OBGYN Lectures Flashcards
Lecture 1 : Menarche
time of the first menstrual cycle in life
Hypermenorrhea (menorrhagia)
prolonged or excessively heavy uterine bleeding with normal periodicity
Metrorrhagia
uterine bleeding at irregular intervals (abnormal periodicity)
Menometrorrhagia
prolonged or excessive uterine bleeding occurring irregularly
Polymenorrhea
menstrual intervals <21 days
Oligomenorrhea
menstrual intervals >35 days
Menopause
no menstruation in 12 consecutive months
What is the estimated duration of pregnancy from the 1st day of the Last Menstrual Period (LMP)?
40 weeks or 280 days from the 1st day of the LMP.
What rule is used to estimate the due date for a pregnancy?
Naegele’s rule.
What is Naegele’s rule for calculating the Estimated Date of Delivery (EDD)?
Add 9 months and 7 days to the first day of the last menstrual period (LMP), or subtract 3 months and add 7 days.
How does Naegele’s rule account for menstrual cycles?
It assumes a 28-day cycle but can accommodate cycles between 21-35 days.
What is important about the first day of the cycle in determining the Estimated Date of Delivery (EDD)?
The first day of the cycle must be accurate.
What can be used in the first trimester to help confirm the Estimated Date of Delivery (EDD)?
A first trimester ultrasound using CRL (Crown-Rump Length) measurement.
What is the definition of a miscarriage?
A miscarriage is the spontaneous end of a pregnancy before 24 completed weeks of gestation, with no vital signs, and fetal weight <500g.
What is a “threatened” miscarriage?
In a threatened miscarriage, the patient experiences contractions and/or bleeding, but the embryo/fetus remains inside the uterus with the cervical os closed. The patient is at risk of miscarriage.
What characterizes an “inevitable” miscarriage?
An inevitable miscarriage is when the cervical os begins to open.
What is a “complete” miscarriage?
A complete miscarriage occurs when all products of conception have been expelled from the uterus.
What is an “incomplete” miscarriage?
An incomplete miscarriage is when only some products of conception have been expelled, with tissue remaining in the uterus.
What is a “missed” (silent) miscarriage?
A missed miscarriage occurs when the embryo or fetus is no longer alive, but there are no physical signs of miscarriage.
What is a “septic” miscarriage?
A septic miscarriage occurs when tissue from a missed or incomplete miscarriage becomes infected.
What is “recurrent” (habitual) abortion?
Recurrent abortion is defined as having more than 2 consecutive miscarriages.
What is an ectopic pregnancy?
An ectopic pregnancy is a complication of pregnancy where the embryo implants outside the uterine cavity.
What is a tubal pregnancy?
A tubal pregnancy is a type of ectopic pregnancy where the embryo implants in the fallopian tube.
What are the locations within the fallopian tube where an ectopic pregnancy can occur?
The locations include the fimbrial, ampullar, isthmic, and interstitial regions of the fallopian tube.
Where can an ectopic pregnancy occur outside of the fallopian tube?
Ectopic pregnancies can also occur in the abdomen, ovary, or cervix.
What is a heterotopic pregnancy?
A heterotopic pregnancy is when there is a simultaneous intrauterine and ectopic pregnancy.
What are the key uterine ligaments in the female pelvis?
The uterine ligaments include the broad ligament, round ligament, cardinal ligament, uterosacral ligament, and pubo-vesical (pubo-cervical) ligament.
What is the anatomical significance of the phrase “bridge over water” in the female pelvis?
The phrase “bridge over water” refers to the topography of the ureter as it passes underneath the uterine artery.
Which arteries are major vessels in the female pelvis?
Major arteries include the common iliac artery, internal iliac artery, uterine artery, inferior vesical artery, medial vesical artery, vaginal artery, umbilical artery (medial umbilical ligament), and medial rectal artery.
Which artery in the female pelvis forms an anastomosis with branches of the external iliac artery?
The uterine artery forms anastomoses with branches of the external iliac artery.
What is the true conjugate diameter of the pelvic inlet?
The true conjugate diameter is the distance between the midpoint of the sacral promontory and the superior border of the pubic symphysis, measuring approximately 12.5 cm.
What is the obstetric conjugate diameter?
The obstetric conjugate diameter is the distance between the midpoint of the sacral promontory and the nearest point on the posterior surface of the pubic symphysis, measuring about 11.5 cm.
What is the diagonal conjugate diameter?
What are the transverse and oblique diameters of the pelvic inlet?
The transverse diameter refers to the widest horizontal distance across the pelvic inlet, while the oblique diameter is the distance from one iliac to the opposite sacroiliac joint.
What does “gravida” refer to in obstetric terminology?
Gravida refers to the total number of pregnancies a woman has had, regardless of outcome.
What does “parity” refer to in obstetric terminology?
Parity refers to the number of pregnancies that have reached 20 weeks of gestation or more, regardless of the outcome.
How is gestational age defined?
Gestational age is the number of completed weeks from the first day of the last menstrual period (LMP).
What defines each trimester of pregnancy?
- First trimester: <12 weeks (embryo)
- Second trimester: 12-24 weeks (fetus)
- Third trimester: 24-40 weeks
What is considered a miscarriage?
A miscarriage is the spontaneous end of a pregnancy before 24 weeks of gestation.
What criteria define a birth?
A birth is defined as occurring at 24 weeks or later, with a weight of 500 grams or more, and involves a viable fetus.
What is a preterm birth?
A preterm birth occurs between 24 and 37 weeks of gestation, with the fetus weighing 500 grams or showing signs of life.
What is a stillbirth?
A stillbirth is the birth of a newborn after the age of viability (>24 weeks) with no vital functions at birth.
What is a postterm birth (postmaturity)?
A postterm birth, or postmaturity, occurs when the fetus has not yet been born after 42 weeks of gestation.
What does “lie” refer to in obstetric terms?
Lie refers to the relationship of the long axis of the fetus to the long axis of the uterus, and can be longitudinal, oblique, or transverse.
What are the types of fetal presentation?
Fetal presentation describes which anatomical part of the fetus is closest to the pelvic inlet just before birth: cephalic, breech, or shoulder presentation. Specific types include vertex, deflected vertex, brow, and face presentations.
What does “position” refer to in obstetric terms?
Position refers to the relationship of the denominator of the presenting part to the inlet of the maternal pelvis, such as occipito-anterior.
What is “engagement” in obstetrics?
Engagement occurs when the widest part of the presenting part of the fetus (usually the head) has successfully passed through the true pelvic inlet.
What does “station” refer to in obstetric terms?
Station refers to the position of the presenting part of the fetus in relation to the ischial spines of the maternal pelvis, measured in centimeters from 1/5 (above the spines) to 5/5 (below the spines).
What is a “malposition” in obstetrics?
Malposition refers to an abnormal position of the fetal presenting part relative to the maternal pelvis, which may complicate labor.
What are key aspects to examine when assessing external genitalia?
Examine vulva, Bartholin glands, hair distributions, skin, size of the clitoris, and any evidence of trauma.
What is the purpose of using a Cusco speculum during an examination?
The Cusco speculum is used to visualize the vaginal mucosa, assess discharge, and check vaginal pH.
What should be done to ensure comfort and accuracy when using a speculum?
Ensure muscle relaxation and apply a lubricant to facilitate insertion and examination.
What can be assessed during a bimanual examination?
The bimanual examination evaluates the size, shape, symmetry, mobility, position, and consistency of the uterus.
What does “version” refer to in relation to the uterus?
Version refers to the position of the uterus relative to the vaginal axis, such as anteverted or retroverted.
What does “flexion” refer to in relation to the uterus?
Flexion refers to the position of the uterine fundus relative to the vaginal axis, such as retroflexed.
What is the purpose of a rectal or recto-vaginal examination?
To assess conditions like cervical cancer or cul-de-sac endometriosis.
What does an ultrasound of the uterus typically evaluate?
An ultrasound evaluates the size, shape, and endometrium of the uterus, as well as the adnexa (ovaries and fallopian tubes).
What is colposcopy used for?
Colposcopy is used to closely examine the cervix, vagina, and vulva for signs of disease.
What areas are assessed during the abdominal portion of a pelvic examination?
The abdomen is examined for any abnormalities or signs related to the pelvic organs.
What is examined during the assessment of the external genitalia?
The vulva and Bartholin glands are assessed, including hair distribution, skin condition, size of the clitoris, and any evidence of trauma.
What tool is used in a speculum examination?
A Cusco speculum is used for the examination.
What areas are evaluated during a speculum examination?
The vaginal mucosa, discharge, pH, vaginal wall relaxation, and the presence of uterine prolapse or descensus are evaluated.
What procedure involves examining the cervix under magnification?
Colposcopy.
What is assessed during a bimanual examination of the uterus?
The uterus is assessed for size, shape, symmetry, mobility, position, and consistency.
What is uterine version?
Uterine version refers to the position of the uterus relative to the vaginal axis, such as being anteverted.
What is uterine flexion?
Uterine flexion refers to the position of the uterine fundus relative to the vaginal axis, such as being retroflected.
What conditions can be evaluated with a rectal or recto-vaginal examination?
Cervical cancer and cul-de-sac endometriosis can be evaluated during a rectal or recto-vaginal examination.
What can be assessed through ultrasound in a pelvic examination?
The ultrasound can assess the size and shape of the uterus, the endometrium, and the adnexa.
What are the key methods for cervical cancer screening?
Cytology-based screening and HPV screening.
What is a limitation of cytology-based cervical cancer screening?
It is subjective and has a lower sensitivity (70-80%).
What system is used for interpreting cytology-based cervical cancer screening results?
The Bethesda system (Papanicolau).
What are the two main types of cytology-based screening for cervical cancer?
Conventional smear and liquid-based cytology.
At what age is HPV screening recommended?
HPV screening is recommended for women above 30 years of age.
Why is HPV screening not commonly recommended for women under 30 years of age?
There is a high prevalence of transient HPV infection in women under 30.
What type of sample can be used for HPV screening?
A self-obtained sample.
What is an HPV co-test?
An HPV co-test is a screening method that combines HPV testing with cytology.
When is screening for STDs recommended during a pelvic exam?
Screening for STDs is recommended when symptoms are present or before IVF procedures.
What are the possible Papanicolau (Pap smear) results in cytology-based screening?
P0, P1, P2, P3, P4, P5.
What is the Bethesda system used for in cytology-based screening?
The Bethesda system (updated in 1988, 1991, 2001, 2014) is used for specimen adequacy, general categorization, interpretation, and suggestions for review schedule, sampling, and co-test.
What does ASC-US, ASC-H, LSIL, and HSIL stand for in the Bethesda system?
ASC-US: Atypical Squamous Cells of Undetermined Significance
ASC-H: Atypical Squamous Cells, cannot exclude HSIL
LSIL: Low-Grade Squamous Intraepithelial Lesion
HSIL: High-Grade Squamous Intraepithelial Lesion
What are AGC, AGC-NOS, and AIS in the context of cervical cytology?
AGC: Atypical Glandular Cells
AGC-NOS: Atypical Glandular Cells Not Otherwise Specified
AIS: Adenocarcinoma in Situ
What does the cervical index C2111 represent?
C2111 is a specific cervical index used for assessing cervical effacement and dilatation, though the exact values are not specified in the image.
What is cervical effacement and dilatation?
Cervical effacement refers to the thinning of the cervix, while dilatation refers to the opening of the cervix during labor.
What is the Bishop score used for in cervical assessment?
The Bishop score assesses cervical readiness for labor based on consistency, effacement, dilatation, and the fetal head’s station.
What are the components of the Bishop score?
Consistency (firm, medium, soft)
Effacement (%)
Dilatation (cm)
Station (head position relative to the ischial spine)
What is the cervical index C2111 used for?
The cervical index C2111 is used to assess cervical favorability for labor, evaluating factors such as position, consistency, effacement, dilation, and station of the fetal head.
What mnemonic is used to remember the components of the cervical index assessment?
Mnemonic: BISHOP
B: (unknown)
I: Effacement
S: Station
H: Hard or soft (consistency)
O: Opening
P: Presenting part
What are the scoring components of the Bishop score?
Position: Posterior (0), Mid (1), Anterior (2-3)
Consistency: Firm (0), Medium (1), Soft (2-3)
Effacement: 0-30% (0), 40-50% (1), 60-70% (2), >80% (3)
Dilation: Closed (0), 1-2 cm (1), 3-4 cm (2), >5 cm (3)
Station: -3 (0), -2 (1), -1 (2), >0 (3)
What is the purpose of palpating the uterine fundus?
Palpating the uterine fundus helps compare the fundal height with anatomical landmarks like the symphysis, umbilicus, and xiphisternum to assess fetal growth and gestational age.
Where is the uterine fundus typically located at 24 weeks of gestation?
At 24 weeks, the uterine fundus is usually at the level of the umbilicus.
How is the symphysial-fundal height measured, and what is the normal growth rate?
The symphysial-fundal height is measured from the symphysis pubis to the top of the uterus. At 20 weeks, it is about 20 cm, and it grows approximately +1 cm per week.
What are Leopold maneuvers?
Leopold maneuvers are a series of abdominal palpation techniques used to determine fetal position, presentation, and engagement in the uterus.
What is the typical length of the menstrual cycle?
The menstrual cycle typically lasts between 21 and 35 days.
Which system regulates the menstrual cycle?
The hypothalamus-pituitary-ovarian axis regulates the menstrual cycle.
How do positive and negative feedback mechanisms play a role in the menstrual cycle?
Positive and negative feedback mechanisms regulate hormone levels, such as estrogen and progesterone, throughout the menstrual cycle.
When does the follicular phase of the menstrual cycle begin?
The follicular phase begins with the onset of menses (menstruation).
What is the luteal phase of the menstrual cycle, and how long does it last?
The luteal phase follows ovulation and typically lasts 14 days.
How is body temperature used in menstrual cycle diagnostics?
Body temperature is measured to detect ovulation, as it typically rises slightly after ovulation due to increased progesterone levels.
What is hormone cytology, and how is it used in cycle diagnostics?
Hormone cytology involves examining a vaginal smear to assess hormone levels and the stages of the menstrual cycle.
How does cervical mucus change during ovulation?
During ovulation, cervical mucus becomes more distensible and shows arborization (ferning pattern) when dried, indicating fertility.
What is the purpose of an endometrial biopsy in cycle diagnostics?
An endometrial biopsy (curettage) is used to assess the health and readiness of the endometrium, particularly for diagnosing cycle abnormalities or infertility.
What role does ultrasound (US) play in diagnosing the menstrual cycle?
Endometrial ultrasound is used to evaluate the thickness and structure of the endometrium during different phases of the menstrual cycle.
What is folliculometry, and how is it used in cycle diagnostics?
Folliculometry is the process of using ultrasound to track the growth and development of ovarian follicles, helping to assess ovulation.
What clinical signs can indicate ovulation?
Clinical signs of ovulation include breast tenderness, midcycle pain (mittelschmerz), midcycle spotting, and postovulatory stress.
Which hormone tests are important for diagnosing the menstrual cycle, particularly in the context of infertility?
Hormone tests for baseline hormone levels, luteinizing hormone (LH), and progesterone (P) are important for diagnosing cycle issues related to infertility.
Why are cycle diagnostics significant in cases of infertility?
Cycle diagnostics help determine if ovulation is occurring normally and whether the endometrium and hormonal environment are conducive to conception, which is crucial for addressing infertility.
What is the significance of screening in the prevention of cervical cancer?
Screening can prevent cervical cancer by detecting Cervical Intraepithelial Neoplasia (CIN) before it progresses to cancer, as it is a multi-year transformation process.
What are the components of cervical cancer screening?
Cervical cancer screening includes:
Colposcopic examination
Exfoliative oncocytology (Pap smear)
HPV screening (especially in cases of suspected cytology or viral infection)
When is HPV screening recommended in cervical cancer screening?
HPV screening is recommended when cytology is suspicious or there is a suspected viral infection (e.g., coliocytosis).
What test provides a definitive diagnosis in cervical cancer screening?
A histological examination provides a definitive diagnosis in cervical cancer screening.
What does “Secunder prevention” refer to in the context of precancerous lesions?
It refers to preventive measures taken after the initial detection of precancerous lesions.
How are precancerous lesions assigned according to the involvement of layers of the epithelium?
The lesions are assigned as CIN I, CIN II, or CIN III based on the extent of epithelial layer involvement.
What is CIN I (low grade SIL)?
CIN I is a condition where the basal one third of the epidermis is affected.
What is CIN II (high grade SIL)?
CIN II is a condition where two thirds of the epithelium is affected.
What is CIN III (high grade SIL)?
CIN III is a condition where atrial epithelial cells can also be observed in the superficial third of the epithelium.
What is colposcopy?
Colposcopy is a diagnostic procedure to visually examine the surface of the cervix, vagina, and vulva using a magnifying device.
How does the application of acetic acid solution and Lugol solution help during a colposcopy?
They help to visualize the abnormal epithelium on the surface of the cervix.
How is the cervical surface divided during a colposcopy?
The cervical surface is divided into three concentric zones (A, B, C) and examined clockwise to the appropriate zone.
What is the purpose of a pelvic examination in the context of cervical cancer?
Cervical cancer screening
What are the types of cytology-based screening methods for cervical cancer?
Conventional smear and liquid-based cytology
What is the sensitivity of cytology-based cervical cancer screening?
Subjective, with a lower sensitivity of 70-80%
What is the Bethesda system (Papanicolaou) used for?
It is used for classifying cervical cytology results.
When is HPV screening recommended?
For individuals above 30 years of age
What is HPV co-testing?
It is a combined screening method for both HPV and cytology.
When else might a pelvic examination be conducted besides cervical cancer screening?
Screening for STDs, evaluating symptoms, or before IVF procedures.
What controls the menstrual cycle?
The hypothalamus and the hypophysis (pituitary gland).
What does the hypothalamus release to regulate the menstrual cycle?
GnRH (Gonadotropin-Releasing Hormone)
What is the role of GnRH in the menstrual cycle?
GnRH stimulates the anterior part of the hypophysis (pituitary gland) to release FSH (Follicle-Stimulating Hormone) and LH (Luteinizing Hormone).
How is GnRH typically released?
GnRH is normally released in pulses, and the frequency of these pulses determines the production of FSH and LH.
What is the median length of a menstrual cycle?
28 days from the first day of one period to the first day of the next.
At what age does menarche typically occur?
Around 12 years of age.
Between what ages does menopause typically occur?
Usually between 45 and 55 years of age.
What are the two main cycles included in the menstrual cycle?
The ovarian cycle and the uterine cycle.
What phases do the ovaries alternate between during the menstrual cycle?
The luteal and follicular phases
What happens to the follicles during the menstrual cycle?
Follicles begin developing, and one or more become dominant while the others die.
When does ovulation occur in relation to the LH surge?
Ovulation occurs about 10–12 hours after the LH surge.
What happens to the dominant follicle after ovulation?
It transforms into a corpus luteum.
What happens to the corpus luteum if implantation does not occur within 14 days?
The corpus luteum degenerates, causing a sharp drop in levels of both progesterone and estrogen.
What is the first part of the menstrual cycle called?
The follicular phase
What does rising FSH level stimulate in the ovarian follicles?
It stimulates folliculogenesis (the development of ovarian follicles).
What determines which follicle will continue to maturity?
The dominant follicle, which has the most FSH receptors.
What role does LH play in follicular development?
LH stimulates further development of the ovarian follicle.
What is a matured follicle called and what does it contain?
A matured follicle is called an antral follicle, and it contains the ovum.
What do the theca cells secrete in response to LH?
Theca cells secrete androstenedione.
What is the role of granulosa cells in follicular maturation?
Granulosa cells have FSH receptors and convert androstenedione to estrogen using the aromatase enzyme.
How does estrogen affect FSH and LH production?
Estrogen inhibits further production of FSH and LH through negative feedback.
How do rising estrogen levels affect the hypophysis?
Rising estrogen levels make the hypophysis (pituitary gland) more responsive to GnRH.
How does increased estrogen level influence FSH and LH secretion?
Increased estrogen levels signal for more FSH and LH secretion (positive feedback).
When does the peak of FSH and LH occur in relation to ovulation?
The peak of FSH and LH occurs before ovulation and leads to the rupture of the antral follicle.
When does ovulation occur after the LH peak?
Ovulation occurs approximately 12 hours after the LH peak.
What role does LH play in ovulation and corpus luteum formation?
LH initiates ovulation around day 14 and stimulates the formation of the corpus luteum.
What does the corpus luteum produce and release following further stimulation by LH?
The corpus luteum produces and releases estrogen, progesterone, and inhibin, which inhibits further secretion of LH.
How does the mature egg compare in size to other human cells?
The mature egg is the largest human cell, about 0.1 mm in size.
What is the luteal phase of the ovarian cycle and how does it correspond to the uterine cycle?
The luteal phase is the final phase of the ovarian cycle and corresponds to the secretory phase of the uterine cycle.
What role do FSH and LH play during the luteal phase?
FSH and LH cause the formation of the corpus luteum, which produces progesterone.
How does progesterone affect estrogen production during the luteal phase?
Progesterone induces the production of estrogen.
How do progesterone and estrogen levels affect FSH and LH production?
Progesterone and estrogen suppress the production of FSH and LH, which are necessary to maintain the corpus luteum.
What happens to FSH and LH levels during the luteal phase and what is the result?
FSH and LH levels fall quickly, leading to the atrophy of the corpus luteum.
What triggers menstruation in the luteal phase?
Falling levels of progesterone lead to menstruation.
How long does the luteal phase typically last?
The luteal phase typically lasts approximately two weeks.
What marks the beginning of the menstrual cycle?
Menstruation marks the first phase of the cycle.
What initiates menstruation?
Menstruation is initiated by falling levels of estrogen and progesterone and the release of prostaglandins, which lead to the constriction of spiral arteries.
What happens to the blood supply to the endometrium during menstruation?
The blood supply to the endometrium is broken, leading to the superficial layer of the endometrium (stratum functionalis) becoming deprived of oxygen.
What happens to the endometrial layers during menstruation?
The superficial layer (stratum functionalis) is lost, leaving only the stratum basalis in place.
How long does menstruation typically last?
Menstruation typically continues for 2–6 days.
What is the usual volume of blood loss during menstruation?
The usual blood loss is around 30–60 milliliters.
What is the second phase of the menstrual cycle?
The second phase is the proliferative phase, which overlaps with the last days of the follicular phase.
What role does estradiol play in the proliferative phase?
Estradiol, secreted by ovarian follicles, initiates the formation of a new layer of endometrium with spiral arterioles.
How does increased estrogen affect cervical mucus?
Increased estrogen levels cause cervical mucus to become less viscous and have a higher pH.
Why does cervical mucus change during the proliferative phase?
The change in cervical mucus increases the chances of fertilization.
How can cervical mucus be detected during the proliferative phase?
The cervical mucus can be detected as a vaginal discharge.
What is the final phase of the uterine cycle, and how does it correspond to the ovarian cycle?
The final phase is the secretory phase, which corresponds to the luteal phase of the ovarian cycle.
What effect does progesterone have on the endometrium during the secretory phase?
Progesterone makes the endometrium receptive to the implantation of a blastocyst.
What is secreted during the secretory phase, and what happens to the cervical mucus?
Glycogen, lipids, and proteins are secreted, and the cervical mucus thickens.
How does progesterone affect blood flow and muscle contractility during the secretory phase?
Progesterone increases blood flow to the endometrial layer, reduces the contractility of the myometrium, and raises basal body temperature.
What does the Cervical Index help determine?
The Cervical Index helps determine the length of the cervix and its dilation at different levels (external, middle, internal cervical canal). It is measured during a bimanual vaginal examination.
What are the stages of cervical effacement and dilatation shown in the diagram?
- Not effaced, not dilated
- Fully effaced, 1 cm dilated
- Fully effaced, fully dilated to 10 cm
What is the Bishop Score used for?
The Bishop Score is a pre-labor scoring system used to predict whether induction of labor will be required and to determine the optimal method of labor induction.
What cervical factors are considered in the Bishop Score?
The Bishop Score assesses cervical position, consistency, effacement percentage, dilation, and station (head position).
What is the score range for cervical effacement in the Bishop Score?
0: 0-30% effacement
1: 40-50% effacement
2: 60-70% effacement
3: >80% effacement
What is the score range for cervical dilation in the Bishop Score?
0: Closed (0 cm)
1: 1-2 cm
2: 3-4 cm
3: >5 cm
How is the station of the fetal head scored in the Bishop Score?
0: -3 station
1: -2 station
2: -1 station
3: 0 station
What is the mnemonic used to assess cervical favorability in cervical assessment?
The mnemonic is “BISHOP”:
B: Cervical position
I: Effacement
S: Station (head position)
H: Hard or soft (consistency)
O: Opening (dilation)
P: Presenting part
What is the Cervical Index (C2111) used for?
The Cervical Index (C2111) is used to assess cervical favorability during labor preparation.
What is palpated during abdominal palpation to assess fetal growth?
The uterine fundus is palpated during abdominal palpation.
What anatomical landmarks are used to compare the position of the uterine fundus during palpation?
The symphysis, umbilicus, and xyphisternum are used as landmarks, and the unit of measurement is fingers.
At how many weeks of pregnancy does the uterine fundus typically reach the umbilicus?
The uterine fundus typically reaches the umbilicus at 24 weeks of pregnancy.
How is the symphysial-fundal height measured, and what is the unit of measurement?
The symphysial-fundal height is measured in centimeters (cm), typically corresponding to the number of weeks of pregnancy.
What is the typical symphysial-fundal height at 20 weeks of pregnancy?
At 20 weeks, the symphysial-fundal height is approximately 20 cm.
How much does the symphysial-fundal height increase after 20 weeks of pregnancy?
The symphysial-fundal height increases by approximately 1 cm per week after 20 weeks.
What are Leopold maneuvers used for?
Leopold maneuvers are used to determine the position and presentation of the fetus by abdominal palpation.
Demonstrate Leopold maneuver
Week 2 : What occurs during fertilization?
During fertilization, a sperm cell fuses with a secondary oocyte, forming a zygote.
What is the 4-cell stage in embryonic development?
The 4-cell stage occurs after several divisions of the zygote, resulting in four distinct cells.
What is the morula?
The morula is a solid ball of cells (blastomeres) formed from the division of a fertilized egg.
What is the blastocyst?
A blastocyst is a structure formed after the morula stage, containing an inner cell mass and a fluid-filled cavity, ready for implantation.
At what stage does implantation occur, and where does it happen?
Implantation occurs at the blastocyst stage, and it happens when the blastocyst embeds into the uterine lining.
What is zona hatching?
Zona hatching is the process where the blastocyst breaks free from the zona pellucida before implantation.
What happens after the blastocyst implants in the uterine wall?
After implantation, the cell mass differentiates into the epiblast and hypoblast, and the bilaminar disc is formed.
What key development occurs by day 10?
By day 10, the mesoderm forms, creating the three germ layers: ectoderm, mesoderm, and endoderm.
What is the significance of the mesoderm spreading?
The spreading of the mesoderm leads to the formation of various tissues and organs, including the heart and muscles.
What forms around day 23 of embryonic development?
Around day 23, the amniotic sac grows, surrounding the developing embryo for protection.
Week 3: What happens to morbidity and mortality rates during pregnancy compared to before and after?
Morbidity and mortality rates during pregnancy are much higher—twice as high—compared to before and after pregnancy, applying to both the mother and the fetus.
What can be done to lower the increased risk of morbidity and mortality during pregnancy?
Using scientific research and evidence-based practices can help optimize circumstances to lower morbidity and mortality risks during pregnancy. This is the goal of antenatal care.
What are the basic aims of antenatal care?
To ensure optimal maternal health
To detect and treat disorders to ensure a healthy mother and infant
How can optimal maternal health and infant well-being be achieved through antenatal care?
Initial health and medical history assessment
Screening tests
Educational support
Regular check-ups to monitor both mother and fetus
Timing of antenatal visits: How often are they scheduled until 28 weeks?
Monthly until 28 weeks.
Timing of antenatal visits: How often are they scheduled at 12 weeks?
At 12 weeks, the visit is scheduled according to screening exams.
Timing of antenatal visits: How often are they scheduled at 18 weeks?
At 18 weeks, the visit is scheduled according to screening exams.
Timing of antenatal visits: How often are they scheduled from 28 weeks to 36 weeks?
2-weekly until 36 weeks.
Timing of antenatal visits: How often are they scheduled from 36 weeks until delivery?
Weekly until delivery.
What immunizations are recommended during preconception care?
Rubella (MMR), Varicella, and possibly Influenza, pertussis (Di-Per-Te, DTeP).
What supplementation is recommended for primary prevention of neural tube defects (NTDs) during preconception care?
Folic acid (0.4 – 0.8 – 3 – 5 mg) and Iodine.
What supplementation is recommended for primary prevention of neural tube defects (NTDs) during preconception care?
Folic acid (0.4 – 0.8 – 3 – 5 mg) and Iodine.
What immunizations are recommended during preconception care?
Rubella (MMR), Varicella, and possibly Influenza, pertussis (Di-Per-Te, DTeP).
Cardinal Movements of Labour
Engagement
• Passage of the widest diameter fetal presenting part below the plane
of the pelvic inlet
• The head is said to be engaged if the leading edge is at the level of the
ishial spines.
Descent
• Refers to the downward passage of the presenting part through the
bony pelvis
• Not steady process
• Greatest at deceleration phase of first stage and during 2nd stage of
labour
Flexion
• Occurs passively as the head descends
due to the shape of the bony pelvis.
• Partial flexion occurs naturally but
complete flexion usually occurs only in
the labor process
• Complete flexion places the fetal head in
optimal smallest diameter to fit through
the pelvis
Internal rotation
• Rotation of the fetal head from occiput
transverse to occiput either in anterior or
posterior position
• Occurs passively due to the shape of the
bony pelvis
Extension
• Occurs when the fetus has descended
to the level of the vaginal introitus
(Crowning)
• When occiput is just past the level of
the symphysis, the angle of the birth
canal changes to upward position
Restitution
• The head turns back to
be in line with its
normal relationship to
the shoulders
External rotation
• Shoulders rotate also to
the longest diameter of
the pelvic outlet, the
sagittal one, before they
are delivered
• This results in further
rotation of the head,
facing to the maternal
thigh
Expulsion
• Delivery of the fetus
• After delivery of the fetal head, descent and intraabdominal pressure
by mother brings shoulder to the level of the symphysis
• Downward traction allows release of the shoulder and the fetus is
delivered.
Fetal risks VAVD
Fetal risks VAVD
Type of Forceps Delivery
What does panel A of the image depict regarding human embryonic development?
Panel A shows the growth of the human embryo during the first two months of development, depicting the lengths of embryos at various Carnegie stages (7 to 23), ranging from 3 mm to 3 cm.
According to panel B, how does the volume of the human embryo change over the first two months?
Panel B shows that the embryo volume increases exponentially, from less than 1 microliter at Carnegie stage 7 (around day 15) to approximately 3 milliliters by Carnegie stage 23 (around day 60).
What does panel C show regarding the volume distribution of different organs during early embryonic development?
Panel C depicts the percentage of embryo volume made up by the liver, neural tube, metanephros, and notochord across Carnegie stages.
The liver shows a substantial increase, the neural tube remains relatively constant, the metanephros grows slightly, and the notochord decreases over time.
What does panel A (bottom) show in terms of visual development during early embryonic growth?
Panel A (bottom) provides a photograph of a human embryo at a later Carnegie stage, showing detailed anatomical features like the limbs, head, and general body shape.
What is highlighted in green in panel C, and what is its significance?
In panel C, the brain (highlighted in green) is shown in a 3D reconstruction, signifying its relative size and importance during early development, with emphasis on its prominent growth.
What do panels D and E reveal about embryonic cross-sections?
Panels D and E display cross-sectional images of the human embryo, showing anatomical structures like the spine and brain in detailed views using imaging technology.
Panel D shows a transverse section, while panel E provides a more detailed look at spinal and brain development.
What does panel A of the image illustrate regarding the human embryo between stages 17 and 20?
Panel A shows the positioning of various organs in the human embryo between stages 17 (42-44 days) and stage 20 (51-53 days).
It highlights the cervical, thoracic, lumbar, sacral, and coccygeal regions, as well as the positioning of organs like the gonads and metanephros as the spine develops.
What does panel B indicate about the relative positions of the gonads, metanephros, and IMA in relation to the spine during early embryonic development?
Panel B shows the positions of the gonads, metanephros, and inferior mesenteric artery (IMA) relative to specific vertebrae at different stages of development (stages 16, 17, and 20).
It indicates that as the embryo develops, these organs shift in relation to the spine, moving upwards along the vertebral column.
What does the graph in panel C represent regarding embryonic organ position?
The graph in panel C represents the changes in relative position of the gonads, metanephros, and IMA over time during stages 16-23.
It shows the dynamics of their positioning along the vertebral column (Th1 to Co1), with notable shifts in positioning for the gonads and metanephros.
What steps are involved in generating 3D reconstructions of human embryos according to the bottom panel?
The process involves four main steps:
- Obtaining original data (digitized sections from staining and image acquisition).
- Generating 3D reconstructions through segmentation and 3D surface generation.
- Data analysis, including morphometry, topography, and heterochrony studies.
- Storing results in a contents database for aligned sections, reconstructions, and analysis.
What is the purpose of the contents database shown in the bottom panel?
The contents database stores aligned sections, 3D reconstructions, and data from morphometry and topography analyses.
It facilitates access to the developmental overviews, chronological data, and other detailed embryo development information for research and educational purposes.
What do the graphs represent in terms of hCG levels during early pregnancy?
The graphs show normal values of hCG (intact + β-subunits) during early pregnancy, with different percentiles (P5, median, and P95) tracked from 3 to 18 weeks.
The first graph highlights the rapid rise in hCG levels between 4-7 weeks, peaking around 9-12 weeks before declining.
What is the significance of the hCG level of 1800 MIU/ml in early pregnancy?
The second graph indicates that a gestational sac becomes visible at around 1800 MIU/ml of hCG, which typically occurs between the 4th and 5th week of pregnancy.
In early pregnancy, how do hCG levels change between weeks 3 and 7?
During weeks 3 to 7, hCG levels increase rapidly, with the 95th percentile (P95) rising steeply, while the median and P5 levels also show a sharp incline during this period.
What happens to hCG levels after week 8 of pregnancy according to the graphs?
After week 8, hCG levels peak and then begin to decline around weeks 9 to 12, stabilizing at lower levels from weeks 14 to 18.
Why is the range of hCG values from weeks 3 to 6 significant in the context of early pregnancy?
The range of hCG values during weeks 3 to 6 is crucial for monitoring the viability of pregnancy, as it is during this time that hCG levels rise rapidly, and the visibility of the gestational sac is used to confirm the pregnancy’s progression.
Yolk sac characteristics
Amnion characteristics in pregnancy
Heartbeat characteristic in pregnancy, using which mode
Practical rules early pregnancy regarding:
- Transvaginal ultrasound
- Abdominal ultrasound
For different measurements
Estimate timing of EDD or Due date
CRL criteria
Dating by HC and FL
Estimating of weight
3rd trimester GA assignment
Physiologic Changes in Pregnancy
Maternal Adaptation
Differences between screening and diagnostic test
Screening for fetal malformations
- Spina bifida : 11-13 weeks, 18-22 weeks
- Fetal chrkmosomal aneuploidies
- Trisomy 21: nuchal translucency measurement, individual risk calculation for trisomy 21,18,13
- Nasal bone, facial angle
- Ductus venous flow
- Tricuspid flow
- Amniocentesis, chorion biopsy
1st trimester combined test and
2nd trimester biochemical screening
1st trimester combined test and
2nd trimester biochemical screening
Markers suggestive of aneuploidies in 2nd trimester
NIPT
Carrier screening
Carrier screening
ECS
ECS
