Correct Answer - C
Prostaglandins
Mid trimester termination of pregnancy
A) Medical methods
i) Prostaglandins : misoprostol (PGE 1) with or without Mife
pristone, gemeprost (PGE1), dinoprostone (PGE2), carboprost
(PGE2)
ii) Oxytocin

Correct Answer - B
Ans. is 'b' i.e., 48 hours
FDA approved protocol - (Original protocol)
600 mg of mifepristone (i.e., 3 tablets) given orally on day 1 followed
2 days (48 hours) later by oral misoprostol 400 tig (2 tablets) on day
3.
The treatment should be started no more than 48 days from the start
of the last menstrual period.
But according to the recent protocol
200 mg of mifepristone (it is as effective as 600 mg of mifepristone)
is given orally on Day 1 followed 2 days (48 hours) later by vaginal
misoprostol 800 pg.
This regime provides highest efficacy within 63 days of amenorrhea.

Correct Answer - A
Ans. A. Neutrophilic leukocytosis
Physiological change observed in leukocyte numbers in pregnancy
is neutrophilic leukocytosis.
It occurs to the tune of 8000/mm3 and may upto 20,000/ mm3 in
labour.
The increase maybe due to the rise in levels of estrogen and
cortisol.

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Correct Answer - B
Ans. B. Fetus papyraceous
Fetus Paoyraceous or compressus-
Is a state which occurs in case of twins when one of the fetuses dies
early.
The dead fetus is flattened mummifed and compressed between the
membranes of livingfetus and uterine waII.
It may occur in both varieties of twins but is more common in
monozygotic twins and is discovered at delivery or earlier by
sonography.

Correct Answer - A
ANS. A. Immediate LSCS
CASE DISCUSSION:
The patient has mild preeclampsia with BP 140 / 96, so TOP is 37
weeks.
This patient is 38 weeks so immediate termination of pregnancy is
required.
The first twin is breech so the mode of delivery is LSCS hence the
answer is A.
INDICATIONS OF CESAREAN SECTION:
The indications are broadly divided into:
Obstetric
Placenta previa
Preeclampsia
Previous cesarean section
Cord prolapse of the first baby
Abnormal uterine contractions
Contracted pelvis.
For twins:
Both the fetuses or even the first fetus with noncephalic (breech ortransverse) presentation
Twins with complications: IUGR, conjoined twins
Monoamniotic twins
Monochorionic twins with TTTS
The collision of both the heads at brim preventing engagement of
either head.
Ref.OBS Dutta 8th ed Page no. 244

Correct Answer - A
Correct Ans: A. PG E1
Misoprostol is a methyl ester of PGE1.
Indications of Misoprostol:
It is used for cervical ripening.
Transvaginally it is used for induction of labour.
Uses of Prostaglandins in Obstetrics:
Induction of abortion
Termination of molar pregnancy
Induction of labour
Cervical ripening prior to induction of labour
Acceleration of labour
Management of atonic postpartum hemorrhage
Medical management of tubal ectopic pregnancy

Correct Answer - B
Ans. B. Placenta has Wharton's jelly
The umbilical cord is a structure that provides vascular flow between
the fetus and the placenta.
It contains two arteries and one vein, which are surrounded and
supported by gelatinous tissue known as Wharton's jelly.

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Correct Answer - A
Ans. A. 3rd trimester
Acute fatty liver of pregnancy (AFLP) is a rare, potentially fatal
complication that occurs in the third trimester or early postpartum
period.
Acute fatty liver of pregnancy is more commonly associated with:
Male fetus
First pregnancy
Maternal obesity
It is due to defect in the long-chain-3-hydroxyacyl-CoA-
dehydrogenase pathway.
It is uncommon in subsequent pregnancies.

Correct Answer - B
Ans. B. Fertilization of two or more ova in different intercourses
in same menstrual cycle
Superfecundation is the fertilization of two or more ova from the
same cycle by sperm from separate acts of sexual intercourse,
which can lead to twin babies from two separate biological fathers.
The term superfecundation is derived from fecund, meaning the
ability to produce offspring.