Diagnosis In Pregnancy

Ans.D. All of the above

At 6 to 8 weeks of menstrual age, the firm cervix contrasts with the now softer fundus and the compressible interposed softened isthmus— Hegar’s sign.

In early pregnancy, increased vascularity within the cervix stroma beneath the epithelium creates an ectocervical blue tint that is characteristic of Chadwick sign.

Cervical edema leads to softening— Goodell’s sign, whereas isthmic softening is Hegar sign.

Ans. A  and C i.e. Braxton hicks contraction; and Quickening

Second trimester of pregnancy (13-28 weeks) can be diagnosed by :

Symptoms :

• Quickening : Perception of active fetal movements felt about the 18th week, about 2 weeks earlier in multiparae. 
• Progressive enlargement Of the lower abdomen by the growing uterus.
• The uterus feels soft and elastic and becomes ovoid in shape.
• Braxton-Hicks contractions are evident
• Palpation of fetal parts can be felt distinctly by 20th week.

Ans.B. 16-20 weeks

Quickening (feeling of life) denotes the perception of active fetal movements by the women. It is usually felt about the 18^th weeks, 2 weeks earlier in multiparous.

Its appearance is a useful guide to calculate the expected date of delivery with reasonable accuracy.

Cullen’s sign

Hegar’s sign:

• It is present in two-thirds of cases. It can be demonstrated between 6 and 10 weeks, a little earlier in multiparae
• This sign is based on the fact that:
• The upper part of the body of the uterus is enlarged by the growing fetus
• The lower part of the body is empty and extremely soft and
• The cervix is comparatively firm. Because of variation in consistency, on bimanual examination (two fingers in the anterior fornix and the abdominal fingers behind the uterus), the abdominal and vaginal fingers seem to appose below the body of the uterus

Palmer’s sign:

• Regular and rhythmic uterine contraction can be elicited during the bimanual examination as early as 4–8 weeks. 

Goodell’s sign:

• The cervix becomes soft as early as 6th week, a little earlier in multiparae. The pregnant cervix feels like the lips of the mouth, while in the non-pregnant state, like that of the tip of the nose.

Cullen’s sign:

• It is described as superficial edema with bruising in the subcutaneous fatty tissue around the periumbilical region. It is also known as periumbilical ecchymosis.

Ans.D. Hegar’s sign

• At 6 to 8 weeks menstrual age, the firm cervix contrasts with the now softer fundus and the compressible interposed softened isthmus—Hegar sign.

Pulsation in the lateral vaginal fornix

Vaginal sign seen in first trimester :There is increased pulsation, felt through the lateral fornices at 8th week called Osiander’s sign.

Ans is B. i.e. Bluish discoloration of the vagina

• In early pregnancy, increased vascularity within the cervix stroma beneath the epithelium creates an ectocervical blue tint that is characteristic of Chadwick’s sign.

Amenorrhoea

Fetal heart sound

Excessive salivation 

Occur during most of the months of pregnancy

Lactobacillus acidophilus is increased in pregnancy.

Ref: Textbook of Obstetrics By Dutta, 6th Edition, Page 47 ; Williams Gynaecology, 2nd Edition, Page 172

The breast becomes fully differentiated during pregnancy and lactation.

The terminal lobular units are most affected during this physiologic state.

Several histologic changes occur in the terminal ducts and lobules with enlargement and formation of new lobular units early in pregnancy.

By the end of the second trimester secretory changes are well developed and the cuboidal luminal epithelial cells show evidence of vacuolization.

Accumulation of fat droplets occurs within the cytoplasm of the epithelium of the lobules during the third trimester.

The lobules undergo striking hyperplasia to occupy most of the breast parenchyma during this time, with a decrease in the interlobular connective tissue.

At term the expanded lobular units show marked distention of their lumina by colostrum.

During pregnancy, the myometrium goes through a period of extensive growth involving both hyperplasia (increasing the number of smooth muscle cells), cell hypertrophy, and increased collagen production by the muscle cells, which strengthens the uterine wall.

This well-developed uterine myometrium contracts very forcefully during parturition to expel the infant from the uterus.

After pregnancy, uterine smooth muscle cells shrink and many undergo apoptosis, with removal of unneeded collagen, and the uterus returns almost to its prepregnancy size.

Ref: Mescher A.L. (2013). Chapter 22. The Female Reproductive System. In A.L. Mescher (Ed), Junqueira’s Basic Histology, 13e.

Ans. is C. i.e. Rhythmic contraction of the uterus

Palmer’s sign refers to the regular and rhythmic uterine contractions which are elicited during the bimanual examination.

It is present as early as 4-8 weeks.

• Osiander’s sign refers to the feeling of increased vaginal pulsation felt through the lateral fornices at the 8th week of gestation.
• Jacquemier’s sign or Chadwick’s sign refers to the dusky hue of the vestibule and anterior vaginal wall visible at about the 8th week of pregnancy.
• Goodell’s sign refers to the softening of the cervix as early as the 6th week of gestation.

Jacquemier’s or chadwick’s sign: It is the husky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy due to local vascular congestion and as such it may be brought about by pelvic tumour such as uterine fibroid.

• Chadwick’s sign: It refers to bluish discoloration of cervix caused by congestion of pelvic vasculature. It is a presumptive sign of pregnancy.
• Jacquemier’s sign: It refers to congested appearance of vaginal mucosa.
• Osiander’s sign: It refers to increased pulsations felt in the lateral fornices at 8 weeks of gestation.
• Goodell’s sign: It refers to softening of the cervix.
• Palmer’s sign: refers to intermittent contractions of the uterus.

• Palpation of fetal parts and perception of active fetal movements
• Ultrasonographic evidence of gestational sac and embryo in early pregnancy and later.

• Change in size, shape and consistency of uterus
• Softening of cervix
• Osiander’s sign, Chadwick’s sign, Goodell sign
• Abdominal enlargement
• Braxton Hicks contraction
• External and internal ballottement

Ans. C i.e. Feeling of first foetal movement by mother

Ans. D i.e. All are same

• MC type: Gynaecoid
• Platypelloid/ flat pelvis: Transverse diameter is more than AP diameter
• Least common type of pelvis: Platypelloid
• Deep transverse arrest/ persistent occipito posterior position is common in: Android pelvis
• AP diameter more than transverse diameter: Anthropoid pelvis
• Face to pubis delivery is common in: Anthropoid pelvis
• Shortest diameter of pelvic inlet: Obstetric conjugate

Ans. B: 4- 6

Ans. C: 24 weeks

The height of the uterus is midway between symphysis pubis and umbilicus at 16th week; at the level of umbilicus at 24^th week and at the junction of the lower third and upper two-third of the distance between the umbilicus and ensiform cartilage at 28^th week.

Ans. B: 2 days

• With a sensitive test, the hormone hCG can be detected in maternal serum or urine by 8 to 9 days after ovulation.
• The doubling time of serum hCG concentration is 1.4 to 2.0 days.
• Serum hCG levels increase from the day of implantation and reach peak levels at 60 to 70 days.
• Thereafter, the concentration declines slowly until a plateau is reached at approximately 16 weeks.