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

Image
  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...
Post a Comment

LATE FGR ;SUMMARY ;Investigation and Care of a Small-for-Gestational-Age Fetus and aGrowth Restricted Fetus (Green-top Guideline No. 31)

🌸 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.

🧪 Check for protein in urine.

💭 Ask about fetal movements.

👶 Fetal Surveillance

Perform the following at regular intervals:

📏 Serial growth scans.

🌊 Umbilical artery Doppler studies.

📈 Computerized CTG (cCTG) for short-term variation and fetal heart rate.

Additional modalities:after  term 

🩸 Middle cerebral artery (MCA) Doppler.

⚖️ Cerebroplacental ratio (CPR).

🔄 Umbilical cerebral ratio (UCR).


⏳ Late FGR Management Based on Gestation

📅 32 to 33+6 Weeks

Deliver via C-section (after magnesium sulfate and steroid cover) if:

🚩 Maternal indication or fetal as 

CTG abnormalities, such as:

  • Spontaneous, repeated, persistent, unprovoked fetal heart rate decelerations.
  • Short-term variation (STV) <3.5 milliseconds.

📅 34+ Weeks and onward if fetomaternal concern as above or 

Deliver if: Short-term variation (STV) <4.5 milliseconds.

Now on basis of Umbilical artery Doppler findings:

  • Reversed end-diastolic flow: Deliver at 32 weeks.
  • Absent end-diastolic flow: Consider delivery at 32 weeks, absolute delivery by 34 weeks.
  • Increase  pulsatility index: Deliver between 36 to 36+6 weeks.

🚼if FGR(<3rd centile )  and umbilical artery doppler normal = continue pregnancy till 37 weeks and not delay after 37 weeks ;even if MCA, CPR OR UCR ARE NORMAL 

🍼 Post-Delivery Care

Offer investigations to identify any underlying problems in the baby.

Monitor the newborn for complications such as hypoglycemia or respiratory distress.

🌈 Planning for the Next Pregnancy

🔄 Address Modifiable Risk Factors Before Pregnancy

Optimize maternal health (e.g., control hypertension, diabetes).

🚭 Counsel on smoking cessation.

🚫 Avoid alcohol and drug use.

🩺 Early Booking and Screening

  • Start aspirin (150 mg daily) before 16 weeks to prevent recurrence of FGR.
  • Conduct serial growth scans throughout the pregnancy.



Comments

Post a Comment

Popular posts from this blog

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

Image
  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...
Read more

IMPORTANT MCQS OF 2024for imm ; fcps ; mcps ; IMM (MUST DO BEFORE EXAM DAY )

Image
  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...
Read more

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...
Read more