Obstetrics Marrow Pg 315-324 (Normal Pregnancy & ANC)
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Obstetrics Marrow Pg 315-324 (Normal Pregnancy & ANC)

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Questions and Answers

Which of the following is NOT a cause of backache?

  • Weight gain
  • Faulty posture
  • Perineural edema (correct)
  • Laxity of joints

    • Back massage is listed as a management option for backache.

    True

    What should be avoided during organogenesis due to its potential to cause cleft lip and cleft palate?

    Glucocorticoid treatment

    The management of Bell's palsy includes short-term __________ treatment.

    <p>glucocorticoid</p> Signup and view all the answers

    Match the following causes of backache with their descriptions:

    <p>Laxity of joints = Due to estrogen and relaxin Weight gain = Increases pressure on the spine Faulty posture = Leads to musculoskeletal strain Hyperlordosis = Exaggerated curvature of the spine</p> Signup and view all the answers

    What is the color code for high-risk factors in antenatal care?

    <p>Red</p> Signup and view all the answers

    Folic acid supplementation is advised only for females with a prior history of neural tube defects.

    <p>False</p> Signup and view all the answers

    What is the prophylactic dose of folic acid for pregnant females?

    <p>400mcg/day</p> Signup and view all the answers

    Women who are ______ should receive 5g/day of folic acid during pregnancy.

    <p>sickle cell anemia</p> Signup and view all the answers

    Match the special cases with their respective folic acid dosage after conception:

    <p>Diabetic females = 4mg/day Patients on anti-epileptic drugs = 4mg/day Sickle cell anemia = 4mg/day To treat megaloblastic anemia = 1g/day</p> Signup and view all the answers

    What is the initial oral medication recommended for managing nausea and vomiting in pregnancy without hypovolemia?

    <p>Dimenhydrinate/Diphenhydramine</p> Signup and view all the answers

    Ondansetron is safe to use at any point during pregnancy without any considerations.

    <p>False</p> Signup and view all the answers

    State the PUQE scoring ranges for mild hyperemesis gravidarum.

    <p>4 to 6</p> Signup and view all the answers

    The management for supine hypotension syndrome is to lie in the ______ position.

    <p>left lateral</p> Signup and view all the answers

    Match the following symptoms with their corresponding conditions:

    <p>Dizziness while supine = Supine Hypotension Syndrome 4 to 6 PUQE score = Mild Hyperemesis Gravidarum IV metoclopramide + IV promethazine = Hypovolemia &lt; 10 weeks IV ondansetron after 2 weeks = Hypovolemia with no response</p> Signup and view all the answers

    What is the frequency range of the transvaginal scan (TVS)?

    <p>5 - 10 Hz</p> Signup and view all the answers

    The gestational sac is the first structure seen on ultrasound and indicates a confirmed intrauterine pregnancy.

    <p>False</p> Signup and view all the answers

    What indicates the presence of an intrauterine pregnancy during ultrasound?

    <p>Yolk sac</p> Signup and view all the answers

    The __________ mode is used to visualize all intrauterine structures during an ultrasound.

    <p>B mode</p> Signup and view all the answers

    Match the following ultrasound structures with their descriptions:

    <p>Gestational Sac = First structure seen on ultrasound, appears as a fluid-filled area Yolk Sac = Second structure seen, indicates intrauterine pregnancy Transabdominal Scan = Type of scan performed on the abdomen Transvaginal Scan = Type of scan performed via the vaginal canal</p> Signup and view all the answers

    How many antenatal visits are recommended in total for ideal care?

    <p>12 to 15 visits</p> Signup and view all the answers

    Government of India recommends 3 visits during the third trimester for antenatal care.

    <p>True</p> Signup and view all the answers

    What test is performed to check for Rh status during the first antenatal visit?

    <p>Indirect Coombs test</p> Signup and view all the answers

    The WHO recommends ___ visit(s) during the first trimester of pregnancy.

    <p>1</p> Signup and view all the answers

    Match the following investigations with their descriptions:

    <p>ABO/Rh status = Check for Rh incompatibility VDRL test/RPR = Screening for syphilis HIV testing = Opt-out approach screening Diabetes testing = Follow DIPSI guidelines</p> Signup and view all the answers

    What is a recommended management option for varicose veins during pregnancy?

    <p>Compression stockings</p> Signup and view all the answers

    Leg cramps during pregnancy are primarily caused by dehydration.

    <p>False</p> Signup and view all the answers

    What should be elevated while resting to help manage varicose veins?

    <p>lower limbs</p> Signup and view all the answers

    Hemorrhoids can be managed by increasing ______ and fluid intake.

    <p>fibre</p> Signup and view all the answers

    Match the condition with its management:

    <p>Leg Cramps = Massage and hot shower Carpal Tunnel Syndrome = Wrist splint Hemorrhoids = Increase fiber and fluid intake Varicose Veins = Compression stockings</p> Signup and view all the answers

    What is one of the main causes of nausea and vomiting in pregnancy?

    <p>hCG, estrogen, and progesterone</p> Signup and view all the answers

    What is the recommended caloric requirement for a sedentary pregnant individual?

    <p>1800 Kcal</p> Signup and view all the answers

    Morning sickness usually peaks at 10 weeks of pregnancy.

    <p>True</p> Signup and view all the answers

    What is the term for severe persistent vomiting during pregnancy that leads to significant weight loss?

    <p>Hyperemesis Gravidarum</p> Signup and view all the answers

    Weight gain in pregnancy is positively affected by smoking.

    <p>False</p> Signup and view all the answers

    What is the recommended amount of calcium for pregnant women starting from the 4th month?

    <p>1000 mg</p> Signup and view all the answers

    In managing nausea and vomiting during pregnancy, it is advisable to avoid _____ and fatty foods.

    <p>spicy</p> Signup and view all the answers

    What is the recommended weight gain in kilograms for a normal BMI during pregnancy?

    <p>11 to 12.5 kg</p> Signup and view all the answers

    Live vaccines are safe to administer during pregnancy.

    <p>False</p> Signup and view all the answers

    An additional caloric requirement during pregnancy is ______ Kcal/day on average.

    <p>350</p> Signup and view all the answers

    Match the symptoms of Hyperemesis Gravidarum with their descriptions:

    <p>Persistent vomiting = Frequent vomiting that does not subside Weight loss = Loss of 5% or more of pre-pregnancy weight Ketonuria = Presence of ketones in urine Quality of life interference = Significant disruption in daily activities</p> Signup and view all the answers

    Match the following BMI categories with their recommended weight gain during pregnancy:

    <p>Normal = 11 to 12.5 kg Low = 12.5 to 18 kg Obese = 5 to 9 kg</p> Signup and view all the answers

    How many additional grams of protein are required per day during the second trimester of pregnancy?

    <p>10g</p> Signup and view all the answers

    It is advised that pregnant women engage in ______ to ______ minutes of walking per day.

    <p>30 to 45</p> Signup and view all the answers

    Match the vaccines with their category during pregnancy:

    <p>MMR = Live vaccine Hep A/B = Killed vaccine BCG = Live vaccine Covid-19 = Killed vaccine</p> Signup and view all the answers

    What testing is recommended for all pregnant females between 35-37 weeks?

    <p>Group B streptococci testing</p> Signup and view all the answers

    Tdap should be administered during the first trimester of pregnancy.

    <p>False</p> Signup and view all the answers

    What live vaccine should be avoided during pregnancy?

    <p>Rubella vaccine</p> Signup and view all the answers

    The patient is considered high risk if they are _____ years or older.

    <p>35</p> Signup and view all the answers

    Match the following vaccines with their administration guidelines:

    <p>Td vaccine = First dose at first visit Tdap vaccine = Single shot between weeks 27-37 Rubella vaccine = Live vaccine not to be given during pregnancy Group B strep testing = Recommended between 35-37 weeks</p> Signup and view all the answers

    Study Notes

    Bell's Palsy

    • Caused by perineural edema, hypercoagulability, and immunosuppression.
    • Managed with short-term glucocorticoid treatment.
    • Avoid glucocorticoids during organogenesis due to potential for cleft lip and palate.

    Backache in Pregnancy

    • Caused by joint laxity due to estrogen and relaxin, weight gain, faulty posture, and hyperlordosis.
    • Management includes posture correction, elevating lower limbs while resting, using a hard bed, back massage, and analgesics.

    Antenatal Care

    Pradhan Mantri Surakshit Matritva Abhiyan

    • Uses a color-coded system with green for no risk factors and red for high-risk factors requiring additional antenatal visits.

    Alert Signs and Symptoms

    • Advise patients to seek immediate medical attention if they experience any of the following: fever ≥ 38°C for ≥ 24 hours, persistent vomiting, headache/blurring of vision, generalized edema/puffiness of the face, discharge/bleeding from the vagina, abdominal pain, decreased fetal movements, or breathlessness at rest.

    Folic Acid Supplementation

    • Prophylactic dose (400 mcg/day) to prevent neural tube defects:
      • Start at least one month before conception.
      • Continue until three months after conception.
    • Therapeutic dose (4 mg/day) to prevent recurrence of neural tube defects:
      • Start two to three months before conception.
      • Continue until three months after conception.
    • RDA during pregnancy: 500 mcg/day.

    Special Cases

    • Diabetic females:
      • Prophylactic dose (400 mcg/day) before conception.
      • Therapeutic dose (4mg/day) after conception.
    • Patients on anti-epileptic drugs:
      • Prophylactic dose (400 mcg/day) before conception.
      • Therapeutic dose (4 mg/day) after conception.
    • Sickle cell anemia:
      • Prophylactic dose (400 mcg/day) before conception.
      • Therapeutic dose (4 mg/day) after conception.
      • 5g/day for treatment of megaloblastic anemia.
    • 4th month onwards: Iron + folic acid supplementation (IFA) as per Anemia Mukt Bharat Programme.
      • 60mg elemental iron + 500mcg of folic acid (red-colored tablet).
      • 1 tablet/day to prevent anemia in pregnant females without anemia.
      • Continue throughout pregnancy or for 180 days of pregnancy and 180 days after delivery.
      • 2 tablets/day to treat anemia in pregnant females with anemia.

    Management of Nausea and Vomiting in Pregnancy

    • No hypovolemia:
      • Oral medications: Dimenhydrinate/diphenhydramine.
      • If no response: Metoclopramide/Promethazine.
      • If no response: Ondansetron.
    • Hypovolemia present:
      • < 10 weeks: Combination of two IV drugs (e.g., IV metoclopramide + IV promethazine).
      • If no response: IV ondansetron (after 2 weeks).
      • > 10 weeks: IV ondansetron (Note: may lead to cleft lip/palate if given before 10 weeks of pregnancy).

    PUQE Scoring

    • 4 to 6: Mild
    • 7 to 12: Moderate
    • ≥13: Severe

    Other Ailments in Pregnancy

    Supine Hypotension Syndrome

    • Symptoms: Dizziness/lightheadedness while lying supine (usually late trimester).
    • Pathology: Pressure of gravid uterus on inferior vena cava causing decreased venous return, cardiac output, maternal hypotension (potentially leading to fetal distress).
    • Management: Lie in left lateral position.

    Antenatal Visits

    • Ideal visits: 12 to 15 visits.

    Frequency of Visits

    Trimester WHO Recommendation Government of India Recommendation
    1st 1 visit 1 visit
    2nd 1 visit 1 visit
    3rd 5 visits 3 visits : 28 to 34 weeks, 4th visit: 36 weeks to term

    First Antenatal Visit Investigations

    1. ABO/Rh status:
      • If Rh-negative female, check husband's Rh status.
      • If Rh-positive, perform Indirect Coombs test (at 1st visit, repeat at 28 weeks of gestation).
    2. Complete Blood Count + Hemoglobin (Hb):
      • ACOG guidelines: Repeat Hb testing at 24-28 weeks of pregnancy.
      • Indian guidelines: Repeat Hb at all 4 visits (using digital hemoglobinometer, provided under Anemia Mukt Bharat Programme).
    3. Urine Routine Microscopy: In all trimesters.
    4. HIV: Opt-out approach (if patient refuses to test).
      • Screening test: ELISA.
      • Diagnostic/Confirmatory: Western Blot.
    5. HBsAg testing: Regardless of vaccination status.
    6. VDRL test/RPR.
    7. Diabetes testing: As per DIPSI guidelines (First test: at 1st visit; Second test: at 24 to 28 weeks of gestation). Also perform Urine Culture & Sensitivity test (ACOG guidelines).

    Notes

    • Minimum visits within 12 weeks (1st visit).
    • 2nd visit: 14 to 26 weeks.
    • High risk for asymptomatic bacteriuria, diabetes, and sickle cell anemia.

    Document Details

    • Page number: 315
    • Active space: On the top right corner
    • Time stamp: 00:00:45
    • Document generated by: Obstetrics v1.0 Marrow 8.0. 2024

    Varicose Veins

    • Commonly present in lower limbs and vulva.

    Pathophysiology

    • Increased blood volume.
    • Increased femoral venous pressure due to pressure from the gravid uterus.

    Management

    • Conservative approach.
    • Avoid standing for long hours.
    • Use compression stockings.
    • Elevate lower limbs while resting.
    • Lie in left lateral position.
    • No medical or surgical procedures during pregnancy.

    Leg Cramps

    • Caused by lactic acid accumulation.

    Prevention

    • Massage.
    • Hot shower before going to bed.
    • Improve hydration.
    • Extend knees and dorsiflex toes during cramps.
    • Monitor magnesium levels.

    Carpal Tunnel Syndrome

    • Numbness and tingling in thumb, index, and middle finger due to compression of the median nerve

    Management

    • Symptomatic treatment.
    • Apply wrist splint.
    • Avoid corticosteroid injection and surgery.

    Hemorrhoids

    Pathophysiology

    • Increased vascular resistance.
    • Progesterone, a smooth muscle relaxant, contributes to relaxation of rectal muscles.

    Management

    • Increase fiber and fluid intake.
    • Local anesthetic gels and anti-inflammatory medication for pain.

    Vulval Varicosities

    • Managed through vulval compressions.

    Ultrasound in Pregnancy Part 1

    • This document describes ultrasound findings in pregnancy.

    Routine USG in Pregnancy

    • Types:

      • Transabdominal scan (TAS).
      • Transvaginal scan (TVS).

    • Frequency of probe:

      • TVS: 5 - 10 Hz.
      • TAS: 3 - 5 Hz.

    • Modes:

      • B mode/Brightness mode: Visualize all intrauterine structures.
      • M mode/Motion mode: To see cardiac activity.

    USG Findings in Pregnancy

    Gestational Sac
    • First structure seen on USG.
    • Appearance: Symmetrical fluid-filled area with echogenic rim.
    • Seen at (TVS): 4 weeks + 3 days to 5 weeks.
    • Indicates: Pregnancy.
    • Note: Gestational sac does not definitively confirm intrauterine pregnancy. A pseudogestational sac can be seen in ectopic pregnancy.
    Yolk Sac
    • Second structure seen on USG.
    • Appearance: Bleb (bubble) inside gestational sac.
    • Appears when mean sac diameter (MSD) is 10mm.
    • Seen at (TVS): 5 weeks to 5 weeks + 3 days.
    • Indicates: Intrauterine pregnancy.

    Nausea and Vomiting in Pregnancy

    • Also known as morning sickness.
    • Cause: hCG + estrogen + progesterone.
    • Can be seen at any time of the day.
    • Peak: At 10 weeks of pregnancy (due to hCG peak).
    • Subsides by 16 weeks of pregnancy.

    Management

    • Dietary modifications: Avoid spicy and fatty foods, consume small frequent meals.
    • Medication:
      • Pyridoxine (10mg) + Doxylamine (10mg) (Anti-histamine).
      • If no relief: Metoclopramide/Promethazine (Orally), Ondansetron (Oral as last resort).
    • Doctor: Consult a doctor.

    Hyperemesis Gravidarum

    • Persistent vomiting and/or weight loss ≥ 5% of pre-pregnancy weight.
    • Ketonuria.
    • Interferes with quality of life.
    • Cause: ↑ hCG.
    • Possible complications: Twin pregnancy.

    Risk Factors

    • ↑ risk:
      • In primigravida.
      • With female fetus.
      • High socioeconomic status.
      • Young females.
      • Previous h/o hyperemesis gravidarum/migraine/motion sickness.
      • Possible association with H.pylori.
      • Genetic predisposition.

    Investigations

    • Perform USG to exclude twin/molar pregnancy.

    Complications

    • Dehydration/Ketonuria.
    • Electrolyte imbalance (Hyponatremia, Hypokalemia).
    • Metabolic alkalosis.
    • Mallory Weiss tear.
    • Vitamin deficiencies (Vitamin K, Thiamine).
    • Wernicke's encephalopathy.

    Other Nutrient Requirements

    Calcium

    • RDA: 1000 mg.
    • Given as tablets from the 4th month onwards.
    • Minimum duration between calcium and iron dosage: 2 hours.

    Protein

    • Average additional requirement: +45g/day.
    • Specifically:
      • T1: No additional requirement.
      • T2: +10g/day.
      • T3: +20g/day.

    Vaccines in Pregnancy

    • Live vaccines: Contraindicated (C/I).
    • Killed vaccines: Not Contraindicated (Not C/I).
    • Minimum period before pregnancy for safe administration of live vaccine: 1 month.
    • (< 1 month: Not an indication for MTP).

    Safe Vaccines

    • MMR (Mumps, measles, Rubella)
    • Small pox
    • Chicken pox
    • BCG
    • HPV (Not live vaccine)
    • Hep A/B
    • Pneumococcus
    • Meningococcus
    • Influenza (In TI)
    • Covid-19 (In TI)

    Vaccines Given in Special Circumstances

    • If traveling to an endemic area:
      • Yellow Fever.
      • Polio.

    Note

    • Air travel: Safe for pregnant women. Not recommended ≥ 36th week of pregnancy (Aviation restriction).
    • Physical exercise: 30 to 45 minutes of walking/day recommended in all pregnant women. Severe physical exercise contraindicated (C/I) in:
      • a. PIH
      • b. Cardiac disease
      • c. Patients at risk of pre-term labor
      • d. Placenta previa

    Assessments in Antenatal Visits

    • In each antenatal visit:

      1. Weight
      2. Blood pressure
      3. Check for pathological edema
      4. Uterine size and fundal height

    • Between 24 to 28 weeks:

      • Hb%/Hematocrit (Hct): By ACOG guidelines
      • Gestational Diabetes Mellitus (GDM): By DIPSI guidelines
      • Indirect Coombs test (if Rh-ve) at 28 weeks

    Nutrition in Pregnancy

    Caloric Requirements

    Activity Level Requirement per day (Kcal)
    Sedentary 1800
    Moderate work 2100
    Heavy work 2700

    Additional Requirement in Pregnancy

    • Average: +350 Kcal/day.
    • Individuals with moderate activities do not need additional calories (National guidelines).
    BMI Recommended weight gain (kg)
    Normal 11 to 12.5
    Low 12.5 to 18
    Obese 5 to 9

    Consequences of Weight Gain

    • Small for gestational age (SGA) baby.
    • High blood pressure (HTN)/Pre-eclampsia (PIH).
    • Macrosomia.
    • Failed induction (C-section).

    Factors affecting weight gain in pregnancy

    1. Socioeconomic status of the patient.
    2. Parity and weight gain.
    3. Ethnicity.
    4. Pre-pregnant weight and weight gain.

    Note

    • Smoking does not affect weight gain in pregnancy.

    Normal Pregnancy and Antenatal Care

    Optional Investigations

    1. TSH:
    2. Aneuploidy screening:
      • Patient susceptibility test.
      • IgM -ve.
      • IgG -ve.
    3. Rubella susceptibility test:
      • Patient is susceptible to rubella.
      • Rubella vaccine: Live vaccine (C/I during pregnancy) – Vaccination after delivery.
    • Note: National guidelines do not recommend routine TORCH testing. ACOG recommends Group B streptococci testing in all pregnant females between 35-37 weeks. Sample: Rectovaginal swab.

    Vaccinations

    1. Td (Tetanus + diphtheria toxoid) vaccine:
      • Td-1 at first visit.
      • Td-2 after 4 weeks.
      • If pregnant female received complete Td vaccination within the last 3 years: Only Td booster in current pregnancy.
    2. Tdap (Tetanus + diphtheria + acellular pertussis) vaccine:
      • Single shot between weeks 27-37 (ACOG guidelines).

    Identification of High Risk Pregnancy

    • High Risk Factors:
      1. Extremes of age: >35 years.
      2. HIV+ve/HbsAg+ve.
      3. Severe systemic illness.
      4. Severe anaemia (Hb < 7 g/dl).
      5. Previous history of premature delivery, stillbirth, or congenital abnormalities.
      6. Multiple pregnancies (twins, triplets, etc.).
      7. Certain medical conditions: diabetes, heart disease, etc.

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    Description

    This quiz focuses on key topics related to antenatal care, including the management of bell's palsy and backache during pregnancy. You'll learn about risk factors, treatment options, and the importance of monitoring for warning signs. Enhance your understanding of maternal health and prenatal management.

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