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ANEMIA IN PREGNANCY : MCQS AND IMPORTANT MCQS By DR MARIA RAFI

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  1.  A 30-year-old pregnant female is undergoing routine blood tests . Pregnancy is associated with an increase in which of the following? A) Mean Cell Hemoglobin Concentration (MCHC) B) Serum ferritin concentration C) Hematocrit D) Total Iron Binding Capacity (TIBC) ✅ Answer: D) Total Iron Binding Capacity (TIBC) Explanation: Pregnancy leads to increased TIBC due to higher transferrin synthesis to compensate for increased iron demand. Serum ferritin and iron decrease due to increased iron utilization. Hematocrit reduces due to physiological hemodilution , not an actual decrease in RBC mass. DR MARIA RAFI ;923324747587 2.  A 28-year-old female, para 2+0 , presents with Hb 7 g/dL . What is the next best investigation? A) Hb electrophoresis   B) Total iron-binding capacity (TIBC) C) MCV and peripheral smear ✅ D) Serum iron Answer: A) Hb electrophoresis Explanation: The first step is to check MCV (Mean Corpuscular Volume) to classify anemia...
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Acute coronary syndromes in pregnancy: a literature review ; 15JUNE 2022 SUMMARY BY DR MARIA RAFI

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Acute Coronary Syndromes (ACS) in Pregnancy Introduction 🌟 Rare but critical: ACS in pregnancy is a rare cause of maternal mortality. 🩺 Key to survival: Early recognition and a multidisciplinary team (MDT) approach improve outcomes. Epidemiology and Risk Factors 📊 Incidence: 0.6–10 per 100,000 pregnancies worldwide. Mortality rate: 5.1–11%. UK MBRRACE-UK (2017–2019): Cardiovascular disease = leading cause of maternal deaths (17%). 📈 Increased risk: Pregnant women are 3–4 times more likely to suffer ACS than nonpregnant women. Rising incidence due to increased maternal age and comorbidities. 🔍 Risk Factors by Pathophysiology: Pregnancy-Associated Spontaneous Coronary Artery Dissection (PASCAD): Marfan syndrome, hypertension, family history of SCAD. Atheromatous Disease: Advanced age, obesity, smoking, diabetes, hypertension, dyslipidemia. Thrombotic Risk: Thrombophilia, hypertensive disorders, infections, multiparity, sickle cell disease. Ergom...
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Peripartum cardiomyopathy ; SUMMARY TOG

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  Key Points on Peripartum Cardiomyopathy (PPCM) Introduction 💔 Leading maternal killer in the UK : Cardiovascular diseases, with PPCM as a significant contributor. 📋 Definition (ESC, 2010): Idiopathic heart muscle disease. Onset: End of pregnancy or within 6 months postpartum. Heart failure due to left ventricular dysfunction (ejection fraction <45%). Diagnosis of exclusion : No other heart failure causes found. Epidemiology and Risk Factors 🌍 Incidence : Western countries: 1 in 1000–4000 pregnancies. High-risk regions: Nigeria: 1 in 100 live births. Haiti: 1 in 300 live births. 👩🏾‍🦱 High-risk populations : Afro-Caribbean lineage (worse outcomes). Advanced maternal age (>30 years). Multiparity , multiple pregnancies , obesity. Chronic hypertension , preeclampsia (22% of PPCM cases). 🤰 Preeclampsia link : Occurs 4 times more in PPCM patients than the general population. Pathogenesis Two-Hit Hypothesis for Pathogenesi...
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SGA ; SUMMARY ; Investigation and Care of a Small-for-Gestational-Age Fetus and aGrowth Restricted Fetus (Green-top Guideline No. 31)

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  Initial Steps: History and Examination 🩺 Take a focused history to identify any risk factors for SGA. Examine the abdomen: Check the symphysis-fundal height: If less than the 10th centile, OR Serial measurements over 2 weeks show no growth ➡️ proceed to investigations. Investigations 🔍 Ultrasound scan to assess: Fetal weight and abdominal circumference (biometry). If: Measurements are <10th centile but >3rd centile, AND Criteria for fetal growth restriction (FGR) are not met, classify as SGA. MANAGEMENT   Counseling and Support 🤝 Counsel the patient on: The condition and its implications. The need for regular antenatal follow-ups. Involve the MDT (Multidisciplinary Team) for comprehensive care. Maternal Monitoring 🤰 At every antenatal visit:Monitor blood pressure and Check for protein in urine to rule out preeclampsia. Ask about fetal movements : Fetal Monitoring 👶 Perform fetal surveillance every 2 weeks: Biometry to monitor growth nd Umbilical artery Dopple...
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LATE FGR ;SUMMARY ;Investigation and Care of a Small-for-Gestational-Age Fetus and aGrowth Restricted Fetus (Green-top Guideline No. 31)

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🌸 Late Fetal Growth Restriction (FGR): SUMMARY  🩺 History and Examination Take a detailed history to identify risk factors for FGR. Perform physical examination: 📏 Symphysiofundal height less than 10th centile. 📅 Serial measurements over 2 weeks showing no growth. GO FOR  🔬 Investigations Focus on Ultrasound: Estimated Fetal Weight (EFW) or biometry: Abdominal circumference (AC) OR Individual or combine parameter or EFW <10th centile. Criteria for Late FGR: AC/EFW < 3rd centile  Or at least two out of three ofthe following: 1. Abdominal circumference (AC) or EFW <10th centile. 2. AC/EFW crossing >2 quartiles on the growth centile chart. 3. Cerebroplacental ratio (CPR) <5th centile or Umbilical Artery Pulsatility Index (UA PI) >95th centile. 🌟 Management Plan 🤝 Support and Counseling Counsel the patient about:The diagnosis of Late FGR. Associated maternal and fetal risks. 👩‍⚕️ Maternal Surveillance At each visit: 📊 Monitor blood pressure. 🧪 Chec...
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EARLY FGR SUMMARY

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  Early FGR: What You Need to Know 🩺 Focused History and Examination Take a detailed history and conduct a thorough examination. If the physiological height is less than the 10th centile or there’s no growth for over 2 weeks, suspect SGR/FGR. 🔬 Investigations Focus on weight/biometry: Less than 3rd centile or less than 10th centile with: 🔴 Abnormal umbilical artery Doppler, or 🔴 Abnormal uterine artery Doppler. 💡 Diagnosis: Early FGR. 🛠 Management Plan 🤝 Support and Counseling Counsel the patient regarding: The diagnosis of Early FGR. Associated fetal and maternal risks. Involve the Multidisciplinary Team (MDT) and ensure follow-ups at a consultant-led unit. 🧑‍⚕️ Maternal Assessment At every visit, check for: 📊 Blood pressure. 🧪 Protein in urine. 💭 Fetal movements (ask the mother). 👶 Fetal Assessment Regular evaluations include: 📏 Growth biometry scans. 🌊 Umbilical artery Doppler. Additional tests: 📈 cCTG (Cardiotocography). 🩸 Ductus venosus Doppler. 📅 Frequency of...
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Review Management of large-forgestational-age pregnancy in non-diabetic women TOG

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  Terminology 📖 Large-for-Gestational-Age (LGA): Fetuses or newborns with an (estimated) weight > 90th percentile or 2 SD from the mean for gestational age. Ponderal Index: Indicates body proportions : weight divided by the third power of length (g/cm³) . Macrosomia: Newborns with a birth weight above specific limits (no universal consensus). Common definitions: Birth weight ≥ 4000g , ≥ 4200g , or ≥ 4500g . Generally, it seems appropriate to consider a fetus or newborn with an estimated or actual birth weight 4000 g as macrosomic,6,9 especially in cases of insulindependent diabetes mellitus In this article, we will define LGA fetuses as those with an (estimated) birth weight 4500 g Risk Factors and Obstetric Complications 🩺 Risk Factors : Male infant sex , multiparity, maternal age (30–40 years), white race , diabetes, and gestational age > 41 weeks . 📅 Complications : Higher rates of cesarean delivery , shoulder dystocia , chorioamnionitis ...
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Information sharing and communication in management of large for gestational age babies in non-diabetic mothers ;7JUNE 2023

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  Large for Gestational Age (LGA) Introduction: Large for Gestational Age (LGA) 🌟 Definition of LGA : Refers to fetal size above the 90th centile nomogram for gestational age. 📏 Prevalence : More common among women with obesity or gestational diabetes. ⚖️ Associated Adverse Outcomes : Maternal complications include: Emergency caesarean birth 🚑 Postpartum hemorrhage (PPH) 🩸 Severe perineal trauma 💔 Neonatal complications include: Shoulder dystocia 🤱 Neonatal hypoglycemia 🍼 Critical Period : Most maternal and neonatal morbidity occurs during labor or attempted vaginal birth. ⏳ Antenatal Discussions : Essential for sharing information, counseling, and collaborative decision-making regarding mode and timing of birth. 🗣️ Lack of Guidelines : Absence of specific guidelines for managing LGA in non-diabetic mothers creates uncertainty for obstetricians. 🤔 HSIB (2020) National Learning Report highlighted poor information sharing and collaborat...
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What happens if your baby is measuring large for dates? NHS

  Patient Information Leaflet Large for Gestational Age (LGA) What is a Large for Gestational Age (LGA) Baby? 🔹 Definition: Babies weighing >4.5 kg (9 lbs 14.5 oz) at birth. Defined as babies larger than 90th or 97th percentile on growth charts. 🔹 Individualized Growth Chart: Created during your 12-week scan appointment , based on your height, weight, previous pregnancies, and ethnicity. 🔹 Prevalence: About 5–8 out of 100 babies are identified as LGA. Why Does it Matter if My Baby is LGA? ✅ Most large babies are healthy. ✅ 90% of women with LGA babies can have a vaginal birth. ⚠️ However, risks increase when: Birthweight exceeds 4.5 kg . Baby measures >97th percentile for gestational age on the growth chart. What Causes a Baby to Be LGA? 🍭 Diabetes: Pre-existing or gestational diabetes (GDM). 🤰 History of LGA Babies: Previous baby weighing >4.5 kg at birth . ⚖️ Maternal Obesity/Overweight: High BMI or excessive weight ga...
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Management of Large for Gestational Age Fetus ; Scientific Impact Paper No. XX Peer Review Draft – February 2018

Scientific Impact Paper No. XX Peer Review Draft – February 2018 Management of Large for Gestational Age (LGA) Fetus Management of Pregnancies with Suspected Macrosomia Background 📝 Definition: Macrosomia: Neonatal birthweight >4000 g (common cut-off), or >4500 g and >5000 g in some definitions. Large for Gestational Age (LGA): Fetal weight >90th percentile for gestational age. 📊 Prevalence: Macrosomia: Occurs in ~10% of pregnancies. Elective Cesarean Section (CS): Recommended for: Diabetic pregnancies: EFW ≥4500 g. Non-diabetic pregnancies: EFW ≥5000 g. Risks Maternal Risks : 🏥 Emergency CS: Risk increases with weight. 🩸 Postpartum Hemorrhage (PPH): Nearly doubles with neonates >4000 g. 🧵 Perineal Trauma: 3-4x higher risk with macrosomic neonates. Neonatal Risks : 💔 Shoulder Dystocia: 20x higher risk in macrosomic neonates. 🦴 Brachial Plexus Injury: 1.3–1.5/1000 births, 20x higher with macrosomia. 🦴 Clavicle or Humerus...
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Insulin TYPE /DOSE AND REGIMEN { SOGP} CPSP

🌟 3.2.2: Insulin 💉 Insulin as Gold Standard : Insulin is the gold standard treatment for women with diabetes in pregnancy. 🌟 When Medical Nutritional Therapy (MNT) and Oral Hypoglycemic Drugs (OHD) fail to control blood glucose (BG) values: Start insulin alone or combine it with Metformin . 🛑 Indications for Insulin Use : Start insulin as a first-line treatment for women with: ⚠️ Obstetrical complications (e.g., pre-eclampsia, polyhydramnios, macrosomia ). FBS ≥ 126 mg/dL (≥7.0 mmol/L) . RBS ≥ 200 mg/dL (≥11.1 mmol/L) . 💡 3.2.2.1: Insulin Types 🟢 Basal Insulin : Recombinant human intermediate-acting insulin ( NPH ). Long-acting insulin analogue ( Detemir ). 🔵 Bolus Insulin : Recombinant human short-acting insulin ( Regular insulin ). Short-acting insulin analogues ( Aspart and Lispro ): 🌟 Preferred for women with nausea and vomiting to reduce hypoglycemia and improve postprandial BG levels. ⚠️ Premixed Insulin Regimens : General...
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ANEMIA IN PREGNANCY : MCQS AND IMPORTANT MCQS By DR MARIA RAFI

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  1.  A 30-year-old pregnant female is undergoing routine blood tests . Pregnancy is associated with an increase in which of the following? A) Mean Cell Hemoglobin Concentration (MCHC) B) Serum ferritin concentration C) Hematocrit D) Total Iron Binding Capacity (TIBC) ✅ Answer: D) Total Iron Binding Capacity (TIBC) Explanation: Pregnancy leads to increased TIBC due to higher transferrin synthesis to compensate for increased iron demand. Serum ferritin and iron decrease due to increased iron utilization. Hematocrit reduces due to physiological hemodilution , not an actual decrease in RBC mass. DR MARIA RAFI ;923324747587 2.  A 28-year-old female, para 2+0 , presents with Hb 7 g/dL . What is the next best investigation? A) Hb electrophoresis   B) Total iron-binding capacity (TIBC) C) MCV and peripheral smear ✅ D) Serum iron Answer: A) Hb electrophoresis Explanation: The first step is to check MCV (Mean Corpuscular Volume) to classify anemia...
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IMPORTANT MCQS OF 2024for imm ; fcps ; mcps ; IMM (MUST DO BEFORE EXAM DAY )

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  1. A 13-year-old girl (P0) presents with irregular vaginal bleeding since menarche one year ago. Examination is unremarkable, and lab reports are normal. What is the best management? a) Anti-Prostaglandins b) Cyclical Progesterone c) Tranexamic Acid d) Combined Oral Contraceptive Pills Key: d) Combined Oral Contraceptive Pills Explanation: Adolescent abnormal uterine bleeding (AUB) is often due to anovulatory cycles. Combined oral contraceptive pills (COCPs) help regulate menstrual cycles by providing hormonal balance. 2. A 27-year-old primigravida (P0) with a breech presentation is being evaluated for the possibility of vaginal delivery. In which type of breech presentation does X-ray pelvimetry still have a role? a) Flexed Breech b) Extended Breech c) Face Presentation d) Shoulder Presentation Key: b) Extended Breech Explanation:  . Among breech presentations, extended breech is considered the safest for vaginal delivery due to better head flexion and descent. 3. A 30-y...
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IMPORTANT MCQS FILE 3 (70 mcqs) : IMM ; MCPS ; FCPS

1. A 32-year-old G2P1 woman with a previous cesarean section presents to OPD at 30 weeks of gestation. She has a history of chronic hypertension and is on oral labetalol 100 mg twice daily. Her BP is 160/100 mmHg, and fundal height corresponds to 26 weeks. Doppler ultrasound shows reduced end-diastolic flow. What is the next step in management? A. Ductus Venosus Doppler B. Umbilical and Middle Cerebral Artery Doppler C. Middle Cerebral Artery Doppler D. Uterine Artery Doppler Answer: A. Ductus Venosus Doppler Explanation: Reverse end-diastolic flow in umbilical artery Doppler is an ominous sign of fetal compromise. Ductus Venosus Doppler is the next step to assess fetal well-being, particularly cardiac compromise to time delivery before time  2. A 35-year-old P4+0 woman presents with complaints of something coming out of the vagina. On POP-Q staging, the findings are Aa +3, Ba +6, C -8, Ap +3, Bp +6, and TVL 10 cm. What is the best management option? A. Manchester Rep...
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