physiology of pregnancy

Question 1

what cause the ovulation

Answer 1

day 14 - sudden surge of LH

Question 2

where does the fertilisation/conception occur

Answer 2

in the follpian tube

Question 3

when does the fertilised egg implant

Answer 3

day 23 into the uterus

Question 4

what is the name of endometrium during pregnancy

Answer 4

decidua

Question 5

how long does it take for a pregnancy test to be able to pick up a pregnancy

Answer 5

3-4 weeks after LMP

Question 6

what produces b-hCG before week 12th of pregnancy

Answer 6

the corpus luteum that is implanted into the decidua

Question 7

what does a pregnancy test test for?

Answer 7

beta-hCG

Question 8

what produces the beta-hCG after week 12th of pregnancy

Answer 8

the placenta

Question 9

Which hormone during pregnancy causes stress incontinence and acid reflux

Answer 9

progesterone - as it causes the relaxation of the smooth muscels

Question 10

in what week can you see the gestational sac

Answer 10

4-5 weeks

Question 11

in what week can you see yolk sac

Answer 11

5-6 weeks

Question 12

in what week can you detect a foetal heart beat

Answer 12

6-7 weeks

Question 13

what is the expected growth of the foetus before 12th weeks

Answer 13

double in size every week untill 12th week

Question 14

in what week can you see the limb buds?

Answer 14

8th week

Question 15

where is the most common place of fertilisation of the zygotes

Answer 15

ampulla of the fallopian tubes

Question 16

when is the highest risk of miscarriage

Answer 16

first trimester

Question 17

what is the major development of 1st trimister

Answer 17

foetus organ development

placenta growth and assume more major roles eg gas exchange, waste products removal, setiodgenesis

Question 18

what is the major development of 2nd trimester

Answer 18

organ growth and enlargement

Question 19

what are the intrinsic factors governing the foetal growth

Answer 19

maternal (genetics) - ethnic group, parity, height & weight

foetal - inherited disease, sex

Question 20

what are the extrinsic factors governing the foetal growth

Answer 20

maternal - nutritional status, socioeconomical group, pre-existing conditions, environmetal alttuides, pregnancy related conditions (HTN, cardiac, renal)

foetal - TORCH syndrome, nutritional status, teratogenic substance eg tobacco

Question 21

where would you find the fundus of the uterus at week 14?

Answer 21

just above the pubic sympthus

Question 22

where would you find the fundus of the uterus at week 20 ?

Answer 22

directly underneath the umbilicus

Question 23

where would you find the fundus of the uterus at week 36-40 ?

Answer 23

just below the ribs of the mother

Question 24

how would you assess the foetus biophysical profile

Answer 24

foetal breathing movement
foetal movement
foetal tone
amniotic fluid volume

Question 25

how would you assess the placementa?

Answer 25

by doppler studies - look at the blood flow characteristic - pulsatility index - resistance index

Question 26

what blood test are carried out in the booking visit

Answer 26

FBC - anaemia? - most commonly due to iron deficiency GS+S - for future surgical purpose Haemoglobinpathies - sickle cells, thalassaemia blood group and antibody screen - rhesus HIV Hep B Syphilis Rubella

Question 27

what can be done to avoid vertical transmission of HIV

Answer 27

treat mum with antiviral treat baby postnatally for 6 weeks C-section avoid breastfeeding

Question 28

what are some of the potentially sensitising events that might require Anti-D therapy

Answer 28

``` TOP ectopic pregnancy ECV blunt abdo trauma invasive uterine procedure eg aminocentesis or CVS intra-uterine death delivery ```

Question 29

when are pregnant women checked for anti-D antibodies?

Answer 29

at booking visit, | week 28 and 34

Question 30

who else should be checked for rhesus status?

Answer 30

other mums --> partner

Question 31

what should you do if mum anti-D antibodies +ve

Answer 31

check for signs of foetal anaemia - peak systolic velocity of the foetal middle cerebral artery (MCA) once a week - if increased the FBS

Question 32

what pre-natal treatment can be given to foetus with intra-utrine haemolytic anaemia?

Answer 32

blood transfusion

Question 33

when are prophylactic Anti-D given to women who are rhesus -ve

Answer 33

IM anti-D immunoglobulin at week 28 and 34

Question 34

what are the routine screening test available?

Answer 34

rhesus haemoglobinpathies foetal anmoalies - Down's, edwards, pateu syndrome infectious disease - HIV, hep B, syphilis, rubella

Question 35

what screening tests for newborn are not routinely done?

Answer 35

Hep C - unless IVDU or previous obstetric cholestac Chlamydia - encourage if under 25 Group B strep - unless swab/urine test are performed

Question 36

what is the detection rate of combined test

Answer 36

85-90%

Question 37

when can you do a CVS for Down's syndrome diagnosis

Answer 37

from week 11

Question 38

when can you do a aminocentesis for Down's syndrome

Answer 38

from week 15

Question 39

what are the risk of miscarriage when carrying out CVS

Answer 39

1%

Question 40

what are the risk of miscarriage when carrying out amniocentesis

Answer 40

0.8%

Question 41

when is the quadruple test offered?

Answer 41

between 15-20 weeks

Question 42

what is in the quadruple test ?

Answer 42

blood test consists of 4 different tests hCG AFP inhibin-A Estriol

Question 43

what is the detection rate of qadriple test

Answer 43

74%

Question 44

what is the false +ve rate of qadriple test

Answer 44

4.1%

Question 45

how long will it take for you to get the results of the CVS

Answer 45

rapid karyotyping (DNA analysisi) - within minutes

Question 46

how long will it take for you to get the results of the aminocentesis

Answer 46

mayb take up to 3 weeks for culture

Question 47

what is the indication of CVS

Answer 47

after screening test shows aneuploidy in 1st trimester DNA analysis to diagnose inherited disease if there are parent carries a trait eg cystic fibrosis or thalassemia

Question 48

what is the indication of aminocentesis

Answer 48

after screening test shows aneuploidy DNA analysis to diagnosis inherited disease if there are parent carries a trait eg cystic fibrosis or thalassemia inborn error infection - confirm presence of TORCH syndrome

Question 49

what are the food/drinks that a pregnant should avoid in pregnancy

Answer 49

caffeine - miscarriage alcohol &liquor - developmental problems deep sea fish - risk of high level of mercury - poisonous for foetus meat related products - salmonella &bacteria which an be harmful MSG unpasteurised milk or cheese - could contain liisteria - critical to foetus raw meats - risk of .COli

Question 50

what is the time period of 1st trimester

Answer 50

up to 12th weeks

Question 51

what is the time period of 2nd trimester

Answer 51

12-27 weeks

Question 52

what is the time period of 3rd trimester

Answer 52

28 till birth

Question 53

How do you confirm diagnosis of pregnancy

Answer 53

Beta-hCG and trans abdominal/ transvaginal USS

Question 54

what is the lower limit of hemoglobin for a pregnant lady?

Answer 54

105 instead of 115 in non-pregnant lady

Question 55

which foetal cell does maternal antibody target if the mother is rhesus -ve

Answer 55

Foetal RBC - leading to foetal haemolytic anaemia can lead to erythropoiesis inadequately compensate which leads to high output cardiac failure --> foetal hydrop and death mild case - neonatal anaemia or neonatal jaundice from HB break down

Question 56

why does maternal antibody does not affect the first child but the second child?

Answer 56

initially, the antibody is IgM mediated which is too big to cross the placenta re-exposure leading to memory B cell to produce IgG which can cross the placenta

Question 57

what is the treatment to the baby whose mother has hep B

Answer 57

newborn straight onto vaccination program - 5 doses vaccine If a baby is born to a mother who is either chronic/acute infected with HBV during pregnancy --> vaccination + 1x immunoglobulin at birth

Question 58

what is the treatment for the baby whose mother has syphilis

Answer 58

full treatment before 36 weeks, otherwise newborn will get IV treatment

Question 59

the detection rate of Non-invasive Prenatal test?

Answer 59

98% but costs 500 pounds

Question 60

when is foetal anomaly USS conducted

Answer 60

from 18+6 till 20+6

Question 61

what are some of the risk of CVS

Answer 61

vertical transmission of HIV and Hep B due to sampling from the placenta which has a mixture of maternal and foetal blood miscarriage - 1%

Question 62

what are some of the risk of amniocentesis

Answer 62

miscarriage - 1%