Transcript Ultrasound cranial measurement

Clinical Aspects of Lipids &
Human Reproduction
• Induce ovulation (Clomid)
• Assess lung maturation (L/S ratio)
• Accelerate lung development
(glucocorticoids)
Hormone levels, follicle
maturation, and development of
the endometrium
See Bettelheim et al. Fig. 20.7, p. 491,
for hormone levels during a cycle.
Not getting pregnant?
• Male problems: not as readily approached
hormonally
• Female problems:
– Physical (Can you think of an example?)
– Chemical, two possibilities:
• Not ovulating (peptide, protein, or steroid hormone)
• Luteal insufficiency (not enough progesterone)
Is the patient ovulating?
• Basal body temperature
• Hormone levels
• Direct endoscopic examination
Clomid has few side effects.
1. This is why it was historically
prescribed as a first line treatment.
2. One notable side effect:
increased incidence of fraternal
multiples.
Back in the (good?) olde days…
• Clomid was often the first drug of choice
regardless of the actual cause of infertility.
• If a patient was ovulating naturally, and Clomid
was administered, what do you think would
happen?
Uterine geography lesson
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#1, Cranial diameter
#2, “Hi there! (and ribs)
#3, Cranial diameter
Femur length
Abdominal circumference
Heart rate
Obtain sample of amniotic fluid for
analysis of lecithin/sphingomyelin (L/S)
Amniocentesis needle was inserted into sac #3
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L/S ratios and Respiratory
Distress Syndrome (RDS)
L/S
> 2.0
1.5-2.0
< 1.5
odds of RDS
1 in 50*
1 in 3
3 in 4
*Action level 2.4
From Practical Clinical Biochemistry 6th ed.,
Gowenlock, p. 867
What if the L/S ratio < 2.4?
1. Administer corticosteroids to mom-to-be.
2. These lipids are transferred to the fetus
where they increase the rate of lung
maturation. Wait for an appropriate time.
3. After waiting (for time, see McEvoy C, et al. Am J
Obstet Gynecol 2000 Oct;183(4):895-9), induce labor
or do elective Ceasarean.
What if your wombmates L/S ratio > 2.4,
but yours isn’t? (~2.5 days later)
~2.5 years later
~ 22 yrs later