The Mumbai Obstetric & Gynecological Society

The Mumbai Obstetric and Gynaecological Society www.mogsonline.org mogs

MOGS Quiz Answers and Winners

69 yrs old patient with Ovarian Cancer, when explored shows bilateral ovarian involvement with presence of ascites with positive washings for malignant cells with retroperitoneal Lymph Nodes involvement.
As per FIGO staging this is stage :
a. I C3
b. III A
c. IVA
d. II B
b. III A
As per the old FIGO staging its stage IIIC, but as per latest 2014 staging, its stage IIIA
Pleural effusion with positive cytology is stage IV A
FIRST PRIZE
Kiran Dabholkar
SECOND PRIZE
Dr. Prachi Risbud
7738535015
THIRD PRIZE
Bhavini Shah

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:

a. Hysteroscopy
b. No need of removal /wait and watch
c. IUCD hook
d. Laparoscopy
d. Laparoscopy
Explanation: Copper can cause inflammatory reaction and can cause intestinal obstruction. Therefore, never wait and watch. When Cu T is embedded within uterine cavity, hysteroscopic removal is the method of choice. It is preferred over IUCD hook. Hysteroscopy cannot visualize the Cu T that is in the abdominal cavity. However, when IUCD enters the abdominal cavity (partly or completely), laparoscopy is the preferred modality for retrieval.
FIRST PRIZE
Dr. Freni Shah
9869562008
SECOND PRIZE
Dr. Shilpa Agrawal
9223280008
THIRD PRIZE
Dr. Rashmi G. Jalvee
9833918836

There is loss of knee jerks when magnesium sulfate concentration reaches:
a. 5–7 mEq/L
b. 10–11 mEq/L
c. 8–10 mEq/L
d. >12 mEq/L
b. 10–11 mEq/L
Explanation: Magnesium sulfate is the treatment of choice for the prevention and treatment of eclamptic seizures. It reduces motor end plate sensitivity to acetyl choline. It induces cerebral vasodilatation, dilates uterine arteries, increases production of endothelial prostacyclin, and inhibits platelet activation. Magnesium may also prevent seizures by interacting with N-methyl- D-aspartate (NMDA) receptors in the central nervous system.
After the initial dose, repeat injections are given only if knee jerks are present, urine output exceeds 30 mL/h, and respiration rate is more than 12/min.
  • 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.
FIRST PRIZE
Dr. Kiran Dabholkar
098192 17200
SECOND PRIZE
Dr. Freni Shah
THIRD PRIZE
Dr. Prachi Risbud
7738535015

The following on USG indicates monozygotic twin pregnancy :
a. 2 separate placenta
b. Twin peak sign
c. Siamese twins
d. Different fetal sex
c. Siamese twins
All siamese twins are Monozygotic
MZ twins are of following varieties depending upon the time of twinning:
1. Within 72 hours of fertilization = DC, DA
2. Between 4th & 8th day = MC, DA
3. Between 8th & 12th day = MC, MA
4. After 12 days = conjoint/Siamese twins
Twin peak sign indicated 2 fused placenta (seen in dichorionic twins)
FIRST PRIZE
Dr. Freni Shah
SECOND PRIZE
Dr. Shilpa Agrawal
THIRD PRIZE
Dr. Prachi Risbud
7738535015

The production rate of the following hormone near term, is the greatest of any known hormone in humans (approximately 1gm/day):

a. Relaxin
b. Progesterone
c. hCG
d. hPL
d. hPL

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
FIRST PRIZE
Dr. Prachi Risbud
7738535015

SECOND PRIZE
Dr. Monika Nathani 
9075013533

THIRD PRIZE
Dr. Nandini Ram Babu
9892911137

Infants of diabetic mother are likely to have which of  the following cardiac anomaly?
a. Coarctation of aorta
b. Fallot’s tetrology
c. Ebstein’s anomaly
d. Transposition of great arteries
d. Transposition of great arteries

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
FIRST PRIZE
Dr. Shilpa Agarwal
9223280008

SECOND PRIZE
Dr. Kiran Dabholkar 
9167008017

THIRD PRIZE
Dr. Nirmal khare
9818427823

16-year-old girl presents with 6 × 6 cm right ovarian mass with absent AFP, negative CA125, and increased alkaline phosphatase. Diagnosis is:
a. Dysgerminoma
b. Mucinous cystadenocarcinoma
c. Endodermal sinus tumor
d. Teratoma
a. Dysgerminoma
Dysgerminoma is the MC malignant germ-cell tumor. Once diagnosed, dysgerminomas respond well to therapy,
potentially sparing patients from infertility and early mortality.

The exact etiology of dysgerminomas has not been determined, although recent molecular studies have implicated loss of
function with potential tumor suppressor gene TRC8/RNF139 as a possible etiology.

Germ-cell tumors generally occur in the first 2 decades of life. Epithelial tumors occur in perimenopausal and postmenopausal ladies.
Ovarian Tumor Tumor Marker
Endodermal sinus /yolk sac AFP
Epithelial CA125
Dysgerminoma LDH/alkaline phosphatase
Choriocarcinoma hCG
Granulosa cell Inhibin
FIRST PRIZE
Dr. Nisha Krishnan
9076547783

SECOND PRIZE
Dr. Shilpa Kaushal 
7506012801

THIRD PRIZE
Dr. Monika Nathani

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 :

a. Grade I Abruptio
b. Grade II Abruptio
c. Grade III Abruptio
d. Grade IV Abruptio
ANSWER : GRADE 3 ABRUPTION
Page’s Classification for Abruptio Placentae

Grade 0 :Retrospective diagnosis (after delivery)
Grade 1 : External bleeding, uterine tenderness, and no fetal distress
Grade 2 : Fetal distress or IUFD
Grade 3 : Maternal shock, with or without DIC
FIRST PRIZE
Dr. Freni Shah
SECOND PRIZE
Dr. Rakhi Sikarwar
THIRD PRIZE
Dr. Asmita More
8767460154

FOURTH PRIZE
Dr. Saumya Niviti
TRUE about CARBETOCIN is :
a. It can be administered intravenously or intramuscularly.
b. The recommended dose for an average adult female is 1000 micrograms
c. Carbetocin can be used to induce or augment labor
d. All of the above
a. It can be administered intravenously or intramuscularly.
Carbetocin is a newer drug used to control PPH particularly following Cesarean section. It is an eight amino acid long analogue of oxytocin (a nonapeptide) and thus has a similar action. It can be administered intravenously or intramuscularly. The recommended dose for an average adult female is 100 ug, administered slowly over a minute. Contractile effects of the uterus are apparent within two minutes and can be observed for approximately one hour, though maximum binding occurs about 30 minutes after intramuscular injection. Administration can be performed only once; further administration would prove risky. If further uterine stimulation is needed, treatment with other forms of oxytocic uterotonic drugs should be used
Endogenous and synthetic oxytocin has a half-life of approximately 3.5 minutes. Carbetocin, in comparison, has a much longer half-life ranging from 85–100 minutes. The elimination half-life following intravenous administration is around 40 minutes Carbetocin should not be used to induce or augment labor since it could cause cardiac or respiratory distress to mother or infant
FIRST PRIZE
Dr. Saumya Niviti
9967769717

SECOND PRIZE
Dr. Rukhsana Mhate
9820645014
THIRD PRIZE
Dr. Ashwini Ingale
8087593134

FOURTH PRIZE
Dr. Sumati Saxena
Identify the abnormality
Quiz No. 18
Battledore placenta  is a placenta where there is marginal insertion of the umbilical  cord called because of the fancied resemblance to the racquet used in badminton
FIRST PRIZE
Dr. Sonam Kataria
9967769717

SECOND PRIZE
Dr. Kiran Dabholkar
THIRD PRIZE
Dr. Kranti Phadnis
FOURTH PRIZE
Dr. Sumati Saxena
9452495704

Identify this image
quiz_16
Cu-Fix IUD (Flexi-Gard): This is frameless IUD consisting of six copper sleeves (300 mm2 of copper) strung on a surgical polypropylene nylon thread, which is knotted at the upper end.
FIRST PRIZE
Dr. Bhavini Shah
SECOND PRIZE
Dr. Parikshit Tank
THIRD PRIZE
Dr. Deepa Talreja
7506987141
FOURTH PRIZE
Dr. Jatinder Kaur
9892590464
Identify the anomaly in this USG image of fetal abdomen
quiz_16
Explanation: The double bubble sign is seen in infants and represents dilatation of the proximal duodenum and stomach. It is seen in both radiographs and ultrasound, and can be identified antenatally.
Causes include :
  • Congenital obstruction
  • duodenal web
  • duodenal atresia
  • duodenal stenosis
  • annular pancreas
  • midgut volvulus
  • external compression of the dudenum
FIRST PRIZE
Dr. Shilpa Agrawal
+91 92232 80008
SECOND PRIZE
Dr. Bhavini Shah
THIRD PRIZE
Dr. Dhaval Belvi
9820273729
FOURTH PRIZE
Dr. Sachin Dalal
9833032120
A pregnant lady presents with jaundice and distension and pedal edema after delivering normal baby. Her clinical condition deteriorates with increasing abdominal distension and severe ascites. Her bilirubin is 5 mg/dL, S. alkaline phosphatase was 450 u/L and ALT 345 IU/L. There is tender hepatomegaly 6 cm below costal margin and ascitic fluid shows protein 3 mg%. Diagnosis is:
a. Preeclampsia
b. Acute fatty liver of pregnancy
c. HELLP syndrome
d. Budd-Chiari syndrome
d. Budd-Chiari syndrome
Explanation: Budd-Chiari syndrome, a disorder characterized by thrombotic occlusion of the hepatic veins, is a rare complication of pregnancy. Most reported cases presented within a few weeks of delivery, but in several cases onset occurred during pregnancy. The increased synthesis of factors II, VII, and X, as well as of fibrinogen observed in normal pregnancy, may be a predisposing factor. The onset may be acute, with the rapid development of abdominal pain and distension and sometimes jaundice. There is tender hepatomegaly, and ascites of high protein content is almost always present. Aminotransferases are often markedly raised when the onset is rapid, but jaundice is present in only half the cases.Treatment is often unsatisfactory, and the prognosis guarded. :
FIRST PRIZE
Dr. Dhaval Belvi
9833700719
SECOND PRIZE
Dr. Kiran Dabholkar
9167008017
THIRD PRIZE
Dr. Rajneet Bhatia
FOURTH PRIZE
Dr. Ranjit Inamdar
9820273729
A female presents with leaking and meconium stained liquor at 32 weeks of gestation. Which of the following organism would be responsible:
a. CMV
b. Listeria
c. Toxoplasma
d. Rubella
b. Listeria

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.

FIRST PRIZE
Dr. Pooja Kale
9029080799
SECOND PRIZE
Dr. Bhavini Shah
THIRD PRIZE
Dr. Shilpa Agrawal
FOURTH PRIZE
Dr. Freni Shah
An intra-uterine pregnancy of approximately 10 weeks’ gestation is confirmed in a 30-year-old   with an IUCD in place. The patient expresses a strong desire for the pregnancy to be continued. On examination, the string of the IUCD is noted to be protruding from the cervical os. The most appropriate course of action is to:
a. Leave the IUCD in place without any other treatment
b. Remove the IUCD to decrease the risk of malformations
c. Remove the IUCD to decrease the risk of infection
d. Terminate the pregnancy because of the high risk of malformations
c. Remove the IUCD to decrease the risk of infection
Explanation: Although there is an increased risk of spontaneous abortion, and a small risk of infection, an intra-uterine pregnancy can occur and continue successfully to term with an IUD in place. However, if the patient wishes to keep the pregnancy and if the string is visible, the IUD should be removed in an attempt to reduce the risk of infection, abortion, or both. An IUD in situ does not cause any malformations/anomalies in the fetus. WHO recommends that if the IUD can be removed easily it should be removed to reduce the risk of infection and abortion. If the IUD cannot be removed easily, it can be kept in situ and it will be expelled after placental delivery.
FIRST PRIZE
Kranti Phadnis
SECOND PRIZE
Dhaval Belvi
9833700719
THIRD PRIZE
Bhavini Shah
FOURTH PRIZE
Shilpa Agrawal
Identify the fetal anomaly
Quiz 12
Cystic hygroma (CH) refers to a type of congenital lymphangioma
Epidemiology: They usually occur in the fetal/infantile and paediatric populations with most lesions presenting by the age of two. The estimated prevalence in the fetal population is 0.2-3%.
Radiographic features: They are usually well circumscribed and are of fluid density. Cystic hygromas may also have an infiltrative appearance, and may be uni or multilocular. The density can also be variable with a combination of fluid, soft-tissue density and fat.
Antenatal Ultrasound: On antenatal ultrasound they may present as a nuchal cyst and may show septations +/- evidence of fetal anasarca/hydrops fetalis. The presence of septations may indicate a poorer outcome
FIRST PRIZE
Dr. Freni Shah
SECOND PRIZE
Dr. Shilpa Kaushal
7506012801
THIRD PRIZE
Dr. Shilpa
9223280008 •
FOURTH PRIZE
Dr. Jatinder Kaur
Identify this Stalwart
Quiz 11
James Marion Sims (January 25, 1813 – November 13, 1883)  was an American physician and a pioneer in the field of surgery, known as the "father of modern gynecology". His most significant work was to develop a surgical technique for the repair of vesicovaginal fistula
Contributions:
  • 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
FIRST PRIZE
Dr. Kiran Dabholkar
9167008017
SECOND PRIZE
Dr. Zubin Sheriar
THIRD PRIZE
Dr. Prachi Risbud
7738535015
FOURTH PRIZE
Dr. Shashikant Avhad
Ovarian cycle can be correlated with all except:
a. Endometrial sampling
b. Vaginal cytology
c. Blood hormonal levels
d. Estrous cycle
d. Estrous cycle
Explanation : Ovarian cycles consists of the following : recruitment & growth of the follicles, ovulation, corpus luteum formation and finally regression of corpus luteum. Because of the changes in the ovary there are simultaneous changes in the uterus (endometrium)-the menstrual cycle. Endometrial sampling and proliferative or secretory endometrium will tell whether the female has ovulated or not. Similarly the hormones FSH, LH, Estradiol, and progesterone will also correlate with the phases of ovarian cycle. Vaginal cytology & calculating the maturation index will tell us the phase of the ovarian & menstrual cycle. Estrous cycle DOES NOT occur in human beings.
The estrous cycle comprises of the recurring physiologic changes that are induced by reproductive hormones in most mammalian placental females. Humans undergo a menstrual cycle instead. Estrous cycles start after puberty in sexually mature females and are interrupted by anestrous phases or pregnancies. Typically estrous cycles continue until death. Animals that have estrous cycles reabsorb the endometrium if conception does not occur during that cycle. Animals that have menstrual cycles shed the endometrium through menstruation instead. Another difference is sexual activity. In species with estrous cycles, females are generally only sexually active during the estrus phase of their cycle. This is also referred to as being “in heat.” In contrast, females of species with menstrual cycles can be sexually active at any time in their cycle, even when they are not about to ovulate.
FIRST PRIZE
Dr. Nisha Krishnan
9076547783 •
SECOND PRIZE
Dr. Pooja Kale
9029080799 •
THIRD PRIZE
Dr. Dhaval Belvi
9833700719
FOURTH PRIZE
Dr. Devika Desai
9561106644 / 9594759110
A newborn with 46XX has external genitalia of male. All of the following are the possible causes except:
a. Placental aromatase deficiency
b. Maternal androgen adrenal tumor
c. Anti-Mullerian hormone (AMH) deficiency
d. Wnt4 mutation
c. Anti-Mullerian hormone (AMH) deficiency
Explanation: The baby has karyotype of 46 XX and external genitalia of male. So this is a case of female pseudohermaphroditism.

Causes of female pseudohermaphroditism are:
  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.
AMH DEFICIENCY= PMDS=UTERINE HERNIA SYNDROME

Karyotype = 46 XY and normal male external genitalia.

Persistent Mullerian duct syndrome (PMDS) refers to the presence of a uterus and sometimes other Mullerian duct derivatives in a male. PMDS typically is an autosomal recessive disorder.

Typical features include cryptorchidism and the presence of a small, underdeveloped uterus in a male. This condition is usually caused by deficiency of fetal anti-Mullerian hormone (AMH) effect due to mutations of the gene for AMH or the anti-Mullerian hormone receptor.
FIRST PRIZE
Dr. Pooja Kale
9029080799 •
SECOND PRIZE
Dr. Shilpa Agrawal
THIRD PRIZE
Dr. Pravina Gandhi
9820190257
FOURTH PRIZE
Dr. Freni Shah
Precocious puberty associated with bony dysplasia and café au lait spots on skin are seen  in:
a. Laurence-Moon-Biedl syndrome
b. McCune-Albright syndrome
c. Alport’s syndrome
d. Frohlich’s syndrome
b. McCune-Albright syndrome
Precocious puberty associated with bony dysplasia and café au lait spots on skin is seen in McCune-Albright syndrome. It is a GnRH-independent/pseudoprecocious puberty in which ovary is the source of estrogen.
Laurence-Moon-Biedl syndrome: hypogonadotropic hypogonadism (hypothalamic amenorrhea), mental retardation, polydactyly, and retinitis pigmentosa Frohlich’s syndrome: hypogonadotropic hypogonadism, obesity, and genital hypoplasia Alport’s syndrome: anterior lenticonus, glomerulonephritis, and hematuria In options a and d, there is delayed/absent puberty.
FIRST PRIZE
Dr. Misbah Inamdar
9920134423 •
SECONDPRIZE
Dr. Pooja Kale
9029080799 •
THIRD PRIZE
Dr. Kiran Dabholkar
9167008017
FOURTH PRIZE
Dr. Dhaval Belvi
9833700719 •
You are delivering an obese primigravida at 41 weeks. After 15 min of pushing, the baby’s head delivers spontaneously but then retracts back against the perineum. As you apply gently downward traction to the head, the baby’s anterior shoulder fails to deliver. All of the following are appropriate next steps in the management of this patient, except:
a. Instruct the nurse to apply fundal pressure
b. Cut a generous episiotomy
c. Flex the maternal legs upon her abdomen
d. Apply supra pubic pressure
a. Instruct the nurse to apply fundal pressure
Explanation: In this clinical scenario, a shoulder dystocia is encountered. Shoulder dystocia becomes obvious when the fetal head emerges and then retracts against the perineum, commonly referred to as the “turtle sign.” 
A shoulder dystocia occurs when the fetal shoulders fail to spontaneously deliver secondary to impaction of the anterior shoulder against the pubic bone, after delivery of the head has occurred. Shoulder dystocia is an obstetric emergency, and one should always call for help when such a situation is encountered. A generous episiotomy should always be made to allow the obstetrician to have adequate room to perform a number of manipulations to try to relieve the dystocia. Such maneuvers include the following: suprapubic pressure, McRoberts maneuver (flexing maternal legs upon the abdomen and abduct them), Wood’s corkscrew maneuver (rotating the posterior shoulder), and delivery of the posterior shoulder.
There is no role for fundal pressure because this action further impacts the shoulder against the pubic bone and makes the situation worse. Never give fundal pressure in cases of shoulder dystocia.
FIRST PRIZE
Dr Nandini Ram Babu
9892911137
SECOND PRIZE
Dr. Shilpa
9223280008 •
THIRD PRIZE
Dr. Pooja Kale
9029080799 •
FOURTH PRIZE
Dr. Freni Shah
27 years old obese female complaints of amenorrhea of 6 months following her abortion at 16 weeks of gestation due to cervical incompetence.
Now her UPT is negative. Progesterone challenge test is negative & Estrogen + progesterone test is also negative. Likely diagnosis is
a. PCOS
b. Premature ovarian failure
c. Hypothalamo- Pituitary failure
d. Asherman's syndrome
d. Asherman's syndrome
Explanation:
In patients with secondary amenorrhea, after ruling out pregnancy, progesterone challenge test is to be done.
Patients with anovulation will get menses with progesterone.
If the patient does not get menses with progesterone then E + P challenge test is done.
Patients with pituitary failure and ovarian failure will get menses with E + P.
Absence of withdrawal by E + P indicates end organ failure.(Asherman syndrome)
The patient had a second-trimester abortion, following which a curettage may have been done to remove the retained products leading to Asherman syndrome.
FIRST PRIZE
Dr. Pooja Kale
9029080799 •
SECOND PRIZE
Dr. Nandini Ram Babu
9892911137 •
Quiz 5

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

a. fetus is sleeping
b. ruptured vasa previa
c. cord compression
d. Excess of Epidural analgesia
e. All of the above
Ruptured vasa previa
The CTG shows " Sinusoidal Pattern" seen in following cases :
Fetal anemia (  ruptured vasa previa, abruption,fetal hemolysis etc)
Chorioamnionitis
Severe fetal asphyxia
Morphine administration to mother
FIRST PRIZE
Dr. Pooja Kale
9029080799 •
SECOND PRIZE
Dr. Shilpa Agrawal
Jaslok Hospital
9223280008 •
A baby is born with the following birth defects: Craniofacial defects, cleft palate, cardiac defects, hydrocephalus & thymic defects. Identify the teratogen.
a) DES (Diethylstilbestrol)
b) Misoprostol
c) Isotretinoin
d) Cocaine abuse
The correct answer is (c) Isotretinoin. Following are the teratogenic effects :
Isotretinoin : Craniofacial defects, cleft palate, cardiac defects, hydrocephalus, thymic defects
DES :Clear cell adenocarcinoma of cervix/vagina, ectropion and adenosis, hypoplastic T-shaped uterus, cervical collars, hoods, septa, withered fallopian tubes; in male fetuses epididymal cysts, microphallus, cryptorchidism, testicular hypoplasia, hypospadias
Misoprostol : Moebius syndrome
Cocaine :Placental abruption, abortions, stillbirth, skull defects, cutis aplasia, porencephaly, ileal atresia, cardiac anomalies and visceral infarcts, urinary defects, periventricular leukomalacia, prune-belly syndrome
FIRST PRIZE
Dr. Ranjeet
SECOND PRIZE
Dr. Freni Shah
IDENTIFY THIS STALWART
HINT : C.SECTION
Quiz No. 3

Ferdinand Adolf Kehrer (February 16, 1837 – June 16, 1914) was a German gynaecologist Kehrer is remembered for performing the first modern Caesarean section. It involved a transverse incision of the lower segment of the uterus On September 25, 1881, he performed the first modern C-section. The patient was a 26-year-old woman, and the operation proved to be a success.
FIRST PRIZE
Dr. Kiran Dabholkar
Cell: 9167008017
SECOND PRIZE
Dr Pooja Kale
Cell: 9029080799
A primigravida had developed varicella infection 3 days before her delivery. Which of the following statement is true?
a. The baby will develop congenital varicella syndrome
b. There is no risk of infection to the baby
c. Mother should be given the vaccine and immunoglobulin before delivery
d. Immunoglobulin should be given to the neonate
d. Immunoglobulin should be given to the neonate

Explanation :
Administration of varicella-zoster immunoglobulin (VZIG) prevents or attenuates varicella infection in exposed susceptible individuals if given within 96 hours of viral exposure.
The center for Disease Control and Prevention recommends VZIG for immunocompromised susceptible adults who are exposed to varicella, and it should be strongly considered for all susceptible pregnant women (not when the women has already developed the infection).
An attenuated live-virus vaccine (Varivax) was approved for use in 1995.
The vaccine is not recommended for pregnant women.

Maternal varicella during the first half of pregnancy may cause congenital malformations which include chorioretinitis, cerebral cortical atrophy, hydronephrosis, and cutaneous and bony leg defects.

There is no clinical evidence of congenital varicella infection after 20 weeks of gestation.

Fetal exposure to the virus just before or during delivery, and therefore before maternal antibody has been formed, poses a serious threat to newborns.
The incubation period for varicella infection is short, usually less than 2 weeks. In some instances, neonates develop disseminated visceral and central nervous system disease, which is commonly fatal.

For this reason, VZIG should be administered to neonates whenever the onset of maternal disease is within about 5 days before or after delivery.
FIRST PRIZE
Dr. Freni Shah
SECOND PRIZE
Dr. Siddesh Iyer
Cell: 9223524599
A 16 year old girl was brought with primary amenorrhoea. Her mother mentioned that she started developing breast at the age of 12. She was prescribed OCPs  2 years back by a doctor with no effect. She was having normal stature and was a football player. On examination breast was well developed (Tanner’s stage 5) and pubic hair was minimal (Tanner’s stage 1). What is the diagnosis ?
Androgen Insensitivity syndrome/Testicular feminization syndrome.

X-linked recessive disorder.
External genitalia looks normal (like female)
Adequate breast development without axillary and pubic hair (or minimal axillary and pubic hair)
Primary amenorrhea and absent uterus ( and hence will not respond to OCPs)
Gonads (testes) are placed in either labia or inguinal canal, or are intra-abdominal
Karyotype XY

Mullerian agenesis patients will also have primary amenorrhea & absent uterus ( & hence will not respond to OCPs) but have normal well developed axillary and pubic hair .
FIRST PRIZE
Dr Pooja S Kale
Cell: 9029080799
SECOND PRIZE
Dr Shital Dilip Potdar
Cell: 09870391024
Punit Bhojani QUIZ MASTER
Dr. Punit Bhojani
MEMBER OF MANAGING COUNCIL
Resi: 24013718 Cell:
9869727515

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The Mumbai Obstetric & Gynecological Society

C-14, 1st Floor, Trade World, D-wing Entrance,
S. B. Marg, Kamala City, Lower Parel (W), Mumbai 400013.

Tel. : 022-24955324 / 24975035 • email: mogs2012@gmail.com

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