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Questions and Answers
What is the primary purpose of conducting a Full Blood Count (FBC) during the booking investigations?
Why is antibody screening performed during the booking investigations?
What would indicate that a Rh-negative woman should receive anti-D immunoglobulin?
During what gestational period is the Glucose Tolerance Test (GTT) typically conducted?
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What does a urinalysis during the booking investigations primarily aim to detect?
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What potential risk does untreated syphilis pose to a pregnancy?
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Which maternal test is essential to determine immunity against rubella during pregnancy?
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What type of screening is required to assess for hepatitis virus infections in pregnant women?
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What is the definition of placental abruption?
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Which of the following conditions is diagnosed through the detection of glycosuria during urinalysis?
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Which factor is NOT a risk for preeclampsia?
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What is the primary management strategy for severe preeclampsia?
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What is a clinical feature of placenta previa?
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In the context of fetal heart rate monitoring, what does a late deceleration indicate?
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Which of the following is a management option for gestational diabetes mellitus (GDM)?
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What does a Bishop score greater than 8 suggest?
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Which of the following is characteristic of placental abruption?
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What would be considered a normal fetal heart rate?
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What is a common management approach if a mother presents with preterm labor?
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Which statement about oligohydramnios is true?
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What is the main reason for conducting antibody screening during booking investigations?
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Which condition is most directly linked to the need for HIV screening during booking investigations?
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What is the primary complication associated with untreated syphilis during pregnancy?
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In what circumstance would a Rh-negative woman require anti-D immunoglobulin?
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What indicates the correctness of the timing for conducting the Glucose Tolerance Test (GTT) in pregnancy?
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What is a critical purpose of performing urinalysis during booking investigations?
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Which screening test is critical for assessing immunity against rubella during pregnancy?
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What is the definition of placental abruption?
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Which of the following blood test results would indicate a diagnosis of thrombocytopenia?
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What is the significance of monitoring abnormal blood counts during booking investigations?
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Which of the following best describes the clinical feature of preeclampsia?
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Which clinical feature is most indicative of placenta previa?
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What is the initial management for a patient diagnosed with severe preeclampsia?
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In cases of placental abruption, which clinical feature is most likely to be present?
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Which of the following is a common risk factor associated with gestational diabetes mellitus (GDM)?
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What is the primary goal of management in a case of gestational hypertension?
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Which investigation is essential for confirming proteinuria in preeclampsia?
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What does a Bishop score of less than 8 indicate?
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Which fetal heart rate pattern is associated with umbilical cord compression?
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In managing oligohydramnios, what is a common intervention?
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What is the primary purpose of performing hepatitis B and C screening during the booking investigations?
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Why is syphilis screening conducted as part of the booking investigations?
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What condition could result from not administering anti-D immunoglobulin to an Rh-negative woman carrying an Rh-positive fetus?
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What is the potential consequence of a diagnosed glycosuria found during urinalysis?
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Which condition is most directly linked to administering antiretroviral therapy during pregnancy?
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When is it appropriate to perform the Glucose Tolerance Test (GTT) in pregnancy?
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What aspect of maternal health does a Full Blood Count (FBC) primarily help to evaluate?
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Which screening is essential for determining rubella immunity during pregnancy?
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Which situation may indicate an increased risk of macrosomia in the newborn during pregnancy?
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What condition might be revealed by the presence of proteinuria in urinalysis during the booking investigations?
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Which condition is characterized by painful vaginal bleeding along with abdominal pain and uterine tenderness?
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What is the typical management approach for a patient diagnosed with complete placenta previa and experiencing severe bleeding?
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Which investigation is most crucial for identifying early signs of severe preeclampsia?
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In the context of gestational diabetes mellitus (GDM), what would primarily indicate the need for insulin therapy during management?
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Which of the following features is characteristic of eclampsia?
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What is the most appropriate action taken for a patient showing late decelerations on fetal monitoring?
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What is the defining measurement used to characterize gestational hypertension?
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Which of the following correctly describes the clinical feature of preeclampsia?
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Which factor is notably NOT a risk for developing gestational diabetes mellitus?
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What is the primary goal of using corticosteroids in the management of placenta previa?
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Which of the following blood parameters is NOT typically assessed in a Full Blood Count during booking investigations?
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What is the primary reason behind conducting an antibody screening during pregnancy?
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In which circumstance would a woman require anti-D immunoglobulin during pregnancy?
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What potential maternal complication could arise from untreated syphilis during pregnancy?
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What does the Glucose Tolerance Test (GTT) primarily aim to detect during pregnancy?
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Which screening test is aimed specifically at determining a woman's immunity to rubella during pregnancy?
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What is the critical health assessment that urinalysis aims to detect during booking investigations?
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Which condition is most likely indicated by the presence of glycosuria in a pregnant woman?
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What management intervention is recommended for a mother diagnosed with iron deficiency anemia during pregnancy?
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What is a key risk factor leading to the need for monitoring blood counts in pregnant women?
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Which of the following is a management step similar for both placental abruption and placenta previa when there is maternal distress?
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What is a common clinical feature distinguishing preeclampsia from gestational hypertension?
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What fetal heart rate pattern would most likely suggest uteroplacental insufficiency?
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What is the primary goal in managing a patient diagnosed with severe preeclampsia?
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In gestational diabetes mellitus, which measure is primarily utilized to manage elevated blood glucose levels effectively?
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Which of the following factors is least related to the development of placenta previa?
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What is the most concerning fetal complication associated with oligohydramnios?
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What is the significance of the Bishop score in obstetric care?
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Which investigation is critical in confirming the diagnosis of preeclampsia?
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What maternal condition is characterized by painful vaginal bleeding during pregnancy?
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Study Notes
Booking Investigations
-
Blood Tests:
- Full Blood Count (FBC): Identifies anemia (treated with iron and folic acid), low platelet count (thrombocytopenia), and high white blood cell count (leukocytosis).
- Blood Group and Rhesus (Rh) Factor: Determines blood type and Rh status. Rh-negative women may need anti-D immunoglobulin if carrying an Rh-positive fetus to prevent hemolytic disease of the newborn.
- Antibody Screening: Detects atypical antibodies that can cause hemolytic disease of the fetus and newborn.
- Syphilis Screening (VDRL/RPR): Screens for syphilis, which if untreated, can lead to stillbirth or congenital syphilis.
- HIV Screening: Identifies HIV-positive mothers enabling early antiretroviral therapy to prevent transmission to the baby.
- Hepatitis B and C Screening: Detects infection and guides healthcare providers to take appropriate precautions for preventing transmission to the baby.
- Rubella Immunity Status: Establishes immunity against rubella, which can cause severe congenital anomalies if contracted during pregnancy.
- Urinalysis and Urine Culture: Detects proteinuria (a sign of preeclampsia), urinary tract infections (UTIs), or glycosuria (suggestive of diabetes).
- Blood Sugar (Glucose Tolerance Test, GTT): Usually performed between 24-28 weeks gestation to identify gestational diabetes mellitus (GDM), which increases the risk of macrosomia, birth trauma, and neonatal hypoglycemia.
Placental Abruption vs. Placenta Previa
-
Placental Abruption: Premature separation of the placenta from the uterine wall before delivery, leading to hemorrhage and compromised fetal oxygenation.
- Risk Factors: Previous placental abruption, hypertension or preeclampsia, trauma, smoking, cocaine use, advanced maternal age.
- Clinical Features: Painful vaginal bleeding, abdominal pain or uterine tenderness, uterine contractions, and fetal distress.
- Management: Stabilize the mother with IV fluids and blood products. Immediate delivery if fetal or maternal compromise; conservative management if stable and preterm.
-
Placenta Previa: The placenta is abnormally implanted in the lower uterine segment, covering or partially covering the cervix.
- Risk Factors: Previous placenta previa, multiple gestations, previous C-section or uterine surgery, advanced maternal age.
- Clinical Features: Painless vaginal bleeding, typically in the second or third trimester; no uterine tenderness or contractions.
- Management: Close monitoring and serial ultrasounds. Corticosteroids for fetal lung maturity if preterm. Delivery via C-section at 36-37 weeks or earlier if severe bleeding occurs.
Preeclampsia
-
Definition: A hypertensive disorder of pregnancy characterized by new-onset hypertension (≥140/90 mmHg) and proteinuria (>300 mg/24 hours) after 20 weeks of gestation.
- Risk Factors: First pregnancy, history of preeclampsia or family history, multiple gestations, chronic hypertension or renal disease, diabetes mellitus, obesity, advanced maternal age (>35 years).
- Investigations: Blood pressure measurement, urinalysis, 24-hour urine collection (confirms proteinuria), blood tests (liver function tests, serum creatinine, platelet count).
-
Management:
- Mild Preeclampsia: Monitor blood pressure and proteinuria, rest, and reduced physical activity.
- Severe Preeclampsia: Hospitalization; blood pressure control with labetalol or nifedipine, magnesium sulfate to prevent seizures. Delivery if ≥37 weeks or if maternal/fetal compromise
Gestational Diabetes Mellitus (GDM)
-
Definition: Glucose intolerance diagnosed during pregnancy, associated with complications like fetal macrosomia, shoulder dystocia, and neonatal hypoglycemia.
- Diagnosis: Oral Glucose Tolerance Test (OGTT) at 24-28 weeks. Fasting glucose > 92 mg/dL, 1-hour > 180 mg/dL, or 2-hour > 153 mg/dL.
- Management: Diet and exercise are first-line treatments. Blood glucose monitoring is essential. Insulin is added if glycemic control is inadequate.
Hypertensive Disorders in Pregnancy
- Gestational Hypertension: BP ≥140/90 mmHg after 20 weeks without proteinuria.
- Preeclampsia: BP ≥140/90 mmHg and proteinuria (>300 mg/24 hours).
- Eclampsia: Preeclampsia with seizures.
- Management: Delivery is the definitive treatment for severe cases. Labetalol or methyldopa for BP control, and magnesium sulfate for seizure prophylaxis.
Additional Conditions and Procedures
-
Preterm Labor: Labor before 37 weeks gestation.
- Management: Tocolytics (e.g., nifedipine), corticosteroids for fetal lung maturity (betamethasone), magnesium sulfate for neuroprotection.
-
Polyhydramnios: Excessive amniotic fluid volume (>2L).
- Etiologies: Diabetes, fetal anomalies, multiple gestations.
- Management: Amnioreduction if symptomatic, consider delivery if severe or near term.
-
Oligohydramnios: Reduced amniotic fluid volume (<500 mL).
- Management: Monitor closely, consider delivery if severe or near term.
-
Postpartum Hemorrhage (PPH): Bleeding exceeding 500 mL after vaginal delivery or 1000 mL after C-section.
- Causes: Uterine atony, retained placenta, lacerations, coagulopathy.
- Management: Uterine massage, oxytocin, ergot alkaloids, and surgical intervention if required.
Fetal Monitoring
- Normal Fetal Heart Rate (FHR): Baseline: 110-160 bpm. Accelerations: Increase of ≥15 bpm for ≥15 seconds. Decelerations: Early, variable, and late decelerations.
-
Decelerations:
- Early Decelerations: Symmetrical to contractions indicating head compression.
- Variable Decelerations: Abrupt onset and offset suggesting umbilical cord compression.
- Late Decelerations: Begin after the contraction peaks, suggesting uteroplacental insufficiency.
- Management of Abnormal Fetal Heart Patterns: Reposition mother to left lateral position, administer oxygen, IV fluids; consider delivery if persistent or severe abnormalities.
Obstetric Procedures
-
Leopold’s Maneuvers: Four-step palpation to determine fetal position and lie.
- First Maneuver: Determine what occupies the fundus (head/breech).
- Second Maneuver: Locate fetal back and extremities.
- Third Maneuver: Identify presenting part above the pelvis.
- Fourth Maneuver: Determine fetal head engagement in the pelvis.
- Bishop Score: Assesses cervical readiness for labor induction. Factors: Dilation, effacement, consistency, position, and station. Scores: >8 indicates a favorable cervix for induction.
Postpartum Care
- Monitor for postpartum hemorrhage (PPH), uterine atony, and signs of infection.
- Assess emotional and psychological well-being (e.g., screen for postpartum depression).
Important Values to Remember
- Normal FHR: 110-160 bpm
- Normal Hemoglobin: 11-13 g/dL (lower limit due to dilutional anemia)
-
Blood Pressure Goals in Pregnancy:
- Systolic: <140 mmHg
- Diastolic: <90 mmHg
Gestational Diabetes Mellitus (GDM) Blood Glucose Goals
- Fasting Glucose: <92 mg/dL
- 1-hour: <180 mg/dL
- 2-hour: <153 mg/dL
Booking Investigations
- Essential assessments conducted at the first antenatal visit (typically between 8-12 weeks gestation).
- Establish a baseline for maternal health, identify existing conditions, assess risk factors, and optimize care for mother and fetus throughout pregnancy.
Full Blood Count (FBC)
- Detects anemia, thrombocytopenia, and leukocytosis.
- Normal Ranges:
- Hemoglobin: 12-16 g/dL
- Platelets: 150-400 × 10⁹/L
- White Blood Cells: 4,000-11,000/µL
- Manage anemia with iron and folic acid supplementation.
- Monitor and investigate abnormal platelet or WBC counts.
Blood Group and Rhesus (Rh) Factor
- Identifies blood group and Rh factor.
- Rh-negative women may require anti-D immunoglobulin if carrying an Rh-positive fetus to prevent hemolytic disease of the newborn.
Antibody Screening
- Checks for atypical antibodies that could cause hemolytic disease of the fetus and newborn (HDFN).
Syphilis Screening (VDRL/RPR)
- Detects syphilis; if untreated, can lead to stillbirth or congenital syphilis.
HIV Screening
- Identifies HIV-positive mothers.
- Initiates antiretroviral therapy to prevent vertical transmission.
Hepatitis B and C Screening
- Detects infection.
- Takes precautions to prevent transmission to the baby.
Rubella Immunity Status
- Determines immunity against rubella.
- Rubella infection during pregnancy can cause severe congenital anomalies.
Urinalysis and Urine Culture
- Detects proteinuria (sign of preeclampsia), urinary tract infections (UTIs), or glycosuria (suggestive of diabetes).
Blood Sugar (Glucose Tolerance Test, GTT)
- Timing: 24-28 weeks gestation.
- Detects gestational diabetes mellitus (GDM), which can increase the risk of macrosomia, birth trauma, and neonatal hypoglycemia.
Placental Abruption
- Premature separation of the placenta from the uterine wall before delivery.
- Leads to hemorrhage and compromised fetal oxygenation.
- Risk Factors:
- Previous placental abruption
- Hypertension or preeclampsia
- Trauma (e.g., motor vehicle accident)
- Smoking, cocaine use
- Advanced maternal age
- Clinical Features:
- Painful vaginal bleeding
- Abdominal pain or uterine tenderness
- Uterine contractions and fetal distress
- Investigations:
- Ultrasound to identify retroplacental clot
- Fetal monitoring for distress
- CBC, coagulation profile
- Management:
- Stabilize the mother with IV fluids and blood products
- Immediate delivery if fetal or maternal compromise
- Conservative management if stable and preterm
Placenta Previa
- Placenta is abnormally implanted in the lower uterine segment, covering or partially covering the cervix.
- Risk Factors:
- Previous placenta previa
- Multiple gestations
- Previous C-section or uterine surgery
- Advanced maternal age
- Clinical Features:
- Painless vaginal bleeding, typically in the second or third trimester
- No uterine tenderness or contractions
- Investigations:
- Ultrasound (transabdominal or transvaginal) to locate placental position
- Fetal monitoring
- Management:
- Close monitoring and serial ultrasounds
- Corticosteroids for fetal lung maturity if preterm
- Delivery via C-section at 36-37 weeks or earlier if severe bleeding occurs
Preeclampsia
- Hypertensive disorder of pregnancy characterized by new-onset hypertension (≥140/90 mmHg) and proteinuria (>300 mg/24 hours) after 20 weeks of gestation.
- Risk Factors:
- First pregnancy
- History of preeclampsia or family history
- Multiple gestations
- Chronic hypertension or renal disease
- Diabetes mellitus
- Obesity or advanced maternal age (>35 years)
- Investigations:
- Blood Pressure Measurement: To monitor hypertension.
- Urinalysis: Detects proteinuria.
- 24-hour Urine Collection: Confirms proteinuria (>300 mg/24 hours).
- Blood Tests:
- Liver function tests (ALT, AST): Detects HELLP syndrome.
- Serum creatinine: Assess renal function.
- Platelet count: Thrombocytopenia can indicate severe preeclampsia.
- Management:
- Mild Preeclampsia:
- Monitor blood pressure and proteinuria.
- Rest and reduced physical activity.
- Severe Preeclampsia:
- Hospitalization, blood pressure control with labetalol or nifedipine.
- Magnesium sulfate to prevent seizures.
- Delivery if ≥37 weeks or if maternal/fetal compromise.
- Mild Preeclampsia:
Gestational Diabetes Mellitus (GDM)
- Glucose intolerance diagnosed during pregnancy.
- Associated with complications like fetal macrosomia, shoulder dystocia, and neonatal hypoglycemia.
- Diagnosis:
- Oral Glucose Tolerance Test (OGTT):
- 75g OGTT at 24-28 weeks.
- Fasting glucose >92 mg/dL, 1-hour >180 mg/dL, or 2-hour >153 mg/dL.
- Oral Glucose Tolerance Test (OGTT):
- Management:
- Diet and Exercise: First-line treatment.
- Blood Glucose Monitoring: Maintain fasting levels <95 mg/dL, 1-hour <140 mg/dL), confirm with a 100g oral glucose tolerance test (OGTT).
- Insulin is added if glycemic control is inadequate.
- Complications: Macrosomia, shoulder dystocia, neonatal hypoglycemia.
Hypertensive Disorders in Pregnancy
- Gestational Hypertension: BP ≥140/90 mmHg after 20 weeks without proteinuria.
- Preeclampsia: BP ≥140/90 mmHg and proteinuria (>300 mg/24 hours).
- Eclampsia: Preeclampsia with seizures.
- Management: Delivery is definitive treatment for severe cases.
- Labetalol or methyldopa for BP control, and magnesium sulfate for seizure prophylaxis.
Placental Abruption
- Clinical Features: Painful vaginal bleeding, abdominal pain, and uterine tenderness.
- Management: Immediate delivery if maternal or fetal distress is noted. Stabilize with IV fluids and blood products if necessary.
Placenta Previa
- Clinical Features: Painless vaginal bleeding in the second or third trimester.
- Management: Monitor and plan for C-section if complete or if bleeding is uncontrollable.
Preterm Labor
- Labor before 37 weeks gestation.
- Management: Tocolytics (e.g., nifedipine), corticosteroids for fetal lung maturity (betamethasone), magnesium sulfate for neuroprotection if <32 weeks.
Polyhydramnios
- Excessive amniotic fluid (AFI >24 cm).
- Etiologies: Diabetes, fetal anomalies, multiple gestations.
- Management: Amnioreduction if symptomatic, consider delivery if severe or near term.
Oligohydramnios
- Low amniotic fluid (AFI <5 cm).
- Causes: Uterine atony, retained placenta, lacerations, coagulopathy.
- Management: Uterine massage, oxytocin, ergot alkaloids, and surgical intervention if required.
Fetal Monitoring
- Normal Fetal Heart Rate (FHR): 110-160 bpm.
- Accelerations: Increase of ≥15 bpm for ≥15 seconds.
- Decelerations: Early, variable, and late decelerations.
- Decelerations
- Early Decelerations: Symmetrical to contractions, indicating head compression.
- Variable Decelerations: Abrupt onset and offset; suggest umbilical cord compression.
- Late Decelerations: Begin after the contraction peaks, indicating uteroplacental insufficiency.
- Management of Abnormal Fetal Heart Patterns:
- Reposition mother to left lateral position.
- Administer oxygen.
- IV fluids for hydration.
- Consider delivery if persistent or severe abnormalities.
Obstetric Procedures
- Leopold’s Maneuvers: Four-step palpation to determine fetal position and lie.
- First Maneuver: Determine what occupies the fundus (head/breech).
- Second Maneuver: Locate fetal back and extremities.
- Third Maneuver: Identify presenting part above the pelvis.
- Fourth Maneuver: Determine fetal head engagement in the pelvis.
- Bishop Score: Assesses cervical readiness for labor induction. Factors: Dilation, effacement, consistency, position, and station. Scores: >8 indicates favorable cervix for induction.
Postpartum Care
- Monitor for PPH, uterine atony, and signs of infection.
- Assess emotional and psychological well-being (e.g., screen for postpartum depression).
Important Values to Remember
- Normal FHR: 110-160 bpm
- Normal Hemoglobin: 11-13 g/dL (lower limit due to dilutional anemia)
- Normal Hemoglobin: 12-16 g/dL
- Blood Pressure Goals in Pregnancy: 92 mg/dL
- 1-hour: >180 mg/dL
- 2-hour: >153 mg/dL
Booking Investigations
-
Antenatal assessments conducted at the first visit, typically between 8-12 weeks gestation.
-
Aims to establish maternal health baseline, identify existing conditions, assess risk factors, and optimize care for mother and fetus.
-
Full Blood Count (FBC)
- Detects anemia, thrombocytopenia, and leukocytosis.
- Normal ranges:
- Hemoglobin: 12-16 g/dL
- Platelets: 150-400 × 10⁹/L
- White Blood Cells: 4,000-11,000/µL
- Anemia treated with iron and folic acid supplementation.
- Abnormal platelet or WBC counts require monitoring and investigation.
-
Blood Group and Rhesus (Rh) Factor
- Identifies blood group and Rh factor.
- Rh-negative women may require anti-D immunoglobulin if carrying an Rh-positive fetus to prevent hemolytic disease of the newborn.
-
Antibody Screening
- Checks for atypical antibodies that could cause hemolytic disease of the fetus and newborn (HDFN).
-
Syphilis Screening (VDRL/RPR)
- Detects syphilis, which can lead to stillbirth or congenital syphilis if untreated.
-
HIV Screening
- Identifies HIV-positive mothers and initiates antiretroviral therapy to prevent vertical transmission.
-
Hepatitis B and C Screening
- Detects infection and takes precautions to prevent transmission to the baby.
-
Rubella Immunity Status
- Determines immunity against rubella, which can cause severe congenital anomalies if contracted during pregnancy.
-
Urinalysis and Urine Culture
- Detects proteinuria (sign of preeclampsia), urinary tract infections (UTIs), or glycosuria (suggestive of diabetes).
-
Blood Sugar (Glucose Tolerance Test, GTT)
- Timing: 24-28 weeks gestation
- Detects gestational diabetes mellitus (GDM), which can increase the risk of macrosomia, birth trauma, and neonatal hypoglycemia.
Placental Abruption vs. Placenta Previa
-
Placental Abruption
- Premature separation of the placenta from the uterine wall before delivery, leading to hemorrhage and compromised fetal oxygenation.
- Risk factors: previous placental abruption, hypertension or preeclampsia, trauma, smoking, cocaine use, advanced maternal age.
- Clinical features: painful vaginal bleeding, abdominal pain or uterine tenderness, uterine contractions, fetal distress.
- Investigations: ultrasound to identify retroplacental clot, fetal monitoring for distress, CBC, coagulation profile.
- Management: stabilize the mother with IV fluids and blood products, immediate delivery if fetal or maternal compromise, conservative management if stable and preterm.
-
Placenta Previa
- The placenta is abnormally implanted in the lower uterine segment, covering or partially covering the cervix.
- Risk factors: previous placenta previa, multiple gestations, previous C-section or uterine surgery, advanced maternal age.
- Clinical features: painless vaginal bleeding, typically in the second or third trimester, no uterine tenderness or contractions.
- Investigations: ultrasound to locate placental position, fetal monitoring.
- Management: close monitoring and serial ultrasounds, corticosteroids for fetal lung maturity if preterm, delivery via C-section at 36-37 weeks or earlier if severe bleeding occurs.
Preeclampsia
- Hypertensive disorder of pregnancy characterized by new-onset hypertension (≥140/90 mmHg) and proteinuria (>300 mg/24 hours) after 20 weeks of gestation.
- Risk factors: first pregnancy, history of preeclampsia or family history, multiple gestations, chronic hypertension or renal disease, diabetes mellitus, obesity, advanced maternal age (>35 years).
- Investigations: blood pressure measurement, urinalysis to detect proteinuria, 24-hour urine collection to confirm proteinuria, blood tests (liver function tests, serum creatinine, platelet count).
- Management: mild preeclampsia (monitor blood pressure and proteinuria, rest, reduced physical activity), severe preeclampsia (hospitalization, blood pressure control with labetalol or nifedipine, magnesium sulfate to prevent seizures, delivery if ≥37 weeks or if maternal/fetal compromise).
Gestational Diabetes Mellitus (GDM)
- Glucose intolerance diagnosed during pregnancy.
- Associated with complications like fetal macrosomia, shoulder dystocia, and neonatal hypoglycemia.
- Diagnosis: oral glucose tolerance test (OGTT) at 24-28 weeks (fasting glucose >92 mg/dL, 1-hour >180 mg/dL, or 2-hour >153 mg/dL).
- Management: diet and exercise as first-line treatment, blood glucose monitoring, insulin if glycemic control is inadequate.
Hypertensive Disorders in Pregnancy
- Gestational Hypertension: BP ≥140/90 mmHg after 20 weeks without proteinuria.
- Preeclampsia: BP ≥140/90 mmHg and proteinuria (>300 mg/24 hours).
- Eclampsia: Preeclampsia with seizures.
- Management: delivery is definitive treatment for severe cases, labetalol or methyldopa for BP control, and magnesium sulfate for seizure prophylaxis.
Placental Abruption
- Clinical features: painful vaginal bleeding, abdominal pain, and uterine tenderness.
- Management: immediate delivery if maternal or fetal distress is noted, stabilize with IV fluids and blood products if necessary.
Placenta Previa
- Clinical features: painless vaginal bleeding in the second or third trimester.
- Management: monitor and plan for a C-section if complete or if bleeding is uncontrollable.
Preterm Labor
- Labor before 37 weeks gestation.
- Management: tocolytics (e.g., nifedipine), corticosteroids for fetal lung maturity (betamethasone), magnesium sulfate for neuroprotection.
Polyhydramnios
- Excessive amniotic fluid volume (AFI >24 cm).
- Etiologies: diabetes, fetal anomalies, multiple gestations.
- Management: amnioreduction if symptomatic, consider delivery if severe or near term.
Oligohydramnios
- Low amniotic fluid volume (AFI <5 cm).
- Etiologies: placental insufficiency, fetal anomalies, maternal conditions.
- Management: serial ultrasounds, close monitoring, amnioinfusion.
Fetal Monitoring
- Normal Fetal Heart Rate (FHR)
- Baseline: 110-160 bpm
- Accelerations: Increase of ≥15 bpm for ≥15 seconds
- Decelerations: Early, variable, and late decelerations.
- Decelerations
- Early Decelerations: Symmetrical to contractions, indicating head compression.
- Variable Decelerations: Abrupt onset and offset, suggest umbilical cord compression.
- Late Decelerations: Begin after the contraction peaks indicating uteroplacental insufficiency.
- Management of Abnormal Fetal Heart Patterns
- Reposition mother to the left lateral position.
- Administer oxygen.
- IV fluids for hydration.
- Consider delivery if persistent or severe abnormalities.
Obstetric Procedures
- Leopold’s Maneuvers
- Four-step palpation to determine fetal position and lie:
- First Maneuver: Determine what occupies the fundus (head/breech).
- Second Maneuver: Locate fetal back and extremities.
- Third Maneuver: Identify presenting part above the pelvis.
- Fourth Maneuver: Determine fetal head engagement in the pelvis.
- Four-step palpation to determine fetal position and lie:
- Bishop Score
- Assesses cervical readiness for labor induction. Factors: dilation, effacement, consistency, position, and station. -Scores: >8 indicates favorable cervix for induction.
Postpartum Care
- Monitor for PPH, uterine atony, and signs of infection.
- Assess emotional and psychological well-being (e.g., screen for postpartum depression).
Important Values to Remember
- Normal FHR: 110-160 bpm
- Normal Hemoglobin: 11-13 g/dL (lower limit due to dilutional anemia)
- Blood Pressure Goals in Pregnancy: <140/90 mmHg
- Gestational Diabetes Mellitus (GDM) Diagnostic Criteria:
- Fasting glucose >92 mg/dL
- 1-hour: >180 mg/dL
- 2-hour: >153 mg/dL
Booking Investigations
- Performed between 8-12 weeks of gestation to establish baseline maternal health
- Includes full blood count, blood group and Rh factor, antibody screening, syphilis, HIV, hepatitis B & C screening, rubella immunity status, urinalysis, and urine culture
-
Full Blood Count (FBC) - Detects anemia, thrombocytopenia, and leukocytosis.
- Normal Ranges:
- Hemoglobin: 12-16 g/dL
- Platelets: 150-400 × 10⁹/L
- White Blood Cells: 4,000-11,000/µL
- Anemia is treated with iron and folic acid supplementation
- Normal Ranges:
-
Blood Group and Rhesus (Rh) Factor
- Identifies blood group and Rh factor
- Rh-negative women may require anti-D immunoglobulin to prevent hemolytic disease of the newborn if carrying an Rh-positive fetus
-
Antibody Screening
- Checks for atypical antibodies that could cause hemolytic disease of the fetus and newborn
-
Syphilis Screening (VDRL/RPR)
- Detects syphilis, which can lead to stillbirth or congenital syphilis if untreated
-
HIV Screening
- Identifies HIV-positive mothers and allows for antiretroviral therapy to prevent vertical transmission
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Hepatitis B and C Screening
- Detects infection and allows for precautions to prevent transmission to the baby
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Rubella Immunity Status
- Determines immunity against rubella, which can cause severe congenital anomalies if contracted during pregnancy
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Urinalysis and Urine Culture
- Detects proteinuria (preeclampsia), urinary tract infections (UTIs), or glycosuria (suggestive of diabetes)
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Blood Sugar (Glucose Tolerance Test, GTT):
- Timing: 24-28 weeks gestation
- Detects gestational diabetes mellitus (GDM)
Placental Abruption
- Premature separation of the placenta from the uterine wall before delivery
- Leads to hemorrhage and compromised fetal oxygenation
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Risk Factors:
- Previous placental abruption
- Hypertension or preeclampsia
- Trauma
- Smoking, cocaine use
- Advanced maternal age
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Clinical Features:
- Painful vaginal bleeding
- Abdominal pain or uterine tenderness
- Uterine contractions and fetal distress
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Investigations:
- Ultrasound to identify the retroplacental clot
- Fetal monitoring for distress
- CBC, coagulation profile
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Management:
- Stabilize the mother with IV fluids and blood products
- Immediate delivery if fetal or maternal compromise
- Conservative management if stable and preterm
Placenta Previa
- Placenta is abnormally implanted in the lower uterine segment, covering or partially covering the cervix
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Risk Factors:
- Previous placenta previa
- Multiple gestations
- Previous C-section or uterine surgery
- Advanced maternal age
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Clinical Features:
- Painless vaginal bleeding, typically in the second or third trimester
- No uterine tenderness or contractions
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Investigations:
- Ultrasound (transabdominal or transvaginal) to locate placental position
- Fetal monitoring
-
Management:
- Close monitoring and serial ultrasounds
- Corticosteroids for fetal lung maturity if preterm
- Delivery via C-section at 36-37 weeks or earlier if severe bleeding occurs
Preeclampsia
- Hypertensive disorder of pregnancy characterized by new-onset hypertension (≥140/90 mmHg) and proteinuria (>300 mg/24 hours) after 20 weeks of gestation
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Risk Factors:
- First pregnancy
- History of preeclampsia or family history
- Multiple gestations
- Chronic hypertension or renal disease
- Diabetes mellitus
- Obesity or advanced maternal age
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Investigations:
- Blood Pressure Measurement: To monitor hypertension
- Urinalysis: Detects proteinuria
- 24-hour Urine Collection: Confirms proteinuria (>300 mg/24 hours)
- Blood Tests:
- Liver function tests (ALT, AST):Detects HELLP syndrome
- Serum creatinine: Assess renal function
- Platelet count: Thrombocytopenia can indicate severe preeclampsia
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Management
- Mild Preeclampsia:
- Monitor blood pressure and proteinuria
- Rest and reduced physical activity
- Severe Preeclampsia:
- Hospitalization, blood pressure control with labetalol or nifedipine
- Magnesium sulfate to prevent seizures
- Delivery if ≥37 weeks or if maternal/fetal compromise
- Mild Preeclampsia:
Gestational Diabetes Mellitus (GDM)
- Glucose intolerance diagnosed during pregnancy
- Associated with complications like fetal macrosomia, shoulder dystocia, and neonatal hypoglycemia
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Diagnosis:
- Oral Glucose Tolerance Test (OGTT):
- 75g OGTT at 24-28 weeks
- Fasting glucose >92 mg/dL, 1-hour >180 mg/dL, or 2-hour >153 mg/dL
- Oral Glucose Tolerance Test (OGTT):
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Management:
- Diet and Exercise: First-line treatment
- Blood Glucose Monitoring: Maintain fasting levels 140 mg/dL), confirm with a 100g oral glucose tolerance test (OGTT).
- Insulin is added if glycemic control is inadequate
- Complications: Macrosomia, shoulder dystocia, neonatal hypoglycemia
Hypertensive Disorders in Pregnancy
- Gestational Hypertension: BP ≥140/90 mmHg after 20 weeks without proteinuria
- Preeclampsia: BP ≥140/90 mmHg and proteinuria (>300 mg/24 hours)
- Eclampsia: Preeclampsia with seizures
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Management: Delivery is definitive treatment for severe cases
- Labetalol or methyldopa for BP control
- Magnesium sulfate for seizure prophylaxis
Postpartum Care
- Monitor for PPH, uterine atony, and signs of infection
- Assess emotional and psychological well-being (e.g., screen for postpartum depression)
Important Values to Remember
- Normal FHR: 110-160 bpm
- Normal Hemoglobin: 11-13 g/dL (lower limit due to dilutional anemia)
- Blood Pressure Goals in Pregnancy:
- Gestational Hypertension: BP ≥140/90 mmHg after 20 weeks without proteinuria
- Preeclampsia: BP ≥140/90 mmHg and proteinuria (>300 mg/24 hours)
- 75g OGTT for gestational diabetes
- Fasting: >92 mg/dL
- 1-hour: >180 mg/dL
- 2-hour: >153 mg/dL
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Description
This quiz covers essential blood tests and screening procedures vital for maternal and fetal health. Participants will learn about tests like Full Blood Count, HIV screening, and syphilis screening, as well as their implications for pregnancy. Understand the significance of each test and how they contribute to safe pregnancy outcomes.
