Obstetrics Flashcards
Placental circulation is established on the …..day of fertilisation
17th
What is Nitabuch’s layer?
Zone of fibrinoid degeneration-where trophoblasts and decidua meet (in placenta)
CVS done before 13 weeks lead to ….
Amniotic fluid at 12 weeks is …..
Amniotic fluid at term is ….
Oromandibular limb defects
50ml
600-800ml
Amniotic fluid is replaced every ……hrs
Causes of oligohydramnios (2)
3 hrs
- Renal agenesis
- Obstructive uropathy
Causes of polyhydrammios (2)
Structurally HCG has …… subunits
HCG is a ……
Esophageal atresia
Duodenal atresia
2 subunits
Glycoprotein
Signs of pregnancy (6)
- Jacquemier’s sign
- Goodell’s sign
- Hegar’s sign
- Piskacek’s sign
- Osiander’s sign
- Palmers sign
Define Jacqueimer’s sign
Seen at ….weeks
Chadwick’s sign
Congestion of pelvis—> blue/purplish hue of vagina/cervix
8 weeks
Define Goodell’s sign
Seen at …..
Cyanosis and softening of cervix
Seen at 6 weeks
Define Hegar’s sign
Seen at …
Compressibility of isthmus on bimanual examination
Seen at 6-10 weeks
Piskacek’s sign define
Seen at …..weeks
Softening of cervix with lateral implantation
7-8 th week
Define osiander sign. Seen at …..
Pulsations in lateral vaginal fornix
Seen at 8 weeks
Define palmers sign . Seen at…weeks
Signs seen at 6 weeks (2)
Rhythmic contraction of uterus
Seen at 4-8 weeks
Goodell’s sign
Hegar’s sign
Minimum number of antenatal visits
Ideal number of antenatal visits
4
12-14
Pregnancy is confirmed by …(3)
Fetal heart rate
Fetal movements
Fetal sac on USG
Transverse diameter > AP diameter in …..pelvis
AP diameter > transverse diameter in …..pelvis
Platypelloid pelvis/ flat pelvis
Anthropoid pelvis
Least common type of pelvis is …..
Deep transverse arrest or persistent occipital posterior position seen in …..
Platypelloid pelvis
Android pelvis
Face to pubis deliver is common in …..
Shortest diameter of pelvic inlet
Anthropoid pelvis
Obstetrics conjugate
Shortest diameter of fetal skull
Largest diameter of fetal skull
Bimastoid 7.5cm
Mentovertical 14 cm
Define presentation
Presenting part in submentovertical diameter
Feral part which lie over the inlet
Face
Presentatimg part in submentobregmatic
Presentation in
Suboccipitobregmatic
Suboccipitofrontal
Face
Vertex- mc LOA
Define placenta succenturiata
- One or more small lobes of placenta
- Size of a cotyledon
May be placed at varying distances from the main placental margin
Define placenta extrachorialis
Circumvallate placenta
Fetal surface shows a central zone surrounded by thick white ring - composed of double fold of amnion
Define placenta marginata
Thin fibrous ring at the margin of chorionic plate where fetal vessels appear to terminate .
Define placenta membranacea
Unduly large thin placenta
Battledore placenta
Cord attached to the margin of placenta
Velamentous placenta
Cord attached to the membranes
Placenta accrete
Placenta increta
Placenta percreta
Placenta is directly anchored to the myometrium
Varying degrees of penetration of the villi into muscle bundles
Penetration of villi upto serosal surface
Total favorable bishop score is
Less favourable score is ….
6-13
5 or less
Bishop score includes (5)
Dilatation of cervix
Effacement of cervix
Consistency of cervix
Position of cervix
Station of head
Define partogram
Graphical representation of stages of labour
Assessment of labor
Stages of labour
1st: onset of labor to dilatation of cervix
6-20 hrs in primigravida
2-10 hrs in multigravida
2nd: from full dilatation of cervix to delivery of baby
3rd stage: delivery of baby to delivery of placenta
What are the lochia that are found ?
Lochia rubra (1-4days)
Lochia serosa (5-9 days)
Lochia alba (10-15 days
Define abortion
Causes of 1st trimester abortion (2)
Expulsion of fetus <500gms/ before 20 weeks
Chromosomal aberration
Embryonic defect
Mc cause of 1st trimester abortion
Management of cervical incompetence (2)
Trisomy 16
Shirodkar’s procedure
Mc Donald’s procedure
Puerperium last for ……weeks after delivery
Uterus becomes a pelvic organ after …..weeks of delivery
6 weeks
2 weeks
Mc site of puerperal infection
Mc route of spread of puerperal infection
Site of placental attachment
Direct spread
Ectopic pregnancy is associated with..(4)
- Tubal disease
- Endometriosis
- PID
- Progesterasert
Mc presentation of EP is …
Expelled products in EP have origin from ….
Pain
Decidua Vera
Mc type of EP which ruptures is ……
Medical management of EP.(2)
Isthmic
Methotrexate
Actinomycin D
Surgery for unruptured tubal pregnancy
Clinical presentation of EP (5)
Salpingostomy
- Ab pain
- Amenorrhea
- Ab mass and empty uterus on USG
- Shock
- Fluid in pouch of Douglas; aspiration reveals dark coloured fluid that does not clot.
H mole is associated with ..(3)
Rx of choice for H mole.
- PIH
- Thyrotoxicosis
- Hyperemesis
Suction-evacuation
Histological feature for H mole
Molar pregnancy is diagnosed in ….trimester
Hydropic degeneration
First trimester
Mc heart disease ass with pregnancy
Pregnancy with worst prognosis
Heart showing highest mortality
Mitral stenosis
Pulmonary HTN
Eisenmengers syndrome
Pathological murmur heart in pregnancy
Condition in which pregnancy is to be terminated (2)
Diastolic murmur
Primary pulmonary HTN
Eisenmenger syndrome
Mc type on conjoined twins
Mc mortality cause in twins is…
Thoracophagus
Prematurity
Retraction ring is known as ….
Cause of retraction ring
Bandl’s ring
Obstructed labour
Location of Bandl’s ring
Always at junction of upper and lower segment
Progressively moves upward
PE for Bandl’ s ring
Tenderness present
Palpation:
Fetal parts are not felt
Ring felt
Round ligaments felt
Fetal heart sounds are usually absent
Vaginal exam: Ring is not felt
Management of Bandl’s ring
Incidence of perinatal transmission of HIV can be reduced by …(4)
To relieve obstruction
- LSCS
- Antiretroviral prophylaxis -zidovudine
- Avoid breast feeding
- Intrapartum Nevirapine
Procedures for delivery of head in breech presentation (2)
Burn Marshall technique
Maureciau-Smeille-Veit method
Management of shoulder dystocia (2)
- Apply suprapubic pressure
- Mc Roberts procedure
Earliest sign on USG for Rh incompatibility
Prognosis of Rh incompatibility depend on…
Skin Edema
Serum bilirubin
Management of Rh incompatibility
Immediate cord ligation
AntiD to mother within 72 hours
Diabetic Nephropathy in pregnancy
Effects of diabetes on mother (4)
Progresses and worsens
- Chorioamnionitis
- Endometritis
- Postpartum bleeding
- Increased risk of death in those with diabetic cardiomyopathy
HTN in pregnancy can be predicted by …test
Eclampsia is defined as ….
Gant’s roll over test
HTN,proteinuria,edema,convulsions
Mc type of eclampsia is
Cause of convulsions in eclampsia
Antepartum
Cerebral anoxia
Earliest symptom of PIH
Sudden loss of vision in PIH is due to …
Rapid weight gain in pregnancy
Retinal detachment
Toxicity of MgSO4 is monitored by (3)
- Urinary output
- RR
- Knee jerk
Complications of preeclampsia is (4)
- Eclampsia
- HELLP syndrome
- Cerebral Hge
- ARDS
Types of placenta previa (4)
Type 1: lateral
Type 2: marginal
Type 3: incomplete Central
Type 4: central
Type 1 placenta previa is …
- Major part of placenta is attached to upper segment
- Only lower margin encroaches onto lower segment
- But not upto the os
- 5cm above the os
Type 2 placenta previa is ….
Placenta reaches the internal os, but does not cover it.
Incomplete central placenta is …
Placenta completely covers the internal is when closed
But not entirely do so when fully dilated
Central placenta previa is …
Placenta entirely covers the internal os even after it is fully dilated
Dangerous placenta previa is …
Type 2 posterior
As it prevents engagement of head, preventing compression of separated placenta to stop bleeding
Mild placenta previa are…
Major placenta previa are …..
- Types 1&2 anterior
- Type 2 posterior , and Types 3&4
Fetal heart sounds in abruptio placenta are …..
Uterus is ….(3)
Absent
Tense , tender and rigid
PPH is said to occur if …..
Drugs used for PPH (2)
Blood loss is >500cc
- Misoprostol PGE1
Carboprost -methylPGF2 alpha - Ergometrine
Cause of uterine inversion is …
Complications of 3rd stage of labour (2)
Mismanaged 3rd stage of labour
Hemorrhage
Neurogenic shock
Idiopathic cholestasis of pregnancy occurs in …..trimester
Most common symptom
3rd trimester
Generalized pruritis
Labs for idiopathic cholestasis of pregnancy
Raised levels of
ALP, AST, ALT
Rx of idiopathic cholestasis of pregnancy
Late deceleration in HR is indicative of ….(2)
Urso-deoxy-cholic acid/ ursodiol
Utero placental insufficiency
Fetal hypoxia
Variable deceleration is indicative of ….
Umbilical cord compression
BPP predicts (2)
- Fetal asphyxia
- Risk of fetal death in antenatal period
Parameters in BPP (5)
- Non stress test
- Amniotic fluid volume
- Fetal breathing movements
- Fetal movements
- Fetal tone
Maternal AFP is lowered in….
Trisomies
Maternal AFP is raised in…(6)
- Wrong gestational age
- Multiple pregnancy
- Anterior ab wall defects
- Open NTD
- Renal anomalies
- IUFD
Organisms crossing placenta (7)
- Syphilis
- HIV
- Hepatitis B&C
- Parvovirus
- Toxoplasma
- Rubella
- CMV
Transplacental transmission of toxoplasmosis in different trimesters
First:
Transmission is less, but disease is severe
Third:
Transmission is more, but disease is less severe
External podalic version is done for
Breech and transverse lie after 37 weeks
Conversion done by external manipulation only
Internal podalic version is done for …
Transverse lie in case of second baby of twins
Conversion is done by one hand introduced into the uterus and other on the abdomen
Indications of forceps application. (9)
- Delay in second stage of labor
- LBW baby
- Postmaturity
- Maternal distress
- Appearance of fetal distress
- Cord prolapse
- After coming head of breech
- Preeclampsia
- Post cesarean pregnancy
Conditions to be fulfilled for forceps application. (7)
- Membranes must have ruptured
- Head must be engaged-station>+2
- No obstruction should be present
- Suitable presentation and position
- Cervix must be fully dilated and effaced
- Live baby
- Uterus actively contracting and relaxing