ANTENATAL AND POSTNATAL
Antenatal diagnostic tests are performed to monitor maternal and fetal health, detect abnormalities, and guide pregnancy management. These tests include routine blood tests, ultrasound, fetal monitoring, and genetic screenings.
✅ Objectives of Antenatal Testing:
✅ Categories of Antenatal Tests:
These tests are performed during the first and second trimester to assess maternal health and fetal well-being.
| Test | Purpose | Normal Findings | Clinical Significance |
|---|---|---|---|
| Beta-hCG Test | Confirms pregnancy | High in early pregnancy | Low levels → Ectopic pregnancy, miscarriage |
| Complete Blood Count (CBC) | Detects anemia, infection | Hb > 11 g/dL | Low Hb → Iron deficiency anemia |
| Blood Group & Rh Factor | Determines Rh compatibility | Rh+ or Rh- | Rh incompatibility → Hemolytic disease of the newborn |
| Urine Routine & Culture | Detects infections, proteinuria | No protein, No bacteria | Proteinuria → Preeclampsia; Bacteriuria → UTI risk |
| Fasting Blood Sugar (FBS) | Screens for gestational diabetes | < 92 mg/dL | High → Risk of gestational diabetes |
| Thyroid Function Test (T3, T4, TSH) | Evaluates thyroid health | TSH: 0.2–2.5 mIU/L | Hypothyroidism → Risk of fetal neurodevelopmental issues |
| HIV, HBsAg, VDRL (Syphilis), Rubella IgG | Screens for infections | Negative | Positive → Risk of congenital infections |
✅ Clinical Correlation:
| Test | Purpose | Normal Findings | Clinical Significance |
|---|---|---|---|
| Quadruple Marker Test | Screens for Down syndrome, Neural tube defects | Normal AFP, hCG, Estriol, Inhibin-A | High AFP → Neural tube defects; Low AFP → Down syndrome |
| Glucose Tolerance Test (GTT – 75g/100g) | Diagnoses gestational diabetes | < 140 mg/dL (1 hr) | > 140 mg/dL → Gestational diabetes mellitus (GDM) |
| Anomaly Scan (Level 2 USG at 18–22 weeks) | Detects structural fetal anomalies | Normal fetal anatomy | Detects congenital heart defects, spina bifida, cleft lip |
| Cervical Length Measurement (TVS) | Assesses risk of preterm labor | > 25 mm | Short cervix → Risk of preterm labor |
| Fetal Echocardiography (20–24 weeks) | Evaluates fetal heart | Normal cardiac structure | Detects congenital heart disease |
✅ Clinical Correlation:
| Test | Purpose | Clinical Use |
|---|---|---|
| Chorionic Villus Sampling (CVS, 10–13 weeks) | Genetic diagnosis | Detects Down syndrome, Thalassemia, Cystic Fibrosis |
| Amniocentesis (15–20 weeks) | Karyotyping, Genetic disorders | Confirms chromosomal abnormalities |
| Non-Invasive Prenatal Testing (NIPT, from 9 weeks) | DNA test for trisomy 13, 18, 21 | Detects Down syndrome (99% accuracy) |
✅ Clinical Correlation:
These tests are done after 28 weeks to assess fetal growth, movement, and oxygenation.
| Test | Purpose | Interpretation | Clinical Use |
|---|---|---|---|
| Fetal Kick Count (Daily from 28 weeks) | Mother counts fetal movements | > 10 kicks in 2 hours | Low movements → Fetal distress |
| Non-Stress Test (NST, from 32 weeks) | Monitors fetal heart rate with movements | Reactive: HR rises with movement | Non-reactive → Placental insufficiency |
| Contraction Stress Test (CST) | Assesses fetal response to contractions | Negative: No decelerations | Positive CST → Fetal distress, may need delivery |
| Amniotic Fluid Index (AFI) | Measures amniotic fluid volume | 8–25 cm | Low AFI (<5 cm) → Oligohydramnios |
| Doppler Ultrasound (Umbilical Artery Flow) | Assesses placental perfusion | Normal flow | Absent/reversed flow → Risk of fetal death |
✅ Clinical Correlation:
| Test | Purpose | Clinical Significance |
|---|---|---|
| Group B Streptococcus (GBS) Culture (35–37 weeks) | Detects bacterial infection | If positive → IV antibiotics in labor |
| Fetal Lung Maturity Test (Amniotic Fluid Lecithin/Sphingomyelin ratio, >34 weeks) | Assesses lung development | L/S ratio > 2:1 → Lungs mature |
| Pelvimetry (X-ray or USG, Late pregnancy) | Assesses pelvic size | Small pelvis → C-section required |
✅ Clinical Correlation:
| Aspect | Clinical Relevance |
|---|---|
| Quadruple Test | Screens for neural tube defects, Down syndrome |
| GTT (Glucose Tolerance Test) | Detects gestational diabetes |
| NST (Non-Stress Test) | Assesses fetal heart rate variability |
| Amniocentesis | Detects genetic disorders |
| Cervical length TVS | Predicts preterm labor |
✅ What is the best test for detecting Down syndrome early in pregnancy?
👉 Non-Invasive Prenatal Testing (NIPT, from 9 weeks)
✅ Which test confirms fetal lung maturity before delivery?
👉 Lecithin/Sphingomyelin (L/S) Ratio
✅ What is the most reliable screening test for gestational diabetes?
👉 75g Oral Glucose Tolerance Test (OGTT)
✅ Which test is performed at 18–22 weeks to detect fetal anomalies?
👉 Anomaly Scan (Level 2 USG)
✅ What test is used to assess fetal distress before delivery?
👉 Non-Stress Test (NST)
Antenatal tests are performed during pregnancy to assess maternal health, detect fetal abnormalities, and ensure fetal well-being. These tests include biochemical markers, genetic screening, imaging techniques, and fetal well-being tests.
✅ Types of Antenatal Tests:
These tests screen for chromosomal and neural tube defects in the fetus.
✅ Definition: A maternal blood test that measures:
✅ Clinical Use: Screens for Down syndrome, Trisomy 18, and Neural Tube Defects (NTDs).
| Condition | AFP | hCG | Estriol |
|---|---|---|---|
| Down Syndrome (Trisomy 21) | ↓ | ↑ | ↓ |
| Trisomy 18 (Edwards Syndrome) | ↓ | ↓ | ↓ |
| Neural Tube Defects (Anencephaly, Spina Bifida) | ↑ | Normal | Normal |
✅ Clinical Correlation:
✅ Definition: A protein produced by the fetal liver, measured in maternal blood to detect NTDs and chromosomal abnormalities.
✅ Normal Value: 10–150 ng/mL (Varies with gestational age).
| Condition | AFP Level | Clinical Significance |
|---|---|---|
| Neural Tube Defects | ↑ | Anencephaly, Spina bifida |
| Down Syndrome | ↓ | Trisomy 21 |
| Multiple Pregnancies | ↑ | Twins or triplets |
| Fetal Demise | ↓ | Intrauterine death |
✅ Clinical Correlation:
These tests diagnose fetal genetic and structural conditions.
✅ Definition: Fetal blood sampling from the umbilical cord, usually done after 20 weeks.
✅ Procedure:
✅ Indications:
✅ Clinical Correlation:
These tests assess fetal health in the third trimester.
✅ Definition: Mother counts fetal movements to assess fetal well-being.
✅ Method:
✅ Normal Result:
✅ Abnormal Findings:
✅ Clinical Correlation:
✅ Definition: Monitors fetal heart rate (FHR) and variability with fetal movement.
✅ Normal (Reactive NST):
✅ Abnormal (Non-Reactive NST):
✅ Clinical Correlation:
✅ Definition: Assesses fetal well-being using 5 parameters:
✅ Scoring System:
✅ Clinical Correlation:
✅ Definition: Measures blood flow in umbilical arteries to assess placental perfusion.
✅ Indications:
✅ Findings:
✅ Clinical Correlation:
| Test | Purpose | Clinical Use |
|---|---|---|
| Triple Marker Test | Screens for Trisomy 21, 18, NTDs | Abnormal results → Amniocentesis |
| MSAFP | Detects neural tube defects | High AFP → Spina bifida |
| Cordocentesis | Fetal blood sampling | Detects anemia, infections, karyotyping |
| Kick Count Test | Assesses fetal movements | <10 kicks in 2 hrs → Fetal distress |
| NST | Fetal heart rate monitoring | Non-reactive NST → Fetal hypoxia |
| BPP | Comprehensive fetal well-being test | Score ≤4 → Emergency delivery |
| Doppler USG | Assesses umbilical blood flow | Absent/reversed flow → Urgent delivery |
✅ Which test screens for Down syndrome in the second trimester?
👉 Triple Marker Test
✅ What is the most accurate test for fetal anemia?
👉 Cordocentesis (PUBS)
✅ Which antenatal test assesses fetal distress by movement count?
👉 Kick Count Test
✅ What is the next step if NST is non-reactive?
👉 Biophysical Profile or Doppler Ultrasound
✅ Which test measures umbilical artery blood flow?
👉 Doppler Ultrasound
During pregnancy, hormonal, physiological, and anatomical changes lead to minor discomforts. These are not serious but may affect maternal well-being. Proper management, lifestyle modifications, and symptomatic treatment help in alleviating symptoms.
✅ Causes of Minor Ailments in Pregnancy:
| Ailment | Trimester | Cause | Management |
|---|---|---|---|
| Nausea & Vomiting (Morning Sickness) | 1st trimester | High hCG & progesterone | Small frequent meals, avoid spicy food, Vitamin B6 |
| Heartburn (Gastric Reflux) | 2nd & 3rd trimester | Relaxed lower esophageal sphincter (Progesterone effect) | Eat small meals, avoid lying down after eating, antacids |
| Constipation | All trimesters | Progesterone slows peristalsis, iron supplements | High fiber diet, fluids, mild exercise |
| Hemorrhoids (Piles) | 2nd & 3rd trimester | Increased venous pressure from uterus | Sitz bath, fiber diet, topical anesthetics |
| Backache | 2nd & 3rd trimester | Relaxin hormone loosens ligaments, increased lumbar curve | Proper posture, maternity belt, back exercises |
| Leg Cramps | 2nd & 3rd trimester | Calcium & Magnesium deficiency | Leg elevation, calcium-rich foods, stretching |
| Varicose Veins | 2nd & 3rd trimester | Increased venous pressure, weight gain | Avoid prolonged standing, compression stockings |
| Breathlessness | 3rd trimester | Diaphragm pushed up by uterus | Deep breathing, posture correction |
| Frequent Urination | 1st & 3rd trimester | Uterus presses on bladder | Avoid caffeine, empty bladder completely |
| Edema (Swelling in Legs & Feet) | 3rd trimester | Fluid retention, pressure on veins | Elevate legs, hydration, avoid prolonged standing |
| Fatigue | All trimesters | Increased metabolic demands, anemia | Iron, folic acid, adequate rest |
| Insomnia | 3rd trimester | Hormonal changes, back pain, frequent urination | Sleep on left side, relaxation techniques |
✅ Clinical Correlation:
| Ailment | Cause | Management |
|---|---|---|
| Morning Sickness | hCG surge | Vitamin B6, ginger tea |
| Frequent Urination | Uterus pressing bladder | Avoid caffeine, urinate regularly |
| Fatigue | Increased progesterone | Rest, iron-rich diet |
| Excessive Salivation (Ptyalism) | Hormonal changes | Frequent mouth rinsing, chewing gum |
| Ailment | Cause | Management |
|---|---|---|
| Back Pain | Weight gain, Relaxin | Maternity belt, back exercises |
| Varicose Veins | Uterine pressure on veins | Compression stockings, leg elevation |
| Leg Cramps | Calcium & magnesium deficiency | Leg stretching, hydration |
| Heartburn | Relaxed LES | Small meals, sit upright after eating |
| Ailment | Cause | Management |
|---|---|---|
| Shortness of Breath | Uterus pushing diaphragm | Deep breathing, good posture |
| Swelling (Edema) | Fluid retention, pressure on veins | Leg elevation, hydration |
| Insomnia | Frequent urination, discomfort | Left-side sleeping, warm bath |
| Hemorrhoids | Pressure on rectal veins | Sitz bath, fiber-rich diet |
✅ Clinical Correlation:
| Ailment | Safe Medications |
|---|---|
| Nausea & Vomiting | Pyridoxine (Vitamin B6), Doxylamine |
| Heartburn | Antacids (Calcium carbonate, Sucralfate) |
| Constipation | Bulk laxatives (Psyllium), Stool softeners (Docusate sodium) |
| Leg Cramps | Calcium & Magnesium supplements |
| Insomnia | Melatonin, Warm milk before bedtime |
✅ Clinical Correlation:
| Aspect | Clinical Relevance |
|---|---|
| Hyperemesis Gravidarum | Severe nausea requiring IV fluids |
| Persistent Edema | Sign of preeclampsia |
| Severe Back Pain | Risk of preterm labor |
| Severe Leg Cramps | Associated with calcium/magnesium deficiency |
| Unilateral Swelling + Pain | May indicate Deep Vein Thrombosis (DVT) |
✅ Which hormone is responsible for morning sickness?
👉 hCG (Human Chorionic Gonadotropin)
✅ What is the safest treatment for heartburn in pregnancy?
👉 Antacids (Calcium carbonate, Sucralfate)
✅ Which condition causes excessive saliva production in pregnancy?
👉 Ptyalism
✅ What is the best sleep position in pregnancy?
👉 Left-side sleeping (Improves circulation to fetus)
✅ Which supplement prevents leg cramps in pregnancy?
👉 Calcium & Magnesium
Fundal height measurement is a clinical method to assess fetal growth and gestational age by measuring the distance from the pubic symphysis to the uterine fundus in centimeters.
✅ Clinical Importance:
| Gestational Age (Weeks) | Fundal Height Location | Clinical Correlation |
|---|---|---|
| 12 Weeks | Just above pubic symphysis | Uterus starts rising into the abdomen. |
| 16 Weeks | Midway between pubic symphysis & umbilicus | Quickening may begin. |
| 20 Weeks | At the umbilicus (20 cm) | Fetal movements easily felt. |
| 24 Weeks | 4 cm above umbilicus | Fetal heartbeat audible via fetoscope. |
| 28 Weeks | Midway between umbilicus & xiphoid process | Fetal viability increases. |
| 32 Weeks | At xiphoid process | Uterus reaches maximum height. |
| 36 Weeks | At costal margin (under ribs) | Maternal discomfort increases. |
| 40 Weeks | Slightly below 36-week level | “Lightening” (descent of fetal head into pelvis). |
✅ Clinical Correlation:
Pregnancy is diagnosed using a combination of presumptive, probable, and positive signs.
✅ Definition: Non-confirmatory symptoms suggesting pregnancy.
| Symptom | Timing | Cause |
|---|---|---|
| Amenorrhea (Absence of Menstruation) | 4+ weeks | High progesterone & hCG |
| Nausea & Vomiting (Morning Sickness) | 6–12 weeks | High hCG levels |
| Breast Tenderness & Enlargement | 6+ weeks | Estrogen & progesterone effects |
| Fatigue | 6–12 weeks | Increased metabolic demands |
| Frequent Urination | 6–8 weeks | Uterus pressing on bladder |
| Quickening (First fetal movements) | 16–20 weeks | Fetal movement sensation |
✅ Clinical Correlation:
✅ Definition: Strong indications of pregnancy but not diagnostic.
| Sign | Timing | Description |
|---|---|---|
| Chadwick’s Sign | 6–8 weeks | Bluish discoloration of the cervix & vagina due to increased blood flow. |
| Goodell’s Sign | 6–8 weeks | Softening of the cervix due to hormonal changes. |
| Hegar’s Sign | 6–12 weeks | Softening of the lower uterus (felt on bimanual exam). |
| Ballottement | 16–20 weeks | Rebounding of fetus upon vaginal examination. |
| Braxton Hicks Contractions | 16+ weeks | Irregular, painless uterine contractions. |
| Abdominal Enlargement | 12+ weeks | Uterus expansion. |
✅ Clinical Correlation:
✅ Definition: Conclusive evidence of pregnancy, detected by medical instruments.
| Sign | Timing | Diagnosis Method |
|---|---|---|
| Fetal Heart Sounds (FHS) | 10–12 weeks | Doppler Ultrasound |
| Ultrasound Detection of Fetus | 5–6 weeks | Transvaginal Ultrasound |
| Palpation of Fetal Parts | 20+ weeks | Leopold’s Maneuvers |
| Fetal Movements (Observed by Clinician) | 20+ weeks | Physical Examination |
✅ Clinical Correlation:
| Test | Timeframe | Purpose |
|---|---|---|
| Urine Pregnancy Test (UPT) | After missed period (4–5 weeks) | Detects hCG in urine. |
| Serum Beta-hCG Test | 4–10 weeks | Confirms pregnancy, detects ectopic pregnancy. |
| Ultrasound (TVS) | 5–6 weeks | Detects gestational sac & cardiac activity. |
| Pelvic Examination | 6+ weeks | Assesses uterine size, cervix changes. |
✅ Clinical Correlation:
| Aspect | Clinical Relevance |
|---|---|
| Fundal height = Gestational age (weeks) after 24 weeks | Used in McDonald’s Rule |
| First pregnancy sign | Amenorrhea |
| First positive pregnancy confirmation | Ultrasound at 5–6 weeks |
| Gold standard for pregnancy diagnosis | Ultrasound |
| Best test for early pregnancy loss detection | Serum Beta-hCG |
✅ At what week does the fundal height reach the umbilicus?
👉 20 weeks
✅ What is the first probable sign of pregnancy?
👉 Chadwick’s Sign (Bluish cervix)
✅ Which test confirms pregnancy earliest?
👉 Serum Beta-hCG (4 weeks)
✅ At what week does the fundal height reach the xiphoid process?
👉 36 weeks
✅ What is the gold standard for confirming pregnancy?
👉 Ultrasound (5–6 weeks)
✅ Which sign is characterized by fetal rebound during vaginal examination?
👉 Ballottement
During pregnancy, hormonal changes support fetal development, maintain pregnancy, and prepare for labor and lactation.
✅ Major Pregnancy Hormones:
| Hormone | Source | Function | Clinical Significance |
|---|---|---|---|
| hCG (Human Chorionic Gonadotropin) | Placenta (Syncytiotrophoblast) | Maintains corpus luteum, stimulates progesterone | High in molar pregnancy, twins |
| Progesterone | Corpus luteum (early), placenta (later) | Maintains pregnancy, prevents uterine contractions | Low → Miscarriage risk |
| Estrogen (Estriol, E3) | Placenta | Uterine enlargement, breast development | High in twins, Low in fetal distress |
| hPL (Human Placental Lactogen) | Placenta | Increases maternal insulin resistance, promotes fetal glucose supply | High → Gestational Diabetes Mellitus (GDM) |
| Relaxin | Corpus luteum & Placenta | Softens pelvic ligaments & cervix, inhibits contractions | Excess → Pelvic girdle pain |
| Oxytocin | Posterior Pituitary | Uterine contractions, milk ejection | Used to induce labor |
| Prolactin | Anterior Pituitary | Milk production | High → Galactorrhea |
✅ Clinical Correlation:
Pregnancy induces systemic changes in all maternal organs to support fetal growth and prepare for delivery.
✅ Categories of Physiological Changes:
| Change | Effect | Clinical Relevance |
|---|---|---|
| Increased Blood Volume | 40–50% increase | Risk of physiological anemia |
| Increased Cardiac Output | 30–50% increase | Helps fetal oxygenation |
| Heart Rate (HR) Increase | 10–15 bpm rise | Palpitations common |
| Decreased Blood Pressure (1st & 2nd Trimester) | Due to progesterone-induced vasodilation | Risk of syncope, hypotension |
| Supine Hypotension Syndrome | Uterus compresses inferior vena cava | Avoid lying flat after 20 weeks |
✅ Clinical Correlation:
| Change | Effect | Clinical Relevance |
|---|---|---|
| Increased Tidal Volume | 40% increase | Helps oxygenate fetus |
| Increased Minute Ventilation | 50% increase | May cause mild hyperventilation |
| Diaphragm Elevation | 4 cm rise | Breathlessness in 3rd trimester |
| Respiratory Alkalosis | Due to increased CO₂ elimination | Maintains fetal oxygenation |
✅ Clinical Correlation:
| Change | Effect | Clinical Relevance |
|---|---|---|
| Increased GFR (Glomerular Filtration Rate) | 50% rise | Increased urine production |
| Increased Renal Plasma Flow | Due to vasodilation | Risk of urinary stasis → UTI risk |
| Glycosuria & Proteinuria | Mild glucose/protein loss normal | >300 mg protein/day → Preeclampsia suspicion |
✅ Clinical Correlation:
| Change | Effect | Clinical Relevance |
|---|---|---|
| Reduced Gastric Motility | Due to progesterone | Constipation, bloating |
| Relaxed Lower Esophageal Sphincter | Due to progesterone | Heartburn, GERD |
| Gallbladder Slows Emptying | Risk of gallstones | Right upper quadrant pain |
✅ Clinical Correlation:
| Change | Effect | Clinical Relevance |
|---|---|---|
| Increased Insulin Resistance | Due to hPL | Risk of Gestational Diabetes |
| Thyroid Enlargement | Increased T3, T4, but normal TSH | Normal, unless TSH >2.5 mIU/L |
| Increased Cortisol & Aldosterone | Fluid retention | Swelling, mild edema |
✅ Clinical Correlation:
| Change | Effect | Clinical Relevance |
|---|---|---|
| Increased Plasma Volume | 50% increase | Causes Physiological Anemia |
| Increased Clotting Factors | Hypercoagulable state | Risk of Deep Vein Thrombosis (DVT) |
| WBC Count Increases | Up to 15,000/mm³ | Normal in pregnancy |
✅ Clinical Correlation:
| Aspect | Clinical Relevance |
|---|---|
| hCG peak at 9–12 weeks | Used for pregnancy test |
| Progesterone prevents contractions | Low levels → Miscarriage risk |
| Preeclampsia screening | BP should not exceed 140/90 mmHg |
| Increased insulin resistance (hPL) | Risk of Gestational Diabetes |
| Physiological anemia | Hb <11 g/dL requires iron therapy |
✅ Which hormone maintains pregnancy by relaxing the uterus?
👉 Progesterone
✅ Which hormone is responsible for insulin resistance in pregnancy?
👉 hPL (Human Placental Lactogen)
✅ What is the main reason for frequent urination in pregnancy?
👉 Increased GFR
✅ Why do pregnant women have mild breathlessness?
👉 Diaphragm elevation & increased oxygen demand
✅ Which cardiovascular change is normal in pregnancy?
👉 Increased cardiac output by 30–50%
Labour is the process of uterine contractions and cervical changes that result in the expulsion of the fetus, placenta, and membranes from the uterus. It is a natural process and is divided into four stages.
✅ Stages of Labour:
| Term | Definition |
|---|---|
| Parturition | The process of giving birth. |
| Effacement | Thinning and shortening of the cervix during labour. |
| Dilation | The opening of the cervix (up to 10 cm). |
| Engagement | The passage of the biparietal diameter through the pelvic inlet. |
| Station | Relationship of the presenting part to ischial spines of the pelvis. |
| Moulding | Overlapping of fetal skull bones to facilitate delivery. |
| Lie | Relationship of the fetal long axis to the maternal long axis. |
| Presentation | Part of the fetus closest to the birth canal. |
| Position | Relationship of the presenting part to the maternal pelvis. |
| Show | Passage of blood-tinged mucus plug from the cervix during labour. |
✅ Clinical Correlation:
Labour pain is caused by uterine contractions, cervical dilation, and stretching of pelvic tissues.
| Type | Cause | Clinical Description |
|---|---|---|
| Visceral Pain (First Stage) | Uterine contractions, cervical dilation | Felt in lower abdomen, back, thighs |
| Somatic Pain (Second Stage) | Perineal stretching, pelvic floor | Sharp pain localized to the vaginal and perineal region |
| Referred Pain | Nerve pathways (T10–L1, S2–S4) | Pain radiating to lower back and thighs |
✅ Clinical Correlation:
These factors influence the progress and outcome of labour.
| Factor | Description |
|---|---|
| Passenger (Fetus) | Fetal size, lie, presentation, position. |
| Passage (Pelvis) | Shape and size of the maternal pelvis. |
| Power (Contractions) | Strength, duration, and frequency of uterine contractions. |
| Psyche (Emotional State) | Anxiety and fear can inhibit progress by increasing catecholamines. |
| Position (Maternal Position) | Positions during labour (squatting, standing, lying) affect descent. |
✅ Clinical Correlation:
✅ Definition: Labour lasting >18 hours in primigravida or >12 hours in multipara.
| Cause | Description |
|---|---|
| Inefficient Uterine Contractions | Weak or uncoordinated contractions. |
| Fetal Malposition | Persistent occipito-posterior (OP) position. |
| Cephalopelvic Disproportion (CPD) | Fetal head cannot pass through the pelvis. |
✅ Clinical Management:
✅ Definition: No progress in labour despite adequate uterine contractions due to fetal obstruction.
| Cause | Description |
|---|---|
| Cephalopelvic Disproportion (CPD) | Fetal head too large for pelvis. |
| Shoulder Dystocia | Fetal shoulder gets stuck after the head is delivered. |
| Transverse Lie | Fetus lies horizontally instead of longitudinally. |
✅ Clinical Correlation:
✅ Definition: Failure to deliver fetal shoulders after the head is delivered due to shoulder impaction at the maternal symphysis pubis.
✅ Risk Factors:
✅ Complications:
| Step | Description |
|---|---|
| H (Help) | Call for assistance. |
| E (Episiotomy) | Consider episiotomy to enlarge the vaginal outlet. |
| L (Legs – McRoberts Maneuver) | Flex maternal thighs to chest, widens pelvis. |
| P (Pressure) | Apply suprapubic pressure to dislodge shoulder. |
| E (Enter Maneuvers) | Internal maneuvers to rotate the fetal shoulder. |
| R (Remove Posterior Arm) | Deliver the posterior arm first. |
| R (Roll Over – Gaskin Maneuver) | Place the mother on all fours to aid delivery. |
✅ Clinical Correlation:
| Aspect | Clinical Relevance |
|---|---|
| Stages of Labour | Helps in monitoring labour progression. |
| Key Factors (5 Ps) | Detects prolonged and obstructed labour. |
| Shoulder Dystocia Management | Prevents fetal brachial plexus injury. |
| Cephalopelvic Disproportion | Requires C-section to avoid rupture. |
| Types of Labour Pain | Guides pain relief options. |
✅ What is the best indicator of labour progress?
👉 Cervical effacement and dilation
✅ Which position is most favorable for vaginal delivery?
👉 Left Occipito-Anterior (LOA)
✅ What is the most common cause of obstructed labour?
👉 Cephalopelvic Disproportion (CPD)
✅ Which maneuver is used to manage shoulder dystocia?
👉 McRoberts Maneuver
✅ What are the main causes of prolonged labour?
👉 Weak contractions, malposition, CPD
Labour is a natural physiological process that leads to the expulsion of the fetus, placenta, and membranes from the uterus. It is divided into four stages.
✅ Definition of Labour:
✅ Key Features of Labour:
Labour is classified into four stages, each with distinct physiological events and management.
| Stage | Timeframe | Key Events |
|---|---|---|
| First Stage (Cervical Dilation Stage) | Onset of labour to full cervical dilation (10 cm) | Latent & Active phases, cervical dilation, effacement. |
| Second Stage (Expulsion of Fetus) | Full dilation to delivery of baby | Pushing, crowning, fetal birth. |
| Third Stage (Placental Delivery) | Delivery of baby to expulsion of placenta | Placenta separates & is delivered. |
| Fourth Stage (Recovery Stage) | 1–2 hours post-delivery | Uterus contracts, postpartum monitoring. |
✅ Clinical Correlation:
✅ Definition: The period from the onset of regular contractions to full cervical dilation (10 cm).
✅ Phases of the First Stage:
| Phase | Cervical Dilation | Duration |
|---|---|---|
| Latent Phase | 0–4 cm | 6–8 hours (Longer in primigravida) |
| Active Phase | 4–10 cm | 3–6 hours (Rapid cervical dilation) |
✅ Physiological Events:
✅ Management:
✅ Complications & Interventions:
✅ Definition: From full cervical dilation (10 cm) to delivery of the baby.
✅ Physiological Events:
✅ Management:
✅ Complications & Interventions:
✅ Definition: From birth of the baby to the expulsion of the placenta.
✅ Physiological Events:
✅ Management (Active Management of Third Stage of Labour – AMTSL):
✅ Complications & Interventions:
✅ Definition: The first 1–2 hours after placental delivery, where the mother is closely monitored.
✅ Physiological Events:
✅ Management:
✅ Complications & Interventions:
| Aspect | Clinical Relevance |
|---|---|
| First Stage (Latent & Active Phases) | Determines labour progress. |
| Second Stage (Expulsion of Baby) | Requires active maternal effort. |
| Third Stage (Placental Separation) | Risk of postpartum hemorrhage (PPH). |
| Fourth Stage (Recovery) | Prevents maternal complications. |
✅ Which stage of labour is the longest?
👉 First Stage
✅ What is the normal duration of the second stage in a primigravida?
👉 Up to 2 hours
✅ What is the best way to prevent postpartum hemorrhage (PPH)?
👉 Active management of third stage (AMTSL: Oxytocin, Controlled Cord Traction, Uterine Massage)
✅ What are the signs of placental separation?
👉 Gush of blood, lengthening of the cord, fundus becoming firm & globular
✅ Which hormone is given to enhance uterine contractions in labour?
👉 Oxytocin
✅ What is the intervention for a retained placenta?
👉 Manual removal of placenta
✅ What is the normal cervical dilation rate in active labour?
👉 1 cm/hr in primigravida, 1.5 cm/hr in multipara
A partograph is a graphical tool used to monitor the progress of labour and identify complications early.
✅ Definition:
A visual record of labour progress, maternal condition, and fetal well-being to prevent prolonged or obstructed labour.
✅ Uses of Partograph:
| Parameter | What It Measures | Normal Findings | Abnormal Findings |
|---|---|---|---|
| Cervical Dilation (cm) | Rate of labour progress | ≥1 cm/hr in primigravida, ≥1.5 cm/hr in multipara | <1 cm/hr → Prolonged labour |
| Descent of Fetal Head (Station) | Position of fetal head in pelvis | Progressive descent after 7 cm dilation | No descent → Cephalopelvic Disproportion (CPD) |
| Uterine Contractions | Frequency, duration, intensity | 3–4 contractions in 10 minutes, lasting 40–60 sec | Weak contractions → Prolonged labour |
| Parameter | What It Measures | Normal Findings | Abnormal Findings |
|---|---|---|---|
| Fetal Heart Rate (FHR) | Fetal oxygenation | 110–160 bpm | <110 or >160 bpm → Fetal distress |
| Amniotic Fluid (Liquor) | Color and amount of fluid | Clear, adequate | Meconium-stained → Fetal distress |
| Parameter | What It Measures | Normal Findings | Abnormal Findings |
|---|---|---|---|
| Maternal Pulse, BP, Temperature | Maternal stability | Pulse <100 bpm, BP <140/90 | Tachycardia, Hypertension |
| Urine Output & Protein | Kidney function, preeclampsia | >30 mL/hr, No proteinuria | <30 mL/hr or proteinuria → Preeclampsia |
✅ Clinical Correlation:
A partograph includes three key lines:
| Line | Purpose | Clinical Action |
|---|---|---|
| Alert Line | Shows expected normal progress of labour | If crossed, monitor closely |
| Action Line | 4 hours after the alert line | If crossed, consider intervention (C-section, oxytocin) |
| Fetal Heart Rate Trends | Tracks fetal well-being | Abnormal FHR requires urgent management |
✅ Management Based on Partograph Findings:
The mechanism of labour refers to sequential movements the fetus undergoes to navigate through the birth canal.
✅ Purpose of Mechanism of Labour:
| Movement | Description | Clinical Importance |
|---|---|---|
| Engagement | Fetal head enters the pelvic inlet | Occurs at station 0 |
| Descent | Fetal head moves downwards | Affected by uterine contractions & maternal effort |
| Flexion | Fetal chin moves towards chest | Reduces biparietal diameter for easy passage |
| Internal Rotation | Occiput rotates anteriorly towards the pubic symphysis | Essential for normal vaginal delivery |
| Crowning & Extension | Head stretches perineum, face moves upwards | Occurs just before delivery |
| External Rotation (Restitution) | Head realigns with body | Allows delivery of shoulders |
| Expulsion | Full delivery of the baby | Baby is completely born |
✅ Clinical Correlation:
| Aspect | Clinical Relevance |
|---|---|
| Partograph | Detects prolonged labour & fetal distress |
| Mechanism of Labour | Ensures smooth delivery process |
| Internal Rotation | Failure may cause persistent OP position |
| Alert & Action Lines | Used to determine labour progress & interventions |
| Engagement | Assessed by Leopold’s Maneuvers & PV Exam |
✅ What is the purpose of a partograph?
👉 To monitor labour progress and prevent complications
✅ Which is the first movement in the mechanism of labour?
👉 Engagement
✅ What is the normal fetal heart rate during labour?
👉 110–160 bpm
✅ What is the significance of the action line in the partograph?
👉 If crossed, intervention (C-section or augmentation) is needed
✅ Which movement allows the fetal head to pass under the pubic arch?
👉 Extension
✅ Which phase of labour is monitored using a partograph?
👉 First & Second Stages
✅ What happens if internal rotation does not occur?
👉 Fetal malposition (e.g., Occipito-Posterior Position)
✅ Definition:
The station of labour refers to the position of the fetal presenting part (usually the fetal head) relative to the maternal ischial spines in the pelvis.
✅ Purpose of Assessing Fetal Station:
✅ How is Fetal Station Measured?
| Station | Position of Fetal Head | Clinical Significance |
|---|---|---|
| -5 to -3 (Floating) | Above the pelvic inlet | Fetal head not engaged in the pelvis. |
| -2 to -1 (Dipping) | Moving towards the ischial spines | Head partially engaged, may be mobile. |
| 0 (Engaged) | At the level of the ischial spines | Indicates complete engagement, head is fixed. |
| +1 to +2 (Descending) | Below ischial spines, entering mid-pelvis | Descent is progressing well. |
| +3 to +4 (Crowning) | Head is visible at the vaginal opening | Labour is almost complete. |
| +5 (Delivered) | Fetal head is fully out | Baby is born! |
✅ Clinical Correlation:
✅ Pelvic Examination (Per Vaginal Exam – PV Exam):
✅ Leopold’s Maneuvers (Abdominal Palpation):
✅ Clinical Signs of Station Progression:
| Situation | Fetal Station | Clinical Decision |
|---|---|---|
| Floating head (not engaged) | -5 to -3 | Watchful waiting, C-section if CPD suspected. |
| Early labour (Engagement occurs) | 0 station | Indicates normal labour progress. |
| Slow descent in active labour | 0 to +1 station | Consider oxytocin augmentation. |
| Prolonged second stage (>2 hours in primigravida, >1 hour in multipara) | +1 to +2 station | Instrumental delivery (forceps/vacuum) if needed. |
| Crowning (Head at perineum) | +3 to +4 station | Prepare for delivery. |
✅ Clinical Correlation:
| Procedure | Indication | Recommended Station |
|---|---|---|
| Vacuum Extraction | Prolonged second stage | +2 to +3 |
| Forceps Delivery | Fetal distress in late labour | +1 to +3 |
| C-Section | Failure to descend (Obstructed labour) | -2 or above |
✅ Clinical Correlation:
| Aspect | Clinical Relevance |
|---|---|
| Fetal station assessment | Determines progress of labour |
| Station 0 | Indicates engagement |
| +3 to +4 station | Crowning → Imminent delivery |
| Failure to descend beyond 0 station | Suggests cephalopelvic disproportion (CPD) |
| Instrumental delivery at +2 station | Used for prolonged labour |
✅ What does “station 0” mean?
👉 The fetal head is at the level of the ischial spines (engaged).
✅ What is the station when crowning occurs?
👉 +3 to +4 station.
✅ What intervention is recommended if the fetal head remains at -3 station despite strong contractions?
👉 C-section (due to CPD or obstructed labour).
✅ Which station is most suitable for vacuum extraction?
👉 +2 to +3 station.
✅ What does a station of -2 indicate?
👉 The fetal head is not yet engaged.
✅ Definition:
The puerperium is the period from delivery of the placenta to 6 weeks postpartum, during which the maternal body returns to its pre-pregnancy state.
✅ Key Features of Puerperium:
✅ Duration:
✅ Clinical Importance:
✅ Definition:
The gradual return of the uterus to its pre-pregnant size and shape.
✅ Timeline of Uterine Involution:
| Day Postpartum | Fundal Height |
|---|---|
| Immediately after delivery | At the level of the umbilicus (~20 weeks size). |
| Day 2 | 1 cm below umbilicus per day. |
| Day 7 | Halfway between umbilicus & pubic symphysis. |
| Day 10 | Cannot be palpated abdominally. |
| 6 Weeks | Uterus returns to normal size (~60g). |
✅ Factors Affecting Involution:
Enhancing Factors:
Delaying Factors:
✅ Clinical Correlation:
✅ Definition:
Lochia is the uterine discharge consisting of blood, mucus, and placental debris after childbirth.
✅ Types of Lochia:
| Type | Appearance | Duration | Composition |
|---|---|---|---|
| Lochia Rubra | Red, heavy bleeding. | Day 1–4 | Blood, decidual tissue, mucus. |
| Lochia Serosa | Pinkish-brown, lighter flow. | Day 4–10 | Blood, cervical mucus, WBCs. |
| Lochia Alba | Yellow-white, minimal flow. | Day 10–6 weeks | WBCs, mucus, epithelial cells. |
✅ Clinical Correlation:
✅ Postpartum Cervical Recovery:
✅ Clinical Correlation:
✅ Postpartum Vaginal Recovery:
✅ Perineum Recovery:
✅ Management:
✅ Clinical Correlation:
✅ Hormonal Adjustments in Puerperium:
| Hormone | Postpartum Changes |
|---|---|
| Estrogen & Progesterone | Drop sharply after delivery. |
| hCG | Becomes undetectable by 2 weeks postpartum. |
| Prolactin | High if breastfeeding, suppressed if not. |
| Oxytocin | Increases uterine contractions and promotes lactation. |
✅ Menstrual Cycle Return:
✅ Clinical Correlation:
✅ Postpartum Breast Changes:
| Day Postpartum | Breast Change |
|---|---|
| Day 1–2 | Colostrum secretion (high in antibodies). |
| Day 3–5 | Milk “comes in”, breasts become full & firm. |
| 6 Weeks | Established lactation. |
✅ Clinical Correlation:
| Complication | Cause | Clinical Significance |
|---|---|---|
| Postpartum Hemorrhage (PPH) | Uterine atony, retained placenta | Heavy bleeding, hypovolemia |
| Puerperal Sepsis | Infection | Fever, foul-smelling lochia |
| Urinary Retention | Perineal trauma, epidural | Inability to void postpartum |
| Mastitis | Blocked ducts, infection | Painful, red, swollen breast |
| Postpartum Depression | Hormonal shifts | Sadness, anxiety, fatigue |
✅ Clinical Correlation:
| Aspect | Clinical Relevance |
|---|---|
| Uterine involution | Delayed in subinvolution |
| Lochia progression | Abnormal in endometritis |
| Hormonal changes | Prolactin suppresses ovulation |
| Menstrual return | Varies based on breastfeeding |
| Common infections | Puerperal sepsis from retained products |
✅ What is the duration of the puerperium?
👉 6 weeks postpartum
✅ What are the three types of lochia?
👉 Lochia rubra, serosa, alba
✅ Which hormone is responsible for lactation?
👉 Prolactin
✅ When does the uterus return to its normal size postpartum?
👉 By 6 weeks
✅ Which finding in lochia suggests infection?
👉 Foul smell, prolonged rubra phase