Antenatal care(Question-Answers)

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    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 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 atleast 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 like susten, microgest etc.
                          Inj HCG ( pubergen , corion etc )
                          Inj proluton depot
                          Ferrous succinate 5mgm thrice daily
                          Vit C 500 mgm thrice daily
                          Investigations like Rh grouping
                          Haemogram
                          USG are to be done to see the cardiac activity.
                            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 16-20weeks?
                                      External ballotment.
                                        What 3 signs are evident after 20th week ?
                                          Fetal heart soun
                                          Palpable fetal parts
                                          Ability to see and feel foetal movements.
                                            What adviceshould 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 fliuds 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 disolves 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 ?
                                                          1he 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 substracting 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)
                                                                      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.
                                                                                    If uterus is not palpable by 14th weeks and woman doesn’t want to go for usg ,
                                                                                    what is the significance of bimanual examination ?
                                                                                      It will exclude miscalculation of the dates , retroverted uterus and missed abortions.
                                                                                        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.
                                                                                          Missed abortion
                                                                                          IUD
                                                                                            What are the causes of excessive enlargement of the uterus ?
                                                                                              Miscalculation of the dates
                                                                                              Multiple pregnancy
                                                                                              Hydramnios
                                                                                              Uterine fibroids
                                                                                              Ovarian cyst
                                                                                                If 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.

                                                                                                                                          References

                                                                                                                                          • Viva in obstetrics, 1977 Dr B N Tiwary

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