OBSTETRICS Page | 1

OBS & GYNE

NCERT
Contents
IMP LISTS................................................................................................3
PAPER -1 ..................................................................................................................3
PAPER -2............................................................................................................9

OBSTETRICS .......................................................................................... 15
Introduction.....................................................................................................16
Labor...................................... .........................................................................22
Hemorrhage & Twin Pregnancy........................................................................28
Hypertensive Disorders....................................................................................38
APH & Medical Illness Complicating Pregnancy...............................................49
PPH & Preterm Labor.......................................................................................66
Purperium........................................................................................................76
Malpresentation...............................................................................................79
Miscellaneous..................................................................................................87

GYNECOLOGY ........................................................................................ 87
Introduction................................................. ...................................................95
Pelvic Infections & Endometriosis..................................................................105
AUB..................................................... ..........................................................115
Displacement of Uterus..................................................................................125
Infertility & Amenorrhea................................................................................134
Benign Lesion and Neoplasm.........................................................................152
Genital Malignancy........................................................................................167
Contraception................................................................................................176
Miscellaneous................................................................................................186

OBSTETRICS & GYNECOLOGY PARTH GOYAL

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OBS & GYNE NCERT

Author’s name: Parth Goyal
Published by: Parth Goyal
Madhoganj, Lashkar, Gwalior – 474001

Printed by Parth Goyal

First Edition, 2025

ISBN : 978-81-954886-7-4

Website: www.medullaonline.com
© Copyright, 2024, Author
All rights reserved, No part of this book may be reproduced, stored in a retrieval system or
transmitted, in any form by any means, electronic, mechanical, magnetic, optical, chemical,
manual, photocopying, recording or otherwise, without the prior written consent of its writer.

Price : Rs.1499/-
Printed in India

OBSTETRICS & GYNECOLOGY PARTH GOYAL

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Obstetrics & Gynecology PART 1 - IMP LIST

Introduction

Functions of Placenta - MPMSU 23 Feb - 5 marks

Enumerate causes of different color Amintonic liquor. - MPMSU 19 Jun - 5 marks

Diagnosis of early Pregnancy. - MPMSU 21 Apr, 23 Feb - 5 marks

Evaluation of antenatal/antepartum fetal well being - MPMSU 22 May, 24 Feb - 20 marks

Labor

Bishops score and its significance. - MPMSU 19 Jun - 5 marks

Define normal labour. Write management of 2nd stage labor. - MPMSU 19 Jun- 20 marks

Partograph. - MPMSU 21 Nov - 5 marks

Hemorrhage in Early Pregnancy

A 24 years old primigravida with 10 weeks of gestation presented with history of profuse vaginal
bleeding and severe abdominal pain since 2 hours. On examination the patient appears pale,
pulse rates is 110 minute, blood pressure is 100/70mm Hg. On P/V examination, size of uterus
is 6 weeks and the internal Os is open. - MPMSU 24 Feb - 20 marks

A) Define abortion.

B) Classify abortions.

C) Enumerate the etiological factors that can cause spontaneous miscarriage.

D) What is the most likely clinical diagnosis in this case?

E) How will you manage this patient?

Write fate of tubal ectopic Pregnancy. - MPMSU 21 July - 5 marks

Describe H mole, risk factors and management - MPMSU 20 Aug - 20 marks

Twin Pregnancy

A G1P0 32 Year old Women Present at 30 weeks of gestation with a fundal height of 36 weeks.
What are the differential diagnosis. Enumerate the complications of twin Pregnancy. - MPMSU
20 Feb - 20 marks

Complications specific to monochorionic twin Pregnancy. - MPMSU 21 Nov - 5 marks

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Hypertensive Disorders

Classify Hypertensive disorders in Pregnancy. How would you manage a Primigravida coming
to you with 36 weeks gestation and generalized tonic clonic seizures for last 2 Hours not in labor
- MPMSU 19 Feb - 20 marks

Classify Hypertensive disorder in Pregnancy. Write management of gestational Hypertension in

28 weeks. - MPMSU 19 Jun - 20 marks

Risk factors for Pre-eclampsia. - MPMSU 22 May - 5 marks

Describe Eclampsia and its complications. How will you manage a case of eclampsia presenting
at 34 weeks of pregnancy - MPMSU 20 Aug - 20 marks

Pritchard regime - MPMSU 20 Feb - 5 marks

A Primigravida of 32 week of gestation was admitted with convulsions and blood pressure of
160/110 mm of hg. What is your provisional diagnosis and how would you manage the case -
MPMSU 21 Nov - 20 marks

A primigravida aged 28 years with 32 weeks of pregnancy comes to the hospital with history of
convulsion (seizures) 3 episodes.
On examination shw has grade 3 odema, BP of 160/110 mm Hg, height of uterus 32 weeks with
cephalic presentation and FHR of 130 to 140 beats/min. - MPMSU 24 Feb - 20 marks

A. What is most probable diagnosis ?

B. How do you manage this case ?
C. What are the differential diagnosis of seizures in third trimester?
D. What is HELLP syndrome
E. What is Pritchard regime

APH

Define Antepartum Haemorrhage. Write its classification, diagnosis and management of

Abruption Placentae - MPMSU 19 Jun, 21 Apr - 20 marks

Define APH. What are the differential diagnosis of APH.

Enumerate the distinguishing features of Placenta Previa and abruption Placentae. - MPMSU
20 Feb, 23 Feb - 20 marks

Discuss about clinical features, management of a second gravida with previous caesarean with
36 weeks of pregnancy with bleeding per vaginum. - MPMSU 22 May - 20 marks

Medical Illness Complicating Pregnancy

Classify anaemia in Pregnancy. Describe the management of a G2P1 patient at 32 weeks with
Hb 8 gm% Who is intolerant to oral iron therapy. - MPMSU 20 Feb, 21 Nov - 20 marks

Classification of Anemia What is Physiological Anemia. - MPMSU 20 Aug - 5 marks

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Outline the management of a case of severe Anemia presenting at 38 Weeks of Pregnancy. -

MPMSU 21 Apr - 5 marks

Describe maternal and fetal complications of Anemia complication pregnancy. - MPMSU 21 July
- 5 marks

Write down Treatment of 3rd gravida with HB% 7.5 gram % at 32 Weeks gestation - MPMSU 22
May - 5 marks

Describe the management of a case of diabetes in Pregnancy - MPMSU 21 Apr - 20 marks

Screening for diabetes in Pregnancy. - MPMSU 22 May, 24 Feb - 5 marks

Complications associated with elderly primigravida - MPMSU 24 Feb - 5 marks

Preterm Labour

Define preterm labor, Discuss antenatal management of a Primigravida, coming to you at 30

weeks gestation with pain lower abdomen - MPMSU 19 Feb - 20 marks

Define preterm labor, Discuss antenatal management of a Primigravida, coming to you at 34

weeks gestation with pain lower abdomen - MPMSU 23 Feb - 20 marks

Describe Etiology, Manifestations, Complication, and management of Premature birth.- MPMSU

22 May - 20 marks

Preterm Labour - MPMSU 20 Aug - 5 marks

Define Prom and write causes of Prom. - MPMSU 19 Jun - 5 marks

Complication of 3rd stage of labour

What is Postpartum Haemorrhage? Describe the type and causes of PPH. - MPMSU 20 Aug -
20 marks

Diagnosis and management of atonic PPH - MPMSU 21 Apr, 20 Aug - 20 marks

What are the causes of atonic PPH. How will you manage a case of atonic PPH during
cesarean section. - MPMSU 21 July - 20 marks

What is Post Partum Haemorrhage. Discuss AMTSL. - MPMSU 21 Nov - 20 marks

Malpresentation
Enumerate types of breech presentation. Describe the etiology, clinical features and diagnosis.
How will you manage a Primigravida in labor with breech presentation - MPMSU 21 July - 20
marks
Principles of assisted breech delivery. - MPMSU 21 Apr - 5 marks

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Define Deep Transverse Arrest. Write down its diagnosis and management. - MPMSU 23 Feb -
20 marks

Shoulder dystocia and its mx - MPMSU 20 Feb, 24 Feb - 5 marks

Puerperium

Define Puerperal sepsis. Describe the Predisposing factors and causative organisms. How will
you manage a case of puerperal sepsis in a primipara patient. - MPMSU 21 July, 20 Aug - 20
marks

Pharmacology

Non-Contraceptive benefits of ocps. - MPMSU 20 Feb, 21 Nov - 5 marks

Describe various uses of Misoprostol in Obstetrics - MPMSU 19 Feb - 20 marks

Community Obstetrics

LAQSHYA Program. - MPMSU 19 Feb - 5 marks

Discuss maternal to child transmission in HIV and measures to prevent vertical transmission -
MPMSU 21 July, 24 Feb - 20 marks

Janani Suraksha Yojana - MPMSU 24 Feb - 5 marks

Miscellaneous

Neonatal Jaundice. - MPMSU 19 Feb - 5 marks

Difference between symmetrical and asymmetrical IUGR - MPMSU 23 Feb - 5 marks

Role of ultrasonography in obstetrics. - MPMSU 19 Feb - 5 marks

2-Marks
2019(feb)

Most Common Causes of maternal deaths in india. - MPMSU 19 Feb - 2 marks

Components of biophysical Profile. - MPMSU 19 Feb - 2 marks
Drugs used for induction of labor. - MPMSU 19 Feb - 2 marks
Neonatal complications of Preterm birth. - MPMSU 19 Feb - 2 marks
Essential (2) Non-Essential Components of AMTSL. - MPMSU 19 Feb - 2 marks
Causes of Anemia in pregnancy. - MPMSU 19 Feb - 2 marks

2019( June)

PPIUCD - MPMSU 19 Jun - 2 marks

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Emergency contraception. - MPMSU 19 Jun - 2 marks

Follow up of vesicular mole. - MPMSU 19 Jun - 2 marks
Antepartum surveillance. - MPMSU 19 Jun - 2 marks
Low birth Weight Newborn. - MPMSU 19 Jun - 2 marks
Lactation Failure. - MPMSU 19 Jun - 2 marks

2020(Jan-Feb)

Medical methods of induction of labor. - MPMSU 20 Feb - 2 marks

Selection criteria for trial of labor after cesarean section (TOLAC) - MPMSU 20 Feb - 2 marks
Oral glucose tolerance test. - MPMSU 20 Feb - 2 marks
AMTSl - MPMSU 20 Feb - 2 marks
Severe features of Pre-eclampsia. - MPMSU 20 Feb - 2 marks
Physical features of a term newborn infant. - MPMSU 20 Feb - 2 marks

2020(August)

Episiotomy. - MPMSU 20 Aug - 2 marks

Importance of Antenatal care. - MPMSU 20 Aug - 2 marks
Biophysical profile. - MPMSU 20 Aug - 2 marks
Types of abruption placenta and its complications. - MPMSU 20 Aug - 2 marks
High Risk Factors for Preeclampsia. - MPMSU 20 Aug - 2 marks
MTP act. - MPMSU 20 Aug - 2 marks

2021( April)
Prevention of pre-Eclampsia. - MPMSU 21 Apr - 2 marks
PGE2 gel. - MPMSU 21 Apr - 2 marks
Unruptured ectopic Pregnancy. - MPMSU 21 Apr - 2 marks
Advantages of ventouse over Forceps. - MPMSU 21 Apr - 2 marks
Threatened abortion. - MPMSU 21 Apr - 2 marks
Premature Rupture of Membranes. - MPMSU 21 Apr - 2 marks

2021( July)
Write Classification of Hypertensive disorders of Pregnancy. - MPMSU 21 July - 2 marks
Neural tube defects and its complications. - MPMSU 21 July - 2 marks
Male Sterilization techniques and its benefits. - MPMSU 21 July - 2 marks
Enumerate direct and indirect causes of maternal mortality. - MPMSU 21 July - 2 marks
Mechanism of Action of DMPA (ANTARA) - MPMSU 21 July - 2 marks
Drugs uses for Parenteral iron therapy in Pregnancy . Write advantages and disadvantages. -
MPMSU 21 July - 2 marks

2021( november)

Medical methods of induction of labor. - MPMSU 21 Nov - 2 marks

RU486. - MPMSU 21 Nov - 2 marks
Benefits of breast feeding. - MPMSU 21 Nov - 2 marks
Causes of breach Presentations. - MPMSU 21 Nov - 2 marks
LNG-IUS. - MPMSU 21 Nov - 2 marks
Screening method in Cancer Cervix. - MPMSU 21 Nov - 2 marks

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2022( May)
Episiotomy. - MPMSU 22 May - 2 marks
Extended breech. - MPMSU 22 May - 2 marks
Bishop’scire. Mifepriston. - MPMSU 22 May - 2 marks
PPIUCD insertion. - MPMSU 22 May - 2 marks
Lower uterine segment. - MPMSU 22 May - 2 marks

2023 (Feb)
Magnesium sulphate dose regimes in the management of eclampsia
Prostaglandin E2 Gel
Incomplete Abortion.
Components of biophysical profile
Advantages of breast feeding
Episiotomy

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Obstetrics & Gynecology PART 2 - IMP LIST

Introduction

Lymphatic drainage of cervix. { MPMSU 20 Feb- 5 marks }

Describe Embryogenesis of female genital organs. { MPMSU 19 Feb - 20 marks}

Describe in short natural defence mechanism of female genital tract. {MPMSU 23 Feb- 20 marks}

Puberty Menorrhagia. { MPMSU 20 Feb, 21 July, 24 Feb- 5 marks }

A 12 year old girl presented with heavy menstrual bleeding since 15 days. Discuss the following .
[A]- Differential diagnosis . [B]-Management of the Patient. { MPMSU 22 May - 20 marks}

Hyperprolactinemia. { MPMSU 21 July - 5 marks }

Menstrual Cycle
Physiology of the menstrual cycle. { MPMSU 21 feb- 20 marks }

Menopause
Health concerns of menopause - MPMSU 24 Feb - 5 marks

Hormone replacement therapy. { MPMSU 21 July, 19 Feb - 5 marks }

Diagnostic Procedures

Colposcopy. { MPMSU 23 Feb- 5 marks }

Pap test.

Pelvic Infections
Work up to diagnose genital tuberculosis. { MPMSU 19 Oct- 5 marks }
PID

STI
Bacterial Vaginosis
Bartholin cyst

Diagnosis and management of trichomonilial vaginitis. What are the factors predisposing to this
condition. { MPMSU 20 April, 21 Feb- 5 marks }

What is Syndromic management of STI’s. How is it more useful than laboratory based
management of STI’s. {MPMSU 19 Feb - 20 marks}

Syndromic approach for STD in Women. {MPMSU 21 Nov, 22 Oct- 5 marks}

Dysmenorrhea
Explain dysmenorrhea with its types. { MPMSU 23 Feb- 5 marks }

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AUB
What is AUB, FIGO classification of AUB and Management of Menorrhagia. .{ MPMSU 20 Aug, 19
Jun, 24 Feb - 20 marks }

What is FIGO classification of AUB. How will you manage a case of 22 year old null-parous female
with submuosal fibroid of 5x4cm having complained of intermenstural bleeding .{MPMSU 19 oct-
20 marks}

Describe diagnosis and management of Abnormal uterine bleeding in P3L3 at 45 yrs of age.
{MPMSU 21 Nov, 24 Feb - 20 marks }

Displacement of Uterus

Supports of the uterus and their importance. { MPMSU 20 April- 5 marks }

Describe the supports of uterus along with the diagram. Discuss its etiology, POP-Q classification
& clinical features of Pelvic organ prolapse. { MPMSU 23 Feb,19 Oct, 21 Nov, 24 Feb - 20 marks}

Describe surgical anatomy of pelvic organ support system. How will you manage a case of
Nulliparous uterovaginal Prolapse. { MPMSU 21 July- 20 marks }

Preventive measures for occurrence of prolapse . { MPMSU 22 May- 5 marks }

Infertility

Define Primary infertility. Describe the tests for detection of ovulation. .{ MPMSU 20 feb- 20 marks
}

Define Primary infertility. Describe fallopian tube patency tests.{ MPMSU 21 Nov, 22 May- 20
marks }

What are the various investigations to assess ovulation? Describe treatment for anovulatory
cycles. { MPMSU 22 May - 20 marks }

Tubal Factor in infertility.{MPMSU 21 April- 20 marks}

WHO parameters for normal semen Analysis. { MPMSU 21Feb - 5 marks }

Define Infertility. Discuss causes of Infertility. Write a management plan for treatment of a couple
with primary infertility. Write 3 indications of surrogacy - MPMSU 24 Feb - 20 marks

Benign Lesion of Uterus

Describe fibroid uterus and its types, Management of large intramural fibroid at the age of 45
years. { MPMSU 20 Aug- 20 marks }

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Clinical features and management of uterine fibroids at 45 years of age. .{ MPMSU 21 April- 20
marks}

What is fibroid uterus, Give its anatomical classification . Write in detail medical management of
fibroid uterus. .{ MPMSU 23 Feb- 20 marks }

Degenerations in fibroid. { MPMSU 20 Feb- 5 marks }

Role of uterine artery embolization in fibroid uterus. {MPMSU 19 Oct- 5 marks}

Benign Neoplasm of Ovary

Benign ovarion Mass-causes. { MPMSU 19 June- 5 marks }

Discuss ovarian dysfunction, diagnosis & management. { MPMSU 21 July- 20 marks }

How is ovarian cancer staged. { MPMSU 19 oct - 20 marks }

Ovarian hyperstimulation syndrome . { MPMSU 19 Oct- 5 marks }

Endometriosis

How would you manage an infertile couple with probable diagnosis of endometriosis in female
partner.{ MPMSU 19 Feb - 20 marks }

Define endometriosis. Enumerate the clinical features. Describe briefly theories proposed for its
Pathogenesis .{ MPMSU 20 feb- 20 marks }

Premalignant Lesions

Define CIN, enumerate risk factors for CIN.{ MPMSU 19 June, 21 Feb - 20 marks }

Discuss the management of CIN.{MPMSU 21 July- 20 marks}

Genital Malignancy

Discuss various methods of screening of carcinoma cervix.{ MPMSU 19 Feb - 20 marks }

Describe the screening guidelines & Methods for diagnosis of cervical cancer. {MPMSU 21 July-
20 marks }

What are the risk factors for development of cancer cervix. Discuss all methods available for
cervical cancer screening and downstaging the disease in our country. .{ MPMSU 22 May - 20
marks }

Staging of carcinoma cervix. { MPMSU 20 Aug, 22 May, 20 Feb- 5 marks }

Prevention of Cancer Cervix. .{ MPMSU 21 April- 20 marks}

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Discuss various types of HPV vaccines - MPMSU 24 Feb - 5 marks

Hydratiform mole. { MPMSU 23 Feb- 5 marks }

Invasive mole follow up. { MPMSU 19 June- 5 marks }

Amenorrhea

PCOS. { MPMSU 22 May- 5 marks }

What is primary amenorrhoea and its aetiology. { MPMSU 20 Aug- 5 marks }

What is secondary amenorrhoea. Briefly write its causes and management - MPMSU 24 Feb - 5
marks

Contraception

Discuss about contraception options available for a post -partum lady. {MPMSU 19 Feb - 20
marks}

Describe Copper-T , What are the indication and Contraindications for Copper-T insertion.
{MPMSU 20 Aug- 20 marks }

Copper-T 375 A. { MPMSU 20 April- 5 marks }

LNG IUCD. { MPMSU 21Feb, 22 Oct - 5 marks }

Complications of IUCD. { MPMSU 22 Oct, 21 Nov- 5 marks }

Enumerate different methods of Hormonal contraception with emphasis on benefits and Hazards of
each. {MPMSU 22 May - 20 marks }

Permanent method of contraception. {MPMSU 19 feb- 5 marks}

Uses of oral contraceptive pills - MPMSU 24 Feb - 5 marks

Others

What are the causes of post menopausal bleeding ? How will you investigate and manage a 60
year old women with post menopausal bleeding. { MPMSU 21 Nov- 20 marks }

A 50 year old P7L7 post menopausal lady come with history of bleeding per vaginum since 2
days.What are the differential diagnosis to consider ?{ MPMSU 20 Feb - 20 marks}

What is Social obstetrics, How can you contribute as medical doctor. { MPMSU 19 June - 20 marks
}

Advantages & Disadvantages of Endoscopic surgeries in Gynacology {MPMSU 19 feb- 5 marks}

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Iron Sucrose use. { MPMSU 19 June- 5 marks }

Ectopic pregnancy its type and management in Rupture ectopic. { MPMSU 20 Aug- 5 marks}

Molar pregnancy. { MPMSU 22 May- 5 marks }

2-Marks Questions:-
2019-{feb}
Q.1- Components of kit-6 for syndromic management of STI.
Q.2- Two newly introduced contraception method by Government of India.
Q.3- POP-Q Staging of genital organ prolapse .
Q.4- First line tests used for infertility work up.
Q.5- High risk factor for carcinoma ovary.
Q.6- Drugs used for medical method regime of MTP.
2019-{June}
Q.7- HRT.
Q.8- Primary Infertility.
Q.9- Blood supply of uterus.
Q.10- Trichomoniasis.
Q.12- Genital TB.
2020-{Jan-feb}
Q.13- Trichomonas vaginitis.
Q.14- Supports of the Uterus.
Q.15- Differentiation between benign and malignant ovarian tumors
Q.16- Indications of diagnostic Laproscopy
Q.17- Self breast Examination.
Q.18- Emergency Contraception.
2020-{August}
Q.19- PaP Smear.
Q.20- High risk factors for ovarian cancer.
Q.21- PCOD.
Q.22- Pelvic inflammatory disease.
Q.23- Non contraceptive uses of combined oral contraceptives.
Q.24- Shaw’s system of classification for pelvic organ prolapse.
2021-{April}
Q.25- Krukenberg’s tumor.
Q.26- Induction of ovulation.
Q.27- Clinical features of acute PID.
Q.28- Non-contraceptive uses of oral pills.
Q.29- Follow up of a case of Hydatiform Mole.
Q.30- Clinical features of endometriosis.
2021-{July}
Q.31- Turner’s syndrome.
Q.32- Mirena.
Q.33- Syndromic management of STI’s.
Q.34- Normal Semen Reports.
Q.35- Indications of operative hysteroscopy.
Q.36- Bartholin’s cyst.
2021-{November}
Q.37- What are the indication of Hysterectomy .

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Q.38- Self breast examination .

Q.39- Write symptoms and signs of malignant ovarian tumor.
Q.40- HPV Vaccine.
Q.41- Complications of laproscopy
Q.42- Normal semen report.
2022-{May}
Q.43- Signs of ovulation.
Q.44- Palm-coien classification of AUB.
Q.45- Dysgerminoma .
Q.46- Emergency Contraception.
Q.47- Cryptomenorrhoea – Causes.
Q.48- Management of Ectopic Pregnancy.
2022{Sep-oct}
Q.49- PALM COEIN classifications.
Q.50- What are the indication of Hysterectomy.
Q.51- Normal Seman Report.
Q.52- High risk factors for ovarian cancer.
Q.53- Medical management of ectopic pregnancy.
Q.54- Medical MTP(abortion)till 9 weeks of gestation.
2023-{Jan-Feb}
Q.55- Puberty menorrhagia.
Q.56- Lymphatic drainage of CX along with diagram.
Q.57- LNG-IVS.
Q.58- Candioial vaginitis.
Q.59- Cryptomenorrhea.
Q.60- Dermoid cyst of the ovary.
2019-{Oct}
Q.61- High risk factor for endometrial carcinoma.
Q.62- AMSEL criteria for diagnosis of bacterial vaginosis.
Q.63- Causes of genitourinary fistula.
Q.64- What is androgen insensitivity syndrome.
Q.65- ACOG recommendation for screening of carcinoma cervix.
Q.66- Krukenberg Tumor.
Q.67- Degeneration occurring in fibroid .
Q.68- Symptoms of acute.
Q.69- Treatment of senile vaginitis.
Q.70- Degrees of uterine prolapse .
Q.71- Torsion of ovary.
Q.72- Staging of cancer cervix.

2023 (Feb)

Candida vaginitis
Cryptomenorrhea
Dermoid cyst of ovary

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OBSTETRICS

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INTRODUCTION
Q.1 Placental functions
Ans. A) Respiratory → O2 intake and CO2 output by simple diffusion.
B) Excretory → urea, uric acid, creatinine by SD
C) Nutritive → glucose by facilited diffusion (GLUT-1), Lipids, Amino
acids and electrolytes.
D) Endocrine function
E) Barrier function
F) Immunological function
 Nutritive function
i. Glucose is transported by facilitated diffusion by GLUT-1
ii. Lipid like triglyceride are transported by mother in early pregnancy
and synthesis by fetus in late pregnancy.
iii. Electrolyte like Na+, K+, Cl- are transported passively while
phosphorus calcium ion are transport actively.
 Barrier function
i. Generally substance with high MW > 500 daltons are held up.
ii. Transfer of large molecule is a facilitated by pinocytes.
iii. Rate of drug transfer is increased in late pregnancy.
 Immunological function
i. The placenta and fetus contains paternally determined antigens,
which are foreign to mother.
ii. In spite of this, there is no evidence of graft rejection.
iii. Placenta hormones, early pregnancy factor, chronic gonadotropin
have some immunosuppressive effects.
Q.2 Amniotic fluid
Ans. Water in the amniotic fluid is a replaced in every 3 hrs.

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→ Presence of lanugo and epithelial scales in meconium shows that fluid is

swallowed by fetus and some of its passes from gut into fetal plasma.
Functions
i. It means function is to protect fetus
ii. Act as shock absorber
iii. Maintains even temperature
• Abnormal colours:
1. Green color
i. Due to meconium: presence of biliverdin.
Seen →
a) Fetal distres
b) Breech/transverse lie
2. Brown color (tobacco juice):
 Intrauterine demise of fetus
3. Golden color:
 Rh. Incompatibility due to presence of bilirubin.
4. Greenish yellow (saffron)
 Post term pregnancy
5. Dark red colour:
 Concealed hemorrhage
Q.3 Diagnosis of early pregnancy.
Ans. 5 symptoms: -
1. Amenorrhea
2. Morning sickness
3. Fatigue
4. Breast tenderness
5. Frequently urination
6. Montgomery tubercles

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4 signs:
a. Breast changes:
I. Enlargement
II. Areola get darker
b. Per abdomen changes:
I. Linea nigra
II. Stria gravidarum
c. Pelvic signs: {Trick : C*ut GHOP}
I. Chadwick sign: bluish discoloration of uterus and vagina.
II. Goodell sign: dilation of cervix
III. Hegar sign: Non-specific indication of pregnancy characterized by the
compressibility and softening of the cervical isthmus.
IV. Osiander sign: pulsation of uterine art. felt in lateral fornix of vagina.
V. Palmer's sign: regular rhythmic contraction of uterus.

Q.4 Evaluation of Antenatal fetal well-being.

Ans. Antenatal assessment of fetal well-being is designed to detect fetal
abnormalities.
It is divided in 3 types: -
1. Clinical
2. Biophysical
3. Biochemical

A. Clinical {Trick – WB SUH(Size of Uterus, Height of fundus) LGI

– Who Bhi SUHagan LAGi}
1. Weight gain
• Normal weight gain is 1 kg in a fortnight.
• If excess weight gain - could be a sign of pre-eclampsia
• If no weight gain or decrease - could be sign of IUGR

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2. Blood pressure
3. Assessment of size of uterus and height of fundus.
• Fundal height is measured from pubic symphysis.
• After 24 weeks of pregnancy, the distance in cm corresponds to pregnancy
in weeks.
4. Amount of liqum: Oligohydramnios, Polyhydramnios.
5. Abnormal girth

B. Bio physical test: {Trick: FU2CNA Band VanCho)

1. Fetal movement count
2. USG
3. Doppler USG
4. Cardiotocography
5. Non stressed test
6. Amniotic fluid volume (AFV)
7. Biophysical profile
8. Vibroacoustic stimulation test
9. Contraction stress test
1. Fetal movement count:
Two method-
i. Cardiff Count 10’ formula: mother count how many hours it takes to
have 10 movements.
ii. Daily fetal movement count (DFMC) :
• If <10 movement in 12 ms, indicate fetal compromise.
2. USG :
• BPD, AC, HC, FL are measured (BPD = Biparietal diameter, AC =
Abdominal circumference, HC = Head circumference, FL = Femur length)
• Amniotic fluid volume measured.
• When HC/AC > 1.0, IUGR suspected.
• Main diagnostic tool

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3. Cardiotocography:
• 100-160 beats/min is normal
• ≥2 acceleration should be there in 20-minute period
4. Non stress test:
• Reactive NST: ≥ 2 acceleration of >15 beats/min for >15 sec in 20 min
period.
• Non-reactive NST: absence of above pattern.
5. Amniotic fluid volume:
• Normal single largest pocket → 2-8 cm
• Normal AFI → 5-25 cm
 If SVF < 2cm or AFI < 5 → Oligohydramnios
 If SVF > 8cm or AFI > 25 → Polyhydramnios
6. Biophysical profile:
a) It is composed of many parameters
b) Observation time = 30 minutes
c) Assess fetal asphyxia
1. Biophysical Profile Scoring
Parameters Minimum normal criteria Score
NST Reactive pattern 2
Fetal breathing ≥ 1 breathing movement lasting 2
movement > 30 sec
Fetal body ≥ 3 discrete body movements 2
movements
Fetal muscle ≥ 1 episode of active extension 2
tone with return to flexion
Amniotic fluid ≥1 pocket width > 2 cm long 2
into two perpendicular places

 If 8 - 10 score → normal

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 If 6 score → eqivoral, suspect chronic asphxia

 If ≤ 4 score → abnormal, suspect chronic asphxia
 If 0 - 2 score → abnormal, severe chronic asphxia
2. Modified BP includes → NST + AFI only
BPP Score Mx
8-10 Do weekly monitoring
6 If ≥ 36 weeks → delivery
4 If ≥ 36 weeks → delivery
If < 32 weeks, repeat testing in 4-6
hrs.
0-2 Deliver regardless of gestational stage

2. Biochemical Tests →
 Assessment of fatal pulmonary maturity
 Fluorescence polarisation

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LABOR
Q.5 Define Normal labor. Mx of 2nd stage of Labor.
Ans. Labour: -
Series of events that takes place in the genital organs to expel the product
of conception i.e. placenta, fetus and membrane out of the womb through
vagina to outer world.
Normal labor criteria: -
1. Spontaneous onset at term
2. Vertex presentation
3. Natural termination (with minimal aids)
4. Without any complications
5. Without undue prolongation
Mx of 2nd stage of labour:-
Principles:
1. To assist natural explusion of foetus.
2. To prevent perineal injuries
General measures: -
1. Patient in bed
2. FHR monitoring
3. Administer inhalational analgesics
4. Vaginal examination
Preparation of delivery :-
1. Position:
 Most common is supine position with hip flexed, knee flexed and
abduction of thigh.
2. Toileting of external genitals
3. Catheterise bladder if it is full

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Condition of delivery: -
1. Delivery of head: -
i. Patient encouraged to ‘bearing-down effort’ or ‘push’ during uterine
contraction.
ii. When scalp visible for 5 cm diameters: -
 Push occiput downwards and backward.
 Press perineum with sterile vulval pad.
iii. When subocciput reaches below the pubic symphysis: -
 gaurding the perineum and perineal massage
iv. When perineum is fully stretched and threatens tear, episiotomy can be
done under local anesthesia.
v. When suboccipitofrontal diameter emerges out→ Ritgen maneuver is
done.
When ociput emerges

With gentle pressure,

Head is extended

Forehead, nose, chin,

Mouth are born

Care of infant following head delivery -

1. Mouth and pharynx mucus is wiped or sucked.
2. Eye lids are wiped
3. Neck is palpated to exclude presence of any loop of cord.
2. Delivery of shoulder: -
1. External rotation happen

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2. First anterior shoulder is born, which are assisted by pulling head of

baby in downward direction.
3. Later posterior shoulder is born by pulling head upward.
3- Delivery of trunk: -
1. Trunk is delivered by lateral flexion.

Q.6 Discuss AMTSL.

Ans. Inj. Oxytocin 10 units 1M (preferred)
Or
Tab misoprostol 600 μg orally or rectally
Or
Inj. Methargine 0.2 mg IM
within one min of birth of baby
↓
Delayed cord clamping
(After 90-120 sec after birth or after
Stoppage of cord pulsation)
↓
Clamp, divide and ligate the cord
↓
Deliver placenta by controlled cord traction
↓
Massaging the uterus immediately after
delivery of placenta
(To incite contraction)
↓
Carfal examination of placenta and
it's membranes
↓

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Post partum vigilance

1. Palpation of uterus every 15 mins for 2 hours to ensure uterus is hard.
2. Estimate blood loss
{Massaging of uterus is not part of AMTSL given by WHO but is a part of
postpartum haemorhhage Rx}

Q.7 Partogram
Ans. Composite graphical record of labor event entered against time on a
single sheet of paper.
It has 5 components →
I. Women
II. Baby
III. Labor progress
IV. Medications
V. Shared decision-making
• Women: -
I. HR (Heart rate)
II. Systolic BP
III. Diastolic BP
IV. Temperature
V. Urine
• Baby:-
I. FHR
II. Amniotic fluid
III. Moulding
IV. FHR deceleration
• Labor progress
I. Cervical dilation

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II. Descent
III. Contraction per 10 minutes
IV. Duration of contraction
• Medications:
I. Oxytocin
II. Medicine
III. IV fluids
• Shared decision making
I. Assessment
II. Plan
Adv. of partogram:
1. Reduced incline of prolonged labors of cesarean section rate.
2. Single sheet provides all necessary information.
3. Easy handover to another obstetrician.

Q.8 Bishops score & its significance.

Ans. To know if female is ready for delivery
(Trick – CaL PeDS – Consistency, Length, Position, Dialation, Station)
Cervix 0 1 2 3
features -
Dilation (cm) Closed 1-2 3-4 5+
Cervical >4 2-4 1-2 <1
Length (cm)
Consistency Firm Medium Soft –
Position Posterior Midline Anterior –

Head Station -3 -2 -1, 0 +1, +2

Total score = 13, Favorable = 6-13, Unfavourable = 0-5

Q.9 MTP Act.

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Ans. Indications of MTP: (English is Tough - Hindi is Simple)

i. Eugenic:
Pregnancy leading to birth of congenitally defected child. Ex→ Down
syndrome, Cystic fibrous etc.
ii. Therapeutic:
Pregnancy resting life of pregnant women. Ex. Cardiac disease, Psychiatric
illness,
Cervical or breast malignancy.
iii. Humanitarianism:
Pregnancy due to rape or sexual assault.
iv. Social grounds:
Pregnancy due to contraceptive failure.
Methods:
First trimester (upto 12 weeks):
Medical:-
1. Mifepristone 200-600 mg orally followed in 48 hrs by misoprostol
200-600 μg.
2. Misoprostol 800μg sublingually
3. Methotrexate + Misoprostol
Surgical:-
1. Vacuum aspiration
2. Suction evacuation
3. Dilation and evacuation:
•Rapid method
•Slow method (laminaria tests)

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