Human Reproduction and Pregnancy Quiz
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Questions and Answers

Where does fertilization occur?

  • Uterine cavity
  • Ampulla of Fallopian tube (correct)
  • Cervix
  • Ovary

    • Implantation in the uterine cavity takes place on Day 11.

    True

    What is the total duration of a full-term pregnancy?

    39-40 weeks

    A pregnancy is considered pre-term if it lasts less than _____ weeks.

    <p>37</p> Signup and view all the answers

    Match the types of pregnancy with their weeks of gestation:

    <p>Pre-term pregnancy = &lt; 37 wks Early-term pregnancy = 37-38 wks + 6 days Full-term pregnancy = 39-40 wks + 6 days Late-term pregnancy = 41-41 wks + 6 days</p> Signup and view all the answers

    What does the 'G' in the GTPAL system represent?

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

    The zona pellucida is lost on Day 5 during the fertilization process.

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

    What is the first step in managing a case of bleeding at or beyond 28 weeks gestation with an unknown diagnosis?

    <p>Resuscitation with IV fluids and oxygen</p> Signup and view all the answers

    What is the ACOG recommendation for termination of pregnancy?

    <p>≥ 41 weeks</p> Signup and view all the answers

    The McAffe and Johnson regimen is initiated under any circumstances for managing placenta previa.

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

    What type of anemia is most commonly associated with pregnancy?

    <p>Iron Deficiency Anemia (IDA)</p> Signup and view all the answers

    The NESTROF test is used to differentiate between _____ and thalassemia.

    <p>Iron Deficiency Anemia</p> Signup and view all the answers

    Match the following anemia types with their characteristics:

    <p>Iron Deficiency Anemia = Microcytic, hypochromic anemia Thalassemia = NESTROF test +ve Normocytic normochromic anemia = MENTZER index &gt; 13 Microcytic anemia = MENTZER index &lt; 13</p> Signup and view all the answers

    Which of the following is a common indirect cause of maternal mortality in India?

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

    The Anemia Mukt Bharat program aims to treat anemia in the population.

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

    List two interventions included in the Anemia Mukt Bharat program.

    <p>Digital hemoglobinometer, Iron-folic acid pills</p> Signup and view all the answers

    What is the standard time frame for performing cervical cerclage during pregnancy?

    <p>12-14 weeks</p> Signup and view all the answers

    A cervical length measurement of less than 2.5 cm at 16 weeks indicates that progesterone treatment is not needed.

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

    What is the main purpose of using ultrasound in cases of placenta previa?

    <p>To confirm diagnosis and detect malpresentation.</p> Signup and view all the answers

    Pregnant females with a history of two or more painless abortions do not need __________.

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

    What is the most common cause of a transverse lie at term?

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

    Match the classification of placenta previa with its description:

    <p>Type 1 = Placental edge &lt; 2 cm from internal os Type 2 = Placental edge reaching the os Type 3 = Placental edge covering part of the os Type 4 = Placental edge covering the os completely</p> Signup and view all the answers

    What should be avoided during physical examinations in cases of placenta previa?

    <p>P/S and P/V examinations</p> Signup and view all the answers

    At what point in pregnancy is the best time to perform an ultrasound to rule out placenta previa?

    <p>Third trimester</p> Signup and view all the answers

    Which heart disease is the most common in pregnancy?

    <p>Mitral stenosis</p> Signup and view all the answers

    Eisenmenger's syndrome has the highest maternal mortality rate among heart diseases in pregnancy.

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

    What is the first symptom of mitral stenosis that may occur during pregnancy?

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

    The maximum permissible radiation exposure during pregnancy is __ Rads.

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

    Which condition is indicated for cesarean section due to heart involvement?

    <p>Aortic aneurysm</p> Signup and view all the answers

    Match the following heart conditions with their associated details:

    <p>Mitral Stenosis = Most common heart disease in pregnancy Atrial Septal Defect = Most common congenital heart disease in pregnancy Eisenmenger's Syndrome = Heart disease with maximum maternal mortality HOCM = Most common lesion reversible after delivery</p> Signup and view all the answers

    Prophylactic use of forceps during vaginal delivery is not recommended in heart disease management.

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

    Patients with heart disease should restrict __ fluids during labor.

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

    What is the recommended mode of delivery for a fetus weighing ≥ 4.5 kgs?

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

    Oral hypoglycemic agents (OHAs) can be used for pregnant patients with diabetes mellitus.

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

    What metabolic goals indicate the starting of insulin in diabetic patients?

    <p>If metabolic goals are not met.</p> Signup and view all the answers

    Fetal hyperglycemia can lead to __________, which is characterized by a fetal weight of ≥ 4 kg.

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

    At what gestational age should GDM screening typically occur?

    <p>24 - 28 weeks</p> Signup and view all the answers

    Match the complications of diabetes with their corresponding effects:

    <p>Macrosomia = Weight ≥ 4 kg Oligohydramnios = Low amniotic fluid Neonatal hypoglycemia = Low blood sugar in newborn Surfactant deficiency = Risk of respiratory distress syndrome</p> Signup and view all the answers

    Women with diabetes have a higher risk of developing gestational complications such as polyhydramnios.

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

    Termination for Type A2 diabetes is recommended to take place between __________ weeks if not well controlled.

    <p>36 - 37 weeks + 6 days</p> Signup and view all the answers

    Study Notes

    Fertilization

    • Fertilization occurs in the ampulla of the fallopian tube.
    • Morula is an 8-16 celled zygote.
    • Morula enters the uterine cavity on day 4.
    • Blastocyst formation begins on day 5.
    • The implantation window is from day 6-10.
    • Implantation ends on day 11.

    Pregnancy Duration

    • Total duration of pregnancy is 9 months + 7 days / 40 weeks / 280 days.
    • Period of gestation (POG) / Period of amenorrhoea (PO) / Period of pregnancy: Calculated from the first day of the last menstrual period (LMP).

    Types of Pregnancy

    • Pre-term pregnancy: Less than 37 weeks.
    • Early term pregnancy: 37-38 weeks + 6 days.
    • Full term pregnancy: 39-40 weeks + 6 days.
    • Late term pregnancy: 41-41 weeks + 6 days.
    • Post-term pregnancy: Greater than or equal to 42 weeks.

    Gravidity & Parity

    • Gravidity: Total number of times a female has conceived (including twins, which are considered a single conception).
    • Parity: Total number of past pregnancies that have resulted in a viable birth at or after 20 weeks.

    Cervical Insufficiency

    • History of two or more painless second trimester abortions : No investigation needed.
    • Pregnant female at 8 weeks (or) at 16 weeks: History-based diagnosis.
    • Pregnant female at 16 weeks with cervical length greater than 25 mm: Transvaginal ultrasound (TVS) for cervical length.
    • Pregnant female with history of one second trimester abortion (or) preterm labor: TVS for cervical length.
    • Length greater than 2.5 cm: Progesterone.
    • Length less than or equal to 2.5 cm: Progesterone + cervical cerclage (between 12-14 weeks).
    • Pregnant female with no history of second trimester abortion but cervical length less than 2.5 cm: Progesterone.

    Placenta Previa

    • New classification:
      • Low-lying placenta: Placental edge less than 2 cm from the internal os.
      • Placenta previa: Type 2, 3, and 4 of the older classification (placental edge either reaches the os or covers it).

    Placenta Previa Management

    • Pelvic examinations are contraindicated in placenta previa.
    • Transabdominal sonogram (TAS) is used to differentiate between placenta previa and abruptio placentae.
    • TVS is the investigation of choice.
    • Ultrasound is essential for:
      • Confirmation of diagnosis.
      • Detection of malpresentation (most common: Transverse lie > Breech).
      • Ruling out placenta accreta spectrum.

    Placenta Previa: Transverse Lie

    • Most common cause of transverse lie: Prematurity.
    • Most common cause of transverse lie at term: Placenta previa.
    • Best time to do USG to rule out previa: Third trimester.

    Management of Bleeding at Greater than or equal to 28 Weeks

    • Resuscitate:
      • Two large-bore IV cannula (14G, 16G).
      • Oxygen via mask.
      • Start intravenous fluids (crystalloids).
      • Urine input/output chart.
    • If vital signs are stable and fetal heart sounds are normal with no evidence of disseminated intravascular coagulation (DIC): Transabdominal sonogram (TAS).
    • If vital signs are unstable, fetal distress is present, or DIC is present: Cesarean section (irrespective of diagnosis).

    Management of Placenta Previa

    • Expected management is to continue the pregnancy with the McAfee and Johnson regimen if all the following are fulfilled:
      • Vitals are stable.
      • Corticosteroids are administered for lung maturity.
      • No active bleeding.
      • Tocolytics are used only if preterm labor is present.

    Iron Deficiency Anemia

    • Iron deficiency anemia is the most common pathological anemia in pregnancy.
    • It is the most common indirect cause of maternal mortality in India.
    • Microcytic hypochromic anemia.
    • NESTROF Test is used to differentiate between iron deficiency anemia and thalassemia.
    • A Mentzer index greater than 13: Iron deficiency anemia.
    • A Mentzer index less than 13: Thalassemia.

    Anemia Mukt Bharat Program

    • The aim of this program is to prevent anemia (not treat it).
    • Interventions:
      • Digital hemoglobinometer in Primary Health Centres (PHCs).
      • Iron-folic acid (IFA) pills.
      • Deworming.
      • Food fortification with iron.
      • Delayed cord clamping (to prevent neonatal anemia).
      • Addressing other causes.

    Heart Disease in Pregnancy

    • Most common heart disease in pregnancy: Mitral stenosis.
    • Most common congenital heart disease in pregnancy: Atrial septal defect (ASD).
    • Heart disease with the highest maternal mortality: Eisenmenger's syndrome.
    • Cesarean section is indicated for heart disease involving the aorta (aortic aneurysm, coarctation of the aorta, Marfan syndrome with aortic involvement, or patients on warfarin at the time of delivery).
    • Mitral stenosis with rheumatic etiology: Surgery should be performed before conception (if not, the first symptom of MS in pregnancy is dyspnea, which mimics a normal pregnancy symptom).

    Management of Symptomatic Mitral Stenosis

    • Area of the valve is less than 1.5 cm2: Balloon valvotomy or surgery is recommended.
    • Area of the valve is greater than 1.5 cm2: Medical management.

    Congenital Malformations

    • Most specific malformation: Caudal regression syndrome (sacral agenesis).
    • Most specific cardiac malformation: Transposition of the great arteries (TGA).
    • Most common lesion: Hypertrophic obstructive cardiomyopathy (HOCM).

    Diabetes in Pregnancy

    • Risk of congenital malformations is proportional to the HbA1C levels.
    • Congenital malformations may be present if HbA1C is greater than 6.5%.

    Radiation Exposure

    • Maximum permissible radiation during pregnancy: 5 rads.

    Management of Diabetes in Pregnancy

    • If metabolic goals are not met with diet and exercise, start insulin.
    • Oral hypoglycemic agents (OHAs) like metformin and glyburide can be used if the patient refuses insulin.
    • OHAs are contraindicated during pregnancy and gestational diabetes.

    Termination in Diabetes

    • Type A1: Termination at greater than or equal to 39 weeks.
    • Type A2:
      • Well controlled with insulin or OHA: Termination at greater than or equal to 39 weeks.
      • Not well controlled with insulin or OHA: Termination at 36-37 weeks + 6 days.

    Mode of Delivery

    • Vaginal delivery is preferred unless the weight of the fetus is greater than or equal to 4.5 kg, in which case a Cesarean section is indicated.

    Complications of Diabetes

    Maternal Complications

    • Increased chances of infection (asymptomatic bacteriuria, candidiasis).
    • Placentomegaly (Increased placental size) which can lead to preeclampsia/ pre-eclampsia (PIH), polyhydramnios, postpartum hemorrhage (PPH), abruption placentae, premature rupture of membranes (PROM), preterm labor (PTL), cord prolapse, and malpresentation.
    • Increased chance of developing diabetes in the future.

    Fetal Complications

    • Fetal hyperglycemia.
    • Macrosomia (weight greater than or equal to 4 kg).
    • Should dystocia.
    • Increased risk of abortion, stillbirth, and intrauterine growth restriction (IUGR).
    • Diabetic vasculopathy can lead to oligohydramnios.

    Neonatal Complications

    • Neonatal hypoglycemia.
    • Hypocalcemia, hypokalemia, hypomagnesemia.
    • Surfactant deficiency can lead to respiratory distress syndrome and necrotizing enterocolitis.
    • Hyperviscosity, hyperbilirubinemia, and polycythemia.
    • No anemia or mental retardation.

    IADPSG/ ADA Guidelines for Gestational Diabetes Mellitus (GDM)

    • Testing should be done at 24-28 weeks.
    • Fasting for 8 hours and then measure fasting blood sugar (FBS).
    • Give 75 g of oral glucose and measure blood glucose after 2 hours.

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    OBG Revision E6.5 PDF

    Description

    Test your knowledge on key aspects of human reproduction and pregnancy, including fertilization, implantation, and the GTPAL system. This quiz covers important milestones in pregnancy duration and ACOG recommendations. Perfect for students studying human biology or reproductive health.

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