Diagnosis of Pregnancy and Antenatal Care MCQs

History of sexual exposure and growths on vulva is consistent with condyloma accuminata. Condylomata acuminata (singular: condyloma acuminatum) refers to anogenital warts caused by human papillomavirus (HPV). The most common strains of HPV that cause anogenital warts are 6 and 11 Condyloma accuminata : Warts are common in the regions affected most directly by coitus i.e. posterior fourchette and lateral areas of vulva. These verrucous growths may coalesce to form large cauliflower growths. Condyloma is associated with vulval, vaginal, and cervical cancers. Reference: Shaw 15th/ed pp 138, 139

Prenatal genetic diagnosis can be made by: Method Chorionic villus sampling Cordocentesis Amniocentesis Reference: Dutta Obs. 7/e, p 106, 07

Eisenmenger's syndrome is the presence of secondary pulmonary hypertension that develops from any cardiac lesion. The syndrome develops when increased pulmonary blood flow due to left to right shunt produces a right side pressure more than the left side and hence reversal of shunt occurs and subsequently cyanosis develops. It is the heart disease with the worst prognosis during pregnancy with a maternal mortality of 50%. Hence, pregnancy is contraindicated in patients of eisenmengers. If diagnosis of Eisenmenger is made in the first trimester, termination of pregnancy is advised. Most common cause of death in Eisenmenger's syndrome is right ventricular failure with cardiogenic shock. Reference: Williams Obs. 22/e, p 1028, 23/e, p 970; Sheila Balakrishnan, p 283

Frequency of micturition is quite a troublesome symptom during 8-12th weeks of pregnancy. It is due to Resting of the bulky uterus on the fundus of the bladder because of exaggerated anteverted position of the uterus, Congestion of the bladder mucosa and Change in maternal osmoregulation causing increased thirst and polyuria. As the uterus straightens up after the 12th week, the symptoms disappear. Reference: DC Dutta textbook of obstetrics, 8th edition; chapter 7

Reference: Dutta Obs. 7/e, p 99; SPM Park 19/e, p 417, 20/e, p 450

Cardiac output increases significantly during pregnancy to meet the increased metabolic demands of both the mother and the developing fetus. This increase begins early in pregnancy and peaks around 28-30weeks gestation. During this time, the volume of blood returning to the heart (venous return) increases due to increased blood volume and the effect of the growing uterus on venous return. Additionally, the cardiac output is supported by elevated heart rate and stroke volume. After reaching its peak around 28-30 weeks, cardiac output may slightly decline as the pregnancy approaches term, but it generally remains elevated compared to pre-pregnancy levels Reference : Arias 5 th edition pg no 177

Serum progesterone concentration Reference: Williams 24/e, p 355

Confirmation of PROM: (1) Speculum examination is done taking aseptic precautions to inspect the liquor escaping out through the cervix; (2) To examine the collected fluid from the posterior fornix (vaginal pool) for: (a) Detection of pH by litmus or Nitrazine paper. The pH becomes 6–6.2 (Normal vaginal pH during pregnancy is 4.5–5.5 whereas that of liquor amnii is 7–7.5). Nitrazine paper turns from yellow to blue at pH > 6; (b) To note the characteristic ferning pattern when a smeared slide is examined under microscope; (c) Centrifuged cells stained with 0.1% Nile blue sulfate showing orange blue coloration of the cells (exfoliated fat containing cells from sebaceous glands of the fetus); (3) AmniSure—A rapid immunoassay is accurate; (4) Ultrasonography Reference : D C Dutta’s textbook of obstetrics 8 th edition, chapter 22