Trial of scar is contraindicated in all EXCEPT :

A 30-year-old primigravida at 39 weeks has been completely dilated and has been pushing for 3 h. She had taken epidural analgesia. She is exhausted and has a temperature of 37.8°C. The fetal heart rate is 170/min with decreased variability. The patient’s membranes have been ruptured for over 24 h. The patient’s cervix is completely dilated and effaced, and the fetal head is visible at the introitus between pushes. The fetal bones are at the +3 station. What is the most appropriate next step in the management of this patient?

A 28-year-old  lady  had Copper T inserted 2 years back. Now Cu-T threads are not seen. USG shows Cu T partly in abdominal cavity. Method of removal is:

• The therapeutic level of serum magnesium is 4–7 mEq/L.
• 8–10 mEq/L = uterus stops contracting.
• Patellar reflux disappears when magnesium level reaches above 10 mEq/L (12 mg/dL), presumably because of curariform action.
• This sign serves to warn of impending magnesium toxicity, because a further increase leads to respiratory depression.
• When magnesium levels reach >12 mEq/L, respiratory depression develops, and respiratory paralysis and arrest follow.
• Treatment is with calcium gluconate 1 g IV and withholding magnesium sulfate reverse mild-to-moderate respiratory depression.

Explanation:
Human placenta lactogen (hPL) was named so , because of its potent lactogenic & growth hormone like bioactivity, as well as immunochemical resemblance to human growth hormone. It is detected as early as 2nd or 3rd week after fertilization. It is a single , nonglycosylated polypeptide chain with a molecular weight of 22,279 Da. It is derived from a 25,000 Da precursor. Maternal plasma concentrations are linked to placental mass & they rise steadily till 34-36 weeks of gestation. The hPL production rate near term is by far the greatest of any known hormone in humans- approximately 1gm/day. The half-life in maternal plasma is between 10 & 30 minutes The functions of hPL are:

• It decreases maternal insulin sensitivity (increases insulin resistance) & ensures nutrient flow to the fetus.
• It promotes maternal lipolysis with the release of free fatty acids. This provides an energy source for maternal metabolism & fetal nutrition. It favors protein synthesis & provides a readily available amino acid source to the fetus.
• Potent angiogenic hormone, & may serve a function in fetal vasculature formation

Explanation:
Incidence of major congenital malformation in children of diabetic mothers is 5–10%, and most common defects are neural defects (such as anencephaly, spina bifida, and encephalocele) cardiac defects (VSD, transposition of great vessels). Caudal regression syndrome/sacral agenesis is a defect most specific to diabetic embryopathy. Hyperglycemia probably increases the development of free oxygen radicals and interferes with arachidonic acid metabolism, which are responsible for embryopathy.
Major Birth Defects in Infants of Diabetic Mothers :

• Neural tube defects(anencephaly, spina bifida)
• VSD, ASD
• Renal agenesis
• Duodenal atresia
• Single umbilical artery
• Microcephaly
• Transposition of great vessels
• Hydronephrosis
• Anorectal atresia
• Sacral agenesis
• HOCM
• Ureteral duplication

36 weeks pregnant lady complains of  bleeding PV since 4 hours. Hb 6gm%, BP-90/60, P/A-uterus tonically contracted, FHS absent. BT=7min & CT= 14min. The likely diagnosis as per Page’s classification is :

• Congenital obstruction
• duodenal web
• duodenal atresia
• duodenal stenosis
• annular pancreas
• midgut volvulus
• external compression of the dudenum

Explanation: Listerial infections are more common in very old or young, pregnant or immunocompromised patients. Listeriosis during pregnancy can have the following effects:

Maternal

1. Fever
   
2. Pyelonephritis
   
3. Meningitis
   
4. Preterm labor

Fetal

1. Discolored, brownish or Meconium Stained Amniotic Fluid even with preterm gestations. (Generally MSAF is seen with postdatism and is very rarely seen with preterm labor)
   
2. Chorioamnionitis
   
3. Fetal infection: disseminated granulomatous lesions with microabscesses
   
4. IUFD
   
5. Neonatal sepsis and mortality

CMV, Rubella and Toxoplasma infections have a teratogenic effect and are unlikely to cause preterm labor and MSAF.

• Vaginal surgery: fistula repair.
• Instrumentation: Sims' speculum; Sims' sigmoid catheter.
• Exam and surgical positioning: Sims' position.
• Fertility treatment: Insemination and postcoital test.
• Cancer care: Sims argued for the admission of cancer patients to the Woman's Hospital, at a time when people opposed him, as they feared that cancer was contagious.
• Abdominal surgery: Sims advocated that in the case of an abdominal bullet wound, a laparotomy was needed to stop bleeding, repair the damage and drain the wound. His opinion was sought when President James Garfield was shot; he responded by telegram from Paris. Sims' recommendations later gained acceptance.
• Gallbladder surgery: In 1878, Sims drained a distended gallbladder and removed its stones. He published the case believing it was the first of its kind; however, a similar case had already been reported in Indianapolis in 1867

1. Congenital adrenal hyperplasia.
   
   
2. Elevated androgens in the maternal circulation which cross the placenta and cause virilization of the external genitalia.  
   
   
3. Placental aromatase deficiency. 
   
   
4. Wnt4 mutation. Wnt4 Mullerian aplasia and ovarian dysfunction is a disorder that occurs in females and affects the reproductive system. This condition is caused by abnormal development of the Mullerian duct. Individuals with Wnt4 Mullerian aplasia and ovarian dysfunction typically have an underdeveloped or absent uterus and may also have abnormalities of other reproductive organs. Women with this condition have normal breast and public hair development and primary amenorrhea. Women with Wnt4 Mullerian aplasia and ovarian dysfunction have higher than normal levels of androgens in their blood. These high levels of androgens cause acne, hirsutism and virilization. Kidney abnormalities may be present in some affected individuals.

This CTG is most likely to be seen in which condition ?