Placenta and Fetal Membranes MCQs

Engagement of head rules out CPD at the level of pelvic inlet. If the head is engaged, it means the head is at ‘O’ station. Engagement can be: When sagittal suture of the head of fetus lies in the transverse diameter of pelvic inlet (midway between the pubic symphysis and the sacral promontory) It occurs in 25% cases It occurs commonly in nulliparous women. Causes of nonengagement of head in a nullipara at term: Malpresentations / Occipito Posterior position/deflexed head Cephalopelvic disproportion Placenta previa / Tumors in the lower segment Tumours of the fetal neck/Cord around the neck / Hydrocephalus Polyhydramnios Distended bladder and rectum. Reference : Dutta Obs. 7/e, pg 81, 82, 352

Causes behind retained placenta: Placenta completely separated but retained is due to poor voluntary expulsive efforts. The commonest cause of retention of non-separated placenta is atonic uterus. Morbidly adherent placenta—partial or rarely, complete. Placenta incarcerated following partial or complete separation due to constriction ring (hourglass contraction), premature attempts to deliver the placenta before it is separated. Reference: D C Dutta’s textbook of obstetrics 8 th edition, chapter 28

Estrogen produced by theca cells is converted to androgens in granulosa cells with the help of enzyme aromatase. Source Granulosa cells (E2 ) Theca cells (E1 ) (produce androgens which are converted to estrogen by enzyme aromatase in adipose tissue) Placenta-(with the help of precursors obtained from fetus) (E3) Corpus luteum (E2 ) Ref. Dutta Gynae 6th/ed p 72

Management of retained placenta: Placenta is separated and retained: expell the placenta out by controlled cord traction. Unseparated retained placenta: Manual removal of placenta is to be done under general anaesthesia. Reference: D C Dutta’s textbook of obstetrics 8 th edition, chapter 28

"Hydrops is characterized by excess fluid in two or more body areas such as thorax, abdomen or skin. It is often associated with hydramnios and a hydropic thickened placenta". It is characterised by: Increased skin thickness (> 5 mm) / skin oedema (first sign seen on USG). Placental enlargement Pleural effusion Ascites The fetus is in Buddha position with a halo around the head. Reference : Williams 23/e, pg 626

The question says - hormones produced by placenta exclusively therefore we cannot include - estrogen which is produced by placenta but not exclusively because the precursors for synthesis of estrogen are made available to the placenta by the fetal adrenal cortex,without which it cannot synthesise estrogen: Reference: Dutta Obs. 7/e, p 58; Williams Obs. 23/e, p 62, 63

(A) Inversion can be induced but in most cases it is spontaneous: This statement is misleading; while inversion can occur spontaneously, but more commonly it is induced-Most common cause is mismanagement of third stage of labour. (B) Always occurs with placenta in situ: This is not true; inversion can occur with or without the placenta attached. (C) Acute inversion can indeed progress to chronic inversion if not treated, making this the correct statement. Reference: D C Dutta’s textbook of obstetrics 8 th edition, chapter 28

During attempted manual removal if no cleavage between the placenta and the uterine wall is made out, diagnosis of a total placenta accreta is certain. Endometritis is a remote complication of retained placenta. Reference: D C Dutta’s textbook of obstetrics 8 th edition, chapter 28