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My Life in Ob-gyn Vance Mason, MD 4-16-2010.

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Presentation on theme: "My Life in Ob-gyn Vance Mason, MD 4-16-2010."— Presentation transcript:

1 My Life in Ob-gyn Vance Mason, MD

2 What is ob-gyn? Women’s health care & reproduction
I don’t see men unless part of infertility I chose it because the patients are mostly healthy most of the time and I love surgery

3 Schooling 4 years college
4 years medical school- 1st 2 books, 2nd 2 “field work” 4 years “residency” in Ob-Gyn ( also called ‘specialty training’) I now teach young doctors and care for patients in Westminster

4 How do embryos know what gender to be?
It’s complicated –

5 How do embryos know what gender to be?
Y chromosome is key – It tells fetal gonad to make testosterone and “Mullerian Inhibiting Factor” MIF tells tubes that make uterus and top half of vagina to go away Testosterone tells lower vagina/cloaca to fuse together and make a penis and scrotum



8 What if the testosterone receptor doesn’t work?
Tubes that make uterus still go away Bottom half of vagina stays vagina-like No scrotum made, No penis made Fetal gonad is still a testis though Chromosomes are still XY

9 What would a person like this look like?


11 Jamie Lee Curtis Looks female (very)
Testosterone is converted to estrogen which assures breast development Can’t have children Chromosomes are XY

12 How fertility works Woman makes an egg (ovulates)
Egg pops loose from ovary, Fallopian tube picks it up As the egg travels down the tube, it meets the sperm-sperm does not have to swim much A single sperm enters the egg Egg immediately changes so no more sperm can enter

13 Fertility Egg cannot let in more than one sperm or there will be too many chromosomes – Our cells each have 46 chromosomes Egg has 23 Sperm has 23 Another sperm would make 69 chromosomes, pregnancy would miscarry


15 Fertilization Fertilized egg begins dividing
Fertilized egg travels down tube to uterus Fertilized egg plants in uterine lining (endometrium)

16 Pregnancy Fertilized egg becomes an embryo Embryo grows and grows
Nine months later, woman goes into labor Baby is pushed out (head first is safest)

17 Do I ever have to choose between baby and mother’s life?
No- Soap opera’s not very medically savvy

18 Can fraternal twins have different dads?
Yes! Tricky though- Fraternal twins come from two different eggs If woman had sex with two different men on the same day, a sperm from one man could fertilize one of the eggs and the other man the other Very rare

19 These Dutch twins were conceived in vitro with sperm from 2 different donors accidentally

20 These twins look different but are really from the same dad- both mom and dad are “mixed race”- normal variation comes up with new gene combos to keep parasites and germs guessing


22 Why do some babies go breech?
No one really knows Most probably just get “stuck” that way Half or more can be turned around by pushing on mother’s stomach at 36 weeks (external version)

23 Why is breech birth more risky?
Head is biggest part of baby Head can be trapped if baby is breech Baby can die Head makes the best “cork” – umbilical cord can sometimes pop out if breech “Prolapsed” umbilical cord can get strangled, baby can’t get oxygen from cord

24 Who gets a Cesarean section?
Baby too big to fit through pelvis or Baby suffers too much stress for safety or Mother is very ill or Breech presentation – dangerous for baby or Mother wants a repeat CS after past CS 32% of all babies in US now delivered by C-section

25 How to operate on a uterus
It takes many people – at least 4 – Anesthesia person to take away pain Surgeon Surgical assistant Helper for the baby if a c-section Scrub nurse Circulating nurse Recovery room nurse

26 How to operate on a uterus
Cut the skin Cut the “fascia” – strong white layer under skin Cut the uterine wall – Be careful not to cut baby or mom’s bladder Deliver baby and placenta Sew each layer up

27 Can you operate on a baby that is still in the womb?
Some super-specialists do this – Some babies have large growths that must be removed or their lungs can’t grow Very experimental still – Risks preterm delivery

28 Miscarriage If pregnancy doesn’t develop properly, it will miscarry
Most miscarriages are before the 12th week Most miscarriages are from chromosome mismatches, even when both parents have normal chromosomes 1/2 our chromosomes from Mom, ½ from Dad

29 Miscarriage Miscarriage is very common – at least 25% of women will have one Mother’s health usually normal even after several miscarriages Mother’s body usually has no trouble miscarrying and getting ready for future pregnancy afterward

30 Infertility If 100 couples try, 90 will be pregnant within one year
Half of those who try will get pregnant within 3 months Woman’s most fertile time is the few days around ovulation – days of a 28 day cycle (day 1 is first day of any bleeding)

31 Infertility Can vigorous weight lifting cause infertility? No

32 Infertility – what is the workup?
Make sure man is making sperm (40% of men getting workup will not be) Make sure woman is ovulating Make sure Fallopian tubes are open Make sure uterus has normal shape Make sure woman’s other hormones are normal (thyroid, prolactin, insulin)


34 Infertility - treatments
Use donor sperm Give drugs to woman to help her ovulate Operate on Fallopian tubes to open them Bring egg and sperm together in petri dish, then put embryo in uterus

35 Signs of ovulation Mittelschmerz – side pains when ovary stretches ovary capsule Clear, sticky cervical mucus (Spinbarkeit mucus)

36 Contraception Abstinence
Withdrawal – not very effective, better than nothing Condoms – also prevents most infections Birth control pill/Vaginal ring/ Patches Morning after pill Intrauterine device (IUD)(hormone or Cu) Depo Provera shots (hormone shots) Implanon (Hormone implant in arm) Vaginal sponge with spermicide

37 contraceptive myths You can’t get pregnant the 1st time you have sex
You can’t get pregnant unless you’re married You can’t get pregnant if your periods are irregular

38 Which contraceptives affect hormones?
Birth control pills Vaginal ring Implanon Depo Provera Patch Plan B Hormone IUD (Mirena)

39 What are pill hormone side effects?
Bad side effects: Nausea Headache Sore breasts Good side effects: Lighter periods or no periods Less painful periods Less acne

40 Morning after pill Brand name: Plan B
The sooner after sex you take it the more effective 90% effective if taken <72 hrs after sex Prescription needed if under 17 Cost is $50

41 How does Plan B work? Egg has to travel down fallopian tube at a normal rate to be fertile Hormones in Plan B probably speed up tubal transport Egg may be in wrong part of tube when sperm arrives, can’t receive/accept sperm Egg may arrive in uterus before it is ready and cannot implant

42 How does Birth control pill work?
Hormones in pill tell ovary not to make an egg Hormones in pill tell cervix not to make stringy, clear mucus (sperm need that type of mucus to get through the cervix)

43 Ovary Cancer Affects one woman in 50
Symptoms are often vague until too late Oncologists specialize in cancers Gyn-oncologists ( Gyn-Oncs) care for women with ovary cancer Five year survival after diagnosis is 20% Taking birth control pill cuts risk 50%

44 Age at first sex National average is 16 The more schooling you get, the older you are when you first have sex For college students, average is 19 All persons having sex should be contracepting unless they want to get pregnant

45 Stress and ob-gyn doctors
Sleep deprivation Lawsuits People can die Many things happening at once Need to be able to make good decisions quickly Money decreasing

46 Prenatal diagnosis Can you tell if a baby will have a mental health issue before they are born? Usually no – Exceptions: Fetal Alcohol syndrome (babies born to alcoholics often mentally retarded), Down syndrome (trisomy 21)

47 Pregnant women who smoke & drink
Smoking during pregnancy causes preterm delivery and skinny babies Alcohol during pregnancy causes mental retardation and skinny babies Counsel women to stop, give nicotine patch, Alcoholics Anonymous, jail if judge thinks baby threatened enough (rare)

48 Career highlights/lowlights
Worst part: Time away from family Best part: Working w/mostly healthy patients most of the time Worse part: Stifling, nonsensical, bureaucratic regulatory agencies and insurances Better part: Getting to talk to all different kinds of people

49 Career highlights/lowlights
First surgery ever: circumcision Most unexpected thing: Finding two babies at a c-section when only one was expected Best moment of my career: Graduating residency

50 What areas of gynecology are poorly understood?
All of them Research is hard to do – Many human-subject-committees reluctant to allow research on pregnant women American health system very fragmented, no good central databases

51 Drugs Drugs are expensive to research
Because of all the testing required, new American drugs are very expensive After 13 years, exclusive patent on new drugs expires and anyone can make them Generic drugs are cheaper and often better than newer non-generics

52 Common drugs I use Antibiotics Vaccines Anti-depressants
Anti-hypertensives (for high blood pressure) Birth control pills

53 Common surgeries I do Remove tubal pregnancies Remove ovary growths
Remove uteruses that bleed often Tie tubes to prevent pregnancy Scrape inside of uteruses that are miscarrying if needed C-sections Drain abscesses

54 Pap smears and cervix ca vaccine
Women should get 1st pap age 21 Women should get cervix cancer vaccine before 1st sex – can be given age 9-12 or anytime before 1st sex Vaccine is 3 shots over 6 months Covered by Medicaid and insurances Men should get vaccine too

55 Chlamydia Sexually transmitted infection that is rampant in teens and early 20s Can be found with simple urine test Can silently kill/clog off the Fallopian tubes, making woman infertile Often no symptoms Sexually active teens and early 20s should be urine-tested at least yearly

56 How can women not know they are pregnant?
“Denial” is a psych condition where we deny reality because the truth is too painful It helps in the short term, hurts in the long term A woman who does not want to be pregnant may deny it and unconsciously hope it goes away somehow

57 The End

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