Maternal Pelvis and Fetal Skull MCQs

Ans. is 'a' i.e., UNFPA [Ref Maternal health fifth report session 2007-2008] UNFPA works with a range of partners to promote reproductive health in India. It pools a significant proportion of its country programme resources in the reproductive and child health II (RCH II) programme, aimed at reducing maternal mortality and child mortality, as well as provision of range of contraceptive services. UNFPA also delivers technical assistance for effective implementation of RCH-II programme at the national as well as state level particularly in the state of Rajasthan, M.P. Maharashtra, Orrisa and Bihar.

Ans, A. Diagonal conjugate Most commonly used clinical conjugate is Diagonal conjugate.

Kleihauer-Betke test It is performed on maternal blood to assess the amount of fetomaternal bleed. In order to calculate the dose of Anti-D prophylaxis required. Principle: HbF is more resistant to acid elution than HbA. The maternal blood is subjected to an acid solution (citric acid phosphate buffer). Acid will elute the adult hemoglobins but not the fetal haemoglobin from the red cells. Hence, the fetal red cells appear stained dark red, unlike the light-coloured maternal red cells or ghost cells. The number of fetal red cells in 50 low power fields is assessed. Also Know Indirect Coombs test - detects antibodies in maternal serum. Direct Coombs test - detects antibodies in fetus/neonate. Reference : Dutta Obs. 7/e, pg 334, Sheila Balakrishnan Textbook of Obs 1/e, pg 368.

It can lead to the following Malformations in the fetus: Microcephaly, cutis aplasia, porencephaly, subependymal and periventricular cysts, ileal atresia, cardiac anomalies, visceral infarcts, limb reduction defects and genitourinary malformations. It produces cerebral infarction and periventricular leukomalacia in the fetus. The risk of malformations in the embryo/fetus is highest after the first trimester. Reference : Sheila Balakrishnan, pg 696; Williams Obs. 22/e, pg 364, 23/e, pg 326, 327

The maternal blood in the lacuna is never in direct contact with fetal blood. They are separated by: Syncytiotrophoblast Cytotrophoblast Basement membrane Together called as placental barrier or membrane (0.025 mm) Mesoderm Endothelium of fetal capillaries Reference: IB Singh, Embryology, p 66, 67

Estimation of fetal weight can be done using Johnson formula: If station of head below ischial spine [Height of uterus above pubic symphysis (in cm) - 11] × 155 If fetal head is at or above ischial spine- [Height of uterus above pubic symphysis (in cm) - 12] × 155 Here fetal head is at + 2, i.e., above ischial spine, so it will be (35 - 12) × 155 = 3.5 kg. Reference: Dutta Obs. 8/e, p 84

Factors facilitating descent are: (1) uterine contraction and retraction, (2) bearing down efforts and (3) straightening of the fetal ovoid specially after rupture of the membranes. Reference : Dutta Obs. 7/e, pg 125

Anencephaly is characterized by absence of the cranium and telencephalic structures, with the skull base and orbits covered only by angiomatous stroma. Acrania is the absence of the cranium, with protrusion of disorganized brain tissue. Both are generally grouped together, and anencephaly is considered to be the final stage of acrania. Reference: Fernando Arias 3/e, p 64; Dutta Obs. 7/e, p 408, 409