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Causes of Primary Amenorrhoea?
- Usually genetic disorders, check for normality of external and internal genetalia and karyotype them.
- Turners is most common (gonadal dysgenesis)
- then Mullerian agenesis,
- abnorms in FSH and LH receptors,
- Stress, Wt loss, Excessive exercise
- Early menopause
- Pituitary tumors and hyperprolactinaemia.
- Pelvic TB
Define Primary amenorrhoea.
- Lack of secondary sexual characteristics by 14
- No menarche by 16.
Causes of Cervicitis?
- Papillomavirus (chronic and leads to cerv cancer)
- Reaction to contaceptives (barrier, IUD)
Causes of post coital bleeding?
- Cervical - Cervicitis, malignancy, polyps, ectropion, trauma
- Vaginal - atrophic vaginitis, sti, trauma, malignancy
- Uterine - abnormal menstruation, endometrial polyps.
Obliterative scarring of the uterine cavity and fibroid production.
Caused by Operations on the uterus.
Mendleson's syndome is...?
Aspiration of gastric contents during anaesthesia of pregnant women.
Sheehan's syndrome is...?
Pituitary infarction occuring in the peri-partum period.
Contraindications to using Provera (progesterone only)?
- Severe arterial disease.
- Liver dysfunction.
- Known or suspected breast malignancy (or any hormone sensitive tumor)
- Thromboembolic disorders
- Known sensitivity to it.
Treatment for mennorhagia and dysmennorhoea?
What is placenta previa?
How does it present?
What do you do about it?
- Low lying placenta. Types 1-4 either covering (3-4) or not covering (1-2) the cervical oss.
- Painless antepartum bleeding, can also present after 20 weeks.
Placental abruption is associated with...?
How does it present?
- Strongly Assoc smoking
- Reduced fetal movments, abdo pain, Collapse.
Risk factors for Amniotic fluid embolus?
- Rapid labour\ delivery
- Artificial ROM
- Oxytocin\prostaglandin induced labour
Amniotic fluid embolus is assoc with...?
Risk factors for Congenital dislocation of the hip?
How do you test for it?
- Being a girl, being breech.
- Ortalani - hips and knees flexed, with index pressure on greater trochanter and abducting with thumb. Feeling for a clunk.
- Barlow - Push knees towards bottom and adduct.
What is synophrys?
What is the incubation period?
For what amount of time are they infectious?
What does a raised IgM titre indicate?
Is the baby of an immune mother at risk?
Does immunisation against it confer lifelong immunity?
- Incubation 2-3 weeks
- Infectious for one week before and one week after rash (3 day rash)
- Raised IgM indicates recent infection.
- No baby will be fine, mum has given antibodies via placenta.
- 50% of those immunised will be re-infected.
What is TORCH?
How do you deal with each one if you find the mother has one of them antenatally?
- Toxo - Spiramycin
- Others - syphillis, varicella
- Rubella - Pueperal vaccination
- CMV -
- Herpes - Best treated perinatally
Define primary Post partum Haemorrhage.
What are the most common causes?
How can you prevent it?
- Haemorrhage of >500mls of blood, within 24 hours of labour.
- Most commonly caused by Uterine Atony, Retained placenta or vulval\vaginal lacerations.
- Prevent with active managment of the third stage of labour.
Secondary Post partum Haemorrhage...
- Prolonged or excessive bleeding once the woman returns home. (>24hrs - 6 weeks)
- Most commonly caused by Infection and retained products of conception.
What is von willebrand's disease?
How would you investigate?
What would you expect of the Ix?
- Von Willebrand's disease is the most common hereditary bleeding disorder with autosomal dominant inheritance. It is caused by a deficiency of von Willebrand factor, which causes platelets to adhere to the blood vessel wall and to each other.
- The usual coagulation profile will be:
- 1. Normal platelet count.
- 2. Prolonged bleeding time.
- 3. Prolonged APTT.
- 4. Normal PT.
Diagnosis is confirmed with reduced Ristocetin co-factor or reduced vWF factor concentrations
Hyperthyroidism in pregnancy...?
- Is more serious than hypo.
- Graves disease is the most common cause.
- Treat with minimal dose of carbimazole.
- Can carry on after birth as carbimazole does go into breast milk but doesn't have much of an effect on fetus. (low concn)
Causes of miscarriage\PROM... (5)
- Cervical incompetence
- Uterine Abnormalaties
Whats the recurrence rate of Gestational Diabetes?
80-90% therefore do a GTT at 16-17 weeks.
Whats the story with antidepressants and pregnancy?
- DONT DO IT!!
- SSRIs are terrible, especially paroxetiene (pulm.HTN).
- TCAs arent as bad but not awesome.