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  <head>
    <title>025-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Reproductive physiology, pregnancy, and lactation">
      <outline text="Sexual differentiation and puberty">
        <outline text="Chromosomal sex fixed at fertilisation">
          <outline text="Gonadal and anatomical sex need genes and hormones"/>
        </outline>
        <outline text="Testis makes anti-Mullerian hormone and androgens">
          <outline text="Absent: ovarian and female tract pathways"/>
        </outline>
        <outline text="Variation needs precise, respectful assessment"/>
        <outline text="Puberty: pulsatile activity drives gonadotropins">
          <outline text="Gonadal steroids: secondary traits, growth, bone"/>
        </outline>
        <outline text="Adrenal androgens: body hair, partly independent"/>
      </outline>
      <outline text="Ovarian cycle">
        <outline text="Granulosa converts theca androgens to oestradiol"/>
        <outline text="Oestradiol first restrains gonadotropins">
          <outline text="Sustained high levels flip to positive feedback"/>
          <outline text="Luteinising-hormone surge: ovulation, luteinisation"/>
        </outline>
        <outline text="Corpus luteum makes progesterone and oestradiol">
          <outline text="Secretory endometrium ready for implantation"/>
        </outline>
        <outline text="No pregnancy: luteal regression">
          <outline text="Hormones fall, spiral arteries constrict, shedding"/>
        </outline>
        <outline text="Length varies in follicular phase, luteal steady"/>
        <outline text="Amenorrhoea or abnormal bleeding: test for pregnancy"/>
      </outline>
      <outline text="Testicular function and sexual response">
        <outline text="Luteinising hormone drives Leydig testosterone"/>
        <outline text="Follicle-stimulating hormone and testosterone aid Sertoli"/>
        <outline text="Production takes weeks and is vulnerable"/>
        <outline text="Erection: parasympathetic nitric oxide">
          <outline text="Smooth-muscle relaxation, inflow, venous occlusion"/>
        </outline>
        <outline text="Ejaculation: sympathetic and somatic pathways"/>
        <outline text="Assess dysfunction domains separately"/>
      </outline>
      <outline text="Fertilisation, implantation, and placenta">
        <outline text="Blastocyst implants in receptive endometrium"/>
        <outline text="Chorionic gonadotropin preserves corpus luteum"/>
        <outline text="Exchange without mixing circulations">
          <outline text="Depends on flow, area, membrane, metabolism, gradients"/>
        </outline>
        <outline text="Active endocrine organ, not passive filter"/>
        <outline text="Poor invasion: growth restriction, pre-eclampsia"/>
        <outline text="Separation before birth: painful bleeding"/>
        <outline text="Placenta praevia: typically painless bleeding"/>
      </outline>
      <outline text="Maternal physiological adaptation">
        <outline text="Plasma, red cells, output, heart rate rise">
          <outline text="Plasma exceeds red cells: haemodilution"/>
        </outline>
        <outline text="Stasis and coagulation raise thrombosis risk"/>
        <outline text="Supine uterine compression cuts venous return"/>
        <outline text="Progesterone raises ventilation">
          <outline text="Low carbon dioxide and bicarbonate, mild alkalosis"/>
        </outline>
        <outline text="Filtration rises, creatinine falls"/>
        <outline text="Later insulin resistance preserves fetal nutrients">
          <outline text="Failed compensation: gestational diabetes"/>
        </outline>
        <outline text="Changes reference ranges and drug handling"/>
      </outline>
      <outline text="Fetal circulation and transition at birth">
        <outline text="Ductus venosus, foramen ovale, ductus arteriosus">
          <outline text="High lung, low placental resistance keep shunts"/>
        </outline>
        <outline text="Birth: lung expansion lowers pulmonary resistance"/>
        <outline text="Cord clamping raises systemic resistance">
          <outline text="Left atrial pressure closes foramen ovale"/>
        </outline>
        <outline text="Oxygen and less prostaglandin close the ductus"/>
        <outline text="Some lesions depend on a patent ductus"/>
      </outline>
      <outline text="Labour, postpartum, and lactation">
        <outline text="Cervical stretch and oxytocin positive feedback"/>
        <outline text="Uterine contraction compresses vessels after delivery">
          <outline text="Atony a major cause of haemorrhage"/>
        </outline>
        <outline text="Steroids build breast but restrain secretion">
          <outline text="Fall after placenta permits prolactin synthesis"/>
        </outline>
        <outline text="Suckling lowers dopamine, raises prolactin">
          <outline text="Oxytocin ejects milk"/>
        </outline>
        <outline text="Effective removal maintains supply"/>
      </outline>
      <outline text="Contraception and fertility">
        <outline text="Long-acting methods reduce user dependence"/>
        <outline text="Combined methods raise thrombotic risk"/>
        <outline text="Infertility: earlier assessment with risk factors"/>
        <outline text="Evaluate both partners"/>
      </outline>
      <outline text="Menopause and reproductive ageing">
        <outline text="Follicle loss lowers oestradiol and inhibin">
          <outline text="Gonadotropins rise"/>
        </outline>
        <outline text="Cardiovascular risk from age and metabolism"/>
        <outline text="Hormone therapy best for vasomotor symptoms">
          <outline text="Oestrogen without endometrial protection: cancer"/>
        </outline>
      </outline>
      <outline text="Pregnancy prescribing and teratology">
        <outline text="Untreated illness can be more dangerous"/>
        <outline text="Early exposure disrupts organ formation"/>
        <outline text="Later exposure: growth, labour, neonate"/>
        <outline text="Folate lowers neural-tube risk"/>
        <outline text="Avoid abrupt withdrawal of essential treatment"/>
      </outline>
    </outline>
  </body>
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