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Specialty Blocks > 6. Obs and Gyn 2 > Flashcards

6. Obs and Gyn 2 Flashcards

1
Q

Give 4 causes of oligohydramnios.

A

Prolonged pregnancy
Ruptured membranes
FGR
Fetal renal congenital abnormalities

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2
Q

What are the US measurements that would indicate oligohydramnios?

A

AFI (amniotic fluid index) <5cm
single DVP (Deepest Vertical Pool) <2cm

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3
Q

Explain 3 implications of oligohydramnios.

A

May cause hypoxia due to cord compression.

If there is concurrent placental dysfunction / FGR may increase risk of stillbirth and hypoxia.

If early may cause pulmonary hypoplasia and pulmonary hypertension.

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4
Q

Give 3 clinical features that would suggest polyhydramnios + indicative measurements.

A

Large for dates
Tense abdomen
Cannot feel fetal parts

Single DVP >8cm // AFI >90th centile for gestation.

AFI is the measurement of DVP in the four quadrants

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5
Q

Causes of polyhydramnios:

A

Idiopathic
LGA
Diabetes (fetal polyuria)
Structural problem causing inability to swallow
Chromosmoal / genetic
Placental tumours
Neurological conditions

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6
Q

Give 6 complications of polyhydramnios.

A

Placental abruption
Malpresentation
Cord prolapse
Need for CS
PPH
Premature birth and perinatal death

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7
Q

Give 5 complications of fetal macrosomia.

A

Shoulder dystocia
PPH
Tears
IOL option
CS option

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8
Q

Reduced fetal movements can be a sign of fetal hypoxia and attempts to conserve energy or if they are unwell e.g. anaemic. What should a women do if she is concerned about reduced fetal movements.

A

Call and attend
CTG +/- scan
Ongoing monitoring if continued
If >37 weeks consider delivery

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9
Q

Give 4 risk factors for a twin / multiple pregnancy.

A

Assisted conception e.g. IVF, ovulation induction
Increased maternal age
FHx
West African origin

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10
Q

Give definitions for each of zygosity, chorionicity & amnionicity.

A

Zygosity = number of fertilized eggs

Chorionicity = number of placentas

Amnionicity = number of sacs

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11
Q

What is the most common type of twins?

A

Dizygotic (2 eggs, 2 sperm)
2/3 of twins in the UK

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12
Q

Identical twins are MONOZYGOTIC. Outline the timeline of the split of the one fertilized egg and the outcomes for each.

A

Splits before day 4; prior to chorion development; dichorionic, diamniotic. 1/3

Splits day 4-8; prior to amnion development; monochorionic, diamniotic. 2/3

Splits from day 9; monochorionic, monoamniotic (risk of conjoined if after day 13). Very rare.

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13
Q

Give 4 fetal risks of multiple pregnancy.

A

Miscarriage
Congenital anomaly
FGR
Pre-term delivery

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14
Q

Give 3 specific complications of monochorionic twins.

A

Acute transfusion
Twin-twin transfusion syndrome
TRAPS (twin reversed arterial perfusion sequence)

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15
Q

All maternal complications are increased with increased fetal / placental number. Give 5 particular antenatal complications that are especially important to be aware of.

A

Hyperemesis gravidarum
GDM
PET
Anaemia
Placenta praevia

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16
Q

Screening for aneuploidy is available for twin pregnancies. Describe the differences in the results for DCDA vs MCDA, and the types of screening available.

A

DCDA per baby result.
MCDA per pregnancy result.

US (determination of chorionicity +/- gender for each baby is essential for differentiation at further appts).

Amniocentesis
CVS

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17
Q

Describe the US schedule for twins (DC vs MC).

A

DC; 4 weekly from 24 weeks.

MC; 2 weekly from 16 weeks.

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18
Q

Twin pregnancies should be delivered via elective delivery. Give the preferred weeks of delivery for DCDA vs MCDA.

A

37 weeks DCDA

36 weeks MCDA

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19
Q

What is the average uterine blood flow at term?

A

400ml / min

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20
Q

Describe the mechanism of acute transfusion in MC twins and the management.

A

Death of one twin can lead to increase in HIE / injury / death due to pressure in dead twin causing transfusion / exsanguination of healthy twin into dying one.

Expedite delivery if near term.
If not, monitoring of survivor for anaemia and transfusional brain injury.

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21
Q

Describe the mechanism of twin-twin transfusion syndrome, including incidence and Dx.

A

Mechanism is chronic net shunting from one twin to another.
Donor twin is growth restricted, oliguric and anhydramniotic.
Recipient twin is polyuria, polyhydramnios, cardiac problems and hydrops present.

Occurs in 15% of MC twins, responsible for 15-20% of perinatal death.

Dx using US: liquor volume, bladder?, cord dopplers, oedema / ascites.

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22
Q

The incidence of breech position at 20 weeks is 40%, reduces to 25% by 32 weeks and is 3-4% at term. Give some associations of breech presentation.

A

Multiple pregnancy
Bicornuate uterus
Fibroids
Polyhydramnios
Oligohydramnios
Placenta praevia
Fetal anomaly e.g. NTD, NM disorders, autosomal trisomies

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23
Q

What are the 3 types of breech birth position?

A

Flexed
Footling
Extended

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24
Q

Vaginal delivery from breech position mainly carries risks to the fetus. Outline some of these risks.

A

Intracranial injury
Widespread bruising
Damage to internal organs
Spinal cord transection
Umbilical cord prolapse
Hypoxia

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24
Q

What are some absolute contraindications to ECV?

A

CS required regardless, e.g. placenta praevia
Abnormal CTG
APH within last 7 days
Major uterine abnormality
Ruptured membranes
Multiple pregnancy (except in delivery of 2nd twin)

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24
Q

What does ECV stand for, who is it offered to and what is the success rate?

A

External Cephalic Version

Offered to all women with breech presentation at term if there are no contraindications.
From 36w in nulliparous and 37 in multiparous.

50% success rate, return to breech in <5% of cases after successful ECV.

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25
Q

There are absolute and relative contraindications when considering ECV for a fetus in breech position. Give some relative contraindications.

A

Morbid maternal obesity
Major fetal anomaly
Nuchal cord
Hyperextended fetal head
Oligohydramnios
FGR
Proteinuric pre-eclampsia

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26
Q

What are the cut offs for low birth weight / very / extremely?

A

LBW = <2501g
Very LBW = <1501g
Extremely LBW = 1000g

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27
Q

Outline 4 aetiological causes of pre-term birth, with each of their incidences.

A

Spontaneous labour / cause unknown = 35%

Iatrogenic e.g. maternal HTN, FG problems, antepartum haemorrhage = 25%

PPROM = 25%

Multiple pregnancy = 15%

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28
Q

Women at risk of preterm birth may be offered cervical length surveillance, a cervical suture or progesterone. Outline 5 risk factors for preterm birth.

A

Previous preterm labour or PROM <34 weeks (strongest indicator).
Previous LLETZ >1cm or multiple.
Previous full dilatation CS.
Previous cervical suture.
Uterine anomaly e.g. bicornuate.
Multiple pregnancy (57% vs 7%)

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29
Q

Preterm delivery before 33 weeks gestation is the leading cause of perinatal morbidity & mortality. Perinatal mortality rates are proportional to immaturity of organ systems, especially the lungs, brain and GIT. Outline some complications associated with preterm birth.

A

RDS
CP
NEC
Retinopathy
Intraventricular haemorrhage

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30
Q

Maternal corticosteroids are often offered to women during suspected labour, definitely between 24+0 and 33+6. What is the mechanism of these on the lungs, and what other benefits do they have? Give one contraindication.

A

IM betamethasone / dex

Cross the placenta and increase the amount of pulmonary surfactant produces by type II fetal pneumocytes.
Reduces incidence of RDS by 44%, neonatal death by 31%, also reductions in NEC and NICU admission.

Contraindicated in active maternal sepsis.

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31
Q

What drug is given to for fetal neuroprotection, and what dose is given?

A

Magnesium sulfate.
Reduces incidence of CP.

<30 weeks give, consider if <32.
4g loading dose, then 1g per hour infusion for up to 24 hours.

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32
Q

What is the definition of stillbirth?

A

A baby delivered with no signs of life that is known to have died after 24 completed weeks of pregnancy.

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33
Q

What are the two most common stillbirth associations? (50% causes unknown)

A

Advanced maternal age
Maternal obesity

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34
Q

Give 3 ultrasound features of a stillbirth.

A

Absence of fetal heartbeat
Spalding sign (overlapping of fetal skull bones)
Hydrops

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35
Q

Stillbirth causes are many, and can be split into 5 different categories. List the 5 categories, and some causes within each category if possible.

A

Fetal
Maternal
Placental-mediated
Structural
Intra-partum

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36
Q

Outline the difference between low-lying placenta and placenta praevia, as per new NICE guidance.

A

Low-lying placenta = placenta in lower segment, edge <20mm from internal os.

Placenta praevia = placenta completely covering internal os.

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37
Q

Hamorrhage in labour is inevitable with placenta praevia. Give delivery advice.

A

LLP <20mm; CS advised, risk of bleeding.
Placenta praevia; CS advised.

Placenta in lower segment but >2cm from os; vaginal delivery may be possible; assess engagement of presenting part etc.

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38
Q

Risks of placenta praevia (3).

A

Sudden unpredictable major / massive haemorrhage.

Massive haemorrhage at CS due to relatively poor capacity of the lower segment of the uterus to contract.

Morbidly adherent placenta.

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39
Q

Outline the management and delivery advice for placenta praevia.

A

Recurrent bleeding = 34 to 36+6
Praevia (covering os) = 36-37
Low lying and asymptomatic = ~ 37-39

Could admit from 30-32 weeks until delivery, but often outpatient management if no bleeding.

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40
Q

What is the definition of placental abruption? + describe the risk of only considering revealed blood in anabruption

A

Retroplacental haemorrhage (bleeding between the placenta and uterus). Usually involves some degree of placental separation.

Revealed blood may not reflect the total blood loss as the haemorrhage may be retroplacental without any external loss, so should always consider in a clinically shocked patient. Concealed abruption is the most hazardous type of abruption.

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41
Q

Placental separation can occur in placental abruption. What does this cause?

A

Reduced area for gas exchange between the fetal and maternal circulations, predisposing to fetal hypoxia and acidosis.

42
Q

Most placental abruptions occur without any identifiable risk factors. State some risk factors for placental abruption.

A

Previous abruption
HTN / PET
Folate deficiency
Thrombophilia
Multiple pregnancy
PROM
Smoking, cocaine use, social deprivation

43
Q

In cases of intrauterine fetal death, vaginal delivery is preferred. However, in a placental abruption there is likely to be high volumes of blood loss. Describe what could happen to the mother, and the risks that must be considered when thinking about mode of delivery.

A

Hypovolaemic shock
Multisystem organ dysfunction
DIC; thromboplastin release from damaged placenta can cause DIC with depletion of platelets, fibrinogen and other clotting factors.

Waiting for vaginal delivery in these cases can exacerbate / cause the complications above.
BUT
CS in the presence of DIC is another big risk.

44
Q

Differentiate clinical presentation of praevia and abruption (both causes of APH).

A

Praevia; painless bleeding, non-engaged presenting part, soft uterus

Abruption; painful bleeding, with hard ‘woody’ uterus (Couvelaire, late sign)

45
Q

What does Sheehan syndrome refer to?

A

Post-partum pituitary necrosis; necrosis of AP cells after significant post-partum bleeding, hypovolaemia and shock.

46
Q

Explain the theory behind why the anterior pituitary is more susceptible to the necrosis that is seen in Sheehan’s syndrome.

A

Increase in pituitary volume and cell count in pregnancy due to prolactin-producing cell (lactotroph) increases.
Hyperplasia = increased nutritional and metabolic demand by the anterior pituitary gland as a whole, but the blood supply does not increase.
The blood supply to the AP is a low pressure system e.g. compared to the PP, resulting in the higher likelihood of ischaemia to the AP cells.

47
Q

Describe the acute clinical manifestation of Sheehan syndrome.

A

Pan-hypopituitarism or selective loss of pituitary function.
Pan is more common.
If selective, prolactin and GH are the most commonly affected.

Acute; hypotension and tachycardic (often in context of PPH), but hyponatraemia and hypoglycaemia are common to Sheehan’s. Difficulty breastfeeding / agalactorrhoea.

48
Q

Sheehan syndrome can present acutely or as a chronic condition after childbirth. Chronic is more common; describe how a woman may experience this e.g. symptoms.

A

Difficulty with menses after childbirth.
Panhypopituitarism symptoms, can occur months to years after the initial vascular insult to the pituitary gland.

https://www.ncbi.nlm.nih.gov/books/NBK459166/#:~:text=Sheehan%20syndrome%20occurs%20when%20the%20anterior%20pituitary%20gland,pituitary%20gland%20not%20being%20able%20to%20produce%20hormones.

fatigue and loss of muscle mass due to growth hormone deficiency

low blood pressure, cold intolerance and weight gain due to TSH deficiency

marked hypotension and hypoglycaemia due to ACTH deficiency

galactorrhoea due to prolactin deficiency

amenorrhoea and no menstrual cycle even after cessation of lactation due to FSH and LH deficiency.

49
Q

What is Asherman’s syndrome?

A

Intrauterine adhesions that may occur following dilation and curettage.

May prevent the endometrium responding to oestrogen as it normally would, so can present with amenorrhoea.

50
Q

Give 6 causes of primary amenorrhoea.

A

Gonadal dysgenesis e.g. Turner’s syndrome (most common).

CAH

Functional hypothalamic amenorrhoea e.g. secondary to anorexia.

Testicular feminisation.

Congenital malformations of genital tract.

Imperforate hymen.

51
Q

Give 7 causes of secondary amenorrhoea.

A

Hypothalamic amenorrhoea e.g. secondary stress, excessive exercise.

PCOS

Hyperprolactinaemia

Premature ovarian failure

Thyrotoxicosis (hypo may also cause amenorrhoea)

Sheehan’s syndrome

Asherman’s syndrome

52
Q

Risk factors for breech presentation:

A

Uterine malformations / fibroids

Placenta praevia

Polyhydramnios / oligohydramnios

Fetal abnormality

Prematurity (due to increased incidence in early gestation)

*Cord prolapse is more common in breech presentations

53
Q

NVP is most common between 8 and 12 weeks. Risk factors for include:

A

Increased bHCG e.g. multiple pregnancy, trophoblastic disease.

Nulliparity

Obesity

Family or personal history of NVP

*Smoking is protective

54
Q

What triad of clinical features should be present before diagnosing hyperemesis gravidarum?

A

5% pre-pregnancy weight loss

Dehydration

Electrolyte imbalance

55
Q

What are first and second line medications for NVP?

A

1ST LINE
Antihistamines e.g. oral cyclizine or promethazine

Phenothiazines e.g. prochlorperazine or chlorpromazine.

2ND LINE
Ondansetron

Metoclopramide / domperidone.

56
Q

Why should metoclopramide not be used for >5 days for nausea and vomiting of pregnancy (NVP)?

A

Risk of EPSEs

57
Q

What does ondansetron slightly increase the risk of when used in pregnancy?

A

Slightly increased risk of the baby having a cleft lip / palate.

58
Q

When can ECV be done, and what are the contraindications to it?

A

After 36 weeks.
Late pregnancy or even early labour if the membranes have not ruptured, and patient is not in active labour.

Maternal rupture in last 7 days = X
Multiple pregnancy (except for 2nd twin) = X
Major uterine abnormality = X

59
Q

What are the 2 indications for surgical definitive management of an ectopic pregnancy?

A

Sac size >35mm

Serum bHCG >5000

60
Q

How would a ruptured ovarian cyst present?

A

Precipitated by intercourse or strenuous exercise.

Unilateral, sharp pain.
Tender on palpation.
No palpable mass

*If a palpable mass was present, consider adnexal torsion as the diagnosis.

61
Q

Obstetric cholestasis is affects around 1% of pregnancies in the UK, and typically occurs after 30 weeks. How may a patient present, and what is the management plan?

A

Pruritis, especially in palms, soles and abdomen.

Clinically detectable jaundice (20%)

Raised Br in 90%

Management includes induction at 37-38 weeks as it increases the risk of stillbirth. Case for IOL is stronger in those with more markedly deranged levels.

Ursodeoxycholic acid is also used, and vitamin K supplementation.

62
Q

A confirmed miscarriage can be diagnosed on US if there is:

A

No cardiac activity +

CRL (crown rump length) >7mm
OR
Gestational sac >25mm

63
Q

What 3 factors are used to calculate the risk of malignancy index (RMI)?

A

CA125
US findings
Menopausal status

64
Q

A 29 year old woman is seen in clinic at 8 weeks. She wishes to terminate medically. What is the best treatment plan?

A

Mifepristone

Misoprostol 48 hours later

Multilevel pregnancy test 2 weeks later

65
Q

Give the MOA of mifepristone and misoprostol in the context of TOP.

A

Mifepristone; binds to progesterone receptor, interrupting it. Mifepristone sensitizes the myometrium to contraction-inducing activity of prostaglandins.

Misoprostol is a synthetic prostaglandin E1 analogue. Prostaglandins bind to smooth muscle cells in the uterine lining and cause contraction and cervical ripening.

66
Q

Fibroids can present with symptoms or be asymptomatic. Give 6 clinical features of uterine fibroids / leiomyomas.

A

Lower abdominal pain, especially during menstruation

Menorrhagia, leading to IDA

Bloating

Urinary symptoms

Subfertility

Rare: polycythaemia due to autonomous production of EPO

67
Q

How are fibroids diagnosed?

A

via TVUS

68
Q

There are both medical and surgical options for removal / shrinkage of fibroids. What medical treatment is currently used to shrink fibroids, and what are the side effects?

A

GnRH agonists

More short term treatment, as side effects include menopausal symptoms e.g. hot flushes, vaginal dryness, as well as loss of BMD.

*Fibroids generally regress after the menopause.

69
Q

Give 4 surgical management options for the removal of fibroids.

A

Myomectomy via abdomen, laparoscopic or hysteroscopic.

Hyperoscopic endometrial ablation.

Hysterectomy.

Uterine artery embolization.

70
Q

ITP is an autoimmune condition. Gestational thrombocytopenia is a relatively common condition of pregnancy. Outline the 3 factors that contribute to the development of gestational thrombocytopenia, and how to differentiate it from ITP in a pregnant woman.

A

Dilutional

Decreased production

Increased destruction (thought to be due to increased work of the maternal spleen, leading to mild sequestration)

Test for serum antiplatelet antibodies if low platelets at booking.

71
Q

Describe the production of a complete hydatiform mole vs a partial mole in terms of fertilisation.

A

Complete: An empty egg / ovum is fertilised by a single sperm that then duplicates the paternal chromosomes to provide 46 chromosomes from the father.

Partial: a normal haploid egg may be fertilised by two sperm, or one sperm with duplication. Usually triploid e.g. 69 XYY

72
Q

Describe the clinical features / symptoms of a complete hydatiform mole.

A

Hyperemesis gravidarum / severe n&v

Bleeding during first and second trimester

Uterus large for dates

Extremely high bHCG levels

Hypertension and hyperthyroid symptoms may be seen (hCG can mimic TSH)

73
Q

Women with hyperemesis gravidarum who are admitted for rehydration therapy should be given * and why should it not include dextrose / glucose?

A

NaCl 0.9% with added potassium due to risk of being hypokalaemic.

Should not be given dextrose or glucose due to risk of precipitating Wernicke’s encephalopathy due to accelerated thiamine deficiency, which is one of the noted complications of hyperemesis.

74
Q

Give 5 maternal complications of hyperemesis.

A

AKI
Oesophagitis
Mallory Weiss tear
Wernicke’s encephalopathy
VTE

75
Q

When does cardiac activity appear in gestation / can be seen on a scan?

A

Around week 5

76
Q

What does ‘missed’ refer to in the context of miscarriage.

A

Missed / delayed:

Gestational sac which contains a dead fetus is present, before 20 weeks, without the symptoms of expulsion.

Cervical os is closed.

Women may experience light vaginal bleeding and symptoms of pregnancy which then disappear.

77
Q

Which two types of miscarriage present with the cervical os open?

A

Inevitable miscarriage; heavy bleeding with clots and pain.

Incomplete miscarriage; not all POC have been expelled. Pain and vaginal bleeding present.

78
Q

What is meant by the term ‘threatened’ miscarriage?

A

Painless vaginal bleeding before 24 weeks, but typically 6-9 weeks.

Cervical os is closed.
Bleeding often less than menstruation.

79
Q

The decision whether to start a woman on the COCP is now guided by the UKMEC. The scale is split into stages 1-4, where 4 represents and unacceptable health risk if prescribed. Give some examples of these UKMEC 4 conditions.

A

> 35yrs and >15 cigarettes per day

Hx of thromboembolic disease / stroke / ischaemic heart disease

APS abs e.g. in SLE

Current breast cancer

Migraine with aura

Breast feeding <6 weeks post partum

Uncontrolled hypertension

Major surgery with prolonged immobilisation

80
Q

The decision whether to start a woman on the COCP is now guided by the UKMEC. The scale is split into stages 1-4, where 3 represents likely risks outweigh the benefits. Give some scale 3 conditions.

A

> 35, less than 15 cigarettes per day

BMI>35

FHx thromboembolic disease in first degree relatives <45

Controlled hypertension

Immobility e.g. wheelchair use

Breast cancer gene carrier e.g. BRCA1/2

Current gallbladder disease

81
Q

How long should you advise most patients to wait before restarting regular hormonal contraception after ulipristal acetate due to missed pills?

A

5 days

82
Q

Which class of drugs can help with severe PMS symptoms, and when can they be taken?

A

SSRIs

Continuously or just during luteal phase (day 15-28, depending on length)

83
Q

List the 5 types of urinary incontinence.

A

Overflow
Stress
Urge
Functional
Mixed (UI + SI)

84
Q

Which hormone does the implantable rod release, and what function does this have?

A

Progesterone / progestogen

Inhibits ovulation as progesterone inhibits FSH and LH from the pituitary. It also increases thickness of mucous within cervical lining, but this is not the predominant role.

85
Q

State 4 risk factors for urogenital prolapse.

A

Multiparity

Increased intra-abdominal pressure e.g. obesity, chronic cough, chronic constipation

Increasing age / menopause; loss of oestrogen and connective tissue strength

Vaginal deliveries involving macrosomia and prolonged 2nd stage; direct trauma e..g avulsion of levator ani or ligaments via forceps, or pudendal nerve damage ?crushed by bony pelvis

86
Q

What is the most common type of prolapse?

A

Cystocele; upper anterior vaginal wall and bladder prolapse

87
Q

List 5 types of prolapse, stating the most common and second most common types.

A

Cystocele (number 1)
Uterine prolapse (number 2)
Cystourethrocele
Rectocele
Enterocele

88
Q

Give 6 preventative measures for prolapse.

A

Weight reduction
Treatment of constipation
Treatment of chronic cough / smoking cessation
Avoid heavy lifting
Lifelong pelvic floor exercises
Good intrapartum care; avoid unnecessary instrumental trauma and prolonged labour

89
Q

What is the surgical repair for a cystocele +/- urethrocele?

A

Anterior colporrhaphy

90
Q

What is the surgical repair for a rectocele?

A

Posterior colporrhaphy

91
Q

What are the options for a surgical repair of uterovaginal prolapse?

A

Vaginal hysterectomy (15% will go on to have a vaginal vault prolapse).

Manchester repair; cervical amputation, shortening of transcervical ligaments therefore pushing uterus back into place.

Sacrohysteropexy; open or laparoscopic. Mesh attaches uerus to anterior longitudinal ligament over the sacrum.

92
Q

Give 3 surgical options for the repair of vaginal vault prolapse.

A

Sacrospinous ligament fixation; vaginal vault is sutured to sacrospinous ligaments, using a vaginal approach.

Sacrocolpopexy; open or lap. Vault is attached to sacrum with mesh.

Colpocleisis; vaginal closure; for women who do not desire future vaginal intercourse.

93
Q

Define primary vs secondary amenorrhoea.

A

Primary; failure to establish menstruation by time of expected menarche.

Secondary; cessation of menstruation in women with previous menses.

94
Q

Primary amenorrhoea can occur with normal secondary sexual characteristics. Give 5 endocrine disorders that can cause primary amenorrhoea.

A

Hypothyroidism

Hyperthyroidism

Hyperprolactinaemia

Cushing syndrome

PCOS (rare cause of
primary)

95
Q

Primary amenorrhoea can occur with no secondary sexual characteristics as well. These can be split into primary ovarian insufficiency and hypothalamic dysfunction. Give Some causes of POI and hypothalamic dysfunction.

A

POI:
Tuner’s Syndrome (46XO)
Gonadal agenesis (46XX/46XY)
Chemo
Pelvic radiation
Autoimmune disease

Hypothalamic Dysfunction:
Stress, excessive exercise +/- weight loss causes functional amenorrhoea (female athlete triad).

Chronic systemic illness e.g. uncontrolled diabetes, severe renal and cardiac disorders, coeliac disease, cancer, infection.

HPA; hypothalamic or pituitary tumours, infection, head injury, Kallman’s syndrome

96
Q

Kallmann’s syndrome is a recognised cause of delayed puberty secondary to hypogonadotrophic hypogonadism. What is the typical inheritance pattern, and give some clinical features of it.

A

X-linked recessive, but can rarely affect females.

Failure of GnRH-secreting neurons to migrate to the hypothalamus.

Anosmia
Hypogonadism, cryptorchidism
LH, FSH low or normal
Sex hormones low
‘Delayed puberty’

97
Q

Secondary amenorrhoea with features of androgen excess can occur; give 3 features of androgen excess, and then some causes of this type of secondary amenorrhoea.

A

Hirsutism
Acne
Virilization

PCOS

Cushing’s

Late-onset CAH

Androgen secreting tumours of ovary or adrenals (rare)

98
Q

How long does menses have to be absent in a) normal women b) oligomenorrhoeic women for it to be classed as secondary amenorrhoea?

A

3-6 months normal

6-12 months with previous oligomenorrhoea

99
Q

Primary amenorrhoea classification (presence vs absence of secondary sexual characteristics).

A

13yrs if no secondary sexual characteristics

15yrs if normal secondary sexual characteristics

100
Q

If amenorrhoea persists for over 12 months, what should be considered?

A

Osteoporosis prophylaxis

101
Q

Give 4 complications of amenorrhoea.

A

Psychological distress
Infertility
Increased CV risk
Osteoporosis

102
Q

What is the pathophysiology of primary dysmenorrhoea?

A

Before menstruation begins, progesterone drops, causing the endometrial cells to release prostaglandins.

These stimulate myometrial contractions, leading to decreased blood flow, uterine hypoxia and pain.

103
Q

What are the time-until-effective stats for the IUD, POP, COC, injection, IUS and implant?

A

Instant = IUD
2 days = POP
7 days = COCP, injection, implant, IUS

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