Human Reproduction and Pregnancy Quiz

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.

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.