Reproduction and Pregnancy

• Upon completion of this problem, students will be able to define metabolic syndrome and examine the consequences of insulin resistance including polycystic ovarian syndrome. Students will also be able to explain the effect of hyperinsulinemia and hyperandrogenism on female sexual function.
• Upon completion of this problem, students should be able to explain the mechanisms that regulate puberty and explain the etiology of precocious puberty.
• Upon completion of this problem, students should be able to describe the normal menstrual cycle and to identify factors that can disrupt normal female reproductive physiology.
• Upon completion of this problem, students should be able to define infertility, to discuss its underlying causes and to describe a basic diagnostic approach to its evaluation. The student should be able to describe the psychological and sexual impacts of infertility.
• Upon completion of this problem, students will have developed an approach to the investigation of male infertility, will understand meiosis and will appreciate the difference between meiosis and mitosis.
• Upon completion of this problem, students should be able to describe the role of the X chromosome in ovarian function.
• Upon completion of this problem, students should be able to explain the physiologic changes that occur during the menopause transition and list the causes of postmenopausal bleeding.
• Upon completion of this problem, students will be able to define conception, normal and abnormal implantation and early pregnancy failure. Students will also review available options for contraception and their mechanisms of action and efficacy.
• Upon completion of this problem, students will recognize prenatal screening and diagnosis in reproduction.
• Upon completion of this problem, students should have explored teratogenicity in pregnancy using warfarin and low molecular weight heparin as examples.
• Upon completion of this problem, students will be able to explain the mechanisms of labour and normal labour progression as well as describe the factors that affect normal labour.
• Upon completion of this problem, students will be able to describe the mechanisms of the third stage of labour and be able to discuss the factors that can lead to postpartum hemorrhage (PPH).
• Upon completion of this problem, students will be able to describe the process of lactation and discuss the advantages and barriers to breastfeeding. Students will also be able to explain how disruptions in the normal flora can lead to Candidal infection.
• Upon completion of this problem, students will be able to discuss sexually transmitted infections.
• Describe the role of yeast in mucosal flora and discuss the parts of the immune system that prevent mucosal candidiasis.
• Name common sexually transmitted infections and their causative pathogens.
• Describe the role of public health and physician reporting requirements in sexual health and sexually transmitted infections.
• Apply the principles behind medication selection (e.g. antibiotics) for use in pregnancy and pre-conception.
• Describe the normal patterns of pubertal development and the neuroendocrine basis for puberty.
• Recognize the impact of puberty on skeletal development (bone age).
• Describe the central and non-central causes of precocious puberty and explain how the principles of treatment differ between between the two.
• Recognize the utility of diagnostic tests (clinical, biochemical and radiological) in aiding the investigation of precocious puberty.
• Discuss the psychological impacts of precocious puberty.
• Define menopause and explain the anatomic and physiologic alterations in the ovary that lead to menopause.
• Discuss theories that seek to explain the vasomotor and other symptoms in menopause and outline treatment strategies for these symptoms.
• Discuss the implications of menopause on population health.
• Explain the causes and describe the assessment of postmenopausal bleeding.
• Give examples of the options and review the risks and benefits of menopausal hormone therapy.
• Describe the hormonal feedback loops operating on the hypothalamic/pituitary/gonadal axis and how they impact the menstrual cycle.
• Describe how meiotic and mitotic errors can result in an abnormal karyotype.
• Describe the physiology of the normal menstrual cycle.
• Explain how dysfunction of the hypothalamic/pituitary/ovarian axis influences menstruation.
• Discuss the principles behind the diagnostic tests to determine the etiology of secondary amenorrhea, particularly the progesterone challenge test.
• Outline the categories of sexual dysfunction.
• Formulate an approach to the presenting problem of an inability to achieve conception after 12 months and explore risk factors for infertility.
• Identify the basic components of an infertility investigation as they apply to men and women.
• Identify methods that can be used to predict the timing of ovulation.
• Describe gametogenesis.
• Distinguish the temporal differences between oogenesis and spermatogenesis.
• Explain the interpretation of a seminal analysis.
• Explain the mechanism of conception and the factors that influence it.
• Describe the natural history of threatened spontaneous abortion.
• Explore the different stages of prenatal development, including embryogenesis.
• Describe the function of the hormones secreted by the placenta.
• Discuss the basic genetic concepts and risk factors related to Down Syndrome.
• Discuss the implications of a positive eFTS (Enhanced First Trimester Screening).
• Examine the ethical, moral and psychological implications of a positive prenatal screen.
• Outline the timing, capabilities and limitations of ultrasound in pregnancy.
• Describe the normal physiological adaptations to pregnancy, including effects on the immune system.
• Define a teratogen and understand the broad classification of teratogens.
• List the physiologic changes to the clotting system in pregnancy and explain how pregnancy increases the risk of venous thromboembolism.
• Define the stages and phases of labour.
• Discuss the mechanisms and physiology of normal labour.
• Describe the factors that influence the normal progression of labour.
• Describe the anatomy of the pelvis particularly as it pertains to parturition.
• Name and discuss analgesic options in labour.
• Define dystocia and understand the principles of its management.
• Define the third stage of labour, outline its active management and discuss the evidence supporting its active management.
• Recall the physiological responses to blood loss and describe how the physiological changes in pregnancy are protective against blood loss during parturition.
• Define postpartum hemorrhage and hemorrhagic shock and review risk factors, causes and principles of management.
• Report on the epidemiology of maternal morbidity and mortality in Canada and globally.
• Describe the anatomy and physiology of the female breast as related to lactation.
• Outline the benefits of breastfeeding in infancy and discuss barriers and contraindications to breastfeeding.
• Discuss strategies and resources to promote breastfeeding.
• List the major nutrients of breast milk and infant formulas.
• Summarize the features of normal infant feeding and expected weight changes over the first weeks of life.
• Outline the diagnosis of polycystic ovarian syndrome (PCOS).
• Describe the assessment of hirsutism and list the possible causes.
• Explain the link between hyperinsulinemia and hyperandrogenism.
• Define metabolic syndrome.
• Explain the link between metabolic syndrome and non-alcoholic fatty liver disease (NAFLD).
• Outline the histological changes seen in the endometrium that occur under the influence of estrogen and progestins.
• Describe the anatomy of the male reproductive system.
• Recognize pelvic inflammatory disease and its consequences.
• Describe the presentation, diagnosis and management of ectopic pregnancy.
• Describe the options and indications for non-invasive prenatal screening including enhanced First Trimester Screening, Multiple Marker screening, and Non-invasive prenatal testing (NIPT).
• Discuss pre-conception and antenatal care as it applies to the first and second trimester.
• Account for the menstrual abnormalities characteristic of PCOS and explain the need to induce menstruation in some women with PCOS.
• Describe the pathophysiology and natural history of NAFLD.
• Describe common cutaneous dermatophyte and yeast fungal infections.
• Discuss the different dermatological presentations of HPV infection.