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    Obs Gyna Vol 1

    Uploaded by

    mohammad farooque razaa

    Copyright:

    © All Rights Reserved
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    of 43
    othe edn esc aay “Hormones veoreted by Placenta t. | mete are marly Two tyferic j 3 2 teroid a PePtide. IJ. Progesterone, '). Hea tae » a). Estrogen (estriol) a). HPL (Human Placental Lact, Sy je Pincantareqaicet HOT (Chorionic Hajrotron Precuurdord From the fety -Pin ) Hat's why estriol sag 4). Pregmancy afecite 6 ap abet fetal well being ~Co Protein, S). PaPP—a ( Pregnancy aK ausy crated Hasina Pretin4 SafortenE Guay: I). Mam site for dynthesig y Placenta =) SynctrotroPhoblayt a). Hormone resPongible for raaincaiwing Pregnancy. =) Progesterone. 3), Progeuterone teocreted 10 weeks during» =) Corfly Luteum. 4). Progesterone secrete Jo Lsetke beyond ” 2) Placenta: 5): Progesterone Convert. endometrium 2, decidua Nye deudual ren, 6). Sn Pregnany Ingully regtytance, dus: to 2) HPL (Human Placental Lactogen), 2), Hormone rePondible for fatal Jrouty a) Inguln. ). Adtt the birth of baby , no by 4) Growl. hormoney. V+ Sraulin decreted tn fetiy , 4] ALE Iduoeeks of. Pregnancy. aad —»- © _ 10], whch Pormone regPondible for maintaining Cor Pur Lictein, qf Pregnancy , 3 as Sf HCG 4 Stig a gdycofrotely, t nn dtynthesig dynctlotroPhoblast . - 34 fot 9 subunits :- 2 and f ' ol —dubunit B-dubunit | abe | I). Non - sPeetfre 1). SPeerfre subunit. | al. St simitar +o a). Seructuray Bq subunce yo RSH of ACH id dimi'lah to =, 2H eesti ee Git Paar) — FSH: geeuin 3). Bute Punetionally , |lorte (wird Heo ae! LuteotroPic Pormone . pene ot ta a iat i Dt doy teste day sdtaet ag’ day, ! ovulation day tg Lised Pertod » eG can -be detected in blood , 22rly of 90 -8.8"4 dog of rmengtural cycle t HOG an -be detected, 6-3 day after fertilization ~oe andy rd day of missed mengtural Cy che TECHNIQUE ..f0R) DETECTION $— Sa rere alas ). RTA Y Radio Damuno Assay. yg) TRMA 2) Smrouno Radio Metrfe Auday. 2) Out of thae two techniquy RTA beter and tt can distinguish blo LH £ eG. But TAMA Can'é metas a dig gusR + Once HCH i detected fn blood, its Levelt doubler in every 48 tours. + And HCG tf maximum ot loweeky ef Pregnancy ov TS" brim egter + Apter lo weeke =) La der 30 CL of Pregnancy ig algo degenerated @ Progedterone Ley bso « That 4 uty Placenta Produce Progesterone. HCG disaPfears Prom: blood and rine after He " Swoaees Of delivery. PREGNANCY TEST $= alge why biochemical He >for detection of. Pregnancy. m yates HOG tracey ore 1). By detecting nd he a * And ULtresound, eo Onin & — blood. for thu a Preprans detechry Rite 4), Urine fregnen yet te DISADVANTAGE [oa pcBRCK AD? = = pen RO pate, ~Pregnany ls chacked only — Can be done at Pome ajier Parent tas mlused — a onte sfot tert- ther Periodrek bofore. Put xu drole urine ont f. Techwipre t— : rent eel morning darofle o¢ Urine ei © 32 only one single’ tne affears am sériP, Hhen this ls a -ive test for fregnancy. 8 Re nanty ty absent- 4 umine drofS. T-4 ok i af twoxtiner affeors on [ L - | Str’P | Hen ty tg tive ” tat Per fregnang) utich indicate that te fragren vd om pred ade | §) Blood tat for Pregnancy By RIA S TRMA techwtyner AQVANTAGES OISADVANTAG Ef | neta Secret ices ee | ruse con do lt 6 dayg + Can not do attome. ' Bedore de middod feried. | . Not a onthe gfot tsb + Should watt for Mu houre, SNPORTANT Ques): Physiological changes in tea | I), Nother gain wit. during Pregnandy ) H-l2Kg- | Veg in a) TH trimester | SkH-5 om wack 94374 trimepter 2). Sbwerghic of Pregnant @ des or temaing station during fregnanay | Hat meang Petey far Duae = Intra Uterine growth, = retardation — o Intra uterine death of Petuy. : 3), werghte of Pregmant Q Neg FOS Kg / week ow 7 KG] mont Sndécate ) Pregnany Induced Hyfertendion- | 4). Total amount of retajned water 2) 65U | fy Pregnansy | + And due to tty retained water , Edema. can ote) edema can te | — Physiological edema — Pathological edema + Wake UP im morhing oft]. ea Pregnancy induced taking rest in night, 2d ern, : + But LE never subsidy Edema. ry a dsgoxt) ema gubatdes (« ) afer taking rant. QNATOMICEL CHANGES IN PREGNANT Penpic| an — Breast = vagina — uterus. BREAST CHANGES :— Renae NE sl Introduce + St tga modified sweat gland Ars Size of the bresst g ut. bothare eg, during Pregnancy. + Modified sebaceous gtords affeor on breast dwing on. ig called of Montgomery stuber alex, HORMONES ACTING ON BREAST DURING PREGNANCY g_ j tg ae [ — Mu a } + Bin et: 6 ai30 = matte Production + Maile Byoctte oHormare raBasb? of breast dusing & Secretion Letdownreflex pee Dd as 5 Sed ance of wik | "ts cy [4 cettedou [ve ed a Patten | y Ne paca Lactogenes's Galactokinesis | Hacomageuis] Laeeegeness] Naromogenests AL by Rarmane Jy Romer eo Asiaetin| Tfaiecth] + Prolactin is gecrekd Anterior Pituitary. HR no secrehom of frolactin then no secretion oP slic alae necrosis of Ant Pituitary OCC 4 die te fut fortum tecoliad' By Ee weaee eeu {sheakons Syndrome, ugar ted * An thin, syndrome motte Ray failure ts Lactate der chidd- > Ne le tumour ef ants Pituitary glond ty Prolactinona: ComPlaing of Prolactinome:— — Galacterrheo — Vigual disturbances (dus te Ded Prenureon ofb'e chiosms). ai lS . © gh. Bed roilk Seeretion by drug 4) Metocloferarvde Pd, gy gre domoensftine -Eabergolind—7 0c. — sépogen — . Testosterone. Lit hed aa ge a =) nipfle atinulation mle method for dtinutaton of mile Production: 3). VAGINAL CHANGES ¢= 1). Chadustcktg or davnawestierrer 4rgn echo ae wegue anes Oe — bluish discolouration of vagina a}. Suering Pregnancy Dedertem bacten'a Tet ushich Convert glycogen dl due to they Aerie of vaginates algo. {ee dead ty Fed fH 4 35. 2). UTERINE CHANGES: 2 weight and aije f utureg 443 during Pregnancy. + Bin Hem , due to pines & cater ‘htm cet tga =auelis =). wat f none Pregnant uterus + 59- bogm: A non Pregnant ” > lev0 gm, a Positton a drteverted - ur Pvsternum “guffer liyrd E muddle qed ees ce. bles I pitted & viPhistorruen Bowery — 325 a Ye Dunetien bles Lowe Ipod gaffer /3"t- yaone Sle AA teitance bls umbiticey @ xi Phtd. aus 4 30" et s, Ubeabr ivi 16 1 taker ld tumbvee aha ss 12» 7 Pubic tynaPlay aie. Enteresions “AT tt trimester, ubeeuy iy 4, below the Pubse syrrPlasig — sey igth pee He SOO an, alee pels Gohl rene | Ne Be 12 uacte 2) at the level of Pubic Sgrofhyats 3 2), 2 paidusoy blo urobilieug ond Pubic symPhyate HL iL i on Qh nF at the Wever of unbilfew. on Bethea gd simetion bfig tower yd and uP foe 2fp4 dytane® blo umbiiiew & wifhigternum- Sn oe a} Junction blia middle 'grd & uf fer Ifpd distance » Unkilieug & viflisternus, jaw gc 2}, at he Level of shiPhiscternum. Bey cn amteote on J} dame ad 3a" uarek. —_——_——- | * Twin Pregnanty, . Poly Rud rambnios + Hewmole (Hydatiforin) Ee \ » Concealed variety of abruftio Placonte Py axsociated tumour wsth Pregnancy, Systemic Cangas Sen Pregnancy Ps I), Heamatological Sugtem >. °° ss Ota _ «4 » Blood volume ‘tes by 30-40 ¥, Uhos — Plaga 6 — RBO'E seCor plana: Vol: Neg ty 2) 4o-So0y iS RBCs nn .2) Q0-30% abe Se NON =) HénodiLution ¢— Plasma Neg Raclstas but Luss. Ww during Pregnancy. suchen Platina Tet more, but Reels Deg in Less volumoe. , dering the freg nany ig Known of Hemodflutfon. Jgmodltlutton., 4 Pecicedl cell volume A Vel. of REC /rral, af Plaga J Hematocrit . Uuckney o vigeosity. of the blood, oD PARAMETERS woHICH “hey | dag dung Pragnatp meet eg Oe pba lees trot hed blend. forameters:, + Packed cell volume APA Re ee ees sb cone. das in gramg/dd.| so, - carcurn cafacity, Hematocrit: a ging “J + Blood clotting Fators, + “WBC — Count =e te Cat) + ALI clotting fac tor — 13 (xm) z o ESR. + Platelets iro, ; » RRO fave Hb in thom, £0, 9ue fo ted recy 1) Hb devel alyo tay, Bi nn Hey Os aCamaing Cafacity algo Deg, + Plat : Platelets Jes durin Pregnancy but Le Be Rave ang effect on bleeding time 1 & chotti 4 time. (sr) CU i4 + All Clotting Pactorg Deg during Pregnan ey, : elm aah “deb Pregnancy u colted oof Leet Stok ee seal of. i dinfortant aa }. Pnticoagulont of cho'ce luring Pregnancy. Ait Unfractionated Hefarin. a) Lewd) kt: “Peflartn dages not uted during Pregnongy, 3. AU blood clotting factors fey during n exee ft n ith n 5 W and 13 4). m : Avene Tats @ fibringgen eg dusting Pregneng,, ' Duet ! Lregnantys— CHANGES TAI CARDIOVASCULAR SYSTEN bes. © aut fat 2)Strotevsi-xneape @ Peri Pherad vascular retistence (sv) tHe) des (1 BP Progesterone ang fe peepee eae reeset) ® Olragtotia BP Lar. R Case) cde Mem ABP 3) tyyblict Sine, 3 | and «+ dystelic BP remarny rarmal during egnang, So jolt te Jed OBP, Mean DGRp PMAled OBP ty gmt trimester (13-0 2! useetes) , a). 84 OBP dees not dey in ord trimester , then thite | ture | males trav re ey fu Pemaly Cen 2 Pregnancy Snduced Haferten| (PtH), | SOB dep dwwing fregnangy, | 4) SRP normed 9 : | | SUPINE HYPOTENSION SYNDROM al 98 tb geen Late: 3rd a vinete SE ~ . Sep Peiadey “ties suPine , Hen Gravtd /[Pegret utertd guPrcgpey the fnferfor vena cove then eutfot det to, due ty thy mrodhoy 2x Pen'en ce tachycardia § 4yPotenaion: And if mothers CO “Lag phen bled dufPly te fetes alo ber ¢ fetes devetof Geter cise PE i { Menaul hey Co L ees capacity ats Ney, 2G — Urea 7 Une agid — Creatinine. | Mesh CRON METABOLISM ha! + Total amount of Tron (fe) iy required during Pregnan gy ‘ '$ leoomg - SSR rales of PETS Beta * Amount of Fe supplemented 2) 40- 60g (dow. Seta ane lot Fe td absorbed Prom diet: That 'y why jto fuufiu the amount gf Fe 1 Shruld Give sufflementds of Inn: f 7 And dusting Pregnonsy Tron gupPlementation (4 absolut: necessary (B45) 3}, whet netrient necessary during Pregnangy? Ant t+ Tron. (fe). + Exeaft for 27's (i,e — Serum Transfern'y dhat - Totalybinding cafactty are Bel | but reprk He al Parameterg ‘of Fe metabolithy Jeg, : 2 Insulin resistance during Pregnancy tg dut to — HPL (Human Placental Lactogen) — whieh i deen blow 24- 9g usceky of Pregnancy, A $0, Pregnanyy ipa diabetogenic. stale. = due to Hu tan develof diabeteg dutrg Prognan gy , ube ig colled a5 "Gortational diababer. + TSH dowels remain’ normal during Pregnant, + Que do Progesterone (WHRME dmeoth mugcle relatand Proferty ) Here tg eg tneldence of — consti ation — Gall gtoneg formation — Paralytic Heus. rae L- CARE 3 + Ideally no. of antenatal visity s2ould -be PNQ=IS tiny o Untiu 92 weeks n ” ron DPV MIE iH every 4 anand Rog 36 Dosage of Fesoy Vet wack: iday + Total Hroughout4 Pregnanty ACC. ty Govt: India © 3) loodays. Eartier each tabled FeSo,, Contain 60 mg @ elemental Tron. nh 100 Ona es. Ieablet {day 1 Searting from te > Wow PT » > > 2 Tablet distribution by the Govt of Indie san PO Tg gf elamenta fe. = 78 Souda. folic acid. ANAEMIA IN PREGNANCY ¢— when 4b devel 2g + +n Sndies mL pogr y, Hen anasnia Ly Considered P Bale tyfe of Anaemia durin Pregnanty Awa Fe [Sron) 6 Fulic acid dnacmia . J ta called og ‘OP morfhre Anaemia. y+ Thole tye ef anaemia during Pregnanty AJ Hoemoly tie or Haematology foal Anarnla. y* Very rare Qnaemia eet Pregnancy 2 Ast vit: B12 dePicrenc, anagwia- TRON DEFICIENCY ANAEMIA 3— » Storage foro ef Tron ig i) Ferritin © Tramsfort 9 na) Transferrin, * Gulortont deny 2 }. TIE marker of Fe defrerenty on aenta/oale Senitve marten dnp 4 DePletion of gerum forrftin | + Sron defictency anagnia .) nlero cyte Ay focRromic: ciendy Amacnclar duuntny Fregrene a, Management of Fe de. oral forin Therafeutte cose ef Fe { — & tablets of FeSo, [dag 1 ELU blsod Parameters become, normal. Saf, Outs » THE fara meter whip bechie. novinal 2 Any 4 Reticuloayte count: 1 + when blood Parameters become normal Hen the maintainance dose oP fe ty 2) Teablet / And give leer Heroughtte apd loo days oto dalveey (or 4tU 3 months), le replinish tore. * Hb hey afer 3 wrecks Giving Orel tron HOub fy wiv be OS — |g | weer. Soh Guey + Spe Pregnant women Bors te doctor wit | severe anaemia ten GEST should be He ptt dtep 7 Lee ae At + Then give blood trons fution te that Pregnant: Os Andif tore YY 4evere anaowia beyond 36 useks op hres Aaa Then altg give blevd transfusion, | A Pg Gndledting “ty 9fve blood trans fusions:— \. Severe cnacmv'a begond 36 weeky g Pregranyy , ad nM due te bleed logy Lite Post Panta, Lomorbage. RR num atuiessteerg Uae ) v tabich ig not corrected by | oral arusy ef Iron. & Role of the Polvo catéd . Ants To Prevent the neural tube defect: Prophylactic dose fr nom a) Aev-ng: Ther afeuti'c Nee ee 3 Ria a) 44 4. VACCINES USED IN PRE@NANO# Jivte : + AULvacciner are Contraindicated. Bet K'iled vacanes can be give. VAcaNes VAC: Safe tn vats Given bh Contes Indicated Absolutely eee Vets sbutiGan be gi. Con dra inde ee Ebidemics iB Pragrant trevetng — Leabed, ty I te 4 endewedrea v v sedi See ee tb —Hefatitis —TyPhoid — Yetlow fever = Mumps —Infivenga ——~ Preumonia — Polio vaccine - —-“ Neatter —Tetenus — Cholera =Robee — Rabies — Meningoco ccug poe =f matt fox: NANCY TNOUCED HYPERTENSIEK + Sf BP ZIAe/IomMHg geen in 9 occasions in different bbs Parts 1). Preclarfsia- 3). Chrome MyPertengion in Pregnanc 2), Gertatonal Payer tension 4), EctomPsia. TROPHOBLASTIC INVASION IN PREGNANCYS_ TroPhoblastic: Invasion yy nat occur Low Pressure. Ta stefs) Han Prey ep 4 Low redigtene Channelt, 4 et) ted reriztence” , 4 Uae aes b/BI lo -[A weeks Ie-1 greene Ale ¥ os Patient Fos ted BP durin ea Pregnancy Opler towaaks, cae co PREELAM PSP GESTATIONAL gf — cHrRerne. Ecian Poa + Din BP beyend + hin BP beyond | -3¢ BP already igiansw’a: anne Heo waeks | ted. TL. BePore deliver = Protemunta + No Protemuria [> BP ted goon ee rote i ti mle), + GP shoutd come | . BP Should Come] before soweeks- | pe ys oo) : pack toate back to the | * BP Luding t Aabour - | normal win | moral uty | Come back-to ee es | 19 useeleg of 1g Useeks of normal Lulthin Ti ater deliv: tyes soled, eli ony. delivery. aks op : ard + D4 oy tusotyfer Docpmetraytdofa,| Poet fortum. Nad 4}. Sn Hs, Gon vultion te ‘ 1 due $y ano’? 2). Severe: te ; Bleed Ploeg ns ep a For Pragnansy induced ruforteraion (ft). 4 Doe >) Labetelol. + for Severe PreeclamPr'a, / tuyfertenaive crighd 4 Boe 4 for Nor Purfase) Hydrazaline. rn PG » +) Labetolot. * DePinttive managemenst’ 3 NTP (Medical termination of Pregnancy). PRotenopiAs— when Protemnyg excreted In un'ne. Mainty albus Tr Urine: |] detect be v ls E etudrg urine, tin dingte Urme + Oi PetifRierte 35 > eon Jou eg Saale op Za Peele ee) omg jdt ‘ ns Al bum RY Bick. tay) using. MLD \ feu RE © BP D140 Aor 4g, but BP 2160 [110m 2160/10 wg | \ 2 Protemntunta: by diPaticks' melted + Potemunta (difsdroy) 4th ro i AD+3- | 0:3 g au Re. PREeciampsiA 1— | + Amount op froternd inurne, + Ampunt Y Potting dy wane. =) 70:33 Jautve (4 Zoey jrubes. but 05g ruby. | 1 Sy rafoey 1 erlesalacke + Efigogty'e fam e HELLP Synd ame J Ive c ae of. 04g una. 2 HeELLe Sintec ye ea Hd Haemotysty, EL) Clevated Liver ensyrnas. LP} Low Platelet count oo ¥ + Mother 4 BP Ret L a tevd Plowdes (7 Pres. amdvolume YS blow d Flo Inversely relased t cock otte.), LuGRe ih [pnctra Uterine gro.oth retardation), S2enin sovere preeclomyn, buknetin med + And tf Mother's BP Neg | Liens! bteod $iow ns GPRS ae capacity Lar Lite Values of derum-Lree ce ae — Creatinine MILO PREECLAMPSIA: = « Role of antihyfertensiver oa ‘Ptignydde ra > in freeclan fsa , 4m b te incidence oP intracranial) Raerorrfoge. ; Antityfertengive of choice 2, Lobe-talol. on, sae in Fregmensy +) I). Labetotel. a). Hydrazabne. 3), ad methytdafa. 4). Cot LeRann ol blocker. 5). Nefed? Pine. area Chabot: 9p -SakL atten. ). ACETY. 2) Lagartan 3). Diuretics, teNat weird Asta. Jer shot is. “I fasts but for Long ute LE comet (nto Cyanide and Coupe Cyanide toxiedty . + Se Pinttive management 4) NTP. tf te id 735 otek of fregnaney, + Mode ef Delivery :— — Of cermin is Pavurable bor vaginal delivery, == ih nn unfavourable. 5 Ce¢arean : >). To Check ue Pavowrabi lity of corvix: lx D BisHoP's SCORE 3— Qdh? — Dilatation of cervix. force — Position on 4 EnPloyad — effacement » vn Sfeval _ Station of head Goromandds — Corvin Cont -tan cyt =). SP Bishof's score ts 76 , then Cervix ty Pavourable ayy a a Seat a ny Bnfavowrable- A. So, TH af ol, we Dave ty make corvix favoureble Le ty called og Feervical ripening . - Bishol's score should abuso hedone before inducing ae Labour. SEVERE PREECLAMPSIA 3— perce oN ead NG tee ae Ber » TH step 3 To Prevent convulsion. Doc > Mg S$Ou. DOC Por efiileRay jim Pregramey —> Phenober bitates aI gteP 5 To frevent hyfertensive crits. (AntiRyferctenivst) Hoc 4 Hydratagine Definitive management MTP Beyond 34 Lasste SeLpaeP Sr ey Manageme wt — Ww —_——— ttlstep:- Mamtainance of airways. ord step — Antreonvultants 4 Mg SOx, 39 seep AntihyPer-tengi ves. Definitive ea caa Gene saa allen imrnedtacely peteuied SEE fhafouy 2 “3 D0C For treating convulsions afuall oF Preventing thomin Pregnancy Induced Hy Per-tension. Mechanian ep Action, (MOA) =), S34 blocky Ca?* channely sand releatep Ach. FE Ng Su, should used Caucttogly uitth Nifedipine: « Narrow theraPeutic range 5) 4-tmey /L. tP 24 Hen Convultion. eeeacat ace at a Indications of Mg SOx, Toxi cites i). NE @rtiege Sign, Lous of knee derk 13f Ng Conc. PlomEq / a). ded urine outPut 4), 230 mL/hr. or Loom in 4 Downe 3). ded ratfiratory rate 9 49 bPr MING Conc. 219 EZ/L But If more from they Conc, then resftrakory clefretsion. Er Sf At 120' Clock , abe took Aoading dose And by midabe ajun ste took refeated sgeearel saitfotl ea ebace SENG REE Tea ap Hera ers We Pees saad dey MIS Seciechy + Antidote 4, ca* gluconate. Ond rP Hes te not available sthen give Calcium chloride. LYTIC -CocktAt: REGIME o— ene te + Given +y Indian , Menon. + 3 deugs regime - for treating Convulsiong tr PTH . D Pettrding D Promethazine > AlorPromazine . Rite factors for Pra ys - Previow Aistory of PLH. Main factors zs Pritntgravrd a [NuluParleg is — Post ator [family istary op — New Pater nitiy ted BP- egnanty) | — Diabetes ees a ae : — Thyroid digeare /Renal diyeore. |= Ant PhosPholifid Ab tyndrome — Collagen Vascular Oivsease . ne Obesity. = RR (ive) Pregnancy, + Smoking tg Prokective for Pregnancy Induced frag Pertension ‘ — Endometriosis. eas + — Frbrofdy. _ , Sober secoeisoNy AMENORRHEA eer Thurg da, 3 | | | amenorrhea meang absence of mengturation. t 4 94 Cam occur Gieye (2 time menses in girl), ; a Po beRtTy) i (Puberty) occur inv females ak -) |Iyearg . ! 4 n yon males n pd 14 - But the range tg lo-l4 years tn females. |B 9 Budding oP breast: (alae) | P > 4APPearance oP Pubic hair C Pabarche)/-dutian faire( Aros Ho hm hethe in Males Menarche (onset of mensturabion) H + Greast budding and Herght inerestes due to x) Exbrogen =~ + Pubertal changer ajo due to estrogen, APfearanc, of axillary § Pabre fair dus to 3 paler | TANNER 'S STAGING :— B Vpone pane Rari Prada brer a sereisphents + st has 5 stages, TANNER S € -I 3, Ean je. Se imererean oteal TANNER STAGE “a. Canty vtnge of se TANNER STAGETY 2 VY +). Lake stagey fulty dlevelofmert © Precautiouf Puberty :- when agexual chasackentudies apfears before <2y.0 (breast buddig) | and menarche. Lioy.o age. {| J lc tame of Precautious Puberty =) 5). Seto Pella. \ v Drug thet der age oP Peberty 4. Gu ty. amateguts (het a: VGelayod Puberty iv ; } eee eee Jf a° sexual peace en pears “ttt age of Mi gsas AMENORRHEA | Tipp aa Ps hg . \° amenorrhea J amenorrhea - No menarche. — Eartior mengtu ration iy normal but Later (oat Resent) mengtusasis, ty absent - ) PRIMARY AMENORRHERS— sets divided trio 1— 1) Oy leemenore es ¢ True I amenorrhea: 0 Cry Ptomenorirhes s— dn which female mensturater normally -but menytural blood fails te Come out ,dur to Some Obstruction tm. Passage: ; >). 3t2 9 ]e example ig 9. frferforated yen. Com Phang». 1). 1 amenorrhea. a). TyPical egtory of cyclical abdominal Pain (but Hoe 1 mo mengturation) occur during the ime of the meng.tu ration. 46K xX EXAMINATION q On Local examined Gonads “5 ovaries v = Hymen fe blue. Hy uty tn Colour Estrogen normal. v (due to Collected blood) 2 Hye“ hy bulging 2° sexual characten- « On virgin fomalass— ues! guste cs — Per vaginal examnation ix @ntreindicated. Per rectal extanafnationa) te temPirmn the Pratence — But we can do of Uterus, a EE A MANAGEMENT 3- To give a Cruciate Imasion on the tuymen and collected bleod drained , then the female fas normal, menuturation. Wi) True P Amenorrhea 3— » Female fot ho menarche flu 14 yro of age. + And iP Bo dexyal characteristics He frgent En 16 Yoory « FOR MENITURATION To occuR:— ( Couty CONDARTMENT-IV. Cpeateehoe: I). Kabinan Syndrome ieee + = | CONPARTNENT-iT i Pituitary, N. Pituitary tumour >. CranioPharyngioma: COM PARTMENT —ir i re syndrome 45 XO Estrogen 2)- Pure adal dyggenesy ») 46 XX ) ovaistion 3): bog eageinte 7 ae Progesterone, | AI Savage 2). hentytant ovary 4. COM PARTMENT—T We Hullarian agenesis (46%X) (cones 2). Teticular Pammizgation (46XY) ynd rome. WPAERTERT Za).MULLARIAN AGENE SS :— a SS + Meong mutlanan duct absent C46xx), Om thdy ovaries are norm develoP Prom genital aes and avariay Crormal) a ovdese Ore never ee ded u but Comflein ap f° fefroam (nornal) : > of f amenorchoa | me ; : uv SM dexudl Characterintier Chrameal “But falloPian tube aes Ore absent ha Cenvix . i uf. Part of Vagina ’ E a 9 Segrosiss— by ultrasound: MANAGEMENT: — 1). Vagino Pasty te Technipee= Me Jndoe Vagino Plosety « At whee time 2 a). Suet before marriage. 2 Mullawan Agenesis alga Known of :— Ww : Mayor Rokgtansky Kuster Hauser Syndrome: ‘ CMREH Syndrome) Frew the 274 y)e cawe oP amenorrhea. ” + Uuth mullanan Ogenarig renal Anomalies ave Ao SHociale, and thay ty detected gor 2. Intravenous (iv) Pyetog ra Phy. (Boisd dove): * Baer bodes 4, Nov of x. Chis magome, -1 1). 9m Feroates barr bodice J 1 XX-) 2 XsI 2). n males » at 2) oO 3x ryullanta : a agonist, 2, ” aa | 4bxK 4). 9 Testicular jes faminization ” 7 ) 6xXy Syndrome 3). TESTICULAR FAMINIZATION SYNDROME? Sea ee se ee eee I Ste: lest + dt4 chromosome no: — H6XY. Gonads are Tertty. + And Patients arel® ae 3. K : ‘And rongen Sngonsitiv Ke St ie at oye casize oP f amenorrdea. eee se as vi thae Patrents ore retis tent to Lert ° & tterene ;-Halls “a es Peritala do not develop Uke tyfieak mate. ni And Huse tyfe of genitalia ant called armbigiou genitalia (erie Thue Patients are Actually male but reared ike Pemalep, | + They clo not fave Y sexual charactenytrieg Like. Sraleg + Tegtodterone Jets converted Pelco irete &strogen 3 Leeds to Pong ation of 2 dens Chara cternubicg of Pemaler, 9 Breast’ devel oPment L + Tanner stage TW fe. + They donut fave. Pubic (Axitary hair develoPmerst fomfared to Tanne —T. Thete ty@ oP Patienty (females) Comes with Iam enorrbas. RO bends absaale |p bot! Malo an pets agenesig Parinizetlon dyndrome. BLS Char bode 1) A6XY (baw betas) Taki why Par Dtaanoig’ | ee Dad T bl do H ake the blood 4 Keryotyfing Lby ty MANAGEMENT ¢- WE Com checle bavi bodey Toe I), Let the Patient be a fermale: 2) Do the vagino Plasty fut before, mam age. 32> Tats ave » Present inbreabdominally ees malignant 1 50 remove Hore testy 4). ee TSE Cue ty testis aie ele the Source of -eetoogen jn that. Pactiencts t do O44e> removal ofteatey , give ther sttmgtn eR lacamene Henle COMPARTNENT —TT. ). Former an ¥ TH ole came of I amenorrhea. “dn thue Pattonty - only one x— Chromadome, (4 Present Ls Ovan'es are not well developed. Land cbed a ‘Streak gonads (ovaries) | tee to there. Esd-ogon JovebrLep + [cabin tesdee 2 ~ abjence ay es Choractertyties 1 weet = ee Buk tn dat Patients , uterus iy Pretant ASXO MANAGEMENTS a eee Whenever, uber iy Preent | never Hve *etbrojen alone. =). Give . Estrogen + Progesterone. + Growth Ror ones, 2): Pure Gonnony DYSGENESE ¢— eo Patients lous he tol Cl omonprme: re te 4exy but the gene rePonaibie Por forming avarves by on Chromosome: . s fe streak grads - : RK 3). SAVAGE SyyoROMes— 6 OME Ore ratigtank 4s exctrogen * Ovartes are normal « + Eabrogen tyaly n COMPARTMENT TZ i}. KALLMAN SYNDROME 3— bed AyPothalamic Punction - + Anosmia (Can't tne Proferty) ComPaing s_. |S amenondea + In Pertittey 2). 2° AMENORRHE Home Contes} 2° amenorrfer ts Pregnancy . The Patients (fem ales) who wore mengicurating normables eaelter but now o Aater Pave absen co of menaturation Mattes Amenonhea for 3) menreceal Cycles oe on n 6 monty. “CONPARTNENT-1D Potralarney iG ExXCetive wt Nose. ee ‘ . i » Exercise. >). GnRH ts Ley Gjacaeeeeties Gy iP ) Re Anorexra . Bulli (exteuive, eating), CONPART NENT iT Pituitary |): Sheehanty dyndrome 2} Simond's disease. uf sn 9 Pebuttamy timour J Pralactinama (tofe turoun), COMPARTMENT —T eT On 1 PeoD / Stem Leventhal Sundrome, Etdogon, 2 5 ovetttien ). Premature ovarian Pailicre (mo Polltchep 7 Laden) Propertetsne, | Avenorbigd— abseneurfowlatine i Lo Ragan Endometniny [COMPARTMENT acty le — Folactin. Complain — >).. Amenor Te ks Paes Lactate MANAGEN ENT 3 — "1 Oem toeeeee » which are ded. 1). TS Rormone Ledin Sheehan's tyndrome . Ante Growth hormone. 2), bhen B57, ant: Pitulten necored manifestations affear. OP Siren mo eae Sictnid date: 3)) Prolactinoma. . — Galactorrfiea - excessive’ Prolactin infibrey 4 Grky Duy SS) Prolactinoma. — Visual yPtoms _, uisaes FSH, ote, MANAGEMENT: THe pe Pies Urine Pregnanag tet Bet 2S Ton. loved debeckrore ia I Pontinal! Hae Poditg So = Prodacting oo mo fo te Reet weep. Ua noe? Progesterone uitKdraol tert Give Progesterone 53 dawg and sto? , Then afjer staffing rt Patient bleeds = ae Patient can Rave-Peoo ait o& — Anovulation. ang Progerbeone” uitidrqul Cee goes oh i ; : Si ESS Of bleeding ive, then Exbrogen + Progesterone withdioud beg = ve then the Probate He devel Crdometriung Juberup Haat meant al ASHERNAN SYNDRONES Ard t} dU not men gturati 1. Before Puberty. 2) After menpPause 2. Pregnaney th Ae the time of Lactation, MENOPAUSE 2— see te condition jideetice absence of mengturation for | year ofter the age of U2 years old, + For indian femaley menofausal Age 2) ARyearg. old, 4 Wettern Sinfortan+ Burgh IP Uunmen Come Us amenorrhea for 2-3 minty | abdte age ef 46 yonry Ata MenoPause. “Primordial Poltrcleg in ovary are ied uP, estrogen des, i & SH Dep! 2), df Aevele of? Coy B®) Hen menofaute 14 attained. {é S Ay Si he im, . ~ ~ ee OM Va widen Oe gy n » 3). ovarian cycle iy invbtated by Fon, 4) uber hormone ty detected fe Quvarten resorne- Anat ESH, “F Fevel of Fou erin menofausal females ) So uxt Can detect FSH Ty Here females urine. JEW cated ag U [D7 _ HO an Henofaus a GONADOTROPIN Jd te Collected Pom HORMONE: (a MG) Post menofausal tiroments wine. Senile vaginitte ee UN u Vaginal dryness. Fi Osteofo nosis 4 due to Led estrogen ae ed bone mass [density bone raineral clenaty) | Jed ettrogen in menofousal uomen Aseday i 4Andin Duct y- ee SCan ,we con goats + Hot Pluthes »— — Inter mittent ad — an yi = Pat Pre Ation + Lous of Abide: MANAGEMENT ; — for menoPausal ComPaing s_ I). Hormone rePlaced therafy. a). Uterud ig intack 4) Estrogen ‘ Progesterone. o 3) IP there is Kysterectory due 4a ong reason [wees if not Pregense =). Hen ave oy exbrogen- 4) Sm Cote of lots of Libido , give =) And rogeng XK Hormone rePlacement thera does not Leyte rate of ML rather it Net the rate of MZ. 1). Hormone rePLaced| therapy Of uterus intact ) ELP (Het) mp hat nt al only & €. a) Thholgne. a Non - hormonal Ste al. fluoxetine (Gelective Serotonin ’ veuftale Gabafentine Inhibitor) MANAGENENT OF OSTEOPORO SISI— vor meremr: OF Os e0r p uterus Intact 4 E+P Is Hormone rePlaced Therafy ei SU hota: yen oe 3): Tibolone SERN A Raloxifene J. Selective estrogen recePtor rnodulatgr( coy) “St can act af Agonist of egtrogen 2) Mnbone_ a antagonist » 7 Mf Side ePects (s/e) ; : Hot flushes. (So , we Con’t we it in Care op bat Pluthes) NON - HORMONAL DRUGS 3— 1). Calererrs 2). Calertonn a). Vit-O- 4). BisPRosPhonatel (unugusl drugs) Very rarely Prescribed. —Alendronate. — Pamid ronate Be Gut TP, we are taking Hese drugy , ut Lave te ytand upright for Ison Dour after taking tee drugy. * these drugs can Cause Gaitro Crofhageal reflex diseoter Gero), OST =MENDPAUSAL BLEEDING:_— at A female wks tar menofause, for Nyear buck after tig Loving beading . Sa Porbane Gea) — ae I. role VM come of Post menofaual bleeding (PNB) fra © Endometrial eco a). mle 2 cause of Pug. Abt Hormone re Placement 3): mle cancer Come PNR py Indian Pomaley , Boat Can ce op Cervix, ") Ie cancer in females world -vilde . Att Breast cancer ENDOMETRIAL HYPERPLASIO 3 s St iS the Precanceouy stage of endometrial cancer St Occurs due ty ex ceive. 2SLrOFen, + Endo. HyferPlagia oy of turo ty Pee: — Sim P lew ComPlex, * Noatyfical collg AEs Pical cs ane Prepert. Are Present. Clave morenchosesr Le bec mahignanse) & Ccombinatio rat ees SO I). StoPle Rafer Plasia urthout atyPrcal cells. (1% ) Se 94 Bar minii ing chance to betpme malignant: 32.94 also known of Cystie SLANDULAR HYPERPLASIA. TS ERRROLAR HY PERPLA GIA. 2) Confer Pay ferPlasra enthouct atyfical elit) (37) iSite Pe isin tata n+ (8%) (‘i Com Plex ie » » rae (307), Wiser May ition Chane to become. malignant. MANAG € MENT: — + op AbyPreal cell are Present. Beep have one Rgtterectomy, sof yPrcal Calls ane agen be reduce the Yalaed *ikrogen.. ive. : zy Progestins : ENDOMETRIAL CANCER: — BENE aa ). MIe hisbologicad Cancer 2). Adengcarcinoma. a). tlc O8e group for endo. cancer 4. 60 -Fo Years, 2. Symmftnrey MBs Yiu Podit-meino Paral: bleeding Risk fAcToRS OF EN90. CanceR s_ aaa ra + Fatty =) Family story for endometrial Cancer ) HyPer-tension : >) Obetiay. : Late tmenoPawe 6 early menarche. =) Dinhetey : Atyficadl endometrial RuferPlasia 2) UniofPoted trogen [?!Coa DHormone rePlaced Hema (Her) females), éovees ye. 2tbrogen. cs) Nut Partty CrYoung tees pen fe 2 aches Ode 2 2) Therafy 1) Tamoxithn (ose for brasiie Cancer) f ) Radintherafy a. aGrincn TNPERTILITY / mengtrepal frregularity Ye Combination Of ~ obesity + Hafertenaton sa CORPUS CANCER era Ge || SYNDROME, ] + 2 Endo. Cancer . iagnosigs — gker a TEE pele. ; dy pectoral Curretogo Faltofie ee biopsy . tube. #Q es Invudigation ey 2). Ayateroseoly. + Br oPty), eee Js Endometrial os Pirate brofey. aoa + Ace. te FIGO 2). Federation of Internatfonal Synacccal ony & obstetrics Ei wh aun, whihig the only ome cancer of female sueaeeteey for which TNm ~dtoging ts uted? i AM+ cancer of Vulva. j STAGEXT. 3) Cancer Conferred to Uteruy n TA 4 involved only endometrium. » IG >) a 43 21/9 of roy om etrium, EC 2 iene /g oP age STAG Aldo » n Cervix. STAGE -Til 4). ———— n THA 4 Cancer jrvolved Serosa ; Prranetrium, Peri di fubeg Adnexa (bibes 6 ovary). itoneum, ieee Bae ae eee » fitc 2), > > & what @re the Pelvic tyro Phe nodes 2 Any, % Internal tl'ac LN (HiyPogabdite? sn). Ne eceerael arn as Pelvic / Para aprtictlyrnPh nodes - . Common n n is Pre-gacral » . Obturator a) STAGE ~TH A etartases of Can cor » TZA ») Local gPread & ~ Bladder. — Rectum: > vB > Any distant Organ can fnvolved. — Liver — Lungs . ' MANAGEMENT) — by Different ty fey of Hyscberectoms STRUCTURE Removed | 2 whole uterus eaaet Kya terectry shi | (Tan), era's: Cea) mle type, wed. z Se ee ee ae | 2). Panbajgterectory « hole Uberus + Cervix eae Po. aan: ; a | . Gitaterd! SabPrngo-coPhrectory : aCe $0 ) | (880) | 3), Wertheing Hysterectomy. uterus ¢¢x + both tuber f both ovary + called of modrfteq radia} + medial Lalp of Cardinal ligament ton A » uterosacral n° ‘Agcterectwoy (only in can cor), Au enlarged Pelvic LyrPh Neckex + whole of Cardinal Ligament + yy Utermgacral +o tea vagina 1 Pelvic Sateen nod eg. | = ——-~ — | “Aj Radical Rysterectony, |= Weer y CK + Grtalerel tubes 4 oventy | oS ietteonectoa de | + Outdated now - )- STAGE -T a). Surgery ( Simfle Rysterectomy), + Followed -by radiotherafy . STAGE-TA 2) oa sondy surgery, sno need to do radiotherafy $1 STAGE =n a) Earlier traditional + Modern affaratus. Se Ree nC eae *SimPle Aysterectormy followed | + ertheing ydterectormy by extensive ee ear (But te Pot side effect). manual” pec orreaal 3). Skoge
      Btiey Hot Jive Radiotherafy oy Hormonal Hhesafy d Ly Progesterone. + Role of CRemotheraPy Cert) tists 4) STAGE “WY . Pattrative treatment FIGR Ht Birbroids are w/e. Pelvic, tumours try Permaler, Sntyormere) | Goes algae sa eemonrtilet uta Ploy eng Ww Subseokeg, SD SNTRAUTERINE EXTRAUTERIN NE }). Intramural m Incterstitral. 1). Geared eee 2). Submutout Prbroid 2) Broad toed fibrord Ese oeee (ste iey: i Sofortare Gua]:— I. Mlccintrauternne fibroid 2), Intramural ov intersected Bod + me Fibroid ; From which oll fiboids bagin J]. Intramural Pbreids. a) wick Bbrod hos masimum chance of, betoming malignats Asta Snterrnural fibroid. v3) whveR fibroid came neastimurm abortions. e ‘dutd Sab mucous fibroid 4), whch fibroid fos: man: dynPtomy. At Submu cous: 5S) Bick Pibroid Ror max, chances of CatciPication. ' Att Subsereug. 4 SL eater Lib isrdetey ee t ” » tersion. 34 Pedunculated fibroids. » Wandering ftbroids =). Se Ve fibroid Roy tout ity Connection te uterus « Fibroid uterus =) ty Hormone defendent -) fed ettrogen. 4 fg mle in nubiParous females. ay le oe JrouP =) 30 gems age. APPEARANCE OF F1GROID a) > Pinkish white in colour. 4 Fire cin Condistency, Surrounded -by PseudocaPaule,( condensation ef surrounding tasve). iL BLood vessers pl saPPly ing fibroids are deen tin’ Proudo caful Pseudo cafsuler | 7a | BOVE es ae Pen Phory. Central Part a) + Calcifications are ro] pede ni bea Th Hag Part: foe por H mie synftom of Pbroidg 2). Mengtural tyroPbomg Y Menorrhagia (xcetlive bleed) j other menttural symPtome can be | . Poly menorrhea (frequent blending ) + Dyamenorhea (Parn ca enol + Nebrerbigia Coogee Gj KH Menstural Agro ftom whieh Artt Amenorrfiog. deen. Never geen th Proved} 2 Complication Sn fertility . Diagnoses pe J. Bebe method for dtagnosis of fibroid 2) Ultra sonograMhy (use), a), Submucont Fibroid diagrasad by 9 Aigsteroscafy Degenerations J geen In Pibrord a Avotd nsrofhy Red 2) Red degeneration HOT =) dyabre Fatty =) Fatty » Mest =) % Chicken. ), Cysette. rie Myxor atove 1 (gralioeramtl anes I ale degeneration begin tn J. centre of fibrosd. a. oy n tg =) tyobhe degeneration. 3). Lest common chanes m fibroids. Ast, Mallmant transformation (o8-o-5y) 4). SymPtoms jules fibroid become mahgnant: Ani Painful + fed trpe of Pbroig, # RED DeGeNERATION S— i eet mle time oP occuring 2.in9°d Ralf of Pregnancy, Glog seafflg 45 (ta de Lee thromb, a vs cern in Blood veel hych, SuPPliieg dna fibroid Subcutancous necros te of. debro'd occung , 4 - a CoNPLAINS 3 + Pain in abdomen, « Naugea + Vomiting. CHANGES IN FIGROIDS DURING REDIeGen ERNE a Fibroids become Salmon- Pink Im colour / Dark red. Seesiss. f aie eee ” fave fishy odour. LABORATORY EXAM: + Leuketyte Count ‘es. MANAGEN ENT: — + Never terminate the Pregnancy, ey do rogomectomy jn Pregnancy | But manage it Congervatively :_ > Bed ret a rev fiwds JF Pnalganree. 2 Antemetic- MANAGEMENT OF FIRROIDS GENEROLLYI— - TH of all Pay attention | ty dards — RayrPtomatic é — SynPtornradic Fibroid. Ube th da, dehy + Pollow uf » Sargon, é « gee few Conditvong. ~ 8 Gut before gurgen should ofk He Pahent 5 ? ASYMPTOMATIC SYMPTOMATIC. FIBROIDS FIBROIDS aes A eos le Best method y urgory . Qudb do tUrgey aces tf Pakte nt: cornfte.ted fer family Joss + Ne Follow uf A. “Indications for | Fende didnot Female cong medieatmanagene ConPleted Para ‘ Ed Her fou! 2). Sndreations for Surgery, Uy rege sizeof Fibroid, plaweeles of Pregnant utery gize. Ud) feduncatated fibroid akely to Undergo torsion 1) Patient refuses |= then dotte | + then dost Si peat. | ace, era ys | —ector qf tusgery, |uenicuate the 3). To buitd | sftbrofd and Jeave.” SMe (d aeraey* 8 Conbraind’ , Wh) OP Frye oP Prbroid tay (MePHmt Abs) the uterus bebi. f oxaied. duddenty . 4). S30.o ive 4 Ue i : fy oso big to | oS . uv) eat Jo ref pes | dont want b : aan underge J WY) H]p unexPlamed Se om infer tileey , | Uterini (VI) Ungure about the} [enborgatton nature of fibroid im (tether benign / maligna: ‘. Ped Pa i ¢ = 3 T Thats usky ghats ; | 5 dente Can never | | pcan cee Bugs in Medics HY maanageme rege toy He ipa of oid = A A) antifibrinoly.tresg Tranexanve ae ee G Major -) nePfePrtstine as oes Gynae GrykH ee Omg clis

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