Obstetrics Flashcards
(338 cards)
1
Q
HCG produced by?
A
Syncytio-trophoblast starting 8th day post fertilization
It is similar to LH*/FSH/TSH, it’s a glycoprotein hormone
Maintains corpus luteum in pregnancy (LH maintains without pregnancy)
2
Q
HCG levels are high in which conditions?
A
Molar pregnancy (GT Disease)
Down syndrome (trisomy 21)
Multi-fetal pregnancy
Erythroblastosis fetalis (Hydrops)
Underestimated gestational age
3
Q
HCG levels are low in which conditions?
A
Ectopic pregnancy
Abortion
Trisomy 18 Edwards
Blighted ovum/Anembryonic pregnancy
Overestimated gestational age
4
Q
Progesterone is produced by ______ in pregnancy.
A
Corpus luteum upto 8 weeks
5
Q
When does placenta take over function of Corpus luteum?
A
After 8 weeks, produces progesterone after 8 weeks
6
Q
Progesterone decreases?
A
Myometrial contractions
7
Q
What is used for prophylaxis of preterm labor?
A
Progesterone - but it can’t stop labor
(>32 weeks Tocolytics)
8
Q
MC Tocolytic drug?
A
Nifedipine - Ca channel blocker
9
Q
Morula enters uterine cavity on?
A
D4 - 16 cell stage
10
Q
Morula -> Blastocyst formed on?
A
D5 - implantation - zona hatching
11
Q
Implantation starting and ending days?
A
D6-D10
12
Q
What prevents polyspermy?
A
Zone pellucida
13
Q
Implantation sign?
A
Bleeding - Hartman’s sign
14
Q
MC site of implantation
A
Upper post wall of the uterus MC
Eccentric - Piskaceks sign
15
Q
Site of fertilization?
A
Ampulla
16
Q
Placenta is made of?
A
Decidua basalis
Chorion frondosum
17
Q
DES syndrome teratogenicity?
A
Clear cell adenocarcinoma of vagina
T-shaped uterine cavity
18
Q
Lithium teratogenicity?
A
Ebstein anomaly - box shaped heart
19
Q
Thalidomide teratogenicity?
A
Phocomelia
20
Q
Valproic acid teratogenicity?
A
NTD - spina bifida, cleft lip
21
Q
Warfarin teratogenicity?
A
Chondrodysplasia punctata - absent nasal bone
22
Q
One condition that allows us to give Warfarin in pregnancy?
A
Prosthetic valves in patient
23
Q
Parvovirus B19/syphilis teratogenicity?
A
Hydrops fetalis non-immune
(Immune caused by Rh incompatibility)
24
Q
Viral infections that do not cause teratogenicity but are transmitted to the baby?
A
HIV and Herpes
25
Vaccines contraindicated in pregnancy?
MMR
Varicella
HPV
Yellow fever can be given but we don't usually give
26
ACEI/Valproate/Methotrexate are?
Teratogenic
27
Y-chromosome induces gonadal secretion of?
MIS - causes mullerian duct involute
By Sertoli cells
28
What makes testis?
SRY region on short arm of Y-chromosome
29
What female parts are formed from Mullerian ducts/paramesonephric?
Uterus, cervix, FT and Upper 1/3rd of vagina
DOES NOT MAKE OVARIES
30
Mesonephric ducts/Wolffian duct require which stimulant to form male internal genitalia?
Testosterone that comes from Leydig cells
31
Wolffian duct (after stimulation from Testosterone) makes which male organs?
Vas deferens, seminal vesicles, Epididymis, and efferent ducts
32
What is required for the formation of male external genitalia?
DHT - makes Penis and scrotum
Testosterone --> 5-alpha reductase --> DHT
33
What happens to BP in pregnancy?
Arterial Systolic and diastolic both decrease - Peripheral vascular resistance increases
(everything else in CVS increases)
34
CO output is lowest in which position in pregnency?
Supine - because of compression of IVC
It's called supine hypotension syndrome
35
Which murmur is MC in pregnancy?
Systolic murmur - physiological
(Diastolic murmur is physiological only in 20% cases)
36
Cardiac output is highest in which pregnancy phase?
Immediate post-partum - highest risk of heart failure > second labor stage
37
Which physiological heart sounds are heard during pregnancy?
Soft diastolic murmur and S3
38
Hematological changes during pregnancy?
RBC mass increases and Hb - hematocrit values decrease
Because of hemodilution
39
Define anemia in pregnancy?
less than 11 gm% Hb
40
ESR in pregnancy?
ESR Increases because of increase in fibrinogen
41
All coagulation factors increase in pregnancy except?
11&13 (they decrease)
Because of Estrogen
42
MC cause of thrombocytopenia in pregnancy?
Gestational thrombocytopenia
43
Which pulmonary parameters increase in pregnancy?
Tidal volume
Minute ventilation
(RR and VC no change and residual/reserve volume decreases)
44
Why are ureters dilated in pregnancy?
Progesterone
(right side ureter more dilated than left)
45
What happens to GFR in pregnancy?
Increases
Hence blood urea nitrogen (BUN), creatinine and uric acid decrease in blood
46
Effects of estrogen in pregnancy?
Increases liver-produced TBG thus increasing total T3 and T4
But free T3 and T4 remain normal
(TSH normal)
Causes skin pigmentation and water retention
47
DOC hyperthyroidism in pregnancy?
1st trimester = PTU
2/3rd trimester = Methimazole
48
Double bleb sign has which 2 blebs?
Yolk sac
Amniotic sac
49
Double decidual sac sign has which 2 rings?
Decidua capsularis and paritalis
their fusion will obliterate the uterine cavity at 16 weeks
50
1st sign that on TVS that tells Intrauterine pregnancy?
G-sac or Intra-decidual sign at 5 weeks
51
Cardiac activity in pregnancy is first seen at?
6 weeks
52
Define superfetation?
Double fertilization in different cycle
53
Define superfecundation?
Fertilization of 2 ova by different acts of coitus in same cycle
54
Softening of Isthmus is which sign?
Hegar's sign - 6 weeks
55
Softening of cervix is which sign?
Goodle's sign - 6 weeks
56
Chadwick/Jaqueimiers sign is?
Bluish discoloration of vagina in pregnancy
57
When does quickening happen?
18 weeks
(multi 16-18 or primi 18-20)
Presumptive sign only felt by patient
58
Which hormone causes linea nigra?
Estrogen
59
Melasma is a sign of?
Pregnancy - pigmentation of mallor bones
60
LMP is?
1st day of last menstrual period
61
Formula for EDD?
Naegeles formula
First day of the last menstrual period (LMP) + 1 year - 3 months + 7 days
62
Naegeles formula can't be used if?
Irregular cycles
does not remember LMP
conceived on OCPs
(USG-CRL used for EDD)
63
What is term for post-term and pre-term pregnancy?
Pregnancy beyond 42 weeks port-term
Pregnancy ended before 37 weeks is pre-term
64
How many extra calories needed in pregnancy?
350 in 2 and 3rd trimester
65
Folic acid supplementation in pregnancy?
0.4 mg upto 12 weeks and IFA tab after that
IFA tab has 60 mg iron + 0.5 mg FA 1 tab per day, 180 days during pregnancy and 180 beyond pregnancy
66
Supplementation for pregnant woman with history of NTD and antiepileptics?
4 mg folic acid upto 12 weeks
67
SCA Supplementation for pregnant woman?
5 mg folic acid throughout pregnancy
68
Iron and Ca supplementation in pregnancy is done after?
12 weeks
69
Tab Albendazole dose?
1 tab 400 mg in second trimester to every pregnancy woman for deworming
70
When do we give infection Dt1?
1st ANC --> 4 weeks Dt2
71
Cause of hyperemesis gravidarum?
HCG (high risk in molar and multifetal)
72
Bleeding gums in pregnancy is called?
Pregnancy tumor - pyogenic granuloma - granuloma gravidarum
NOT A TUMOR
73
Test mandatory at first ANC?
Hb, VDRL, BgRh, HIV
2 hour OGTT done at first ANC (if normal repeat beyond 24 weeks)
74
Urine test done at first ANC?
Dipstick for protein and sugar
75
Screening for Down's syndrome is done at?
First trimester 11-13 weeks > Second trimester
76
Which USG is mandatory in ANC?
Level 2 USG - done at 18/22 weeks
77
What is best parameter for gestational age assessment in first trimester?
CRL 7-9 weeks
78
What is best parameter for gestational age assessment in second trimester?
BPD
79
Indications for mandatory USG in first trimester?
Suspected ectopic (pain and bleeding)
Discrepancy between uterine size and pregnancy dating (molar or multifetal pregnancy)
Fetal Viability doubt - we look for cardiac activity
Chronicity in a twin pregnancy
Screening for Down's - NT scan, CV sampling
80
DUAL test includes?
done in first trimester for Down's syndrome
HCG high and PAPPA low
81
NT scan is done at?
11-13 weeks for Down's syndrome
82
If NT is increased more than or equal to 3 mm, next step?
CV sampling done at 10-13 weeks
83
Combined test is a test of which trimester?
First, it includes DUAL and NT scan
84
Quadruple test is a test of which trimester?
Second, 15-22 weeks (HCG, UE3, AFP and Inhibin A)
same time triple test also done
85
Amniocentesis is done at which week?
16-18 weeks (anytime beyond 15 weeks)
Second trimester test
86
Cordo is done at which week?
Beyond 18 weeks
87
Early-amnio is done at?
11-14 weeks
88
Level 2 ultrasound is done for?
Congenital anomalies hence its called anomaly scan
TIFFA - Targeted imaging for fetal anomalies
18-22 weeks - MENDATORY
89
Diabetes screening in pregnancy?
2 hour OGTT
If normal at first ANC repeat again after 24-28 weeks
90
Plasma glucose level values in 2-hour OGTT?
more than 140 GDM
more than 200 overt diabetes
91
What do we suspect if NT is increased?
Down's trisomy 21 > Turners syndrome monosomy X 45XO
If karyotyping normal, then heart disease
92
NT increased more than 4 mm, karyotyping after CVS normal. What's the next step?
Anomaly scan + fetal echo to find cardiac issues
18-22 weeks
93
Reasons for AFP elevation in pregnancy after Quad test?
NTD and abdominal defects
94
MC NTD?
Anomaly that can be diagnosed using USG in first trimester?
Anencephaly - frog eye sign, mickey mouse sign
As early as 10-11 weeks
Has polyhydramnios because of absent swallowing
95
Define abortion?
Pregnancy lost before 20 weeks <500 gm
96
MC cause of early pregnancy loss?
First trimester abortions - chromosomal anomalies
MC trisomy > monosomy X
97
MC cause of pregnancy loss in 2nd trimester?
Uterine abnormalities
98
MC congenital and acquired anomaly to cause pregnancy loss in second trimester?
Congenital Septae
Cervical incompetence acquired
99
Cervical incompetence presentation?
RPL in 2nd trimester
Painless
<25mm
100
TOC Cervical incompetence?
Cervical cerclage - McDonalds + progesterone
101
CT for Cervical cerclage?
Ruptured membranes, Uterine contractions, Active infection, Gross congenital anomalies
102
Antiphospholipid antibody syndrome antibodies (APLA) are?
LAC, ACA, Anti beta-2 GP1
103
TOC APLA syndrome?
LMWH + Aspirin low dose
LMWH given only if there's history of abortion or thrombosis
104
OS open + IU bleeding indicates?
Inevitable abor = no history of passage
Incomplete abor= History of passage of products
105
OS closed + IU bleeding indicates?
Threatened abor: Size of uterus same
Missed abor: size uterus smaller
Complete abor: history of passage of products present
106
As per new MTP act, MTP can be done up to?
24 weeks
up to 20 weeks if OCP failure
Beyond 24 weeks in GCA
107
Outpatient abortions is possible up to?
9 weeks - MMA
Mifepristone 200 mg (RU486 - Antiprogesterone) and Misoprostol (PGE1 tab) 800 mg
Vaginal + buccal + sublingual + oral
108
MTP method beyond 9 weeks up to 12 weeks?
Suction and evacuation
MVA - pressure 660 mmhg - 60 ml
109
MTP method in second trimester?
Drugs: PGs, Extra-amniotic ethacridine, Intra-amniotic saline, Oxytocin
D&E - Ovum forceps used
110
MC PG used in MTP?
MISO
400 mcg every 3-4 hours, 5 total doses
Other PGs: PGE2, PGF2 alfa - carboprost
111
Uses for Karman's cannula?
Suction and evacuation
Molar pregnancy
Incomplete abortion
Endometrial sampling
112
Pressure generated by Karman's cannula?
600 mmhg
spoon shaped tip without lock
113
Use of uterine sound?
UCL measurement
Direction of uterus
IUD insertion
114
Ideal time for McDonald's/purse string cerclage?
14 weeks (up to 28 weeks)
Remove at 37 weeks/active labor/ruptured membranes
115
Sharp end of uterine curette is only used in?
Molar pregnancy
116
Sims speculum is used for?
Posterior vaginal wall retraction
117
Cusco's speculum advantages?
Self-retracting
retracts both anterior and posterior walls of vagina
118
Ectopic pregnancy risk factors?
MC PID
Infertility/IVF
FT surgery
Previous ectopic
Tubal ligation > IUD > POP
119
MC site for Ectopic pregnancy?
Ampulla - ruptures at 8 weeks
(intramural/interstitial least common - rupture at 10-12 weeks)
120
Obs triad of Ectopic pregnancy?
Pain + amenorrhea + bleeding
If ruptured generalized abdominal pain, shoulder tip pain
121
IOC Ectopic pregnancy?
TVS
122
No uterine or extrauterine pregnancy with embryo or cardiac activity + complex adnexal mass + ring of fire sign, next step?
Beta-HCG test
If more than 2000 IU - Medical management of ectopic
If less than 2000 IU - repeat test in 48 hours
123
Most important finding in Ectopic pregnancy?
Adnexal mass
124
TOC Ectopic pregnancy?
Medical management best, only if:
Hemodynamically stable (SBP<90 mmhg)
Unruptured
Less than 4 cm
HCG less than 5000 IU
Absent CVS activity (surgical if present)
125
DOC Ectopic pregnancy?
Methotrexate 1 mg/kg IM (50 mg/m2)
126
Preferred Sx in Ectopic pregnancy?
Salpingostomy
(salpingectomy if ruptured or family complete or more than 5 cm size)
127
Cervical Ectopic pregnancy criteria?
Pallmann Rubins
128
Ovarian Ectopic pregnancy criteria?
Spiegelberg
129
Abdominal Ectopic pregnancy criteria?
Studdiford
130
Colpotomy is done for?
To drain pelvic abscess - open POD
131
Culdocentesis is done for?
Ruptured ectopic pregnancy
132
Define antepartum hemorrhage?
Bleeding beyond period of viability (28 weeks)
133
Key words for abruptio placentae?
Bleeding in 3rd trimester
Painful bleeding/dark color
Fundal height more than POG
Uterus tense and tender - well made out
Retroplacental clot on USG
Distress fetal HR
Fetal parts difficult to feel
134
Sign on USG for APH?
Retroplacental clot
clot between placenta and decidua basalis
135
Warning hemorrhage is seen in?
Placenta previa
136
Preeclampsia in APH is likely to be?
abruptio placentae
137
Risk factors of abruptio placentae?
Preeclampsia
Polyhydramnios
Trauma
Advanced maternal age
Multiparity
PROM
Smoking
Fibroid uterus
138
Smoking is protective for?
Preeclampsia
139
Normal fetal HR?
110-160
140
Key words for rupture placentae?
Abdomen tense and tender
Distress fetal HR
Fetal parts easy to feel superficially
Loss of uterine contour
141
Why is Cervix dilated in abruptio placentae?
Cervix dilated because patient in labor - because of tissue thromboplastin (DIC MC cause abruptio placentae)
142
Indication for CS in abruptio placentae?
Fetal distress
Mother hemodynamically unstable
(Vaginal delivery if none of the above or fetal HR absent)
143
Special thing we do in Vaginal delivery in case of abruptio placentae?
ARM
144
Indication for RARE conservative management in abruptio placentae?
Remote from term <34 weeks
No bleeding and contractions
145
Blood between the myometrial fibers appearing like bruises is called?
Couvelaire Uterus
Accidental hemorrhage
Utero placental apoplexy
146
Bleeding type in placenta previa?
Red/fresh bleeding in 3rd trimester
Painless and causeless
147
USG finding in placenta previa?
Placenta over internal OS
(low lying placenta means it's near the OS, around 2 cm)
148
IOC placenta previa?
TVS
149
Risk factors for placenta previa?
Multiparity
Smoking
Advanced maternal age
Twin pregnancy
History of CS, curettage or uterine anomalies
Transverse lie
150
Features of placenta previa?
Fundal height POG (if less then means transverse lie)
Relaxed uterus non-tender
FHR/fetal parts normal
151
Management of placenta previa?
LSCS - in all scenarios if delivery needed
(Johnson's and McAfee's regime for conservative management)
152
Reason behind occurrence of PAS in placenta previa?
If placenta previa occurs over scar tissue
It enters myometrium layers causing PAS
153
PAS doesn't have?
D. Basalis and Nita Buch's membrane
154
IOC PAS?
USG - moth eaten placenta/heterogenous placenta/lakes
Other doppler and MRI
155
Management of PAS?
Elective classical CS + Hysterectomy
Upper segment vertical incision
156
Define Vasa previa
Fetal vessels over internal OS
vessels from Velamentous/succenturiata
157
Diagnosis of Vasa previa?
USG + doppler
158
Classic presentation of Vasa previa?
Fetal distress and bleeding right after membranes rupture
159
Test which tells its fetal blood?
APT - alkali denaturation test
160
Management of Vasa previa
Emergency CS or Elective CS
161
Key words for Uterine rupture?
Previous CS and rupture
Patient in labor
Misoprostol
Myomectomy
162
Drug that is contraindicated in induction for labor in previous CS?
Misoprostol
163
Which CS has highest risk of uterine rupture?
Classical CS - vaginal delivery never allowed
164
Uterine rupture presentation?
Uterine contour loss, no contractions
Teder abdomen
Severe FHR distress
Fetal parts superficial
Management: emergency laparotomy
Most specific finding: loss of station
165
Gestational trophoblastic disease includes?
Molar pregnancy and GTN (invasive mole, chorio CA, PSTT, ETT)
166
Complete molar pregnancy
46XX - diploid
Monospermic
Empty ovum
Absent fetus
Complete hydropic change
fundal height more than POG
HCG >10⁵
Theca leuein cyst present
USG snowstorm/honeycomb
Partial molar pregnancy
69XXY - triploid
Di-spermic
no ovum
present fetus dies early
Focal hydropic change
Fundal height less/same as POG
Higher HCG than expected
Theca leuein cyst absent
USG not seen snowstorm or honeycomb
167
TOC for molar pregnancy?
S&E
Hysterectomy if >40 yo and family complete
OCP used IUD not used
168
Period of surveillance for complete mole?
6 months
169
Prophylactic chemo indications in molar pregnancy?
Age >40
HCG >100000
Bilateral theca leutein cyst
FH>POG
Post S&E chemo
170
DOC molar pregnancy?
Methotrexate
171
Diagnosis of GTN - Gestational trophoblastic neoplasia?
3 consecutive values of HCG showing rise - 2 weeks
4 consecutive values showing Plateau -3 weeks
Histopathological confirmation
172
MC GTN?
Invasive mole
173
Chorio Ca arises after?
Complete mole
174
MC site of mets?
Lungs > Vagina
Canon ball 3 - blue sub-urethral nodule 2 stage
175
Low risk GTN key words
Stage 1 GTN and >6 FIGO WHO score
Single agent multi dose chemo - methotrexate/leucovorin folinic acid
176
High risk GTN key words
Stage 4 GTN and >7
Multi agent chemo EMACO - cyclophosphamide
FU - 12 months
177
Preeclampsia definition?
140/90 mmhg on 2 occasions 4 hours apart
POG more than 20 weeks
proteinuria >+2
end organ damage
Pul edema
178
Gestational HTN definition?
No proteinuria and no end organ damage
179
Eclampsia is?
PE with seizures (GTCS)
180
DOC HTN pregnancy?
Labetalol (not given in asthma and HF) > hydralazine > nifedipine
181
CI in HTN pregnancy?
ACEI, ARB, Diuretics, beta-blockers
182
Well controlled PE BP, pregnancy terminated at?
37 weeks
183
Severe PE with controlled BP terminate pregnancy at?
34 weeks
184
ECV is CT in?
PE
185
Impending eclampsia TOC?
symptoms: Epigastric pain, headache, visual changes
Next step: MgSO4 then anti-HTN then delivery
Preferred vaginal delivery
186
Cause of tonic-clonic seizures?
Hypoxia and cerebral edema
187
Therapeutic blood levels of MgSO4?
4-7 meq
First sign of toxicity is loss of knee jerk
188
Loading dose MgSO4?
Loading dose - 4 gm IV over 10 minutes
10 g IM (5 gm in each buttock)
189
What to check before giving MgSO4 loading dose?
Patellar reflex
RR>12
Urine output > 100ml or 30 ml per hour
190
Antidote for MgSO4?
IV Ca-gluconate
191
Indications for MgSO4?
Tocolytic
Neuroprotection for baby
Impending eclampsia
192
HELLP syndrome criteria and full form?
Tennessee criteria
Hemolysis - raised indirect bilirubin
Elevated liver enzymes two times
Low platelet count less than 1 lac
Schistocytes - Helmel cells
High LDH and low haptoglobin
193
Management HELLP?
PE with severe features = 34 weeks termination
194
Acute fatty liver of pregnancy features?
Epigastric pain
Risk factor: PE/primigravida/multifetal/male baby (LCHAD)
hypoglycemia, high ammonia, disorientation, renal failure, coagulopathy
Third trimester
195
Management Acute fatty liver of pregnancy?
TOP - vaginal anytime
196
Intrahepatic cholestasis in pregnancy features?
Stimulated by Estrogen
3rd trimester
Important symptom is Pruritic
high direct bilirubin and liver enzymes
197
Diagnostic findings in Acute fatty liver of pregnancy?
Serum bile acids
198
DOC Acute fatty liver of pregnancy
Ursodeoxycholic acid
IOL at 37-38 weeks
199
Effects of Acute fatty liver of pregnancy on baby?
Sudden IUD, prematurity, meconium aspiration syndrome
200
MC heart disease in pregnant woman?
Mitral stenosis > RHD
201
When to switch from warfarin to LMWH in pregnancy?
1st trimester - if dose is more than 5 mg/d then switch at 12 weeks
Switch back from warfarin to LMWH at 36 weeks
12-36 weeks - patient stays on warfarin
202
Preferred analgesic/anesthesia in pregnant woman with heart disease?
Epidural
203
Preferred mode of delivery in woman with heart disease?
Vaginal
204
Drug CI in pregnant woman with PPH and heart disease?
Methergin
205
Pregnant woman on warfarin, she's in labor preterm management?
CS
206
Which heart disease is indication for CS?
Severe AS/Aortic dissection/Marfan's with aortic root/coarctation with aortic valve
207
A1 GDM is managed?
Diabetic diet only
208
A2 GDM is managed?
Diet + drug
209
Insulin resistance in pregnancy is because of?
HPL
210
Insulin levels in pregnancy?
Increased
(Resistance also high)
211
2 hour OGTT done at?
first ANC and 24-28 weeks
75 gm 300 ml within 10 min
212
2 hour OGTT DIPSI value >140 then?
If more than 200?
Diabetic diet for 2 weeks - GDM
Initiate Insulin: Overt
213
Target of 2 hour PP value?
<120 - start on insulin (and avg value 100)
214
Anomalies are seen in which diabetes?
Overt - Sacral agenesis/caudal regression syndrome
Not seen in GDM
215
MC anomaly in baby of a diabetic mother?
VSD
216
USG done at which term to look for anomalies?
18-22 weeks
217
USG findings in diabetic mother?
Polyhydramnios
Macrosomia >4kgs
218
When do we induce labor in a diabetic pregnancy?
39-40 weeks
219
CS for fetal weight?
>4kg
220
Insulin requirement during labor?
Decreased - that's why night dose given but day dose not given on day of induction
221
Shoulder Dystocia is seen in?
Macrosomia fetus
222
First maneuver done in Shoulder Dystocia?
McRoberts then Suprapubic pressure
(Fundal pressure not given and ask not to push)
223
Last maneuver done in Shoulder Dystocia?
Zavanelli
Cleidotomy or fracture of anterior clavicle can be done
224
Maneuvers done in Shoulder Dystocia?
Woods corkscrew Maneuver and Rubin -- internal rotational
Removal of post arm
Gaskin all 4s
Zavanelli
McRoberts then Suprapubic pressure
225
Erb's palsy MC cause in baby?
Shoulder Dystocia
C5-C6 brachial plexus
226
Neonatal issues?
Hypoglycemia
Hyperbilirubinemia
Polycythemia
Hypocalcemia/hypomagnesemia
RDS
Hypertrophic cardiomyopathy
227
MC anemia in preg?
Iron deficiency
Microcytic
Hypocromic
228
DOC Iron deficiency anemia in pregnancy?
Iron sucrose IV
DO NOT GIVE PARANTRAL in first trimester
229
Iron requirement in pregnancy?
1000 mg (300 for fetus)
If hb<8gm% 2 tabs per day
230
MC type of twins?
Dizygotic - DCDA
231
Up to 72 hours zygote separation?
Morula - DCDA
232
Between 4-8 days zygote separation?
Blastocyst - MCDA
233
Between 9-12 days zygote separation?
MCMA
234
After 12 days zygote separation?
Conjoint/Siamese = MC Paraphagus > Thoracovagus
235
2 separate placenta means which twins?
DCDA
Opposite sex twin
Lamda sign - twin peak sign 10-14 weeks
4 layers in dividing membrane
236
Sign in Monochorionic twins?
T sign
237
Twin-twin transfusion syndrome is seen in?
MCDA
Recipient twin has polyhydramnios and polycythemia
Donor twin gets oligo and anemia
238
Twin-twin transfusion syndrome staging?
Quintero
Stage 5 is worst - either or both babies dead
Stage 4 - Either one or both babies have hydrops
Stage 3 - oligo + poly doppler abnormal
Stage 2 - oligo + poly doppler normal bladder invisible
Stage 1 - oligo + poly doppler normal bladder visible
239
TOC TTTS?
IU Sx - Fetoscopic laser ablation vascular anastomosis
240
Mode of delivery in MA twins?
CA
241
Cord entanglement is a sign of?
MCMA
242
Max amniotic fluid is seen at?
32/34 weeks
243
Dye used in chromotubation?
Methylene blue
244
Drugs for medical abortion?
Mifepristone 200 mg and misoprostol 800 McG after 48 hours
245
USG snowstorm appearance?
Hydatidiform mole
246
Placenta developes by which gestational week?
12 weeks
247
Vessel which disappears in placenta?
RUV
248
Largest fetal heart diameter?
Mentovertical
249
Lowest estrogen and progesterone seen at which phase?
Follicular phase
250
True support for uterus?
Cardinal ligament
251
Smallest transverse diameter of fetal heart?
Bimastoid
252
Best time to do self breast exam?
3 days after menstruation
253
Size of graffican follicle at time of ovulation?
20 mm
254
Vertex fetal position means?
Left occiput anterior
255
Pacemaker of uterine contractions located at?
Tubal ostia
256
Pressure in the uterus during the second stage of labor?
100-120 mmHg
257
Anti D is not given if?
ICT positive
DCT positive
baby or father negative
258
Anti D dose?
RhoGAM
>12 weeks = 300 mcg IM
<12 weeks = 50 mcg IM
Best time 28 weeks
Post delivery give at 72 hours 300 mcg
259
Intrauterine transfusion is done if?
Hb is less than 8gm% or hematocrit less than 30%
(hydrops develops when hematocrit is less than 15% and hb less than 5 gm%)
260
Non-immune hydrops fetalis causes?
MC CVS > anemia
Parvovirus/syphilis
261
USG criteria hydrops fetalis?
fluid in two or more compartments
1. Pleural effusion
2. Pericardial effusion
3. Ascites
4. Subcutaneous edema
placento-megaly and polyhydramnios
262
Next step in preterm labor?
Find out cervical length
If less than 25 mm = cerlage + progesterone
If more than 25 mm = only progesterone
263
Diagnosis of pre-term labor?
more than or equal to 5 cm = labor = treatment of preterm
if less than 5 cm = USG find out cervical length
264
MgSO4 given only before?
32 weeks POG
Increases risk of PPH
265
Steroids dosage in pregnancy and preferred drug?
up to 36+6
Dexamethasone 6 mg 4 doses 12 hourly IM
266
Tocolytic agents given in pregnancy?
Only if POG less than 34 weeks - Nifedipine
Increases risk of PPH
267
Indomethacin to be used in pregnancy if POG is
<32 weeks as it causes premature closure of DA
268
Causes of Polyhydramnios?
NTD
GID - cleft palette, duodenal atresia
Diabetes in pregnancy
Fetal anemia - MCA doppler done
TTTS
IU infections
269
Polyhydramnios can cause?
Abruption
Cord prolapse
preterm labor
PPH
Malpresentation
Fetal barter syndrome
270
Biophysical profile is also called?
Manning score - done on USG
Components: fetal breathing movements, gross body movements, fetal tone, AF and NST
271
Biophysical profile BPP score 8-10 means?
Normal
6 = Equivocal
0-4 = hypoxia or fetal acidosis = CS immediate
272
Modified BPP components?
NST and AFI
273
PPH min blood loss criteria?
Vaginal 500 ml
CS 1000 ml
274
Primary PPH if?
within 24 hours
Secondary if beyond 24 hours up to 12 weeks
275
MC cause of PPH?
Retained placental tissue
276
Prevention of PPH is done by?
Oxytocin - DOC - within 1 min - 10IU IM/IV infusion only
delayed clot clamping
277
Why oxytocin is only given IV infusion and not IV bolus?
Because it causes severe hypotension = MI, cardiac arrest, arrythmias
278
Dose of Methergin for Prevention of PPH?
0.2 mg
Side effect: HTN
279
Dose of Carbetocin for Prevention of PPH?
100 mcg IV over 1 min
280
Dose of Misoprostol for Prevention of PPH?
600 mcg oral
Side effect: fever with chills
281
Dose of Tranexa for Prevention of PPH?
1 gm IV
282
Carboprost drug features?
Most potent drug
dose 0.25 mg IM (Max 2mg)
DO NOT use in AMTSL or IOL
CI asthma
Side effect: diarrhea
283
Next step after balloon tamponade if vitals stable?
UAE
B-lynch - UT compression suture - only effect on atonic PPH
If still bleeding, then stepwise devascularization
284
Next step after balloon tamponade if vitals unstable?
Stepwise pelvic devascularization
Uterine A. first - UT-Ovarian anastomosis
285
Cause of PPH is uterus is well contracted?
Trauma
286
Precipitate labor is?
If entire labor finishes within 3 hours
287
Sign of uterine inversion?
Red mass sticking out of vagina + shock (neurogenic)
Cause of death = hypovolemia
OS will not be visible
Management is manual re-positioning, stop oxytocin
288
MC reason of post-partum shiviring?
Blood loss > misoprostol
289
4th trimester/puerperium is how long?
6 weeks
290
Uterus becomes pelvic organ how much longer after delivery?
2 weeks/10-12 days postpartum
Complete involution by 6 weeks
291
MC postpartum neuropathy?
Lateral cutaneous nerve of thigh
or common peroneal nerve = foot drop
292
HCG returns to normal after delivery by?
2 weeks
293
Cardiac output returns to normal after delivery by?
2 weeks
294
Ovulation can start after delivery by?
3 weeks in breastfeeding and 6-8 weeks in non-breastfeeding
295
Reason of amenorrhea during breast feeding?
High level of prolactin -- negative feedback suppression GnRH/LH/FSH
296
Prolactin levels are highest in?
3rd T and decrease after delivery
297
First stimulus for initiation of lactation is?
Decreased progesterone and Estrogen
298
Failure of lactation + persistent amenorrhea + delivery complicated by severe PPH indicates?
Sheehan syndrome
299
Colostrum (first breastmilk) has?
Has less lactose, K and Ca less fat and sugar
High NaCl, Mg are higher -- for immunogenicity
300
DOC breast milk supression?
Cabergoline
301
CI breast feeding?
Best - Galactosemia
Active untreated pul TB
Active herpes on breast
Chemo/radio therapy
Recent varicella infection
302
When to start contraception in breastfeeding and non-breastfeeding women?
3 weeks - Non breastfeeding
3 months - breastfeeding
303
Contraception of choice in breast feeding?
POP, minipill
IUD
304
Post-partum tubal ligation done upto which day? and method?
7 days
Mini laparotomy/Modified Pomeroy
DO NOT USE laparotomy and falope rings
305
Smallest diameter of pelvic cavity?
IID - 10.5 (less than 8 when contracted)
306
Direct of persistent OP which pelvis?
Anthropoid
face to pubes
307
Face/brow position which pelvis?
Platypelvic
308
Occipital-posterior which pelvis?
Android
Deep transverse arrest
309
Hands superior to belly near diaphragm?
Leopold 1 - fundal grip
310
Hands on lateral sides of belly?
Leopold 2 - umbilical - lateral grip
311
First pelvic grip?
Leopold 3 - hands on inferior side below umbilicus
312
Only grip in which fingers are directed downwards?
Leopold 4 - pelvic - 2nd pelvic
313
MC position in labor?
LOT
LOA in late labor
314
Indications of Occipito-post malposition?
Infraumbilical flattening
fetal limb in midline and back in the flank
Fetal HR in flanks
Ant shoulder away from midline
Delayed engagement head deflexed (ED = occipito frontal)
Ant-fontanel is felt easily
315
Engaging diameter (ED) if head is flexed?
Suboccipito-bregmatic - 9.5
316
If baby head is well flexed, what position is it?
Vertex
We feel post-fontanel on PV exam
317
Management of Occipito-post malpresentation?
Wait and watch - longer labor
318
Smallest diameter of baby head?
Bimastoid = 7.5
Bitemporal = 8
319
Cardinal steps of labor?
Engagement
Descent
Flexion
Internal rotation
Extension
Est rotation
Expulsion
320
Management of prolonged latent stage?
(>20 hours in primi and >14 hours in multi)
Augment the labor with oxytocin
and sedate for pain
321
MC cause of arrest labor/labor dystocia/slow progress of labor?
CPD
322
MCC of breech?
Prematurity
MC type Frank and least common type Complete/flexed breech
323
Risk of cord prolapse?
Transverse lie
Footling - in breech high risk of cord prolapse
324
Management of breech?
ECV 37 weeks
then CS only
(if vaginal baby weight less than 4 kg)
325
Contraindications of ECV (External Cephalic Version)
Footling breech
Stargazer breech - hyperextension
Ruptured membranes
Contracted pelvis
Placenta previa
326
Lonest forceps in obs?
Piper - after coming head of breech - bada pakadne wala handle
(Wrigley is shorter with cross lock short handle)
327
CI to using vaccum?
Prematurity
Face presentation
Aftercoming head of breech
Big caput
USE ONLY FORECEPS
328
MC Fetal injuries caused by forceps?
Facial N palsy
Brachial plexus
Cornea of the eye
Intraventricular hemorrhage
329
SE of Ritodrine?
Hyperglycemia
Hypokalemia - Tremor
330
Order of Lochia?
Lochia rubra - lochia serosa - lochia alba
331
Oxytocin is CI during labor in?
Abnormal lie - transverse lie - CS
332
If division of zygote occurs between 9-12 days after fertilization, outcome of twins is?
MCMA
333
Which anti-thyroid medication is safe in pregnency?
Propylthiouracil
334
HTN DOC in pregnancy?
Methyldopa
(If HTN emergency Hydralazine)
335
Lithium during pregnancy causes which anomaly?
Ebstein anomaly
336
Angle in episiotomy?
60' from midline
337
Last to rupture tubal ectopic?
Interstitial
338
Double decidual sign is seen in?
Intrauterine pregnancy
(pseudo sac is seen in ectopic)
