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Questions and Answers
What is the primary role of hCG during pregnancy?
What is the primary role of hCG during pregnancy?
- Promotes fetal lung development
- Maintains the corpus luteum (correct)
- Increases maternal blood volume
- Stimulates sperm production
HCG is only produced after the first trimester of pregnancy.
HCG is only produced after the first trimester of pregnancy.
False (B)
What are the two subunits of hCG, and which one is specific?
What are the two subunits of hCG, and which one is specific?
α-Subunit and β-Subunit; the β-Subunit is specific.
HCG can be detected in urine on the day of the ______ period.
HCG can be detected in urine on the day of the ______ period.
Match the following functions of hCG with their descriptions:
Match the following functions of hCG with their descriptions:
At what hCG level is a gestational sac visible on a transvaginal ultrasound (TVS)?
At what hCG level is a gestational sac visible on a transvaginal ultrasound (TVS)?
Increased hCG levels are associated with ectopic pregnancy.
Increased hCG levels are associated with ectopic pregnancy.
What condition is indicated by increased hCG levels in a pregnancy?
What condition is indicated by increased hCG levels in a pregnancy?
A decrease in hCG is associated with __________ pregnancy.
A decrease in hCG is associated with __________ pregnancy.
Match the following conditions with their associated hCG levels:
Match the following conditions with their associated hCG levels:
What type of reproduction complication is most commonly associated with velamentous insertion of the cord?
What type of reproduction complication is most commonly associated with velamentous insertion of the cord?
Fetal distress following artificial rupture of membranes usually indicates a normal fetal heart rate pattern.
Fetal distress following artificial rupture of membranes usually indicates a normal fetal heart rate pattern.
What is the recommended mode of delivery for cases detected antenatally with complications related to fetal distress?
What is the recommended mode of delivery for cases detected antenatally with complications related to fetal distress?
In cases of _____________, fetal heart rate is usually normal until significant blood loss occurs.
In cases of _____________, fetal heart rate is usually normal until significant blood loss occurs.
Match the following complications with their characteristics:
Match the following complications with their characteristics:
What is the main complication associated with velamentous insertion of the umbilical cord?
What is the main complication associated with velamentous insertion of the umbilical cord?
Battledore placenta refers to the umbilical cord being inserted at the center of the placenta.
Battledore placenta refers to the umbilical cord being inserted at the center of the placenta.
What connective tissue is lost in the membranes during velamentous insertion?
What connective tissue is lost in the membranes during velamentous insertion?
The most common cause of vasa previa is __________ insertion of the cord.
The most common cause of vasa previa is __________ insertion of the cord.
Match the type of abnormal cord insertion with its description:
Match the type of abnormal cord insertion with its description:
What is the earliest detectable level of hCG in a blood pregnancy test?
What is the earliest detectable level of hCG in a blood pregnancy test?
HCG has a half-life of 48 hours.
HCG has a half-life of 48 hours.
What is the minimum detectable value for a urine pregnancy test?
What is the minimum detectable value for a urine pregnancy test?
Increased hCG levels by less than 30% may indicate a probable __________ pregnancy.
Increased hCG levels by less than 30% may indicate a probable __________ pregnancy.
Match the following hCG patterns with their clinical interpretations:
Match the following hCG patterns with their clinical interpretations:
What initiates uterine contractions at the onset of labor?
What initiates uterine contractions at the onset of labor?
Relaxin is responsible for joint laxity during pregnancy.
Relaxin is responsible for joint laxity during pregnancy.
What hormone is produced by the syncytiotrophoblast?
What hormone is produced by the syncytiotrophoblast?
In anencephaly, the adrenal glands are __________ or __________.
In anencephaly, the adrenal glands are __________ or __________.
Match the following placental hormones with their functions:
Match the following placental hormones with their functions:
What is a major risk associated with a retained lobe of a placenta succenturiata?
What is a major risk associated with a retained lobe of a placenta succenturiata?
Placenta accreta is characterized by a placenta that is superficially attached to the myometrium.
Placenta accreta is characterized by a placenta that is superficially attached to the myometrium.
What are the two types of placental anomalies mentioned?
What are the two types of placental anomalies mentioned?
Placenta __________ is when the placenta is divided into two roughly equal parts connected by blood vessels.
Placenta __________ is when the placenta is divided into two roughly equal parts connected by blood vessels.
Match the types of placenta with their corresponding descriptions:
Match the types of placenta with their corresponding descriptions:
Which of the following is a feature of the Apt test?
Which of the following is a feature of the Apt test?
Fetal blood, specifically HbF, is sensitive to both acid and alkali.
Fetal blood, specifically HbF, is sensitive to both acid and alkali.
What color change indicates a negative Apt test result?
What color change indicates a negative Apt test result?
In fetal hematopoiesis, the first site is the ______, which functions until 6 weeks.
In fetal hematopoiesis, the first site is the ______, which functions until 6 weeks.
Match the following sites of fetal hematopoiesis with their corresponding timing:
Match the following sites of fetal hematopoiesis with their corresponding timing:
What is characteristic of a circumvallate placenta?
What is characteristic of a circumvallate placenta?
A circumvallate placenta is associated with increased risk of intrauterine growth restriction (IUGR).
A circumvallate placenta is associated with increased risk of intrauterine growth restriction (IUGR).
What is the primary impact of an abnormal cord insertion?
What is the primary impact of an abnormal cord insertion?
The normal insertion of the umbilical cord occurs at the __________ of the fetal surface.
The normal insertion of the umbilical cord occurs at the __________ of the fetal surface.
Match the types of placentas with their characteristics:
Match the types of placentas with their characteristics:
What is the time of placental separation during labor?
What is the time of placental separation during labor?
The human placenta is classified as non-deciduate.
The human placenta is classified as non-deciduate.
What is the surest sign of placental separation during labor?
What is the surest sign of placental separation during labor?
The feature of placental separation in the Schultze method occurs from the ______.
The feature of placental separation in the Schultze method occurs from the ______.
Which method of placental separation features a dull maternal surface?
Which method of placental separation features a dull maternal surface?
Match the signs of placental separation with their descriptions:
Match the signs of placental separation with their descriptions:
What is the characteristic feature of retro-placental clots in the Duncan Method?
What is the characteristic feature of retro-placental clots in the Duncan Method?
What is the average hemoglobin level in newborns?
What is the average hemoglobin level in newborns?
The plane of placental separation is the ______.
The plane of placental separation is the ______.
Placental separation occurs 24 hours after delivery.
Placental separation occurs 24 hours after delivery.
Study Notes
hCG
- Glycoprotein hormone with alpha (similar to LH, FSH, TSH) and beta (specific) subunits.
- Functions:
- Maintains corpus luteum in pregnancy.
- Stimulates testosterone release from testes.
- Stimulates maternal thyroid gland.
- Relaxes smooth muscle, keeping uterus quiescent during pregnancy.
- Produced from the 3rd week of pregnancy, peaking at the 36th week.
- Indicator of placental well-being, ensuring sufficient glucose supply to the fetus.
- Responsible for insulin resistance in pregnancy, increasing with advancing gestation.
- Increases lipolysis in the mother, sparing glucose for the fetus.
- Detectable in blood 8 days after fertilization or day 22, and in urine on the day of the missed period.
- Doubling time in early pregnancy is 48 hours.
hCG Values and Associated Conditions
- Increased hCG:
- Twin pregnancy.
- Molar pregnancy.
- Rh-negative pregnancy.
- Down syndrome.
- Gestational trophoblastic neoplasia.
- Decreased hCG:
- Ectopic pregnancy.
- Abortion.
- Trisomy (other than Down syndrome).
Types of Abnormal Cord Insertion
- Battledore placenta/Lateral Insertion of Cord: Umbilical cord attaches laterally to the placenta instead of the center.
- Velamentous Insertion of Cord:
- Umbilical cord inserts indirectly into the placenta through fetal membranes.
- Loss of Wharton's jelly in the membranes.
- Blood vessels directly attach to the placenta.
- Grave complication: Vasa previa (fetal blood loss).
Vasa Previa
- Most common cause is velamentous insertion of the cord.
- Fetal membranes rupture resulting in bleeding from umbilical vein and artery (fetal blood loss).
- Complication: Perinatal mortality.
Types of Placental Anomalies
Placenta Bilobata
- Placenta divided into two roughly equal parts connected by blood vessels.
Placenta Succenturiata
- Placenta unequally divided into a big and small part (succenturiate lobe) connected by blood vessels.
- Complications:
- Retained lobe of placenta → PPH.
- Increased placenta size ↑ risk of placenta previa → APH.
Placental Separation
- Human placenta: Deciduate.
- Time of separation: 3rd stage of labor.
- Plane of separation: Zona spongiosa.
Methods of Placental Separation
Schultze Method
- Placental separation from the center.
- Retro-placental clot forms after complete placental separation.
- Shiny fetal surface expelled first (most common).
Duncan Method
- Placental separation from the periphery.
- Retro-placental clot forms as soon as the placenta separates.
- Dull maternal surface expelled first (less common).
Signs of Placental Separation
- Gush of blood.
- Umbilical bulge.
- Slight increase in height of uterus.
- Permanent + apparent lengthening of cord.
- Surest sign: Placenta felt on PV examination.
Apt test / Singer's alkali denaturation test
- Used to differentiate between vasa previa and placenta previa.
- Reagent: KOH/NaOH.
- Principle: Fetal blood (HbF) is resistant to acid and alkali, while maternal blood (HbA) is sensitive.
- Procedure: Blood from the mother's vagina + KOH/NaOH
- No change in color of blood (HbF): Apt test +ve, Vasa previa.
- Color changes to brown (HbA): Apt test –ve, Placenta previa.
Fetal Hematopoiesis
| Site | Timing | Hemoglobin |
|---|---|---|
| Yolk sac (1st) | < 6 wks | Gower I, Gower 2, Portland Hb |
| Liver | 6 - 30 wks | HbF |
| Bone marrow | ≥ 20 wks | HbA |
Extrachorial Placenta
- Maternal surface of placenta is bigger than the fetal surface, forming a ring around the fetal surface.
Types
Circummarginate Placenta
- Smooth transition between fetal and maternal surfaces.
- Fetal and maternal surfaces are at the same level.
Circumvallate Placenta
- A valve-like thickening is present between fetal and maternal surfaces.
- Fetal surface is slightly depressed compared to the maternal surface.
Complications (Circummarginate Placenta)
- IUGR.
- APH.
Abnormal Cord Insertion
- Normal: Umbilical cord inserted at the center of the fetal surface of the placenta.
Placenta Accreta Spectrum
- Placenta Accreta, Increta, Percreta
- Based on villi attachment depth.
- Superficial, Deep, Attached to Serosa
Site vs Applied Anatomy
| Site | Applied Anatomy |
|---|---|
| Placenta | Upper uterine segment |
| Chorionic Villi | Attached to endometrium |
| Placenta previa located in the lower uterine segment (LUS) |
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Description
This quiz covers the role of human chorionic gonadotropin (hCG) in pregnancy, including its functions, production timeline, and significance in detecting pregnancy. Additionally, it explores conditions associated with increased hCG levels and their implications for maternal and fetal health.
