Obstetrics Marrow Pg 295-304 (Fundamentals of Reproduction)
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Obstetrics Marrow Pg 295-304 (Fundamentals of Reproduction)

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Questions and Answers

What is the expected due date (EDD) for a fresh IVF cycle if fertilization occurs on Day 14?

  • Day of fertilization + 280 days
  • Day of fertilization + 266 days (correct)
  • Day of fertilization + 263 days
  • Day of fertilization + 261 days

    • A pregnancy is considered full term if it occurs between 39 weeks and 40 weeks + 6 days.

    True

    What is the classification of a preterm pregnancy that occurs at 33 weeks?

    Moderate PTB

    A pregnancy loss occurring at less than 20 weeks is classified as _____.

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

    Match the following classifications of preterm pregnancy with their definitions:

    <p>Early preterm = &lt; 34 weeks Late preterm = 34 weeks to 36 weeks + 6 days Very PTB = &lt; 32 weeks Extreme PTB = &lt; 28 weeks</p> Signup and view all the answers

    What is indicated for a pregnancy with moderate and severe oligohydramnios?

    <p>Weekly NST and biophysical score starting at 28 weeks</p> Signup and view all the answers

    Termination of pregnancy by induction of labor occurs at 39 weeks for uncomplicated oligohydramnios.

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

    What is the most common complication of oligohydramnios early in pregnancy?

    <p>Pulmonary hypoplasia</p> Signup and view all the answers

    Which period does the fetal growth encompass after fertilization?

    <p>All of the above</p> Signup and view all the answers

    Late deceleration on a CTG may be indicative of ______.

    <p>uteroplacental insufficiency</p> Signup and view all the answers

    Naegele's formula can be used for any type of pregnancy, regardless of circumstances.

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

    Match the following conditions with their descriptions:

    <p>Meconium aspiration syndrome = Fetus swallows meconium-stained amniotic fluid Limb reduction defects = Abnormalities in limb formation due to limited space Cord compression = Decreased fetal blood supply due to cramped space Club foot = Congenital deformity of the foot associated with oligohydramnios</p> Signup and view all the answers

    What is the first step in calculating the Estimated Day of Delivery (EDD) using Naegele's formula?

    <p>Add 7 days to the 1st day of LMP.</p> Signup and view all the answers

    If the cycle length is shorter than 28 days, you should ______ the difference from the approximate EDD.

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

    Match the following terms with their definitions:

    <p>Fetal period = From the 9th week after fertilization to delivery Embryonic period = From the 3rd to 8th week after fertilization Period of fertilized ova = Up to 2 weeks after day of fertilization Naegele's formula = Method to calculate Estimated Day of Delivery</p> Signup and view all the answers

    What is the specific gravity range of amniotic fluid?

    <p>1.008-1.010</p> Signup and view all the answers

    The pH of amniotic fluid is typically lower than 7.

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

    What is oligohydramnios and when is it commonly observed?

    <p>Oligohydramnios is a condition characterized by low amniotic fluid volume, commonly observed in post-term pregnancies.</p> Signup and view all the answers

    At 40 weeks, the volume of amniotic fluid is approximately ______.

    <p>800 mL</p> Signup and view all the answers

    Match the timing with the primary source of amniotic fluid:

    <p>1st Trimester = Ultrafiltration of maternal plasma across placenta Up to 20 weeks = Transudation across fetal skin ≥ 20 weeks = Fetal urine Post-term = Oligohydramnios</p> Signup and view all the answers

    Which condition is characterized by an amniotic fluid index (AFI) of ≥ 25 cm?

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

    Oligohydramnios is defined by an AFI measurement of less than 5 cm.

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

    What is the most common cause of oligohydramnios?

    <p>Renal anomalies</p> Signup and view all the answers

    The amniotic fluid index (AFI) is considered normal when it ranges between _____ cm and _____ cm.

    <p>5, 25</p> Signup and view all the answers

    Match the following causes with their respective conditions:

    <p>Diabetes = Polyhydramnios Renal anomalies = Oligohydramnios Bartter syndrome = Polyhydramnios Uteroplacental insufficiency = Oligohydramnios</p> Signup and view all the answers

    What is the total duration of pregnancy in days?

    <p>280 days</p> Signup and view all the answers

    The fetal age is the same as the gestational age.

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

    When does cardiac activity in the fetus typically start?

    <p>5th week of pregnancy</p> Signup and view all the answers

    The first trimester of pregnancy lasts until _____ weeks.

    <p>13</p> Signup and view all the answers

    What is the most common cause of polyhydramnios?

    <p>Renal anomaly of the fetus</p> Signup and view all the answers

    Match each trimester with its duration:

    <p>First Trimester = 1st day of LMP to 13 weeks + 6 days Second Trimester = 14 weeks to 27 weeks + 6 days Third Trimester = 28 weeks to delivery</p> Signup and view all the answers

    Oligohydramnios is only caused by fetal renal anomalies.

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

    Name one investigation step that should be performed if generalized congenital anomaly (GCA) is suspected.

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

    In polyhydramnios cases, the _____ check is performed to evaluate for anemia.

    <p>MCA Doppler</p> Signup and view all the answers

    Match the following conditions with their descriptions:

    <p>Indomethacin = Used for treatment of polyhydramnios beyond 32 weeks TVS = First step investigation for polyhydramnios and oligohydramnios Umbilical artery Doppler = Rules out umbilical cord problems and IUGR DIPSI check = Conducted to check for diabetes in polyhydramnios cases</p> Signup and view all the answers

    What color of amniotic fluid is typically indicative of fetal distress?

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

    Colorless amniotic fluid is abnormal at term.

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

    What does AFI stand for in the context of amniotic fluid assessment?

    <p>Amniotic Fluid Index</p> Signup and view all the answers

    The AFI is calculated by summing the largest vertical length of amniotic fluid pockets in ___ quadrants of the abdomen.

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

    Match the color of amniotic fluid with its condition:

    <p>Straw color = Normal at term Golden = Bilirubin Dark red = Blood Saffron/yellowish green = Unspecified condition</p> Signup and view all the answers

    What is the timing for performing amnio-infusion?

    <p>At labor</p> Signup and view all the answers

    Reduced renal blood flow leads to increased GFR in cases of oligohydramnios.

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

    What are the three main characteristics of Potter's syndrome?

    <p>Bilateral renal agenesis, pulmonary hypoplasia, typical flat facies</p> Signup and view all the answers

    The condition characterized by severe oligohydramnios and a band wrapping around the baby's digit is known as _____ syndrome.

    <p>Amniotic Band</p> Signup and view all the answers

    Match each association of oligohydramnios with its effect:

    <p>UPI = Reduced blood supply to fetus Oliguria = Decreased urine output IUGR = Brain sparing effect Oligohydramnios = Reduced amniotic fluid volume</p> Signup and view all the answers

    What is the maximum amount of fluid that can be removed during serial amniocentesis?

    <p>2-2.5 L</p> Signup and view all the answers

    Tocolytics are recommended for women with severe polyhydramnios who are 34 weeks pregnant or older.

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

    Name one potential complication of severe polyhydramnios.

    <p>Preterm labor</p> Signup and view all the answers

    In cases of polyhydramnios, the artificial rupture of membrane is indicated when the condition is classified as _____ (C/1).

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

    Match the following tocolytic medications with their recommended usage:

    <p>Indomethacin = &lt; 32 weeks Nifedipine = 32-34 weeks Not given = ≥ 34 weeks</p> Signup and view all the answers

    Study Notes

    Antepartum Fetal Monitoring

    • Weekly Non-Stress Test (NST) is recommended for pregnancies with moderate and severe oligo/polyhydramnios starting from 28 weeks
    • Weekly Biophysical Score (BPS) is advised for moderate and severe oligo/polyhydramnios starting at 28 weeks
    • Ultrasound for fetal growth should be performed every 3 weeks for moderate and severe oligo/polyhydramnios starting at 28 weeks

    Treatment of Oligo/Polyhydramnios

    • Uncomplicated oligo/polyhydramnios: Termination of pregnancy by induction of labor at 39 weeks
    • Complicated oligo/polyhydramnios: Termination of pregnancy by induction of labor at 37 weeks

    Complications of Oligohydramnios

    • Early pregnancy complications include:
      • Limited uterine distension
      • Restricted space for fetal development
      • Pulmonary hypoplasia (most common)
      • Limb reduction defects
    • Late pregnancy complications include:
      • Cord compression leading to decreased fetal blood supply and fetal distress
      • Meconium staining of amniotic fluid which can be swallowed by the fetus causing meconium aspiration syndrome
      • Club foot/Congenital talipes equinovarus (CTEV)

    Cardiotocography (CTG) Findings in Oligohydramnios

    • Variable decelerations
    • Late decelerations with or without decreased variability due to Uteroplacental Insufficiency (UPI)

    Normal Pregnancy and Antenatal Care

    • Fresh In Vitro Fertilization (IVF) cycle:
      • Day 14 of the cycle = Day of fertilization = Day of oocyte retrieval
      • Estimated Date of Delivery (EDD) = Day of fertilization + 266 days
    • Frozen IVF cycle:
      • Day of fertilization doesn't coincide with the day of oocyte retrieval
      • Day 3 transfer (D 17 of the cycle) + 263 days = EDD
      • Day 5 transfer (D 19 of the cycle) + 261 days = EDD

    Important Terminologies and Intrauterine Death

    • Preterm Pregnancy: < 37 weeks
    • Early Term: 37 weeks to 38 weeks + 6 days
    • Full Term: 39 weeks to 40 weeks + 6 days
    • Late Term: 40 weeks to 41 weeks + 6 days
    • Post-term Pregnancy: ≥ 42 weeks (≥ 294 days)
    • Abortion: Pregnancy loss at < 20 weeks
    • Intrauterine Death (IUD)/Stillbirth: Pregnancy loss at ≥ 20 weeks

    Classification of Preterm Birth

    • American College of Obstetricians and Gynecologists (ACOG) classification:
      • Early preterm: < 34 weeks
      • Late preterm: 34 weeks to 36 weeks + 6 days
    • World Health Organization (WHO) classification:
      • Late preterm birth: 34 weeks to 36 weeks + 6 days
      • Moderate preterm birth: 32 weeks to 33 weeks + 6 days
      • Very preterm birth: < 32 weeks
      • Extreme preterm birth: < 28 weeks

    Basics of Pregnancy: Part 1

    • Fetal growth period is calculated from the day of fertilization:
      • Period of fertilized ova: Up to 2 weeks after fertilization
      • Embryonic period: 3rd - 8th week after fertilization
      • Fetal period: 9th week after fertilization until delivery
    • Fetal growth period is the only pregnancy event not calculated from the 1st day of the Last Menstrual Period (LMP)

    Calculation of Estimated Day of Delivery (EDD)

    • Natural conception:
      • Regular 28-day cycle: EDD using Naegele's formula: 1st day of LMP + 7 days + 9 months (add 7 days first)
      • Exception: LMP in February: Add 9 months first, then 7 days
    • Cycle length < or > 28 days:
      • Calculate approximate EDD using Naegele's formula
      • Calculate the difference between given cycle length and 28 days
      • If cycle length > 28 days: Add the difference to approximate EDD
      • If cycle length < 28 days: Subtract the difference from approximate EDD
    • Naegele's formula is not applicable for:
      • Pregnancy due to oral contraceptive failure
      • Lactational amenorrhea
      • Irregular cycles
      • Unsure about LMP

    Amniotic Fluid

    • Features:
      • Specific gravity: 1.008-1.010
      • pH: 7-7.5 (7.2)
      • Osmolarity: 260 osmol/L
      • Volume:
        • Maximum at 32-34 weeks: 1 L
        • At 40 weeks: 800 mL
        • At 42 weeks: 200 mL
    • Applied aspect: Oligohydramnios in post-term pregnancy
    • Source:
      • 1st Trimester: Ultrafiltration of maternal plasma across placenta
      • Up to 20 weeks: Transudation across fetal skin
      • ≥ 20 weeks: Fetal urine
    • Maintenance of Amniotic Fluid Volume: Depends on fetal swallowing
    • Notes:
      • Fetal urine production at term: 1000 mL/day
      • Keratinization of fetal skin: 22-25 weeks of pregnancy

    Amniotic Fluid Disorders

    • Polyhydramnios vs Oligohydramnios:

    PolyhydramniosOligohydramniosAmniotic Fluid Index (AFI)≥ 25 cm< 5 cmSingle Deepest Pocket (SDP)≥ 8 cm< 2 cmMost Common (m/c)IdiopathicIdiopathicMildCauseIdiopathic Gross congenital anomalies (GCA): 1.Large placenta: Twin pregnancy Rh -ve pregnancy Diabetics 2.Increased urine output: Twin pregnancy Maternal diabetes: maternal hyperglycemia → Fetal hyperglycemia → Fetal polyuria → Polyhydramnios Bartter syndrome: Polyuria Fetal anemia: D/t a.Rh incompatibility b.Parvovirus B19 infection c.ThalassemiaIdiopathic Gross congenital anomalies (GCA): m/c: Renal anomalies 1.Small placenta PIH UPI (uteroplacental insufficiency) IUGR 3.Decreased urine output: Renal anomalies in fetus Posterior urethral valve Drugs: Indomethacin, ACE inhibitors 4.Decreased volume: Leaking after amniocentesis PPROM 5.Chromosomal anomalies: Triploidy 6.Abruptio: Rare (D/t ↓ in functional size of placenta)SevereGIT anomalies > NTD

    • Notes:
      • AFI: Amniotic Fluid Index
      • SDP: Single Deepest Pocket

    Polyhydramnios and Oligohydramnios

    • Document outlines causes, investigations, and treatment of polyhydramnios and oligohydramnios.
    • Polyhydramnios:
      • Other causes:
        • Increased transudation from skin
        • Abdominal wall defects (omphalocele, gastroschisis)
        • Swallowing defects (esophageal atresia, tracheo-esophageal fistula, duodenal atresia, cleft lip/palate)
        • Congenital diaphragmatic hernia
        • Chromosomal anomalies (trisomy)
        • Chorangioma of placenta
        • Sacrococcygeal teratoma
        • TORCH infections
        • Twin-to-twin transfusion syndrome
      • Note:
        • Most common cause (m/c) of polyhydramnios is a renal anomaly of the fetus
        • Other possible causes include UPI/PROM
        • In all cases of oligohydramnios, a sterile P/S examination is performed to rule out PROM.
    • Oligohydramnios:
      • Note:
        • A common cause of oligohydramnios is a renal anomaly of the fetus.
        • Possible causes include UPI/PROM.

    Investigations for Oligo/Polyhydramnios

    • First Step: Transabdominal ultrasound (TVS)
    • Next Steps:
      • Level 2/Anomaly scan: To rule out Generalized Congenital Anomaly (GCA)
      • If GCA is suspected, karyotyping should be done.
      • Sterile P/S examination: To rule out premature rupture of the membranes (PROM)
      • Umbilical artery Doppler: To rule out umbilical cord problems, IUGR (intrauterine growth restriction), or PIH (pre-eclampsia)
      • In polyhydramnios cases, DIPSI check is performed to check for diabetes and MCA Doppler check to evaluate for anemia
    • Additional Information:
      • Indomethacin: Used for treatment of polyhydramnios beyond 32 weeks, and for premature closure of ductus arteriosus
      • P/A Height: Uterine height does not correspond to the gestational age for oligo/polyhydramnios
    • Important Note: The document uses arrows (→\rightarrow→) to indicate potential causes.

    BASICS OF PREGNANCY: Part 1

    • Presumptions in a pregnant woman:

      • Prior to pregnancy:
        • Regular cycles:
          • Cycle length: 28 days
          • Day 14 of cycle: Day of ovulation
          • Total duration of pregnancy: 9 months + 7 days / 40 weeks / 280 days

    • Timeline of pregnancy:

    DayEvent1st day1st day of LMP (Last menstrual period)14th dayOvulation/Fertilization28th dayMissed period (corresponds to 4th week of pregnancy; Fertilization occurs a week prior)

    • Period of pregnancy & fetal age:

    ParameterDay of calculationPeriod of pregnancy/Gestation1st day of LMPFetal ageDay of fertilization

    • Notes:
      • Difference between gestational age & fetal age = Fetal age + 2 weeks
      • Example: Cardiac activity starts at 5th week of pregnancy, 3 weeks after fertilization.
    • Trimesters & Fetal growth period:

    TrimesterCalculationT11st day of LMP → 13 weeks + 6 daysT214 weeks → 27 weeks + 6 daysT328 weeks → Delivery

    Amniotic Fluid Assessment

    • Color of Amniotic Fluid:

    ColorConditionStraw colorNormal at termColorlessNormal at termGreenMeconium +, Fetal distress, Transverse lie/breech, Listeria infectionTobacco juiceSaffron/yellowish greenGoldenBilirubinDark redBlood

    • Amniotic Fluid Index (AFI):
      • Method:
        • Sum the largest vertical length of amniotic fluid pockets in all four quadrants of the abdomen
      • Formula:
        • AFI = a + b + c + d
      • Interpretation:

    Fundamentals of Reproduction

    • Management of Oligo/Polyhydramnios:
      • Conservative management:
        • Maintain current management
        • Bed rest: Left lateral position
        • Improve hydration
      • Amnio-infusion:
        • Indication: Persistent variable deceleration
        • Timing: At labour
        • Fluid: Normal saline
    • Associations of Oligohydramnios:

      • UPI (Uteroplacental Insufficiency):

        • Effect on blood supply to the fetus: reduced blood supply to the fetus
        • Effect on IUGR (↓ growth): brain sparing effect (Blood supply from peripheral organs directed towards the brain)
        • Effect on renal blood flow: reduced renal blood flow; reduced GFR
        • Effect on Oliguria: oliguria
        • Effect on Oligohydramnios: oligohydramnios

      • Syndromes:

        SyndromeDescriptionPotter's syndromeBilateral renal agenesis + Pulmonary hypoplasia + Typical flat facies.Potter's sequence: Above feature occurring due to any other reason.Amniotic Band syndromeAKA Streeter's syndrome/constriction band.Preterm Premature Rupture of Membranes (PPROM) before 37 weeks.Severe oligohydramnios.Membrane wraps tightly around the baby's digit in the form of a band.Digital amputation.

    Polyhydramnios Management

    • Management of Polyhydramnios:
      • Asymptomatic/mild symptoms: No intervention is required
      • Severe polyhydramnios (SVP ≥ 16/AFI ≥ 35cm): Respiratory discomfort, uterine irritability
    • Additional Points:
      • Serial amniocentesis: Maximum amount: 2-2.5 L
      • Tocolytics:
        • < 32 weeks: Indomethacin
        • 32-34 weeks: Nifedipine
        • ≥ 34 weeks: Not given
      • Complications of polyhydramnios:
        • Preterm labor (due to uterine overdistension)
        • Premature rupture of membranes(PPROM)
        • Cord prolapse
        • Malpresentation/unstable lie (head of baby not fixed)
        • Abruption of placenta
        • Postpartum hemorrhage (PPH)
        • Subinvolution of uterus
      • Artificial rupture of membrane (C/1): In polyhydramnios
    • Imaging Related to Amniotic Fluid Disorders: Displays ultrasound images showing specific conditions
      • Conditions:
        • Posterior urethral valve
      • Associations:
        • Polyhydramnios
        • Down syndrome
        • Oligohydramnios (late in pregnancy)
    • Other Related Conditions:
      • Phocomelia (D/t Thalidomide)
      • Amniotic band syndrome

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    Description

    This quiz covers key aspects of antepartum fetal monitoring, particularly in the context of oligo/polyhydramnios. It addresses recommended tests, treatment strategies, and potential complications associated with these conditions. Perfect for those studying maternal-fetal medicine.

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