What are the symptoms of pregnancy?
Amenorrhoea, morning sickness, breast discomfort and frequency of micturition.
How will you confirm it?
By doing card test ( urine pregnancy test ) and by beta Hcg in blood and seeing the cardiac activity and gestational sac on ultrasound at 6 weeks of gestation.
What is Hegar’s sign?
In early pregnancy if we do per vaginal examination, there is velvety touch of cervix, increased warmth and temperature.
PV should be avoided in threatened abortion or history of abortion.
What is Palmer’s sign?
Regular and rhythmic contractions of the uterus in early pregnancy.
Two fingers of right hand are put into the vagina and left hand is put on the lower abdomen. Pregnancy should be of at least 8 weeks duration, wait for 2-3 minutes, uterus becomes firm and then ill defined according to its contractions and relaxation.
When USG was not there these two signs were important , now a days they are only of theoretical use.
What are the causes of threatened abortion?
Blighted ovum, progesterone deficiency, hypothyroidism, bicornuate uterus, infections, taking any medicine without consulting the doctor.
How will you treat threatened abortion?
- Strict bed rest
- Avoidance of purgatives
- Folic acid thrice daily 5mg doses
- Micronised progesterone .Inj HCG,Inj proluton depot
- Ferrous succinate 5mgm thrice daily
- Vit C 500 mgm thrice daily
What is hyperemesis gravidarum?
Severe persistent vomiting , abdominal pain and signs of dehydration may be present.
What is the preventive measure of hyperemesis gravidarum?
Women should be encouraged to take 1-2 biscuits immediately on rising in the morning and should have small, dry and frequent meals. Plenty of glucose in between the meals is advised.
What are the symptoms of pregnancy in second trimester?
Quickening movements at 18 weeks in primigravida and at 16th week in multigravida.
What is the important sign elicited between 16-20 weeks?
External ballotment.
What 3 signs are evident after 20th week?
Fetal heart sound
Palpable fetal parts
Ability to see and feel foetal movements.
What advices should be given to a pregnant lady regarding diet?
- Minimum amount of fat in early months
- No limit to first class proteins.
- Take yeast , oranges , lemons , B-complex tablets
- Have fish meals if non vegetarian so as to meet the iodine requirement.
- No limit to green vegetables and fruits.
- An ideal diet should contain maximum protein, minimum carbohydrates and fats, abundance of fruits, vegetables, milk, butter in moderation, eggs and fish.
- Vitamin and minerals must be added in tab form.
- Lot of fluids juices and soups.
Why constipation is a common complaint?
Due to relaxing effect of progesterone on involuntary muscle of the bowel.
Lack of exercise increases constipation
Liquid paraffin should be avoided as it dissolves the fat soluble vitamins such as A and D
Constipation can be relieved by increasing the roughage in diet and drinking lot of fluids and senna can be given.
What about the exercises in normal pregnancy?
Daily walks, household work are encouraged.
They ensure good sleep at night.
What should be the amount of rest period?
1 hour rest in the afternoon during first trimester, 2 hrs in the second and 3 hrs in the third trimester.
What are the dangers of dental sepsis?
It may give rise to infection in pregnancy, labour and puerperium.
How will you calculate the expected date (EDD)?
By adding 9mths +7 days to the first day of last menstrual period or by subtracting 3 months.
What medical diseases are taken note of , during history at first visit?
Rheumatic fever, tuberculosis, thyroid disease, epilepsy, asthma, diabetes etc.
What past history is significant?
History of infertility
Recurrent abortions
Surgery for ectopic or fibroid
Twin pregnancy
Medical diseases duration and number of previous pregnancies, whether normal or LSCS
Number of children alive
History of PPH
Blood transfusions
Birth weight of previous children and any history of jaundice in the new born.
What is done in general examination of antenatal care?
Pulse , BP, height , weight , heart , lungs ,
Investigations like–Pregnancy tes
USG
Haemogram
Grouping
Urine examination especially for albumin
HIV
HbsAg
Blood sugar (F)
TSH
What is suggested by five feet or under ?
Pelvis might be contracted.
At what time HB should be done ?
At first visit , at 20th, 32nd, 36 and 38 weeks.
What is the importance of retinal finding ?
Evidence of retinal spasms may be the first finding in pre-eclampsia.
Why do you do pelvic examination during last months ?
To assess the pelvic cavity.
What is the level of uterus per abdominally according to weeks ?
12 weeks–at symphysis pubis.
16 weeks–half way between symphysis and umbilicus.
20 weeks-just below umbilicus
24 weeks–at umbilicus
What are the causes in which size decreases ?
Miscalculation of the dates.
Intrauterine growth retardation
IUD
What are the causes of excessive enlargement of the uterus ?
Miscalculation of the dates
Multiple pregnancy
Hydramnios
Uterine fibroids
Ovarian cystIf
subumbilical flattening is seen after 32 weeks what does it suggest ?
Occipito-posterior position.
What do you see in per abdominal examination during last weeks ?
To define the presenting part and relation between head and brim of pelvis.
Why the lower pole of uterus is palpated first ?
To identify the presenting part .
How do you identify a vertex presentation ?
By hardness, roundness, and ballotability.
How is the breech differentiated from vertex ?
It is soft to touch , irregular in outline and not ballotable.
What does fundal palpation reveal ?
Features of breech in vertex presentation and vice versa.
What is the aim of lateral grip ?
To identify the side of spine by it’s hardness and soft limbs on apposite side.
What is pawlik’s grip ?
The presenting part is grasped between the thumb and fingers of the right hand and left hand is placed on the fundus to steady the foetus.
What is the difference between the sites of fetal heart sounds in vertex and breech ?
In vertex it is below umbilicus and in breech it is above umbilicus.
What do you mean by engagement of the head ?
When it’s widest diameter ( biparietal ) has passed through brim. It can not be moved freely and only a small part is felt above the brim.
When does it engage in primigravida ?
At 36 weeks.
What are the signs of toxaemia ?
Pitting oedema on ankles, High BP and albuminuria .
For 32 weeks onwards these signs should not be missed.
What is best pelvimeter ?
It is fetal head.
How do you get idea of the pelvic outlet ?
By configuration of the ischial spines , subpubic arch and assessing the anatomical outlet.
What is indicated by the head passing through inlet ?
That it will pass through outlet also except in certain cases like maternal exhaustion.