Explanation:

Anomalies of the skeletal system may be extremely difficult to diagnose and may not manifest after 20 weeks.

Explanation:

The pituitary gland increases the production of prolactin and adrenocorticotrophin (ACTH). Plasma concentrations of cortisol, aldosterone, renin and angiotensin rise. There is an increase in the production thyroid hormone, but an increase in production of thyroid binding globulin means that the free plasma concentration of thyroid hormones (thyroxin) remains unchanged (not increased).

Explanation:

Valproate is associated with neural tube defects (extra folate should be prescribed), captopril is teratogenic and valsartan is contraindicated. Methyldopa is used for hypertension in pregnancy and paracetamol is safe throughout a normal pregnancy.

Explanation:

High concentrations of bupivacaine may cause an increase in the rate of instrumental delivery but not an increase in the rate of caesarian sections (NEJM 2005; 352:655-665).
Pruritus is due to opiates.
Tinnitus may occur when bupivacaine is given intravascularly or when the plasma levels of bupvacaine reach toxic levels. A total spinal or high spin block occurs when a large volume of bupivacaine is injected into the subarachnoid space and is a rare complication of an epidural (read the question).
Epidural bupivacaine does not decrease uterine contractility.

Explanation:

Spina bifida is a congenital defect of the spine resulting from the failure of closure of the neural tube at 3 to 4 gestational weeks. In cases where the meninges protrude through this defect, it is called a meningocele, and if neural tissue is involved, it is a myelomeningocele. These lesions may occur anywhere along the spine but are more common in the lumbar and sacral regions. Its prevalence is estimated to be around 1 in 1000 births, but there is much racial and geographic variation. For example, prevalence is higher in Wales. It does not follow any particular pattern of inheritance; however the recurrence risk is higher for women who have previously given birth to a child with a neural tube defect (2-3%). If there are two previously affected children, the risk is approximately 6%. The ultrasound diagnosis of spina bifida is based on the evaluation of the fetal spine, which is usually clearly visualized by 16 weeks of gestation in the majority. Each vertebra has three ossification centres, one anterior and two posterior. The normal posterior ossification centres are seen as two closely spaced parallel lines of echoes. When spina bifida is present, there is spraying of the posterior ossification centres on the transverse and longitudinal scans. Polyhydramnios is an excess of amniotic fluid in the uterus. In general, it is caused by either excessive production of fluid or inadequate utilization or removal of fluid. It may be associated with neural tube defects. Women who take folate supplementation before and during the early stages of pregnancy have a lower chance of having a child with spina bifida. Children with Spina bifida are at risk of paving a neuropathic bladder and hence urinary incontinence.

Explanation:

Postpartum hemorrhage is blood loss of > 500 mL during or immediately after the 3rd stage of labor. Risk factors for bleeding include uterine atony due to over-distention (caused by multifetal pregnancy, polyhydramnios, or an abnormally large fetus), prolonged or dysfunctional labor, grand multiparity (delivery of 2 5 viable fetuses), relaxant anesthetics, rapid labor, chorioamnionitis, and retention of placental tissue (eg, due to placenta accreta).
Treatment involves intravascular volume replenishment with IV fluids. Blood transfusion is used if this volume of saline is inadequate. Hemostasis is attempted by bimanual uterine massage and IV oxytocin.

Explanation:

Uteroplacental insufficiency is associated with late decelerations. Cord compression is associated with variable decelerations. Head compression is associated with early decelerations

Explanation:

This patient manifests a rapid onset of preeclampsia at term. The symptoms of epigastric pain and headache categorize her preeclampsia as severe. These symptoms indicate that the progress is well advanced and that convulsions are imminent. Treatment should focus on rapid control of symptoms and delivery of the infant.

Explanation:

Explanation:

Routine prenatal care begins at the onset of pregnancy. By 36 weeks gestation the majority of the tests that are usually done are no longer able to be done since they fall well outside the recommended time frame for the test results.
The following is a brief summary of the approximate time for some of the prenatal tests:
Triple marker: 15-18 weeks gestation
Amniocentesis: if necessary, usually15-18 weeks
Screen for gestational diabetes: 24-28 weeks gestation
Group B strep: 35-37 weeks gestation

Explanation:

The 1st stage, from onset of labor to full dilation of the cervix (about 10 cm), has 2 phases latent and active. During the latent phase, irregular contractions become progressively better coordinated, discomfort is minimal and the cervix effaces and dilates to 4 cm. During the active phase, the cervix becomes fully dilated, and the presenting part descends well into the midpelvis. On average, the active phase lasts 5 to 7 hours in nulliparas and 2 to 4 hours in multiparas. If the membranes have not spontaneously ruptured, some clinicians use amniotomy (artificial rupture of membranes) routinely during the active phase. As a result, labor may progress more rapidly, and meconium-stained amniotic fluid may be detected earlier.
Amniotomy during this stage may be necessary for specific indications, such as facilitating internal fetal monitoring to confirm fetal well-being.
Amniotomy should be avoided in women with HIV infection or hepatitis B or C, so that the fetus is not exposed to these organisms.

Explanation:

Explanation:

Explanation:

Preeclampsia is the likeliest cause of this constellation of symptoms in a patient who is eight months pregnant. Hepatitis B would not produce hypertension and edema. A drug overdose leading to this picture would be unusual. Cytomegalovirus infection, while a cause of hepatitis, would not produce edema and hypertension. An adrenal adenoma would not cause this pattern of symptoms.

Explanation:

Good prenatal care is the best predictor of the delivery of a healthy neonate. Multivitamins may be considered part of good care, but are not a major factor alone. There is no role for prophylactic antibiotics in normal pregnancies. Folate is indicated when a woman is deficient, but is not otherwise indicated. Family history is not associated with delivery outcome.

Explanation:

The corpus luteum is maintained by placental HCG secretion and produces progestogens and oestradiol until later the placenta can maintain this role. Relaxin is found in pregnant humans but at higher levels early in pregnancy than close to the time of birth. Relaxin promotes angiogenesis and in humans it probably plays a more important role in the development of the interface between the uterus and the placenta that it does in the birth

Explanation:

Stroke volume increases by 20-30% during pregnancy. The systemic vascular resistance decreases by about 30% due to hormone-mediated vasodilation. The systolic and diastolic blood pressures decrease by 10% at 20 weeks gestation. Heart rate increases by 25% in the middle of the third trimester. Central venous pressures and pulmonary capillary wedge pressures remain stable.

Explanation:

Cremation of fetal remains less than 24 weeks is not subject to the Cremation Act.
As such, forms 4 and 5 should not be completed. In spite of this most crematoria are happy to make arrangements to cremate fetal remains. Where body parts are removed at post mortem, arrangements for cremation of these are normally made by the pathology service.

Explanation:

Under such unusual circumstances, when a second twin is breech or a breech vaginal birth is progressing quickly, a cesarean is neither recommended nor possible.
There are several different types of vaginal breech deliveries: The delivery can occur without help from a health professional (spontaneous breech birth). During a spontaneous breech birth, the fetus comes out of the vagina without problems. The health professional just supports the fetus´s body as it emerges from the birth canal.
A health professional may need to help deliver the upper part of the fetus´s body (partial breech extraction). During a partial breech extraction, a health professional pulls gently downward on the fetus and rotates its body as needed to deliver the shoulders, arms, and head. Occasionally, a health professional may need to help the fetus during the entire delivery (total breech extraction). This is usually done only when the fetus is having problems and needs to be delivered as quickly as possible.
During a partial or total breech extraction, the health professional may need to reach into the birth canal in order to move part of the fetus into a better position for delivery. If the health professional is having difficulty delivering the fetus´s head, forceps may be used to guide the head through the birth canal. Forceps may also be used to speed delivery if the fetus is in danger.

Explanation:

The fetal biophysical profile is a means of assessing fetal well-being by combining information from dynamic ultrasonography with fetal heart rate response to fetal movements. The ultrasound components include fetal breathing movements, gross body movements, fetal tone, and a qualitative assessment of amniotic fluid volume. This test is commonly dove after 28 weeks gestation (after which fetal viability is likely) and can be used to assess fetal well-being in patients with intrauterine growth retardation (IUGR> or other high-risk pregnancies.
The test is performed at varying frequencies depending upon the obstetric or fetal risk level. A normal score (10/10) is reliable evidence of fetal well-being at the time of the test and that fetal demise is unlikely in the following 7 days. Lower scores have variable interpretations, depending on the clinical circumstances. For example, a score of 8/10 with low amniotic fluid volume may indicate risk for acute decompensation. Adequate amniotic fluid is defined as one of more pockets of fluid > 2 cm in vertical diameter.

Explanation:

Explanation:

The process to diagnose the cause for infertility usually begins with physical exams and health and sexual histories. If there are no obvious problems, like poorly timed intercourse or absence of ovulation, tests will be needed.
For a man, doctors usually begin by testing his semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man´s hormones.
For a woman, the first step in testing is to find out if she is ovulating each month. There are several ways to do this. A woman can track her ovulation at home by recording changes in her morning body temperature (basal body temperature).for several months. Doctors can also check if a woman is ovulating by doing blood tests and an ultrasound of the ovaries. If the woman is ovulating normally, more tests are needed.
Hysterosalpingography and laparoscopy can be done after the initial tests if necessary.

Explanation:

Injectable medroxyprogesterone acetate is not causally linked with thromboembolic events. The most common side effect is menstrual irregularities; weight gain is also a bothersome side effect. There may be a decrease in HDL-cholesterol and an increase in LDL. The cost is similar to that of combination oral contraceptives.

Explanation:

Explanation:

Smoking reduces birth weight which may be of critical importance if the baby is born pre-term.
On average, the babies of smokers weigh 170g less than non-smokers, but the reduction in birth weight is related to the number of cigarettes smoked per day.
Smoking is also associated with an increased risk of miscarriage and still birth. The infant has a greater risk of sudden infant death syndrome.There is some evidence that maternal smoking may adversely affect ovarian function in female children.No dysmorphic syndrome has yet been described.

Explanation:

Endometriosis is a noncancerous disorder in which functioning endometrial tissue is implanted outside the uterine cavity. Symptoms depend on location of the implants and may include dysmenorrhea, dyspareunia, infertility, dysuria, and pain during defecation. Diagnosis is by biopsy, usually via laparoscopy.
Diagnostic laparoscopy is a surgical procedure used to evaluate intra- abdominal or pelvic pathology (eg, tumor, endometriosis) in patients with acute or chronic abdominal pain and operability in patients with cancer. It is also used for lymphoma staging and liver biopsy.

Explanation:

The vacuum extractor has a probable advantage compared with forceps in a number of areas. These induce easier application; lower maternal anesthesia requirements, and less risk of maternal soft-tissue and fetal facial injury. There is an increased incidence of cephalohematoma, Neonatal outcomes as measured by Apgar scores and. umbilical artery blood gases, have not been shown to be significantly different between forceps and vacuum deliveries. Forceps have been associated with higher rates of successful delivery in some studies, as they may represent an option for delivery when vacuum extraction has failed. Incomplete cervical dilatation is a relative contraindication to use of the vacuum extractor.

Explanation:

Explanation:

Potter syndrome is a term used to describe the typical physical appearances of a fetus or neonate due to a dramatically decreased amniotic fluid volume oligohydramnios, or absent amniotic fluid anhydramnios, secondary to renal diseases such as bilateral renal agenesis. Other causes of Potter syndrome can be obstruction of the urinary tract, polycystic or multicystic kidney diseases, renal hypoplasia and rupture of the amniotic sac.
The decreased volume of amniotic fluid causes the growing fetus to become compressed by the mother´s uterus. This compression can cause many physical deformities of the fetus, most common of which is Potter facies. Lower extremity anomalies are frequent in these cases, which often presents with clubbed feet and/or bowing of the legs.

Explanation:

Causes of bleeding during the third trimester include placenta previa (20%), placental abruption (30%), ruptured vasa previa, uterine scar disruption and bloody show.
Threatened abortion is vaginal bleeding occurring before the 20th week of pregnancy and indicating that spontaneous abortion may occur.

Explanation:

Maternal serum triple marker screening is done between 15-18 weeks. Post partum visit happens 6 weeks after delivery. CVS can be done between 10-12 weeks. GTT is done between 24-28 weeks. Rhogam is given at 28 weeks to RH negative women.