Obstetrics Marrow Pg 285-294 (Fundamentals of Reproduction)
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Questions and Answers

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.

    False

    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.

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

    Match the following functions of hCG with their descriptions:

    <p>Maintains corpus luteum = Supports the ovarian structure during early pregnancy Stimulates testosterone release = Encourages male sex characteristics and sperm production Indicates placental well-being = Reflective of the health and function of the placenta Increases insulin resistance = Adaptation for better glucose availability for the fetus</p> Signup and view all the answers

    At what hCG level is a gestational sac visible on a transvaginal ultrasound (TVS)?

    <p>2000 IU</p> Signup and view all the answers

    Increased hCG levels are associated with ectopic pregnancy.

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

    What condition is indicated by increased hCG levels in a pregnancy?

    <p>Twin pregnancy</p> Signup and view all the answers

    A decrease in hCG is associated with __________ pregnancy.

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

    Match the following conditions with their associated hCG levels:

    <p>Twin pregnancy = Increased hCG Ectopic pregnancy = Decreased hCG Abortion = Decreased hCG Down syndrome = Increased hCG</p> Signup and view all the answers

    What type of reproduction complication is most commonly associated with velamentous insertion of the cord?

    <p>Vasa previa</p> Signup and view all the answers

    Fetal distress following artificial rupture of membranes usually indicates a normal fetal heart rate pattern.

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

    What is the recommended mode of delivery for cases detected antenatally with complications related to fetal distress?

    <p>Elective C-section</p> Signup and view all the answers

    In cases of _____________, fetal heart rate is usually normal until significant blood loss occurs.

    <p>placenta previa</p> Signup and view all the answers

    Match the following complications with their characteristics:

    <p>Vasa previa = Less bleeding, marked fetal distress Placenta previa = Fetal distress only with significant blood loss Type 1 complication = D/t velamentous insertion of cord Type 3 complication = D/t placenta previa (rare)</p> Signup and view all the answers

    What is the main complication associated with velamentous insertion of the umbilical cord?

    <p>Vasa previa</p> Signup and view all the answers

    Battledore placenta refers to the umbilical cord being inserted at the center of the placenta.

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

    What connective tissue is lost in the membranes during velamentous insertion?

    <p>Wharton's jelly</p> Signup and view all the answers

    The most common cause of vasa previa is __________ insertion of the cord.

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

    Match the type of abnormal cord insertion with its description:

    <p>Battledore placenta = Lateral insertion of the cord Velamentous insertion = Cord inserts through fetal membranes Vasa previa = Complication of fetal blood loss Wharton's jelly = Connective tissue in umbilical cord</p> Signup and view all the answers

    What is the earliest detectable level of hCG in a blood pregnancy test?

    <p>1-2 mIU/ml</p> Signup and view all the answers

    HCG has a half-life of 48 hours.

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

    What is the minimum detectable value for a urine pregnancy test?

    <p>20-60 mIU/ml of urine</p> Signup and view all the answers

    Increased hCG levels by less than 30% may indicate a probable __________ pregnancy.

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

    Match the following hCG patterns with their clinical interpretations:

    <p>↑ by &lt; 30% = Probable ectopic pregnancy ↑ by 33% to 66% = Viable intrauterine pregnancy ↓ = Dying IU pregnancy; Abortion</p> Signup and view all the answers

    What initiates uterine contractions at the onset of labor?

    <p>Functional withdrawal of progesterone and estrogen</p> Signup and view all the answers

    Relaxin is responsible for joint laxity during pregnancy.

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

    What hormone is produced by the syncytiotrophoblast?

    <p>Human placental lactogen</p> Signup and view all the answers

    In anencephaly, the adrenal glands are __________ or __________.

    <p>absent, hypoplastic</p> Signup and view all the answers

    Match the following placental hormones with their functions:

    <p>Relaxin = Smooth muscle relaxation and vasodilation Human placental lactogen = Supports fetal growth and alters maternal metabolism Hormones involved in labor onset = Withdrawal of progesterone and estrogen Relaxin and Human placental lactogen = Produced by placenta</p> Signup and view all the answers

    What is a major risk associated with a retained lobe of a placenta succenturiata?

    <p>Postpartum hemorrhage (PPH)</p> Signup and view all the answers

    Placenta accreta is characterized by a placenta that is superficially attached to the myometrium.

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

    What are the two types of placental anomalies mentioned?

    <p>Placenta bilobata and placenta succenturiata.</p> Signup and view all the answers

    Placenta __________ is when the placenta is divided into two roughly equal parts connected by blood vessels.

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

    Match the types of placenta with their corresponding descriptions:

    <p>Placenta accreta = Deeply attached to myometrium Placenta increta = Attached to serosa Placenta percreta = Morbidly adherent placenta Placenta bilobata = Divided into two equal parts</p> Signup and view all the answers

    Which of the following is a feature of the Apt test?

    <p>It differentiates between vasa previa and placenta previa.</p> Signup and view all the answers

    Fetal blood, specifically HbF, is sensitive to both acid and alkali.

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

    What color change indicates a negative Apt test result?

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

    In fetal hematopoiesis, the first site is the ______, which functions until 6 weeks.

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

    Match the following sites of fetal hematopoiesis with their corresponding timing:

    <p>Yolk sac = &lt; 6 wks Liver = 6 - 30 wks Bone marrow = ≥ 20 wks</p> Signup and view all the answers

    What is characteristic of a circumvallate placenta?

    <p>A valve-like thickening is present between fetal and maternal surfaces.</p> Signup and view all the answers

    A circumvallate placenta is associated with increased risk of intrauterine growth restriction (IUGR).

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

    What is the primary impact of an abnormal cord insertion?

    <p>It can lead to complications such as fetal distress.</p> Signup and view all the answers

    The normal insertion of the umbilical cord occurs at the __________ of the fetal surface.

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

    Match the types of placentas with their characteristics:

    <p>Circummarginate Placenta = Smooth transition between surfaces. Circumvallate Placenta = Valve-like thickening present. Normal Cord Insertion = Inserted at the center.</p> Signup and view all the answers

    What is the time of placental separation during labor?

    <p>Third stage of labor</p> Signup and view all the answers

    The human placenta is classified as non-deciduate.

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

    What is the surest sign of placental separation during labor?

    <p>Placenta felt on PV examination</p> Signup and view all the answers

    The feature of placental separation in the Schultze method occurs from the ______.

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

    Which method of placental separation features a dull maternal surface?

    <p>Duncan Method</p> Signup and view all the answers

    Match the signs of placental separation with their descriptions:

    <p>Gush of blood = Vaginal bleeding often occurring after delivery Umbilical bulge = Visible protrusion of the umbilical cord Height of uterus increase = Slight increase in the depth of the uterus Lengthening of cord = Permanent and apparent elongation of the umbilical cord</p> Signup and view all the answers

    What is the characteristic feature of retro-placental clots in the Duncan Method?

    <p>Form as soon as the placenta separates</p> Signup and view all the answers

    What is the average hemoglobin level in newborns?

    <p>16 - 18 g/dL</p> Signup and view all the answers

    The plane of placental separation is the ______.

    <p>zona spongiosa</p> Signup and view all the answers

    Placental separation occurs 24 hours after delivery.

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

    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.

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