Gynac SQ - Docx 1480428309093

October 7,
SURGERY SQ BY JAY,LUV,HARSH,SMEET,DHRUV,CHINMAY,SMIT
2015
OBSTETRICS AND GYNAECOLOGY SHORT QUESTIONS:

1. What is PPTCT?
Ans.: PPTCT is a programme to prevent the HIV infec on from mohter to child during
labour and most commonly breast feeding.
2. Cord prolapse
Ans.: Umbilical cord prolapse is a complica on that occurs prior to or during delivery of
the baby. In a prolapse, the umbilical cord drops (prolapses) through the open cervix
into the vagina ahead of the baby. The cord can then become trapped against the
baby's body during delivery.
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3. Vertex
Ans.: A cephalic presenta on is a situa on at childbirth where the fetus is in a
longitudinal lie and the head enters the pelvis first; the most common form of cephalic
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presenta on is the vertex presenta on where the occiput is the leading part (the part
that first enters the birth canal).
4. Defini on of normal labor

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Ans.: Series of events that take place in the genital organs in an effort to expel the viable
products of concep on out of the womb through the vagina into the outer world is
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called Labor.
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5. Lie
Ans.: the presenta on of a fetus about to be born refers to which anatomical part of the
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fetus is leading, that is, is closest to the pelvic inlet of the birth canal. According to the
leading part, this is iden fied as a cephalic, breech, or shoulder presenta on. A
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malpresenta on is any presenta on other than a vertex presenta on (with the top of
the head first).
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6. Sheehan’s syndrome
Ans.: Sheehan syndrome, also known as Simmond syndrome, postpartum
hypopituitarism or postpartum pituitary gland necrosis, is hypopituitarism (decreased
func oning of the pituitary gland), caused by ischemic necrosis due to blood loss and
hypovolemic shock during and a er childbirth.
7. Threatened abor on
1
Ans.: It is a clinical en ty where the process of miscarriage has started but has not
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progressed to a state from which recovery is impossible
8. Apgar score
Ans.:
9. Premenstrual syndrome
Ans.: Premenstrual syndrome (PMS) has a wide variety of symptoms, including mood
swings, tender breasts, food cravings, fa gue, irritability and depression which are
experienced before the menstrua on. It's es mated that as many as 3 of every 4
menstrua ng women have experienced some form of premenstrual syndrome.
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10. Transforma onal zone
Ans.:
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11. Hirsu sm
Ans.: Hirsu sm is the excessive hairiness[1] on women[2] in those parts of the body
where terminal hair does not normally occur or is minimal — for example, a beard or
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chest hair. It refers to a male pa ern of body hair (androgenic hair) and it is therefore
primarily of cosme c and psychological concern. Akin to the modern day hypertrichosis
(werewolf syndrome) or the historical figure wild man. Hirsu sm is a medical sign rather
than a disease and may be a sign of a more serious medical condi on, especially if it
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develops well a er puberty. The amount and loca on of the hair is measured by a
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Ferriman-Gallwey score.
12. Hydrosalpinx
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Ans.: Hydrosalpinx is a fallopian tube dilated with fluid. The plural term is
"hydrosalpinges" The only way for a fallopian tube to become dilated with fluid is if it is
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blocked at the end of the tube away from the uterus.
13. Ovarian cryopreserva on

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Ans.: Human oocyte cryopreserva on (egg freezing) is a process in which a woman's

eggs (oocytes) are extracted, frozen and stored. Later, when she is ready to become
pregnant, the eggs can be thawed, fer lized, and transferred to the uterus as embryos.
14. Precocious puberty

2
Ans.: Precocious puberty refers to the appearance of physical and hormonal signs of
pubertal development at an earlier age than is considered normal.
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15. Nebothelial cyst

Ans.: A nabothian cyst (or nabothian follicle) is a mucus-filled cyst on the surface of the
cervix. They are most o en caused when stra fied squamous epithelium of the
ectocervix (toward the vagina) grows over the simple columnar epithelium of the
endocervix (toward the uterus)
16. Two complica ons of uterine leiomyoma

Ans.: sarcomatous leiomyoma and red degenera on
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17. Naegele’s rule (A.96)
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Ans.: Calcula on of the expected date of delivery (EDD): This is done according to
Naegele’s formula (1812) by adding 9 calendar months and 7 days to the first day of the
last normal (28 day cycle) period. Alterna vely, one can count back 3 calendar months
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from the first day of the last period and then add 7 days to get the expected date of
delivery; the former method is commonly employed.
18. Define engagement (A.81)

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Ans.: When the greatest horizontal plane, the biparietal, has passed the plane of the
pelvic brim, the head is said to be engaged
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19. Define Maternal mortality ra o (A.602)

Ans.: The MMR is expressed in terms of such maternal deaths per 100,000 live births. In
most of the developed countries, the MMR varies from 4–40 per 100,000 live births. In
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the
developing countries, it varies from 100–700 with India having about 254 per 100,000
live births. Most of the figures of the developing countries are however, based on the
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data from teaching hospitals as very o en, the vital sta s cs from the whole country are
not available
20. Blighted ovum (A.161)
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Ans.: It is a
sonographic diagnosis. There is absence of fetal pole in a
gesta onal sac with diameter of 3 cm or more. Uterus is to
be evacuated once the diagnosis made.
21. Alert & ac on lines in partogram (A.531) 3

Ans.: In cervicograph (Philpo & Caste — 1972), the alert line starts at 3 cm of cervical
dilata on and ends at 10
cm dilata on (at the rate of 1 cm/hr). The ac on line is drawn 3-4 hours to the right and
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parallel to the alert

line. In a normal labor, the cervicograph (cervical dilata on) should be either on the
alert line or to the le
of it
22. What is PPTCT? (A.301)
Ans.: Perinatal transmission of HIV:Ver cal transmission to the neonates is about
14–25%. Transmission of HIV 2 is less frequent (1–4%) than for HIV 1 (15-40%).
Transplacental transmission occurs: 20% before 36 weeks, 50% before delivery and 30%
during labor. Ver cal transmission is more in cases with preterm birth and with
prolonged membrane rupture. Risks of ver cal transmission is directly related to
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maternal viral load (measured by HIV RNA) and inversely to maternal immune status
(CD4 + count). Maternal an -retroviral therapy reduces the risk of ver cal transmission
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by 70% (see below). Breas eeding increases transmission by 30–40%.
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23. Defini on of puerperal pyrexia. (A.432)
Ans.: A rise of temperature reaching 100.4°F (38°C) or more (measured orally) on 2
separate occasions at 24 hours apart (excluding first 24 hours) within first 10 days
Ed
following delivery is called puerperal pyrexia
24. Ac ve management of third stage of labour. (A.141)

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Ans.: The underlying principle in ac ve management is to excite powerful uterine
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contrac ons within one minute of delivery of the baby (WHO) by giving parenteral
oxytocic. This facilitates not only early separa on of the placenta but also produces
effec ve uterine contrac ons following its separa on.
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25. Non contracep ve uses of combined oral contracep ve pills. (B.489)

Ans.: Improvement of menstrual abnormali es—(1) Regula on of menstrual cycle (2)
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Reduc on of dysmenorrhea (40%) (3) Reduc on of menorrhagia (50%) (4) Reduc on of

premenstrual tension syndrome (PMS) (5) Reduc on of Mi elschmerz’s syndrome (6)
Protec on against iron-deficiency anemia. Protec on against health disorders — (7)
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Pelvic
inflammatory disease (thick cervical mucus) (8) Ectopic pregnancy (9) Endometriosis
(10) Fibroid uterus (11) Hirsu sm and acne (12) Func onal ovarian cysts (13) Benign
breast disease (14) Osteopenia and postmenopausal osteoporo c fractures (15)
Autoimmune disorders of thyroid (16) Rheumatoid arthri s. Preven on of
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malignancies—(17) Endometrial cancer (50%) (18) Epithelial ovarian cancer (50%) (19)
Colorectal cancer (40%).
26. Mechanism of ac on of Cu-T as a contracep ve (B.480)

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Ans.: Mechanism of an fer lity effect of all the IUDs is not yet clear. They act
predominantly in the uterine cavity and do not inhibit ovula on. Probable factors are:
xx Biochemical and histological changes in the endometrium — There is a nonspecific
inflammatory reac on along with biochemical changes in the endometrium which have
got gametotoxic and spermicidal property. Lysosomal disintegra on from the
macrophages a ached to the device liberates prostaglandins, which are toxic to
spermatozoa. Macrophages cause phagocytosis of spermatozoa.
xx There may be increased tubal mo lity which prevent fer liza on of the ovum.
xx Endometrial inflammatory response decreases sperm transport and impedes the
ability of sperm to fer lize the ovum.
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xx Copper devices — Ionized copper has got an addi onal local an fer lity effect by
preven ng blastocyst implanta on through enzyma c interference. Copper ini ates the
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release of cytokines which are cytotoxic. Serum copper level is not increased. It seems
that the progressive calcium deposi on in the device prevents copper diffusion, if kept
for longer period.
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xx Levonorgestrel-IUS (Mirena)— It induces strong and uniform suppression of
endometrium. Cervical mucus becomes very scantly. Anovula on and insufficient luteal
phase ac vity has also been men oned. Serum progesterone level is not increased.
Contraindica ons for Inser on of IUCD: Ed
27. Indica ons of laparoscopy in gynaecology. (B.614)
Ans.: Minor procedures
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⦁ Tubal steriliza on (see p. 496, Fig. 35.8).
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⦁ Adhesiolysis (without bowel involvement)(Fig. 35.7)

⦁ Aspira on of simple ovarian cysts.
⦁ Ovarian biopsy Moderate procedures (Fig. 35.4)
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⦁ Ectopic pregnancy:
⦁ Salpingostomy—(Fig. 35.4)
⦁ Segmental resec on
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⦁ Salpingectomy
⦁ Salpingo-oophorectomy
⦁ Endometriosis: Abla on by diathermy or laser.
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⦁ Ovary
⦁ Diathermy for PCOS (Fig. 35.6)
⦁ Drainage of endometriomas
⦁ Ovarian cystectomy
⦁ Salpingo-ovariolysis (Fig. 35.7).
⦁ Uterus
⦁ Myomectomy
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⦁ Laparoscopic assisted vaginal hysterectomy (LAVH)
⦁ Adhesiolysis – including bowel involvement (Fig. 35.7)
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⦁ Extensive procedures
⦁ Major endometriosis
⦁ Myomectomy
⦁ Retroperitoneal lymphadenectomy
⦁ Hysterectomy
⦁ Urinary incon nence
⦁ Sacrocolpopexy
28. Define menorrhagia. (B.185)
Ans.: Menorrhagia is defined as cyclic bleeding at normal intervals; the bleeding is either
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excessive in amount (> 80 mL) or dura on (>7 days) or both
29. Progesterone challenge test. (B.534)
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Ans.: Progesterone challenge test: In the inves ga on of pathological amenorrhea, this
test is employed. If withdrawal bleeding occurs, it proves (i) intact hypothalamopituitary
ovarian axis, (ii) there is adequate endogenous estrogen (>40 pg/ml), (iii) the
endometrium is responsive and (iv) the uterovaginal canal is patent. The individual is
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likely to respond to ovula on induc on drugs (p. 469
30. Pearl index (C.200)
Ans.: Ed
31. Informed consent for tubal liga on surgery.
Ans.:
32. Other uses of condom. (B.476)
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Ans.: (1) As an elec ve contracep ve method (2) As an interim form of contracep on
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during pill use, following vasectomy opera on (see later) and if an IUD is thought lost
un l a new IUD can be fi ed; (3) During the treatment of trichomonal vagini s of the
wife, the husband should use it during the courseof treatment irrespec ve of
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contracep ve prac ce; (4) Immunological infer lity — male partner to use for 3 months.
33. Amnio c fluid index (A.39)
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Ans.: Maternal abdomen is divided into quadrants taking the umbilicus, symphysis pubis
and the fundus as the reference points. With ultrasound, the largest ver cal pocket in
each quadrant is measured. The sum of the four measurements (cm) is the AFI. It is
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measured to diagnose the clinical condi on of polyhydramnios or oligohydramnios

respec vely.
34. Diagonal conjugate (A.88)
Ans.: It is the distance between the lower border of symphysis pubis to the midpoint on
the sacral promontory. It measures 12 cm (4 ¾′′)
35. Braxtan Hick’s contrac ons (A.47)
Ans.: From the very early weeks of pregnancy, the uterus undergoes spontaneous 6
contrac on. This can be felt during bimanual palpa on in early weeks or during
abdominal palpa on when the uterus feels firmer at one moment and so at another.
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Although spontaneous, the contrac ons may be excited by rubbing the uterus. The
contrac ons are irregular, infrequent, spasmodic and painless without any effect on
dilata on of the cervix. The pa ent is not conscious about the contrac ons. Intrauterine
pressure remains below 8 mm Hg. Near term, the contrac ons become frequent with
increase in intensity so as to produce some discomfort to the pa ent. Ul mately, it
merges with the painful uterine contrac ons of labor. In abdominal pregnancy,
Braxton-Hicks contrac on is not felt.During contrac on there is complete closure of the
uterine veins with par al occlusion of the arteries in rela on to intervillous space
resul ng in stagna on of blood in the space. This diminishes the placental perfusion,
causing transient fetal hypoxia which leads to fetal bradycardia coinciding with the
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contrac on.
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36. Android pelvis (A.346)
Ans.: Table 23.1: Anatomical features of parent pelvic types (Figs 23.1A to C)
Gynecoid Anthropoid Android Platypelloid
Inlet
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• Shape Round Antero-posteriorly
oval
Triangular Transversely oval
• Anterior and
posterior
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segment
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Almost equal and
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spacious
Both increased
with slight
anterior narrowing
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Posterior segment
short and anterior
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segment narrow
Both reduced-flat
• Sacrum Sacral angle (SA)
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more than 90°.

Inclined backwards.
Well curved from
above down and
side to side
SA more than 90°.
Inclined posteriorly.
Long and narrow.
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Usual curve
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Sacral angle less

than 90°.
Inclined forwards
and straight
SA more than 90°.
Inclined posteriorly.
Short and straight
Cavity
• Sacroscia c
notch
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Wide and shallow More wide and
shallow
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Narrow and deep Slightly narrow and
small
• Side walls Straight or slightly
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divergent
Straight or divergent Convergent Divergent
Outlet
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• Ischial spines Not prominent Not prominent Prominent Not prominent
• Pubic arch Curved Long and curved Long and straight Short and curved
• Subpubic
angle
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Wide (85°) Slightly narrow Narrow Very wide (more

than 90°)
• Bituberous
diameter
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Normal Normal or short Short Wide

37. Deep transverse arrest (A.372)
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Ans.: The head is deep into the cavity; the sagi al suture is placed in the transverse
bispinous diameter and there
is no progress in descent of the head even a er 1/2–1 hour following full dilata on of
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the cervix. The arrest

in occipito-transverse posi on may be the end result of incomplete anterior rota on
(1/8th of circle) of oblique
occipitoposterior posi on, or it may be due to non-rota on of the commonly primary
occipito-transverse posi on
of normal mechanism of labor.
38. Missed abor on (A.163)

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Ans.: When the fetus is dead and retained inside the uterus for a variable period, it is
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called missed miscarriage or early fetal demise.
39. A tude of foetus (A.76)

Ans.: The rela on of the different parts of the fetus to one another is called a tude of
the fetus. The universal a tude is that of flexion. During the later months, the head,
trunk and limbs of the fetus maintain the a tude of flexion on all joints and form an
ovoid mass that corresponds approximately to the shape of uterine ovoid. The
characteris c flexed a tude may be modified by the amount of liquor amnii. There
may
be excep ons to this universal a tude and extension of the head may occur (deflexed
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vertex, brow or face presenta on, according to the degree of extension), or the legs may
become extended in breech.The course of labor in such circumstances may be modified
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accordingly
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40. Supine hypotension syndrome (A.53)
Ans.: During late pregnancy, the gravid uterus
produces a compression effect on the inferior vena cava when the pa ent is in supine
Ed
posi on. This, however, results inopening up of the collateral circula on by means of
paravertebral and azygos veins. In some cases (10%), when the collateral
circula on fails to open up, the venous return of the heart may be seriously curtailed.
This results in produc on of hypotension,
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tachycardia and syncope. The normal blood pressure is quickly restored by turning the
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pa ent to lateral posi on. The

augmenta on of the venous return during uterine contrac on prevents the
manifesta on from developing during labor.
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41. Side effects of Danazol (B.530)

Ans.: hypoestrogenic androgenic metabolic
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Diminished breast size acne oily skin eleva on of lDl, total cholesterol
Decreased libido edema Weight gain reduc on of HDl
atrophic vagini s Hirsu sm Decrease in TbG and total thyroxine level
Hot fl ushes Deepening of voice (irreversible
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42. Describe characteris cs of cervical mucous in mid cycle (B.115)

Ans.: During the midcycle, the cervical mucus is obtained by a pla num loop or pipe e
and spread on a clean glass slide and dried. When seen under low power microscope, it
9
shows characteris c pa ern of fern forma on. It is due to high sodium chloride and low
protein content in the mucus due to high estrogen in the midmenstrual phase prior to
ovula on. A er ovula on with increasing progesterone, the ferning disappears
completely a er 21st day. Thus, the presence of ferning even a er 21st day suggests
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anovula on and its disappearance is presump ve evidence of ovula on (Fig. 9.19)
43. Three swab test (B.419)

Ans.: test—The three-swab test not only
confirms the VVF but also differen ates it from
ureterovaginal and urethrovaginal fistula.
Procedure of Three Swab Test (Fig. 25.3)
Three co on swabs are placed in the vagina—one
at the vault, one at the middle and one just above
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the introitus. The methylene blue is ins lled into the
bladder through a rubber catheter and the pa ent is
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asked to walk for about 5 minutes. She is then askedto lie down and the swabs are
removed for inspec on
(Table 25.1).
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Observa on Inference
Upper most swab soaked
with urine but unstained
with dye. The lower two
fistula swabs remain dry
Ureterovaginal fistula
Ed
Upper and lower swabs
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remain dry but the middle
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swab stained with dye

Vesicovaginal fistula
The upper two swabs
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remain dry but the lower

swab stained with dye
Urethrovaginal fistula
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44. Define micro invasive carcinoma of cervix (B.344)

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Ans.: Microinvasive carcinoma is one which is predominantly

intraepithelial carcinoma, except that there
is disrup on of the basement membrane.
45. Red degenera on (B.275)

Ans.: Red degenera on (carneous degenera on) occurs in
a large fibroid mainly during second half of pregnancy
10
and puerperium. Par al recovery is possible and as
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such called necrobiosis. The cause is not known but

is probably vascular in origin. Infec on does not play
any part.
46. Contraindica ons for IUCD (B.480)

Ans.: (1) Presence o\f pelvic infec on current or within
3 months; (2) Undiagnosed genital tract bleeding;
(3) Suspected pregnancy; (4) Distor on of the shape
of the uterine cavity as in fibroid or congenital
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uterine-malforma on; (5) Severe dysmenorrhea;
(6) Past history of ectopic pregnancy; (7) Within
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6 weeks following cesarean sec on; (8) STIs —
Current or within 3 months; (9) Trophoblas c disease;
(10) Significant immunosuppression. Addi onally
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for CuT are: (11) Wilson disease and (12) Copper
allergy. For LNG-IUS are: (13) Hepa c tumor or
hepatocellular disease (ac ve); (14) Current breast
cancer and (15) Severe arterial disease Ed
47. Advantages of using proges n only pills (B.491)
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Ans.: (1) Side effects a ributed to estrogen
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in the combined pill are totally eliminated (2) No

adverse effect on lacta on and hence can be suitably
prescribed in lacta ng women and as such it is o en
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called “Lacta on Pill” (3) Easy to take as there is

no “On and Off” regime (4) It may be prescribed
in pa ent having (medical disorders) hypertension,
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fibroid, diabetes, epilepsy, smoking and history of

thromboembolism (5) Reduces the risk of PID and
endometrial cancer.
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48. Injectable contracep ves (B.491,492)

Ans.: The prepara ons commonly used are depomedroxy
progesterone acetate (DMPA) and norethisterone
enanthate (NET-EN). Both are administered
intramuscularly (deltoid or gluteus muscle) within 5 11
days of the cycle. The injec on should be deep, Z-tract
technique and the site not to be messaged. DMPA in a
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dose of 150 mg every three months (WHO 4 months)

or 300 mg every six months; NET-EN in a dose of 200
mg given at two-monthly intervals.
Depo-Sub Q provera 104, contains 104 mg of
DMPA. It is given subcutaneously over the anterior
thigh or abdomen. It suppresses ovula on for 3
months as it is absorbed more slowly.
Mechanism of ac on: (1) Inhibi on of ovula on
— by suppressing the mid cycle LH peak (2) cervical
mucus becomes thick and viscid thereby prevents
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sperm penetra on (3) Endometrium is atrophic
preven ng blastocyst implanta on.
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Advantages: (1) It eliminates regular medica on as
imposed by oral pill (2) It can be used safely during
lacta on. It probably increases the milk secre on
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without altering its composi on (3) No estrogen related
side effects (4) Menstrual symptoms, e.g. menorrhagia,
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dysmenorrhea are reduced (5) Protec ve against
endometrial cancer (6) Can be used as an interim
contracep on before vasectomy becomes effec ve
(7) Reduc on in PID, endometriosis, ectopic pregnancy
and ovarian cancer. The non-contracep ve benefits:
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DMPA reduces the risk of—salpingi s, endometrial

cancer, iron deficiency anemia, sickle cell problems
and endometriosis.
Disadvantages: Failure rate for DMPA – (0–0.3)
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(HWY). There is chance of irregular bleeding and occasional

phase of amenorrhea. Return of fer lity a er their
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discon nua on is usually delayed for several months (4–8

months). However, with NET-EN the return of fer lity is
quicker. Loss of bone mineral density (reversible) has been
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observed with long-term use of depot provera. Overweight,

insulin resistant women may develop diabetes. Other side
effects are: weight gain and headache.
Contraindica ons: Women with high risk factors for
osteoporosis and the others are same as in POP (see above).
49. Naegele’s rule (A.96)

12
Ans.:
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50. Features of Down ‘s syndrome (A.495)

Ans.: Diagnosis of the affected baby:
— General appearance: Craniofacial abnormali es include small
ears (100%), brachycephaly, upwards and outwards slan ng of the
eyes with epicanthic folds; short upper lip with small mouth and
macroglossia. The baby’s face resembles that of the Mongolian race
(Fig. 32.8). The hands are short and broad with a single palmar crease
(30%). There is increased associa on of congenital heart disease (VSD),
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omphalocoele, cataracts and esophageal atresia, duodenal atresia,
imperforate anus. The affected baby is mentally retarded.
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Hypotonia may cause breathing difficul es, poor swallowing and
aspira on.
Expecta on of life is reduced. Adult Mongol is likely to develop
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leukemia. Male infer lity is the rule. In female puberty may be delayed
and may be fer le.
— Confirma on is established by chromosomal analysis (karyotype)
Ed
using bone marrow aspira on or leucocyte culture.
Gene c counseling in subsequent pregnancy. The risk of recurrence due to trisomy 21 is
1 percent. That of transloca on
is higher. Following amniocentesis, if karyotyping of the exfoliated cells shows the
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abnormal chromosome, therapeu c
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termina on will have to be seriously considered.
51. Define engagement (A.81)

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Ans.:
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52. Causes of DIC in obstetrics (A.626)

Ans.: Endothelial injury Release of thromboplas n Release of phospholipids
• Pre-eclampsia, eclampsia, HELLP
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syndrome
• Sep cemia
– Sep c abor on
– Chorioamnioni s
– Pyelonephri s
• Hypovolemia
• Amnio c fluid embolism
• Dead fetus syndrome
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• Abrup o placenta
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• Hyda diform mole

• Cesarean sec on
• Intra-amnio c hypertonic saline
• Shock
• Fetomaternal bleed
• Incompa ble blood transfusion
• Hemolysis
53. Principle of non stress test (A.108)
Ans.: Non-stress test (NST): In non-stress test, a con nuous electronic monitoring of the
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fetal heart rate along
with recording of fetal movements (cardiotocography) is undertaken. There is an
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observed associa on of
FHR accelera on with fetal movements, which when present, indicates a healthy fetus.
It can reliably be
used as a screening test. The accelera ons of the FHR associated with fetal movements
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are presumably reflex
mediated. It should be emphasized that the test is valuable to iden fy the fetal wellness
rather than illness.
Interpreta on Ed
• Reac ve (Reassuring)—When two or more accelera ons of more than 15 beats per
minute above the
baseline and longer than 15 seconds in dura on are present in a 20 minute observa on
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(see p. 611).
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• Non-reac ve (Non-reassuring)—Absence of any fetal reac vity.

A reac ve NST is associated with perinatal death of about 5 per 1000. But perinatal
death is about 40 per
1000 is when the NST is nonreac ve. Tes ng should be started a er 30 weeks and
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frequency should be twice

weekly. The test has a false nega ve rate of 0.5% and false posi ve rate of 50%.
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54. Defini on of puerperal pyrexia (A.432)

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separate occasions
at 24 hours apart (excluding first 24 hours) within first 10 days following delivery is
called puerperal pyrexia.
55. Causes of polyhydramnios (A.211)

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Ans.: I. FETAL ANOMALIES: Congenital fetal malforma ons (structural and chromosomal)
are associated with polyhydramnios
in about 20% cases.
• Anencephaly—Hydramnios is found in associa on with anencephaly in about 50%
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cases. The causes of excessive

produc on of liquor amnii may be due to—(a) transuda on from the exposed
meninges (b) absence of fetal
swallowing reflex and (c) possible suppression of fetal an diure c hormone leading to
excessive urina on.
• Open spina bifida—increased transuda on from the meninges.
• Esophageal or duodenal atresia—preven ng swallowing of the liquor. However,
hydramnios is associated only in
about 15% cases of esophageal atresia.
• Facial cle s and neck masses—by interfering normal swallowing.
• Hydrops fetalis due to Rhesus isoimmunisa on, cardiothoracic anomalies and fetal
h
cirrhosis are o en associated
ec
with hydramnios.
• Aneuploidy.
II. PLACENTA: Chorioangioma of the placenta: Tumor growing from a single villus
consis ng of hyperplasia of blood
ut
vessels and connec ve ssue results in increased transuda on.
III. MULTIPLE PREGNANCY: Mul ple pregnancy is about 10 mes more common than its
overall incidence. Hydramnios
recipient twin develops

Ed
is more common in monozygo c twins, usually affec ng the second sac. In TTTS the
polydramniosIV. MATERNAL: (i) Diabetes—It is more common in hydramnios.

Hydramnios is associated with diabetes in about 30%
i
cases. However, with adequate supervision, the incidence of hydramnios can be
hu
lowered. It is presumed that a raised maternal

blood sugar → raised fetal blood sugar → fetal diuresis → hydramnios. (ii) Cardiac or
renal disease — may lead to edema
of the placenta leading to increase in transuda on.
rs
V. IDIOPATHIC
CLINICAL TYPES: Depending on the rapidity of onset, hydramnios may be: (a) Chronic
va
(mostcommon) —
onset is insidious taking few weeks. (b) Acute (extremely rare) — onset is sudden,
within few days or may
appear acutely on pre-exis ng chronic variety. The chronic variety is 10 mes
De
commoner than the acute one.].
56. Hegar’s sign (A.65)

Ans.: Hegar's sign is a non-sensi ve indica on of pregnancy in women — its absence
15
does not exclude pregnancy. It pertains to the features of the cervix and the uterine
isthmus.
57. Advantage of MVA over suc on MTP (A.174,567)

October 7,
2015
Ans.: VACUUM ASPIRATION

This procedure is similar to menstrual regula on and is done as outpa ent basis (p.
174). The procedure may be manual
vacuum aspira on (MVA) or electric vacuum aspira on (EVA) and is highly effec ve
(98–100%). Termina on of pregnancy
is done upto 12 weeks with minimal cervical dilata on (Fig. 41.20). A hand operated
double valve plas c syringe (60 mL)
is a ached to a Karman’s cannula (upto 12 mm size). The cannula is inserted
transcervically into the uterus and the vacuum
is ac vated. A nega ve pressure of 660 mm Hg is created. Aspira on of the products of
concep on is done. This procedure
h
takes less me (5–15 mins) and is less trauma c. Complica ons are similar to other
ec
surgical methods (p. 565) but are less
severe.
VACUUM ASPIRATION (MVA/EVA) is done upto 12 weeks with minimal cervical
dilata on. It is
ut
performed as an outpa ent procedure using a plas c disposable cannula (up to 12 mm
size) and a 60 mL plas c
(double valve) syringe (Fig. 41.20). It is quicker (15 minutes), effec ve (98–100%), less
trauma c and safer than Ed
dilata on, evacua on and cure age (details see p. 567).
SUCTION EVACUATION AND/OR CURETTAGE:
This improvised method consists of a suc on machine fi ed with a cannula either
i
plas c (Karman) or
hu
metal available in various sizes. The details of its technique are described in the chapter
of opera ve obstetrics
(p. 566).
Advantages: (1) It is done as an outdoor procedure (2) Hazards of general anesthesia are
rs
absent as it is done, at best,

under paracervical block anesthesia (3) Ideal for termina on for therapeu c indica ons
va
(4) Blood loss is minimal (5) Chance

of uterine perfora on is much less specially with the plas c cannula.
Drawbacks: (1) The method is not suitable with bigger size uterus of more than 10
weeks as chance of retained products
De
is more (2) Requires electricity to operate and the machine is costly.

DILATATION AND EVACUATION: • Rapid method • Slow method
• Rapid method: This can be done as an outdoor procedure with diazepam seda on
and paracervical
block anesthesia. The details are described in p. 563.
a er the seda ve effect is over. (2)

Chance of sepsis is minimal.
16
Advantages: (1) As it can be done as an outdoor procedure, the pa ent can go home
Drawbacks: (1) Chance of cervical injury is more (2) Uterus should not be more than 6–8
October 7,
2015
weeks of pregnancy. (3) All the

drawbacks of D and E (see p. 565).
• Slow Method: Slow dilata on of the cervix is achieved by inser ng laminaria tents
(hygroscopic osmo c
dilators) into the cervical canal (synthe c dilators like Dilapan, Lamicel are also used).
This is followed
by evacua on of the uterus a er 12 hours. Vaginal Misoprostol (PGE1) 400 μg 3 hours
before surgery
is equally effec ve for cervical ripening. The details are described in p. 566.
Advantages: (1) Chance of cervical injury is minimal (2) Suitable in cases of therapeu c
indica ons.
h
Drawbacks: (1) Hospitaliza on is required at least for one day (2) Chance of introducing
ec
sepsis (3) All the
complica ons of D and E (see p. 565).
ut
58. Management of displaced Cu-T (B.483)
Ans.: Management: Lippes loop — As it is an open device
made of inert material, it will cause no harm if le
Ed
in the peritoneal cavity. Adhesions and intes nal
injury are unlikely. But for psychological reason or
otherwise, it is be er to remove it by laparoscopy
or by laparotomy.
i
Copper device — A copper bearing device induces
hu
an intense local inflammatory reac on with adhesions

with the surrounding structures. Thus, as soon as the
diagnosis is made, it is to be removed by laparoscopy
rs
or laparotomy.
Pregnancy — The pregnancy rate with the
device in situ is about 2 per 100 women years
va
of use. Lowest pregnancy rates are observed

with Cu T 380A (0.8–HWY) and LNG-IUS
(0.2–HWY). Should pregnancy occur with a
De
device in situ, there is risk of ectopic pregnancy

(0.02percent). IUD can thus prevent an uterine
but not an ectopic pregnancy. Third genera on
of IUDs like Cu T 380 A and LNG-IUS give
some amount of protec on against an ectopic
pregnancy.
Management: If the thread is visible through the
17
cervix it is best to remove the device. This will
minimize such complica ons as abor on, preterm
October 7,
2015
labor sepsis and low birth weight baby. However, if the

thread is not visible it is be er to leave it alone a er
counseling with the pa ent about the risks involved
59. Whiff test for bacterial vaginosis (B.152)

Ans.: Whiff Test: Fishy (amine) odor when a drop
of discharge is mixed with 10 percent potassium
hydroxide solu on
h
60. What is Pearl index? (C.200)
ec
Ans.: \mbox{Pearl-Index} = \frac{\mbox{Number of Pregnancies} \cdot 12}
{\mbox{Number of Women} \cdot \mbox{Number of Months}} \cdot 100
ut
61. Defini on stress urinary incon nence (B.398)
Ans.: Genuine stress incon nence (GSI) is
defined, according to the interna onal con nence
Ed
society (ICS) as involuntary urethral loss of urine
when the intravesical pressure exceeds the maximum
urethral pressure in the absence of detrusor ac vity.
The diagnosis of GSI should be made following
i
urody-namic assessment only
hu
62. Indica ons for cryosurgery (B.591)

Ans.: Indica ons
rs
Cervical ectopy (p. 267).

Benign cervical lesions—such as CIN, condyloma
va
accuminata, leukoplakia, etc.

Condyloma accuminata of vulva and VIN
diagnosed colposcopically and not more than 2
De
cm in size.
VAIN, condyloma accuminata or vault granula on
ssue following hysterectomy.
As a pallia ve measure to arrest bleeding in
carcinoma cervix or large funga ng recurrent
vulval carcinoma.
18
63. Non-contracep ve uses of OC pills (B.489)
Ans.: Improvement of
October 7,
2015
menstrual abnormali es—(1) Regula on of

menstrual cycle (2) Reduc on of dysmenorrhea
(40%) (3) Reduc on of menorrhagia (50%)
(4) Reduc on of premenstrual tension syndrome
(PMS) (5) Reduc on of Mi elschmerz’s syndrome
(6) Protec on against iron-deficiency anemia.
Protec on against health disorders — (7) Pelvic
inflammatory disease (thick cervical mucus)
(8) Ectopic pregnancy (9) Endometriosis
(10) Fibroid uterus (11) Hirsu sm and acne
h
(12) Func onal ovarian cysts (13) Benign breast
disease (14) Osteopenia and postmenopausal
ec
osteoporo c fractures (15) Autoimmune disorders
of thyroid (16) Rheumatoid arthri s. Preven on
of malignancies—(17) Endometrial cancer (50%)
ut
(18) Epithelial ovarian cancer (50%) (19) Colorectal
cancer (40%).
64. Indica ons of hysteroscopy (B.122)

Ed
Ans.: Indica ons: Diagnos c Opera ve
The technical details and opera ve hysteroscopy are
i
dealt in Chapter 35.
hu
Diagnos c
Unresponsive irregular uterine bleeding to exclude
uterine polyp, submucous fibroid or products of
rs
concep on
Congenital uterine septum in recurrent abor on
Missing threads of IUD
va
Intrauterine adhesions (uterine synechiae)

To visualize transforma on zone with colpomicrohysteroscopy
when colposcopic finding is
De
unsa sfactory.
Opera ve—(see p. 622). Abdominal /vaginal hystrectomy
65. Defini on of antepartum haemorrhage (A.241)

19
Ans.: It is defined as bleeding from or into the genital tract a er the 28th week of
pregnancy but before
the birth of the baby (the first and second stage of labor are thus included). The 28th
week is taken arbitrarily
October 7,
2015
as the lower limit of fetal viability. The incidence is about 3% amongst hospital deliveries
66. Diagnosis of inevitable abor on (A.161)

Ans.: CLINICAL FEATURES: The pa ent, having the features of threatened miscarriage,
develops the following
manifesta ons. (1) Increased vaginal bleeding (2) Aggrava on of pain in the lower
abdomen which may be
colicky in nature (3) Internal examina on reveals dilated internal os of the cervix
through which the products
of concep on are felt (Fig. 15.2). On occasion, the features may develop quickly without
h
prior clinical evidence
of threatened miscarriage. In the second trimester, however, it may start with rupture
ec
of the membranes or
intermi ent lower abdominal pain (mini labor).
ut
67. Characteris cs of true labour pains (A.116)
Ans.: (i) Uterine contrac ons at regular intervals (ii) Frequency of
progressively (iv) Associated

Ed
contrac ons increase gradually (iii) Intensity and dura on of contrac ons increase
with “show” (v) Progressive effacement and dilata on of the cervix (vi) Descent of the
presen ng part (vii)
i
Forma on of the “bag of forewaters” (viii) Not relieved by enema or seda ves
hu
68. Causes of preterm labour (A.314)

Ans.: In about 50%, the cause of preterm labor is not known. O en it is mul factorial.
rs
The following are, however,

related with increased incidence of preterm labor.
va
High risk factors:

(A) History: There is an increased incidence of preterm labor in cases such as: (1)
Previous history of induced
or spontaneous abor on or preterm delivery; (2) Pregnancy following assisted
De
reproduc ve techniques
(ART); (3) Asymptoma c bacteriuria or recurrent urinary tract infec on; (4) Smoking
habits (5) Low socioeconomic
and nutri onal status; (6) Maternal stress.
(B) Complica ons in present pregnancy: May be due to maternal, fetal or placental.
• Maternal: (a) Pregnancy complica ons: Preeclampsia, antepartum hemorrhage,
premature rupture of the
membranes, polyhydramnios; (b) Uterine anomalies: Cervical incompetence,
20
malforma on of uterus;
October 7,
2015
(c) Medical and surgical illness: Acute fever, acute pyelonephri s, diarrhea, acute
appendici s,
toxoplasmosis and abdominal opera on. Chronic diseases: Hypertension, nephri s,
diabetes,
decompensated heart lesion, severe anemia, low body mass index (LBMI); (d) Genital
tract infec on:
Bacterial vaginosis, beta-hemoly c streptococcus, bacteroides, chlamydia, mycoplasma.
• Fetal: Mul ple pregnancy, congenital malforma ons, intrauterine death.
• Placental: Infarc on, thrombosis, placenta previa or abrup on.
(C) Iatrogenic: Indicated preterm delivery due to medical or obstetric complica ons.
h
(D) Idiopathic: (Majority)—Premature effacement of the cervix with irritable uterus and
early engagement
ec
of the head are o en associated. In the absence of any complica ng factors, it is
presumed that there is
premature ac va on of the same systems involved in ini a ng labor at term
ut
69. Partogram (A.531)
Ans.: Partograph is a composite graphical record of key data (maternal and fetal) during
labor, entered against me on a single
sheet of paper (Fig. 34.5).
Ed
In cervicograph (Philpo & Caste — 1972), the alert line starts at 3 cm of cervical
dilata on and ends at 10
i
cm dilata on (at the rate of 1 cm/hr). The ac on line is drawn 3-4 hours to the right and
hu
parallel to the alert

line. In a normal labor, the cervicograph (cervical dilata on) should be either on the
alert line or to the le
of it. When it falls on Zone 2 (see p. 404 and Fig. 26.2) it is abnormal and need to be
rs
cri cally assessed. When

it falls in Zone 3 case should be reassessed by a senior person. Decision is to be made
va
either for termina on of

labor (cesarean sec on) or for augmenta on of labor (amniotomy and or oxytocin).
The components of a partograph are: (a) Pa ent iden fica on (b) Time — recorded at
hourly interval.
De
Zero me for spontaneous labor is the me of admission in the labor ward and for
induced labor is the me
of induc on (c) Fetal heart rate — recorded at every 30 minutes (d) State of membranes
and color of liquor
: to mark ‘I’ for intact membranes, ‘C’ for clear and ‘M’ for meconium stained liquor (e)
Cervical dilata on
21
and descent of the head (see p.143) (f) Uterine contrac ons — the squares in the
ver cal columns are shaded
according to dura on and intensity (see p.143) (g) Drugs and fluids (h) Blood pressure
(recorded in ver cal
October 7,
2015
line) at every 2 hours and pulse at every 30 minutes (i) Oxytocin — concentra on in the
upper box and dose
(m IU/min) in the lower box (j) Urine analysis (k) Temperature record.
Advantages of a partograph: (i) A single sheet of paper can provide details of necessary
informa on at
a glance (ii) No need to record labor events repeatedly (iii) It can predict devia on from
normal progress
of labor early. So appropriate steps could be taken in me (see Fig. 26.2, p. 403) (iv) It
facilitates handover
procedure (v) Introduc on of partograph in the management of labor (WHO 1994) has
reduced the incidence
h
of prolonged labor and cesarean sec on rate. There is improvement in maternal
ec
morbidity, perinatal
morbidity and mortality.
ut
70. Lower uterine segment (A.119)
Ans.: LOWER UTERINE SEGMENT: Before the onset of labor, there is no complete
anatomical or func onal division
passive lower segment

Ed
of the uterus. During labor, the demarca on of an ac ve upper segment and a rela vely
is more pronounced. The wall of the upper segment becomes progressively thickened
with progressive
i
thinning of the lower segment (Fig. 12.7). This is pronounced in late first stage, specially
hu
a er rupture of the
membranes and a ains its maximum in second stage. A dis nct ridge is produced at the
junc on of the two,
called physiological retrac on ring which should not be confused with the pathological
rs
retrac on ring—a
feature of obstructed labor (p. 363). Lower segment of uterus is characterized by
following features:
va
Figs 12.5A to C: (A) Forma on of bag of membranes and

forewaters, (B) Well fi ng presen ng part dividing the forewater
from hindwater, (C) Ill fi ng presen ng part allows
De
the hindwaters to force into the bag of membranes during

contrac on which may lead to its early rupture
A
B
C
LOWER SEGMENT OF UTERUS AND THE CLINICAL SIGNIFICANCE
Anatomical features Clinical significance 22
1. It is developed from the isthmus of the (nonpregnant)
uterus which is bounded above anatomical and below by
October 7,
2015
histological internal os.

1. The phenomenon of recep ve relaxa on enables
expulsion of the fetus by forma on of complete birth
canal along with the fully dilated cervix (Fig. 12.17).
120 TEXTBOOK OF OBSTETRICS
2. In labor it is bounded above by the physiological
retrac on ring (p. 121) and below by the fibro muscular
junc on of cervix and uterus.
3. This segment is formed maximally during labor and the
peritoneum is loosely a ached anteriorly.
h
4. It measures 7.5–10 cm when fully formed and becomes
cylindrical during the second stage of labor (Figs 12.7B, C).
ec
5. The wall becomes gradually thin due to: (i) Relaxa on
of the muscle fibers to allow elonga on. (ii) The muscle
fibers are drawn up by the muscle fibers of the upper
ut
uterine segment by contrac on and retrac on during
labor (p. 118). (iii) Descent of the presen ng part causes
p. 121).
Ed
further stretching and thinning out of wall (see
6. This segment has got poor retrac le property compared

to the upper segment.
2. Implanta on of placenta in lower segment is known as
i
hu
placenta previa (p. 241).

3. It is through this segment that cesarean sec on is
performed.
4. Poor decidual reac on in this segment facilitates
rs
morbid adherent placenta (p. 247), once the placenta

is implanted here.
va
5. In obstructed labor, the lower segment is very much

stretched and thinned out and ul mately gives way
(ruptures) specially in mul parae (p. 362).
De
6. It is en rely the passive segment of the uterus.

Because of poor retrac le property, there is chance of
postpartum hemorrhage if placenta is implanted over
the area.
Figs 12.6A and B: Diagramma c representa on of the dilata on and “taking up” of the
cervix in (A) primigravida and (B) mul para.
23
(A) a – cervix before labor; b, c – progressive ‘taking up’ of the cervix without much
dilata on; d – cervix completely taken up with
external os s ll remaining undilated. (B) a – cervix before labor, to note the patulous
cervix; b, c – progressive and simultaneous
October 7,
2015
dilata on and ‘taking up’ of the cervix; d – taking up and dilata on of the external os
occur simultaneously
AB
(a)
(b)
(c)
(d)
(a)
(b)
(c)
h
(d)
ec
ut
i Ed
hu
rs
va
De
24
October 7,
2015
71. Aims of antenatal care (A.94)

Ans.: The aims are: (1) To screen the ‘high risk’ cases (see p. 630). (2) To prevent or to
detect and treat at the earliest
any complica ons. (3) To ensure con nued risk assessment and to provide ongoing
primary preven ve health
care. (4) To educate the mother about the physiology of pregnancy and labor by
demonstra ons, charts and
diagrams (mother cra classes), so that fear is removed and psychology is improved. (5)
To discuss with the
couple about the place, me and mode of delivery, provisionally and care of the
h
newborn. (6) To mo vate the
ec
couple about the need of family planning and also appropriate advice to couple seeking
medical termina on
of pregnancy.
ut
72. An -D (A.334)
Ans.: • To prevent ac ve immuniza on • To prevent or minimise fetomaternal bleed
• To avoid mismatched transfusion Ed
TO PREVENT ACTIVE IMMUNIZATION: To prevent ac ve immuniza on of Rh-nega ve yet
unimmunized, Rh
an -D immunoglobulin (IgG) is administered intramuscularly to the mother following
i
child birth. The other
hu
condi ons that the Rh an -D immunoglobulin should be given are men oned before (p.
332).
Mode of ac on is an body mediated immune suppression (AMIS). The possible
mechanisms are:
rs
(i) The an D an body when injected, blocks the Rh-an gen of the fetal cells; (ii) The
intact an body coated fetal
red cells are removed from the maternal circula on by the spleen or lymph nodes; (iii)
va
Central inhibi on—the

fetal red cells, coated with an D an bodies interfere the produc on of IgG from the B
cells.
De
When to administer? It should be administered within 72 hours or preferably earlier

following delivery
or abor on. It should be given provided the baby born is Rh-posi ve and the direct
Coombs’ test is nega ve.
In case, where the specified me limit is over (>72 hours), she may be given upto 14–28
days a er delivery to
25
avoid sensi za on. Similarly, when the Rh factor of the fetus cannot be determined, it
should be administered
without any harm.
Dose—An D-gamma globulin is administered intramuscularly to the mother 300 μg
October 7,
2015
following delivery. All

Rh-nega ve unsensi zed women should receive 50 μg of Rh-immune globulin IM within
72 hours of induced
or spontaneous abor on, ectopic or molar pregnancy or CVS in the first trimester.
Women with pregnancy
beyond 12 weeks should have full dose of 300 μg. Generally 300 μg dose will protect a
woman from fetal
hemorrhage of upto 30 mL of fetal whole blood.
Calcula on of the dose—Approximate volume of
fetal blood entering into the maternal circula on is to be
es mated by “Kleihauer-Betke test” using acid elu on
h
technique to note the number of fetal red cells (dark,
ec
refrac le bodies) per 50 low power fields (Fig. 22.5). If
there are 80 fetal erythrocytes in 50 low power fields
in maternal peripheral blood films, it represents a
ut
transplacental hemorrhage to the extent of 4 mL of
fetal blood. More accurate tests are immunofluorescence
and flow cytometry. If the volume of fetomaternal
Ed
haemorrhage is greater than 30 mL whole blood, the dose
of Rh-immune globulin calculated is 10 μg for every 1 mL
of fetal whole blood.
i
hu
73. Spasmodic dysmenorrhea (B.178)

Ans.: The primary dysmenorrhea is one where there is no
iden fiable pelvic pathology
rs
74. Contraindica ons of oral contracep ves (B.487:C208)

Ans.:
va
75. Mechanism of ac on of cut (B.480:C.206)

Ans.:
De
76. Clomiphene citrate (B.533:C.284)

Ans.:
77. GNRH analogues (B.525:C.288)
Ans.:
78. CIN (Cervical intraepithelial neoplasia) (B.320:C.359)
Ans.: 26
October 7,
2015
79. Corpus luteum (B.87:C.28)

Ans.:
80. Fallopian tube in genital tuberculosis (B.137:C.137)
Ans.: The commonest site of affec on
is the fallopian tubes (100%). Both the tubes areaffected simultaneously. The ini al site
of infec on
is in the submucosal layer (inters al salpingi s)
of the ampullary part of the tube.
The infec on may spread medially along the wall
h
causing destruc on of the muscles which are replaced
by fibrous ssue. The walls get thickened, become
ec
calcified or even ossified. The thickening may at
me become segmented. The infec on may spread
inwards; the mucosa gets swollen and destroyed.
ut
The fimbria are everted and the abdominal os um
usually remains patent. The elongated and distended
distal tube with the patent abdominal os um gives
Ed
the appearance of “tobacco-pouch”. Occlusion of
the os um may however occur due to adhesions.
The tubercles burst pouring the caseous material
inside the lumen producing tubercular pyosalpinx,
i
which may adhere to the ovaries and the surrounding
hu
structures. O en the infec on spreads outwards

producing perisalpingi s with exuda on, causing
dense adhesions with the surrounding structures—
rs
tubercular tubo-ovarian mass. Rarely, miliary

tubercles may be found on the serosal surface of the
tubes, uterus, peritoneum or intes nes. These are o en
va
associated with tubercular peritoni s (Fig. 10.4).

However, not infrequently the tubes may look
absolutely normal or nodular at places. If the nodules
De
happen to be present in the isthmus near the uterine

cornu, it cons tutes salpingi s isthmica nodosa.
Salpingi s isthmica nodosa is the nodular thickening
of the tube due to prolifera on of tubal epithelium
within the hypertrophied myosalpinx (muscle
layer). Exact ae ology is unknown. It is diagnosed
radiologically as a small diver culum (Fig. 10.7). It is
27
however not specific to tubercular infec on only (see
p. 172). It is also observed in pelvic endometriosis
October 7,
2015
81. Tocoly c drugs (A.507)

Ans.:
82. Neonatal jaundice (A.476)

Ans.: Yellow discolora on of the skin and the mucosa is caused by accumula on of
excess of bilirubin in the ssue
and plasma (serum bilirubin level should be in excess 7 mg/dl). A value > 15 mg/dl is
considered severe. About
h
30–50 percent of term newborn and more of preterm newborns develop clinical
jaundice. Types 1.physiological 2.pathological
ec
83. Abnormali es in placenta (A.216)
Ans.: 1)PLACENTA SUCCENTURIATA 2) PLACENTA EXTRACHORIALIS
ut
Two types are described: (1) Circumvallate placenta (2) Placenta marginata 3)PLACENTA
MEMBRANECAE
Ans.:
i Ed
84. Inves ga ons in antenatal woman. (A.18,70,105,106,110)
hu
85. Causes of maternal mortality. (A.603)

Ans.:
rs
86. Cuvuelier uterus. (A.254)

Ans.: It is a pathological
va
en ty first described by Couvelaire and is

met with in associa on with severe form
of concealed abrup o placentae. There is
De
massive intravasa on of blood into the

uterine musculature upto the serous coat.
The condi on can only be diagnosed on
laparotomy.
Naked eye features: The uterus is of dark port
wine color which may be patchy or diffuse. It tends
to occur ini ally on the cornu before spreading to
other areas, more specially over the placental site.
28
Subperitoneal petechial hemorrhages are found
October 7,
2015
under the uterine peritoneum and may extend into the broad ligament. There may be
free blood in the peritoneal cavity or
broad ligament hematoma.
Microscopic appearance: The uterine muscles over the affected area are necrosed and
there is infiltra on of blood and
fluid in between the muscle bundles. Most of the muscular dissocia on occurs in the
middle and outer muscle layers. The
serosa may split on occasions, to allow the blood to enter the peritoneal cavity. The
blood vessels show acute degenera ve
changes with thrombosis.
The myometrial hematoma rarely interferes with uterine contrac ons following delivery.
h
Thus, the presence of Couvelaire
ec
87. Embryo reduc on. (A.211)
Ans.: If there are 4 or more fetuses, selec ve reduc on of the fetuses leaving behind
ut
only two is done
to improve outcome of the cofetuses. This can be done by intracardiac injec on of
potassium chloride between 11 and 13
targeted twin is occluded by fetoscopic

Ed
weeks under ultrasonic guidance. It is done transabdominally. Umbilical cord of the
liga on or by laser or by bipolar coagula on, to protect the co-twin from adverse drug
effect. Mul ple pregnancy reduc on
i
improves perinatal outcome in women with triplets or more.
hu
88. Cystocole. (B.204:C.299)

Ans.: Cystocele — The cystocele is formed by laxity
rs
and descent of the upper two-thirds of the

anterior vaginal wall. As the bladder base is
va
closely related to this area, there is hernia on of

the bladder through the lax anterior wall
De
89. Cervical biopsy. (B.589:C.362)

Ans.: This is the common diagnos c procedure carried out
both in the hospital and in the office.
Types
• Surface (ch. 9) • Punch • Wedge
• Ring • Cone
29
90. Specific inves ga ons in carcinoma of ovary. (B.375:C.378)
October 7,
2015
Ans.: W sPEcial iNvEs ga oNs

Inves ga on aims at:
y To confirm malignancy preopera vely.
y To iden fy the extent of lesion.
y To detect the primary site.
to confirm Malignancy
y Cytologic examina on for detec on of malignant
cells is carried out from the fluid collected by
abdominal paracentesis or “cul-de-sac”aspira on.
y Tumor marker: In epithelial carcinoma, there is no
h
specific tumor marker. But, elevated CA-125 level
> 65 U/mL with a pelvic mass may be sugges ve.
ec
Other biomarkers: HE4, CA-19-9, CA-15-3,
OVXI may also be sugges ve.
W to iden fy the extent of lesion
ut
x Straight X-ray chest to exclude pleural effusion
and chest metastasis.
x Barium enema to detect any lower bowel
malignancy.
Ed
x Cytologic examina on of thoracocentesis fluid.
x Sonography is of limited help but can be
employed to detect involvement of the omentum
i
hu
or contralateral ovary.
x Computed Tomography (CT) is helpful for
retroperitoneal lymph node assessment and
detec on of metastasis (liver, omentum). It helps
rs
in staging of ovarian carcinoma (see p. 662).

x Magne c Resonance Imaging (MRI) is helpful
va
to determine the nature of ovarian neoplasm and

also for the retroperitoneal lymph nodes and
detec on of metastasis. It can also detect relapse
De
of the tumor following ini al treatment.

x Positron Emission Tomography (PET) can
differen ate normal ssues from cancerous
ssues. It is more sensi ve than CT or MRI
(p. 119).
x Intravenous pyelography.
x Examina on under anesthesia.
x Diagnos c uterine cure ageTo detect the Primary Site
30
x Barium meal X-ray.
October 7,
2015
x Gastroscopy/colonoscopy.
x Mammography.
91. Immuniza on against carcinoma of cervix. (B.326)

Ans.: PREVENTIVE
▼ HPV vaccines has been developed from the
capsid coat of the virus. It has high immunogenicity.
Bivalent vaccines (cervarix) against HPV types 16, 18
and quadrivalent (Gardasil) against HPV types 16, 18,
6, 11 are effec ve in preven on of about 90% cervical
h
cancer. Both the vaccines have some cross protec on
ec
aginst HPV types 31, 33 and 45. Vaccines are given
to girls aged 12–18 years, in three doses IM over the
deltoid muscle. The impact of vaccines is greatest
when it is given to females who have not been already
ut
infected. This is the reason it is recommended to
adolescent girls. Vaccines are safe and well tolerated.
Ed
Vaccine induced neutralizing an bodies (IgG,
IgA) works locally (cervix) by preven ng the
a achment of the virus to the cervical epithelium.
Immune defense is type specifi c and is effec ve
i
only when given prophylac cally.
hu
Vaccines are effec ve for atleast 7.5 years.

However, screening with Pap test should be con nued
as the vaccines are type specifi c and do not protect
against the other types of HPV.
rs
▼ Other measures
To delay sexual exposure un l the cervical
va
epithelium, especially in the transforma on zone,

has a ained physiological maturity.
To maintain a local hygiene and to treat vaginal
De
infec ons.
To use condom specially during early sexual life.
To maintain penile hygiene as it may be the
reservoir for high risk HPV.
Reducing or qui ng smoking reduces CIN
92. Hysterosalphingography. (B.588:C.190)

31
Ans.:
October 7,
2015
93. Premature ovarian failure. (B.463)

Ans.: when ovarian failure occurs before the age of forty.
It occurs in about 1% of the female popula on. During
intrauterine life either there is failure of germ cell
migra on or there may be normal germ cell migra on
but an accelerated rate of germ cell deple on
(apoptosis) due to various reasons (see below). This
results in either no follicle or only few follicles le
h
behind in the ovary by the me they reach puberty.
Causes of Premature Ovarian Failure
ec
Gene c: (i) Turner’s syndrome (45X0), (45X/46XX),
(ii) Gonadal dysgenesis 46XX, 46XY, (iii) Trisomy 18 and
13, (iv) X-chromosome dele on, transloca on.
ut
Autoimmune: (i) Autoan bodies: an nuclear an bodies
(ANA), Lupus an coagulant, (ii) Polyglandular autoimmune
syndrome (an bodies against thyroid, parathyroid, adrenal,
islet cells of pancreas).
Infec ons: Mumps, tuberculosis.
Ed
Iatrogenic: Radia on therapy, Chemotherapy (cyclophosphamide),
Surgery.
i
Metabolic: Galactosemia, 17α hydroxylase deficiency.
hu
In galactosemia, the enzyme galactose-1-phosphate uridyl

transferase is absent. Follicles are destroyed to the toxic
effects of galactose.
rs
Environmental: Smoking.
FSH receptor absent or postreceptor defect (Savage’s
syndrome).
va
Idiopathic
De
94. Inves ga ons in post-menopausal woman. (C.56)

Ans.:
95. Conges ve Dysmenorrhea (B.181:C.265)
Ans.: Secondary dysmenorrhea is normally considered to
be menstrua on — associated pain occurring in the
presence of pelvic pathology.
32
96. Involu on of Uterus (A.144)
October 7,
2015
Ans.:
97. Injec on an -D (A.334)

Ans.: Dose—An D-gamma globulin is administered intramuscularly to the mother 300
μg following delivery. All
72 hours of induced
h
woman from fetal
ec
98. PEP (post exposure prophylaxis)
h p://whalibdoc.who.int/publica ons/2007/9789241596374_eng.pdf)
Ans.:
ut
99. Reten on of urine in pregnancy (A.299,311)
Ans.: Reten on of urine is not an uncommon complica on during pregnancy state. The
causes are Ed
divided into—(A) During early pregnancy — (1) Incarcerated retroverted gravid uterus
(2) Impacted pelvic tumors. (B) During
labor—(1) Associated with abnormal uterine ac vity commonly with incoordinate
i
uterine ac on (2) Obstructed labor. (C)
hu
During puerperium—(a) diminished bladder tone (b) reflex from vulval injuries (3)
Bruising and edema of the bladder neck.
If simple measures fail, catheteriza on is to be done using a disposable catheter.
rs
100. Func on of placenta (A.35)

Ans.: The main func ons of the placenta are:
va
1. Transfer of nutrients and waste products between the mother and fetus. In this
respect it a ributes to
the following func ons: • Respiratory • Excretory • Nutri ve
De
2. Endocrine func on: Placenta is an endocrine gland. It produces both steroid and
pep de hormones
to maintain pregnancy (p. 58).
3. Barrier func on.
4. Immunological func on.
101. Preterm baby (A.456)

Ans.: A baby born before
33
37 completed weeks of gesta on
October 7,
2015
calcula ng from the first day of last menstrual period is called preterm baby.
102. Iron sucrose (A.267)
Ans.: Total iron dose (mg) = 2.3 × W × D + 500 [W = Weight (kg) before pregnancy; D =
Hb (Target
103. Physiological edema in pregnancy (A.50,51)
Ans.: Total iron dose (mg) = 2.3 × W × D + 500 [W = Weight (kg) before pregnancy; D =
Hb (Target
– Actual) g/dL; 500 mg for body store]. It is given IV, 100 mg (at a me) in 100 mL
normal saline over 15 minutes.
h
104. Clomiphene citrate (B.244,533:C.195,284)
Ans.: ™™ Normogonadotropic—normoprolac nemic
ec
pa ents who are having normal cycles with absent
or infrequent ovula on.
™™ PCOS cases with oligomenorrhea or amenorrhea.
ut
The estradiol level should be > 40 pg per mL.
™™ Hypothalamic amenorrhea following stress or
‘pill’ use.
Ed
Dose: Clomiphene therapy is simple, safe and at the
same me cost-effec ve. Most centers use an ini al
dose of 50 mg daily. Dose is increased in 50 mg
steps to a maximum 250 mg daily, if ovula on is not
i
induced by the lower dose. The actual star ng day
hu
of its administra on in the follicular phase varies

between day 2 and day 5 and therapy is given for 5
days. Ovula on is expected to occur about 5–7 days
rs
a er the last day of therapy. Therapy for six cycle is

generally given.
Mechanism of ac on of clomiphene: Clomiphene
va
citrate is an -estrogenic as well as weakly estrogenic.

It blocks the estrogen receptors in the hypothalamus.
This results in increased GnRH pulse amplitude
De
causing increased gonadotropin secre on from the

pituitary. An -estrogenic effects are seen on the
endometrium and on the cervical mucus.
Side Effects: hot flushes, nausea, vomi ng,
headache, visual symptoms and ovarian
hypers mula on (rare). Incidence of abor on and
congenital fetal malforma ons are not increased.
34
Couple instruc on: The couple is advised to have
sexual intercourse as per following guidelines:
October 7,
2015
Daily or on alternate days beginning 5–7 days a er

the last dose of clomiphene therapy.
Several mes for 24–48 hours a er the color
change in urine when tested by LH kit.
Number of mes over 24–36 hours following hCG
administra on.
Result: Successful induc on rate is as high as 80
percent but cumula ve pregnancy rate is about 70
percent over 6–9 cycles. The discrepancy is due to
premature luteiniza on, LPD, cervical mucus hos lity
h
and other non-ovulatory factors. The incidence of
mul ple pregnancy is about 7 percent.
ec
Adjuvant therapy
Despite the high success rate of clomiphene, some
adjuvant therapy is o en needed.
ut
a. Hyperinsulinemia and Insulin sensi zer
- Pa ents with polycys c ovarian disease
with BMI > 25 (see p. 459) are o en found
insulin resistant. Obese women with PCOS
o en suffer from impaired glucose tolerance
Ed
(33%) or type 2 diabetes (10%). Correc on of
their metabolic abnormality (see p. 470) along
i
hu
with weight reduc on gives sa sfactory result.

Treatment with me ormin (insulin sensi zer)
is found to reduce hyperinsulinemia and
hyperandrogenemia. Combina on treatment
rs
with me ormin and clomiphene increases

ovula on rate significantly.
va
b. Pre-exis ng or induced elevated androgens may

be suppressed by dexamethasone 0.5 mg daily for
10 days, star ng from 1st day of cycle. The drug
De
should be stopped soon a er ovula on.

105. Frac onal cure age (B.357:C.375)
Ans.: Endocervical cure age (ECC).
„ To pass an uterine sound to note the length of the
uterocervical canal.
„ Dilata on of the internal os.
„ Uterine cure age at the fundus and lower part of 35
the body. The endometrial ssue is usually profuse
and o en dark color.
October 7,
2015
„ Finally, a polyp forceps is introduced in case any

endometrial polyp has escaped the cure e.
The specimens, so obtained, should be placed in
separate containers, labelled properly and submi ed
for histological examina on.
„ Computed Tomography (CT) scan of pelvis
and abdomen may be used to detect lymph node
metastases (p. 118).
„ Magne c Resonance Imaging (MRI) can detect
myometrial invasion (see p. 118).
h
„ Positron Emission Tomography (see p. 119).
Surgical staging: Increased inaccuracy of clinical
ec
staging and the importance of prognos c factors, some
of which can only be iden fied surgically, resulted in
introduc on of surgicopathological staging by FIGO
ut
106. Secondary amenorrhea (B.457:C.258)
Ans.: It is the absence of menstrua on for 6 months or more
Ed
in a woman in whom normal menstrua on has been
established.
107. Red degenera on of fibroid (B.275:C.318)
Ans.: Red degenera on (carneous degenera on) occurs in
i
a large fibroid mainly during second half of pregnancy
hu
and puerperium. Par al recovery is possible and as

such called necrobiosis. The cause is not known but
is probably vascular in origin. Infec on does not play
rs
any part.
108. Forthergill opera on (B.216:C.305)
va
Ans.: The opera on is designed to correct uterine descent

associated with cystocele and rectocele where preserva on
of the uterus is desirable.
De
The indica ons are:

i. Preserva on of reproduc ve func on.
ii. When the symptoms are due to vaginal prolapse
associated with elonga on of the (supravaginal)
cervix.
109. Types of tubal liga on (B.496:C.216)
Ans.: 1) Abdominal (2) Vaginal
36
(1) Abdominal:
(A) Conven onal (B) Minilaparotomy
October 7,
2015
110. Bartholin cyst (B.162:C.111)

Ans.: There is closure of the duct or the opening of an
acinus.The cause may be infec on or trauma followed
by fibrosis and occlusion of the lumen
111. Defini on of SUI (B.398:C.169)

Ans.: Stress urinary incon nence (SUI) is defined
as involuntary escape of urine from the external
urinary meatus due to sudden rise in intra-abdominal
h
pressure.
112. Anterior frontanellae (A.84)
ec
Ans.: It is formed by joining of the four sutures in the midplane. The sutures
are anteriorly frontal, posteriorly sagi al and on either side, coronal. The shape is like a
diamond.
ut
Its anteroposterior and transverse diameters measure approximately 3 cm each. The
floor is formed by a
membrane and it becomes ossified 18 months a er birth. It becomes pathological, if it
fails to ossify even a er
24 months.
Importance:
Ed
— Its palpa on through internal examina on denotes the degree of flexion of the head.
i
— It facilitates moulding of the head.
hu
— As it remains membranous long a er birth, it helps in accommoda ng the marked

brain growth; the brain becoming
almost double its size during the first year of life.
— Palpa on of the floor reflects intracranial status—depressed in dehydra on, elevated
rs
in raised intracranial tension.

— Collec on of blood and exchange transfusion, on rare occasion, can be performed
va
through it via the superior

longitudinal sinus.
— Cerebrospinal fluid can be drawn, although rarely, through the lateral angle of the
anterior fontanelle from lateral ventricle.
De
113. PC-PN DT act (A.642)

Ans.: The act (PC & PNDT) is enforced to prohibit sex selec on before or a er
concep on to prevent its misuse that
leads to female fe cide. The act has got several chapters. It also covers the regula on of
gene c counseling
37
centers, gene c laboratories and gene c clinics. The act permits such procedure to
detect any of the following
abnormali es only : (i) Chromosomal abnormali es (ii) Gene c metabolic diseases (iii)
Hemoglobinopathies
October 7,
2015
(iv) Sex-linked gene c diseases (v) Congenital anomalies (vi) Any other abnormali es or
diseases as may be
specified by the central supervisory board.
The person qualified to do the procedure must be sa sfied for reasons to fulfil the
following condi ons
and it must be recorded in wri ng : (i) Age of the pregnant woman is above 35 years. (ii)
The pregnant woman
has undergone two or more spontaneous abor ons or fetal loss. (iii) The pregnant
woman had been exposed
to poten ally teratogenic agents, e.g. drugs, radia on, infec on or chemicals. (iv) The
pregnant woman or her
h
spouse has a family history of mental retarda on or physical deformi es such as
ec
spas city or any other gene c
disease. (v) Any other condi ons as may be specified by the central supervisory board.
Wri en consent of the
pregnant woman is obtained and there is prohibi on of communica ng the sex of fetus
ut
114. Exchange transfusion (A.339)
Ans.: Exchange transfusion is a life saving procedure in severely affected hemoly c
disease of the newborn. With
Ed
the advent of wider use of prophylac c an -D immunoglobulin, less and less problem
babies are born and
through exchange transfusion, the incidence of kernicterus has also been reduced.
INDICATIONS: Rh-posi ve with direct Coombs’ test posi ve babies having:
i
• Cord blood bilirubin level > 4 mg/dL and hemoglobin level is <11 g/dL.
hu
• Rising rate of bilirubin is over 1 mg/dL/hour despite phototherapy.

• Total bilirubin level 20 mg/dL or more.
115. Nifedepine (A.506)
rs
Ans.: Direct arteriolar

vasodilata on by
va
inhibi on of slow inward

calcium channels in
vascular smooth muscle.
De
Orally 5-10 mg d
maximum dose
60-120 mg/day
Flushing, hypotension,
headache, tachycardia,
inhibi on of labor
116. Hegar sign (A.65)
38
Ans.: It is present in two-thirds of cases. It can be demonstrated between 6–10 weeks, a
li le
October 7,
2015
earlier in mul parae. This sign is based on the fact that : (1) upper part of the body of
the uterus is
enlarged by the growing fetus (2) lower part of the body is empty and extremely so
and (3) the cervix
is compara vely firm. Because of varia on in consistency, on bimanual examina on
(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
117. Indica ons of LSCS (A.589)
h
Ans.: Vaginal delivery is not possible. Cesarean is needed even
with a dead fetus
ec
Indica ons are few:
1. Central placenta previa
2. Contracted pelvis or cephalopelvic dispropor on
ut
(absolute)
3. Pelvic mass causing obstruc on (cervical or broad
ligament fibroid)
4. Advanced carcinoma cervix Ed
Vaginal delivery may be possible but risks to the mother and/
or to the baby are high
More o en mul ple factors may be responsible
i
1. Cephalopelvic dispropor on (rela ve) see p. 352
hu
2. Previous cesarean delivery (p. 330)—(a) when primary

CS was due to recurrent indica on (contracted pelvis).
(b) Previous two CS (c) Features of scar dehiscence.
rs
(d) Previous classical CS

3. Non-reassuring FHR (fetal distress)
4. Dystocia may be due to (three Ps) rela vely large fetus
va
(passenger), small pelvis (passage) or inefficient uterine

contrac ons (Power)
De
118. Analgesia in labour (A.515)

Ans.: The pain during labor results from a combina on of uterine contrac ons and
cervical dilata on. During cesarean delivery
incision is usually made around the T12 dermatome anesthesia is required from the
level of T4 to block the peritoneal
discomfort. Labor pain is experienced by most women with sa sfac on at the end of a
successful labor. Antenatal (mothercra ) 39
classes, sympathe c care and encouraging environment during labor can reduce the
need of analgesia. Drugs have an
important part to play in the relief of pain in labor but it must not be supposed that
October 7,
2015
they are of greater importance than

proper prepara on and training for child birth. The intensity of labor pain depends on
the intensity and dura on of uterine
contrac ons, degree of dilata on of cervix, distension of perineal ssue, parity and the
pain threshold of the subject. The
most distressing me during the whole labor is just prior to full dilata on of the cervix.
119. Pudendal block (A.518)
Ans.: It is a safe and simple method of analgesia
during delivery. Pudendal nerve block does not relieve the pain of labor
but affords perineal analgesia and relaxa on. Pudendal nerve block is mostly used for
h
forceps and vaginal breech delivery.
Simultaneous perineal and vulval infiltra on is needed to block the perineal branch of
ec
the posterior cutaneous nerve of
the thigh and the labial branches of the ilio-inguinal and genito-femoral nerves (vide
supra). This method of analgesia is
ut
associated with less danger, both for the mother and for the baby than general
anesthesia.
Technique: The pudendal nerve may be blocked by either the transvaginal or the
transperineal route.
120. Mefepristone (B.537:C.286)
Ed
Ans.: It is a compe ve antagonist of progesterone
and glucocor coid receptors. It is a deriva ve
i
of 19-nortestosterone. It binds compe vely to
hu
progesterone receptors and nullifies the effect of

endogenous progesterone. As a result, there is
an increased release of prostaglandins from the
rs
endometrium, resul ng in menstrual bleeding or

termina on of early pregnancy.
Three important biochemical characters of RU 486
va
are high affinity for progesterone receptors, long

half life and ac ve metabolites.
Uses: Therapeu c abor on
De
It is an effec ve abor facient upto 7 weeks.

Combina on of prostaglandins as vaginal pessary
48 hours a er RU 486, increases its efficacy.
Dose: Tab 200 mg (1 tab = 200 mg) orally, followed
48 hours later by misoprostol 400 μg (PGE1) oral
or 800 mg vaginal pessary. Success rate is 95–100
percent. 40
Emergency contracep on
A single dose of 10 mg is to be taken on 27th day
October 7,
2015
of the cycle irrespec ve of the day and number of

intercourse. Efficiency is 95–100 percent.
Induc on of labor—Mifepristone has been used for
cervical ripening. It is given orally.
Uterine fibroids—Shrinkage of uterine leiomyoma
has been observed following mifepristone therapy
(25–50 mg daily) (see p. 280).
Ectopic pregnancy—Injec on of mifepristone into
the ectopic pregnancy (unruptured sac) is used as a
medical management.
h
Cushing’s syndrome—as it blocks the glucocor coid
receptors.
ec
Side effects: Minor side effects are nausea, vomi ng,
headache and cramp. There is risk of ongoing
pregnancy (failure of medical induc on of abor on)
ut
in about 1 percent of cases. Evacua on of the uterus
should be done for such a failure. Long-term use
causes endometrial hyperplasia.
Contraindica ons:
Age > 35 years
Ed
Heavy smoker.
Adrenal insufficiency
i
hu
Cor costeroid therapy
121. Centchromone (B.501:C.213)

Ans.: Centchroman (saheli)—Ormeloxifene is a
rs
research product of Central Drug Research Ins tute of

Lucknow, India. It is a non-steroidal compound with potent
va
an -estrogenic and weak-estrogenic proper es. It is taken

orally (30 mg) twice a week for first 3 months then once
a week. It works primarily by preven ng implanta on of
De
fer lized ovum. It does not inhibit ovula on.

122. Follicular monitoring (B.244:C.194)
Ans.: For diagnosis of ovula on, BBT recording is enough.
With some therapies, diagnosis of ovula on is
obtained from BBT chart supplemented by cervical
mucus study (clear, watery, stretchable type). But
when a complicated regimen is followed to achieve 41
pregnancy by me intercourse or by ART, a detailed
monitoring is a must which is only possible in selected
October 7,
2015
centers. Not only the drugs are costly, the regimens

are complicated and me consuming.
Apart from BBT chart and cervical mucus study
which are noninvasive, simple and quite informa ve,
other parameters used are serial es ma on of plasma
E2 and ultrasonic measurement of growing follicles
(folliculometry). These last two are obligatory in ART
123. Ovula on (B.92:C.527)
Ans.: LH surge ini ates luteiniza on ac ng through its
h
receptors about 24–48 hours. prior to ovula on. A
trace amount of 17-α-hydroxy progesterone is formed
ec
which is probably responsible for comple on of the
first meio c division of the oocyte and compounds
the effect of estrogen for LH surge. Progesterone
ut
also facilitates the posi ve feedback ac on to induce
FSH surge → increase in plasminogen ac vator →
plasminogen → plasmin → helps lysis of the follicular
wall.
124. IUI (B.250)
Ed
Ans.: lUI may be either AIH (ar ficial insemina on
husband) or AID (ar ficial insemina on donor).
i
Husband’s semen is commonly used. The purpose
hu
of IUI is to bypass the endocervical canal which is

abnormal and to place increased concentra on of
mo le sperm as close to the fallopian tubes
rs
125. Hysteroscopy (B.122:C.443)

Ans.: Hysteroscopy is an opera ve procedure whereby
va
the endometrial cavity can be visualized with the

aid of fiberop c telescope. The uterine distension
is achieved by carbon dioxide, normal saline or
De
glycine. The instrument is to pass transcervically,

usually without dilata on of the cervix or local anesthesia.
However, for opera ve hysteroscopy, either
paracervical block or general anesthesia is required.
Diagnos c hysteroscopy should be performed in
the postmenstrual period for be er view without
bleeding. 42
126. Transemic acid (B.192:C.274,275)
Ans.: reduces menstrual blood loss by 50 percent. It
October 7,
2015
counteracts the endometrial fibrinoly c system.

It is par cularly helpful in IUCD induced
menorrhagia. Gastrointes nal side effects are
common. An fibrinoly c agents can be used as a
second line therapy
127. Cervical erosion (B.267:C.294)
Ans.: Cervical ectopy is a condi on where the squamous
epithelium of the ectocervix is replaced by columnar
epithelium, which is con nuous with the endocervix.
h
It is not an ulcer
128. Asyncli sm (A.123)
ec
Ans.: Head brim rela on prior to the engagement as revealed by imaging studies show
that due
to lateral inclina on of the head, the sagi al suture does not strictly correspond with
ut
the available transverse
diameter of the inlet. Instead, it is either deflected anteriorly toward the symphysis
pubis or posteriorly towards
is called asyncli sm
129. Tocoly c drugs (A.507)
Ed
the sacral promontory (Fig. 12.12). Such deflec on of the head in rela on to the pelvis
Ans.: Preterm labor and delivery can be delayed by drugs in order to improve the
i
perinatal outcome. Short
hu
term delay of 48 hours allows the use of cor costeroids that can reduce the perinatal
mortality and serious
morbidity significantly. The commonly used drugs are: Betamime cs, Prostaglandin
synthetase inhibitors,
rs
Magnesium sulphate, Calcium channel blockers, Oxytocin receptor antagonists, Nitric

oxide donors and
progesterone.
va
130. Bandl’s ring (A.362)

Ans.: This type of uterine contrac on is predominantly due to obstructed labor.
De
Pathological anatomy of the uterus: There is gradual increase in intensity, dura on and
frequency
of uterine contrac on. The relaxa on phase becomes less and less; ul mately a state of
tonic contrac on
develops. Retrac on, however, con nues. The lower segment, elongates and becomes
progressively thinner to
43
accommodate the fetus driven from the upper segment (Fig. 24.5). A circular groove
encircling the uterus is
formed between the ac ve upper segment and the distended lower segment, called
pathological retrac on
October 7,
2015
ring (Bandl’s ring).
131. Ventouse (A.580)

Ans.: Ventouse is an instrumental device designed to assist delivery by crea ng a
vacuum between it and the
fetal scalp. The pulling force is dragging the cranium while in forceps, the pulling force is
directly transmi ed
to the base of the skull
132. Apgar score (A.470)
Ans.: Table 32.1: Apgar scoring
h
Score
Signs 0 1 2
ec
Respiratory
effort
Apneic Slow, irregular Good,
ut
crying
Heart rate Absent low
(below 100)
Over 100
Muscle
Ed
tone
Flaccid Flexion of
i
hu
extremi es
Ac ve body
movements
Reflex
rs
irritability
No
va
response
Grimace Cough or
sneeze
De
Color Blue, pale Body pink,

extremi es blue
Complete
pink
• Total score = 10
• Mild depression = 4–6
• No depression = 7–10
• Severe depression = 0–3
44
133. Bishop’s score (A.523)
October 7,
2015
Ans.: TABLE 34.4: BISHOP’S PRE-INDUCTION CERVICAL

SCORING SYSTEM (MODIFIED)
Parameters Score
0123
Cervix
Dilata on
(cm)
Closed 1–2 3–4 5 +
* Effacement
(%)
h
0-30 40-50 60-70 ≥ 80
Consistency Firm Medium So –
ec
Posi on Posterior Midline Anterior –
Head: Sta on –3 –2 –1,0 + 1, + 2
Total score = 13; Favorable score = 6-13; Unfavorable score
ut
= 0-5
* Cervical
length (cm)
> 4 2-4 1-2 < 1
Ed
* Modifica on (1991) replaces effacement (%) with cervical
length in cm.
i
134. Spalding’s sign (A.324)
hu
Ans.: The irregular

overlapping of the cranial bones on one another is
due to liquefac on of the brain ma er and so ening
rs
of the ligamentous structures suppor ng the vault.

It usually appears 7 days a er death. Similar
features may be found in extra-uterine pregnancy
va
with the fetus alive.

135. Importance of ischial spine (A.133)
Ans.: Sta on of the head in rela on to ischial spines (Fig. 12.21).
De
Spines are the most prominent bony projec ons felt on internal examina on and the
bispinous diameter
is the shortest diameter of the pelvis in transverse plane being 10.5 cm. The level of
ischial spines (see
Fig. 12.21) is the halfway between the pelvic inlet and outlet. This level is known as
sta on zero (0). The
45
levels above and below the spines are divided into fi hs to represent cen meters. The
sta on is said
to be ‘O’ if the presen ng part is at the level of the spines. The sta on is stated in minus
October 7,
2015
figures, if it is
above the spines (–1 cm, –2 cm, –3 cm –4 cm and –5 cm) and in plus figures if it is
below the spines (+1
cm. +2 cm. +3 cm +4 cm and +5 cm)
136. Cryptomenorrhoea (B.450:C.257)
Ans.: In cryptomenorrhea, there is periodic shedding of
the endometrium and bleeding but the menstrual
blood fails to come out from the genital tract due to
obstruc on in the passage
h
137. D & C (B.585)
Ans.: This is an opera ve procedure whereby dilata on
ec
of the cervical canal followed by uterine cure age
is done. This is the most common gynecological
opera on done.
ut
138. Hysterosalpingography (B.588:C.190)
Ans.: HSG is an opera ve procedure used to assess the
interior anatomy of the uterus and tube including
Ed
tubal patency. It is a radiographic study and a contrast
media is used.
139. Emergency contracep on (B.492:C.213)
i
Ans.: • Hormones • IUD
hu
• An -progesterone • Others
Indica ons of emergency contracep on: Unprotected
intercourse, condom rupture, missed pill, delay in taking
POP for more than 3 hours, sexual assault or rape and first
rs
me intercourse, as known to be always unplanned. Risk

of pregnancy following a single act of unprotected coitus
va
around the me of ovula on is 8 percent

140. T.V.S (B.117:C.247)
Ans.: Transvaginal Sonography (TVS) is done with
De
a probe, which is placed close to the target organ.

There is no need of a full bladder. It also avoids the
difficul es due to obesity, faced in TAS. TVS operates
at a high frequency (5–8 MHz). Therefore, detailed
evalua on of the pelvic organs (within 10 cm of
the field) is possible with TVS. But the drawbacks
of TVS are mainly due to narrow vagina as in virgins,
46
postmenopausal women or post-radia on vaginal
stenosis.
October 7,
2015
141. Paps smear (B.111,112:C.71)

Ans.: The principle of the staining is to achieve clear nuclear
defini on and to define cytoplasmic colora on.
The material so collected should be immediately
spread over a microscopic slide and at once put
into the fixa ve ethyl alcohol (95%) before drying.
A er fixing for about 30 minutes, the slide is taken
out, air dried and sent to the laboratory with proper
iden fica on. The slide so sent is stained either with
h
Papanicolaou’s or Sorr’s method and examined by a
trained cytologist. Indeed, trained cytopathologist
ec
and cytotechnologist are vital for the success of
any screening program (Table 9.1).
Benefits : The objec ve of screening is to reduce the
ut
incidence and mortality from cervical cancer. Even a
single smear in a life me, if appropriately med, will
Ed
produce some benefits. If extended only to high-risk
group, the mortality from the cancer deaths will s ll
be reduced to 60 percent.
Pap smear test has been effec ve reducing the
incidence of cervical cancer by 80% and the mortality
i
hu
by 70%. As a result of Pap test, more and more

preinvasive carcinoma is detected.
142. Red degenera on in fibroid uterus (B.275:C.318)
rs
Ans.:
143. Colposcopy (B.115:C.447)
Ans.: Colposcope and colpomicroscope are
va
the low-power binocular microscope, mounted

on a stand. It is designed to magnify the surface
epithelium of the vaginal part of the cervix including
De
en re transforma on zone. The magnifica on is to

the extent of 15–40 mes in colposcopy and about
100–300 mes in colpomicroscopy
144. Hegar’s sign (A.65)
Ans.:
145. Bandl’e ring (A.362)
47
Ans.:
October 7,
2015
146. Trial of labour (A.355)

Ans.: It is the conduc on of spontaneous labor in a moderate degree of cephalo-pelvic
dispropor on, in
an ins tu on under supervision with watchful expectancy, hoping for a vaginal delivery.
Every arrangement
should be made available for opera ve delivery, either vaginal or abdominal, if the
condi on so arises.
147. Vasa praevia (A.218)
Ans.: The cord is a ached to the membranes. The branching vessels traverse between
the membranes for a varying distance before they reach and supply the placenta. If the
h
leash of blood vessels
happen to traverse through the membranes overlying the internal os, in front of the
ec
presen ng part, the condi on
is called vasa previa. Rupture of the membranes involving the overlying vessels leads to
vaginal bleeding. As
ut
it is en rely fetal blood, this may result in fetal exsanguina on and even death
148. Caput succedaneum (A.86)
Ans.: It is the forma on
of swelling due to stagna on of fluid in
the layers of the scalp beneath the girdle
Ed
of contact. The girdle of contact is either
bony or the dila ng cervix or vulval ring.
i
hu
The swelling is diffuse, boggy and is not

limited by the suture line (Fig. 9.6). It may
be confused with cephalhematoma (see ch.
32). It disappears spontaneously within 24
rs
hours a er birth.
149. Low dose aspirin in obstetrics (A.227)
va
Ans.: Low dose aspirin 60 mg daily beginning early in pregnancy in poten ally high
risk pa ents is given. It selec vely reduces platelet thromboxane produc on. Aspirin in
low doses is
De
known to inhibit cyclo-oxygenase in platelets thereby preven ng the forma on of

thromboxane A2
without interfering with prostacyclin genera on.
150. Name four teratogenic drugs (A.513)
Ans.: Efavirenz, vit A (in large doses), lithium, s lbesterol, tetracyclines
151. Spalding sign (A.324) 48

Ans.:
152. Bartholin cyst (B.162:C.197)
October 7,
2015
Ans.:
153. Krukenberg’s tumour (B.324,346-47:C.361)
Ans.:
154. Pruritus vulvae (B.553:C.107)
Ans.: About 10 percent of pa ents
a ending the gynecologic clinic complain of vulval
itching.
Defini on: Pruritus means sense of itching.
When it is confined to the vulva, it is called pruritus
h
vulvae. It should not be confused with pain.
ec
155. Frac onal cure age (B.357:C.375)
Ans.:
156. Hydrosalpinx (B.170:C.402)
ut
Ans.: Collec on of mucus secre on into the fallopian tube
is called hydrosalpinx
157. TVS in gynaecology (B.117:C.247)
Ans.:
158. Bromocrip ne (B.471:C.289)
Ed
Ans.: Bromocrip ne (lysergic
i
acid deriva ve) a dopamine agoinst is the drug first
hu
choice. Common side effects are: giddiness, nausea,

vomi ng, headache, cons pa on and orthosta c
hypotension. In hyperprolac nemia
rs
159. Safe period (B.478:C.200)

Ans.: The method is based on
iden fica on of the fer le period of a cycle and to
va
abstain from sexual intercourse during that period.

This requires partner’s coopera on. The methods to
determine the approximate me of ovula on and the
De
fer le period include — (a) recording of previous

menstrual cycles (calendar rhythm) (b) no ng the
basal body temperature chart (temperature rhythm)
and (c) no ng excessive mucoid vaginal discharge
(mucus rhythm). The users of the calendar method
obtain the period of abs nence from calcula ons based
on the previous twelve menstrual cycle records. The
49
first unsafe day is obtained by subtrac ng 20 days
from the length of the shortest cycle and last unsafe
October 7,
2015
day by deduc ng 10 days from the longest cycle. Users

of temperature rhythm require abs nence un l the
third day of the rise of temperature. Users of mucus
rhythm require abs nence on all days of no ceable
mucus and for 3 days therea er.
160. Habitual abor on (A.167)
Ans.: Recurrent miscarriage is defined as a sequence of three or more consecu ve
spontaneous abor on
before 20 weeks. Some however, consider two or more as a standard. It may be primary
or secondary (having
h
previous viable birth)
ec
ut
i Ed
hu
rs
va
De
50
October 7,
2015
161. Axis of Brim (A.88)

Ans.: It is a mid-perpendicular line drawn to the plane of the inlet (see Fig. 9.17). Its
direc on is downwards
and backwards. When extended, the line passes through the umbilicus to coccyx. It is
important that the uterine
axis should coincide with the axis of the inlet so that the force of the uterine
contrac ons will be spread in the
right direc on, to force the fetus to pass through the brim
162. Contraindica ons of ECV (A.380)
Ans.: • Antepartum hemorrhage (placenta previa or abrup on)—
h
risk of placental separa on
• Fetal causes—hyperextension of the head, large fetus (>
ec
3.5 kg), congenital abnormali es (major), dead fetus, fetal
compromise (IUGR)
• Mul ple pregnancy
ut
• Ruptured membranes—with drainage of liquor
• Known congenital malforma on of the uterus
• Abnormal cardiotocography
• Contracted pelvis Ed
• Previous cesarean delivery—risk of scar rupture
• Obstetric complica ons: Severe pre-eclampsia, obesity,
elderly primigravida, bad obstetric history (BOH)
i
• Rhesus isoimmuniza on
hu
163. Causes of bleeding in first trimester of pegnancy (A.158)

Ans.: • Those related to the pregnant state: This group relates to abor on (95%), ectopic
pregnancy, hyda diform
rs
mole and implanta on bleeding.

• Those associated with the pregnant state: The lesions are unrelated to
va
pregnancy—either pre-exis ng
or aggravated during pregnancy. Cervical lesions such as vascular erosion, polyp,
ruptured varicose
veins and malignancy are important causes
De
164. Cephalohaematoma (A.483)

Ans.: It is a collec on of blood in between the pericranium and the flat bone of the
skull,
usually unilateral and over a parietal bone (Fig. 32.5). It is due to rupture of a small
emissary vein from the
51
skull and may be associated with fracture of the skull bone. This may be caused by
forceps delivery but may
also be met with following a normal labor
October 7,
2015
165. Third degree perineal tear (A.422)

Ans.: Injury to perineum, involving the
anal sphincter complex (both external and internal
166. Alfa feto protein (A.106)
Ans.: Maternal serum alpha fetoprotein (MSAFP): AFP is an oncofetal protein (Molecular
weight 70,000). It is produced by yolk sac and fetal liver. Highest level of AFP in fetal
serum and amnio c
fluid is reached around 13 weeks and therea er it decreases. Maternal serum level
reaches a peak around 32
h
weeks. MSAFP level is elevated in a number of condi ons: (a) wrong gesta onal age (b)
open neural tube
ec
defects (NTDs) (c) mul ple pregnancy, Rh isoimmuniza on (d) IUFD (e) anterior
abdominal wall defects
and (f) renal anomalies. Low levels are found in trisomies (Down’s syndrome),
gesta onal trophoblas c
ut
disease
167. Fetal distress (A.613)
result of
intrauterine fetal hypoxia.
Ed
Ans.: Fetal distress is an ill-defined term, used to express intrauterine fetal jeopardy, a
168. Whiff’s test (B.152:C.117)

i
Ans.:
hu
169. Hormonal cytology (B.113)

Ans.: The vaginal epithelium
is highly sensi ve to the hormones estrogen and
rs
progesterone. The non-invasive study of the epithelium

for hormonal status is steadily increasing owing to the
speed, cheapness and accuracy.
va
170. Shirodkar sling opera on (B.221:C.306,308)

Ans.: The non-absorbable suture (Mersilene) material is placed as a purse string suture
De
as high as possible (level

of internal os) at the junc on of the rugose vaginal epithelium and the smooth vaginal
part of the cervix below
the level of the bladder. The suture starts at the anterior wall of the cervix. Taking
successive deep bites (4–5
sites) it is carried around the lateral and posterior walls back to the anterior wall again
where the two ends of
the suture are ed. 52
The opera on is simple having less blood loss, and has got a good success rate. There is
less forma on of
October 7,
2015
cervical scar and hence less chance of cervical dystocia during labor.
171. Cervical mucous studies (B.114:C.33,194)

Ans.: Bacteriological study Hormonal status
Infer lity inves ga on
Bacteriological study
172. Luteal phase Defects (B.229:C.189)
Ans.: In this condi on, there is inadequate growth and
func on of the corpus luteum. There is inadequate
h
progesterone secre on. The lifespan of corpus luteum
is shortened to less than 10 days. As a result, there
ec
is inadequate secretory changes in the endometrium
which hinder implanta on. LPD is due to defec ve
folliculogenesis which again may be due to varied
ut
reasons.
173. Complica on of laparoscopy (B.619:C.442)
Ans.: Complica ons are grouped into: (i) specific to
Ed
laparoscopy itself, (ii) due to anesthesia, (iii) common
to any surgical procedures.
Complica ons due to laparoscopy itself:
(1) Extraperitoneal insuffla on
i
(a) Surgical emphysema
hu
(b) Omental emphysema

(c) Cardiac arrhythmia
(2) Injury to blood vessels—mesenteric, omental,
rs
injury to major pelvic or abdominal artery or vein.

Inferior epigastric vessels may be injured during
inser on of accessory trocars.
va
(3) Injury to bowel—with veress needle or trocar

especially when there is adhesions.
(4) Injury to organs like bowel, bladder or ureter.
De
Damage may be mechanical during dissec on or

thermal by electrical or laser energy.
(5) Electrosurgical complica ons—causing thermal
injury (electrode burns, insula on defects).
(6) Gas (carbon dioxide) embolism—resul ng in
hypotension, cardiac arrhythmia.
Anesthe c complica ons peculiar to laparoscopy
53
are:
(1) Hypoven la on (pneumoperitoneum and Trendelenburg
October 7,
2015
posi on lead to basal lung compression and

reduced diaphragma c excursion).
(2) Hypercarbia and metabolic acidosis (when CO2 is
used for pneumoperitoneum).
(3) Basal lung atelectasis.
(4) Others—esophageal intuba on, aspira on and
cardiac arrest.
Complica ons common to any surgical
procedure
(1) Hemorrhage (2) Infec on
h
(3) Wound dehiscence (4) Port site hernia.
Death rate in diagnos c laparoscopy is about
ec
5/100,000 procedures. With experience, the fatality
is markedly reduced to even zero. Causes of death
are cardiac arrest, gas embolism
ut
174. Asherman’s syndrome (B.459:C.139,141)
Ans.: There is forma on of adhesions following postabortal
and puerperal cure age and also following Ed
diagnos c cure age in dysfunc onal uterine bleeding.
175. Menometrorrhagia (B.186:C.65)
Ans.: Menometrorrhagia is the term applied when the
i
bleeding is so irregular and excessive that the menses
hu
(periods) cannot be iden fied at all.

176. Abnormal presenta on (enumerate four)
Ans.:
rs
177. Precipitated labour—defini on (A.361)

Ans.: A labor is called precipitate when the combined dura on of the first and
va
second stage is less than two hours.

178. Enumerate four complica ons of pre-eclampsia (A.226)
Ans.: Fetal: (1) Abor on (2) Deformity due to intra-amnio c adhesions or due to
De
compression. The deformi es

include altera on in shape of the skull, wry neck, club foot, or even amputa on of the
limb (3) Fetal pulmonary
hypoplasia (may be the cause or effect) (4) Cord compression (5) High fetal mortality.
Maternal: (1) Prolonged labor due to iner a (2) Increased opera ve interference due to
malpresenta on.
The sum effect may lead to increased maternal morbidity 54
179. Enumerate four indica ons for induc on of labour (A.523)
Ans.: • Pre-eclampsia, eclampsia (see p. 221) (hypertensive
October 7,
2015
disorders in pregnancy)
• Maternal medical complica ons
–– Diabetes mellitus (see p. 288)
–– Chronic renal disease (see p. 241)
–– Cholestasis of pregnancy
• Postmaturity (see p. 322)
• Abrup o placenta (see p. 259)
• Intrauterine Growth Restric on (IUGR) see p. 466
• Rh-isoimmuniza on (see p. 337)
• Premature rupture of membranes (see p. 317)
h
• Fetus with a major congenital anomaly
• Intrauterine death of the fetus (see p. 325)
ec
• Oligohydramnios, polyhydramnios (see p. 217)
• Unstable lie-a er correc on into longitudinal lie (see p. 397)
ut
180. Types of breech presenta on (A.374)
Ans.: There are two varie es of breech presenta on
(Fig. 25.9):
t Complete t Incomplete
Complete (Flexed breech): The normal
Ed
a tude of full flexion is maintained. The thighs
are flexed at the hips and the legs at the knees.
i
The presen ng part consists of two bu ocks,
hu
external genitalia and two feet. It is commonly

present in mul parae (10%).
Incomplete: This is due to varying degrees
rs
of extension of thighs or legs at the podalic pole.

Three varie es are possible:
• Breech with extended legs (Frank breech):
va
In this condi on, the thighs are flexed on the

trunk and the legs are extended at the kneejoints. The presen ng part consists of the
two bu ocks and external genitalia only. It is commonly present in
De
primigravidae, about 70%. The increased prevalence in primigravida is due to a ght

abdominal wall, good
uterine tone and early engagement of breech.
• Footling presenta on (25%): Both the thighs and the legs are par ally extended
bringing the legs to
present at the brim.
55
• Knee presenta on: Thighs are extended but the knees are flexed, bringing the knees
down to present at
the brim. The la er two varie es are not common
October 7,
2015
181. Define ante partum haemorrhage (A.241)

Ans.:
182. Four indica ons for LSCS (A.589)
Ans.:
183. Four uses of prostaglandins in obstetrics (A.504)
Ans.: USE IN OBSTETRICS
— Induc on of abor on (MTP and
missed abor on p. 172)
— Termina on of molar pregnancy (p.
h
194)
— Induc on of labor (p. 522)
ec
— Cervical ripening prior to induc on of
abor on or labor
— Augmenta on (accelera on) of labor
ut
— Management of atonic postpartum hemorrhage (p. 414)
— Medical management of tubal ectopic pregnancy
184.
Ed
Screening in carcinoma cervix (B.346-47:C.361)
Ans.: have been described in chapters 8 and 21. The abnormal
cervical pathology likely to progress to invasive
carcinoma can be detected. Its effec ve therapy reduces
i
drama cally the incidence of invasive carcinoma in
hu
areas where it has been implemented. Even when the

invasive carcinoma is detected, it is so early that a
85–100 percent 5-year survival rate could be achieved.
Downstaging screening (Who 1986)
rs
Downstaging for cervical cancer is defined as “the

detec on of the disease at an earlier stage when
va
it is s ll curable. Detec on is done by nurses and other

paramedical health workers using a simple speculum
for visual inspec on of the cervix”.
De
The “downstaging screening” is an experimental

approach suggested by WHO as an alterna ve
to regular cytologic screening. In the developing
countries, where effec ve mass screening cannot
be extended and the majority of cases of carcinoma
cervix are diagnosed at an advanced stage, ‘down
staging screening’ offers at least an early detec on
of disease. Compared to cytological screening it is
56
subop mal. But in places where prevalence of cancer
October 7,
2015
is high and cytological screening is not available,

“downstaging screening” is useful. The strategy is,
however, not expected to lower the incidence of
cancer cervix, but it can certainly minimize the
cancer death through early detec on.
Downstaging procedure: A female primary health
care worker is trained for 2–3 weeks to perform
speculum examina on. They are trained to dis nguish
a normal cervix from an abnormal one
h
185. Treatment of candid vagini s (B.165:C.132)
Ans.: Treatment: Correc ons of the predisposing
ec
factors should be done, if possible. Local fungicidal
prepara ons commonly used are of the polyene or
azole group. Nysta n, clotrimazole, miconazole,
ut
econazole are used in the form of either vaginal
cream or pessary.
One pessary is to be introduced high in the vagina
Ed
at bed me for consecu ve 2 weeks. In severe cases,
addi onal use of pessary in the morning is advocated.
The treatment should be con nued even during
menstrua on. Single dose oral therapy with fluconazole
i
(150 mg) or itraconazole is also found effec ve.
hu
Associated intes nal moniliasis should be treated

by fluconazole 50 mg daily orally for 7 days. Husband
should be treated with nysta n ointment
rs
locally for few days following each act of coitus.

The use of condom is preferred.
Resistance to these drugs is not known. The
va
systemic an fungal drugs fluconazole and itraconazole

are effec ve in a single dose oral therapy.
De
186. Inves ga on (specific) in post-menopausal women (B.560:C.61)

Ans.: Ultrasonography transvaginal probe (TVS) is more
accurate because of its proximity to the target ssue
(endometrium). Endometrial thickness less than
5 mm indicates atrophy. On the other hand, thick
polypoid endometrium (9–10 mm), irregular texture,
fluid within the uterus require further evalua on
57
(to exclude malignancy).
Saline infusion sonography (SIS) is more
October 7,
2015
accurate compared to sonography alone and

biopsy is taken (see p. 118).
Hysteroscopic evalua on and directed biopsy.
Endometrial biopsy may be done using the
Sharman cure e as an outpa ent basis.
Frac onal cure age, if the cervical cytology
becomes nega ve (p. 356).
Endometrial biopsy for diagnosis of endometrial
carcinoma under guidance of sonohysterography
or hysteroscopy has got the similar diagnos c
h
accuracy.
Laparoscopy in suspected cases of ovarian or
ec
adnexal mass.
CT and MRI may be useful in selected cases of
postmenopausal bleeding (p. 118).
ut
Detec on of a benign lesion should not prevent
further detailed inves ga ons to rule out malignancy
187.
Ans.:
Ed
Defini on of stress urinary incon nence (B.398:C.169)
188. Three swab test (B.419:C.168)

Ans.:
i
hu
189. Clue cell (B.152:C.118)

Ans.: A smear of vaginal discharge is prepared
with drops of normal saline on a glass slide and is
seen under a microscope. Vaginal epithelial cells are
rs
seen covered with these coccobacilli and the cells

appear as s ppled or granular. At mes, the cells are
va
so heavily s ppled that the cell borders are obscured.

These s ppled epithelial cells are called “clue cells”
(Fig. 11.1). Presence of clue cells ( >20% of cells) are
De
diagnos c of BV.
190. Chromo perturba on (B.238:C.191)
Ans.:
191. Four uses of progesterone in gynaecology (B.534-36:C.282)

58
Ans.: contracep ons,endometriosis,dysmenorrhea,luteal phase defect,premenstrual
syndrome
192. Enumerate four complica ons of LSCS (A.597)
Ans.:
October 7,
2015
193. Define presenta on (A.76)

Ans.: The part of the fetus which occupies the lower pole of the uterus (pelvic brim) is
called
the presenta on of the fetus. Accordingly, the presenta on may be cephalic (96.5%),
podalic (3%) or shoulder
and other (0.5%). When more than one part of the fetus present, it is called compound
presenta on
194. Bishop score (A.523)
Ans.: (A)Endothelial injury
h
• Pre-eclampsia, eclampsia, HELLP syndrome
ec
• Sep cemia
– Sep c abor on
– Chorioamnioni s
– Pyelonephri s
ut
• Hypovolemia
(B) Release of thromboplas n
• Amnio c fluid embolism
• Dead fetus syndrome
Ed
• Hyda diform mole
i
• Cesarean sec on
hu
• Intra-amnio c hypertonic saline

• Shock
(C)Release of phospolipids
• Fetomaternal bleed
rs
• Incompa ble blood transfusion

• Hemolysis
va
195. Enumerate four causes of DIC (A.627)

Ans.: (i) Suc oning—first oropharynx and then nose.
When baby fails to respond to tac le s mula on;
De
(ii) Proceed to Mechanical ven la on—Bag and

mask provide adequate ven la on with 100% O2.
It is to be correctly applied (Figs 32.2A and B).
Most baby respond to PPV with 100% O2. When
there is no favorable response in 30–40 seconds
then proceed to; (iii) Endotracheal intuba on.
(iv)Chest compression: The sternum is compressed
59
1.3–1.9 cm at a regular rate of 90 compressions/
min while ven la ng (PPV) the infant at 30
October 7,
2015
breaths/min (3:1). The HR is checked periodically

and chest compression is discon nued when the
HR is > 60 bpm. It is given when HR is persistently
< 60 bpm by 30 second of age in spite of relentless
assistance. The thumbs are placed at the junc on
of middle and lower thirds of sternum just below
the line joining the nipples. The palms encircle the
torso and support the back.
h
196. Enumerate first four steps of neonatal resuscita on (A.472)
Ans.:
ec
197. Three common causes of antepartum haemorrhage (A.241)
Ans.: Anencephaly and spina bifida comprise 95% of NTD and the remaining 5% is
encephalocele.
ut
198. Enumerate neural tube defects (A.408)
Ans.: (1) diminished colloid osmo c tension due to hemodilu on driving the fluid out of
the vessels and (2) increased venous
Ed
pressure of the inferior extremi es. Thus, slight edema of the legs is not uncommon, in
otherwise normal
pregnancy
199. Causes of edema feet in pregnancy (A.50)
i
hu
Ans.:
200. Enumerate causes of post coital bleeding
Ans.:
rs
201. Contraindica ons of OC pills (B.487:C.208)

Ans.: Surgical procedures may be :
va
(A) Restora ve—(i)

correc ng her own support ssues
or (ii) compensatory — using permanent gra
De
material
(B) Ex rpa ve — removing
the uterus and correc ng the support ssues.
(C) Oblitera ve — closing the vagina
202. Name-three conserva ve surgeries for treatment of prolapse (B.211:C.304)
Ans.: Meigs’ syndrome: Ascites and right side hydrothorax
in associa on with fibroma of the ovary, Brenner,
60
thecoma and granulosa cell tumor is called Meigs’
syndrome. There is spontaneous remission
October 7,
2015
of ascites and hydrothorax on removal of the tumor.

Ascites and hydrothorax when present in condi ons
other than those men oned above, are called pseudo-
Meigs’ syndrome.
203. Meig syndrome (B.296)
Ans.:
204. Safe period (B.478:C.200)
Ans.: (a)Pregnaneprogestogens:-
• 17α hydroxy
h
progesterone caproate
• medroxyprogesterone
ec
acetate
• chlormanidone acetate
• cyproterone acetate
ut
(b)Norpregnaneprogestogens
• nomegestrol acetate
• Gestonorone caproate
205.
Ed
Name progestogens (B.535:C.282)
Ans.: The causa ve organism was previously thought to
i
be Gardnerella vaginalis (Haemophilus vaginalis).
hu
The present concept is that along with G vaginalis,

anaerobic organisms such as Bacteroides species,
Peptococcus species, mobiluncus, and Mycoplasma
hominis act synergis cally to cause vaginal infec on.
rs
There is marked decrease in lactobacilli

206. Organism causing bacterial vaginosis (B.152:C.117)
va
Ans.: 1.™™ Vasomotor symptoms

™™2.Urogenital atrophy
3.™Osteoporosis and fracture
De
™™4.Cardiovascular disease
™™5.Cerebrovascular disease
™™6.Psychological changes
™™7.Skin and Hair
™™8.Sexual dysfunc on
™™9.Demen a and cogni ve decline
207. Enumerate three symptoms of menopausal syndrome (B.59:C.54)
61
Ans.: (1)Hemorrhage which is either totally concealed inside the uterus or more
commonly, part is revealed outside.
October 7,
2015
There may be intraperitoneal or broad ligament hematoma

(2) Shock may be out of propor on to the blood
loss. Release of thromboplas n into the maternal circula on results in DIC or there may
be amnio c fluid
embolism
(3) Blood coagula on disorders (see above)
(4) Oliguria and anuria due to—(a) hypovolemia (b)
serotonin liberated from the damaged uterine muscle producing renal ischemia and (c)
Acute tubular necrosis.
However, a severe case may lead to (d) cor cal necrosis and renal failure
h
(5) Postpartum hemorrhage due
to — (a) atony of the uterus and (b) increase in serum FDP
ec
(6) Puerperal sepsis.
208. Enumerate 4 complica ons of abrup o placenta (A.256)
ut
separate occasions
209.
Ed
In some countries, postabortal fever is also included
Define pueparal pyrexia (A.432)
Ans.: Maternal
• Inadequate expulsive efforts
i
hu
• Maternal exhaus on (distress)

• Where expulsive efforts (valsalva)
are to be avoided (e.g. cardiac
disease, hypertensive crises,
rs
cerebrovascular diseases)
Fetal
va
• Nonreassuring fetal heart rate—

fetal distress (e.g. low birth weight
baby, postmaturity)
De
• A er coming head of breech

• Suspicion of fetal compromise
Others
• Prolonged second stage of labor
(Nullipara > 2 h; mul para > 1 h)
• To cut short the second stage of
labor as in severe pre-eclampsia,
cardiac disease, postcesarean pregnancy
62
210. Indica ons for obstetric forceps (A.574)
October 7,
2015
Ans.: The Apgar score is related to the status of oxygena on

of the fetus at or immediately a er birth. Long-term neurological correla on is obtained
at the 5 minute score
which is of more value. In cases where the score remains significantly depressed at 5
minutes, it should be
evaluated again a er 15 minutes. This scoring is done in a newborn baby at 1 minute, 5
minutes and 15 minutes
and can be tabulated as in follows
211. APGAR score (A.470)
h
Ans.: There are four types of placenta previa depending upon the degree of extension
of placenta to the lower segment.
ec
Type—I (Low-lying): The major part of the placenta is a ached to the upper segment
and only the lower
margin encroaches onto the lower segment but not up to the os.
ut
Type—II (Marginal): The placenta reaches the margin of the internal os but does not
cover it.
Type—III (Incomplete or par al central): The placenta covers the internal os par ally
(covers the internal os
Ed
when closed but does not en rely do so when fully dilated).
Type—IV (Central or total): The placenta completely covers the internal os even a er it
is fully dilated.
Currently with ultrasound precision, more accurate placental loca on is made in
i
rela on to the cervical internal
hu
os . In the majority, the placenta lies either in the anterior or posterior wall, the la er is
more common.
212. Types of placenta praevia (A.242)
rs
Ans.:
213. Enumerate 4 causes of rupture uterus (A.426)
va
Ans.: 1. Grand mul para—Inadequate retrac on and frequent adherent placenta

contribute to it. Associated
anemia may also probably play a role.
De
2. Over-distension of the uterus as in mul ple pregnancy, hydramnios and large baby.
Imperfect retrac on
and a large placental site are responsible for excessive bleeding.
3. Malnutri on and anemia—Even slight amount of blood loss may develop clinical
manifesta ons of
postpartum hemorrhage
63
4. Antepartum hemorrhage: The causes of excessive bleeding are men oned in ch. 18 p.
241.
5. Prolonged labor: Poor retrac on, infec on (amnioni s), dehydra on are important
factors.
October 7,
2015
6. Anesthesia: Depth of anesthesia and the anesthe c agents (ether, halothane) may
cause atonicity.
7. Ini a on or augmenta on of delivery by oxytocin: Post-delivery uterine atonicity is
likely unless the
oxytocin is con nued for at least one hour following delivery.
8. Malforma on of the uterus: Implanta on of the placenta in the uterine septum of a
septate uterus or
in the cornual region of a bicornuate uterus may cause excessive bleeding.
9. Uterine fibroid causes imperfect retrac on mechanically.
214. Enumerate 4 causes atomic P.P.H (A.410)
h
Ans.: Per abdomen:-
Uterus becomes globular, firm and ballo able. The fundal height is slightly raised as
ec
the separated placenta comes down in the lower segment and the contracted uterus
rests on top of it. There
may be slight bulging in the suprapubic region due to distension of the lower segment
ut
by the separated
placenta.
Per vaginam:-
Ed
There may be slight gush of vaginal bleeding. Permanent lengthening of the cord is
established. This can be elicited by pushing down the fundus when a length of cord
comes outside the vulva
which remains permanent, even a er the pressure is released. Alterna vely, on
i
suprapubic pressure upwards
hu
by fingers, there is no indrawing of the cord and the same lies unchanged outside the
vulva.
rs
215. Sings of placental separa on and descent (A.122)

Ans.: • Genital malignancy
• DUB
va
• Senile endometri s
• Decubitus ulcer
• Urethral caruncle
De
• Retained pessary or IUCD

216. Enumerate 4 important causes of postmenopausal bleeding (B.559:C.61)
Ans.: Contraindica ons for Inser on of IUCD:
(1) Presence o\f pelvic infec on current or within
3 months; (2) Undiagnosed genital tract bleeding;
(3) Suspected pregnancy; (4) Distor on of the shape
of the uterine cavity as in fibroid or congenital
64
uterine-malforma on; (5) Severe dysmenorrhea;
(6) Past history of ectopic pregnancy; (7) Within
October 7,
2015
6 weeks following cesarean sec on; (8) STIs —

Current or within 3 months; (9) Trophoblas c disease;
(10) Significant immunosuppression.
Addi onally for CuT are:
(11) Wilson disease and (12) Copper
allergy. For LNG-IUS are: (13) Hepa c tumor or
hepatocellular disease (ac ve); (14) Current breast
cancer and (15) Severe arterial disease
217. Enumerate 4 contraindica ons for copper-T (B.480:C.205)
h
Ans.: :-Mifepristone (RU 486):-It is a compe ve antagonist of progesterone and
glucocor coid receptors.
ec
It is a deriva ve of 19-nortestosterone. It binds compe vely to progesterone receptors
and nullifies
the effect of endogenous progesterone. As a result, there isan increased release of
prostaglandins from the
ut
endometrium, resul ng in menstrual bleeding ortermina on of early pregnancy.
:-Three important biochemical characters of RU 486 are
high affinity for progesterone receptors,
long half life and
ac ve metabolites.
Ed
:-Uses: Therapeu c abor onIt is an effec ve abor facient upto 7 weeks.
Combina on of prostaglandins as vaginal pessary48 hours a er RU 486, increases its
i
efficacy.
hu
:-Dose: Tab 200 mg (1 tab = 200 mg) orally, followed 48 hours later by misoprostol 400
μg (PGE1) oral
or 800 mg vaginal pessary. Success rate is 95–100 percent.
rs
:-Emergency contracep on:-A single dose of 10 mg is to be taken on 27th day of the

cycle irrespec ve of
the day and number ofintercourse. Efficiency is 95–100 percent.Induc on of
va
labor—Mifepristone has
been used forcervical ripening. It is given orally.Uterine fibroids—Shrinkage of uterine
leiomyoma
De
has been observed following mifepristone therapy(25–50 mg daily)

:-Ectopic pregnancy—Injec on of mifepristone into the ectopic pregnancy (unruptured
sac) is used as a
medical management.
:-Cushing’s syndrome—as it blocks the glucocor coid receptors.
:-Side effects: Minor side effects are nausea, vomi ng,headache and cramp. There is risk
of ongoing 65
pregnancy (failure of medical induc on of abor on) in about 1 percent of cases.
Evacua on of the uterus
should be done for such a failure. Long-term usecauses endometrial hyperplasia.
October 7,
2015
:-Contraindica ons:
Age > 35 years
Heavy smoker.
218. Mifepristone (RU-486) (B.537:C.286)
Ans.:
There are two types :
1.Uterovaginal prolapse:- is the prolapse of theuterus, cervix and upper vagina.
h
This is the commonest type. Cystocele occursfirst followed by trac on effect on the
cervix causing
ec
retroversion of the uterus. Intra-abdominal pressurehas got piston like ac on on the
uterus thereby
pushingit down into the vagina.
2.Congenital:-There is usually no cystocele. The uterus herni-ates down along with
ut
inverted upper vagina.
This is o en met in nulliparous women and hence called nulliparous prolapse.
The cause is congenital weak-ness of the suppor ng structures holding the uterus in
posi on.
219.
Ed
Degrees of uterine prolapse (B.205:C.301)
Ans.: It is a metasta c tumors from the GI tract can be associated with sex hormone
(estrogen and androgen) produc on.
i
Pa ent may present with postmenopausal bleeding.
hu
naked eye appearance:

The tumor is usually bilateral, solid with smooth surfaces and usually maintaining the
shape of the ovary.
rs
They typically form rounded or reniform, firm white masses. Some mes they are
bosselated and may a ain
a big size. There is no tendency of adhesion (i.e. capsule remains intact)
va
The cut surfaces usually look yellow or white incolor with cys c space at places due to
degenera on.
Cut surface has waxy consistency.histologically the stroma is highly cellular. Themucin
De
within epithelial cells

compresses the nuclei to one pole, producing ‘signet ring’ appearance. The
sca ered ‘signet ring’ looking cells are characteris c of Krukenberg tumor In most
pa ents with Krukenberg’s
tumors, the prognosis is poor. Median survival being less than ayear. Rarely, no primary
site can be iden fied
and the Krukenberg’s tumor may be a primary tumor.
220. Krukenberg tumour (B.387:C.379,381)
66
Ans.:
October 7,
2015
221. Enumerate types of leiomyomas (B.273:C.316)

Ans.:
222. Ring pessary (B.199,201,643:C.303)
Ans.: Non-contracep ve benefits:
Improvement of menstrual abnormali es—(1) Regula on of menstrual cycle (2)
Reduc on of dysmenorrhea(40%)
(3) Reduc on of menorrhagia (50%) (4) Reduc on of premenstrual tension
syndrome(PMS)
(5) Reduc on of Mi elschmerz’s syndrome (6) Protec on against iron-deficiency
h
anemia.
Protec on against health disorders — (7) Pelvic inflammatory disease (thick cervical
ec
mucus)
(8) Ectopic pregnancy (9) Endometriosis (10) Fibroid uterus (11) Hirsu sm and acne
(12) Func onal ovarian cysts (13) Benign breast disease (14) Osteopenia and
ut
postmenopausal
osteoporo c fractures (15) Autoimmune disorders of thyroid (16) Rheumatoid arthri s.
Preven on
Ed
of malignancies—(17) Endometrial cancer (50%)(18) Epithelial ovarian cancer (50%) (19)
Colorectal cancer (40%).
223. Enumerate 4 non-contracep ve benefits of oral pills (B.489:C.208)

i
Ans.: It is the conduc on of spontaneous labor in a moderate degree of cephalo-pelvic
hu
dispropor on, in
an ins tu on under supervision with watchful expectancy, hoping for a vaginal delivery.
Every arrangement
should be made available for opera ve delivery, either vaginal or abdominal, if the
rs
condi on so arises.
224. Define trial of labour (A.355)
va
Ans.: Parenteral therapy:

• Intravenous route: (i) Repeated injec ons (ii) Total dose infusion (TDI) • Intramuscular
route
De
Indica ons of parenteral therapy:

— Contraindica ons of oral therapy as previously men oned.
— Pa ent is not coopera ve to take oral iron.
— Cases seen for the first me during the last 8–10 weeks with severe anemia.
The main advantage of parenteral therapy is the certainty of its administra on to
correct the hemoglobin
67
deficit and to fix up the iron store. The expected rise in hemoglobin concentra on a er
parenteral therapy is
0.7 to 1 g/100 mL per week.
October 7,
2015
225. Parenteral iron therapy (A.266)

Ans.:
226. Write 4 causes of inversion of uterus (A.420)
Ans.: Abdominovaginal method (Muller-Munro Kerr): This bimanual method is superior
to the
abdominal method as the pelvic assessment can be done simultaneously. Muller
introduced the
method by placing the vaginal finger ps at the level of ischial spines to note the
descent of the head.
Munro Kerr added placement of the thumb over the symphysis pubis to note the
h
degree of
overlapping
ec
Lower bowel is emp ed preferably by enema. The pa ent is asked to empty the
bladder. The pa ent is
placed in lithotomy posi on and the internal examina on is done taking all asep c
ut
precau ons. Two fingers of the
right hand are introduced into the vagina with the finger ps placed at the level of
ischial spines and thumb is
a downward and
backward direc on into the pelvis
Ed
placed over the symphysis pubis. The head is grasped by the le hand and is pushed in
227. Munrokerr Muller’s test (A.353)

i
Ans.:
hu
• Pre-eclampsia, eclampsia (hypertensive

disorders in pregnancy)
• Maternal medical complica ons
rs
–– Diabetes mellitus
–– Chronic renal disease
–– Cholestasis of pregnancy
va
• Postmaturity
• Intrauterine Growth Restric on (IUGR)
De
• Rh-isoimmuniza on
• Premature rupture of membranes
• Fetus with a major congenital anomaly
• Intrauterine death of the fetus
• Oligohydramnios, polyhydramnios
• Unstable lie-a er correc on into longitudinal lie
228. 4 indica ons for induc on of labour (A.522)
68
Ans.:
October 7,
2015
CAPUT SUCCEDANEUM: It is the forma on of swelling due to stagna on of fluid in

the layers of the scalp beneath the girdle of contact. The girdle of contact is either
bony or the dila ng cervix or vulval ring. The swelling is diffuse, boggy and is not
limited by the suture line . It may be confused with cephalhematoma.It disappears
spontaneously within 24
hours a er birth.
Mechanism of forma on: While the head descends to press over the dila ng cervix or
vulval ring, the
overlying scalp is free from pressure, but the ssues in contact with the full
circumference of the girdle of
h
contact is compressed. This interferes with venous return and lympha c drainage from
the unsupported area
ec
of scalp → stagna on of fluid and appearance of a swelling in the scalp . Caput usually
occurs a er
rupture of the membranes.
Importance:
ut
— It signifies sta c posi on of the head for a long period of me.
— Loca on of the caput gives an idea about the posi on of the head occupied in the
pelvis and the degree
Ed
of flexion achieved. In le posi on, the caput is placed on right parietal bone and in
right posi on, on
le parietal bone. With increasing flexion, the caput is placed more posteriorly.
229. Caput succedaneum (A.86)
i
hu
Ans.: Grade-I: Uncompromised and no limita on of physical ac vity

Grade-II: Slightly compromised with slight limita on of physical ac vity. The pa ents are
comfortable at rest
but ordinary physical ac vity causes discomfort
rs
Grade-III: Markedly compromised with marked limita on of ac vity. The pa ents are
comfortable
at rest but discomfort occurs with less than ordinary ac vity
va
Grade-IV: Severely compromised with discomfort even at rest

Limita on: This classifica on has considered the symptoms only but not the anatomical
type and severity of
De
pathology. It does not predict pregnancy outcome
230. New York heart associa on classifica on (A.276)

Ans.:
There are four types of placenta previa depending upon the degree of extension of
placenta to the lower segment. 69
Type—I (Low-lying): The major part of the placenta is a ached to the upper segment
and only the lower
margin encroaches onto the lower segment but not up to the os.
October 7,
2015
Type—II (Marginal): The placenta reaches the margin of the internal os but does not
cover it.
Type—III (Incomplete or par al central): The placenta covers the internal os par ally
(covers the internal os
when closed but does not en rely do so when fully dilated).
Type—IV (Central or total): The placenta completely covers the internal os even a er it
is fully dilated.
h
ec
ut
i Ed
hu
rs
va
De
70
October 7,
2015
231. Degrees of placenta praevia (A.242)

Ans.: 1. Torsion of the pedicle (axial rota on)
2. Intracys c hemorrhage
3. Infec on
4. Rupture
5. Pseudomyxoma peritonei
6. Malignancy
232. Enumerate four complica ons of ovarian tumour (B.298:C.342)
Ans.: Second Trimester (13–20 Weeks)
h
• Prostaglandins PGE1 (Misoprostol), 15 methyl PGF2a (Carboprost), PGE2 (Dinprostone)
and their
ec
analogues (used-intravaginally, intramuscularly or intraamnio cally)
• Dila on and evacua on (13–14 weeks)
• Intrauterine ins lla on of hyperosmo c solu ons
a. Intra-amnio c hypertonic urea (40%), saline (20%)
ut
b. Extra-amnio c—Ethacrydine lactate, Prostaglandins (PGE2, PGF2a)
• Oxytocin infusion high dose used along with either of the above two methods
233.
Ed
• Hysterotomy (abdominal)— less commonly done
Enlist methods of second trimester MTP (A.173:C.223)
Ans.: The possible symptoms of pain and slight vaginal bleeding should be explained.
The pa ent should be
i
advised to feel the thread periodically by the finger.The pa ent is checked a er 1 month
hu
and then annually

234. Instruc ons to the pa ent a er Copper T inser on (B.482)
Ans.:
rs
235. Counselling of the pa ent before myomectomy (B.282:C.323)

Ans.:
va
236. Enumerate 4 complica ons of radiotherapy (B.508:C.393)

Ans.:
237. Corpus cancer syndrome (B.354)
De
Ans.: Gross hymenal abnormality of significance is imperforate hymen. It is due to

failure of
disintegra on of the central cells of the Müllerian eminence that projects into the
urogenital sinus.
The existence is almost always unno ced un l the girl a ains the age of 14–16 years. As
the
71
uterus is func oning normally, the menstrual blood is pent up inside the vagina behind
the hymen
(cryptomenorrhea). Depending upon the amount of blood so accumulated, it first
distends the vagina
October 7,
2015
(hematocolpos). The uterus is next involved and the cavity is dilated (hematometra). In
the late and
neglected cases, the tubes may also be distended a er the fimbrial ends are closed by
adhesions
(Hematosalpinx)
238. Imperforate hymen (B.41:C.83)
Ans.: Culdocentesis is the transvaginal aspira on of peritoneal
fluid from the cul-de-sac or pouch of Douglas.
Indica ons
1. In suspected disturbed ectopic pregnancy or other
h
causes producing hemoperitoneum
2. In suspected cases of pelvic abscess.
ec
239. Culdocentesis (B.120:C.247)
Ans.: A circular groove encircling the uterus is formed between the ac ve upper
ut
segment and the distended lower segment, called pathological retrac on ring (Bandl’s
ring).
240. Bandl’s ring (A.362)
flat bone of the skull,

Ed
Ans.: CEPHALHEMATOMA: It is a collec on of blood in between the pericranium and the
usually unilateral and over a parietal bone (Fig. 32.5). It is due to rupture of a small
emissary vein from the
i
skull and may be associated with fracture of the skull bone. This may be caused by
hu
forceps delivery but may

also be met with following a normal labor. Ventouse applica on does not increase the
incidence of
cephalhematoma. It is never present at birth but gradually develops a er 12–24 hours.
rs
The swelling
is limited by the suture lines of the skull as the pericranium is fixed to the margins of
the bone.
va
It is circumscribed, so , fluctuant and incompressible. There may be underlying fracture

of the skull. In course of me, a hard sharp edge can be felt surrounding the swelling
due to organiza on
De
of the blood. The condi on may be confused with caput succedaneum or meningocele.
Meningocele always lies over a suture line or fontanelle and there is impulse on crying.
The blood
is absorbed in course of me (6–8 weeks) leaving an en rely normal skull. Prognosis is
good. Rarely,
suppura on occurs. No ac ve treatment is necessary. Preven on of infec on and
avoidance of trauma are 72
important. A head CT should be obtained if neurological symptoms are present.
241. Cephalohaematoma (A.483)

October 7,
2015
Ans.: To prevent ac ve immuniza on of Rh-nega ve yet unimmunized, Rh

an -D immunoglobulin (IgG) is administered intramuscularly to the mother following
child birth.
Mode of ac on is an body mediated immune suppression (AMIS). The possible
mechanisms are:
(i) The an D an body when injected, blocks the Rh-an gen of the fetal cells; (ii) The
intact an body coated fetal
red cells are removed from the maternal circula on by the spleen or lymph nodes; (iii)
Central inhibi on—the
fetal red cells, coated with an D an bodies interfere the produc on of IgG from the B
cells.
h
When to administer? It should be administered within 72 hours or preferably earlier
ec
following delivery
or abor on. It should be given provided the baby born is Rh-posi ve and the direct
Coombs’ test is nega ve.
In case, where the specified me limit is over (>72 hours), she may be given upto 14–28
ut
days a er delivery to
avoid sensi za on. Similarly, when the Rh factor of the fetus cannot be determined, it
should be administered
without any harm. Ed
Dose—An D-gamma globulin is administered intramuscularly to the mother 300 μg
following delivery. All
i
72 hours of induced
hu
woman from fetal
rs

va
242. An -D (A.334)
Ans.:
243. Prostaglandins in obstetrics (A.504)
De
Ans.:
244. Indica ons of USG in pregnancy (A.645)
Ans.: Roll over test: This screening test is done between 28 and 32 weeks. Blood
pressure is measured with the pa ent on
her side first and then the pa ent is asked to roll on her back to check the blood
pressure once again. An increase of
73
20 mm Hg in diastolic pressure from side to back posi on indicates a posi ve “roll over
test”. About 33% of women
with posi ve “roll over test” developed hypertension later. A nega ve test is of value.
October 7,
2015
245. Roll-over test (A.227)

Ans.: When the fetus is dead and retained inside the uterus for a variable period, it is
called missed
miscarriage or early fetal demise.
PATHOLOGY: The causes of prolonged reten on of the dead fetus in the uterus is not
clear. Beyond 12 weeks,
the retained fetus becomes macerated or mummified. The liquor amnii gets absorbed
and the placenta becomes
pale, thin and may be adherent. Before 12 weeks, the pathological process differs when
the ovum is more or
h
less completely surrounded by the chorionic villi.
CLINICAL FEATURES: The pa ent usually presents with features of threatened
ec
miscarriage followed by: (1) Persistence
of brownish vaginal discharge (2) Subsidence of pregnancy symptoms (3) Retrogression
of breast changes (4) Cessa on of
ut
uterine growth which in fact becomes smaller in size (5) Nonaudibility of the fetal heart
sound even with Doppler ultrasound
if it had been audible before (6) Cervix feels firm (7) Immunological test for pregnancy
becomes nega ve (8)
Ed
Real me ultrasonography reveals an empty sac early in the pregnancy or the absence
of fetal mo on or fetal cardiac
movements.
COMPLICATIONS: The complica ons of the missed miscarriage are those men oned in
i
intrauterine fetal death.
hu
Blood coagula on disorders are less likely to occur in missed miscarriage
246. Missed abor on (A.163)

rs
Ans.:
247. Apgar score (A.470)
va
Ans.: 1. Protec on against sexually transmi ed diseases, e.g.

gonorrhea, chlamydia, HPV and HIV
2. Protec on against pelvic inflammatory diseases Disadvantages
De
3. Reduces the incidence of tubal infer lity and ectopic

pregnancy
4. Protec on against cervical cell abnormali es
5. Useful where the coital act is infrequent
and irregular
6.also used in trans vaginal sonography
248. Non contracep ve uses of condom (B.477:C.202)
74
Ans.:
October 7,
2015
249. Classify DUB (B.187:C.271)

Ans.: No-scalpel vasectomy: Also known as a "key-hole" vasectomy, is a vasectomy in
which a sharp hemostat (as opposed to a scalpel) is used to puncture
the scrotum.This method has come into widespread use as the resul ng smaller
"incision" or puncture wound typically limits bleeding and hematomas.
Also the smaller wound has less chance of infec on, resul ng in faster healing mes
compared to the larger/longer incisions made with a scalpel.
The surgical wound created by the No-Scalpel method usually does not require
s tch(es)
250. NSV (B.494:C.214)
h
Ans.:
Tumor markers: CA 125 is a glycoprotein, which has been used for screening of
ec
epithelial cancers of
the ovary. Value more than 35 U/mL is sugges ve of epithelial ovarian cancer. It is also
used for monitoring
ut
a pa ent during chemotherapy and for follow up. But it is not a tumorspecific an gen.
There are several
other condi ons, where level of CA-125 is raised:
- Normal woman (1%). Ed
- Carcinomas of the breast, lung, colon and endometrium.
- Endometriosis.
- Pelvic inflammatory disease.
i
- Peritoni s.
hu
The serum level of CA-125 falls a er surgical resec on of the tumor or following
chemotherapy.
Elevated level indicates bulky residual disease or tumor recurrence or resistant clones to
rs
chemotherapy.
Serum half life of CA-125 is 20 days.
Other tumor markers of value are macrophage colony-s mula ng factors (M-CSF), OVXI,
va
HER-2/
neu and inhibin.
De
251. Tumour markers (B.377:C.71)

Ans.:
- Gonorrhoea
- non-gonococcal urethri s
- Syphilis
- lymphogranuloma venereum
- Chancroid
- Granuloma inguinale
75
- non-specific vagini s
October 7,
2015
- mycoplasma infec on
- AIDS
- Genital herpes
- Condyloma acuminata
- molluscum contagiosum
- Viral hepa s
- CIN.etc
252. Enumerate STDs (B.146:C.123)
Ans.:
h
253. Post-exposure prophylaxis (B.156:C.135)
Ans.:
ec
254. Principles of myomectomy (B.604:C.323)
Ans.: Mifepristone (RU-486) and Misoprostol: Mifepristone an analog of proges n
(norethindrone) acts as an antagonist,
ut
blocking the effect of natural progesterone. Addi on of low dose prostaglandins (PGE1)
improves the efficiency of
first trimester abor on. It is effec ve upto 63 days and is highly successful when used
within 49 days of gesta on. Ed
PROTOCOL: 200 mg of mifepristone orally is given on day 1. On day 3, misoprostol
(PGE1) 400 μg orally or
800 μg vaginally is given. Pa ent remains in the clinic for 4 hours during which expulsion
i
of the conceptus
hu
(95%) o en occurs. Pa ent is re-examined a er 10–14 days. Complete abor on is

observed in 95%, incomplete
in about 2% of cases and about 1% do not respond at all. Oral mifepristone 200 mg (1
tablet) with vaginal
rs
misoprostol 800 μg (4 tablet, 200 μg each) a er 6–48 hours is equally effec ve. This
combipack (1+4) is
approved by DGHS, Government of India for MTP up to 63 days of pregnancy. Medical
va
methods are safe,

effec ve, noninvasive and have minimal or no complica ons.
Methotrexate and Misoprostol—Methotrexate 50 mg/m2 IM (before 56 days of
De
gesta on) followed by 7 days later

misoprostol 800 μg vaginally is highly effec ve. Misoprostol may have to be repeated
a er 24 hours if it fails. If the procedure
fails, ultrasound examina on is done to confirm the failure. Then suc on evacua on
should be done. Methotrexate and
misoprostol regimen is less expensive but takes longer me than Mifepristone and
Misoprostol. Misoprostol has less side 76
effects and is stable at room tempera ve unlike other PGs, which must be refrigerated.
255. Medical method of early pregnancy MTP (A.173:C.222)
October 7,
2015
Ans.: Triple test: It is a combined biochemical test which includes MSAFP, hCG and UE3
(unconjugated estriol).
Maternal age in rela on to confirmed gesta on age is also taken into account. It is used
for detec on of Down’s
syndrome. In an affected pregnancy, level of MSAFP and UE3 tend to be low while that
of hCG is high. It is
performed at 15–18 weeks. It gives a risk ra o and for confirma on amniocentesis has
to be done. The result
is considered to be screen posi ve if the risk ra o is 1:250 or greater.
256. Triple test (A.106)
h
Ans.: ATTITUDE: The rela on of the different parts of the fetus to one another is called
a tude of the fetus. The
ec
universal a tude is that of flexion. During the later months, the head, trunk and limbs
of the fetus maintain
the a tude of flexion on all joints and form an ovoid mass that corresponds
ut
approximately to the shape of
uterine ovoid. The characteris c flexed a tude may be modified by the amount of
liquor amnii. There may
vertex, brow or face Ed

be excep ons to this universal a tude and extension of the head may occur (deflexed
presenta on, according to the degree of extension), or the legs may become extended
in breech.The course
oflabor in such circumstances may be modified accordingly.
i
hu
257. Define a tude of the fetus (A.76)

Ans.: Striae gravidarum: These are slightly depressed linear marks with varying length
and breadth found
in pregnancy. They are predominantly found in the abdominal wall below the umbilicus,
rs
some mes
over the thighs and breasts. These stretch marks represent the scar ssues in the
deeper layer of
va
the cu s. Ini ally, these are pinkish but a er the delivery, the scar ssues contract and
obliterate the
capillaries and they become glistening white in appearance and are called striae
De
albicans. Apart from

the mechanical stretching of the skin, increase in aldosterone produc on during
pregnancy are the
responsible factors. Controlled weight gain during pregnancy and massaging the
abdominal wall by
lubricants like olive oil may be helpful in reducing their forma on. Apart from
pregnancy, it may form
in cases of generalized edema, marked obesity or in Cushing’s syndrome.
77
258. Striae gravidarum (A.50)
October 7,
2015
Ans.: SUPINE HYPOTENSION SYNDROME (POSTURAL HYPOTENSION): During late

pregnancy, the gravid uterus
produces a compression effect on the inferior vena cava when the pa ent is in supine
posi on. This, however, results in
opening up of the collateral circula on by means of paravertebral and azygos veins. In
some cases (10%), when the collateral
circula on fails to open up, the venous return of the heart may be seriously curtailed.
This results in produc on of hypotension,
tachycardia and syncope. The normal blood pressure is quickly restored by turning the
pa ent to lateral posi on. The
augmenta on of the venous return during uterine contrac on prevents the
h
manifesta on from developing during labor.
ec
259. Supine hypotension syndrome (A.53)
Ans.: Dangerous placenta previa is the name given to the type-II posterior placenta
previa
(1) Because of the curved birth canal major thickness of the placenta (about 2.5 cm)
ut
overlies
the sacral promontory, thereby diminishing the anteroposteriordiameter of the inlet
and prevents
Ed
engagement of the presen ng part. This hinders effec ve compression of the separated
placenta
to stop bleeding.
(2) Placenta is more likely to be compressed, if vaginal delivery is allowed.
i
(3) More chance of cord compression or cord prolapse. The last two may produce fetal
hu
anoxia or even death.

260. Why posterior placenta previa is dangerous placenta previa? (A.243)
Ans.:
rs
261. Fetal macrosomia (A.405)

Ans.: COUVELAIRE UTERUS (uteroplacental apoplexy):
va
It is a pathological en ty first described by Couvelaire and is met with in associa on

with severe form
of concealed abrup o placentae. There is massive intravasa on of blood into the
De
uterine musculature upto the serous coat. The condi on can only be diagnosed on
laparotomy.
262. Couvelaire uterus (A.254)
Ans.: Contrac ons (Braxton-Hicks): Uterine contrac on in pregnancy
has been named a er Braxton-Hicks who first described its en ty
during pregnancy. From the very early weeks of pregnancy, the uterus
undergoes spontaneous contrac on. This can be felt during bimanual
78
palpa on in early weeks or during abdominal palpa on when the
uterus feels firmer at one moment and so at another. Although
October 7,
2015
spontaneous, the contrac ons may be excited by rubbing the uterus.

The contrac ons are irregular, infrequent, spasmodic and painless
without any effect on dilata on of the cervix. The pa ent is not
conscious about the contrac ons. Intrauterine pressure remains below
8 mm Hg. Near term, the contrac ons become frequent with increase
in intensity so as to produce some discomfort to the pa ent. Ul mately,
it merges with the painful uterine contrac ons of labor. In abdominal
pregnancy, Braxton-Hicks contrac on is not felt.
263. Braxton-hicks contrac ons (A.47)
h
Ans.: Osteoporosis and fracture: Following menopause there is decline in collagenous
bone matrix
ec
resul ng in osteoporo c changes. Bone mass loss and microarchitectural deteriora on
of bone ssue
occurs primarily in trabecular bone (vertebra, distal radius) and in cor cal bones. Bone
loss increases to
ut
5% per year during menopause. Osteoporosis may be primary (Type 1) due to estrogen
loss, age, deficient
nutri on (calcium, vit. D) or hereditary. It may be secondary (Type 2) to endocrine
abnormali es Ed
(parathyroid, diabetes) or medica on (see p. 62).Osteoporosis may lead to back pain,
loss of height
and kyphosis. Fracture of bones is a major health problem. Fracture may involve the
i
vertebral body,
hu
femoral neck, or distal forearm (Colles’ fracture).Morbidity and mortality in elderly

women following
fracture is high.
rs
264. Define osteoporosis (B.60:C.55)

Ans.: 1.Hos le cervical mucus
™™2.Cervical stenosis
va
™™3.Oligospermia or asthenospermia
™™4.Immune factor (male and female)
™™5.Male factor—impotency or anatomical defect (hypospadias) but normal ejaculate
De
can be obtained
™™6.Unexplained infer lity
265. Indica ons of IUI (B.250:C.186)
Ans.: The period of life beginning with the appearance of secondary sex characters and
termina ng
with cessa on of soma c growth is described as adolescence.
266. Define adolescence (B.546:C.45)
79
Ans.: Meigs’ syndrome: Ascites and right side hydrothorax in associa on with fibroma of
the ovary, Brenner,
October 7,
2015
thecoma and granulosa cell tumor is called Meigs’ syndrome. There is spontaneous
remissionof ascites
and hydrothorax on removal of the tumor.Ascites and hydrothorax when present in
condi ons
other than those men oned above, are called pseudo-Meigs’ syndrome.
267. Define Meigs syndrome (B.296)
Ans.: Correc ons of the predisposing factors should be done, if possible. Local
fungicidal
prepara ons commonly used are of the polyene or azole group. Nysta n, clotrimazole,
miconazole,
h
econazole are used in the form of either vaginal cream or pessary.One pessary is to be
introduced high
ec
in the vagina at bed me for consecu ve 2 weeks. In severe cases,addi onal use of
pessary in the morning
is advocated.
ut
The treatment should be con nued even during menstrua on. Single dose oral therapy
with fluconazole
(150 mg) or itraconazole is also found effec ve.
days. Husband
Ed
Associated intes nal moniliasis should be treated by fluconazole 50 mg daily orally for 7
should be treated with nysta n ointment locally for few days following each act of
coitus.
The use of condom is preferred.
i
Resistance to these drugs is not known. The systemic an fungal drugs fluconazole and
hu
itraconazole
are effec ve in a single dose oral therapy.
268. Treatment of monilial vagini s (B.165:C.132)
rs
Ans.: LH surge:-
Sustained peak level of estrogen for 24–48 hours in the late follicular phase results in LH
va
surge from
the anterior pituitary (posi ve feedback effect). Effec ve LH surge persists for about 24
hours.
The LH surge s mulates comple on of retuc on division of the oocyte and ini ates
De
luteiniza on
of the granulosa cells, synthesis of progesteroneand prostaglandins
269. LH surge (B.86:C.41)
Ans.: In a proved case,
HSG is contraindicated for the risk of reac va on of the lesion. HSG done as a rou ne
work up in the
inves ga on of infer lity may reveal the following sugges ve features:
80
1.Vascular or lympha c extravasa on of dye
2.Rigid (lead-pipe) tubes with nodula ons at places.
October 7,
2015
3.‘Tobacco pouch’ appearance with blocked fimbrial end

4.Beaded appearance of the tube with variable filling density
5.Distal tube obstruc on.
6.Coiling of the tubes or calcified shadow at places.
7.Bilateral cornual block
8.Tubal diver cula and/or fluffiness of tubal outline.
9.Uterine cavity—irregular outline, honeycomb appearance or presence of uterine
synechiae.
270. H.S.G. in genital tuberculosis (B.141:C.141)
Ans.: The classic lesion of pelvic endometriosis is described as ‘powder burns’ or ‘match
h
s ck’ spots on
the peritoneum of the pouch of Douglas
ec
ut
i Ed
hu
rs
va
De
81
October 7,
2015
271. Laparoscopic appearance of endometriosis (B.308:C.420)

Ans.: Menopause means permanent cessa on of menstrua on at the end of
reproduc ve life due to loss of
ovarian follicular ac vity. It is the point of me when last and final menstrua on occurs.
272. Define menopause (B.57:C.52)
Ans.: Intracytoplasmic sperm injec on (ICSI)
ICSI was first described by van Steirteghem and colleagues in Belgium (1992).
Indica ons:-
1.Severe oligospermia (5 million sperm/mL)
2.Asthenospermia, teratospermia
h
3.Presence of sperm an bodies
ec
4.Obstruc on of efferent duct system (male)
5.Congenital absence of vas (bilateral)
6.Failure of fer liza on in IVF
7.Fer liza on of cryopreserved oocytes (with hardened zona pellucida)
ut
8.Unexplained infer lity.
Sperm is recovered from the ejaculate. Otherwise sperm is retrieved by TESE (tes cular
sperm extrac on) Ed
or by MESA (microsurgical epididymal sperm aspira on) procedures.
Technique: One single spermatozoon or even a sperma d is injected directly into the
cytoplasm of an oocyte by
micropuncture of the zona pellucida. This procedure is carried out under a high quality
i
inverted opera ng
hu
microscope. The oocyte is stabilized at 6 or 12 O’clock

273. ICSI (B.254:C.187)
Ans.: Schiller’s test: Employing iodine solu on (Schiller’s 0.3% or Lugol’s 5%), mul ple
rs
punch
biopsies are taken from the unstained areas. Stained areas (normal) appear brown due
va
to
presence of glycogen
274. Schiller’s test (B.325:C.448)
De
Ans.: A young girl who has not yet menstruated by her 16 years of age is having primary
amenorrhea rather than delayed menarche. The normal upper age limit for menarche is
15 years.
In view of lower mean age of menarche, currently a cut off value at 14 years (in the
absence of secondary sexual
characters) and 16 years (regardless of the presence of secondary sexual characters) is
being considered.
275. Primary amenorrhoea (B.450:C.256)
82
Ans.: Complica ons are grouped into: (i) specific to laparoscopy itself, (ii) due to
anesthesia, (iii) common to any surgical procedures.
October 7,
2015
(A)Complica ons due to laparoscopy itself:

(1) Extraperitoneal insuffla on
(a) Surgical emphysema
(b) Omental emphysema
(c) Cardiac arrhythmia
(2) Injury to blood vessels—mesenteric, omental,injury to major pelvic or abdominal
artery or vein.
Inferior epigastric vessels may be injured during inser on of accessory trocars.
(3) Injury to bowel—with veress needle or trocar especially when there is adhesions.
(4) Injury to organs like bowel, bladder or ureter.Damage may be mechanical during
h
dissec on or
thermal by electrical or laser energy.
ec
(5) Electrosurgical complica ons—causing thermal injury (electrode burns, insula on
defects).
(6) Gas (carbon dioxide) embolism—resul ng in hypotension, cardiac arrhythmia.
ut
(B)Anesthe c complica ons peculiar to laparoscopy are:
(1) Hypoven la on (pneumoperitoneum and Trendelenburg posi on lead to basal lung
compression and
reduced diaphragma c excursion). Ed
(2) Hypercarbia and metabolic acidosis (when CO2 is used for pneumoperitoneum).
(3) Basal lung atelectasis.
(4) Others—esophageal intuba on, aspira on and cardiac arrest.
i
(C)Complica ons common to any surgical procedure
hu
(1) Hemorrhage
(2) Infec on
(3) Wound dehiscence
rs
(4) Port site hernia.

276. Complica ons of laparoscopy (B.619:C.442)
Ans.: The treatment is very much effec ve with metronidazole. Metronidazole 200 mg
va
thrice daily by
mouth is to be given for 1 week. A single dose regimen of 2 g is an alterna ve.
Tinidazole single 2 gm dose
De
PO is equally effec ve. The husband should be given the same treatment schedule for 1
week. Resistance to
metronidazole is extremely rare. The husband should use condom during coitus
irrespec ve of contracep ve
prac ce un l the wife is cured.
277. Treatment of trichomonal vaginal infec on (B.164:C.131)
83
Ans.: Cervical intraepithelial neoplasia (CIN), also known as cervical dysplasia and
cervical inters al neoplasia, is the poten ally premalignant transforma on and
abnormal growth (dysplasia) of squamous cells on the surface of the cervix
October 7,
2015
278. CIN (B.320:C.359)

Ans.: Presence of func oning endometrium (glands and stroma) in sites other than
uterine mucosa is
called endometriosis. It is not a neoplas c condi on, although malignant
transforma on is possible.
These ectopic endometrial ssues may be found in the myometrium when it is called
endometriosis
interna or adenomyosis. More commonly, however, these ssues are found at sites
other than uterus and
are called endometriosis externa or generally referred to as endometriosis.
h
Endometriosis is a disease of contrast. It is a benign but it is locally invasive,
disseminates
ec
widely. Cyclic hormones s mulate growth but con nuous hormones suppress it.
279. Define endometriosis (B.304:C.419)
Ans.:
ut
280. Pre requisites for the forceps applica on
Ans.: Abor on is the expulsion or extrac on from its mother of an embryo or fetus
weighing 500 g Ed
or less when it is not capable of independent survival (WHO). This 500 g of fetal
development is a ained
approximately at 22 weeks (154 days) of gesta on. The expelled embryo or fetus is
called abortus. The term
i
miscarriage is the recommended terminology for spontaneous abor on.
hu
281. Define abor on (A.302)

Ans.:
rs
282. Preven on of parent to child transmission of HIV in a HIV pa ent (A.523)

Ans.:
va
283. Bishop’s score (A.523)

Ans.: Clinical diagnos c criteria (Rubin–1983) for cervical pregnancy are—(a) So ,
enlarged
De
cervix equal to or larger than the fundus (b) Uterine bleeding following amenorrhea,
without cramping pain
(c) Products of concep on en rely confined within and firmly a ached to endocervix
(d) A closed internal
cervical os and a par ally opened external os .
284. Rubin’s criteria for cervical pregnancy (A.189)
84
October 7,
2015

as the lower limit of fetal viability.
285. Define antepartum haemorrhage (A.241)
Ans.: Amnio c fluid index (AFI) is an es mate of the amount of amnio c fluid[1] and is
an index for the fetal well-being.
It is a part of the biophysical profile.
AFI is the score (expressed in cm) given to the amount of amnio c fluid seen on
ultrasonography of a pregnant uterus.
To determine the AFI, doctors may use a four-quadrant technique,when the deepest,
unobstructed, ver cal length of each
h
pocketof fluid is measured in each quadrant and then added up to the others,or the
so-called "Single Deepest Pocket" technique.
ec
An AFI between 8-18 is considered normal.
Median AFI level is approximately 14 from week 20 to week 35,
when the amnio c fluid begins to reduce in prepara on for birth.
ut
An AFI < 5-6 is considered as Oligohydramnios
The exact number can vary by gesta onal age. The fi h percen le for gesta onal age is
some mes used as a cutoff value.
286. Amnio c fluid index

Ed
An AFI > 20-24 is considered as Polyhydramnios.
Ans.: HYDROPS FETALIS: This is the most serious form of Rh hemoly c disease. Excessive
i
destruc on of the fetal
hu
red cells leads to severe anemia, ssue anoxemia and metabolic acidosis. These have got
adverse effects on
the fetal heart and brain and on the placenta. Hyperplasia of the placental ssue occurs
rs
in an effort to increase
the transfer of oxygen but the available fetal red cells (oxygen carrying cells) are
progressively diminished due
va
to hemolysis. As a result of fetal anoxemia, there is damage to the liver leading to

hypoproteinemia which is
responsible for generalized edema (hydrops fetalis), ascites and hydrothorax. Fetal
death occurs sooner or
De
later due to cardiac failure. The baby is either s llborn or macerated and even if born
alive, dies soon a er.
287. Hydrops foetalis (A.333)
Ans.: Hysteroscopy is a procedure that allows direct visualiza on inside the uterus . It
can be
used for diagnos c as well as therapeu c purposes
288. Hysteroscopy in gynaecology (B.619:C.443)
85
Ans.:
October 7,
2015
289. Tubal patency test (B.238:C.190)

Ans.: as above 279
290. Define endometriosis (B.304:C.419)
Ans.:
291. Use of hormones in gynaecology (B.524:C.279)

Ans.: A cervical biopsy is a procedure performed to remove ssue from the cervix to
test for abnormal
or precancerous condi ons, or cervical cancer.
h
The cervix is the lower, narrow part of the uterus (womb) located between the bladder
and the rectum.
ec
It forms a canal that opens into the vagina, which leads to the outside of the body.
This is the common diagnos c procedure carried out both in the hospital and in the
office
types:-
ut
• Surface
• Punch
• Wedge
• Ring
• Cone
Ed
292. Cervical biopsy (B.589:C.362)
i
Ans.:
hu
293. Endometrial aspira on cytology (B.120:C.375)

Ans.: There is closure of the duct or the opening of an acinus.The cause may be
infec on or trauma followed
rs
by fibrosis and occlusion of the lumen.

- Pathology: It may develop in the duct (common) or in the gland. Commonly, it involves
the duct; the gland
va
is adherent to it posterolaterally. Cyst of the duct or gland can be differen ated by the
lining epithelium.
The content is glairy colorless fluid—secre on of the Bartholin’s gland.
De
- Clinical Features: A small size o en remains unno ced to the pa ent or escapes
a en on to the
physician even following internal examina on. If it becomes large (size of hen’s egg),
there is local
discomfort and dyspareunia. Examina on reveals an unilateral swelling on the posterior
half of the
86
labium majus which opens up at the posterior end of the labium minus. Its medial
projec on makes
the vulval cle ‘S’-shaped. The overlying skin is thin and shiny. The cyst is fluctuant and
not tender
October 7,
2015
- Treatment: Marsupializa on is the gra fying surgery for Bartholin’s cyst. An incision is
made on
the inner aspect of the labium minus just outside the hymenal ring. The incision
includes the vaginal wall
and the cyst wall. The cut margins of the either side are to be trimmed off to make the
opening an ellip cal
shape and of about 1 cm in diameter. The edges of the vaginal and cyst wall are sutured
by interrupted
catgut, thus leaving behind a clean circular opening.The advantages of marsupializa on
over
the tradi onal excision opera on are:
h
(i) Simple
ec
(ii) Can be done even under local anesthesia.
(iii) Shorter hospital stay (24 hours).
(iv) Postopera ve complica on is almost nil.
(v) Gland func on (moisture) remains intact.
ut
294. Bartholin’s cyst (B.162:C.111)
Ans.: Immediate
1. Vault celluli s
2. Pelvic abscess
3.Thrombophlebi s
Ed
4.Pulmonary embolism
i
Late :
hu
1.Vault prolapse
295. Complica ons of vaginal hysterectomy (B.222:C.325)

rs
Ans.: “Quickening” (feeling of life) denotes the percep on of ac ve fetal movements by

the women. It is
usually felt about the 18th week, about 2 weeks earlier in mul parae. Its appearance is
va
an useful guide
to calculate the expected date of delivery with reasonable accuracy
296. Define “quickening” (A.68)
De
Ans.:
297. Define missed abor on (A.163)
Ans.: The head is deep into the cavity; the sagi al suture is placed in the transverse
bispinous diameter and there
the cervix. The arrest 87

is no progress in descent of the head even a er 1/2–1 hour following full dilata on of
in occipito-transverse posi on may be the end result of incomplete anterior rota on

(1/8th of circle) of oblique
occipitoposterior posi on, or it may be due to non-rota on of the commonly primary
October 7,
2015
occipito-transverse posi on
of normal mechanism of labor.
Causes: (a) Faulty pelvic architecture such as prominent ischial spines, flat sacrum and
convergent side
walls, (b) Deflexion of the head, (c) Weak uterine contrac on, (d) Laxity of the pelvic
floor muscles.
Diagnosis: (a) The head is engaged, (b) The sagi al suture lies in the transverse
bispinous diameter,
(c) Anterior fontanelle is palpable, (d) Faulty pelvic architecture may be detected.
Management: The fetal condi on and pelvic assessment give the guide as to the line of
management
h
(men oned earlier).
ec
(1) Vaginal delivery is found not safe (big baby and or inadequate pelvis): Cesarean
sec on.
(2) Vaginal delivery is found safe (any of the methods may be employed): (1)
Ventouse—Excessive trac on force
ut
should not be used (2) Manual rota on and applica on of forceps. (3) Forceps rota on
and delivery
with Kielland in the hands of an expert. Opera ve vaginal delivery for DTA should only
be performed by a Ed
skilled obstetrician. Otherwise cesarean delivery is always preferred.
298. Define deep transverse arrest (A.372)
Ans.: (1) Engagement
i
(2) Descent
hu
(3) Flexion
(4) Internal rota on
(5) Crowning
rs
(6) Extension
(7) Res tu on
(8) External rota on
va
and (9) Expulsion of the trunk.

299. What are the components of a mechanism of labour (A.127)
De
Ans.: 1. Doppler ultrasound

2. Presence of diastolic notch at 24 weeks gesta on by Doppler velocimetry in the
uterine artery
3.Absence of end-diastolic frequencies or reverse diastolic flow pa erns in the umbilical
artery
4.Average mean arterial pressure (MAP) in second trimester > 90 mm Hg may predict
the onset. 88
5.Fetal DNA—Detec on of free fetal DNA in maternal serum in early pregnancy may be
predic ve of pre-eclampsia
6.Roll over test
October 7,
2015
300. Enumerate predic ve tests for pre-eclampsia (A.227)

Ans.:
301. Define caput succedaneum (A.86)

Ans.: Death of a woman while pregnant or within 42 days of the termina on of
pregnancy irrespec ve of the dura on and the site of pregnancy, from any cause related
to or aggravated by
the pregnancy or its management but not from accidental or incidental causes.
302. Define maternal death (A.602)
h
Ans.: The term bad obstetric history (BOH) is applied to a pregnant mother where her
present obstetric
ec
outcome is likely to be affected adversely by the nature of previous obstetric disaster.
The previous pregnancy
loss should be obstetrically related and as such mishaps to the baby due to some other
reasons should not
ut
come under the purview of BOH.
303. Define bad obstetric history (A.342)
unprotected coitus
Ed
Ans.: Infer lity is defined as a failure to conceive within one or more years of regular
Primary infer lity denotes those pa ents who have never conceived.
304. Define primary infer lity (B.227:C.180)
i
Ans.: Premenstrual syndrome (PMS) is a psychoneuroendocrine disorder of unknown
hu
e ology, o en no ced
just prior to menstrua on. There is cyclic appearance of a large number of symptoms
during the last 7–10
rs
days of the menstrual cycle. It should fulfil the following criteria (ACOG) :
™ 1.Not related to any organic lesion.
™ 2.Regularly occurs during the luteal phase of each ovulatory menstrual cycle.
va
™ 3.Symptoms must be severe enough to disturb the life style of the woman or she
requires medical help.
™ 4.Symptom-free period during rest of the cycle.
De
When these symptoms disrupt daily func oning they are grouped under the name
premenstrual
dysphoric disorder (PMDD).
305. Define premenstrual tension (B.182:C.266)

Ans.: • Laparoscopy
• Hysteroscopy 89
• Salpingoscopy
• Falloposcopy
October 7,
2015
• Cystoscopy
• Culdoscopy
• Sigmoidoscopy and proctoscopy
306. Types of endoscopy (B.121:C.435)
Ans.: DUB is defined as a state of abnormal uterine bleeding without any clinically
detectable
organic, systemic, and iatrogenic cause (Pelvic pathology, e.g. tumor, inflamma on or
pregnancy is excluded).
307. Define dysfunc onal uterine bleeding (B.187:C.270)
h
Ans.: 1.Persistent menorrhagia, metrorrhagia or con nued vaginal bleeding → severe
anemia
ec
2.Severe intraperitoneal hemorrhage due to rupture of veins over subserous fibroid
3.Severe infec on leading to peritoni s or sep cemia
4.Sarcoma (rare)
ut
308. Complica ons of uterine fibroid (B.275,278:C.318)
Ans.: During the midcycle, the cervical mucus is obtained by a pla num loop or pipe e
and spread on a clean glass slide and dried. When seen under low power microscope, it
shows Ed
characteris c pa ern of fern forma on. It is due to high sodium chloride and low
protein
content in the mucus due to high estrogen in the midmenstrual phase prior to
i
ovula on. A er
hu
ovula on with increasing progesterone, the ferning disappears completely a er 21st

day.
Thus, the presence of ferning even a er 21st day suggests anovula on and its
disappearance
rs
is presump ve evidence of ovula on

The cervical scoring system of Insler (1979) takes into the account the amount,
spinnbarkeit, ferning of the
va
mucus along with state of the external os of the cervix. A score of 10–12 indicates
complete follicular matura on.
309. Fern test (B.115:C.194)
De
Ans.: Colposcopy is a medical diagnos c procedure to examine an illuminated,

magnified view of the cervix and
the ssues of the vagina and vulva.[1] Many premalignant lesions and malignant lesions
in these areas have
discernible characteris cs which can be detected through the examina on. It is done
using a colposcope,
90
which provides an enlarged view of the areas, allowing the colposcopist to visually
dis nguish normal from
abnormal appearing ssue and take directed biopsies for further pathological
examina on. The main goal of
October 7,
2015
colposcopy is to prevent cervical cancer by detec ng precancerous lesions early and

trea ng them
310. Colposcopy (B.115:C.447)

Ans.: Genuine stress incon nence (GSI) is defined, according to the interna onal
con nence
society (ICS) as involuntary urethral loss of urine when the intravesical pressure exceeds
the maximum
urethral pressure in the absence of detrusor ac vity.
The diagnosis of GSI should be made following urody-namic assessment only.
h
311. Define stress urinary incon nence (B.398:C.169)
ec
Ans.: When the greatest horizontal plane, the biparietal, has passed the plane of the
pelvic brim,
the head is said to be engaged,and at the me presen ng part would be the vertex.
ut
312. Define engagement of the fatal head in vertex presenta on (A.81)
Ans.: Series of events that take place in the genital organs in an effort to expel the viable
products
Ed
of concep on out of the womb through the vagina into the outer world is called Labor.
313. Define labour (A.113)
Ans.: Quan ta ve defini on is arbitrary and is related to the amount of blood loss in
i
excess of 500 mL
hu
following birth of the baby (WHO). It may be useful for sta s cal purposes. As the effect
of the blood loss is
important rather than the amount of blood lost, the clinical defini on which is more
prac cal states, “any
rs
amount of bleeding from or into the genital tract following birth of the baby up to the
end of the puerperium,
which adversely affects the general condi on of the pa ent evidenced by rise in pulse
va
rate and falling blood

pressure is called postpartum hemorrhage”.
314. Define PPH (A.410)
De
Ans.:
315. What are the components of a biophysical profile score? (A.108)
Ans.:
316. What are the components of Bishop’s score? (A.523)
91
Ans.: MATERNAL MORTALITY RATE:- indicates the number of maternal deaths divided
by the number of women of
reproduc ve age (15–49). It is expressed per 100,000 women of reproduc ve age per
year. In India, it is about
October 7,
2015
120.
317. Define maternal mortality rate (A.602)
Ans.: Perinatal mortality is defined as deaths among fetuses weighing 1000 g or more at
birth (28 weeks gesta on)
who die before or during delivery or within the first 7 days of delivery. The perinatal
mortality rate is
expressed in terms of such deaths per 1000 total births.
318. Define perinatal mortality (A.605)
h
ec
as the lower limit of fetal viability. The incidence is about 3% amongst hospital
deliveries.
319. Define antepartum haemorrhage (A.241)
ut
Ans.: The term precocious puberty is reserved for girls who exhibit any secondary sex
characteris cs before the
Ed
age of 8 or menstruate before the age of 10.
Precocious puberty may be isosexual where the features are due to excess produc on
of estrogen. It
may be heterosexual where features are due to excess produc on of androgen (from
ovarian and adrenal neoplasm)
i
hu
320. Define precocious puberty (B.51:C.547)

Ans.: Infer lity is defined as a failure to conceive within one or more years of regular
unprotected coitus.
Secondary infer lity:- indicates previous pregnancy but failure to conceive
rs
subsequently.
Fecundability is defined as the probability of achieving a pregnancy within one
menstrual cycle. In a healthy young
va
couple, it is 20 percent. Fecundity is the probability of achieving a livebirth within a

single cycle
De
321. Define secondary infer lity (B.227:C.180)

Ans.: Bleeding per vagina following established menopause is called postmenopausal
bleeding.
The significance of postmenopausal bleeding, whatever slight it may be, should not be
underes mated.
As many as one-third of the cases are due to malignancy. The same importance is also
given to 92
those cases where normal menstrua on con nues even beyond the age of 55 years.
322. Define post menopausal bleeding (B.559:C.61)
October 7,
2015
Ans.: It is the absence of menstrua on for 6 months or more in a woman in whom

normal menstrua on has been
established.
The physiological causes and cryptomenorrhea has been described earlier in the
chapter. Only the true
secondary amenorrhea will be discussed here.
323. Define secondary amenorrhea (B.457:C.258)
Ans.: Adenomyosis is a medical condi on characterized by the presence of ectopic
glandular ssue found in muscle.
The term adenomyosis is derived from the Greek terms adeno- (meaning gland), myo-
h
(meaning muscle),
and -osis (meaning condi on). Previously named as endometriosis interna,
ec
adenomyosis actually differs from
endometriosis and these two disease en es are found together in only 10% of the
cases.
ut
324. Define adenomyosis (B.314:C.427)
Ans.:
325.
Ed
Name common sexually transmi ed diseases (B.146:C.123)
Ans.: Preven ve measures include:
1.‘Safer sex’ prac ce with health educa on. Barrier methods (Condoms and
Spermicides) are effec ve
to reduce transmission (80%).
i
hu
2.LNG-IUS with condoms give excellent benefit.

3.Male circumcision reduces transmission by 50%.
4.Use of blunt pped needles to avoid needle s ck injury during surgery.
5.HIV nega ve blood transfusion (screening of donors).
rs
6.HIV nega ve frozen semen to use for ar ficialv donor insemina on.
7.Postexposure prophylaxis with zidovudine and lamivudine is advisable.
va
8.Termina on of pregnancy in HIV posi ve women when requested.

9.Avoiding breas eeding—in the developing world, avoidance of breas eeding may not
be
possible. Mother needs to be counseled as regard the risks and benefits of
De
breas eeding. She is

helped to make an informed choice.
10.Infer lity — Serodiscordant couples (female HIV nega ve) may have assisted
concep on with
insemina on following sperm washing.
11.To maintain protocols for correct handling of all body fluids.
12.Wide spread voluntary counseling and tes ng 93
326. Preven on of HIV infec on (B.155:C.134)
Ans.: The Pap smear is a screening test for cervical cancer. Cells scraped from the
October 7,
2015
opening of the cervix are examined under a microscope. The cervix is the lower part of
the uterus (womb) that opens at the top of the vagina.
327. Pap smear (B.111,112:C.71,361)
Ans.:
328. Define normal labour (A.113)
Ans.: Antenatal diagnosis is rarely made. Diagnosis is made only during labor but in
about half, the detec on is made
at the me of delivery.
ABDOMINAL FINDINGS:- Inspec on: Because of ‘S’ shaped spine, there is no visible
h
bulging of the flanks.
Palpa on:-The diagnos c features in
ec
mentoanterior and mentoposterior are tabulated below:
329. Diagnosis of face presenta on (A.389)
Ans.: In non-stress test, a con nuous electronic monitoring of the fetal heart rate along
ut
with recording of fetal movements (cardiotocography) is undertaken. There is an
observed associa on of
FHR accelera on with fetal movements, which when present, indicates a healthy fetus.
It can reliably be Ed
used as a screening test. The accelera ons of the FHR associated with fetal movements
are presumably reflex
mediated. It should be emphasized that the test is valuable to iden fy the fetal wellness
rather than illness.
i
hu
330. Define non stress test (A.108)

Ans.: It is one form of antepartum hemorrhage where the bleeding occurs due to
premature
separa on of normally situated placenta. Out of the various nomenclatures, abrup o
rs
placentae seems to
be appropriate one.
va
331. Define abrup o placenta (A.252)

Ans.: Spines are the most prominent bony projec ons felt on internal examina on and
the bispinous diameter
De
is the shortest diameter of the pelvis in transverse plane being 10.5 cm. The level of
ischial spines
is the halfway between the pelvic inlet and outlet. This level is known as sta on zero
(0). The
levels above and below the spines are divided into fi hs to represent cen meters. The
sta on is said
94
to be ‘O’ if the presen ng part is at the level of the spines. The sta on is stated in minus
figures, if it is
above the spines (–1 cm, –2 cm, –3 cm –4 cm and –5 cm) and in plus figures if it is
below the spines (+1
October 7,
2015
cm. +2 cm. +3 cm +4 cm and +5 cm).

332. Importance of ischial spine during labour (A.133)
Ans.: Es ma on of the total requirement: The manufacturers informa on is to follow
for dose calcula on. One such
formula for iron dextran is:
• 0.3 × W (100–Hb%) mg of elemental iron. Where W = pa ent’s weight in pounds. Hb%
= observed
hemoglobin concentra on in percentage. Addi onal 50% is to be added for par al
replenishment of
the body store iron.
h
333. Calcula on of total dose Iron therapy (A.266)
ec
Ans.:
334. Amnio c fluid index (A.39)
ut
separate occasions
Ed
In some countries, postabortal fever is also included.
CAUSES: The causes of pyrexia are—(1) Puerperal sepsis, (2) Urinary tract infec on,
(cys s, pyelonephri s),
(3) Mas s, (4) Infec on of cesarean sec on wound, (5) Pulmonary infec on, atelectasis
pneumonia, (6) Sep c
i
hu
pelvic thrombophlebi s, (7) A recrudescence of malaria or pulmonary tuberculosis

—not uncommon in the
tropics, (8) Unknown origin.
The pathology and preven on of child birth fever (puerperal pyrexia) is best known
rs
from the works of Ignaz Semmelweis,

working in Vienna in the nineteenth century. He faced difficul es to establish his
doctrine. Unfortunately he died of an
va
infec on on his right hand, that he contracted during an opera on.
335. Puerperal pyrexia (A.432)

De
Ans.:
336. Treatment of trichomonal vagini s (B.164:C.132)
Ans.:
337. Types of uterine fibroid (B.273:C.316)
Ans.: 1.Coagula on disorders
2.Endometrial polyps 95
3.Genitourinary infec on
4.intrauterine device
October 7,
2015
5.Liver disease/failure
6.Medica ons
7.Renal disease/failure
8.Steroid hormones
9.Uterine fibroids
338. D/D of menorrhagea (B.185:C.269)
Ans.: Dysmenorrhea can be classified as either primary or secondary based on the
absence or presence of an underlying cause.
Secondary dysmenorrhea is dysmenorrhea which is associated with an exis ng
condi on.
h
ec
339. Types of dysmenorrhoea (B.:C.)
Ans.:
Causes:
ut
• Obstetrical :-
It results from prolonged compression effect on the bladder base between the head
and
->fistula.
Ed
symphysis pubis in obstructed labor ischemic ->necrosis-> infec on-> sloughing
Thus, it takes few days (3–5) following delivery to produce such type of fistula.
Trauma c: This may be caused by: Instrumental vaginal delivery such as
destruc ve
i
opera ons or forceps specially with Kielland. The
hu
injury may also be inflicted by the bony spicule of

the
fetal skull in craniotomy opera on.
rs
™™ Abdominal opera ons such as hysterectomy for rupture uterus or Cesarean

sec on specially a repeat
one or for cesarean hysterectomy. The injury may be
va
direct or ischemic following a part of the bladder wall

being caught in the suture.
Gynecological:-
De
Although a rarity in the developing countries, it is the commonest type met in the
developed ones and accounts for more than 80 percent of fistulae.
1.Opera ve injury likely to produce fistula includes opera ons like anterior
colporrhaphy, abdominal
hysterectomy for benign or malignant lesions or removal of Gartner’s cyst.
a pointed object, by a 96
2.Trauma c—The anterior vaginal wall and the bladder may be injured following fall on
s ck used for criminal abor on, following fracture of pelvic bones or due to retained
and forgo en pessary.
October 7,
2015
3.Malignancy—Advanced carcinoma of the cervix, vagina or bladder may produce fistula

by direct spread.
4.Radia on—There may be ischemic necrosis by endarteri s obliterans due to radia on
effect, when the
carcinoma cervix is treated by radia on. Apart from overdose or malapplica on, it may
occur even with
accurate therapy. It takes usually long me (1–2 years) to produce such fistula.
5.Infec ve—Chronic granulomatous lesions such as vaginal tuberculosis,
lymphogranuloma venereum,
schistosomiasis or ac nomycosis may produce fistula.
h
340. Causes of VVF (B.418:C.166)
ec
Ans.: This is an opera on whereby the eroded area of the cervix is destroyed either by
thermocoagula on or
red hot cauteriza on.
ut
Indicat ion: Cervical ectopy with troublesome discharge. Prior cervical smear or biopsy
if necessary,
should be undertaken.
Ed
Proc edures : While the superficial cauteriza on can be done without anesthesia as an
outdoor procedure but where extensive cauteriza on is required, it should be done
under general anesthesia.
Lower part of the cervical canal is dilated by one or two small dilators.
The whole eroded area is cauterized by cautery point giving linear radial strokes
i
hu
star ng
from inside the cervical canal to over the eroded area. The strokes should be made
about 2 mm
deep and at a distance of 1 cm. The area is smeared with an bio c ointment.
rs
Healing: It takes about 2–3 weeks for sloughing of the burn area. Complete
epithelializa on by squamous
epithelium occurs by 6–8 weeks. Pa ent informa on: There may be serosanguineous
va
or even blood stained discharge for about 2–3 weeks. Local (cream) and systemic
an bio c need to be
given, when infec on is there.
De
341. Cervical cauteriza on (B.590:C.295)

Ans.: Medical management: Number of chemotherapeu c agents have been used
either systemic or direct
local (under sonographic or laparoscopic guidance) as medical management of ectopic
pregnancy. The
97
drugs commonly used for salpingocentesis are: methotrexate, potassium chloride,
prostaglandin (PGF2α),
hyperosmolar glucose or ac nomycin. The pa ent must be (i) hemodynamically stable
(ii) Serum hCG level
October 7,
2015
should be < 3000 IU/L (iii) tubal diameter should be less than 4 cm without any fetal
cardiac ac vity (iv) There
should be no intra-abdominal hemorrhage. For systemic therapy, a single dose of
methotrexate (MTX) 50 mg/
M2 is given intramuscularly.
342. Medical management of unruptured ectopic pregnancy (A.186:)
Ans.: 1.Carcinoma or sarcoma
2.Cervical ectropion
3.Ectopic pregnancy
4.Menstrual dysfunc on
h
5.Sexually transmi ed diseases
6.Uterine fibroid (myoma)
ec
7.Vaginal varicosi es
8.Vagini s
ut
343. D/D of uterine polyp (B.285:C.315)
Ans.: severe PET have foloowing features:-
(1) A persistent systolic blood pressure of >160 mm Hg or diastolic pressure of >110 mm
Hg.
(2) Protein excre on of >5 gm/24 hr.
(3) Oliguria (<400 ml/24 hr).
Ed
(4) Platelet count < 100,000/mm3.
i
(5) HELLP syndrome.
hu
(6) Cerebral or visual disturbances.

(7) Persistent severe epigastric pain.
(8) Re nal hemorrhages, exudates or papilledema.
(9) Intrauterine growth restric on of the fetus.
rs
(10) Pulmonary edema.

344. Define severe PET (A.224)
va
Ans.: Diagnos c laparoscopy is helpful to assess the size and site of perfora on and the
amount of hemorrhage.
Laparotomy o en needed to tackle the situa on.
De
345. Diagnosis of uterine perfora on during D x E (A.565)

Ans.: To mother:-
DURING PREGNANCY:
(1) Pre-eclampsia may be related to malnutri on and hypoproteinemia
(2) Intercurrent infec on—Not only does anemia diminish resistance
98
to infec on, but also any pre-exis ng lesion, if present, will flare up. It should be
noted that the infec on itself
impairs erythropoiesis by bone marrow depression
(3) Heart failure at 30–32 weeks of pregnancy (4) Preterm labor.
October 7,
2015
DURING LABOR:
(1) Uterine iner a is not a common associate, on the contrary the labor is short because
of a small baby and mul parity
(2) Postpartum hemorrhage is a real threat. Pa ent tolerates badly even a minimal
amount of blood loss
(3) Cardiac failure may be due to accelerated cardiac output which occurs during labor
or
immediately following delivery. As the blood in the uterine circula on is squeezed in
the general circula on,
it puts undue strain on the weak heart already compromised by hypoxia
(4) Shock—Even a minor trauma c delivery without bleeding may produce shock or a
h
minor hypoxia during
ec
anesthesia which may be lethal.
PUERPERIUM: There is increased chance of:
(1) Puerperal sepsis
(2) Subinvolu on
ut
(3) Poor lacta on
(4) Puerperal venous thrombosis
(5) Pulmonary embolism.
To baby:-
Ed
Amount of iron transferred to the fetus is unaffected even if the mother suffers from
iron
deficiency anemia. So the neonate does not suffer from anemia at birth.
i
hu
(1) There is increased incidence of low birth weight babies with its incidental hazards
(2) Intrauterine death—due to severe maternal anoxemia. The sum effect is increased
perinatal loss.
346. Effect of severe anemia on mother & fetus (A.264)
rs
Ans.: • History—Repeated mid trimester painless cervical dilata on (without apparent

cause) and escape
va
of liquor amnii followed by painless expulsion of the products of concep on

is very much sugges ve.
• Internal examina on: (i) Interconcep onal period-Bimanual examina on reveals
presence of unilateral or
De
bilateral tear and /or gaping of the cervix upto the internal os.
347. Diagnosis of cervical incompetence (A.168)
Ans.: 1.miscarriage
-threatened miscarriage : with or without iden fiable subchorionic haemorrhage
-missed miscarriage
-incomplete miscarriage
2.ectopic pregnancy
99
3.gesta onal trophoblas c disease
October 7,
2015
4.demise of a twin
5.implanta on bleeding
348. D/D of 1st trimester bleeding PV (A.158)
Ans.:
349. Main causes of early neonatal deaths (A.607)
Ans.: Fetal distress is an ill-defined term, used to express intrauterine fetal jeopardy, a
result of
intrauterine fetal hypoxia. Nonreassuring fetal status is characterized by tachycardia or
bradycardia, reduced
h
FHR variability, decelera ons and absence of accelera ons (spontaneous or elicited). It
must be emphasised
ec
that hypoxia and acidosis is the ul mate result of the many causes of intrauterine fetal
compromise.
350. Fetal distress (A.613)
ut
Ans.: Amniotomy (also referred to as ar ficial rupture of membranes [AROM]) is the
procedure by which the amnio c sac is deliberately ruptured
so as to cause the release of amnio c fluid. Amniotomy is usually performed for the
Ed
purpose of inducing or expedi ng labor or in an cipa on
of the placement of internal monitors (uterine pressure catheters or fetal scalp
electrodes). It is typically done at the bedside in the labor and
delivery suite.
i
hu
351. A.R.M.
Ans.:
352. N.S.V. (B.494:C.214)
rs
Ans.: The most common cause of pruritus vulvae is vaginal discharges either due to
Trichomonas vaginalis or Candida albicans or
both.
va
353. Main causes of leucorrhea with itching of vulva (B.553:C.107)

Ans.: (A) Hormones
1.Norethisterone acetate
De
2.Medroxyprogesterone acetate
3.Dydrogesterone
4.Equine conjugated estrogen
5.Combined estrogens and progestogens (contracep ve pills)
6.19 Norsteroid deriva ve (Gestrinone)
7.Danazol (17 α-ethinyl testosterone)
8.Proges n releasing IUCD LNG – IUS 100
9.Mifepristone (RU 486)
10.GnRH analogues
October 7,
2015
11.Desmopressin
(B) Prostaglandin synthetase inhibitors (PSI)
1.Fenamates (Mefenamic acid)
(C) An fibrinoly c agents
1.Tranexamic acid (TA)
354. Drug therapy of D.U.B. (B.191:C.273)

Ans.: (Fibroid, Ca Endometrium, Adenomyosis, Haematometra,
Pyometra-Leomyosarcoma)
h
355. Gynacological causes of enlarged uterus
Ans.: The complica onsrelated to steriliza on can be grouped into:
ec
(a) General complica ons: These include occasional obesity, psychological upset.
(b) Gynecological:-
(1) Chronic pelvic pain.
ut
(2) Conges ve dysmenorrhea.
(3) Menstrual abnormali es in the form of menorrhagia,
356.
Ans.:
357.
Ed
Complica ons of tubal steriliza on procedures (B.499:C.217)
Types of amenorrhea (B.449:C.256)

Ans.: Stress urinary incon nence (SUI) is defined as involuntary escape of urine from
i
the external
hu
urinary meatus due to sudden rise in intra-abdominal pressure.

358. Define SUI (B.398:C.169)
Ans.:
rs
359. Treatment of benign cervical erosion (B.269:C.295)

Ans.: (Clean Surface, Tie, Cut, Cord care)
va
360. ‘Five cleans’ during delivery

Ans.:
De
101
October 7,
2015
361. What is post partum programme? (D.477)

Ans.: :-Lower segment
:-Classical or upper segment
362. Enumerate types of caesarean sec on. (A.590)
Ans.:
363. Parameters in Apgar score (A.470)
Ans.: • Prostaglandins PGE2, PGE1
• Oxytocin
• Mifepristone
h
364. Name drugs used for induc on of labour (A.524)
ec
Ans.: Atonicity of the uterus is the commonest cause of postpartum hemorrhage.
365. Commonest cause of PPH (A.410)
Ans.: A. Composi on: Breast milk is an ideal food with easy diges on and low osmo c
ut
load.
-Carbohydrate: Mainly lactose, s mulates growth of intes nal flora, produces organic
acids needed
for synthesis of vitamin B
Ed
-Fat: Smaller fat globules, be er emulsified and digested
-Protein: Rich in lactalbumin and lactoglobulin, less in casein
-Minerals: Low osmo c load (K+, Ca2+, Na+ Cl–), less burden on the kidney.
i
B. Protec on against infec on and deficiency states:
hu
1. Vit D promotes bone growth, protects the baby against rickets

2. Leucocytes, lactoperoxidase prevents growth of infec ve agents
3. Lysozyme, lactoferrin, interferon—protect against infec on
4. Long chain omega-3 fa y acids—essen al for neurological development
rs
5. Immunoglobulins IgA (secretory), IgM, IgG protect against infec on

6. Supply of nutrients and vitamins.
va
C. Breast milk is a readily available food to the newborn at body temperature and
without any
D. Breast feeding acts as a natural contracep on to the mother .
De
C. Addi onal advantages are: (i) It has laxa ve ac on; (ii) No risk of allergy; (iii)
Psychological benefit
of mother-child bonding; (iv) Helps involu on of the uterus (v) Lessens the incidence
of sore bu ocks, gastrointes nal infec on and atopic eczema. The incidence of scurvy
and rickets is
significantly reduced.
366.
Ans.:
Major benefits of breast feeding (A.449) 102
367. Three criteria of preterm baby (A.456)
October 7,
2015
Ans.:
368. Define uterocervical prolapse (B.204-205:C.301-302)
Ans.: 1.White, thick vaginal discharge.
2.Swelling, itching, redness and irrita on of the vagina and possibly the lips of the
vagina (vulva).
3.Burning or painful urina on.
4.Painful intercourse.
369. Three symptoms of moninial vagini s (B.165:C.132)
Ans.: Time of inser on
h
(a) Interval (When the inser on is made in the interconcep onal period beyond 6 weeks
following
ec
childbirth or abor on) — It is preferable to insert 2–3 days a er the period is over.
But
it can be inserted any me during the cycle even during menstrual phase which has
certain
ut
advantages (open cervical canal, distended uterine cavity, less cramp). However,
during lacta onal
amenorrhea, it can be inserted at any me.
evacua on or D and E,
Ed
(b) Postabortal — Immediately following termina on of pregnancy by suc on
or following spontaneous abor on, the device may be inserted. The addi onal
advantage of
i
preven ng uterine synechia can help in mo va on for inser on.
hu
(c) Postpartum — Inser on of the device can be done before the pa ents are
discharged from the
hospital. Because of high rate of expulsion, it is preferable to withhold inser on for 6
rs
weeks when
the uterus will be involuted to near normal size.
(d) Postplacental delivery — Inser on immediately following delivery of the placenta
va
could be done.
But the expulsion rate is high.
370. When copper T can be inserted? (B.480)
De
Ans.: 1.Ovaries
2.Pelvic peritoneum
3.Pouch of Douglas
4.Uterosacral ligaments
5.Rectovaginal septum
6.Sigmoid colon
7.Appendix 103
8.Pelvic lymph nodes
9.Fallopian tubes
October 7,
2015
371. What is commonest site for endometriosis externa? (B.305:C.421)

Ans.: 1-Light vaginal bleeding.
2-Nausea and vomi ng with pain.
3-Lower abdominal pain.
4-Sharp abdominal cramps.
5-Pain on one side of your body.
6-Dizziness or weakness.
7-Pain in your shoulder, neck, or rectum.
8-If the fallopian tube ruptures, the Pain and bleeding could be severe enough to cause
h
fain ng.
ec
372. Symptoms of ruptured ectopic pregnancy. (B.180:C.240)
Ans.: Emergency contracep on is a safe and effec ve way to prevent pregnancy a er
unprotected intercourse.
ut
373. What is emergency contracep on? (B.492:C.213)
Ans.: Congenital:-
-Imperforate hymen
-Transverse vaginal septum Ed
-Atresia of upper-third of vagina and cervix.
Acquired
-Stenosis of the cervix following amputa on, deep cauteriza on and coniza on.
i
-Secondary vaginal atresia following neglected anddifficult vaginal delivery.
hu
374. Three condi ons which cause cryptomenorrhea. (B.450)

Ans.: A cystocele is a medical condi on that occurs when the tough fibrous wall
between a woman's bladder
rs
and her vagina (the pubocervical fascia) is torn by childbirth, allowing the bladder to
herniate into the
vagina
va
375. Define cystocele. (B.204:C.299)

Ans.:
De
376. Characteris cs of uterine contrac ons in 2nd stage of labour (A.121)

Ans.: 1- tachycardia or bradycardia,
2- reduced FHR variability,
3- decelera ons and absence of accelera ons (spontaneous or elicited).
377. Diagnosis of fetal distress during labour (A.613)
104
Ans.: Postpartum hemorrhage is the real danger in twins. It is due to: (i) Atony of the
uterine muscle due to overdistension of the uterus (ii) A longer me taken by the big
placenta to separate (iii) Bigger surface area of the placenta exposing more uterine
sinuses
October 7,
2015
(iv) Implanta on of a part of the placenta in the lower segment which is less retrac le.
378. Post partum hemorrhage is the real danger in twin delivery is due to
(A.205)
Ans.:
379. List five morbidi es to the baby during vaginal breech delivery. (A.378)
Ans.: The components of a partograph are:
(a) Pa ent iden fica on
(b) Time — recorded at hourly interval.Zero me for spontaneous labor is the me of
admission in the
h
labor ward and for induced labor is the me of induc on
(c) Fetal heart rate — recorded at every 30 minutes
ec
(d) State of membranes and color of liquor : to mark ‘I’ for intact membranes, ‘C’ for
clear and ‘M’ for meconium stained liquor
(e) Cervical dilata on and descent of the head
(f) Uterine contrac ons — the squares in the ver cal columns are shaded according to
ut
dura on and intensity
(g) Drugs and fluids
minutes
Ed
(h) Blood pressure (recorded in ver cal line) at every 2 hours and pulse at every 30
(i) Oxytocin — concentra on in the upper box and dose (m IU/min) in the lower box
(j) Urine analysis
(k) Temperature record.
i
hu
380. Main components of WHO model of partograph (A.531)

Ans.: (Twins, Polyhydroamnios, Hyda d Mole, Macrrosomia, Fibroid with pregnancy,
Wrong CMP, Acute retension of urine)
rs
381. Diagnos c value – fundal height is greater than gesta onal age.
Ans.: The denominator is mentum.
va
The engaging diameter of the head is submento-bregma c 9.5 cm (3 3/4”)

in fully extended head or submento-ver cal 11.5 cm (4 1/2”) in par ally extended head.
Mento-anterior is the more favourable presenta on.
De
382. Write denominator engaging diameter and favourable condi on in face

presenta on. (A.388)
Ans.: Menorrhagia is defined as cyclic bleeding at normal intervals; the bleeding is either
excessive in amount
(> 80 mL) or dura on (>7 days) or both. The term menotaxis is o en used to denote
prolonged bleeding.
383. 105
What is normal menstrual blood loss when do you call it menorrhagea?
(B.185:C.269)
Ans.: (Fibroid uterus, Elonga on of cervix, Endometrial cancer)
October 7,
2015
384. Men on three condi ons when uterocervical length increases.

Ans.:
385. List the conserva ve opera ons for prolapse. (B.211:)
Ans.: Failure rate is about 5–21/HWY.
386. Failure rate of condom. (B.476:C.202)
Ans.: (1) Presence o\f pelvic infec on current or within 3 months;
(2) Undiagnosed genital tract bleeding;
(3) Suspected pregnancy; (4) Distor on of the shape of the uterine cavity as in fibroid or
congenital uterine-malforma on;
h
(5) Severe dysmenorrhea;
(6) Past history of ectopic pregnancy;
ec
(7) Within 6 weeks following cesarean sec on;
(8) STIs — Current or within 3 months;
(9) Trophoblas c disease;
ut
(10) Significant immunosuppression.
(11) Wilson disease and
(12) Copper allergy.
387.
Ans.:
Ed
Write three contraindica ons for copper T inser on. (B.480:C.205)
388. Write three immediate beneficial effects of OC pills (B.488:C.208)

i
Ans.:
hu
389. Drugs used for induc on of ovula on (B.243:C.195)

Ans.: Mifepristone (RU 486)
It is a compe ve antagonist of progesterone and glucocor coid receptors. It is a
rs
deriva ve
of 19-nortestosterone. It binds compe vely to progesterone receptors and nullifies the
va
effect of
endogenous progesterone. As a result, there is an increased release of prostaglandins
from the
endometrium, resul ng in menstrual bleeding or termina on of early pregnancy.
De
Three important biochemical characters of RU 486 are high affinity for progesterone
receptors, long
half life and ac ve metabolites.
Uses: Therapeu c abor on It is an effec ve abor facient upto 7 weeks. Combina on of
prostaglandins
as vaginal pessary 48 hours a er RU 486, increases its efficacy.
106
Dose: Tab 200 mg (1 tab = 200 mg) orally, followed 48 hours later by misoprostol 400 μg
(PGE1) oral
or 800 mg vaginal pessary. Success rate is 95–100 percent.
October 7,
2015
Emergency contracep on:-

A single dose of 10 mg is to be taken on 27th day of the cycle irrespec ve of the
day and number of
intercourse. Efficiency is 95–100 percent. Induc on of labor—Mifepristone has
been used for
cervical ripening. It is given orally.
Uterine fibroids—Shrinkage of uterine leiomyoma has been observed following
mifepristone therapy
(25–50 mg daily)
Ectopic pregnancy—Injec on of mifepristone into the ectopic pregnancy (unruptured
h
sac) is used as a
medical management.
ec
Cushing’s syndrome—as it blocks the glucocor coid receptors.
Side effects: Minor side effects are nausea, vomi ng,headache and cramp. There is risk
of ongoing
pregnancy (failure of medical induc on of abor on) in about 1 percent of
ut
cases.
Evacua on of the uterus should be done for such a failure. Long-term use
causes endometrial hyperplasia.
Contraindica ons:
Age > 35 years
Ed
Heavy smoker.
i
hu

Ans.:
rs
va
De
107

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October 7,

OBSTETRICS AND GYNAECOLOGY SHORT QUESTIONS:

4. Deﬁni on of normal labor

progressed to a state from which recovery is impossible

blocked at the end of the tube away from the uterus.

13. Ovarian cryopreserva on

Ans.: Human oocyte cryopreserva on (egg freezing) is a process in which a woman's

14. Precocious puberty

15. Nebothelial cyst

16. Two complica ons of uterine leiomyoma

18. Deﬁne engagement (A.81)

19. Deﬁne Maternal mortality ra o (A.602)

21. Alert & ac on lines in partogram (A.531) 3

parallel to the alert

24. Ac ve management of third stage of labour. (A.141)

25. Non contracep ve uses of combined oral contracep ve pills. (B.489)

Reduc on of dysmenorrhea (40%) (3) Reduc on of menorrhagia (50%) (4) Reduc on of

26. Mechanism of ac on of Cu-T as a contracep ve (B.480)

⦁ Adhesiolysis (without bowel involvement)(Fig. 35.7)

measured to diagnose the clinical condi on of polyhydramnios or oligohydramnios

more than 90°.

Sacral angle less

Wide (85°) Slightly narrow Narrow Very wide (more

Normal Normal or short Short Wide

the cervix. The arrest

38. Missed abor on (A.163)

called missed miscarriage or early fetal demise.

39. A tude of foetus (A.76)

pa ent to lateral posi on. The

41. Side eﬀects of Danazol (B.530)

42. Describe characteris cs of cervical mucous in mid cycle (B.115)

anovula on and its disappearance is presump ve evidence of ovula on (Fig. 9.19)

43. Three swab test (B.419)

swab stained with dye

remain dry but the lower

44. Deﬁne micro invasive carcinoma of cervix (B.344)

Ans.: Microinvasive carcinoma is one which is predominantly

45. Red degenera on (B.275)

such called necrobiosis. The cause is not known but

46. Contraindica ons for IUCD (B.480)

in the combined pill are totally eliminated (2) No

called “Lacta on Pill” (3) Easy to take as there is

ﬁbroid, diabetes, epilepsy, smoking and history of

48. Injectable contracep ves (B.491,492)

dose of 150 mg every three months (WHO 4 months)

DMPA reduces the risk of—salpingi s, endometrial

(HWY). There is chance of irregular bleeding and occasional

discon nua on is usually delayed for several months (4–8

observed with long-term use of depot provera. Overweight,

49. Naegele’s rule (A.96)

50. Features of Down ‘s syndrome (A.495)

termina on will have to be seriously considered.

51. Deﬁne engagement (A.81)

52. Causes of DIC in obstetrics (A.626)

• Hyda diform mole

• Non-reac ve (Non-reassuring)—Absence of any fetal reac vity.

frequency should be twice

54. Deﬁni on of puerperal pyrexia (A.432)

55. Causes of polyhydramnios (A.211)

cases. The causes of excessive

recipient twin develops

polydramniosIV. MATERNAL: (i) Diabetes—It is more common in hydramnios.

lowered. It is presumed that a raised maternal