IMP SYNOPSIS.
The uterus is a hollow, muscular organ of the female reproductive system, located in the pelvic cavity between the bladder and rectum. It is responsible for implantation, fetal development, and childbirth.
The uterus has three layers:
| Aspect | Clinical Relevance |
|---|---|
| Myometrium | Contracts during labor, targeted by oxytocin. |
| Endometrium | Site of implantation, sheds in menstruation, affected in endometriosis. |
| Decidua Basalis | Forms maternal placenta, involved in placental abnormalities like placenta accreta. |
| Decidua Capsularis | Protects the embryo, later disappears. |
| Decidua Parietalis | Fuses with capsularis, significant in chorionic villi development. |
✅ Which layer of the uterus is responsible for contractions during labor?
👉 Myometrium
✅ Which endometrial layer regenerates after menstruation?
👉 Stratum Basalis
✅ What is the function of the decidua basalis?
👉 Forms the maternal part of the placenta
✅ What happens to the decidua capsularis by the 4th month?
👉 It fuses with decidua parietalis and disappears.
The Fallopian tubes (Uterine Tubes or Oviducts) are paired, slender, muscular tubes that extend from the uterus to the ovaries, facilitating the transport of ova (eggs) from the ovary to the uterus. They are the site of fertilization and play a crucial role in early embryonic development.
The Fallopian tube has four major parts, each with distinct functions:
The Fallopian tube has three layers:
| Layer | Description | Function |
|---|---|---|
| Serosa (Peritoneal Covering) | Outer protective layer | Reduces friction. |
| Muscularis | Smooth muscle layer | Helps in peristalsis and ciliary movements for ovum transport. |
| Mucosa | Inner ciliated epithelium | Moves egg and nourishes it. |
| Aspect | Clinical Relevance |
|---|---|
| Fimbriae | Capture ovum; failure can lead to ectopic pregnancy. |
| Ampulla | Most common site of fertilization and ectopic pregnancy. |
| Isthmus | Common site for tubal ligation (sterilization). |
| Interstitial part | Dangerous site for ectopic pregnancy due to heavy bleeding risk. |
| Ciliated epithelium | Dysfunction can lead to infertility. |
✅ Which part of the Fallopian tube is responsible for capturing the ovum?
👉 Fimbriae of the Infundibulum
✅ Where does fertilization usually occur?
👉 Ampulla of the Fallopian tube
✅ Which part of the Fallopian tube is most commonly ligated for female sterilization?
👉 Isthmus
✅ Which part of the Fallopian tube is located inside the uterus?
👉 Interstitial part
✅ What is the function of the ciliated epithelium in the Fallopian tube?
👉 To facilitate the movement of the ovum towards the uterus.
The breast (Mammary Gland) is a paired, modified sweat gland that functions as an exocrine gland. It plays a crucial role in lactation (milk production and secretion) and undergoes significant changes during puberty, pregnancy, and menopause.
The breast consists of three main components:
| Component | Description |
|---|---|
| Glandular tissue | Produces and secretes milk. |
| Fibrous connective tissue | Supports the glandular tissue. |
| Adipose (fatty) tissue | Provides size, shape, and cushioning. |
| Layer | Description |
|---|---|
| Skin | Outer covering, contains nipple and areola. |
| Subcutaneous Tissue | Rich in fat, determines size. |
| Glandular Tissue | Produces and secretes milk. |
| Fibrous Connective Tissue | Supports breast structure (Cooper’s ligaments). |
| Retromammary Space | Separates breast from pectoralis major muscle. |
| Hormone | Function |
|---|---|
| Estrogen | Stimulates ductal growth and fat deposition. |
| Progesterone | Stimulates lobular and alveolar development. |
| Prolactin | Initiates milk production (lactogenesis). |
| Oxytocin | Causes milk ejection (let-down reflex). |
| Human Placental Lactogen (hPL) | Prepares the breast for lactation during pregnancy. |
| Aspect | Clinical Relevance |
|---|---|
| Axillary Tail of Spence | Site of breast cancer spread. |
| Cooper’s Ligaments | Shortening leads to skin dimpling in breast cancer. |
| Montgomery’s Glands | Secrete protective lubricant for nipple. |
| Retromammary Space | Allows breast mobility; invasion can indicate advanced malignancy. |
| Colostrum | First milk, rich in IgA, protects newborns. |
✅ What is the functional unit of the breast?
👉 Lobules (Alveoli) within lobes
✅ Which hormone is responsible for milk ejection?
👉 Oxytocin
✅ What is the significance of the Axillary Tail of Spence?
👉 Common site of breast cancer metastasis
✅ Which structure supports the breast and is responsible for dimpling in cancer?
👉 Cooper’s Ligaments
✅ Which hormone initiates milk production?
👉 Prolactin
Menstrual disorders refer to abnormalities in the menstrual cycle, including irregular cycles, excessive bleeding, painful periods, and absence of menstruation. These disorders can result from hormonal imbalances, structural abnormalities, lifestyle factors, or underlying medical conditions.
✅ Normal Menstrual Cycle:
Menstrual disorders can be classified into seven major types:
👉 Definition: The absence of menstrual periods for three or more consecutive cycles.
👉 Types:
👉 Definition: Menstrual cycles longer than 35 days but less than 6 months.
👉 Causes:
👉 Definition: Cycles shorter than 21 days.
👉 Causes:
👉 Definition: Prolonged (>7 days) or excessive (>80 mL) bleeding in regular cycles.
👉 Causes:
👉 Definition: Bleeding at irregular intervals outside the normal cycle.
👉 Causes:
👉 Definition: Minimal bleeding (<30 mL) with regular cycles.
👉 Causes:
👉 Definition: Severe lower abdominal pain during menstruation.
👉 Types:
| Category | Examples |
|---|---|
| Hormonal Disorders | PCOS, Hyperprolactinemia, Thyroid disorders, Ovarian failure |
| Structural Abnormalities | Fibroids, Endometriosis, Adenomyosis, Uterine polyps |
| Blood Disorders | Von Willebrand Disease, Clotting disorders |
| Medications | Anticoagulants, Hormonal contraceptives, Chemotherapy drugs |
| Lifestyle Factors | Excessive exercise, Stress, Malnutrition, Obesity |
✅ History Taking:
✅ Physical Examination:
✅ Investigations:
| Condition | Treatment |
|---|---|
| Primary Dysmenorrhea | NSAIDs (Ibuprofen), Oral Contraceptive Pills (OCPs) |
| PCOS | Lifestyle changes, OCPs, Metformin |
| Menorrhagia | Tranexamic acid, Progesterone therapy |
| Amenorrhea (due to hypothyroidism) | Thyroid hormone replacement |
| Endometriosis | Hormonal therapy (GnRH analogs), Surgery |
| Fibroids | OCPs, Myomectomy, Uterine artery embolization |
| Aspect | Clinical Relevance |
|---|---|
| Primary Amenorrhea | Seen in Turner syndrome, Mullerian agenesis. |
| Secondary Amenorrhea | Pregnancy most common cause, followed by PCOS. |
| Dysmenorrhea | Primary: Excess prostaglandins; Secondary: Endometriosis. |
| Menorrhagia | Linked to fibroids, thyroid disorders, clotting disorders. |
| Polymenorrhea | Short cycles, commonly due to PID, luteal phase defect. |
✅ What is the most common cause of secondary amenorrhea?
👉 Pregnancy
✅ Which menstrual disorder is commonly seen in PCOS?
👉 Oligomenorrhea (Infrequent menstruation)
✅ What is the most common cause of menorrhagia in women over 40 years?
👉 Uterine fibroids
✅ What is the primary cause of dysmenorrhea?
👉 Increased prostaglandin production
✅ What is the best investigation for PCOS?
👉 Ultrasound (USG) showing multiple ovarian cysts
The maternal pelvis is a bony structure that plays a critical role in childbirth (labor and delivery). It supports the weight of the body, protects pelvic organs, and provides the birth canal for the passage of the fetus.
The pelvis consists of four bones:
The Caldwell-Moloy Classification categorizes the female pelvis into four types based on shape:
| Type | Features | Incidence | Obstetric Importance |
|---|---|---|---|
| Gynecoid (Ideal for Delivery) | Round shape, wide subpubic arch, well-curved sacrum | 50% | Most favorable for normal vaginal delivery |
| Android (Male-type Pelvis) | Heart-shaped, narrow subpubic arch, prominent ischial spines | 20% | Difficult labor (Arrest of Descent, Forceps Delivery, C-section needed) |
| Anthropoid | Oval shape, AP diameter longer than transverse, narrow pelvic outlet | 25% | Can lead to persistent occipito-posterior position |
| Platypelloid | Flat pelvis, shortened AP diameter, wide transverse diameter | 5% | Transverse arrest, often requires C-section |
The pelvic diameters are critical in labor as they determine the ease of fetal passage.
| Diameter | Length (cm) | Significance |
|---|---|---|
| Anteroposterior (True Conjugate) | 11 cm | Narrowest fixed diameter |
| Obstetric Conjugate | 10.5 cm | Measured clinically, crucial for fetal passage |
| Diagonal Conjugate | 12.5 cm | Measured via per vaginal examination |
| Transverse Diameter | 13.5 cm | Widest diameter of pelvic inlet |
| Diameter | Length (cm) | Significance |
|---|---|---|
| Interspinous Diameter | 10 cm | Narrowest part of midpelvis, determines fetal head descent |
| Anteroposterior Diameter | 12 cm | From pubic symphysis to sacrum |
| Diameter | Length (cm) | Significance |
|---|---|---|
| Anteroposterior (Sacrococcygeal to Symphysis Pubis) | 13 cm | Increases due to coccyx movement during labor |
| Transverse (Intertuberous) | 11 cm | Measured between ischial tuberosities |
✅ Gynecoid pelvis is the most favorable for vaginal delivery.
✅ Android pelvis is associated with arrest of labor and requires instrumental delivery or C-section.
✅ Pelvimetry (assessment of pelvic diameters) is crucial in cases of cephalopelvic disproportion (CPD).
✅ Interspinous diameter (10 cm) is the narrowest fixed diameter of the pelvis.
The fetal skull is the largest and most rigid part of the fetus that needs to pass through the birth canal. Its size, shape, and flexibility are important factors influencing labor.
👉 Sutures: Fibrous joints between skull bones that allow molding during birth.
| Suture | Location | Significance |
|---|---|---|
| Sagittal | Between two parietal bones | Helps in molding |
| Coronal | Between frontal and parietal bones | |
| Lambdoid | Between occipital and parietal bones |
👉 Fontanelles: Soft membranous gaps at skull junctions.
| Fontanelle | Shape | Closes by | Importance |
|---|---|---|---|
| Anterior Fontanelle (Bregma) | Diamond | 18 months | Used for fetal head assessment |
| Posterior Fontanelle (Lambda) | Triangular | 6-8 weeks |
Diameters of the fetal head determine engagement and passage through the birth canal.
| Diameter | Length (cm) | Presentation | Significance |
|---|---|---|---|
| Suboccipitobregmatic | 9.5 cm | Vertex (Flexed Head) | Ideal for normal delivery |
| Occipitofrontal | 11.5 cm | Partially deflexed | May cause labor difficulty |
| Mentofrontal | 11.5 cm | Brow | Unfavorable for vaginal delivery |
| Submentobregmatic | 9.5 cm | Face | Needs C-section |
| Biparietal | 9.5 cm | Widest transverse diameter | Determines fetal head engagement |
✅ Molding – Overlapping of skull bones to reduce head size for birth.
✅ Engagement – The passage of the biparietal diameter through the pelvic inlet (first sign of labor progression).
✅ Cephalic Presentation (Head-first) is the most common fetal presentation.
| Aspect | Clinical Relevance |
|---|---|
| Suboccipitobregmatic diameter | Smallest diameter, ideal for vaginal delivery |
| Biparietal diameter | Used to assess engagement |
| Gynecoid pelvis | Best for normal delivery |
| Android pelvis | Causes arrest of labor |
| Platypelloid pelvis | Commonly leads to C-section |
| Molding | Helps in reducing fetal skull size for passage |
✅ Which pelvis type is most favorable for normal delivery?
👉 Gynecoid pelvis
✅ What is the narrowest fixed diameter of the pelvis?
👉 Interspinous diameter (10 cm)
✅ Which fetal skull diameter is the smallest and most favorable for normal delivery?
👉 Suboccipitobregmatic (9.5 cm)
✅ What is the most common type of pelvis?
👉 Gynecoid pelvis (50%)
✅ Which part of the fetal skull undergoes molding?
👉 Vault (Cranium)
✅ Which fetal skull presentation is most difficult for vaginal delivery?
👉 Brow presentation (Mentofrontal diameter – 11.5 cm)
Obstetric examination is systematic clinical assessment of a pregnant woman to evaluate fetal well-being, position, and presentation for safe delivery. It includes history-taking, general examination, abdominal examination, and vaginal examination.
Leopold’s maneuvers help assess fetal lie, presentation, position, and engagement.
| Leopold’s Maneuver | Method | Clinical Significance |
|---|---|---|
| First Maneuver (Fundal Grip) | Hands placed over the fundus | Determines fetal lie (longitudinal, oblique, transverse) |
| Second Maneuver (Umbilical Grip) | Hands on lateral sides of abdomen | Locates fetal back & limbs, helps in auscultating FHS |
| Third Maneuver (Pawlik’s Grip) | One hand above the symphysis pubis | Assesses presenting part (head or breech) |
| Fourth Maneuver (Pelvic Grip) | Hands at pelvic inlet | Determines fetal engagement in the pelvis |
✅ Clinical Correlation:
👉 Definition: Relationship of the fetal long axis to the maternal long axis.
✅ Types of Lie:
✅ Clinical Correlation:
👉 Definition: Part of the fetus closest to the birth canal.
| Type | Description | Incidence | Clinical Relevance |
|---|---|---|---|
| Cephalic (Head-first) | Vertex (most common), Brow, Face | 96% | Best for vaginal delivery |
| Breech (Buttocks-first) | Frank, Complete, Footling | 3–4% | Higher risk of C-section |
| Shoulder (Transverse lie) | Shoulder or arm presenting | 1% | Always requires C-section |
✅ Clinical Correlation:
👉 Definition: A fixed reference point on the presenting part, used to describe fetal position.
| Presentation | Denominator |
|---|---|
| Vertex | Occiput |
| Brow | Frontal bone |
| Face | Mentum (Chin) |
| Breech | Sacrum |
| Shoulder | Acromion (Scapula) |
✅ Clinical Correlation:
👉 Definition: The relationship of the fetal denominator to the maternal pelvis.
✅ Position is named using:
| Position | Denominator | Clinical Significance |
|---|---|---|
| LOA (Left Occipito-Anterior) | Occiput | Most common and favorable for normal delivery |
| ROP (Right Occipito-Posterior) | Occiput | Leads to prolonged labor, back pain |
| LST (Left Sacro-Transverse) | Sacrum | Breech position, C-section needed |
| RMT (Right Mentum-Transverse) | Mentum | Face presentation |
✅ Clinical Correlation:
👉 Definition: The passage of the biparietal diameter (9.5 cm) through the pelvic inlet.
✅ Signs of Engagement:
✅ Clinical Correlation:
| Aspect | Clinical Relevance |
|---|---|
| Leopold’s maneuvers | Used to determine fetal lie, presentation, and engagement |
| LOA position | Best for vaginal delivery |
| ROP/LOP position | Causes prolonged labor and back pain |
| Transverse lie | Always requires C-section |
| Mentum posterior face presentation | Incompatible with vaginal delivery |
| Shoulder presentation | Needs emergency C-section |
✅ Which fetal position is most favorable for normal vaginal delivery?
👉 Left Occipito-Anterior (LOA)
✅ Which maneuver determines fetal lie?
👉 First Leopold’s Maneuver (Fundal Grip)
✅ Which denominator is used for cephalic presentation?
👉 Occiput
✅ What is the most common fetal presentation?
👉 Vertex (Cephalic) Presentation
✅ Which presentation is associated with the highest risk of birth trauma?
👉 Breech presentation (especially footling breech)
✅ Which fetal lie is incompatible with vaginal delivery?
👉 Transverse Lie
The zygote is the single-cell fertilized ovum, which undergoes cell division, differentiation, and implantation to form the embryo and placenta.
✅ Normal Fertilization Process:
| Stage | Day Post-Fertilization | Key Events |
|---|---|---|
| Zygote | Day 1 | Single-cell fertilized egg |
| Cleavage | Day 2–3 | Rapid mitotic division |
| Morula (16–32 cells) | Day 3 | Solid ball of cells |
| Blastocyst | Day 5 | Fluid-filled cavity, ready for implantation |
| Implantation | Day 6–7 | Blastocyst attaches to the endometrium |
| Gastrulation | Week 2–3 | Formation of three germ layers |
| Embryo Formation | Week 4–8 | Organogenesis begins |
✅ Clinical Correlation:
The placenta is a temporary organ that develops during pregnancy to supply nutrients and oxygen to the fetus.
| Stage | Timeframe | Key Features |
|---|---|---|
| Trophoblast Differentiation | Week 2 | Forms Cytotrophoblast & Syncytiotrophoblast |
| Chorionic Villi Formation | Week 3 | Villi invade maternal blood vessels |
| Placentation Completion | Week 12 | Fully developed maternal-fetal circulation |
✅ Fetal Side: Smooth, covered by amnion (umbilical cord attaches here).
✅ Maternal Side: Rough, made up of 15–20 cotyledons.
| Function | Details |
|---|---|
| Nutrition | Transfers glucose, amino acids, lipids to the fetus. |
| Respiration | Oxygen supply and CO₂ removal (acts as fetal lungs). |
| Excretion | Removes fetal waste products via maternal circulation. |
| Hormone Production | Secretes hCG, Estrogen, Progesterone, hPL. |
| Immune Protection | Transfers maternal IgG antibodies to fetus. |
| Barrier Function | Prevents entry of maternal cells into fetal circulation. |
✅ Clinical Correlation:
| Disorder | Description | Clinical Significance |
|---|---|---|
| Placenta Previa | Placenta implants over cervix | Causes painless vaginal bleeding in late pregnancy, requires C-section |
| Placental Abruption | Premature separation of placenta | Causes painful vaginal bleeding, fetal distress |
| Placenta Accreta | Abnormal placental attachment to myometrium | Leads to postpartum hemorrhage, requires hysterectomy |
| Placenta Increta | Placenta invades deeper into myometrium | Causes severe hemorrhage |
| Placenta Percreta | Placenta penetrates the uterine wall | Can cause uterine rupture |
✅ Risk Factors: Previous C-section, uterine scarring, multiple pregnancies.
| Disorder | Cause | Clinical Features |
|---|---|---|
| Ectopic Pregnancy | Implantation outside the uterus | Severe abdominal pain, vaginal bleeding |
| Molar Pregnancy (Hydatidiform Mole) | Abnormal trophoblastic proliferation | High hCG levels, grape-like vesicles on ultrasound |
| Anembryonic Pregnancy (Blighted Ovum) | Fertilized egg develops without embryo | Empty gestational sac on ultrasound |
| Congenital Malformations | Teratogens, genetic defects | Neural tube defects, cardiac anomalies |
✅ Clinical Correlation:
| Disorder | Cause | Clinical Effects |
|---|---|---|
| Fetal Growth Restriction (FGR/IUGR) | Placental insufficiency | Low birth weight, hypoxia |
| Gestational Hypertension (Preeclampsia) | Placental vascular dysfunction | High BP, proteinuria, edema |
| Twin-Twin Transfusion Syndrome (TTTS) | Unequal blood flow in monochorionic twins | One twin becomes polycythemic, the other anemic |
✅ Clinical Correlation:
| Aspect | Clinical Relevance |
|---|---|
| Trophoblast invasion failure | Leads to preeclampsia, IUGR |
| hCG production | Monitored in early pregnancy and molar pregnancy |
| Placenta previa | Causes painless bleeding, requires C-section |
| Placental abruption | Causes painful bleeding, fetal distress |
| Fetal growth restriction (IUGR) | Due to placental insufficiency |
✅ Where does fertilization normally occur?
👉 Ampulla of the Fallopian tube
✅ Which hormone maintains pregnancy in the first trimester?
👉 hCG (Human Chorionic Gonadotropin)
✅ What is the most common site of ectopic pregnancy?
👉 Fallopian tube (Ampulla)
✅ Which placental abnormality causes painless bleeding in the third trimester?
👉 Placenta previa
✅ What is the major function of the placenta?
👉 Oxygen and nutrient transfer to the fetus
✅ Which condition occurs due to abnormal trophoblastic proliferation?
👉 Molar pregnancy (Hydatidiform mole)
✅ Which antibody crosses the placenta to provide immunity?
👉 IgG
The development of a human begins with fertilization, followed by zygote formation, embryogenesis, and fetal growth. It occurs in three stages:
✅ Gestation Period: 40 weeks (280 days) from the Last Menstrual Period (LMP).
✅ Trimesters:
| Stage | Week | Key Events |
|---|---|---|
| Zygote | Day 1 | Single-cell formed after fertilization. |
| Morula | Day 3 | 16-cell solid ball. |
| Blastocyst | Day 5 | Hollow sphere, implantation occurs. |
| Gastrulation | Week 3 | Formation of three germ layers (Ectoderm, Mesoderm, Endoderm). |
| Neurulation | Week 4 | Neural tube formation (brain & spinal cord). |
| Organogenesis | Week 4–8 | Major organ systems develop. |
✅ Clinical Correlation:
| Germ Layer | Organs Derived |
|---|---|
| Ectoderm (Outer Layer) | CNS (Brain, Spinal Cord), PNS, Skin, Hair, Nails, Eyes, Ears, Enamel, Pituitary Gland. |
| Mesoderm (Middle Layer) | Muscles, Bones, Heart, Blood Vessels, Kidneys, Gonads, Lymphatics. |
| Endoderm (Inner Layer) | Gastrointestinal Tract, Liver, Pancreas, Lungs, Thyroid, Bladder. |
✅ Clinical Correlation:
| Week | Developmental Milestone |
|---|---|
| Week 3 | Primitive streak, neural plate formation. |
| Week 4 | Heart starts beating, limb buds form. |
| Week 5 | Brain, spinal cord, eye development. |
| Week 6 | Facial features begin forming. |
| Week 7 | Digits form, fetal heartbeat detected by ultrasound. |
| Week 8 | All major organs develop (Organogenesis completes). |
| Week 9 | Fetus starts moving, ossification begins. |
✅ Clinical Correlation:
| Week | Developmental Milestone |
|---|---|
| Week 12 | External genitalia develop (Sex determination via ultrasound). |
| Week 16 | Quickening (fetal movements felt by mother). |
| Week 20 | Vernix caseosa (skin protection) and lanugo (fine hair) appear. |
| Week 24 | Lungs start producing surfactant, fetal viability increases. |
✅ Clinical Correlation:
| Week | Developmental Milestone |
|---|---|
| Week 28 | Eyelids open, brain grows rapidly. |
| Week 32 | Fetus gains subcutaneous fat, better thermoregulation. |
| Week 36 | Fetal lungs mature, position fixed in cephalic presentation. |
| Week 40 | Term birth, full organ maturity. |
✅ Clinical Correlation:
| Disorder | Cause | Clinical Effects |
|---|---|---|
| Neural Tube Defects | Folic acid deficiency | Spina bifida, anencephaly |
| Congenital Heart Defects | Genetic, viral infections | Tetralogy of Fallot, ASD, VSD |
| Limb Malformations | Thalidomide exposure | Phocomelia (missing limbs) |
| Oligohydramnios | Low amniotic fluid | Potter’s syndrome (renal agenesis) |
| Polyhydramnios | Excess amniotic fluid | Associated with esophageal atresia |
| IUGR (Intrauterine Growth Restriction) | Placental insufficiency | Low birth weight, fetal distress |
✅ Clinical Correlation:
The fetus has a unique circulation system to bypass non-functioning lungs.
| Structure | Function in Fetus | Changes After Birth |
|---|---|---|
| Ductus Venosus | Shunts blood from umbilical vein to IVC | Becomes Ligamentum venosum |
| Foramen Ovale | Shunts blood from right to left atrium | Closes after birth |
| Ductus Arteriosus | Connects pulmonary artery to aorta | Becomes Ligamentum arteriosum |
✅ Clinical Correlation:
| Aspect | Clinical Relevance |
|---|---|
| Neural tube defects | Due to folic acid deficiency |
| First organ to develop | Heart (Week 4) |
| Viability of fetus | Possible after 24 weeks |
| Lung maturation | Requires surfactant (Week 28–36) |
| Patent Ductus Arteriosus | Causes continuous murmur |
✅ Which organ develops first in the embryo?
👉 Heart (starts beating by Week 4)
✅ At what week does quickening occur?
👉 Week 16
✅ Which structure allows blood to bypass the lungs in fetal circulation?
👉 Ductus Arteriosus
✅ What is the major cause of polyhydramnios?
👉 Esophageal Atresia
✅ At what week is the fetus viable outside the womb?
👉 Week 24