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Questions and Answers
What does Gravida represent in a woman's pregnancy history?
What does Gravida represent in a woman's pregnancy history?
Parity includes the current pregnancy in its calculation.
Parity includes the current pregnancy in its calculation.
False
What is the period of viability as considered in India?
What is the period of viability as considered in India?
28 weeks
The method that combines the Gravida and Parity calculations is known as ______.
The method that combines the Gravida and Parity calculations is known as ______.
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Match the following components of GTPAL with their definitions:
Match the following components of GTPAL with their definitions:
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Which of the following is NOT a significant finding associated with Single Umbilical Artery (SUA)?
Which of the following is NOT a significant finding associated with Single Umbilical Artery (SUA)?
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Karyotyping is necessary if a gross congenital anomaly is present in the case of Single Umbilical Artery.
Karyotyping is necessary if a gross congenital anomaly is present in the case of Single Umbilical Artery.
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List one predisposing factor for Single Umbilical Artery.
List one predisposing factor for Single Umbilical Artery.
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In high-risk pregnancies with SUA, fetal monitoring should begin at __________ weeks gestation.
In high-risk pregnancies with SUA, fetal monitoring should begin at __________ weeks gestation.
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Match the following conditions with their associated fetal complications:
Match the following conditions with their associated fetal complications:
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Which of the following is NOT a definitive sign of pregnancy?
Which of the following is NOT a definitive sign of pregnancy?
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Quickening is the first sensation of fetal movement felt by a mother.
Quickening is the first sensation of fetal movement felt by a mother.
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At what gestational week does the height of the uterus reach the pubic symphysis?
At what gestational week does the height of the uterus reach the pubic symphysis?
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The symptoms of morning sickness are primarily attributed to ______.
The symptoms of morning sickness are primarily attributed to ______.
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Match the following symptoms to their correct trimester:
Match the following symptoms to their correct trimester:
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What is the average length of a normal umbilical cord?
What is the average length of a normal umbilical cord?
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The umbilical cord contains only two vessels at term.
The umbilical cord contains only two vessels at term.
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What is the connective tissue found in the umbilical cord?
What is the connective tissue found in the umbilical cord?
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A short umbilical cord is defined as being less than ______ cms.
A short umbilical cord is defined as being less than ______ cms.
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What is the most common idiopathic cause of intrauterine fetal death?
What is the most common idiopathic cause of intrauterine fetal death?
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Match the following features of umbilical cord with their descriptions:
Match the following features of umbilical cord with their descriptions:
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A stillbirth is defined as a pregnancy loss that occurs after 20 weeks of gestation.
A stillbirth is defined as a pregnancy loss that occurs after 20 weeks of gestation.
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What is the preferred mode of delivery for a case of intrauterine fetal death?
What is the preferred mode of delivery for a case of intrauterine fetal death?
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The _____ sign indicates collapse of the fetal skull in ultrasound findings for intrauterine fetal death.
The _____ sign indicates collapse of the fetal skull in ultrasound findings for intrauterine fetal death.
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Match the following signs with their respective descriptions related to intrauterine fetal death:
Match the following signs with their respective descriptions related to intrauterine fetal death:
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What is a key factor that contributes to changes in blood flow patterns as pregnancy progresses?
What is a key factor that contributes to changes in blood flow patterns as pregnancy progresses?
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At what week can a fetal heart sound (FHS) be detected using a hand-held Doppler?
At what week can a fetal heart sound (FHS) be detected using a hand-held Doppler?
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The S/D ratio increases as pregnancy advances.
The S/D ratio increases as pregnancy advances.
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What condition is referred to as Uteroplacental Insufficiency (UPI)?
What condition is referred to as Uteroplacental Insufficiency (UPI)?
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External ballottement can be observed as early as 16 weeks of pregnancy.
External ballottement can be observed as early as 16 weeks of pregnancy.
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As pregnancy progresses, the S/D Ratio __________.
As pregnancy progresses, the S/D Ratio __________.
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What is the primary symptom in the third trimester that results from the fetal head irritating the bladder?
What is the primary symptom in the third trimester that results from the fetal head irritating the bladder?
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During the second trimester, cutaneous changes and breast changes are most prominent, leading to the appearance of __________.
During the second trimester, cutaneous changes and breast changes are most prominent, leading to the appearance of __________.
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Match the following blood flow characteristics with their significance in pregnancy:
Match the following blood flow characteristics with their significance in pregnancy:
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Match the symptoms experienced in the third trimester with their descriptions:
Match the symptoms experienced in the third trimester with their descriptions:
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Which sign is the first to become positive in pregnancy?
Which sign is the first to become positive in pregnancy?
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An elderly primigravida is a female who has conceived for the first time at age 30 or older.
An elderly primigravida is a female who has conceived for the first time at age 30 or older.
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What are the two types of signs that can be felt by the patient during pregnancy?
What are the two types of signs that can be felt by the patient during pregnancy?
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The __________ sign involves bluish discoloration of the cervix and vagina at around 8 weeks of pregnancy.
The __________ sign involves bluish discoloration of the cervix and vagina at around 8 weeks of pregnancy.
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Match the following probable signs of pregnancy with their descriptions:
Match the following probable signs of pregnancy with their descriptions:
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What is the recommended management if absent end diastolic flow is detected at 33-34 weeks?
What is the recommended management if absent end diastolic flow is detected at 33-34 weeks?
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Middle Cerebral Artery Doppler is used to evaluate Intrauterine Growth Restriction (IUGR).
Middle Cerebral Artery Doppler is used to evaluate Intrauterine Growth Restriction (IUGR).
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What is the peak systolic velocity (PSV) threshold by MCA that indicates significant fetal anemia?
What is the peak systolic velocity (PSV) threshold by MCA that indicates significant fetal anemia?
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In cases of polycythemia, the peak systolic velocity of the MCA is __________.
In cases of polycythemia, the peak systolic velocity of the MCA is __________.
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Match the following components of Doppler evaluation with their indications:
Match the following components of Doppler evaluation with their indications:
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At what gestational week is excessive breathlessness most commonly experienced due to the baby's head descending into the pelvis?
At what gestational week is excessive breathlessness most commonly experienced due to the baby's head descending into the pelvis?
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The height of the uterus increases from 32 weeks to 40 weeks of pregnancy.
The height of the uterus increases from 32 weeks to 40 weeks of pregnancy.
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What does it indicate if the height of the uterus is less than the expected period of gestation?
What does it indicate if the height of the uterus is less than the expected period of gestation?
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The measurement for fundal height in centimeters should equal the period of gestation in ________.
The measurement for fundal height in centimeters should equal the period of gestation in ________.
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Match the following conditions with their potential causes of abnormal uterine height:
Match the following conditions with their potential causes of abnormal uterine height:
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What symptom is relieved at 40 weeks of gestation as compared to 32 weeks?
What symptom is relieved at 40 weeks of gestation as compared to 32 weeks?
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Ultrasound is advised if the fundal height discrepancy is less than 3 cm.
Ultrasound is advised if the fundal height discrepancy is less than 3 cm.
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List one reason why the height of the uterus may be greater than the expected period of gestation.
List one reason why the height of the uterus may be greater than the expected period of gestation.
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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: < 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.
- < 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).
- Goodell sign: 1st sign to be +ve.
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
-
- Absent end diastolic flow:
- TOP 33-34 weeks.
-
- 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.
- Umbilical artery doppler: Order of vessels to be studied.
- 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.
- Fetal anemia:
- In polycythemia:
- PSV of MCA: ↓.
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Description
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.