Question: Postpaum decidual secretions present are referred to as

Lochia refers to vaginal discharge for the first few weeks following delivery. It consists of blood from the placental site along with necrotic decidua. For the first few days following delivery, it is red in color and is termed as lochia rubra. After 3-4days - lochia serosa. After 10th day - lochia alba(refer to pgno: 422 Sheila 2nd edition)


Question: SRY gene is located on

The elaboration of H-Y antigen complex in the sho arm of Y chromosome is known as sex determining region(SRY), which induces testicular development Ovarian determinant : Unless SRY is expressed ovarian development ensues in the presence of XX karyotype SHAW&;S TEXTBOOK OF GYNAECOLOGY,Pg no:106,15th edition


Question: Definitive criteria for PID is

Chronic pelvic inflammatory disease manifest as Hydrosalpinx Chronic pyosalpinx Tubo ovarian abscess or cyst Tubercular tubovarian masses Ref: Shaw Gynecology 17 e pg 340.


Question: Minimum effective dose of Ethinyl estradiol in combination oral pills is

Ans. is a i.e. 20p.g -intensive pharmacological research clinical trials conducted to minimise the adverse effects of estrogen without reducing the contraceptive efficacy, resulted in lowering the dose of oestrogen to a minimum of 20gg or even 15gg." Examples of pills with 20p.g estrogen : Femilon : Loette Estrogen (EE) = 2opg Estrogen (EE) = 20pg Progestin (Desogestrel) = 0.15mg Progestin (Levonorgestrel) = 0.1mg Benefits of Low dose OCP's Decreased risk of Thromboembolic events with low dose OCP's.deg Note : Thrombosis risk is apparent by 4 months after staing estrogen containing OC's and does not increase fuher with continued use. Risk is highest during the first year of useq Decreased risk of high blood pressure (as compared to traditional high dose OCP's) Minimum adverse effect on lipid profile Less complains of Nausea and vomiting (as these complications are related to Estrogen component). The beneficial effects and efficacy of low dose OCP's is similar to traditional high dose OCP's whereas side effects have decreased. Extra Edge : Once a month (long acting pill). Contains : Ouniestrol (long acting estrogen) + sho acting progestin.


Question: In stage III ovarian cancer patient with upper abdominal disease < 5cm, management of choice is

Management of Advanced stage diseaseIncludes stage III and IVDebulking surgery versus neoadjuvant chemotherapy followed by Postoperative chemotherapyPrimary cytoreduction surgery is the preferred in1. Retroperitoneal only disease preoperatively 2. Patients with stage IIIC or IV disease with good performance status who have < 5cm upper abdominal disease 3. Patients who are considered ideal for intraperitoneal chemotherapy if optimally reducedNeoadjuvant chemotherapy and interval debulking surgery is preferred in1. Patients with bulky upper abdominal peritoneal disease >5cm in diameter2. Medically unfit for surgeryPostoperative chemotherapySystemic chemotherapy with 6 cycles of carboplatin and paclitaxelPostoperative radiotherapy1. Not effective compared to chemotherapy2. Used clear cell or mucinous carcinomasMAINTENANCE THERAPY1. No role after the complete clinical response 2. Drugs used: 3month or 12month paclitaxel every 28days


Question: Mrs. X, 25years old with a history of 2 previous pregnancies, and now 28weeks of gestation her gravidity is

Nulligravida: a woman who currently is not pregnant and has never been pregnant.Gravida: a woman who currently is pregnant or has been in the past, irrespective of the pregnancy outcome. With the establishment of the first pregnancy, she becomes a primigravida, and with successive pregnancies, a multigravida.Reference: William's obstetrics; 25th edition


Question: Management of stage II endometrial cancer is

Stage II endometrial cancer (cervix involved)
Modified radical hysterectomy is done.
Simple hysterectomy will have high relapse rate . Chemotherapy is not indicated.


Question: Twin Peak sign is characteristic of

Determination of ZygositySonographic Determination:ChorionicityDividing inter-twin membrane thicknessSignDichorionicity> 2mmTwin peak sign or Lambda signMonochorionicity< 2mmT signReference: William's Obstetrics; 25th edition; Chapter 45; Multifetal pregnancy


Question: For hysteroscopy, following are/is used

Distending Media Uterine cavity is distended with a media to seperate the uterine walls and have a panoramic view during hysteroscopy CO2: Commonly used for diagnostic purposes. It is solouble in blood and is safe Glycine1.5%: Excellent visualisation, hyperosmolar Mannitol 5%+ Glycine 2.2% Normal saline D.C.DUTTA&;S TEXTBOOK OF GYNECOLOGY; 6th edition; Pg no:620

Gynaecological diagnosis and operative surgery


Question: MgSO4 have no role in prevention of

Magnesium sulphate: - Mechanism of action:- * Reduced presynaptic release of the neurotransmitter glutamate * Blockade of glutaminergic n-methyl-d-aspaate (nmda) receptor * Potentiation of adenosine action * Improved calcium buffering by mitochondria * Blockage of calcium entry voltage-gated channels Used for: - * Severe preeclampsia * Recurrent eclamptic seizures * Neuroprotection Must check: - * Urine output * Respiratory rate * Patellar reflexes Ref:- Williams obstetrics 25th Edition; Pg num:- 38/68


Question: Bilateral germ cell tumour is .

Ans. is c i.e. Embryonal cell carcinoma Friends, this is one of those type of questions where we will derive a correct answer by ruling out other options. Let see, Option 'a' : Dysgerminoma "They are bilateral in about 10% of cases". Option 'b' : Immature teratoma "In a premenopausal patient whose lesion appears to be confined to a single ovary, unilateral oophorectomy and surgical staging should be performed. For a postmenopausal patient, a total abdominal hysterectomy and bilateral salpingo-oophorectomy may he performed. Contralateral involvement is rare, and routine resection or wedge biopsy of the contralateral ovary is unnecessary." Coming on to Option 'c' with embryonal cell carcinoma. It is a rare type of Germ cell tumor and so is the information available on at. The only information I could lay my hands was : Options 'c': Embryonal cell carcinoma The primary lesions tend to be large, and about two thirds are confined to one ovary at the time of diagnosis Option 'd' : Endodermal Sinus Tumour (EST) It is unilateral in 100% of cases. Considering all above options I choose embryonal cell carcinoma as the option of choice I have provided you with all related references, you are free to have your opinion.


Question: A woman with the history of 2 pregnancies, her gravidity is

Gravida: a woman who currently is pregnant or has been in the past, irrespective of the pregnancy outcome.With the establishment of the first pregnancy, she becomes a primigravida, and with successive pregnancies, a multigravida.Reference: William's obstetrics; 25th edition


Question: Most common uterine malformation associated with poor obstetric outcome

Septate Uterus Paial lack of resorption of the midline septum between the two mullerian ducts results in fibromuscular defects which range from a slight midline septum to a significant midline division of endometrial cavity Defect is not a cause of infeility, but once pregnant, greater the septum - greater the risk of recurrent spontaneous miscarriage, more in second trimester Complete septate uterus is associated with high risk of spontaneous miscarriage, Preterm labor, FGR and Breech presentation Outcomes are excellent with treatment by hysteroscopy Post treatment miscarriage rates are approximately 10% compared to 90% pretreatment with a complete septum Surgical procedure is not indicated in arcuate uterus Clinical Gynecologic Endocrinology and Infeility; Eigth Edition; Chapter 4


Question: Gold standard investigation for uterine cavity evaluation is

Hysteroscopy is considered the gold standard for uterine cavity evaluation because it allows for direct visualization. The procedure involves inseion of an endoscope through the cervical canal into the uterine cavity and instillation of distension media to allow for visualization.To optimize visualization of the endometrial cavity and avoid performing the procedure during early pregnancy, hysteroscopy is typically scheduled during the early- to mid follicular phase of the cycle. Disadvantages to the procedure include poor visualization when uterine bleeding is present and the inability to evaluate structures outside the uterine cavity, including those in the myometrium and adnexa. Reference: Novak's Gynecology; 14th edition; Chapter 32; Infeility and Assisted Reproductive Technology


Question: The triangular area bounded by clitoris, fourchette and labia minora is

Vestibule : It is a triangular area bounded Anteriorly by clitoris Posteriorly by fourchette Either side by labia minora Ref: D.C. Dutta's Textbook of Gynaecology, 6th edition, page no: 2


Question: Laparoscopy detects


Question: Urge urinary incontinence is

Urge urinary incontinence is urinary leakage preceeded by strong desire to void.

Involuntary urinary leak with increase in abdominal pressure

Involuntary urinary leak preceeded by strong imminent need to void

Urinary urgency with increased daytime frequency and nocturia


Question: Fetal marker of growth restriction in USG is

One of the most frequent perinatal complications in high‐risk pregnancy is fetal growth retardation.
The aim of the study was the development of instrumental and laboratory criteria for the development of placental
insufficiency and IUGR on a preconception stage and in the early stages of gestation.


Question: A 26 years old female at 39 weeks gestation presents with gush of fluid and regular contractions. On examination, she is grossly ruptured, contraction every two minutes and a cervical dilatation of 4 cms. The fetal heart rate is 140/min and reactive. She was admitted for labor and delivery. Over the next four hours, the cervical dilatation progressed to 9 cms. In the past hour, the fetal heart rate increased from the baseline of 140/min to 160/min. There is moderate to severe variable decelerations are seen with each contraction. The fetal heart rate does not responds to scalp stimulation. It was decided to proceed for caesarean section. The most important reason for the decision is

Answer: d) Non reassuring fetal heart rate tracingCardio toco graphy-Continuous electric fetal monitoring:CharacterNormalBaseline FHR110-150bpmBaseline variability5-25bpmAcceleration2 in 20 minDecelerationNone or earlyBaseline FHR is the mean level of FHR between the peaks and the depressions in beats per minute (bpm).Baseline variability is the oscillation of baseline FHR excluding the accelerations and decelerations. A base line variability of 5-25 bpm is a sign of fetal wellbeing.Accelerations are increased in FHR by 15 bpm or more lasting for at least 15 secs. Denotes healthy fetus.Deceleration is decrease in FHR below the baseline by 15 bpm or more. Three basic types of deceleration are observed:Early decelerationLate decelerationVariable decelerationType-1 dips.Due to headcompression.Type-ll dips.Due to utero-placentalinsufficiency and fetal hypoxiaIndicates cord compression and may disappear with the change in position of the patient.Pneumonic: (VEAL-CHOP)V- variable decelerationsC- cord compression/ prolapseE- early decelerationsH- Head compressionA- AccelerationsO-OKL- late acceelrationsP-Placental insuffiencyWith each uterine contraction, blood flow to the placenta decreases, and the fetus is exposed to transient hypoxia.As the labor progresses and more and more contractions occur, this hypoxia can eventually lead to a change from aerobic to anaerobic metabolism- fetal acidemia.However, the fetus has a variety of protective mechanisms, including a blood buffering system and the diving reflex (a lowering of the heart rate in times of hypoxic stress), to protect it from becoming dangerously acidemic.Electronic fetal monitoring is not a very specific tool for identifying fetal acidemia.Many fetuses with a non-reassuring fetal heart rate tracing do not have acidemia and are not in distress.However, it can be very difficult to distinguish non-acidemic fetuses with non-reassuring fetal heart rate tracings from acidemic fetuses with non-reassuring fetal heart rate tracings.Thus, the delivery of many fetuses is expedited because of the concern for fetal acidemia when, in fact, the fetus is not acidemic at all.Thus, it is most accurate to state, as is in this case, that the fetus was delivered because of the non-reassuring fetal heart rate tracing.Fetal acidemia is not the reason for delivery. In fact, there is a strong likelihood that this fetus is not acidemic at all.Fetal distress is not the reason for delivery. There is a strong likelihood that this fetus is perfectly healthy and will have high neonatal APGAR scores and no distress at all.Fetal hypoxic encephalopathy is not the reason for delivery. The desire to prevent hypoxic/acidemic damage to organs, including the brain, is the reason for expediting delivery.However, the non-reassuring fetal tracing does not indicate that hypoxic encephalopathy is necessarily occurring.Low neonatal APGAR scores can be a marker of fetal acidemia.However, many fetuses with non-reassuring fetal heart rate tracings do not have low neonatal APGAR scores.


Question: In a female with appendicitis in pregnancy treatment of choice is

Acute Appendicitis incidence is about 1 in 1000 pregnancies. It is most common nongyneocological cause of acute abdomen requiring surgery. Management of appendicitis Treatment consists of laparotomy at the earliest oppuunity.Once the diagnosis is suspected it is better to operate rather than to wait until generalised peritonitis has developed.Muscle splitting incision should be made at the point of maximum tenderness.Laparoscopic appendicectomy can be done before 28 weeks of gestation. D.C.DUTTA'S TEXTBOOK OF OBSTETRICS,Pg no:285,9th edition

Medical, surgical and gynaecological illness complicating pregnancy


Question: About Ovary

The ovary is attached to Posterior layer of broad ligament by mesovarium To the lateral pelvic wall by infundibulopelvic ligament Uterus by ovarian ligament Ovarian aeries are direct branches of abdominal aoa Ovarian veins drain into Right side drains into inferior vena cava Left side drains into left renal vein Histology of Ovary Surface Epithelium: Single layer of flattened cuboidal to low columnar epithelium that is continuous with the peritoneum at the mesovarium Coex: Composed of specialized stroma and follicles in various stages of development or attrition Medulla: Small poion of ovary in its hilar region and is composed primarily of fibromuscular tissue and blood vessels Few hilar cells homologues to interstitial cells of testes are present in medulla and may rarely cause hilar cell tumour of the ovary

It is attached to the posterior layer of the broad ligament by mesovarium

Ovarian veins drain into internal iliac veins

Is connected to the uterus by infundibulopelvic ligament


Question: Common route of spread of puerperal sepsis

Puerperal pyrexia – is defined as a rise of temperature reaching 100.4° F (38° C) or more (measured orally) on 2 separate occasions at 24 hours apart (excluding first 24 hours) within first 10 days following delivery.
Any infection of genital tract which occurs as a complication of delivery is called as Puerperal sepsis.
Most common site of Puerperal infection – Placental site. In vaginal delivery and uterine incision in cesarean section.
Most common manifestation of Puerperal infection – Endometritis.
Most common cause of Puerperal sepsis – Streptococcus.
Most common route of infection – Direct spread.
Single most significant risk factor for development of puerperal sepsis (uterine infection) = Route of delivery (It is M/C in cesarean delivery than vaginal delivery)
Mgt: Clindamycin + Gentamycin ± Ampicillin


Question: Prolonged pregnancy is the one that exceeds

The international definition of prolonged pregnancy, endorsed by the American College of Obstetricians and Gynecologists (2016b,d) is one that exceeds 420/7 weeks, namely, 294 days or more from the first day of the last menstrual period.Reference: William's Obstetrics; 25th edition; Chapter 43; Postterm pregnancy


Question: Snow storm appearance is seen in

Molar pregnancy is an abnormal form of pregnancy in which non - ble feilized egg implants in the uterus and will fill to come to term a molar pregnancy. It Is a gestational trophoblastic disease which grow into a mass in the uterus that has swollen villi on ultrasound mole resemble a bunch of grapes or snow - storm. There is increased trophoblast proliferation and enlarging of the chronic villi.


Question: An elderly multiparous woman with intrauterine foetal death was admitted with strong labour pains The patient suddenly goes in shock with cyanosis respiratory disturbances and pulmonary oedema The most likely clinical diagnosis is;

<p> Amniotic fluid enter the maternal circulation and sets up a DIC,leading to consumptive coagulopathy. Classically a woman in late labour gasps for air,has bronchospasm,become cyanotic and undergoes immediate collapse and cardiorespiratory arrest,usually accompanied by hemorrhage. Reference: Textbook of obstetrics,Sheila Balakrishnan,2nd edition,page no;408 <\p>


Question: Position of fetus definition

(C) Oreientation of foetus in relation to pelvis before delivary# In obstetrics, position is the orientation of the fetus in the womb, identified by the location of the presenting part of the fetus relative to the pelvis of the mother. It is the position assumed by the fetus before the process of birth.

Orientation of foetus in relation to pelvis before delivery

Orientation of womb in relation to pelvis before delivery


Question: Endometrial biopsy in infertility" is done at

C. i.e. (21 - 23rd day of menstrual cycle) (222 - Dutta 4th) (142 - Shaw's 14th)ENDOMETRIAL BIOPSY - most reliable method to study the endometrium is by obtaining the material by curettage after dilatation of the cervix usually under general anaesthesiaIndication of Dilatation and CurettageDiagnosticInfertility, DUB, Pathological amenorrhoea, Endometrial tuberculosis, Endometrial carcinoma Postmenopausal bleeding, chorionepitheliomaTherapeuticDUB, Endometrial polyp. Removal of IUD, Incomplete abortion.CombinedDUB. Endometrial polyp* Dilatation and curettage should be carried out in the late premenstrual phase (142 - Shaw's 14th). This is so done because the tubercles are present in superficial layers and are shed during menstruation.* In Infertility biopsy is to be done on 21-23rd day of the cycle, Barrier contraceptive should be prescribed during the cycle to prevent accidental conception. However if the cycle is irregular. It is done within the 24 hours of the period**SubnucIear vacuolation is the earliest evidence appearing 36 -48 hours following ovulation* The curettage material is preserved in 10% formolsaline (Normal saline is suspected tubercular endometritritis) - Short history of the case and first day of last menstrual period specially in infertility cases and DUB should be positively mentioned. (534 - Dutta 4th)Endometrial biopsy - preferably 1 or 2 days before the onset of menstruation (Pre menstrual phase)* *** Post coital test is done usually at 12 - 13 days after LMP**


Question: Metrorrhagia is

The term intermenstrual bleeding is updated nomenclature for metrorrhagia.


Question: An obese female having hirsutism on laboratory investigation has a high level of LH and androgens. Likely cause is

The clinical and laboratory features of the patient described in the question match with those of PCOS as depicted in the table.
So the most appropriate answer is PCO


Question: Progress of the labour is assessed with the help of March 2005, March 2013

Ans. B: Paogram The paogram is a series of chaed measurements which are used to assess the progress of labour. Paograms are designed to encourage a universal manner of dealing with labour and to give an early, easy way of recognising problems in labour. Information recorded includes: Maternal - BP (2 hourly), hea rate (half hourly), temperature (once unless abnormal), Contractions - length, frequency, strength Baby - hea rate (2 hourly) State of membranes and colour of liquor. Also - maternal state of mind, drugs administered etc.


Question: Preimplantataion genetic diagnosis is used for

Pre implantation genetic diagnosis is used for daignosis of single gene disorders such as cystic fibrosis, β - thalassemia and hemophilia.


Question: The first change in precancerous lesion on colposcopy is

The first change in precancerous lesion is punctuation


Question: MC Type of female pelvis


Question: Genital was in pregnancy treatment is

Cryotherapy T/T of anogenital was Topical medication Trichloracetic acid or Podophyllin resin applied weekly. hniquinod or podofilox should also be used. Crvotherapy and laser therapy Cryotherapy (freezing) using nitrous oxide or carbon dioxide is used in was who do not respond to topical treatment. Carbon dioxide laser is used for larger and more numerous was. TIT of anogenital was during pregnancy :- "Cryotherapy and laser therapy are the preferred t/t methods" The only topical therapy which can be used during pregnancy is Trichloracetic acid. Podophyllin resin is not used during pregnancy.


Question: Duct of Bartholins gland opens

Duct of Bartholins gland opens on the inner side of Labium minus external of hymen.


Question: Eye movements in fetus begins from

16th Gestational WeekThe fetal crown-rump length is 12 cm, and the weight is 110grams. By 14 weeks, gender can be determined by experienced observers by inspection of the external genitalia. Eye movements begin at 16 to 18 weeks, coinciding with midbrain maturation.Reference: William&;s Obstetrics; 24th edition; Chapter 7; Embryogenesis and Fetal Morphological Development


Question: A primigravida is in second stage of labour since 1 hr. On examination the leading point of fetal skull is at +2 station and rotation is 450 sho. This can fuher be managed by

The patient fulfills the criteria for applying low forceps The criteria for applying low forceps - (1) Leading point of fetal skull at station+ 2 cm and not on the pelvic floor, (2) Rotation is 45o or less. If the fetal head is at station below this or rotation doesn't exceed 45o, then one can apply outlet forceps. A: Unrotated head in transverse position B: 45 degree sho of complete rotation C: fully rotated head (ideal for application of forceps) In modern obstetrics there is no role of midcavity or high forceps, i.e. only station +2 and below are extracted with forceps (low and outlet forceps)

Labour - normal, abnormal, malposition, malpresentation and their management


Question: Number of sperms required for fertilization per oocyte in invitro fertilization is

100000 sperms per oocyte is required for IVF.


Question: Antidote of MgSO4 is

Ans: b (Calcium gluconate) Ref: Dutta, 6th ed, p. 236; Davidson, 20th ed, p. 441Management of hyper magnesemia:Stop magnesium.Promote urinary excretion by loop diuretic with IV hydration in RFT normal cases.IV calcium gluconate to reverse overt cardiac effects.Dialysis if renal function is minimal.Magnesium sulphate:Drug of choice in pre-ecclampsiaMechanism of action:1. Reduction of motor end plate sensitivity to acetyl choline.2. It blocks neuronal calcium influx.3. Induces cerebral vasodilation.Adverse effects:Maternal - flushing, headache, muscle weakness, diplopia, pulmonary edema, cardiac arrest.Fetal and neonatal - lethargy, hypotonia and respiratory depression.


Question: Specific gravity of amniotic fluid

Specific gravity of the amniotic fluid is 1.010 Fluid is faintly alkaline It becomes highly hypotonic to maternal serum at term pregnancy Ref: Dutta Obs 9e pg 34.


Question: Failure rate is after tuba! sterilization with pomeroys technique


Question: Drug given to reduce the uterine contraction during preterm labour with least side effect

Progesterone Among the given options progesterone is the drug with the least side effect. - Natural progesterone is completely innocuous for the mother and fetus. - The problem is that, the use of progesterone as tocolytics is controversial. Some studies have proved that progesterone can be used as tocolytics. Progesterone does have a role in prefer'', labour According to American college of obs and Gynae (ACOG) progesterone is given in patients with history of previous preterm labour and in women who are at risk for preterm labour (i.e., women with sho cervix). - In these patients progesterone administration stas from 16th month and is continued up to 36 months progesterone acts by reducing uterine contractions. An impoant point Progesterone reduces or prevents uterine contractions when the uterine contractions are not fully established but once the labour sets in i.e., regular uterine contractions sta progesterone has no role. - Progesterone cannot prevent regular uterine contractions of labour. We are not sure from the question, what they want to ask. The question does not clearly differentiate if they are asking about uterine contractions of pregnancy or labour. Once again remember If labour has begun, progesterone has no use. Among other tocolytics, calcium channel blockers have the least side effects. It is an effective tocolytic that is well tolerated by the majority of the pregnant patient. No significant fetal problems have been repoed after treatment with Nifedipine. The most common side effect seen with Nifedipine is lowering of B.P, facial flushing can be seen in ceain cases. Unlike the [3 adrenergic tocolytics they have no effect on carbohydrate metabolism and can be given to diabetic patient. Beta adrenergic agonists These are usually the tocolytics of choice for the treatment of preterm labour. They also have serious side effects which are Pulmonary edema - It is a serious and common side effect of 13 agonists. - It occurs in patients receiving oral or intravenous treatment. - It is common in patients having chorioamnionitis and in twins. Hyperglycemia - When 13 adrenergic drugs are given to patients with insulin dependent diabetes it causes significant hyperglycemia, glycosuria and ketonuria. - This occurs due to increased glycogenolysis and increased lipolysis. fi adrenergic agents are contraindicated in chorioamnionitis Side effects of magnesium Pulmonary edema Hypothermia Neuromuscular toxicity


Question: Enterocele formation is a common complication of

BURCH COLPOSUSPENSION COMPLICATIONS Hemorrhage during dissection of the space Urethra and bladder neck injury due to injudicious placement of sutures Osteitis pubis voiding difficulty detrusor instability Enterocele formation Failure and recurrence D.C.DUTTA&;S TEXTBOOK OF GYNAECOLOGY,Pg no:404,6th edition


Question: Intrahepatic cholestasis of pregnancy occurs in

DisorderOnset in PregnancyHyperemesisEarlyCholestasisLateFatty liverLatePreeclampsiaMid to lateHepatitisVariable(Ref: William's Obstetrics; 25th edition)


Question: In Swyers syndrome

Swyers syndrome: Gonads are testis (46XY) but dysgenetic. Due to loss of negative feedback FSH and LH are elevated.


Question: Sho structured primi gravida has height less then


Question: In women having PCOD with irregular menstrual cycles, combined oral contraceptive pills

In combined OCPS, estrogen component increases levels of SHBG, which binds free androgen.


Question: A neonate born before 259th day is

Term neonate: A neonate born any time after 37 completed weeks of gestation and up until 42 completed weeks of gestation (260 to 294 days).The American College of Obstetricians and Gynecologists (2013b) endorse and encourage specific gestational age designations. Early term refers to neonates born at 37 completed weeks up to 386/7 weeks. Full-term denotes those born at 39 completed weeks up to 406/7 weeks. Last, late-term describes neonates born at 41 completed weeks up to 416/7 weeks.Preterm neonate: A neonate born before 37 completed weeks (the 259th day).Postterm neonate: A neonate born anytime after completion of the 42nd week, beginning with day 295.Ref: Williams Obstetrics; 24th edition; Chapter 1; Page no: 55


Question: The recommended treatment for pregnant women with syphilis is

Syphilis therapy during pregnancy is given to eradicate maternal infection and to prevent or treat congenital syphilis. Parenteral penicillin G remains the preferred treatment for all stages of syphilis during pregnancy.(Ref: William's Obstetrics; 25th edition)


Question: Fourteen weeks pregnancy with third degree prolapse. Best M/n will be

Ans. is 'c' i.e. . "Ring Pessary" 3rd degree prolapse means that cervix is outside uterus and such patients are managed by replacing the cervix inside the vagina and then it is kept in that position by a ring pessary.The pessary is to be kept there until 18-20 weeks of pregnancy when the body of the uterus will be sufficiency enlarge to sit on the brim of the pelvis.


Question: Best contraceptive method during lactation

(B) (Progesterone- only pill) (491- Dutta 6th)POP/MINIPILL* POP is contain very low dose of a progestin Leuonorgestrel, Norethisterone, desogestrel, lynestrenol or norgestrel* It has to be taken daily from the first day of the cycle*** Mechanism of action - it works mainly by making cervical mucus thick and viscous, thereby prevents sperm penetration**AdvantagesDisadvantages1. Side effects attributed to estrogen in the combined pill are totally eliminated1. Acne, mastalgia headache back through bleeding2. No adverse effect on lactation (''Lactation pill")2. All the side effects, attributed to progestins may be evident3. Easy to take as there is no ''on and off' regime3. Simple cysts of the ovary may be seen, but they do not require any surgery4. It may be prescribed in patients having (medical disorder) Hypertension, fibroid DM, epilepsy, smoking and history of thrombo-embolism4. Failure rate is about o.5-2 per 100 women years of use5. Reduces the risk of PID and endometrial cancerCONTRAINDICATION1. Pregnancy2. Unexplained vaginal bleeding3. Recent breast cancer4. Arterial disease5. Thromboembolic disease* OCP do not act by interference with placental functioning* Contraceptive of choice for Rheumatic heart disease is Barrier method (condom)* Ideal contraceptive for newly married couple is combined OCP* Ideal contraceptive for a couple living in different cities meeting only occasionally - Barrier method* Best contraceptive for parous young women- IUCD* Progesterone of choice in emergency contraceptive is Levonorgestrel*** Effective life of device - Nova Cu-T (5 years) Multiload Cu-T 375 (5years) Cu-T 380A (10 years)* OCP should be avoided in patients on antiepileptic medication* The risk of chlamydial infections is increased in patients using OCP. In most patients such chlamydial infection is asymptomaticAzithromycin is drug of choice in chlaraydial infection in pregnancy* Fishy vaginal odor is most characteristic of Bacterial vaginosis due to Gardnella viginalis (Gram negative bacilli, decreased number of lactobacilli, clue cells, few leucocytes (polymorphs), PH of discharge is >4.5)


Question: Treatment of carcinoma cervix stage MB include

Neoadjuvant chemotherapy followed by radiotherapy


Question: Pregnancy rate with female condom as compared to male condom,

Pregnancy rate with female condum is higher than with the male condom.


Question: Uterine aery is a branch of

The uterine aery arises from the anterior trunk of the internal iliac (or hypogastric aery). Its course is at first downwards and forwards until it reaches the parametrium when it turns medially towards the uterus. It reaches the uterus at the level of the internal os, where it turns upwards, at right angles, and follows a spiral course along the lateral border of the uterus to the region of the uterine cornua. Here it sends a branch to supply the fallopian tube and ends by anastomosing with the ovarian aery.Reference: Shaw's Textbook of Gynecology; 16th edition; Chapter 1; Anatomy

Anterior division of internal iliac aery

Posterior division of internal iliac aery


Question: Grade III intraventricular hemorrhage is

Grade I - Hemorrhage limited to the germinal matrix
Grade II - Intraventricular hemorrhage
Grade III - Hemorrhage with ventricular dilatation
Grade IV - Parenchymal extension of hemorrhage.


Question: Antithyroid drug of choice in pregnancy is


Question: Ophthalmic exam to screen for retinopathy of prematurity is mandatory for newborns with bih weight less than


Question: A patient at 28 weeks pregnancy presents with low grade fever, malaise, vomiting since 1 week. On examination she is icteric, Her Hb is 10 gm%, bilirubin is 5 mg/dL, SGOT and SGPT at 630 and 600 with normal platelet count. Most probable cause of her jaundice is

Patient here has presented with prodrome of viral hepatitis. Investigations to diiferentiate various causes of jaundice in pregnancy are IHCP AFLP HELLP Viral hepatiis Bilirubin (mg/dL) 1-5, direct 2-10, direct <2 >5 SGOT/ SGPT <200 <1000 <500 500-3000 ALP Raised Normal Normal Normal/raised Platelets Normal low Low Normal Prothrombin time Normal Prolonged prolonged prolonged


Question: Elevated androgens in PCOD

Elevated androgen convert vellus hair into coarse terminal hair. This conversion is irreversible.

Convert terminal hair to vellus hair irreversibly.

Convert vellus hair to terminal hair irreversibly.

Reversible conversion of vellus hair to terminal hair.

Reversible conversion of terminal hair to vellus hair.


Question: HPV vaccine Cervarix is protective against subtypes

HPV vaccines have been developed from the capsid coat of the virus. It has high immunogenicity. Bivalent vaccine is against HPV 16 & 18. Quadrivalent vaccine is against 16, 18, 6 & 11. Effective in the prevention of 90% of cervical cancer. Both vaccines have some cross-protection against strains 31, 33 & 45. Vaccines are given at an age of 12-18years, safe and well tolerated. Three doses, IM over deltoid muscle. The impact is greatest when given before women are infected with HPV. Vaccine-induced neutralizing antibodies works locally on cervix by preventing attachment of the virus to the cervical epithelium. Immune defense is type specific & is effective only when given prophylactically. Vaccines are effective for at least 7.5years. Pap smear screening should be continued as vaccines are type specific and do not protect all types of HPV. Reference: Dutta's Textbook of Gynecology


Question: Most common cause of abnormality in first trimester abortion

(Chromosomal anomaly) (161 - Dutta 6th)Common Causes of AbortionFirst Trimester -1. Genetic factor (50%) of early miscarriage are due to chromosomal abnormality in the conceptus, Autosomal trisomy is the commonest (50%) cytogenic abnormality2. Endocrine disorders (LPD) thyroid abnormalities DM3. Immunological disorders (Autoimmune and Alloimmune)4. Infection5. UnexplainedSecond trimester1. Anatomic abnormalities(a) Cervical incompetance (congenital or acquired) is Most common(b) Mullerian fusion defects (Bicomuate uterus, septate uterus)(c) Uterine synechiae(d) Uterine fibroid2. Maternal medical illness3. Unexplained


Question: The drug being given is

Ethacridine lactate (0.1%) is used only extra - amniotically.


Question: Hypothyroidism in pregnancy is least likely associated with

Ove or symptomatic hypothyroidism is repoed to complicate between 2 and 10 pregnancies per 1000. Clinical/ ove hypothyroidism is confirmed when an abnormally high serum TSH level is accompanied by an abnormally low thyroxine level. Most common cause is Hashimoto thyroiditis Subclinical hypothyroidism is defined by an elevated serum TSH level and normal serum thyroxine concentration Complications in pregnancy Aboion Placental abruption Pretem bih Low Bih weight Stillbih placental abruption Pre eclampsia Impaired psychomotor development of baby Also a cause of infeility, menstrual disturbances


Question: The most impoant indication for surgical repair of a bicornuate uterus is

Bicornuate uterus Defective mullerian fusion such as double uterus,septate,or ,bicornuate results in recurrent aboion (12%). Aboions tend to occur beyond 12 weeks and the successive pregnancies are carried longer. Hysteroscopic resection of the uterine septa,synechae,improves the pregnancy outcome. Uterine unification operation (metroplasty)is done for bicornuate uterus D.C.DUTTA&;S TEXTBOOK OF OBSTETRICS,Pg no:169,7th edition


Question: Prolonged latent phase in nullipara is defined as one exceeding

A prolonged latent phase was defined as one exceeding 20 hours in the nullipara and 14 hours in the multiparous women.(Ref: William's Obstetrics; 25th edition)


Question: Ovarian fibroma develops from

Histologically fibroma has a cellular or myxomatous stroma which are scattered large signet ring cells. Ref: Shaw Gynecology 17 e pg 464.


Question: Indication for Induction of labor is

Induction is indicated when the benefits to either mother or fetus outweigh those of pregnancy continuation. The more common indications include Membrane rupture without labor, Gestational hypeension, Oligohydramnios, Nonreassuring fetal status, Postterm pregnancy, and Various maternal medical conditions such as chronic hypeension and diabetesRef: William&;s; 25th edition


Question: Sampson's Theory proposed to explain endometriosis is

Sampson's theory: Reflux of menstrual endometrium through fallopian tubes causes endometriosis.

Embolization of menstrual fragments through lymphatic channels.

Metaplastic changes in embryonal cell rests.


Question: Testosterone secreted by;

Testosterone is secreted by Leydig cell In the testes, Leydig cells arise from the original mesoderm of the genital ridge and lie between the testicular cords. Leydig cells begin to secrete testosterone by 8-week gestation due to stimulation of the testes by human chorionic gonadotropin (hCG).


Question: Hormone replacement therapy is not

Answer- D (Prevention CAD)Hormone replacement therapy increases the risk of MI (coronary aery disease). The increased risk is attributed to progestin component.o H restore Ca++ balance, fuher bone loss is prevented and the excess fracture risk is nullified. o There is a higher incidence of breast cancer.o Risk for endometrial carcinoma is not increased as protective effect of progestin nullify the carcinogenic effect of estrogen.o There is increased risk for gall stone and migraine.o There is a small protective effective of H on colorectal cancer.Note :?o Usually in H combination of estrogen and progestin is given (combined H), except in hysterectimized women where estrogen alone is given.o With estrogen alone there is increased risk of endometrial cancer and decrease risk of coronary aery disease (as estrogen increases HDL and decreases LDL and triglyceride level).o So for H with estrogen alone the answer of this question will change. In that case it will be option 'a' i.e., increased risk of coronary aery disease.


Question: Amsel's criteria is used for;

Amsel's criteria is used for diagnosis of Bacterial vaginosis MC Vaginitis Caused by Hemophilus vaginalis aka Gardnerella vaginalis Amsel's criteria - >= 3 out of 4 required for diagnosis of Bacterial vaginosis Creamy discharge Whiff test + Fishy odor Clue cells


Question: Best Indicator of Ovarian reserve

None of the ovarian reserve tests currently in use are accurate predictors for pregnancy
With current methods, basal FSH concentration is simplest and most widely used to test ovarian reserve. Levels greater than 10 IU/L (10-20 IU/L) have high specificity (80-100%) for predicting poor ovarian response to ovulation. Serum FSH levels vary significantly across the cycle hence FSH is best measured during the early follicular phase ( cycle day 2-4).
Basal serum estradiol concentration has little value as ovarian reserve test.
AMH: Antimullerian hormone is produced from preantral and small antral follicles hence AMH levels are gonadotropin-independent and exhibit little variation within and between menstrual cycles. AMH threshold levels (0.2-0.7ng/ml) has 40-97% sensitivity, 70-92% specificity, 22-88% PPV and 97-100% NPV for predicting poor response to stimulation (<3 follicles or < 2-4oocytes).


Question: A lady with 16 weeks pregnancy presents with acute appendicitis,TLC of 24000. Management includes

In pregnancy, if the patient develops symptoms of appendicitis and it has been confirmed with diagnostics. The preferable option is to do early surgery to avoid the complications like puerperial sepsis, aboion or intrauterine deaths and also complications of untreated appendicitis like rupture of appendix, pyoperitoneum etc

Appendecectomy with termination of pregnancy

Medical treatment with surgery on recurrence


Question: Percentage of cystic glandular hyperplasia turning to malignancy

WHO classification and Progression to Carcinoma
Percentage of cystic glandular hyperplasia turning to malignancy is 1%


Question: Modified Biophysical profile is

Modified biophysical profile: NST+AFI (takes only 10 minutes to perform) Biophysical profile : most accurate means of assessing fetal health as used 5 variables instead of 1.5 fetal biophysical components used are - a) Hea rate acceleration b) Breathing c) Movements d) Tone e) Amniotic fluid volumeThis test takes 30-60 minutes of examiner time.

Intra Uterine Growth Restriction, Intrapaum and Antepaum Fetal Surviellance


Question: Tocolytic of choice in hea disease

Atosiban [Ref: Ian Donald practical problems in obstetrics 6h/e Most tocolytics are contraindicated in women with cardiac disease because of their potential to precipitate cardiac failure. - As there are no studies performed to look at the safety of tocolytic drugs in setting of existing hea failure the recommendations for their use can be best made on the basis of their side effect profile in normal women. "Atobisan, an oxytocin antagonist seems to be the drug of choice at present" -In an animal study it was shown to have no central hemodynamic effect although some concern has been expressed over increased infant moality rate. Indomethacin has minimal effect on hea rate and mean aerial pressure and may be used as an alternative for sho term tocolysis. None of the other tocolytics are considered safe for cardiac disease. Beta inimetics probably are the worst They are contraindicated in :? - Cardiac arrhythinias - Valvular disease - Cardiac ischemia Nifedipine It is contraindicated in :? - Conduction defects - Left ventricular failure Magnesium sulfate - Status of magnesium sulfate as regards it safety in cardiac disease in unceain.


Question: Ligamentum teres is

Circulatory Changes at Bih:After bih, the umbilical vessels, ductus aeriosus, foramen ovale, and ductus venosus normally constrict or collapse. The more distal poions of the hypogastric aeries, which course from the level of the bladder along the abdominal wall to the umbilical ring and into the cord as the umbilical aeries, undergo atrophy and obliteration within 3 to 4 days after bih. These become the umbilical ligaments, whereas the intraabdominal remnants of the umbilical vein form the ligamentum teres. The ductus venosus constricts by 10 to 96 hours after bih and is anatomically closed by 2 to 3 weeks, resulting in the formation of the ligamentum venosumReference: William&;s Obstetrics; 24th edition; Chapter 7; Embryogenesis and Fetal Morphological Development


Question: Antihormonal substance used to induce ovulation

Shaw's textbook of Gynaecology- 16th edn- pg no- 257. Clomiphene citrate is used for ovulation induction. Dose- 50mg/day startingfrom day 2 to day 6 of the cycle for 5 days.


Question: Paracervical block is associated with

Paracervical nerve block : Given at the end of the first stage of the labor It is injected at the site of the cervix, given on both sides It can be repeated to relieve pain Fetal bradycardia is the known complication. Ref: Dutta Obs 9e pg 480.


Question: Ovarian tumours are commonly arise from

(Surface epithelium) (397-S) (333-S14th)Ovarian cancers* Epithelial ovarian cancers accounts for 80 to 90% of ovarian cancers* Non-epithelial cancers account for 10 to 20%These include malignancies of:I) Germ cell originII) Sex cord stromal cell originIII) Metastatic cancersIV) Rare malignancies like lipoid cell tumours sarcomas


Question: Urethral caruncle is best treated by

Excision followed by repeated dilatation A urethral caruncle is a benign red polyp or leison covered by transitional epithelium.deg Usually found on the posterior aspect of the urethral meatus.deg Urethral caruncle is common in postmenopausal female.deg Due to atrophy of vulva and vagina : urethral meatus is exposed to infection. The posterior urethral mucosa becomes swollen, congested and pouts out like a cherry from the posterior wall of external meatus. Symptoms Dyspareuniadeg Post coital bleedingdeg Paindeg Dysuriadeg Investigation :In women complaining of post - menopausal bleeding, other genital malignancies should be ruled out. Management :Friends here there is some confusion : all books mention excision as the best line of management but no where it is mentioned that it is to be followed by repeated dilatation. ''Treatment is by excision and diathermy coagulation of the base of the stalk. The patient should be given antibiotics to treat the underlying chronic urethritis." "Excision biopsy is the definitive surgery. The raw area may be sutured or cauterised. Continous bladder drainage is required for few days." "Treatment is by excision biopsy followed by local or systemic oestrogens." As far as cauterisation is concerned - diathermy is done but chemical cauterisation is not mentioned anywhere. I have given you all references - decide for yourself.


Question: Most common site for endometriosis in urinary system is

Bladder is most common site for urinary endometriosis.


Question: Drug of choice of ovulation induction in PCOD patients

Clomiphene citrate is drug of choice for ovulation induction in PCOD patients.


Question: Fetal alcohol syndrome is characterized by

Fetal alcohol syndrome - dysmorphic facies

Small palpebral fissure
Thin vermillion border
Microsomia
Hypoplastic phltrum.


Question: Treatment of choice for endocervical polyp is

Polyp is categorized and defined by ultrasound, saline sonography, hysteroscopy with or without histopathology It is treated by polypectomy Ref: Shaw Gynecology 17 e pg 132.


Question: Use of folic acid to prevent congenital malformation should be best initiated;

Therapy recommendations suggest that women begin taking folic acid supplements before becoming pregnant and continue taking the supplements of at least 0.4 mg/day throughout the first trimester to reduce the risk of neural tube defects. recommended because it has been shown to reduce the occurrence and recurrence of neural tube defects . For low-risk women, folic acid supplementation of 400 micrograms per day currently is recommended because nutritional sources alone are insufficient. For women at high risk of NTDs or who have had a previous pregnancy with an NTD, folic acid supplementation of 4 mg per day is recommended.


Question: Atonic PPH is not seen in

Causes of Atonic PPH: Multiparity Overdistention of abdomen Malnutrition and anemia Antepaum hemorrhage Prolonged labor Anesthesia Initiation or augmentation of delivery by oxytocin Malformation of uterus Uterine fibroid Mismanaged third stage of labor Precipitate labor Ref: Dutta Obs 9e pg 385.


Question: Ovarian tumour staging if one ovary involved without surface involvement or rupture

STAGE 1A: Ovarian cancer limited to one ovary without malignant ascites or positive peritoneal washings, surface involvement or rupture


Question: Recurrent aboion in 1st trimester is most often due to.

Ans. is a i.e. Chromosomal abnormalities Historically. recurrent pregnancy loss or "habitual aboion" was defined as 3 or more consecutive spontaneous miscarriages. Today, recurrent pregnancy is usually defined as 3 or more pregnancy losses (not necessarily cnnc,ecr_itive). Most obstetricians also consider clinical investigation and treatment should be considered in couples with ,,,,ntaneo-- miscarriages, especially when any of the following are present : Embryonic hea activity observed before any earlier pregnancy loss. Normal karyotype of products on conception from an earlier loss. Female paner age over 35 years. Infeility. cause rf recurrent aboions 1st trimester * Genetic factor / defective germplasm. Most common type of chromosomal abnormality is balanced translocation. 2nd trimester * Cervical incompetence


Question: The instrument used in


Question: Chronic pelvic pain is defined as

Chronic pelvic pain is defined as pain of greater than 6 months in duration, localized to the anatomic pelvis, and severe enough to cause functional disability or necessitating medical care


Question: During pregnancy HIV transmission occurs mostly during

Ans. is 'd' i.e. during labour HIV can be transmitted from an infected mother to the fetus during pregnancy, during delivery or by breastfeeding.HIV can be transmitted to the fetus as early as the first and second trimester of pregnancy.The transmission during birth (intrapartum) and the immediate period thereafter (peripartum) is considered to be the most common.In the absence of prophylactic antiretroviral therapy of the mother during pregnancy, labor and delivery and to the fetus following birth, the probability of transmission of HIV from mother to infant ranges from 15-25% in industrialized countries and 25-35% in developing countries.Higher risk of transmission is associated with high maternal viral load.Low CD4 count is also considered a risk factor.A prolonged interval between membrane rupture and delivery is another well documented risk factor for transmission.Other conditions that are potential risk factors but which have not been consistently demonstrated are:Presence of chorioamnionitis at deliverySTD's during pregnancyHard drug use during pregnancyCigarette smokingPreterm deliveryObstetrics procedures such as amniocentesis, amnioscopy fetal scalp electrodes, episiotomy.There is significant decrease in the risk of HIV transmission with elective cesarean.LSCS reduces the risk because during this procedure, the intrapartum period which accounts for significant proportion of transmission is by passed.


Question: For MTP, consent should be obtained from

For medical termination of pregnancy : Only female consent is required Husband consent is not required If the age is less than 18 yrs, consent of parent or guardian is required Ref: Dutta Obs 9e pg 165.


Question: Regarding antibiotic of choice for urinary tract infection (UTI) during pregnancy at third trimester;

Usually a combination of ampicillin of cephalosporin and gentamicin is commended empirically and changed if necessary ,after the urine and blood culture results are obtained. Any of the following drugs can be used: Amoxicillin(500mg tid) Nitrofurantoin (100mg bid) Cephalexin(500mg tid) Amoxicillin-clavulanic acid(875mg bid) A Course of 10-14days will cure 70-100% of cases. Refer page no 274 of Text book of obsteics,sheila balakrishnan,2 nd edition and Textbook of Dutta, 9th edition,page 279.

Medical, surgical and gynaecological illness complicating pregnancy


Question: Karyotype of Sweyer syndrome

Sweyer syndrome is an uncommon form of gonadal dysgenesis, characterized by a 46, XY karyotype. Despite the presence of a Y chromosome, the phenotype is female because the dysgenetic (streak) gonads produce neither AMH nor androgens. Consequently, the vagina, cervix, uterus, and fallopian tubes develop normally and the internal and external genitalia do not masculinize. In approximately 10-15% of patients, the disorder results from an inactivating mutation in the SRY gene, but in most, no cause can be identified. Patients with Swyer syndrome generally present after the expected time of pubey with delayed sexual maturation, primary amenorrhea, normal pubic hair, and normal female internal and external genital anatomy. Evaluation reveals hypergonadotropic hypogonadism, prompting a karyotype that establishes the diagnosis. Gonadectomy is indicated soon after diagnosis due to the significant risk for development of germ cell tumours in occult testicular elements (20-30%). Reference: Clinical Gynecologic Endocrinology; 8th edition; Chapter 9; Normal and Abnormal Sexual Development


Question: Classical symptom of endocervical polyp is

Intermenstrual bleeding is classical symptom of endocervical polyp.


Question: Most common mass descending mass per vaginum

Ans. is 'd' i.e., Uterovaginal prolapseMass descending per vaginum is a common gynaecological complaint and is most often due to uterovaginal prolapse.


Question: Villous pattern is lost in

Choriocarcinoma : On histopathology , it is composed of cells of early cytotrophoblast and synctiotrophoblast There are no villi Has ability to metastatic Most common mode of spread is hematogenous Ref: Dutta Obs 9e pg 187.


Question: Endometriosis is best diagnosed by

Endometriosis is best diagnosed by laparoscopy Role of Laparoscopy: To detect and diagnose pelvic endometriosis Locate site of endometriosis and staging To take biopsy To surgically treat endometriosis by ablation and removal


Question: Large placenta is seen in

Ans. a Twins. (Ref. Dutta, Obstetrics, 4th/pg.221)D/d of Large placenta/hyperplacentosis:# Twin pregnancy# Hydrops fetalis# Diabetes in pregnancy# IUGRHUMAN PLACENTA# It is Discoid, Deciduate and Haemchorial.# It develops from--- foetal (4/5th)--chorionic frondosum and- maternal (l/5th)--decidua basalis.# Its development begins at 6th week of gestation and is completed by 12th week.Q# Its weight is 500 gms and weight of blood in it is 500 ml.# Fetal blood flow through placenta = 400 ml/min# Decidua basalis retains its characteristic appearance till term and becomes the maternal portion of placenta.# Line of separation of placenta after birth of the baby is through decidua spongiosum.# Fetal surface has attachment of umbilical cord with ramification of umbilical vessels and aminon.# Only decidua basalis and blood in the inter villou space are of maternal origin.# Maternal surface has shaggy looks with cotyledons.# Placentome = fetal cotyledon.# Villi are the functional units of placenta. Umbilical arteryUmbilical veinO2 saturation50-60%70-80%pO2 (mm Hg)20-2530-40# Placental calcification is a feature of postmaturity.# Signs of Placental aging:- Appearance of syncytial knots.- Decreased stromal tissue including Hofbauer cells.- Partial deficiency of Langhan's cells.- Thinning of basement membrane layer of foetal endothelium.# Most common tumour of placenta is choriohaemangioma.QDiscriptionDiscriptionType of placentaPlacenta with umbilical cord attached to its marginPlacenta with chorionic plate smaller than basal platePlacenta associated with increased rate of prematurityPlacenta with accessory lobes in the membranes away from main body of placenta, connected by large vessels to main body which if it goes to cervix causes formation of "Vasa previa"--a vital cause of bleeding of fetal originBattledore placentaCircumvallate placenta.Circumvallate placenta.Succenturiate placenta.Placenta with functioning villi covering all foetal membranesPlacenta with central portion missingMembranous placenta.Fenestrated placenta.


Question: Female homologue of scrotum is

Embryologically, Labia majora are homologous with male scrotum.


Question: Major source of estrogen in postmenopausal women is

All postmenopausal and symptomatic per menopausal women who do not have contraindication paicularlyThose with high-risk factors osteoporosis.Those with premature menopauseEvaluation before staing H:History-personal, medical, gynecological, familyExamination -HT, wt., BMI, BP, breast, vaginal examinationPap smearMammographyLipid profileTransvaginal sonography-endometrial thicknessWork up relevant to symptoms, e.g. urinary continence, carbohydrate intolerance, psychoemotional states.Contraindications of H:PregnancyCA breastCA endometriumUndiagnosed abnormal vaginal bleedingActive liver diseasePresent deep vein thrombosis, thromboembolic disorderInvestigation not routinely needed before staing HEndometrial sampling-Only did if the history of abnormal vaginal bleeding, TVS shows endometrial thickness> 5 mm.Serum FSH-Only did if the diagnosis of menopause is not clear, e.g. vasomotor symptoms in absence of amenorrhoea Bone densitometry-Using DEXA (dual energy X-ray absorptiometry) of lumber veebrae, hip bone for women with risk factors for osteoporosis, persistent backache, bone aches, history of recent fracture, for research purpose

Peripheral conversion of androstenedione


Question: Outlet forceps, meansa) Head at station "0"b) Full cervical dilatationc) Rupture of membraned) Rotation > 45


Question: Endometrial hyperplasia is seen in

Polycystic ovarian disease - endometrial hyperplasia due to high content of estrogen, largely estrone, by extraglandular aromatization of circulating androstenedione.


Question: Most common Vagal carcinoma is

Ans. is a i.e. Squamous cell Ca Vaginal carcinoma Primary cancer of vagina are very rare. Most common age group is Elderly females - 70 years. Most common histologic type is Squamous cell carcinoma Most common site is Upper third of Posterior wall of vagina. Mostly asymptomatic Patient may present with abnormal vaginal bleeding (including post coital bleeding). Foul smelling discharge per vaginum. P/S - Ulcerative/exophytic growth on vagina. Cervix appears normal. Lymphatic Drainage : Tumor arising in upper vagina : drain to pelvic lymph node. Tumor arising in lower pa : drain to inguinal lymph node. Management : Growth limited to middle third : Radiotherapy Growth limited to upper third and lower third : Surgery.


Question: Decreased vascularity of fibroid is seen with

GnRH analogues used for 6months reduce the size by 50-80%. It is also useful in reducing the vascularity besides size preoperatively and thus causing amenorrhoea which restores hb level. Ref:shaw's textbook of gynaecology;15th edition; Pg :359


Question: FSH to LH ratio during reproductive years

During reproductive years, LH exceeds FSH levels.


Question: Staging of ovarian tumor involving bladder

-Stage II ovarian cancer: tumor involves one or both ovaries or fallopian tubes with pelvic extension or primary peritoneal cancer. IIA: ovarian tumor involving uterus or fallopian tubes IIB: ovarian tumor involving pelvic intraperitoneal organs ( bladder, rectum or pelvic side walls) Reference : textbook of gynaecology Sheila balakrishnan, 2nd edition, pg no:277 <\p>


Question: Volume of amniotic fluid needed for fetal karyotyping.

20 ML of amniotic fluid is required for fetal karyotyping.
10 ML is required for FISH.


Question: Uteroplacental blood flow per minute

Uteroplacental blood flow per minute : 450 - 650 mL/min


Question: Goodell sign in early pregnancy is

In early pregnancy, increased vascularity within the cervix stroma beneath the epithelium creates an ectocervical blue tint that is characteristic of Chadwick sign. Cervical edemaleads to softening , whereas isthmic softening is Hegar sign.(Ref: William's Obstetrics; 25th edition)


Question: P/V examation is contraindcated in

(Placenta previa) (244- Dutta 7th)PLACENTA PREVIAVaginal examination must not be done outside the operation theater in the hospital, as it can provide further separation of placenta with torrential hemorrhage and may be fatal. It should only be done prior to termination of pregnancy in the operation theater under anesthesia, keeping everthing ready for casarean section* The regimen used for expectant management of placenta previa is- Macafee & Johnson regimen**Expectant Management of placenta previa* Rest (Absolute bed rest for up to 72 hours after bleeding stops)* Careful monitoring (clinical/ Laboratory/ USG every 2-3 weeks* Blood transfusion and Hematinics (maintain Hb atleast 10 g/dl and Hematocrit of 30%)* Antenatal steroids for foetal maturity (Between 24-34 weeks of gestation)* Anti D immunoglobulin (to all RH negative women)Use of Tocolysis (controversial) May be justified in selected cases but their use is not supported by strong evidenceCervical Encirclage - Not currently recommended insufficient evidence* First sign of magnesium toxicity is loss of deep tendon reflex* Bile acids represent best markers for intrahepatic cholestasis of pregnancy* Ursodiol (uricodeoxycholic acid) is treatment of choice for Intrahepatic cholestases in pregnancy* Methotrexate is absolutely contraindicated during pregnancy (class x)and lactation due to its potential for spontaneous abortion and teratogenecity* Transplacental transmission is rare with both Herpes simplex and Hepatitis B


Question: Ventouse in the 2nd stage of labour is contraindicated in

1.Ventouse in the 2nd stage of labour is contraindicated in Prematurity as it can lead to - cephalohematoma, subgaleal hemorrhage, retinal hemorrhage, neonatal jaundice secondary to these hemorrhages and scalp lacerations. 2. A forceps is known to cage a small preterm head and in fact protect it.So, it is prefered


Question: Commonest diameter of fetal head engagement is

The commonest diameter for fetal head engagement is suboccipitobregmatic, as it leads to veex presentation for normal vaginal delivery. Fetal skull diameters Measurements Suboccipitobregmatic Biparietal diameter Submentobregmatic 9.5 cm Suboccipitofrontal 10cm Occipitofrontal Submentoveical 11.5 cm Mentoveical 14 cm


Question: Late hyperglycemia in pregnancy is associated with

Fetal macrosomia Definition: Those infants exceeding the 90th percentile for a given gestational week are usually used as the threshold for macrosomia or large-for-gestational age (LGA) bihweight The primary effect attributed to gestational diabetes is excessive fetal size or macrosomia Maternal hyperglycemia prompts fetal hyperinsulinemia, paicularly during the second half of gestation . This in turn stimulates excessive somatic growth or macrosomia. Except for the brain, most fetal organs are affected by the macrosomia that characterizes the fetus of a diabetic woman. Infants are anthropometrically different from other large-forgestational age (LGA) infants with excessive fat deposition on the shoulders and trunk, which predisposes to shoulder dystocia or cesarean delivery The incidence of macrosomia rises significantly when mean maternal blood glucose concentrations chronically exceed 130 mg/dL Reference: William&;s Obstetrics; 24th edition; Chapter 57

Medical, surgical and gynaecological illness complicating pregnancy


Question: Isotretinoin to be stopped before pregnancy

Isotretinoin iseffective for treating severe acne but it is is category X drug in pregnancy. It is recommended that a woman should wait at least 1 month after stopping Isotretinoin before trying to became pregnant but the desirable time is 3 months.


Question: Retinal vessels develop by

Ans: a (4th month) Ref: yanoff 3rd ed p- 606During development, retinal vessels migrate from the optic disc to the ora serrata beginning at 16 weeks of gestation.Mature vessels develop from these networks and extend to the nasal ora serrata by 36 weeks of gestation and to the temporal ora serrata by 39 - 41 weeks.


Question: Endo metrial tuberculosis causing infertility is due to

B. i.e. (Tubal blockage) (189 - Shaw's 14th) (215-130 Dutta 4th)GENITAL TUBERCULOSIS* Endometrial ulceration may lead to adhesions or synechiae formation (Asherman's syndrome). This may cause infertility, secondary amenorrhoea or recurrent abortion* In pelvic tuberculosis, blockage of tubes and endometrial tuberculosis causing As Herman syndromes (adhesions) are responsible* Breast milk is known to transmit - Untreated tuberculosis*** The uterine fibroid - which accounts for infertility is a corneal fibroid blocking the medial end of the fallopian tube, submucous fibroid, and cervical fibroid distorting the passage of the sperms**Isthumo- isthemic anastomosis is associated with maximum chances of re- canalization during surgery for reversal of tubal ligation.


Question: Patient with NTD, dose of folic acid in next pregnancy

Folic acid supplementation 4 mg daily 1 month before conception to about 12 weeks of pregnancy. Ref : Dutta book of obstetrics 8th Ed


Question: Burch technique of treating urinary incontinence is

Burch colposuspension is procedure of retropubic urethropexy, wherein pubocervical fascia is attached to cooper ligament to lift anterior vaginal wall and periurethral fibromuscular tissue.


Question: Treatment of choice for molar pregnancy is

Regardless of uterine size, molar evacuation by suction curettage is usually the preferred treatment.Reference: William's Obstetrics; 25th edition, chapter 20; Gestational trophoblastic diseases


Question: Most commonly this tumour is due to carcinoma of

Transperitoneal implantation of the carcinoma of the stomach may occur in which the carcinoma cells pass from, stomach into the peritoneal cavity; they "gravitate" into the pelvis where the secondaries palpable on rectal examination I may develop. In females, occasionally, they "alight" upon the ovaries giving rise to Krukenberg tumors which are I liable to produce diagnostic confusion. The term Krukenberg tumor is classically reserved" for metastatic involvement of the ovary by a gastrointestinal tumor. The microscopic appearance of Krukenberg tumors shows characteristic mucin-containing signet-ring cells. This term is often used loosely to describe the metastatic involvement of the ovaries in general. These metastatic lesions often present clinically as primary ovarian lesions and may have a similar radiographic appearance to primary carcinoma of the ovary.


Question: Pseudomyxoma peritonei occurs in

i.e. (Mucinous cystadenocarcinoma of the ovary): (375-388-Shaw9s 15th) (1003-Bailey & Love 25th) (476-CSDT 13th)PSEUDOMYXOMA PERITONEI* Caused by low grade mucinous cystadenocarcinomas of the appendix or ovary* Recent studies suggest that most cases arise from a primary appendiceal tumour with secondary implantation on to one or both ovaries* The abdomen is filled with a yellow jelly, large quantities of which are often encysted* Painless and there is frequently no impairment of general health* Pseudomyxoma peritonei does not give rise to extraperitoneal metastasis* CT and USG shows a distinctive peritoneal scalloping of the liver margin, calcified plaques, ascites and low density masses* The appendix if present should be excised together with any ovarian tumour**** Adjuvant intracavitary radiotherapy - for residual disease**


Question: Cause of death in breech delivery

Ans. is a i.e. Intracranial hemorrhage Intracraniai hemorrhage is the most common cause of fetal loss. occurs due to tear of tentorium cere.belli and falx cerebri. It is caused by traumatic delivery of the after coming head of breech or too rapid delivery of the soft head of a premature baby.


Question: Absolute contraindication to Hormone replacement therapy

Absolute conrtraindications to HRT

Suspected pregnancy
Breast cancer
Endometrial cancer
Active liver disease
Known thrombophilia
Osteosclerosis.


Question: Most sensitive test for assessment of fetal well being is

(Biparietal diameter) (85-Dutta 6th)Real ultrasound measurement of fetal growth* First trimester - Crown - rump length* Second trimester - Biparietal diameter (BPD)* Third trimester - Multiple foetal growth parameters are considered together. These are- Prior to 36 weeks - Combination of biparietal diameter, abdominal circumference and femur length (FL)- After 36 weeks - Combination of head circumference, abdominal circumference and femur lengthA- BPD greater than 9.2 cm indicates foetal pulmonary maturity corroborated by L:S ratio* Early measurement of BPD and FL are the most useful in establishing gestational age Later measurement of fetal growth are best achieved by measurement of the head circumference and the abdominal circumference (G. chamberlain 7th)* Foetal head: abdominal circumference ratioMaximum - 1.29 at 12 weeksEqual - 1.00 at 36 weeksMinimum - <1.00 after 37 weeks* Bishop score is used for induction of labour* Manning score is most sensitive & reliable test for fetal well beingDifferent diameter of skull in newborn are* Suboccipito-bregmatic =9.5cm* Suboccipito-frontal =10cm* Occipito frontal =11.5cm* Mento vertical =14cm* Sub mento vertical =11.5cm* Sub mento-bregmatic =9.5cm* Biparietal diameter =9.5cm* Super-subparietal =8.5cm* Bitemporal diameter =8cm* Bimastoid diameter =7.5cm* Twin peak sign - Ultrasonography shows extension of placental tissue into the inner twin membrane in diaminiotic dichorionic (DD)


Question: Lifespan of the fetal RBC approximately is

The lifespan of fetal red cells is 80 days and Rh factor is developed by 38 days.


Question: Tumor marker of Dysgerminoma

Dysgerminoma is the most common malignant germ cell tumour, accounting for about 30% to 40% of all ovarian cancers of germ cell origin. Placental alkaline phosphatase (PLAP) and lactate dehydrogenase (LDH) are produced by up to 95% of dysgerminomas, and serial measurements of LDH may be useful for monitoring the disease. Reference: Berek and Novak's Gynecology; 14th edition; Chapter 37; Ovarian, Fallopian Tube, and Peritoneal Cancer


Question: Follistatin

Follistatin is gonadal peptide, that suppresses FSH β gene expression thereby preventing interaction of activin with its receptor.

Prevents interaction of activin with receptor


Question: This organism may cause epidemics of puerperal sepsis.

Most female pelvic infections are caused by bacteria indigenous to the genital tract. Over the past 20 years, there have been repos of group A b-hemolytic streptococcus causing toxic shock-like syndrome and life-threatening infection Gram-positive cocci--group A streptococci, enterococcus, Staphylococcus aureus, Staphylococcus epidermidis Gram-negative bacteria--Escherichia coli, Klebsiella, Anaerobes Cocci--Peptostreptococcus and Peptococcus species Others--Clostridium, Bacteroides, and Fusobacterium species, Mobiluncus species


Question: The Point of distinction between paial mole to complete mole is

Ref: Shaw&;s Textbook of Gynecology; 16th edition; Chapter 22; Gestational Trophoblastic Diseases

Paial mole show trophoblastic proliferation with absent villi

Typical of paial mole is cellular atypia

Paial mole is more prone to tumor malignancy


Question: Transverse uterine incision is preferred to vertical incision because

Compared with classical incision, transverse incision is easier to repair, is located in inactive segment and thus least likely to rupture in future pregnancies.
It causes less incision site bleeding and promotes less bowel adhesions.

Lessens risk of rupture in subsequent pregnancy.


Question: MgSO4 is/are indicated in

The drug of choice for control and prevention of convulsion in eclampsia is magnesium sulphate ,usually given by Pritchard&;s regime.The mechanism of action thought to have a peripheral action at the neuromuscular junction,by competing with calcium for entry into the cells.It may also have central action. TEXT BOOK OF OBSTETRICS,Sheila Balakrishnan,2nd edition,page no.268

Medical, surgical and gynaecological illness complicating pregnancy


Question: Average blood loss in normal menstruation

The duration of menstruation is 4-5 days and the amount of blood loss estimated to be 20-80ml with an average of 35ml. Reference: D.C.DUTTA&;S TEXTBOOK OF GYNECOLOGY; 6th edition; PG NO:82


Question: Area of mitral valve in severe mitral stenosis during pregnancy

Normal area of mitral valve is 4-6cm2 Symptoms usually appear when stenosis <2.5cm2 Severe mitral stenosis is less than 1.5cm2 Critical area is less than 1cm2- High rate of Pulmoary edema(55%) and Arrhythmia(33%) Reference: William's Obstetrics; 24th edition; chapter 49 & DC.Duttas ,9th edition,page 260

Medical, surgical and gynaecological illness complicating pregnancy


Question: Intermenstrual bleeding is frequent side effect seen with

Intermenstrual bleeding is frequent with progestin - only pills throughout use and with combined OCPs during early months of use.

Progestin-only pills during early months of use.

Progestin-only pills resultant AUB never occurs.

Combined OCPs during early months of use.


Question: A forceps rotation of 30deg from left occiput anterior (LOA) to occiput anterior (OA) with extraction of fetus from +2 station

FORCEPS OUTLET FORCEPS Scalp visible at introitus without seperating labia leading point of fetal skull is at the pelvic floor saggital suture in AP diameter or rotation<45 degree LOW FORCEPS leading point of fetal skull is at station +2cm or below,not on pelvic floor rotation not more than 45 degree MIDCAVITY FORCEPS fetal head 1/5 palpable per abdomen head engaged but station above +2cm rotation>45 degree HIGH FORCEPS never done TEXTBOOK OF OBSTETRICS,SHEILA BALAKRISHNAN,pg no:443,2nd edition


Question: Red degeneration most commonly occurs in

Ans. is 'b' i.e. 2nd Trimester Red degeneration of the myomasRed degeneration of uterine myomas develops most frequently during pregnancy. It typically occurs during 2nd trimester (20-22) weeks of pregnancy.During red degeneration, the myomas become tense, tender and causes severe abdominal pain with constitutional upset and fever.Although the patient is febrile with moderate Leucocytosis and raised E.S.R., the condition is an aseptic one.It needs to be differentiated from appendicitis, twisted ovarian cyst, pyelitis and accidental hemorrhage.During the red degeneration, the tumour itself assumes a peculiar purple red colour and develops a fishy odour. If the tumour is carefully examined, some of the large veins in the capsule and the small vessels in the substance of the tumour will be found thrombosed. The discoloration is possibly caused by diffusion of blood pigments from thrombosed vessels.Conservative treatment with analgesia, reassurance and supportive therapy is almost always adequate.Also knowAnother complication of myoma which is seen during pregnancy is torsion of the myoma.Torsion of the myoma is also characterized by acute abdominal pain with point tenderness over the site of leiomyoma.Conservative t/t is adequate.

Clinical Features, Diagnosis, and Pathology


Question: Compared with other mullerian duct defects, a transverse vaginal septum is associated with lower rate of

In contrast to other mullerian duct defects, transverse vaginal septum is associated with few urologic abnormalities.


Question: Prelabour pains are mediated through

T11-T12 Pain pathways during labour The pain of labour arises from - Contraction of myometrium, against the resistance of cervix and perineum - Progressive dilatation of the cervix and lower uterine segment - Stretching and compression of pelvic and perineal structures Pain during the, first stage of labour is mostly visceral pain resulting from uterine contractions and cervical dilatation. It is usually confined to the T11-T12 dermatomes during the latent phase but eventually involves the TIO-LI dermatomes as the labour enters the the active phase. The visceral afferent fibres responsible for labour pain travel with sympathetic nerve.fibres.first to the uterine and cervical plexes then through the hypogastric and aoic plexes before entering the spinal cord with the T10-L1 nerve roots. The onset of perineal pain at the end of fist stage signals the beginning of the fetal descent and the second stage of labour. Stretching and compression of pelvic and perineal structures intensify the pain. Sensory innervations of the perineum is provided by the pudendal nerve (S2-S4) so pain during the second stage of labour involves the T10-S4 dermatosomes.


Question: The immunoglobulin that crosses placental barrier is

Ans. b (IgG). (Ref: Jawetz's Medical Microbiology, 24th/Table 8-l;Obstetrics by Dutta, 4th/677)# Antigens of MCH have been shown to be well expressed in newborn, in the fetus and in embryo of 10th week.# IgG abs can cross placenta. IgGIgAIgMIgEIgDHeavy chain symbolgabedMolecular weight (x 1000)150170 or 4001900190150Serum concentration (mg/mL)7-180.8-40.4-2.5< 0.0005< 0.003Serum half-life (days)217722Activates complementYes (+)NoYes (++)NoNoPercentage of total immunoglobulins in serum80136< 1< 1Crosses placentaYesNoNoNono


Question: FSH rise in menopause is attributed to

Increased FSH levels reflect the reduced capability of aging follicles to secrete inhibin.


Question: In postmenopausal women, RANK ligand expression is

In post menopausal women, decreased oestrogen levels lead to increased RANK ligand expression and decreased osteoprotegerin (OPG), resulting in bone resorption.


Question: Strassmann metroplasty is done in case of

Strassman metroplasty is done in bicornuate or didelphic uterus.

Unicornuate uterus with rudimentary horn


Question: Singer's alkali denaturation test is used to differentiate

Singer's alkali denaturation test : It is a diagnostic test for vasa pre In this nucleated red blood cells are detected Ref: Dutta Obs 9e pg 243.


Question: Time required for ovulation from the onset of LH surge is

From the onset of the LH surge, it takes 34-36 hours and from the peak it takes 10-12 hours to ovulate. The midcycle LH surge is responsible for a dramatic increase in local concentrations of prostaglandins and proteolytic enzymes in the follicle. These substances progressively weaken the follicular wall and ultimately allow a perforation to form.

Normal Menstruation, Abnormal Menstruation, Menopausal Physiology and forsight of conception


Question: Earliest detectable congenital malformation by USG


Question: The recommended non surgical treatment of stress incontinence

Conservative treatment is the first line of treatment especially in younger women Indications Milder forms of incontinence Patient medically unfit for the surgery Patient doesn't wish to undergo surgery Who have yet to complete their families Methods Pelvic floor muscle training : First line Periniometry Vaginal cones Maximum electrical stimulation Ref: SHAW&;S TEXTBOOK OF GYNAECOLOGY; 15th edition; Pg no:192


Question: Engaging diameter in brow presentation is

Brow presentation : Engaging diameter of head is Mentoveical which is 14 cm The position is commonly unstable and conves to either veex or face presentation Position can be confirmed by Palpating supraorbital ridges and anterior fontanel. Ref: Dutta Obs 9e pg 367.


Question: Commonest site of Tubal pregnancy is

(Ampulla) (240- Shaw's 14th) (181-Dutta 6th)* Ampullary portion is the site of ectopic pregnancy in 80%, fimbrial end is the site in 6% isthmus in 12% and interstial in 2%* Commonest site - Ampulla. Least - Interstitial* In a tubal pregnancy, the most frequent inplantation site is the ampulla, because the plicae are most numerous in this situation, and previous salpingitis is more likely to produce crypts here than else where along the fallopian tube* Tubal abortion is the common mode of termination if implantation occurs in the ampulla or infundibulum* Tubal rupture is predominantly common in isthmic and interstitial implantation* Isthmic rupture usually occurs at 6 - 8 weeks the ampullary one at 8-12 weeks and the interstitial one at about 4 months


Question: A patient treated for infeility with clomiphene citrate presents with sudden onset of abdominal pain and distension with ascites the probable cause is

Ovarian Hyperstimulation syndrome It is an iatrogenic complication of ovulation induction with exogenous gonadotropins and clomiphene-induced cycles Charecteristic feature of OHSS is an increase in capillary permeability resulting in fluid shift from intravascular to extravascular spaces Mechanism of Action Probably mediated by increased ovarian secretion of vasoactive substances including Vascular endothelial growth factor , elements of Renin-Angiotensin system and other cytokines Risk factors Young age, low body weight, PCOS, higher doses of gonadotropins and previous episodes of hyperstimulation Mild illness Charecterised by Ovarian enlargement, lower abdominal discomfo, mild nausea and vomiting, diarrhea and abdominal discomfo. Managed by outpatient basis with analgesics and bedrest; monitored by daily weight checkup, urinary frequency, clinical examination to detect ascites, lab tests of hematocrit, electrolytes and serum creatinine Serious illness Characterised by severe pain, rapid weight gain, tense ascites, hemodynamic instability, respiratory diffiulty, progressive oliguria leadng to renal failure, ovarian rupture and thromboembolic phenomenon Hospitalization and treated according to symptoms Ref: Clinical Gynecologic Endocrinology and Infeility; Eigth Edition; Chapter 31

Reproductive physiology and hormones in females


Question: Cystic degeneration is seen commonly in

Cystic degeneration is seen commonly seen in interstitial fibroid.


Question: Regarding IUGR

‘AC is the single most sensitive parameter to detect IUGR’
Dutta Obs 7/e, p 462
‘Serial measurements of AC (not BPD) and estimation of fetal weight are more diagnostic to fetal growth restriction’
Dutta Obs 7/e, p 462
Head circumference (HC) and abdominal circumference (AC) ratios: In a normally growing fetus the HC/AC ratio exceeds 1.0 before 32 weeks. It is approximately 1.0 at 32 to 34 weeks. After 34 weeks, it falls below 1.0. If the fetus is affected by asymmetric IUGR, the HC remains larger. The HC/AC is then elevated. In symmetric IUGR, both the HC and AC are reduced. The HC/AC ratio remains normal. Using HC/AC ratio, 85% of IUGR fetuses are detected
Pathophysiology: Basic pathology in small for gestational age is due to reduced availability of nutrients in the mother or its reduced transfer by the placenta to the fetus. It may also be due to reduced ultilization by the fetus. Brain cell size (asymmetric–SGA) as well as cell numbers (symmetric-SGA) are reduced. Liver glycogen content is reduced. AC indirectly reflects the decreased fetal liver size and glycogen content.

Abdominal circumference (AC) is the least sensitive parameter for detection of IUGR

In asymmetric IUGR head circumference/abdominal circumference (HC/AC) is reduced

Serial biparietal diameter (BPD) is the only important measurement in IUGR

AC indirectly reflects fetal liver size and glycogen storage


Question: Subnuclear vacuolation is a characteristic sign of

The most characteristic signs of secretory phase are found in the glands. Their epithelial cells develop spherical translucent areas between the nuclei and the basement membrane which contain the precursors of the glandular secretion and which persist until about the 21st day of the cycle. This characteristic appearance is called subnuclear vacuolation and is presumptive evidence of progesterone activity and therefore of ovulation.Reference: Shaw's Textbook of Gynecology; 16th edition; Chapter 2; Normal Histology

Reproductive physiology and hormones in females


Question: M/c cause of APH is

Abruptio placenta is defined as the haemorrhage occurring in pregnancy due to separation of a normally situated placenta.It is also called accidental haemorrhage or premature separation of placenta (refer pgno:133 sheila textbook of obstetrics 2 nd edition)


Question: Temporary method of contraception among the following is

Temporary contraceptive methods are

Hormonal contraception
Intrauterine devices
Barrier contraception
Natural family planning methods


Question: The nerve root blocked in pudendal block is

Pudendal nerve block : Pudendal nerve arises from S2,3,4. Doesn't relieve the pain of labor Cause perineal analgesia and relaxation Ref: Dutta Obs 9e pg 480.


Question: Risk of ureteric injury is more with

Maximum chances of injuring ureter is seen in case of wertheim's (modified radical) hysterectomy, as medial half of cardinal ligament is removed.


Question: Main hormone acting upon uterus to initiate labour

Oxytocin is a nonapeptide,
 It is secreted by posterior pituitary along with vasopressin (ADH).
Both oxytocin and ADH are synthesized within the nerve cell bodies in supraoptic and paraventricular nuclei of the hypothalamus; are transported down the axon and stored in the nerve endings within the neurohypophysis.
They are stored in separate neurones as complexes with their specific binding proteins (Neurophysin).

 Actions

Uterus It increases the force and frequency of uterine contraction. Estrogens sensitize the uterus to oxytocin, while progestins decrease the sensitivity. The increased contractility is restricted to the fundus and body„ lower segment is not contracted, may even be relaxed at term.
Breast Oxytocin contracts myoepithelium of mammary alveoli and forces milk into bigger sinusoids - Milk ejection or milk letdown reflex.
CVS Higher doses cause vasodilation → Brief fall in BP, reflex tachycardia and flushing. The umbilical vessels are constricted oxytocin may help their clossure at birth.
Kidney Oxytocin in high doses exerts ADH like action —» water retention can occur.


Question: Multiple bih are commonest among .


Question: Internal podalic version is done in

Internal podalic version is done for only delivery of second twin (Transverse lie).


Question: Menopause is diagnosed by

Menopause - Permanent cessation of mensturation. Clinical diagnosis- Stoppage of menses for 1 year without any other pathology Cessation of menses before the age of 40 is known as premature ovarian failure Investigation- Increase FSH> 40mIU/ml ( 3 values at weekly interval required) LH>20 IU Estradiol <20 pg Vaginal cytology: maturation index : 10/85/5

Normal Menstruation, Abnormal Menstruation, Menopausal Physiology and forsight of conception


Question: Thickness of placental barrier in early pregnancy

Placental barrier in early pregnancy consists of Synctiotrophoblast Cytotrophoblast Basement membrane Stromal tissue Endothelium of fetal capillary wall It is about 0.025 mm thick Ref: Dutta Obs 9e pg 30.


Question: Progesterone of choice in emergency contraception is

Levonorgestrel Levonorgestrel alone, 0.75 mg stat F/B another 0.75 mg 12 hrs later, taken within 72 hrs of unprotected intercourse is the method of choice .for emergency contraception Emergency contraception is also k/a postcoital morning after contraception. Basically the methods used interfere with the physiological events before implantation, for e.g. inhibition or delaying of ovulation or interference with postovulatory events necessary for implantation & longevity of the blastocyst. Agents used for emergency contraception are known as 'interceptives'. Methods of emergency contraception Drugs Dosage Time frame Preg. rate * High dose estrogens (not used now) - Ethinyl estradiol (EE) 2.5 mg BD x 5 days Within 72 hrs of coitus L-0.15% - Conjugated equine estrogen (CEE) 15 mg BD x 5 days 0-0.6% * Estrogen & progestin combination pill ,, - Yuzpe method EE 50 rg + d, l-NG 0.5 mg (Ovral) 2 tabs stat & 2 tabs after 12 hrs ,, ,, 0-2% (Total dose EE 0.2 mg & LNG 2 mg) - Low dose pills ,, II 0-2% EE 30 lig + LNG 0.15mg (Ovral L, Mala-N etc.) 4 tabs stat & 4 tabs after 12 hors * Levonorgestrel (LNG) alone (Ecee 2, i- 0.75 mg stat F/B Preferably 0-1% pill, E-pill, unwanted-72, Plan-B) 0.75 mg after 12 hrs or 1.5 mg stat within 72 hrs but can be given upto 5 days * Centchroman 30mg 2 tab BD x 1 day Within 5 days not known (Saheli) * Danazol 400/800 mg BD x Within 72 hrs 0.8 - 1.7% 3 days or 1200 mg BD x 2 days * Mifepristone (RU 486) 600 mg/200 mg / Within 5 days to - 1.3% 10 mg single dose 27th day of cycle * Copper IUD (more effective than steroids) To be inseed within 7 days < 1%


Question: The dose of folic acid per day for treating megaloblastic anaemia in pregnancy

Folic acid deficiency in Pregnancy

In nonpregnant women, the folic acid requirement is 50 to 100 μg/day
During pregnancy, requirements are increased and 400 μg/day is recommended

The earliest biochemical evidence is low plasma folic acid concentrations
Normal serum folate levels

Non Pregnant women: 5.4-18ng/ml
1st trimester: 2.6-15ng/ml
2nd trimester: 0.8-24ng/ml
3rd trimester: 1.4-20.7ng/ml

Early morphological changes usually include neutrophils that are hypersegmented and newly formed erythrocytes that are macrocytic
 As the anaemia becomes more intense, peripheral nucleated erythrocytes appear, and bone marrow examination discloses megaloblastic erythropoiesis
The fetus and placenta extract folate from maternal circulation so effectively that the fetus is not anaemic despite severe maternal anaemia

Treatment

 As little as 1mg of folic acid administered orally once daily produces a striking haematological response
By 4 to 7 days after beginning folic acid treatment, the reticulocyte count is increased, and leukopenia and thrombocytopenia are corrected
American College of Obstetricians and Gynecologists (2013c) have recommended that all women of childbearing age consume at least 400 μg of folic acid daily

Increased need of Folic acid

Multifetal pregnancy
Hemolytic anaemia
Crohn disease
Alcoholism
Inflammatory skin disorders


Question: Post delivery uterus becomes pelvic organ by

Following delivery, the fundus lies about 13.5 cm (5 1/2") above the symphysis pubis. During the first 24 hours, the level remains constant; thereafter, there is a steady decrease in height by 1.25 cm (1/2") in 24 hours, so that by the end of the second week the uterus becomes a pelvic organ. The rate of involution thereafter slows down until by 6 weeks, the uterus becomes almost normal in sizeReference: DC Dutta&;s Textbook of Obstetrics; Chapter 13; Normal Puerperium


Question: Oxytocin will not do the following action

Ans. (a) Milk productionRef : D.C. Dutta 8th ed. /136, 574Milk production is by Prolactin.


Question: Bleeding associated with anovulation is due to

As ovulation does not occur, proliferative endometrium persists causing bleeding.

Alterations in endometrial vascular structure.

Increased endometrial responsiveness to vasodilating prostaglandins.


Question: Gonadotropin levels decline to prepubertal levels by age

Gonadotropin levels gradually decline to reach prepubertal levels by age 1 to 2 years.


Question: Augmented retraction ring in labour is known as

Ans. b (Bandl's ring). (Ref. Williams, Obstetris 21st/pg.836, Dutta, Obstetrics 4th/pg.367)BANDL'S (PATHOLOGICAL RETRACTION) RING# A circular groove encircling the uterus, formed between active upper segment and distended lower segment.SCHROEDER'S (CONSTRICTION) RING# Situated at the junction of upper and lower segment.# Usually reversible and complete.# May appear in all stages of labour.# Ring is not felt per abdomen, round ligament also not felt.


Question: Minimum dose of estrogen in combined OCP&;s


Question: Most dangerous hepatitis in pregnancy

Ans. is 'd' i.e., Hepatitis EHas been explained in previous sessions.


Question: Tocolytic of choice in pregnancy with hea disease (OBG)

Calcium-channel blockers, especially nifedipine, are safer and more effective tocolytic agents than are B-agonists Nifedipine is the best first-line tocolytic agent available at this time. The initial dose should be 30 mg and subsequent doses 20 mg every 6 hours. MgSO4 which is an excellent drug for ecclampsia prevention and management is also used for tocollyis. This has a'Neuroprotective effect' on the preterm fetus and prevent s cerebral palsy instances main subjective maternal complaints to Mgs04 are related to the mental effects ("out of it" or "felt like a zombie") and the overall muscular weakness produced by the drug. The most frequent side effects of magnesium sulfate are pulmonary congestion, respiratory depression,hypothermia, and neuromuscular toxicity. Infants of mothers treated with IV magnesium sulfate sholy before delivery are frequently Hypotonic . neonatal/fetal complications are hypocalcemia & Intraventricular hage NOTE: FDA had denied approval of Atosiban (Oxytocin receptor antagonist) in view of concerns regarding efficacy and fetal-newborn safety.


Question: Deep transverse arrest is seen in

Ans. a (Occipitoposterior position). (Ref. Dutta, Obstetrics 4th/367, Ref. Williams Obstetrics, 21st/305)OCCIPITO-POSTERIOR POSITION# A vertex presentation with occiput placed posteriorly over SI joint or directly over the sacrum.# During delivery when occiput rotates through l/8th of a circle, anterior and sagital sutures come to lie in bispinous diameter, further anterior rotation becomes unlikely and arrest occurs in this position, and there occurs no progress of descent of head even after Vi hour following full dilatation of cervix, called as deep transverse arrest.# Etiology:- Lax pelvic floor- Android pelvis,- Weak uterine contraction,# Treatment:- Ventouse is ideal- Application of forceps can be useful- LSCS, if big baby, inadequate pelvis.


Question: The cause of &;postpaum blues&; is

Also called maternity blues Affects women within 3-5 days of delivery Symptoms include insomnia, unexplained weepiness, depression, anxiety, headache, poor concentration, and fatigue.The condition is self-limiting and requires only reassurance and emotional suppo especially family suppo (refer to pgno:438 Sheila 2 nd edition)


Question: 70yrs old patient diagnosed with ovarian cancer. Surgical staging involving inguinal lymph nodes

Stage IV: distant metastasis excluding peritoneal metastasis. IVA: pleural effusion with positive cytology. IVB: hepatic and/ or splenic parenchyma metastasis, metastasis to extra abdominal organs (including inguinal lymph nodes and lymph nodes outside of the abdominal cavity) Reference: textbook of gynaecology Sheila balakrishnan, 2nd edition, pg no:277 <\p>


Question: Chassarmoir surgery is done in

Chassarmoir technique Used for repair of vesicovaginal Fistula Technique: Flap splitting method Bladder and vaginal are widely separated and sutured in two layers Ref: SHAW&;S TEXTBOOK OF GYNECOLOGY; 15th edition; Pg no:187

Gynaecological diagnosis and operative surgery


Question: Preferred procedure for obtaining endometrial sample for histopathology is

Endometrial aspiration should be the preferred procedure for obtaining endometrial sample for histopathology. If endometrium is thick on imaging, but where HPE is inadequate or atrophic, hysteroscopy should be performed to rule out polyps. Dilatation and curettage should not be the procedure of choice for endometrial assessment. Reference: Novak's gynaecology; 14th edition; Chapter 14; Benign Diseases of the Female Reproductive Tract


Question: Incidence of preterm delivery in twin pregnancy is

Incidence of preterm in twin pregnancy is 50% Mean gestational age for twins is 37weeks Causes of prematurity: Overdistention of uterus Hydromnios Premature rupture of membranes Ref: Dutta Obs 9e pg 193.


Question: In a post paum patient the blood volumes becomes normal after non pregnant state in


Question: The recurrent risk for postpaum psychosis in next pregnancy is

Postpaum psychosis has a 50% recurrence risk in the next pregnancy. Impoant risk for postpaum psychosis is a history of bipolar disease. (Ref: William's Obstetrics; 25th edition)


Question: Pregnancy is contraindicated in

WHO 4 Category: Very high risk of maternal moality or severe morbidity; Pregnancy contraindicated and termination discussedPulmonary aerial hypeensionSevere systemic ventricular dysfunction Previous peripaum cardiomyopathy with any residual impairment of left ventricular functionSevere left hea obstructionMarfan syndrome with aoa dilated > 40mm(Ref: William's Obstetrics; 25th edition)


Question: Most common nerve injured during normal vaginal delivery is

Most common nerve injured during vaginal delivery - Lateral femoral cutaneous nerve followed by femoral nerve Most common nerve injured during cesarean section - Iliohypogastric nerve and Ilioinguinal nerve Ref: Williams Obs 24e pg 677.


Question: A diabetic female at 40 wks of gestation delivered a baby by elective cesarean section. Soon after bih the baby developed respiratory distress. The diagnosis is

Ans. is a i.e. Transient tachypnea of the new born Friends don't get shocked by the answer, even I was perplexed when I went through the texts given in all the standard reference books. Let's see what they have said. Respiratory distress syndrome (RDS) or hyaline membrane disease (HMD) RDS almost always occurs in nreterm babies often less than 34 weeks of gestation. It is the commonest cause of respiratory distress in a preterm neonate. According to Ghai -- RDS is seen in preterm babies and not the term babies (as is given in our question). Now let's see what Ghai says about transient tachypnea of newborn : Transient tachypnea of newborn (TTN) Transient tachypnea of the newborn is a benign self-limiting disease occurring usually in term neonates and is due to delayed clearance of lung fluid. These babies have tachypnea with minimal or no respiratory distress. Chest X-ray may show prominent vascular marking and prominent interlobar fissure. Oxygen treatment is often adequate and ventilatory suppo is necessary and prognosis is good. But Ghai didn't mention any correlation between TTN and Diabetes. So, I had to search other books for more information. Neonatal complications : RDS and transient tachypnea are more common in infants of women with poorly controlled diabetics. Respiratory distress : "Conventional obstetrical teaching through the late 1980s generally held that fetal lung maturation was delayed in diabetic pregnancies. Thus, these infants were at increased risk for respiratory distress (Gluck and Kulovich, 1973). Subsequent observations have challenged this concept, and gestational age rather than ove diabetes is likely the most significant factor associated with neonatal respiratory distress (Berkowitz and colleagues, 1996; Kjos and colleagues. 1990b)". So, it is the gestational age and not diabetes which is the main factor causing neonatal respiratory distress. In our question the baby is delivered at 40 weeks gestation (Full term) so, the answer can not be Hyaline membrane disease rather it is transient tachypnea of newborn (i.e. option 'a is correct).


Question: Oligohydramnios is associated with

Etiology of oligohydramnios:

Intrauterine growth restriction
Post-term pregnancy
Premature rupture of membrane
Drugs like ACE inhibitors and prostaglandin inhibitors
Renal anomalies
Renal Agenesis
Infantile polycystic disease
Upper urinary tract obstructions
Lower urinary tract obstructions


Question: Lactional amenorrhea is due to

High levels of prolactin inhibits GnRH release from Hypothalamus and thus indirectly FSH and LH secretion from anterior pituitary Reference: Textbook of Gynaecology; Sheila balakrishnan; 2nd edition; Page no 27


Question: "Tule neck sign" is associated with

Inability to feel the neck of the baby, when fetal head retracts/recoils against the maternal perineum and external rotation is not accomplished as such there is inability to deliver the shoulders after the head has been delivered. This is an impoant sign to diagnose &;shoulder dystocia&; after full dilatation of cervix. And this sign is known as tule neck sign.