Puberty, amenorrhoea, VBAC, IUD

Question 1

What are the causes of delayed puberty? (5)

Answer 1

Constitutional
Coeliac disease
Turner syndrome
Congenital hypogonadotrophic hypogonadism
Chronic diseases such as CF

Question 2

Order of normal puberty

Answer 2

Adrenarche, thelarche, puberache, rapid growth velocity and menarche

Question 3

Causes of Primary amenorrhoea (5)

Answer 3

Familial
Kallman’s sydrome
Hyperprolactinemia
Androgen insensitivity syndrome
Thyroid dysfunction

Question 4

Causes of secondary amenorrhoea (9)

Answer 4

Asherman’s syndrome
Cervical stenosis
PCOS
Premature ovarian failure
Prolactinemia
Hypopituitarism
Excessive weight loss, exercise and stress (hypothalamic)
Systemic - thyroid, cushings, CAH, DM, renal and liver failure
Iatrogenic such as radiotherapy

Question 5

Causes of premature ovarian failure (4)

Answer 5

Idiopathic 75%
Autoimmune diseases
Chromosomal abnormalities
Infections such as mumps oopheritis

Question 6

Causes of intrauterine death (IUD) (4)

Answer 6

Hyperthyroidism
Syphilis
Fetal aneuploidy
Maternal smoking

Question 7

Factors associated with increased risk of uterine rupture in VBAC (7)

Answer 7

Less inter-pregnancy interval <12m
Lower prelabour Bishops score
Obesity
Previous Hx of morbidly adherent placenta
Age>40
Decreased lower segment thickness <2mm
Macrosomia

Question 8

Central causes of precocious puberty (6)

Answer 8

CNS tumours; esp hypothalamic hamartoma,CNS injury
Genetics
Syndromes; NF1, Sturge-Weber, Tuberous sclerosis
Familial
Environmental; internationally adopted children, withdrawal from sex steroids

Idiopathic is the most common cause for female PP

Question 9

Peripheral causes of precocious puberty (5)

Answer 9

Congenital adrenal hyperplasia
McCune-Albright Syndrome (CAH)
Gonadal tumours
Adrenal tumours
Exogenous exposure to sex steroids

Question 10

Umbilical artery doppler changes in FGR

Answer 10

absent a/o reversed end-diastolic volumes

Question 11

MCA doppler changes in FGR

Answer 11

Peak systolic velocity is low. Check every 3 days. A better predictor.

Question 12

Risk factors for cord prolapse (5)

Answer 12

Multiparity
Polyhydramnios
Prematurity
SGA fetus with high head engagement
Breech presentation

Question 13

Complications of vaginal breech delivery (5)

Answer 13

• cord prolapse
• tentorial tear and ICH
• dislocation of hips
• arrest after coming head
• fractures of the femur and humerus

Question 14

Complications of VBAC (5)

Answer 14

• Increased risk of maneuvers & instrumental delivery —–> - - increased chance of endometritis
• Uterine ruptures
• Operative injury at emergency CS
• Higher risk of OASISHigher risk of blood transfusion
• Risk of delivery related perinatal death