Physiological Changes During Pregnancy MCQs

Although reflexive fetal movements begin at the end of the first trimester, they typically cannot be felt until the fifth month of pregnancy. At the end of the fetal period, there is much movement, all of it extra-uterine. Reference - Textbook of Langman's, 12th Edition, General Embryology Page number - 51

In the case of a 35-week pregnant diabetic female with a non-reactive non-stress test (NST), the next step should be (D) proceed to biophysical profile. This helps further assess fetal well being before deciding on intervention. Biophysical Profile (BPP): This test combines an NST with an ultrasound assessment to evaluate several aspects of fetal health. The BPP assesses: Fetal Heart Rate (NST component): Evaluates heart rate patterns. Fetal Breathing Movements: Checks for episodes of breathing. Fetal Movement: Assesses general body movements. Fetal Tone: Looks for muscle tone and flexion of the limbs. Amniotic Fluid Volume: Measures the amount of amniotic fluid. Reference: Management of High Risk Pregnancy, Manjupuri, SS Trivedi, p 62

Why do pregnant ladies get leg cramps? It may have to do with changes in blood circulation and stress on your leg muscles from carrying extra weight. Your growing baby also puts pressure on the nerves and blood vessels that go to your legs. And some doctors say low calcium, or a change in the way your body processes calcium, may cause cramps If you get a leg cramp, stretch the calf muscle. Walking and then sitting and raising your legs might help keep the leg cramp from coming back. A hot shower, warm bath, ice massage or muscle massage may help too. Reference: https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/leg-cramps-during-pregnancy/faq-20057766#:~:text=Leg%20cramps%20are%20painful%20muscle,take%20steps%20to%20prevent%20them.

In a woman at 35 weeks of pregnancy (AG2P) who complains of decreased fetal movement, the next step in management is (B) do NST (Non-Stress Test). This test helps assess fetal well-being by monitoring heart rate patterns in response to movement. If the NST is non-reactive, further evaluation such as a biophysical profile (BPP) may be considered Reference: Williams Obs. 23/e, p 339

Positive or absolute signs of pregnancy: Palpation of fetal parts and perception of fetal movements by examiner, at about 20 weeks. Auscultation of fetal heart sounds. USG evidence of embryo (at 6th week) and later on of the fetus. Radiological demonstration of fetal skeleton at 16 weeks and onwards. Friends there is no need to mug up the presumptive/probable signs of pregnancy. Generally it is not asked in exams. Also remember: These positive or absolute signs of pregnancy are never seen in pseudocyesis or phantom pregnancy. Reference: Dutta Obs. 7/e, p 72

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

Ans. B. Acyclovir + immunoglobulin Varicella during pregnancy The risk of congenital malformations is nearly absent when maternal infection occurs after 20 weeks. VariceIa vaccine is not recommended in pregnancy. Varicella zoster immunoglobulin (VZIG) should be given to exposed non-immune as it reduces the mortality. Oral acyclovir is safe in pregnancy & reduces the duration of illness when given with in 24 hrs of rash but it cannot prevent congenital infection.

Pelvic joints have a limited degree of mobility but can relax remarkably during pregnancy. At term, the sacroiliac joint can glide upward. This is greatest in dorsal lithotomy position and may increase the diameter of the outlet by 1.5 to 2.0 cm for delivery. Sacroiliac joint mobility also likely aids the McRoberts maneuver to release an obstructed shoulder in cases of shoulder dystocia. These changes may also contribute to the success of the modified squatting position to hasten second-stage labor. Squatting may increase the interspinous diameter and the pelvic outlet diameter. Reference: williams obstetrics 26th edition chapter 2