EDD ( Expected Date of Delivery) is calculated by:
In a couple, which of the following investigations are included in the initial work-up for infertility?
A 32 year old pregnant woman presents with 36 week pregnancy with complaints of pain abdomen and decreased fetal movements. Upon examination PR= 96/min, BP = 156/100 mm Hg, FHR = 128 bpm. On per-vaginum examination there is altered blood seen and cervix is soft 1 cm dilated. What is the preferred management?
'Cafeteria approach' is related with:
FMGE 2018 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 11: EDD ( Expected Date of Delivery) is calculated by:
- A. Cardiff Formula
- B. McDonald's rule
- C. Hadlock Formula
- D. Naegele's formula (Correct Answer)
Explanation: ***Naegele's formula*** - **Naegele's formula** is the most common and widely accepted method for calculating the estimated date of delivery (EDD). - It involves adding one year, subtracting three months, and adding seven days to the **first day of the last menstrual period (LMP)**. *Cardiff Formula* - The **Cardiff Formula** is a method used for assessing fetal movements, particularly for monitoring fetal well-being, not for calculating EDD. - It establishes a baseline of fetal movements over a specific period to detect any significant decrease. *McDonald's rule* - **McDonald's rule** is a clinical method used to estimate the gestational age based on fundal height measurements. - While it helps in estimating gestational age, it is not primarily used for calculating the precise EDD. *Hadlock Formula* - The **Hadlock Formula** refers to a set of widely used ultrasound-based formulas for estimating fetal weight and gestational age, typically involving biometry measurements like BPD, HC, AC, and FL. - While accurate for gestational age estimation, it's an imaging-based method, not a direct calculation of EDD from the LMP like Naegele's.
Question 12: In a couple, which of the following investigations are included in the initial work-up for infertility?
- A. Testicular biopsy, USG, Sperm penetration test
- B. Ovulation, tubal patency, Mantoux test
- C. Semen analysis, CXR, Mantoux
- D. Semen analysis, Tubal patency test, Ovulation test (Correct Answer)
Explanation: ***Semen analysis, Tubal patency test, Ovulation test*** - This option correctly identifies the **key initial investigations** for both male and female factors in infertility: **semen analysis** for male fertility, **tubal patency test** for assessing fallopian tube function, and **ovulation test** to confirm female ovulatory cycles. - These tests are fundamental in a comprehensive initial infertility work-up as they address the most common causes of infertility. *Testicular biopsy, USG, Sperm penetration test* - While **testicular biopsy** and **sperm penetration test** are relevant, they are typically **second-line investigations** performed if initial tests (like semen analysis) are abnormal. - **Ultrasound (USG)** is a general imaging modality and not a primary, specific infertility test for both partners as listed. *Ovulation, tubal patency, Mantoux test* - **Ovulation** and **tubal patency** are essential, but the **Mantoux test** (for tuberculosis) is generally not part of the *initial routine* infertility work-up unless there is clinical suspicion or prevalence in the region. - The Mantoux test is specific for a particular infection, and not a broad screening test for infertility. *Semen analysis, CXR, Mantoux* - **Semen analysis** is appropriate, but a **Chest X-ray (CXR)** and **Mantoux test** are not routine initial investigations for infertility. - These tests would only be indicated if there were specific clinical signs or a history suggestive of underlying pulmonary or infectious disease.
Question 13: A 32 year old pregnant woman presents with 36 week pregnancy with complaints of pain abdomen and decreased fetal movements. Upon examination PR= 96/min, BP = 156/100 mm Hg, FHR = 128 bpm. On per-vaginum examination there is altered blood seen and cervix is soft 1 cm dilated. What is the preferred management?
- A. Observation and monitoring
- B. Perform cesarean section (Correct Answer)
- C. Initiate labor induction
- D. Administer medications to delay labor
Explanation: ***Perform cesarean section*** - The clinical presentation strongly suggests **placental abruption**: abdominal pain, decreased fetal movements, hypertension (risk factor), and altered blood per vaginum - **Decreased fetal movements** with FHR at 128 bpm (lower end of normal) indicates **potential fetal compromise** - At **36 weeks gestation**, the fetus is viable and immediate delivery is warranted when abruption is suspected with fetal distress - **Emergency cesarean section** is the preferred management for placental abruption with signs of fetal compromise, as it provides the fastest route to delivery - Attempting vaginal delivery in suspected abruption with fetal distress risks further compromise and maternal hemorrhage *Initiate labor induction* - Labor induction is **contraindicated** in suspected placental abruption with fetal compromise - Induction takes hours to achieve delivery, during which time the fetus may deteriorate further and maternal bleeding may worsen - The presence of altered blood, decreased fetal movements, and hypertension makes this a **high-risk scenario** requiring immediate delivery, not a gradual process - Induction might be considered only in very mild, stable cases of abruption without fetal distress, which is not the case here *Observation and monitoring* - The clinical findings indicate an **obstetric emergency** (suspected placental abruption), not a condition suitable for expectant management - **Decreased fetal movements** are a warning sign of fetal hypoxia requiring immediate action - Progressive abruption can lead to **maternal hemorrhage, DIC, and fetal death** if not managed promptly - At 36 weeks with concerning features, continued observation risks catastrophic outcomes *Administer medications to delay labor* - **Tocolytics are absolutely contraindicated** in placental abruption - Delaying delivery when abruption is suspected and fetal compromise is present would worsen both maternal and fetal outcomes - At 36 weeks gestation, the fetus has adequate maturity and there is no benefit to prolonging pregnancy - The goal is **expedited delivery**, not pregnancy prolongation
Question 14: 'Cafeteria approach' is related with:
- A. Diet program
- B. National vector borne disease control programme
- C. Child and maternal health
- D. Contraception (Correct Answer)
Explanation: ***Contraception*** - The **cafeteria approach** in contraception refers to offering a wide variety of **contraceptive methods** to individuals, allowing them to choose the option that best suits their needs, preferences, and circumstances. - This approach promotes **informed choice** and adherence by recognizing that no single contraceptive method is ideal for everyone. *Diet program* - While diet programs involve choices, the term **cafeteria approach** is not specifically or exclusively associated with the methodology of diet selection. - Diet programs typically focus on dietary guidelines or meal plans rather than a broad offering of methods. *National vector borne disease control programme* - This program focuses on managing and preventing **vector-borne diseases** through public health interventions, which does not involve individual "choices" in a cafeteria-style manner. - Its strategies include surveillance, vector control, and case management, without a direct "cafeteria approach" element. *Child and maternal health* - This broad field encompasses various health interventions, but the **cafeteria approach** is not a specific methodology used to describe comprehensive child and maternal health services. - While choices are involved in healthcare, this term is not standard in this context.