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Chapter 8

The document discusses the clinical approach to confirming pregnancy in women, including history taking, symptoms, and diagnostic tests such as urine and serum hCG assays, as well as ultrasound assessments. It also covers preconceptional care for women planning to conceive, emphasizing the importance of identifying risk factors, conducting thorough medical evaluations, and ensuring appropriate vaccinations and medications. Key recommendations include lifestyle modifications, laboratory investigations, and the initiation of folic acid supplementation to promote a healthy pregnancy.

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Sneha Ganesh
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41 views1 page

Chapter 8

The document discusses the clinical approach to confirming pregnancy in women, including history taking, symptoms, and diagnostic tests such as urine and serum hCG assays, as well as ultrasound assessments. It also covers preconceptional care for women planning to conceive, emphasizing the importance of identifying risk factors, conducting thorough medical evaluations, and ensuring appropriate vaccinations and medications. Key recommendations include lifestyle modifications, laboratory investigations, and the initiation of folic acid supplementation to promote a healthy pregnancy.

Uploaded by

Sneha Ganesh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Chapter6

1. A 28-year-oid woman who has been married for 6 months visits the clinic with a history of two
months' amenorrhea. She wants to know whether she is pregnant.
a) What history should be taken in this case? What are the early symptoms of pregnancy?
b) How will you confirm this woman's pregnancy?
c) What is the most sensitive pregnancy test and what are the indications?
d) How would you confirm pregnancy by USG assessment?

Answers
a) lt is important to ask about the woman's last menstrual period as well as the regularity of her
menstrual cycles in the past. lt is also important to ask about subjective symptoms such as nausea,
vomiting, increased frequency of micturition, giddiness and early fatiguability.
b) A urine pregnancy test should be performed, preferably with the first morning sample. This test is
an immunological test that detects the presence of hCG in the urine.
c) The most sensitive pregnancy test is the serum �-hCG assay, which can detect 2-20 mTU/mL of
hCG in the serum. Tt is useful for confirming pregnancy and very useful following ART techniques
and in the follow-up of molar pregnancy and ectopic gestations, where serial measurements can be
made.
d) On USG, the gestational sac is detected as a well-defined white ring by the fourth to fifth week.
The yolk sac appears at five weeks. The fetal pole is seen at 5.5 weeks and fetal cardiac activity is
detected at 6 weeks of gestation. At 8-14 weeks, the crown -rump length of the embryo can be
measured.

Chapter8

1. A 22-year-old IT professional who has been marriedfor 3 months comes to the clinic for
preconceptional advice.
a) What is the goal of preconceptional care?
b) Discuss in detail the history to be elicited and examinations to be carried out.
c) What investigations would you carry out?
d) What medications and vaccination would you advice?

Answers
a) The goal of preconceptional care is to identify and correct the potential risk factors that may have
an adverse effect on pregnancy so as to achieve a healthy pregnancy and a healthy neonate.
b) A detailed medical and family history should be taken to identify potential risk factors. A detailed
general examination should be carried out to check the woman's weight and BP and assess her
cardiovascular system. The presence of anemia and malnutrition should be identified and corrected.
Pre-existing medical conditions such as diabetes, obesity, hypothyroidism, seizure disorders and HIV
should be managed appropriately before attempting conception. The current medications should be
evaluated in detail to avoid using teratogenic drugs and to switch to safer drugs. The woman should
be advised on the cessation of smoking, alcohol and substance abuse and to maintain the ideal body
weight. Temporary contraception may also be discussed.
c) General investigations such as complete hemogram, urine analysis, blood sugar levels and serology
are recommended as part of preconception care. ln obese individuals, a thyroid function test should
also be carried out.
o
d) All women planning pregnancy should be started on 0.4 mg off lic acid to prevent neural tube
defects in the fetus. The woman's vaccination history against rubella, chickenpox and hepatitis B
should be verified. If seronegative, she should be given these vaccinations.

Chapter9

l . A 28-year-old gravida 2, para 1, alive 1, visits the clinic with history of2 months of amenorrhea
and complaints of nausea and vomiting that is not manageable. While detailing her history, she

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