONTRACEPTIVE PATCH : parche anticonceptivo
16) CONDOM : preservativo; condon
17) VAGINAL RING : anillo vaginal
18) EMERGENCY CONTRACEPTIVE : anticoncepcion de urgencia; anticoncepcion
poscoital
19) DIAFRAGM : diafragma
20) TUBAL LIGATION : ligadura de trompas
21) STERILIZATION : esterilizacion
22) TORCH COMPLEX : complejo TORCH
23) PERINATAL INFECTIONS : infecciones perinatales
24) CHORIORETINITIS : corioretinitis
25) MENTAL RETARDATION : retraso mental
26) CYTOMEGALOVIRUS : citomegalovirus
27) SILVER NITRATE : nitrato de plata
28) NEWBORN : recien nacido
29) BREASTS : mamas; pechos; senos
30) LACTATION : lactancia
31) NIPPLE : pezon
32) LATCH ON : prenderse
33) LUMP : nodulo
34) LUMPECTOMY : nodulectomia
35) NIPPLE DISCHARGE : secrecion por el pezon
36) NIPPLE INVERSION : pezon umbilicado
37) BREAST CANCER : cancer de mama
38) METASTASIZE : hacer metastasis
39) LYMPH NODES : ganglios linfaticos
40) ADENOPATHY : adenopatia
41) FIBROADENOMA : fibroadenoma
42) CYST : quiste
43) ABSCESS : absceso
44) MASTITIS : mastitis
45) BREAST SELF EXAMINATION : autoexamen de senos; autoexploracion mamaria
46) ASPIRATION BIOPSY : biopsia aspirativa; biopsia con aguja fina
47) CORE BIOPSY : biopsia con aguja gruesa
48) INVASIVE PROCEDURE : procedimiento invasivo; procedimiento cruento
49) MAMMOGRAM : mamografia
50) ROUTINELY : de rutina; habitualmente
51) BONE SCAN : centellografia osea; gammagrafia osea
52) ANTINEOPLASTIC DRUGS : medicamentos antineoplasicos
53) VINCRISTINE : vincristina
54) FLUOROURACIL : fluoruracilo
55) RADIATION THERAPY : radioterapia
56) LYMPHEDEMA : linfedema
57) MASTECTOMY : mastectomia
58) TOTAL MASTECTOMY : mastectomia total
59) BREAST RECONSTRUCTIVE SURGERY : cirugia reconstructiva del seno; cirugia
reparadora de la mama
60) BREAST IMPLANT : protesis mamaria; implantes de seno
61) MODIFIED RADICAL MASTECTOMY : mastectomia radical modificada
62) HORMONE THERAPY : tratamiento hormonal; hormonoterapia
63) ANTI-ESTROGEN : antiestrogeno
64) TAMOXIFEN : tamoxifeno
In this presentation we have gone over many terms related to OBSTETRICS AND FERTILITY
while we discussed topics like the menstrual cycle, contraception and obstetric infections. We have also
discussed the breasts, their anatomy and diseases and some diagnostic procedures and treatments. At
the end of the presentation a list of 64 related terms were provided in English and the target language
for you to review. I hope you've enjoyed this lesson and come away with a better understanding of the
field of OBSTETRICS and the terms related to this field of medicine.
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