Obstetrics Marrow Pg 305-314 (Normal Pregnancy & ANC)
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Obstetrics Marrow Pg 305-314 (Normal Pregnancy & ANC)

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Questions and Answers

What does Gravida represent in a woman's pregnancy history?

  • The number of pregnancies that have reached viability
  • The number of times a woman has been pregnant (correct)
  • The current pregnancy only
  • None of the above

    • Parity includes the current pregnancy in its calculation.

    False

    What is the period of viability as considered in India?

    28 weeks

    The method that combines the Gravida and Parity calculations is known as ______.

    <p>Gx Py</p> Signup and view all the answers

    Match the following components of GTPAL with their definitions:

    <p>G = Number of pregnancies including current T = Number of term deliveries (≥37 weeks) P = Number of preterm deliveries (&lt;37 weeks) A = Number of pregnancies ending in abortion</p> Signup and view all the answers

    Which of the following is NOT a significant finding associated with Single Umbilical Artery (SUA)?

    <p>Increased fetal movement</p> Signup and view all the answers

    Karyotyping is necessary if a gross congenital anomaly is present in the case of Single Umbilical Artery.

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

    List one predisposing factor for Single Umbilical Artery.

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

    In high-risk pregnancies with SUA, fetal monitoring should begin at __________ weeks gestation.

    <p>32</p> Signup and view all the answers

    Match the following conditions with their associated fetal complications:

    <p>Parvovirus B19 infection = Fetal anemia Twin-to-twin transfusion syndrome = Fetal anemia Rh isoimmunization = Fetal anemia Single Umbilical Artery = Cardiovascular abnormalities</p> Signup and view all the answers

    Which of the following is NOT a definitive sign of pregnancy?

    <p>Nausea in the morning</p> Signup and view all the answers

    Quickening is the first sensation of fetal movement felt by a mother.

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

    At what gestational week does the height of the uterus reach the pubic symphysis?

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

    The symptoms of morning sickness are primarily attributed to ______.

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

    Match the following symptoms to their correct trimester:

    <p>Amenorrhea = First trimester Quickening = Second trimester Braxton Hicks contractions = Second trimester Morning sickness = First trimester</p> Signup and view all the answers

    What is the average length of a normal umbilical cord?

    <p>40-70 cms</p> Signup and view all the answers

    The umbilical cord contains only two vessels at term.

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

    What is the connective tissue found in the umbilical cord?

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

    A short umbilical cord is defined as being less than ______ cms.

    <p>32</p> Signup and view all the answers

    What is the most common idiopathic cause of intrauterine fetal death?

    <p>Unrecognized intrauterine growth restriction</p> Signup and view all the answers

    Match the following features of umbilical cord with their descriptions:

    <p>Short cord = &lt; 32 cms Long cord = ≥ 70 cms Normal length = 40-70 cms Folds of cord = Folds of Hoboken</p> Signup and view all the answers

    A stillbirth is defined as a pregnancy loss that occurs after 20 weeks of gestation.

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

    What is the preferred mode of delivery for a case of intrauterine fetal death?

    <p>Vaginal delivery</p> Signup and view all the answers

    The _____ sign indicates collapse of the fetal skull in ultrasound findings for intrauterine fetal death.

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

    Match the following signs with their respective descriptions related to intrauterine fetal death:

    <p>Robert's sign = Bubbles in great vessels of the fetus Ball sign = Hyperflexion/Hyperextension of fetal spine Crowding of ribs = Decreased space around fetal ribs Absence of cardiac activity = Indicators of fetal death in ultrasound</p> Signup and view all the answers

    What is a key factor that contributes to changes in blood flow patterns as pregnancy progresses?

    <p>Progesterone levels</p> Signup and view all the answers

    At what week can a fetal heart sound (FHS) be detected using a hand-held Doppler?

    <p>10 weeks</p> Signup and view all the answers

    The S/D ratio increases as pregnancy advances.

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

    What condition is referred to as Uteroplacental Insufficiency (UPI)?

    <p>A condition related to pregnancy that involves inadequate blood flow to the placenta.</p> Signup and view all the answers

    External ballottement can be observed as early as 16 weeks of pregnancy.

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

    As pregnancy progresses, the S/D Ratio __________.

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

    What is the primary symptom in the third trimester that results from the fetal head irritating the bladder?

    <p>Increased urinary frequency</p> Signup and view all the answers

    During the second trimester, cutaneous changes and breast changes are most prominent, leading to the appearance of __________.

    <p>striae gravidarum</p> Signup and view all the answers

    Match the following blood flow characteristics with their significance in pregnancy:

    <p>Decreased S/D Ratio = Indicates increased placental blood flow Increased Progesterone = Supports fetal development Uteroplacental Insufficiency = Limits oxygen and nutrients to the fetus Normal Blood Flow Pattern = Promotes optimal placental function</p> Signup and view all the answers

    Match the symptoms experienced in the third trimester with their descriptions:

    <p>Increased urinary frequency = Irritation of the bladder by fetal head Respiratory discomfort = Diaphragm pushed upward by uterus Pedal edema = Pressure from the gravid uterus Backache = Pain due to changes in body posture</p> Signup and view all the answers

    Which sign is the first to become positive in pregnancy?

    <p>Goodell sign</p> Signup and view all the answers

    An elderly primigravida is a female who has conceived for the first time at age 30 or older.

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

    What are the two types of signs that can be felt by the patient during pregnancy?

    <p>Presumptive signs and probable signs</p> Signup and view all the answers

    The __________ sign involves bluish discoloration of the cervix and vagina at around 8 weeks of pregnancy.

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

    Match the following probable signs of pregnancy with their descriptions:

    <p>Goodell sign = Softening of cervix Hegar sign = Soft isthmus on bimanual palpation Palmer sign = Rhythmic uterine contractions Piskacek sign = Asymmetric enlargement of uterus</p> Signup and view all the answers

    What is the recommended management if absent end diastolic flow is detected at 33-34 weeks?

    <p>Administer corticosteroids and monitor</p> Signup and view all the answers

    Middle Cerebral Artery Doppler is used to evaluate Intrauterine Growth Restriction (IUGR).

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

    What is the peak systolic velocity (PSV) threshold by MCA that indicates significant fetal anemia?

    <p>≥ 1.5 mom</p> Signup and view all the answers

    In cases of polycythemia, the peak systolic velocity of the MCA is __________.

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

    Match the following components of Doppler evaluation with their indications:

    <p>Umbilical artery Doppler = Uteroplacental insufficiency (UPI) Middle Cerebral Artery Doppler = Fetal anemia Absent end diastolic flow = Admit and corticosteroids Reversed end diastolic flow = Fetal heart monitoring</p> Signup and view all the answers

    At what gestational week is excessive breathlessness most commonly experienced due to the baby's head descending into the pelvis?

    <p>36 weeks</p> Signup and view all the answers

    The height of the uterus increases from 32 weeks to 40 weeks of pregnancy.

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

    What does it indicate if the height of the uterus is less than the expected period of gestation?

    <p>Intrauterine Growth Restriction (IUGR) or uteroplacental insufficiency</p> Signup and view all the answers

    The measurement for fundal height in centimeters should equal the period of gestation in ________.

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

    Match the following conditions with their potential causes of abnormal uterine height:

    <p>Fundal height &gt; Period of gestation = Polyhydramnios Fundal height &lt; Period of gestation = Transverse lie</p> Signup and view all the answers

    What symptom is relieved at 40 weeks of gestation as compared to 32 weeks?

    <p>Respiratory difficulties</p> Signup and view all the answers

    Ultrasound is advised if the fundal height discrepancy is less than 3 cm.

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

    List one reason why the height of the uterus may be greater than the expected period of gestation.

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

    Study Notes

    Gravida & Parity

    • Gravida refers to the total number of times a woman has been pregnant, including the current pregnancy.
    • Parity refers to the number of pregnancies that have reached the period of viability, excluding the current pregnancy.
    • Viability in India is considered to be 28 weeks.
    • Two methods are used to illustrate Gravida and Parity:
      • Gx Py: Combines Gravida and Parity using a numerical combination (e.g., G3P2).
      • GTPAL: Preferred method.
        • G: Gravida
        • T: Number of term deliveries (≥37 weeks)
        • P: Number of preterm deliveries (20-37 weeks)
        • A: Number of abortions (spontaneous or induced)
        • L: Number of living children

    Single Umbilical Artery (SUA)

    • Micro/coarse vascular abnormality of the umbilical cord.
    • Significant finding associated with gross congenital anomaly (GCA).
    • Associated with renal system and cardiovascular system abnormalities.
    • Doppler USG for umbilical artery:
      • If GCA present, karyotyping is not necessary.
      • If GCA absent, karyotyping is necessary.
    • Predisposing factors for SUA:
      • Twin pregnancy
      • Diabetes in pregnancy

    High-Risk Pregnancies

    • Initiate fetal monitoring from 32 weeks gestation.
    • Fetal monitoring includes:
      • Non-stress test (NST): weekly/biweekly/daily.
      • Biophysical profile score: weekly/biweekly/daily.
      • Ultrasound for fetal growth: weekly/biweekly/daily.

    Cardiotocography (CTG)

    • Intrauterine pressure (UPI): Late decelerations.
    • Cord compression: Variable decelerations.
    • Fetal anemia: Sinusoidal heart rate pattern.

    Conditions Associated with Fetal Anemia

    • Parvovirus B19 infection.
    • Twin-to-twin transfusion syndrome (TTTS).
    • Rh isoimmunization.

    Definitive Signs of Pregnancy

    • Gestational sac with yolk sac/Fetal poles.
    • Cardiac activity +
    • FHS + on auscultation.
    • Fetal parts felt on examination.
    • Fetal skeleton on x-ray.

    Pseudocyesis/False pregnancy:

    • Patient presumes/Fakes pregnancy.

    Presumptive Symptoms of Pregnancy

    • Symptoms of 1st trimester (T₁):
      • Amenorrhea: D/t ↑ Progesterone.
      • Morning sickness: Nausea + vomiting d/t hCG.
      • ↑ Urinary frequency: Growing uterus irritates bladder.
      • Breast tenderness.

    Size of Uterus

    • ↑ by 1cm/week after the 4th week of pregnancy.
    • Pelvic organ.
    • At 12 wks: Height of uterus = Pubic symphysis.

    Period of Gestation | Comparable to

    • 6-8 wks | Pear
    • 8-10 wks | Orange
    • 10-12 wks | Grapefruit

    Second Trimester (T₂)

    • Nausea & vomiting subside: minimum levels of hCG at ≥ 16 wks.
    • ↓ urinary frequency: uterus becomes an abdominal organ.
    • Quickening:
      • 1st sensation of fetal movement by mother.
      • Timing→ Primigravida: 18-20 wks.
      • multigravida: 16-18 wks.
    • Braxton Hicks contractions:
      • Onset: 16 wks, ↑ Near term.
      • Painless uterine contraction.
      • Does not lead to cervical dilatation.

    True Labor Pains

    • Painful.
    • Leads to dilatation of cervix.

    Features of Umbilical Cord

    • Length of cord: 40-70cms.
    • Short cord: &#60 32cms.
    • Long cord: ≥ 70 cms.
    • Connective tissue of cord: Wharton's jelly.
    • Folds of cords: Folds of Hoboken.

    Umbilical Vessels

    • Early intrauterine life: 4 vessels
      • Right and left umbilical artery
      • Right and left umbilical vein.
    • At term: 3 vessels
      • Right and left umbilical artery
      • Left umbilical vein.
    • Hyrti anastomosis: Between umbilical arteries near placenta.

    Umbilical Artery Doppler

    • Regulation:
      • No nerve supply of its own.
      • Responds to vasoconstriction and vasodilation present in maternal blood.
      • Findings
        • Normal: Forward flow in systole and diastole.
        • As pregnancy advances:
          • ↓ PVR in umbilical artery (in response to progesterone).
          • Blood flow during diastole ↑.

    Intrauterine Fetal Death (IUD)

    • AKA Stillbirth.
    • Death of fetus ≥ 20 weeks.
    • Causes:
      • Idiopathic: most common.
      • Unrecognized IUGR (most common single cause).

    WHO Definitions:

    • IUD: Pregnancy loss when fetal weight ≥ 500gms.
    • Stillbirth: Pregnancy loss ≥ 28 weeks.

    Diagnosis of IUD:

    • ≥ 32 weeks:
      • Loss of fetal movement.
      • Modified BPS (Biophysical score) or NST.
    • &#60 32 weeks:
      • USG

    USG Findings:

    • Absence of cardiac activity.
    • Spalding sign: Collapse of fetal skull / Overlapping of skull bones.
    • Robert's sign (1st sign): Bubbles in great vessels of fetus.
    • Ball sign: Hyperflexion/Hyperextension of fetal spine.
    • Crowding of ribs.
    • Amniotic fluid: Tobacco juice color.

    Complications of IUD:

    • DIC (Rare):
      • Risk factor: Dead fetus retained ≥ 4 weeks.
      • Applied aspect: Diagnosed case of IUD 2/3 weeks back: Coagulation profile to be done.

    Management of IUD:

    • Mode of delivery: Vaginal delivery (Preferred).
    • Spontaneous Labor/Induction.
    • Indications for C-section:
      • Placenta previa.
      • Transverse Lie.
      • Obstructed labor.
      • ≥ 2 previous LSCS.

    Fetal Heart Sound (FHS)

    • Hand-held Doppler: 10 weeks.
    • Stethoscope: 20 weeks.

    Internal Ballottement

    • Head of the Baby: Pushed up per vaginally.
    • Head strikes opposite end of the uterus and returns to touch examiner's fingers; seen by 16 weeks.

    External Ballottement

    • Baby pushed from one side: Pushed from one side per abdominally.
    • Strikes palm of the opposite hand and returns; seen by 20 weeks.

    Cutaneous Changes + Breast Changes

    • Prominent in T2.
    • Linea nigra.
    • Striae gravidarum.
    • Chloasma.

    Third Trimester (T3)

    • Symptoms:
      • Increased urinary frequency: Due to irritation of the bladder by the fetal head.
      • Respiratory discomfort: Increased uterine height pushes the diaphragm up, leading to shortness of breath.
      • Pedal edema: Due to pressure from the gravid uterus.
      • Backache.

    Uteroplacental Insufficiency (UPI)

    • Normal Pregnancy Blood Flow: Diagram showing a graph of systolic and diastolic blood flow as pregnancy progresses.
    • S/D Ratio: Decreases as pregnancy advances.
    • Normal S/D ratio: ≤ 0.7.

    Important Terminologies

    • Multipara: Female who has given birth at least two times.
    • Grand Multipara: Female who has given birth at least five times.
    • Primigravida: Female who has conceived for the first time.
    • Elderly Primigravida: Female who has conceived for the first time at age 35 or older.
    • Multigravida: Female who has conceived at least two times.

    Signs & Symptoms of Pregnancy

    • Types:
      • Presumptive Signs: Felt by the patient.
      • Definitive Signs: Diagnostic of pregnancy.Felt by the examiner.
      • Probable Signs: First trimester (T₁).

    First Trimester (T1)

    • Probable Signs:
      • Goodell sign: 1st sign to be +ve.
        • Seen in 6 weeks of pregnancy.
        • Softening of cervix.
      • Piskacek sign:
        • Seen in 8 weeks.
        • Asymmetric enlargement of uterus d/t eccentric implantation.
      • Osiander sign:
        • Seen in 8 weeks.
        • Pulsations felt in the lateral fornix of vagina; D/t ↑ uterine blood flow.
      • Chadwick/Jacquemier sign:
        • Seen in 8 weeks.
        • Bluish discoloration of cervix & vagina.
      • Palmer sign:
        • Seen in 8 weeks.
        • Rhythmic uterine contractions.
      • Hegar sign:
        • Seen in 6-10 weeks.
        • Soft. Bimanual palpation: Vaginal & Abdominal fingers approximate each other (D/t Isthmus: Empty + Soft in early pregnancy).

    Height of Uterus

    • Diagram illustrating the height of the uterus relative to anatomical landmarks (xiphisternum, umbilicus, and pubic symphysis) at different gestational weeks (12, 16, 20, 24, 28, 32, and 36 weeks). Arrows indicate the downward movement of the uterus as the pregnancy progresses.
    • Table comparing 32 weeks and 40 weeks of pregnancy.
      • Parameters | 32 Weeks | 40 Weeks
      • Fetal head on P/A examination | Not Felt | Felt
      • Flanks | Empty | Full
      • Shelving | - | +
    • Text describing the difference between 32 weeks and 40 weeks of pregnancy:
      • At 36 weeks, common symptoms include excessive breathlessness, as the baby's head begins to descend into the pelvis. The height of the uterus decreases.
      • At 40 weeks the height of the uterus is equal to 32 weeks, but symptoms are different. Relief from respiratory difficulties, "lightening".

    Applied Aspects:

    • Height of uterus > Period of gestation: This condition may be due to a full bladder, wrong dates, polyhydramnios, twin pregnancy, molar pregnancy, concealed abruptio placentae, macrosomia, or intrauterine fibroid.
    • Height of uterus < Period of gestation: This could indicate wrong dates, Intrauterine Growth Restriction (IUGR), uteroplacental insufficiency, Pre-eclampsia (PIH), transverse lie, or an Intrauterine Device (IUD). Oligohydramnios is noted as a possible cause in the case of the height of the uterus is less than the period of the gestation.
    • Fundal height (in cms) = Period of gestation (In weeks):
      • If the fundal height does not correspond to the gestational period, an ultrasound (USG) is advised.
      • A discrepancy of 3 weeks/3cm suggests a pathological cause, needing further investigation.

    Umbilical Cord and Doppler in Pregnancy

      1. Absent end diastolic flow:
      • TOP 33-34 weeks.
      1. Reversed end diastolic flow:
      • TOP 30-32 weeks.
    • If POG < 33 weeks:
      • Admit.
      • Corticosteroid.
      • Fetal monitoring.

    Evaluation of Umbilical Artery Doppler

    • At 33-34 weeks (TOP):
      • Umbilical artery doppler: Order of vessels to be studied.
        • First umbilical artery.
        • Last umbilical vein.
    • Note: Indication of umbilical artery doppler:
      • UPI.
      • PIH.
      • IUGR.

    Middle Cerebral Artery Doppler

    • Not used to evaluate:
      • IUGR: D/t brain sparing effect.
      • Early UPI: Normal MCA blood flow.
    • Indication:
      • Fetal anemia:
        • Hyperdynamic circulation.
        • ↑ Peak systolic velocity (PSV) by MCA: ≥ 1.5 mom.
      • Significant fetal anemia → Fetal heart failure.
    • In polycythemia:
      • PSV of MCA: ↓.

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    Test your knowledge on pregnancy history concepts, including Gravida and Parity, and key terms like GTPAL. This quiz also covers fetal anomalies such as Single Umbilical Artery and associated complications. Perfect for students studying obstetrics and maternal health.

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