Properties and Structure of organic materials, chemical synthesis and design
Melissa and Greg
Melissa, 34 years, and her husband Greg, 35 years old, have been trying to start a family for about one year.Melissa weighs 60kg and her height is 160cm. She does not smoke or drink alcohol. Greg stopped smoking about 2 years ago and they have adopted a healthy life style to improve their chances of success.Melissa has regular 30-day cycles, which she describes as very painful and heavy. She takes naproxen for her period pain. She has asthma and it is well managed with Symbicort Rapihaler®. She is also taking Elevit® daily (started 1.5 years ago).
About a year ago, they visited their GP worried that they may have a problem and the GP referred them to a fertility specialist.The fertility specialist orders a semen analysis for Greg and a blood test for Melissa. The specialist also performs a transvaginal ultrasound. Ultrasound images showed a cystic mass (measuring 70 mm) on her right ovary with diffuse, low level echoes; which the doctor describes as a “chocolate cyst”. The gynecological scan also showed that the uterus is adherent to the ovaries and not very mobile. She has no history of STI/PID. The specialist diagnosed Melissa with stage 4 endometriosis.
Melissa is prescribed Nafarelin 2mg/mL spray (Synarel®) – 1 dose twice day. She later has surgery to remove the endometrial lesions and adhesions. Melissa is then referred to an IVF specialist and undergoes fertility treatment. She has undergone 4 IVF cycles with Gonal-F injection. Each time the doctors retrieve about 20 eggs from her ovaries, however less than 10% of embryos survive to embryo transfer stage and in one cycle no embryos survived till the embryo transfer.
After 6 IVF cycles, Melissa falls pregnant. At 10 weeks gestation Melissa visits her obstetrician complaining of nausea and vomiting. She has lost 5kg (from pre-pregnancy weight). She complains of dizziness and her BP is 80/69 mmHg. The obstetrician admits her to the nearest hospital. Diagnostic tests revealed abnormal sodium and potassium levels.
- Outline the most likely diagnosis for Melissa’s current presentation, explaining your reasoning. Explain the most suitable treatment protocol for Melissa, justifying your treatment. (250 words +/- 10%, use APA referencing).
- Outline the most suitable pharmacological method(s) that can be used to induce her labor, and ensure safety of the mother and the baby. Your answer should detail the dose and frequency of the therapeutic agent. (10 marks) (200 words)
- Describe the most suitable treatment protocol for Melissa’s current presentation, justifying the reasons for your choice. Your answer should detail the pharmacological agent(s) that should be used, monitoring requirements and therapeutic targets. Provide a risk benefit analysis for the pharmacological agent(s) recommended. (20 marks) (250 words +/- 10%, use APA referencing)