Various theories are proposed regarding the mechanism of development of increased nuchal translucency in Down’s syndrome. They are:

Cardiac failure due to structural malformation
Abnormalities in the extracellular matrix
Abnormal or delayed development of the lymphatic system

Priscilla White was a pioneer in the treatment of Diabetes complicating pregnancy
She proposed the famous White classification
It emphasizes the importance of 3 factors

Age of patient
Duration of diabetes
Presence of vasculopathy

It was modified by the American College of Obstetricians and Gynaecologists in 1986
The original version consists of 7 classes
The modified version splits class A – consisting of patients who developed diabetes during pregnancy – into 2 subcategories – A1 and A2
A1 corresponds to those who have carbohydrate intolerance detected during 100g 3 hour glucose tolerance test, but fasting and post prandial glucose …

Amount of aminotic fluid at present at 36-38 weeks in case of a normal pregnancy is?
A. 500ml
B. 1L
C. 1.5L
D. 2L

Heart disease is classified into 4 classes based on risk to the mother if she becomes pregnant
In patients who are classified under class 4, pregnancy is not advised
They should be offered emergency contraception and termination if they become pregnant

Class 4 cardiac conditions:

Pulmonary artery hypertension of any cause (such as Eisenmenger complex)
Severe systemic LV dysfunction with:

NYHA class III – IV
LV ejection fraction less than 30%

Previous peripartum cardiomyopathy with residual impairment of LV function
Obstructive lesion of left heart – aortic or mitral stenosis with valve area less than 1cm2
Marfans with aortic root dilatation more …

Monochorionic monoamniotic twins have single placenta and lie in a single amniotic cavity.

Mechanism:

* It arises from division of the implanted blastocyst 9-13 days after fertilisation
* Division of blastocyst beyond this period results in conjoint twins

MTP stands for:

Medical Termination of Pregnancy

Late onset Intra Uterine Growth Restriction occurs after 32 weeks of gestation
It is usually caused by uteroplacental insufficiency
The various etiologies proposed in the development of delayed onset IUGR are:

hypertension
pre eclampsia
diabetes mellitus
maternal malnutrition

Late in pregnancy, the fetus grows mainly by cellular hypertrophy rather than hyperplasia and hence late onset IUGR is more amenable to therapy
The abdominal circumference will be much lower than normal as the deposition of glycogen in liver is impaired
The head circumference will be almost normal due to the brain sparing effect

Sibai regimen is an intravenous magnesium sulphate regimen for treatment of eclampsia
It was introduced by Sibai et al in 1990
Loading dose – 6g IV given over 20 minutes
Maintenance dose – 2-3g IV every hour

Maternal and fetal outcome after treatment with Sibai regimen:

In a study published by Sibai et al in 1990, treatment of eclampsia with Sibai regimen had a maternal mortality of 0.5% and a perinatal mortality of 5%.

Zuspan regimen is a treatment regimen using Magnesium sulphate for the treatment of eclampsia
Magnesium sulphate 4g is given as IV bolus dose in the beginning
This is followed by intravenous infusion of Magnesium sulphate at the rate of 1g/hour till 24 hours have elapsed after the last seizure
Other regimens using MgSO4 for treatment of eclampsia are

Pritchard’s regmimen
Sibai regimen

HELLP stands for:

Hemolysis, Elevated Liver enzymes, and Low Platelets