Mission NEET-PG

@OBG Classes by Dr Raina

@Cerebellum Academy
 About me
Teacher (MBBS, MS, FICOG)
• @Cerebellum Academy
• @OBGclassesbyDrRaina/ OBG_classes_by_drraina
• Former Faculty at Lady Hardinge Medical College New Delhi, ESIC Medical College,
Faridabad and KMC, Mangalore

Senior Consultant and Unit Head @Sarvodaya Hospital

Poet @I_write_to_breathe

Mom to Eva and Neev

 1st Session
Day Date Topics to be Covered
Day 1 19/7/2023 Basics of Obstetrics (Antenatal care, Physiology of pregnancy,
Diagnosis of pregnancy, Teratogens, Fetal Imaging, Prenatal
Screening

Day 2 20/7/2023 Early pregnancy complications (Abortions, Ectopic Pregnancy,

Molar Pregnancy)
Complications specific to pregnancy (Amniotic fluid disorders,
Placental disorders. APH, Multiple Pregnancy)
Day 3 21/7/2023 Complications specific to pregnancy contd… (Rh isoimmunization,
FGR, Preterm, Post term)
Medical Complications in Pregnancy (HTN, DM, Important others)

Day 4 22/7/2023 Labor: Normal and Abnormal (including complications)

2nd Session
Day 5 1/8/2023 Menstrual physiology – basics, Amenorrhea, Mullerian Anomalies
Infertility

Day 6 2/8/2023 Benign Gyn Disorders

Gyn Oncology
Day 7 3/8/2023 Contraception
Urogynecology
Instruments and Operative of both Obs and Gyn
Day 8 4/8/2023 E&D
Day 1 (19/7/2023)
• Physiology of Pregnancy
• Diagnosis of Pregnancy
• Antenatal Care
• Prenatal Screening
• Teratogens
• Fetal imaging
Physiology of
Pregnancy
Hematological Changes
o ↑ Blood volume (by 40%)
o Max at 32-34 weeks
o Higher in multigravida, multiple pregnancy and large babies
o ↑ Red cell volume (20%)
o Physiological Anemia
o ↓ Hb (13.5 g% to 11.5g%)
Blood Coagulation Factors

Pregnancy is a hypercoagulable state

o Fibrinogen level: raised by 50%
o ↓ Platelet count (slight fall)
o Increase in plasma levels of Factors: 1, 7, 8, 9, 10
o Plasma levels of 2, 5, 12 and protein C – unchanged/ mildly increased
o Factors 11, 13 and protein S – Decreased (remember 13 is unlucky; also 11)
Normal Cardiac Exam findings in Pregnant women

1. Jugular venous distension

2. Mammary souffle
3. Venous Hum
4. Apex Beat deviated to the 4th intercostal space; 2.5 cm outside the
midclavicular line
5. Occasional S3
6. Aortic or Pulmonary Flow murmurs
7. Systolic Ejection murmur
Cardiac Output ↑ 40%
Stroke Volume ↑ 25%
Heart Rate ↑ 15%
BP Slightly falls (max in 2nd trimester)
CVP No change
MAP Slightly increased
Vascular resistance (pulmonary ↓
and systemic)
Pulmonary capillary wedge ↑
pressure
Supine hypotension syndrome:
o Seen in 3rd trimester
o Pressure of gravid uterus on the IVC in supine position
o C/F: Hypotension, tachycardia and syncope
o Especially dangerous during cesarean where spinal anesthesia
causes hypotension
Respiratory Function Definition Change
Respiratory Rate No of breaths/ minute No change (14 – 16/
min)
Vital Capacity IRV + TV +ERV No change
Respiratory Function Definition Change
Tidal volume Volume of air inspired/ expired Increased (500 to 700
in each respiration ml; + 40%)
Inspiratory capacity Maximum volume of air that can Increased (+10%)
be inspired after reaching the
end of a normal, quiet expiration
(TV + IRV)
Minute ventilation Amount of air inspired in a Increased (by 40%)
minute
Inspiratory Reserve Maximum amount of volume of No change/ slightly
Volume air which can be inspired beyond increased
normal tidal volume
 Respiratory Function Definition Change
Expiratory reserve Maximum amount of air that Decreased (by 18%)
Volume (ml) can be expired from the resting
end expiratory position
Residual Volume (ml) Volume of air in lungs after Decreased (by 20 –
maximal expiration 25%)
Functional residual Amount of air remaining in the Decreased (by 22%)
Volume resting end expiratory position
Total Lung Capacity Amount of air in lungs after Unaffected/ slightly
maximal inspiration decreased (5%)
Vital Capacity IRV + TV +ERV No change
Renal System
● Dilatation of the ureters, renal pelvis, calyces; Kidneys enlarge in length by 1 cm
● Renal plasma flow increased; GFR increased – reduced plasma levels of serum creatinine
● Decreased reabsorption of
o Glucose (physiological glycosuria)
o Uric acid
o Amino acids
o Water soluble vitamins
● Ureter
o Relaxed, dilated (especially > 24 weeks)
o Right > Left (due to dextrorotation of the uterus and pressure by the right ovarian vein)
● Bladder
o Congestion, hypertrophy; Edema In the 3rd trimester
o Frequency of micturition at 6 – 8 weeks and then in the 3 rd trimester
o Stress incontinence due to weakness of the urethral sphincter and pressure of the gravid uterus
Thyroid Physiology in Pregnancy
● Pregnancy is associated with an Increased iodine requirement; RDA: 250 mcg
● Increase mean thyroid volume
● TRH
● Fetus: relies on maternal T4 initially; starts its own production at 10 – 12 weeks
● Similarity in α-subunits of TSH, FSH, LH and HCG
o Hence HCG has intrinsic thyrotropic activity
o So TSH reduces in the 1st trimester: Physiological Hyperthyroidism
● Thyroid Binding Globulin (TBG) rises; peaks at 20 weeks
o Due to increased hepatic production
o Increased Total T4 and T3 levels
o Free T3 and T4 –unchanged
Diagnosis of
Pregnancy
Sign Where Description Weeks
Jacquemier’s or Vaginal sign Bluish hue of ant vaginal wall 8th week
Chadwick’s sign
Osiander’s sign Vaginal sign Increased pulsation felt through the 6 – 8 weeks
lateral fornices
Sign Where Description Weeks
Jacquemier’s or Vaginal sign Bluish hue of ant vaginal wall 8th week
Chadwick’s sign
Osiander’s sign Vaginal sign Increased pulsation felt through the 6 – 8 weeks
lateral fornices
Goodell’s sign Cervical sign Soft cervix 6th week
Sign Where Description Weeks
Jacquemier’s or Vaginal sign Bluish hue of ant vaginal wall 8th week
Chadwick’s sign
Osiander’s sign Vaginal sign Increased pulsation felt through the 6 – 8 weeks
lateral fornices
Goodell’s sign Cervical sign Soft cervix 6th week
Piscacek’s sign Uterine sign Asymmetrical uterine enlargement in 8 – 10 weeks
lateral implantation
Hegar’s sign Uterine sign On bimanual exam, the abdominal 6 – 10 weeks
and vaginal fingers appose below the
body of the uterus

Palmer’s sign Uterine sign Regular and rhythmic uterine 4 – 8 weeks

contractions elicited on bimanual
exam
Laboratory Evaluation for Diagnosis of
Pregnancy
• HCG
• Detection of beta subunit
• In 5% of pregnancies: Detectable about 8 days after conception in
serum
• In most pregnant women, detectable on 11th post conception day
• Doubles every 2 days (after 4 weeks)
• Peaks at 10-12 weeks, declines and plateaus
Ultrasound
True gestational Sac Pseudo Sac
Eccentric Central
Regular, round Irregular
Double decidual sac sign seen Not seen
Intra decidual sign seen Not seen
Yolk sac and fetal pole seen Not seen
Peripheral vascularity seen Not seen
Diagnosis > 2nd trimester
 Symptoms:
o Persisting amenorrhea
o Quickening
o Abdominal enlargement
o Frequency of micturition reappears in the 3rd trimester
• Signs
o Chloasma: Appears at 24 weeks
o Breast changes are more prominent
o External Ballotment > 20 weeks
o Internal Ballotment > 16 weeks
o Most Definitive sign?
Sonography in the 2nd and 3rd trimester
o TIFFA is usually done at 18 – 20 weeks
o For gestational age estimation:
 CRL (till 14 weeks): Most accurate determination of gestational
age
 The BPD most accurate in 2nd trimester
 AC: Greatest variation for gestational age
Obstetric Examination in the 2nd and 3rd
trimester
Uterine Height
SFH
Leopold Maneuvers
Prenatal Care
• Pre-conceptional counselling
• Parity Index and Obstetric history
• Calculating the EDD/ Period of gestation/ Trimesters
• Diet and supplementation
• Immunization
• Prenatal Screening
Pre-conceptional Counselling and Care

• Screening of risk factors

• Immunization status
• Assess genetic risk
• Nutrition and supplements
• Stop teratogenic drugs
• Substitute with safer drugs
• Start pre-conceptional folic acid
Recommendations for Pre-conceptional
Care
Intervention Proven Health Benefit

Folic Acid Supplementation

• Low Risk: 400 mcg
• High Risk: 4 mg

Rubella vaccination
Obstetric History and Parity Index

• Gravida
• Para
• Abortion

Writing Parity Index:

1. G_P_L_A_
2. P A-B-C-D
Some Examples
EDD and POG

• LMP
• EDD calculated by
• Subtract 3 months + 7 days
• Add 9 months + 7 days
• In IVF Pregnancy: ET + 38 weeks (Add 9 months - 7 days)
• In Irregular cycles, add the extra days to the EDD
• Period of Gestation
• Trimesters: 1st/ 2nd/ 3rd
Pyramid of Antenatal Care
Schedule of Antenatal Visits

As per MoHFW As per WHO guidelines: 8 As per ACOG and what is

guidelines: 4 visits contact visits ideal/ practiced in most
settings: 12 - 15
Weight Gain in Pregnancy
Category (BMI) Total Weight Gain Weight gain (kg/week) in
Range (kg) the 2nd and 3rd trimester

Underweight (< 18.5) 12 – 18 0.5

Normal Weight (18.5 – 24.9) 11- 15 0.4

Overweight (25 – 29.9) 7 – 11 0.3

Obese (≥ 30) 5–9 0.2

Diet and Supplementation
• Increased calorie requirement in pregnancy (i.e. 300 extra cal/ day avg)
• 1st trimester
• 2nd trimester
• 3rd trimester
• Protein requirement: ↑ by about 15g/ day (Total: 60 mg/d)
• Iron requirement ↑ed
• Calcium requirement: Doubled (600 mg to 1200mg)
• Vitamin A: Requirement increased in lactation
• Folic acid: requirement doubled
• Iodine, vit D, Thiamine, riboflavin, niacin, pyridoxine, Vit C, vitamin B12, Zinc: ↑
Diet and Supplementation
Calcium Supplementation:
• Prevents pre-eclampsia, pre-term birth, neonatal mortality
• Improves maternal bone mineral content and bone development of neonates
• Improves breast milk concentration of calcium
• Recommendation:
• Oral swallowable calcium tablets
• Twice a day (total 1g calcium/day)
• Start from 14 weeks of pregnancy
• Till six months post-partum
• Tablet: 500 mg elemental calcium & 250 IU Vitamin D3
Diet and Supplementation
• Pre conceptionally and 1st trimester: Folic Acid
• Iron supplementation: As per AMB,
• Daily, 1 Iron and Folic Acid tablet starting from the fourth month of
pregnancy, continued throughout pregnancy (minimum 180 days during
pregnancy)
• To be continued for 180 days, post-partum
• Each tablet containing 60 mg elemental Iron + 500 mcg Folic Acid,
sugar-coated, red color
• Single dose of 400 mg albendazole preferably in the 2 nd trimester
Immunization
• Td (has replaced TT)
• 1st dose: Early in pregnancy
• 2nd dose: 4 weeks after 1st dose
• Td-Booster
• Tdap recommended by ACOG
• 2nd dose of Td should be replaced with Tdap between 27 – 36 weeks
• Covid vaccine recommended in pregnancy and lactation
• Live vaccines are contra-indicated: Exceptions:
• Yellow fever
• Rabies vaccine
Q. As per the WHO, the number of antenatal visits in a low-
risk woman should be:
A. 4
B. 5
C. 8
D. 12
Q2. A primigravida visits the antenatal clinic at 6 weeks gestation. She
asks how much extra she needs to increase her calorie intake by
A. Zero Kcal
B. 200 Kcal
C. 300 Kcal
D. 500 Kcal
Q. A 25 y Primi gravida is at 20 weeks pregnancy. Her pre-pregnancy
BMI was 20. She is concerned that she hasn’t been gaining enough
weight during pregnancy. What should her ideal weight gain (kg)/ week
be?
A. 0.5 kg/ week
B. 0.4 kg/ week
C. 0.3 kg/ week
D. 0.2 kg/ week
Q. All are components of pre-conceptional counselling except?

A. Identifying potential high-risk factors like Hypertension, anemia,

diabetes
B. Starting women on folic acid preconceptionally
C. Assessing for genetic diseases and offering counselling
D. Offering Rubella immunization if IgG positive
Q. Which of the following vaccines is NOT contraindicated in
Pregnancy?
A. Measles
B. Rabies
C. Rubella
D. Varicella
Q. Use of folic acid to prevent neural tube defects should be best
initiated
A. At 6 weeks of pregnancy
B. At 8 weeks of pregnancy
C. At least 3 months prior to conception
D. At least 6 months prior to conception
Q. You are posted at the Primary Health Center. As per the Anemia
Mukt Bharat campaign, what is the dose of Iron and Folic acid
supplementation dose for pregnant women?
A. 500 mcg folic acid and 100 mg iron daily
B. 500 mcg folic acid and 60 mg iron daily
C. 400 mcg folic acid and 100 mg iron daily
D. 400 mcg folic acid and 60 mg daily
Q. A lady, 30weeks pregnant comes to the antenatal OPD for a routine
checkup. She has a history of normal twin delivery at term 2 years ago.
What is her obstetric score?
A. G2P2
B. G2P1
C. G3P2
D. G3P1
Q. A 30y G2A1 presents at 12 weeks for her 1st antenatal visit. Which of
the following will NOT be advised?
A. Hepatitis B Ag
B. TORCH
C. TSH
D. Urine culture/ sensitivity
Immunization in
Pregnancy
Outline

• Vaccines safe in pregnancy

• Vaccines contra-indicated
• Vaccines given in pregnancy
Vaccines contra-indicated in pregnancy:
Live Attenuated Vaccines
• Viral • Bacterial
• Measles • BCG
• Mumps • Oral Typhoid
• Rubella
• Human papilloma virus
• Varicella
• Herpes Zoster
• Rotavirus
• Live attenuated influenza
• Oral Polio
Vaccines contra-indicated in pregnancy:
Live Attenuated Vaccines
• After administration, pregnancy should be avoided for at least 4
weeks.
• Termination is not recommended on inadvertent administration
• HPV: If HPV vaccine series was interrupted for pregnancy, the series
should be resumed postpartum with the next dose
• HPV vaccine can be given to breastfeeding women who have not been
previously vaccinated
Vaccines recommended during every Pregnancy:

1. TT, Td or Tdap
• Td has replaced TT (as per MOHFW)
• 1st dose: early in pregnancy
• 2nd dose: After 4 weeks
• Booster: if received 2 Td doses in a pregnancy within the last 3 years
• Tdap: One dose of Td replaced with Tdap preferably given between
27-36 weeks of gestation (ACOG Committee 2017)
2. Influenza: Inactivated Influenza
• One dose IM, should be given with each influenza season
• Can be given in any trimester, irrespective of duration of pregnancy
• Provides passive immunity to the fetus
• In suspected/documented infection- immunization should be given
along with treatment with oseltamivir
Also remember
• All vaccines are safe in lactating women
• Small-pox: Only vaccine known to cause fetal harm!
MCQs
Q1. Which of the following vaccines is NOT contraindicated in
Pregnancy?
A. Measles
B. Rabies
C. Rubella
D. Varicella
Q2. What is the recommended schedule of Tetanus immunization in
pregnancy as per the MOHFW guidelines?
A. 2 doses of TT
B. 2 doses of Td
C. 1 dose of Td and 1 of Tdap
D. 1 dose of TT and 1 of Tdap
Teratogens
Teratogens
Exposure must occur during a CRITICAL developmental period
• The Pre-implantation period: “All or None” period
• Embryonic period: 2nd week – 8th week post-conception: Period
of organogenesis
• Fetal period: beyond 8 weeks post-conception: some organs
vulnerable
 Alcohol
• Leading cause of preventable developmental disabilities worldwide
• Fetal Alcohol Syndrome
o Neurobehavioral impairment
o Minor facial abnormalities
Anti-epileptics
• Orofacial clefts, NTD (neural tube defects) and cardiac defects
o Valproic Acid: Greatest risk: 4-8-fold
o Topiramate: 4-fold
o Carbamazepine and Phenytoin: 3-fold
o Phenobarbital: 2-fold
• Multiple agents: higher risk
• Newer: Levetiracetam and Lamotrigine: safer
Anti-epileptics
Fetal Hydantoin Syndrome:
• Upturned nose
• Midfacial hypoplasia
• Distal digital hypoplasia
ACE-Inhibitors/Angiotensin Receptor
Blockers
• ACE- inhibitor fetopathy
• Renal hypoperfusion – subsequent ischemia and renal hypoperfusion
• Oligohydramnios – pulmonary hypoplasia (Potter sequence)
• Shift to safer anti-hypertensives pre-conceptionally
Potter’s Sequence
NSAIDs
• Important: Indomethacin
• Constriction of the fetal ductus arteriosus – subsequent pulmonary
hypertension
• > 32 weeks > 72 hours
• < 32 weeks: Safer
Anti-Microbials
1. Aminoglycosides 3. Sulfonamides
o Nephrotoxic and ototoxic o Neonatal hyperbilirubinemia
2. Nitrofurantoin 4. Tetracycline
o Cleft lip in the 1st trimester
o Yellowish brown
o Hypoplastic left heart discoloration of deciduous
syndrome
teeth
Anti-Neoplastic Drugs
• Methotrexate
o Craniosynostosis/ Clover leaf skull

• Tamoxifen
o Vaginal adenosis

• Trastuzumab
o Renal failure, pulmonary hypoplasia and skeletal abnormalities
Lithium
• Ebstein anomaly
Retinoids
• Isotretinoin embryopathy
o Bilateral microtia/ anotia
o Flat/ depressed nasal bridge
Thalidomide
• Thalidomide tragedy
• Phocomelia
Methimazole
• Cutis aplasia
Warfarin
• Warfarin embryopathy (Disala
syndrome)- stippled epiphysis and nasal
hypoplasia
• > 5 mg/ day
• Results from fetal exposure between the
6th and 9th weeks
• Beyond the first trimester- hemorrhage
into fetal structures
• Switch over to heparin preconceptionally
or in the first trimester
Recreational Drugs
• Amphetamines: major teratogen
• Cocaine: Additional maternal complications
• Opioid Narcotics: Neonatal abstinence syndrome
• Marijuana: Preterm, Fetal growth restriction (FGR)
• Tobacco/ smoking
o FGR
o Preterm
o APH (Antepartum hemorrhage)
o Spontaneous abortion
SSRIs
 Teratogen Defect
Antiepileptic Drugs Facial features, Distal digital hypoplasia (Fetal
hydantoin syndrome)
ACE-I and ARBs Fetal renal hypoperfusion
Alcohol Fetal Alcohol Syndrome
Lithium Ebstein’s anomaly
Indomethacin Premature closure of the ductus arteriosus

Methimazole Cutis aplasia

Warfarin Warfarin embryopathy
Thalidomide Phocomelia
Methotrexate Clover leaf skull
DES(Diethyl Stilbestrol) Clear cell adenocarcinoma, T-shaped uterus,
hypospadias
Q1. This defect is associated with which drug:

A. Cyclosporine
B. Leflunomide
C. Thalidomide
D. Warfarin
Q. Clover leaf skull is seen with which teratogenic drug?

A. Retinoic acid
B. Warfarin
C. Alcohol
D. Methotrexate
Q. The ultrasonographic finding is consistent with teratogenic effect of:

A. Valproate
B. Warfarin
C. Thalidomide
D. Phenytoin
Q. Match the teratogen with the defect
1. Methotrexate a. Cranial nerve palsy
2. Thalidomide b. Clover leave skull
3. Misoprostol c. Phocomelia
4. Valproic acid d. Cleft lip

A. 1c 2d 3a 4b
B. 1b 2c 3d 4a
C. 1d 2c 3a 4b
D. 1b 2c 3a 4d
Q. All or none effect is seen if teratogenic exposure occurs during which
phase?

A. Embryonic period
B. Fetal period
C. Pre-conceptional period
D. Pre-implantation period
Prenatal
Screening
Dr Raina
Chawla
 Screening for Pre – Screening for
Screening for Fetal
existing maternal Pregnancy associated
Conditions
conditions conditions
• Anemia • Pre-eclampsia • Down Syndrome
• Diabetes • Gestational • NTDs and other
(Pregestational) Diabetes Mellitus anomalies
• Thyroid disorders • In certain
• Asymptomatic populations:
bacteriuria scrrening for Cystic
• Viral infections fibrosis,
Thalassemias etc.
Screening for Pre-existing
Maternal Conditions
Screening for Anemia

• Hb checked pre-conceptionally
• Checked at booking visit and every trimester
• As per “Anemia Mukt Bharat”: Hb checked at every contact
Screening for overt diabetes
• HBA1C
• FBS
• RBS
Screening for Thyroid disorders
• Why screen?

• How to screen?
• TSH levels during pregnancy are lower in the 1st trimester

• Pregnancy-specific levels for TSH

Screening for infections
• Potential for vertical transmission
Screening for UTI
o UTI is common in Pregnancy

o Screening every trimester

Screening for Pregnancy
Associated Conditions
Screening for Pre-eclampsia

• History and MAP

• Ultrasound (PI of uterine artery)

• Biochemical Factors
Medical history Ultrasound markers Biochemical markers
(Uterine A Pl)

PE risk calculation

Low risk High risk

Routine antenatal care Intensive antenatal care

Low dose aspirin prophylaxis

before 16 weeks
Screening for Diabetes in Pregnancy
• India: DIPSI test
Screening for Fetal Conditions
Down Syndrome
Down Syndrome Screening
• Every woman has a background risk
• This risk is based on age
At 25y: 1 in 5000
At 30y: 1 in 1000
At 33y: 1 in 500
At 35y: 1 in 250
At 40y: 1 in 70
At 45y: 1 in 20
1st Trimester Screening (11 – 14 weeks)
1. Ultrasound 2. Biochemical serum analytes
1st Trimester Screening (11 – 14 weeks)

3. Combined
1st Trimester Screening (Ultrasound)
1st Trimester Screening (Serum Analytes)

Β hCG PAPP-A

TRISOMY 21
1st Trimester Screening (Serum Analytes)

Β hCG PAPP-A

TRISOMY 21

TRISOMY 18
1st Trimester Screening (Serum Analytes)

Β hCG PAPP-A

TRISOMY 21

TRISOMY 18

TRISOMY 13
1st Trimester Screening (Ultrasound)

Detection Rate

NT

Dual marker

Combined Test
 2nd Trimester Screening
1. Biochemical Markers (Serum analytes):
 2nd Trimester Screening
2. Ultrasound (TIFFA):
2nd Trimester Screening (Biochemical Markers)

Beta hCG AFP uE3 Inhibin A

Trisomy 21
2nd Trimester Screening (Ultrasound)
Non-Invasive Prenatal Testing (NIPT)/ Cell
Free DNA
Prenatal Diagnostic Tests
• Chorionic Villous Sampling
• Amniocentesis
• Cordocentesis
Amniocentesis
• Most commonly performed prenatal diagnostic Test
• 15 – 20 weeks or later
• Indications:
 Diagnosis of fetal genetic disorders
 Diagnosis of congenital infections
 Rh alloimmunization
 Assessment of fetal lung maturity
• Technique
Amniocentesis
Chorionic Villous Sampling

• 10 – 13 weeks
• Biopsy of chorionic villi
• Results available early
• Technique
• Complications
Chorionic Villous Sampling
Fetal Blood Sampling (Cordocentesis)
• Also called cordocentesis or PUBS
• Initially described for fetal anemia
• Also performed for fetal karyotype determination particularly in
mosaicism on amniocentesis/ CVS
• Quick: 24 – 48 h
• Technique
• Complications
Fetal Blood Sampling (Cordocentesis)
Detection Rates
Tests Detection Rate (%)
Maternal Age alone 20%
NT alone 60%
Double marker 70%
Combined Test 80%
Triple test 70%
Quadruple test 80%
Combined 1st and 2nd trimester 90 – 95%
NIPT 99%
Q. In a woman with a Down Syndrome fetus, triple test was done. What would the
expected result be?

A. High βhCG, low ue3, low AFP

B. Low βhCG, high ue3, high AFP

C. High βhCG, high ue3, low AFP

D. Low βhCG, low ue3, high AFP

Q. Which of the following is not included in quadruple test for
antenatal detection of Down syndrome?

A. AFP
B. ß- hCG
C. Unconjugated Estriol
D. Inhibin-B
Q. Non-Invasive Prenatal Testing (NIPT) is?
A. Amniocentesis for evaluation of fetal chromosomal anomalies
B. Pre-conceptional gene testing of an ova
C. Maternal serum for evaluation of Down syndrome
D. Testing of maternal tissue
Q. A 34y primi presents at 12 weeks for a routine check up. The following
measurement was taken on the ultrasound (marked by yellow cursors) What is this
measurement?
A. Crown rump length
B. Nasal bone
C. Nuchal fold thickness
D. Nuchal translucency
Q. As per DIPSI, a value of more than how much is diagnostic of
gestational diabetes
A. 120 mg/dl
B. 130 mg/dl
C. 140 mg/dl
D. 200 mg/dl
Q. A 35y primi at 12 weeks presents to the OPD. Her mother is hypertensive. On
ultrasound, the uterine artery PI > 1. What is the best intervention to reduce her
risk of developing preeclampsia after 20 weeks?
A. Starting her on low molecular weight heparin
B. Starting her on high dose calcium
C. Starting her on aspirin
D. Starting her on labetalol
Q. The risk of asymptomatic bacteruria developing into pyelonephritis if
not treated is?
A. 10%
B. 15%
C. 25%
D. 50%