Obstetrics 8

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prem.sigdel7
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Obstetrics 8
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2015-04-12 06:00:14
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IUGR Spontaneous abortions threatened missed inevitable incomplete complete Intrauterine fetal death
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Obstetrics
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  1. What is the full form of IUGR?
    Intrauterine growth restriction.

    It is not Intrauterine growth retardation as the baby is not retarded.
  2. Define IUGR?
    Birth weight <2500gms or 5 pound 8 ounces.

    Fetuses weighting <10th percentile for gestational age or < 2SD below the mean for gestational age have been classified as IUGR.
  3. What are the causes of IUGR? [AIIMS 91]
    • A. Fetal causes:
    • – Aneuploidy, Infections, (TORCHS), Structural anomalies (CHD, NTD, VWD)
    • – Symmetrical IUGR
    • B. Placental:
    • – Infarction, Abruption, TTTS, Velamentous cord insertion,
    • - Asymmetrical IUGR
    • C. Maternal cause:
    • – HTN, Renal diseases, Malnutrition, Tobacco, Smoking,  Alcohol
    • – Asymmetrical IUGR
    • D. Drugs:
    • - Captopril, Caffeine, Atenolol
  4. What is symmetrical and asymmetrical IUGR?
    • Symmetrical IUGR:
    • – HC, BPD, AC, FL all are smaller than expected.
    • - It results because of decreased growth potential as in aneuploidy, infections, gross anatomic anomaly.
    • - It is early onset. 

    • Asymmetrical IUGR:
    • head sparing [BHU 96] (BPD is comparatively normal) but abdomen small.
    • - It results d/t decreased placental perfusion because of placenta or maternal cause.
    • - It is late onset.
  5. What are the complications related small for date (IUGR) infants? [PGI 01]
    • Congenital anomalies 
    • Meconium aspiration 
    • Persistent pulmonary hypertension
    • Hypoglycemia [AIIMS 95] 
    • Hyponatremia
    • Perinatal depression
    • Pulmonary hemorrhage 
    • Hypothermia
    • Hypocalcemia
    • Polycythemia
  6. Why is the abdominal circumference small and and head normal in size in asymmetrical IUGR? Why are both abdomen and abdomen small In symmetrical IUGR?
    • The brain determines the BPD and liver determines the abdominal circumference.
    • In asymmetrical IUGR, The problem is decreases substrates to the fetus. the reason liver is small is because there is no enough storage of glycogen and fatty acids in the liver thus, making the liver small. This baby is starving in utero, the head is spared because the most of the nutrients go to the head via foramen ovale and into the aorta that takes blood to brain.
    • In symmetrical IUGR, both head and abdomen are small , it is because there is decreased potential of the fetus to grow.
  7. What are  Macrosomic babies?
    Birth wt > 4500 gms
  8. If you need to choose the baby with symmetrical and asymmetrical IUGR, which do you choose?
    • Asymmetrical IUGR - if you properly feed these babies, they will grow.
    • But the symmetrical IUGR babies donot grow enough how much you feed.
  9. What is the most common cause  of 1st trimester abortion? [UP 99]
    • Chromosomal abnormality (Aneuploidy).
    • Turners syndrome is the most common Aneuploidy disorder to be lost in 1st trimester – about   98%  of Turners syndrome  are lost during  1st trimester.
  10. What is  Anticardiolipin antibody?
    • It  is the antibody directed against the fetal  tissue   or placental tissue and causes recurrent  abortion. (???????)
    • - Management -- s/c  Heparin
  11. What is the most  important lab test after performing 1st trimester D&C?
    Blood Rh Status – if negative give RhoGAM.
  12. What are the differential diagnosis of 1st trimester bleeding? How do you manage them?
    • Note that ,  cervical/vaginal bleeding, Ectopic pregnancy and Molar pregnancy are the important causes  of bleeding. 


    These abortions  are actually the  same pathological processes but are picked  at different times. 

  13. What is Mobius syndrome?
    Mobius syndrome in fetus is recognized in infants of pregnant women exposed to Misoprostol [AI 12] (especially first trimester) if it fails to cause miscarriage/abortion. 

    Mobius syndrome is a rare disorder characterized by congenital palsy of abducent and facial nerves. The paralysis may be partial or complete, but is always non progressive.



    [Note: Mobius sign of eye - inability to converge eye, seen in Grave's dz]
  14. A lady presents with features of threatened abortion at 32 weeks of pregnancy. Which of the following statements with regard to antibiotic usage is NOT correct? [AI 10]
    A. Antibiotic prophylaxis even with unruptured membranes
    B. Antibiotics if asymptomatic but significant bacteremia
    C. Antibiotics for preterm premature rupture of membranes
    D. Metronidazole if asymptomatic but significant bacterial vaginosis
    A. Antibiotic prophylaxis even with unruptured membranes

    Routine use of antibiotics is not recommended with intact membranes.
    (this multiple choice question has been scrambled)
  15. Define fetal demise?
    Death ≥20 weeks POG upto birth either antepartum or intrapartum.
  16. What are the main causes of fetal demise?
    • Idiopathic
    • APLA. Treatment is Heparin in next pregnancy.
    • DM out of control
    • Maternal trauma
    • Severe isoimmunization
    • Fetal aneuploidy or infection
  17. What is the cause of DIC in fetal demise? How do you diagnose DIC due to fetal demise?
    • Release of tissue thromboplastin from dead fetus.
    • Diagnosis:
    • – low platelet and low fibrinogen (remember that all the plasma proteins go up in pregnancy except albumin),
    • - Increased d-dimer, PT and PTT
  18. What is the management of of fetal demise if DIC Is present and if DIC is absent?
    • DIC present - Immediate delivery
    • DIC absent - allow/enhance grief response, serial DIC labs.
    • (<20wks - D and E, >20wks, if fetal anomaly present, prefer PG to obtain the gross structure of the fetus for autopsy)
  19. What is Kleihauer Betke test?
    • It is a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother's bloodstream.
    • It is usually performed on Rhesus-negative mothers to determine the required dose of Rho(D) immune globulin (RhIg) to inhibit formation of Rh antibodies in the mother and prevent Rh disease in future Rh-positive children.
    • By counting the number of fetal cells in high power field, you can know how much ml of fetal blood are in maternal circulation.

    • [Fetal cells – larger and darker staining, Maternal cells – smaller and lighter staining]

    • [Note:
    • Apt-downey test aka Apt test, alkali denaturation test, is a qualitative test for fetal hemoglobin. [PGI 98]
    • It helps to differentiate fetal/neonatal blood from maternal blood in newborn's stool/vomitus.

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