OG12.1-11,OG16.4 | Medical Disorders in Pregnancy — Glossary

Bile salt export pump — the primary hepatocanalicular bile acid transporter; loss-of-function variants predispose to ICP in pregnancy when oestrogen further suppresses its activity.

Administration of oxytocin 10 IU IM immediately after delivery of the anterior shoulder, controlled cord traction, and uterine massage to prevent PPH.

Symptomatic lower urinary tract infection in pregnancy characterised by dysuria, frequency, urgency, and suprapubic discomfort without fever or systemic illness; treated with a 7-day antibiotic course.

A rare but life-threatening third-trimester condition caused by mitochondrial fatty acid β-oxidation failure (often LCHAD-fetal link), resulting in microvesicular hepatic steatosis, acute liver failure, hypoglycaemia, coagulopathy, and encephalopathy; delivery is curative.

Ascending upper urinary tract infection reaching the renal parenchyma; presents with high fever, rigors, costovertebral angle tenderness, and loin pain; requires inpatient IV antibiotic therapy; carries risk of sepsis, AKI, and ARDS.

Umbilical artery Doppler waveform finding in which there is no forward diastolic flow, indicating approximately 60–70% obliteration of placental villous vessels; associated with significantly increased perinatal morbidity and mortality.

Criteria used to assess whether HIV-positive mothers can safely practice replacement (formula) feeding: Affordable, Feasible, Acceptable, Sustainable, Safe; if ALL are met, exclusive formula feeding is recommended; if NOT met, exclusive breastfeeding + maternal ART is the safer option.

A clinical sign to distinguish uterine from extra-uterine sources of tenderness: tenderness that moves with the uterus when the patient rolls to the left lateral position is of uterine origin; tenderness that remains fixed suggests an extra-uterine source.

Haemoglobin below 11 g/dL at any trimester, per WHO criteria; reflects reduced red cell mass or increased plasma volume beyond the physiological norm.

Betamethasone 12 mg IM 24 hours apart × 2 doses (or dexamethasone 6 mg IM 6-hourly × 4 doses) administered when preterm delivery is anticipated before 34 weeks to accelerate fetal lung maturation and reduce RDS, IVH, and NEC.

Concentrated polyclonal human IgG anti-D antibodies; given IM to Rh-negative non-sensitised (ICT-negative) women after sensitising events or routinely at 28 weeks; prevents sensitisation by rapidly clearing D-positive fetal red cells from the maternal circulation before a primary immune response can develop; standard dose 300 µg (covers 30 mL fetal blood).

Autoantibody present in 80–90% of Hashimoto's thyroiditis and many Graves' patients; confirms autoimmune thyroid disease; positive anti-TPO with normal TSH (euthyroid anti-TPO positive) is associated with pregnancy loss, preterm birth, and postpartum thyroiditis.

Compression of the inferior vena cava and aorta by the gravid uterus in the supine position from approximately 20 weeks, reducing venous return to the heart and causing maternal hypotension and reduced uteroplacental perfusion; prevented by left lateral tilt (15 degrees).

Congenital absence of scalp skin — a specific teratogenic defect associated with methimazole/carbimazole exposure during the first trimester (organogenesis, weeks 6–10); part of the methimazole embryopathy spectrum.

Inflammation of the vermiform appendix, typically due to luminal obstruction by a faecolith or lymphoid hyperplasia; the commonest non-obstetric surgical emergency in pregnancy.

Acute respiratory distress syndrome complicating 2–8% of acute pyelonephritis in pregnancy; mediated by endotoxin-induced pulmonary capillary injury; presents with bilateral infiltrates and hypoxaemia; a rare but potentially lethal complication.

The most common type of IUGR, characterised by disproportionate AC reduction with relative preservation of HC (brain-sparing), elevated HC/AC ratio, late onset (>28 weeks), caused primarily by uteroplacental insufficiency.

Presence of ≥100,000 CFU/mL of a single uropathogen on mid-stream urine culture in the absence of urinary tract symptoms; prevalence 2–10% in pregnancy; requires mandatory treatment due to 20–40% risk of progression to acute pyelonephritis.

Irregularly irregular cardiac rhythm; particularly dangerous in mitral stenosis because it reduces ventricular filling time and removes the atrial 'kick', precipitating acute haemodynamic decompensation.

Return of 300–500 mL blood to the central circulation with each uterine contraction; causes transient surges in cardiac output; significant haemodynamic stress in mitral stenosis and cardiomyopathy during labour.

Developmental Origins of Health and Disease (DOHaD) concept: intrauterine undernutrition during critical developmental windows programmes fetal metabolism via epigenetic mechanisms, predisposing the individual to hypertension, type 2 diabetes, coronary artery disease, and metabolic syndrome in adult life.

1.2 MU IM every 3–4 weeks; secondary prevention of rheumatic fever in patients with established RHD; continued throughout pregnancy to prevent new streptococcal-triggered valve damage.

Reduced gallbladder motility in pregnancy due to progesterone-mediated smooth muscle relaxation, leading to prolonged bile retention and supersaturation with cholesterol — the primary mechanism of gallstone formation in pregnancy.

Composite ultrasound + NST assessment of five fetal parameters (fetal breathing movements, gross movements, tone, amniotic fluid volume, NST); each scored 0 or 2; total score ≤4 is abnormal and usually warrants delivery consideration.

A fetal adaptive response to chronic uteroplacental hypoxia in which cardiac output is preferentially redistributed to the brain, heart, and adrenals by cerebrovascular vasodilatation and visceral vasoconstriction, producing the characteristic HC/AC ratio elevation of asymmetrical IUGR.

The antidote for MgSO4 toxicity: 1 g IV (10 mL of 10% solution) administered slowly over 10 minutes; acts by competitive antagonism of magnesium at calcium-dependent neuromuscular junctions. Must be kept at the bedside of every patient on MgSO4.

Recommended (1.5–2 g/day elemental calcium) by WHO and FOGSI/ICMR guidelines in populations with low dietary calcium intake to reduce pre-eclampsia risk; approximately 50% risk reduction in meta-analyses.

Antithyroid drug preferred in second and third trimesters; carbimazole is a prodrug converted to methimazole (the active form); mechanism: inhibits thyroid peroxidase; TERATOGENIC in T1 organogenesis (weeks 6–10) — causes aplasia cutis, choanal atresia, oesophageal atresia, methimazole embryopathy; safe and preferred in T2-T3.

Heart rate × stroke volume; rises 30–50% above baseline by 28–32 weeks in normal pregnancy — this is the haemodynamic challenge that unmasks previously compensated cardiac disease.

Canadian Cardiovascular Obstetric Network risk score predicting adverse cardiac events in pregnancy; predictors include prior cardiac event, NYHA class >II, left heart obstruction, and reduced ejection fraction.

Rare but pathognomonic congenital anomaly of pre-gestational DM; sacral agenesis and lower limb hypoplasia; results from hyperglycaemia disrupting mesoderm development during organogenesis.

Measure of HIV-induced immunosuppression: normal ≥500 cells/µL; <200 = AIDS-defining immunosuppression requiring OI prophylaxis; under Option B+, CD4 no longer determines when to start ART in pregnancy (all women start), but guides co-trimoxazole prophylaxis and monitoring.

Ratio of MCA pulsatility index to umbilical artery pulsatility index; CPR below 1.0 or below the 5th centile for gestational age indicates that cerebral resistance has fallen below placental resistance (brain-sparing threshold crossed); sensitive marker of fetal compromise.

The presence of gallstones within the common bile duct; may cause obstructive jaundice, ascending cholangitis, or acute pancreatitis; diagnosed by MRCP in pregnancy (preferred over ERCP to avoid radiation) and treated by ERCP with sphincterotomy if required.

Percutaneous umbilical blood sampling — direct sampling of fetal blood from the umbilical vein under real-time ultrasound guidance; provides fetal haemoglobin, haematocrit, blood group, and Coombs test; procedure-related fetal loss rate ~0.5–1%; performed when MCA-PSV >1.5 MoM to confirm fetal anaemia and initiate IUT in the same sitting.

The antibody titre above which fetal haemolytic disease (up to and including hydrops fetalis) becomes a significant risk; conventionally ≥1:16; above this threshold, titre values alone are unreliable for predicting fetal anaemia severity and MCA-PSV Doppler takes over as the primary monitoring tool.

A fetal growth chart that adjusts for maternal height, weight, parity, and ethnicity to derive an individualised growth potential for each pregnancy, superior to population-based charts for identifying pathological IUGR.

Combined iron and folate/B12 deficiency producing a mixed microcytic and macrocytic picture on peripheral smear; RDW is markedly elevated.

Diabetes in Pregnancy Study Group India screening method: 75 g oral glucose given in the NON-FASTING state; 2-hour venous plasma glucose ≥140 mg/dL = GDM. FOGSI-endorsed for universal screening in India.

Test performed on infant/neonatal cord blood; detects anti-D IgG antibodies already bound to the fetal red cells; positive DCT on cord blood confirms active haemolytic disease of the newborn.

Systemic activation of the coagulation cascade leading to consumption of clotting factors and platelets, paradoxical bleeding and thrombosis; occurs in AFLP and severe HEV hepatitis; manifests as prolonged PT/APTT, low fibrinogen (<1.5 g/L), thrombocytopaenia, and elevated D-dimers.

Assessment of venous blood flow from the umbilical vein to the inferior vena cava; absent or reversed 'a' wave (corresponding to atrial contraction) indicates elevated right heart end-diastolic pressure and is a pre-terminal marker in IUGR.

The occurrence of new-onset generalised tonic-clonic convulsions in a woman with pre-eclampsia, in the absence of other causative neurological conditions; a life-threatening obstetric emergency.

Non-nucleoside reverse transcriptase inhibitor (NNRTI); the EFV component of TDF+3TC+EFV; CNS side effects (vivid dreams, dizziness) are common initially; current NACO/WHO guidelines support its use throughout pregnancy including the first trimester.

Pulmonary hypertension with reversal of a previously left-to-right cardiac shunt; characterised by cyanosis; maternal mortality 30–50% in pregnancy; absolute contraindication to pregnancy.

Neonatal procedure replacing the infant's blood volume with donor blood (usually twice the blood volume = 160–170 mL/kg); removes bilirubin, maternal antibodies, and antibody-coated red cells simultaneously; performed for rapidly rising or severely elevated bilirubin (>20 mg/dL in term infant) or severe anaemia in HDNB.

The main intracellular iron storage protein; serum ferritin below 12 ng/mL indicates depleted iron stores; it is also an acute-phase reactant (rises in inflammation).

Transfer of fetal red blood cells into the maternal circulation through defects in the trophoblast; occurs physiologically in small volumes throughout pregnancy; larger volumes occur at delivery, miscarriage, and other sensitising events; detected and quantified by the Kleihauer-Betke test.

Excessive insulin secretion by the foetal pancreas in response to transplacental glucose delivery from a hyperglycaemic mother; the central mechanism for macrosomia, neonatal hypoglycaemia, RDS, and polycythaemia.

The biologically active, protein-unbound fraction of thyroxine in plasma; used in pregnancy (not total T4) because total T4 is elevated by increased TBG; interpreted alongside trimester-specific TSH to classify hypothyroid/hyperthyroid states and to monitor ATD dose adequacy.

Formula to calculate total parenteral iron dose: Weight (kg) × (Target Hb − Actual Hb) × 2.4 + 500 mg (to replenish stores).

Glucose intolerance of any degree first detected or diagnosed during the current pregnancy, excluding overt pre-existing diabetes; typically diagnosed at 24–28 weeks using DIPSI or IADPSG protocols.

New-onset hypertension (BP ≥140/90) after 20 weeks of gestation without proteinuria or end-organ dysfunction, resolving within 12 weeks postpartum.

Transient biochemical hyperthyroidism in the first trimester caused by hCG cross-reacting with TSH receptors (shared alpha subunit); characterised by suppressed TSH, mildly elevated FT4, NEGATIVE TRAb, no goitre or eye signs, often associated with hyperemesis gravidarum; self-limiting by 18–20 weeks; no antithyroid drugs required.

The characteristic renal histopathological lesion of pre-eclampsia: swelling and vacuolation of glomerular endothelial cells causing reduced filtration and proteinuria.

Glucose in the urine occurring physiologically due to the increased GFR of pregnancy exceeding tubular reabsorptive capacity; provides a nutritive medium for uropathogens such as E. coli.

Anaemia due to premature destruction of red blood cells; causes in pregnancy include malaria, sickle cell disease, and autoimmune haemolysis.

Neonatal haemolytic anaemia caused by maternal IgG anti-D (or other alloantibodies) crossing the placenta and destroying fetal/neonatal red cells; presents with jaundice within 24 hours of birth, anaemia, hepatosplenomegaly; severe cases require exchange transfusion to prevent kernicterus.

Hyperglycaemia and Adverse Pregnancy Outcomes multicentre cohort study (2008) of 25,000+ women demonstrating a continuous graded relationship between maternal blood glucose and adverse perinatal outcomes; the evidence base for IADPSG criteria.

Autoimmune hypothyroidism caused by lymphocytic infiltration and progressive destruction of thyroid follicles, mediated by anti-TPO and anti-thyroglobulin antibodies; the most common cause of hypothyroidism in pregnancy in iodine-sufficient areas; tends to partially remit in mid-pregnancy (immune tolerance) then flare postpartum.

An open entry method for laparoscopic trocar insertion using a small transverse incision and direct visualisation of the peritoneum, preferred over Veress needle entry in pregnancy to reduce the risk of uterine puncture.

hCG shares an identical alpha subunit with TSH, LH, and FSH; at high first-trimester concentrations (peak 10–12 weeks), hCG weakly stimulates TSH receptors → direct thyroid stimulation → suppressed TSH via negative feedback; the mechanism of gestational transient thyrotoxicosis; disappears as hCG falls from 12–14 weeks.

A severe complication of pre-eclampsia characterised by Haemolysis (microangiopathic), Elevated Liver enzymes (AST/ALT ≥ twice normal), and Low Platelets (<100 × 10⁹/L).

Concentrated antibodies against hepatitis B surface antigen (HBsAg) given to neonates born to HBsAg-positive mothers within 12 hours of birth alongside the first dose of HBV vaccine; provides passive-active immunisation that reduces vertical transmission by >90%.

A non-enveloped RNA enterically-transmitted virus (Orthohepevirus A); genotype 1 predominates in India and causes fulminant hepatic failure in 20–25% of infected pregnant women (vs ~1% in non-pregnant adults), likely due to oestrogen-mediated immunosuppression and direct placental tropism.

Polymerase chain reaction assay detecting HIV proviral DNA in infant whole blood; the standard diagnostic test for HIV in infants <18 months because it is not confounded by maternally transferred HIV antibodies; performed at 6 weeks of age as the first diagnostic test.

Concentration of HIV RNA copies per mL of plasma; reflects active viral replication; goal of ART is undetectable (<50 copies/mL); measured at baseline and at 36 weeks to guide delivery mode; at 36 weeks: <1,000 = vaginal delivery acceptable; ≥1,000 = elective LSCS.

Placenta-derived hormone that antagonises insulin signalling at peripheral tissues; the primary diabetogenic hormone of pregnancy; levels rise progressively with placental mass, peaking in the third trimester.

Generalised fetal oedema with fluid in at least two serous cavities (ascites, pleural effusion, pericardial effusion) plus skin oedema; in Rh haemolytic disease, caused by severe anaemia → high-output cardiac failure + hypoalbuminaemia from hepatic compromise → capillary oncotic pressure failure; can be immune (alloimmunization) or non-immune.

A spectrum of conditions characterised by elevated blood pressure in pregnancy, including chronic hypertension, gestational hypertension, pre-eclampsia, eclampsia, and HELLP syndrome.

International Association of Diabetes and Pregnancy Study Groups criteria: 75 g oral glucose given in the FASTING state; GDM diagnosed if ANY ONE threshold is met — fasting ≥92 mg/dL, 1-h ≥180 mg/dL, or 2-h ≥153 mg/dL.

Government-designated facility under NACO where HIV testing, pre- and post-test counselling, confirmatory testing, PPTCT programme enrolment, and ART initiation occur; all reactive ANC HIV test results are referred to the ICTC for programme enrolment.

NHM programme providing 60 mg elemental iron + 500 mcg folic acid daily to all pregnant women; the cornerstone of anaemia prevention in India.

Antibody screening test performed on maternal serum; detects free, unbound anti-D IgG antibodies circulating in maternal serum by mixing with D-positive test red cells and anti-human globulin; positive = sensitisation has occurred.

Mechanical obstruction of the bowel during pregnancy, most commonly caused by adhesions from prior pelvic or abdominal surgery tethering bowel loops that are subsequently compressed or distorted by the enlarging uterus; characterised by colicky central pain, bilious vomiting, absolute constipation, and distension.

A pregnancy-specific liver disorder characterised by intractable pruritus and elevated serum bile acids (≥10 µmol/L), caused by oestrogen-mediated impairment of canalicular bile acid transporters (ABCB11/ABCB4); bile acids ≥40 µmol/L define severe disease with increased stillbirth risk.

Blood glucose 4–7 mmol/L (72–126 mg/dL) maintained during labour using glucose-insulin-potassium (GIK) infusion; tight control prevents neonatal hypoglycaemia by avoiding foetal hyperinsulinaemia at delivery.

Direct transfusion of O-negative irradiated packed red blood cells into the fetal umbilical vein under ultrasound guidance; performed when MCA-PSV >1.5 MoM and cordocentesis confirms fetal Hb <10 g/dL (or haematocrit <30%); can be repeated every 2–4 weeks; gestational window 18–34 weeks.

Anaemia caused by depletion of iron stores; characterised by microcytic hypochromic red cells, low serum ferritin, low serum iron, and elevated TIBC.

Parenteral iron preparation administered IV; preferred over iron dextran in pregnancy due to lower anaphylaxis risk; given as 200 mg in 100 mL normal saline over 30 minutes.

Development of maternal antibodies against a fetal red cell antigen inherited from the father that is absent in the mother; Rh D alloimmunization is the most common and clinically important form.

Failure of a fetus to achieve its genetically determined growth potential, operationally defined as an estimated fetal weight below the 10th centile on a customised growth chart with abnormal growth velocity; associated with uteroplacental insufficiency and increased perinatal risk.

Acid elution test on maternal blood that distinguishes fetal red cells (HbF, acid-resistant) from adult red cells (HbA, acid-eluted) under microscopy; used to quantify fetomaternal haemorrhage volume and calculate whether additional anti-D doses are needed above the standard 300 µg.

Spoon-shaped concavity of the nail plate; a sign of chronic iron deficiency; reflects impaired keratin formation due to iron-dependent enzymatic processes.

A combined alpha- and beta-adrenergic blocker used as a first-line antihypertensive for acute severe hypertension in pregnancy (BP ≥160/110); contraindicated in asthma and heart failure.

Surgical removal of the appendix using keyhole (laparoscopic) technique; preferred approach for appendicitis in the first and second trimesters of pregnancy due to smaller incision, less post-operative pain, and equivalent fetal outcomes to open surgery.

Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency — an autosomal recessive mitochondrial fatty acid oxidation disorder; a fetus homozygous for LCHAD deficiency cannot oxidise long-chain fatty acids, which accumulate and cross the placenta to overwhelm the heterozygous mother's hepatocyte mitochondria, precipitating AFLP.

Synthetic T4 — the treatment for hypothyroidism in pregnancy; dose must be increased by approximately 25–30% on confirmation of pregnancy to meet increased T4 demands; taken on an empty stomach; monitored by trimester-specific TSH targeting; postpartum dose reduced to pre-pregnancy level.

75–150 mg aspirin given orally at night, started before 16 weeks of gestation; inhibits thromboxane synthesis preferentially, reducing platelet aggregation and placental microthrombus formation; recommended for prevention of placenta-mediated IUGR and pre-eclampsia in high-risk women.

Aspirin 75–150 mg/day started before 16 weeks of gestation (ideally before 12 weeks) to reduce pre-eclampsia risk in women with ≥1 high-risk factor; mechanism includes thromboxane/prostacyclin rebalancing and potential effect on trophoblast invasion.

Anticoagulant used in the first trimester (instead of warfarin, which is teratogenic) and from 36 weeks (to allow reversal at delivery) in pregnant women with AF or mechanical prosthetic heart valves.

Birth weight above 4 kg (or above 90th centile for gestational age); principal obstetric consequence of foetal hyperinsulinaemia; increases risk of shoulder dystocia, brachial plexus injury, and caesarean section.

The drug of choice for both prevention and treatment of eclamptic convulsions; acts via cerebral vasodilation, NMDA-receptor antagonism, and membrane stabilisation. Has no meaningful antihypertensive action.

Non-invasive ultrasound Doppler measurement of blood flow velocity in the fetal middle cerebral artery; anaemic fetuses have increased cardiac output and reduced blood viscosity → higher MCA-PSV; >1.5 MoM (multiples of the median for gestational age) indicates moderate-severe fetal anaemia and is the threshold for cordocentesis.

The point one-third of the way from the anterior superior iliac spine to the umbilicus along this line — classically the site of maximum tenderness in appendicitis (less reliable in pregnancy beyond the first trimester due to appendix displacement).

Anaemia characterised by macrocytic erythrocytes and hypersegmented neutrophils, caused by deficiency of folate or vitamin B12 impairing DNA synthesis.

First-line oral pharmacological agent in GDM in India (FOGSI guidelines); reduces hepatic gluconeogenesis and improves insulin sensitivity; crosses the placenta but short-term neonatal safety demonstrated in the MiG trial.

Administration of magnesium sulphate (4 g IV loading over 20–30 min, then 1 g/h maintenance) before anticipated preterm delivery at <32 weeks (some guidelines <34 weeks) to reduce the risk of cerebral palsy; distinct from the eclampsia treatment regimen.

Mechanical destruction of red blood cells as they are sheared across fibrin deposits in small vessels; causes elevated LDH, low haptoglobin, schistocytes on peripheral blood film, and anaemia; the haemolysis component of HELLP syndrome.

Accumulation of small fat droplets within hepatocyte cytoplasm without displacing the nucleus; the histological hallmark of AFLP; represents mitochondrial β-oxidation failure; distinct from macrovesicular steatosis (large droplet, nucleus displaced) seen in alcoholic/non-alcoholic fatty liver.

The gold standard investigation for UTI in pregnancy; collected using clean-catch technique; significant bacteriuria defined as ≥100,000 CFU/mL of a single uropathogen.

Narrowing of the mitral valve orifice obstructing left ventricular filling; the most dangerous valvular lesion in pregnancy because it creates a fixed obstruction that prevents the increase in cardiac output required by pregnancy.

Combination of breastfeeding and formula/supplemental foods given to the same infant; the most dangerous feeding practice for HIV-exposed infants because it damages the gut mucosa, dramatically increasing the risk of HIV transmission via breast milk; must be actively discouraged.

Magnetic resonance cholangiopancreatography; a non-invasive, non-ionising MRI technique for imaging the biliary and pancreatic ductal system; preferred over ERCP for diagnosis of choledocholithiasis and biliary obstruction in pregnancy.

Transmission of HIV from an HIV-positive mother to her infant via antepartum (transplacental), intrapartum (birth canal exposure), or postnatal (breastfeeding) routes; overall untreated rate 25–45%; reduced to <2% with full PPTCT implementation.

Arrest of inspiration during deep palpation of the right hypochondrium, indicating acute cholecystitis; caused by the inflamed gallbladder descending to meet the examining hand and eliciting pain.

Transient neonatal thyrotoxicosis caused by transplacental transfer of maternal TRAb (IgG), which stimulates the neonatal thyroid gland; presents 3–7 days after birth (when maternal ATD clears); features include tachycardia, irritability, poor feeding, goitre; usually self-limiting (3–12 weeks); treated with low-dose carbimazole and propranolol.

National Family Health Survey-5 (2019–21); reported 52% prevalence of anaemia in Indian pregnant women aged 15–49 years, highlighting the unresolved public health burden.

A dihydropyridine calcium channel blocker used for acute severe hypertension in pregnancy; 10–20 mg orally; effective and widely available; do NOT use sublingual route due to risk of precipitous hypotension.

Nitrofurantoin is contraindicated after 36 weeks of gestation (term) due to the risk of neonatal haemolytic anaemia — premature neonatal erythrocytes lack sufficient glutathione to handle the oxidative stress generated by nitrofurantoin metabolites.

Daily oral nevirapine syrup given to all infants of HIV-positive mothers from birth for 6 weeks (standard risk) or 12 weeks with added AZT (high risk) to prevent intrapartum and early postnatal HIV transmission.

New York Heart Association classification of cardiac disease severity: Class I (no limitation), II (slight with strenuous activity), III (marked with ordinary activity), IV (symptoms at rest). Classes III–IV carry maternal mortality 5–15%.

Reduced amniotic fluid volume defined as AFI ≤5 cm or deepest vertical pocket <2 cm; in IUGR, reflects preferential renal vasoconstriction with reduced fetal urine output; a marker of moderate-to-severe fetal compromise.

NACO/WHO PPTCT strategy (2015 onward): all HIV-positive pregnant and breastfeeding women start lifelong ART regardless of CD4 count or WHO clinical stage; the current standard of care in India.

Rotation of the ovary on its ligamentous pedicle, initially obstructing venous and lymphatic drainage, then arterial inflow, leading to ovarian ischaemia and haemorrhagic infarction if not promptly reversed.

Balloon mitral valvuloplasty performed via catheter; can be performed in the second trimester in pregnant women with severe MS (MVA <1.5 cm²) refractory to medical management, using lead shielding and minimising radiation exposure.

Deaths occurring between 28 weeks gestation and 7 days after birth; severe maternal anaemia is a significant preventable contributor through IUGR and preterm birth.

Pregnancy-specific dilated cardiomyopathy presenting in the last month of pregnancy or within 5 months postpartum, in the absence of prior cardiac disease, with EF below 45%; may recur and worsen in subsequent pregnancies if EF has not normalised.

Apparent fall in Hb due to disproportionate plasma volume expansion (40–50%) relative to red cell mass expansion (20–30%); not a pathological state; indices and iron studies are normal.

Dilatation of the renal pelvis and ureters occurring in most pregnancies, caused by progesterone-mediated ureteric smooth muscle relaxation and mechanical compression of the ureters by the enlarging uterus; creates urinary stasis that predisposes to ascending UTI.

A pro-angiogenic vascular growth factor produced by the placenta; markedly reduced in pre-eclampsia due to sequestration by excess sFlt-1. The sFlt-1/PlGF ratio is a predictive biomarker.

Excess amniotic fluid (AFI >24 cm or deepest pool >8 cm); occurs in diabetes due to foetal osmotic polyuria (high glucose drives foetal urination); risks cord prolapse, preterm labour, and malpresentation.

A neuroimaging syndrome (white-matter T2/FLAIR hyperintensity on MRI) associated with eclampsia, reflecting vasogenic oedema from cerebrovascular autoregulatory failure and endothelial dysfunction; typically reversible with BP control and MgSO4.

75 g fasting OGTT performed at 6–12 weeks postpartum in ALL women with GDM to determine if glucose tolerance has normalised, reveals impaired glucose tolerance, or confirms persistent diabetes (T2DM).

Painless destructive autoimmune thyroiditis occurring in 5–10% of postpartum women (higher with anti-TPO positivity); biphasic: transient hyperthyroid phase (weeks 1–4 postpartum from thyroid follicle destruction) followed by hypothyroid phase (weeks 4–12); usually resolves by 12 months; 20–30% develop permanent hypothyroidism requiring long-term LT4.

Prevention of Parent-to-Child Transmission / Prevention of Mother-to-Child Transmission — India's national programme under NACO providing universal ANC HIV testing, ART, intrapartum care, infant prophylaxis, and feeding counselling to eliminate vertical HIV transmission.

New-onset hypertension (BP ≥140/90 mmHg) after 20 completed weeks of gestation, accompanied by proteinuria or end-organ dysfunction; eclampsia adds generalised convulsions.

Type 1 or Type 2 diabetes diagnosed before the current pregnancy; carries risks of congenital anomalies, worsening microvascular complications, and IUGR in addition to the macrosomia risks of GDM.

The IM MgSO4 protocol for eclampsia: loading 4 g IV + 10 g IM (5 g each buttock); maintenance 5 g IM every 4 h in alternate buttocks; standard regimen in India per FOGSI/ICMR guidelines.

Bacterial endotoxins (lipopolysaccharide from E. coli) stimulate prostaglandin E₂ and F₂α synthesis in the decidua and myometrium, triggering uterine contractions and preterm labour — the mechanism linking UTI to preterm birth.

Antithyroid drug preferred in the first trimester; inhibits thyroid peroxidase (blocking iodine organification and coupling) and partially inhibits peripheral T4→T3 conversion; does not cause methimazole-specific embryopathy; risk of severe hepatotoxicity (including fatal hepatic necrosis) with prolonged use → switch to carbimazole in T2.

Acute haemorrhagic necrosis of a fibroid occurring most commonly during pregnancy (14–22 weeks), caused by impaired venous drainage due to rapid fibroid growth stimulated by hCG and progesterone; managed conservatively.

Umbilical artery Doppler waveform finding in which diastolic flow is reversed (negative), indicating >70–80% placental vascular obliteration and severe fetal hypoxia; associated with up to 10-fold increased perinatal mortality.

The most clinically significant red cell surface antigen in the Rhesus blood group system; expressed on fetal red cells; absent in ~5–8% of Indian women (Rh-negative); highly immunogenic — a single exposure of as little as 0.1 mL of D-positive blood can trigger sensitisation in an Rh-negative host.

Valvular damage resulting from rheumatic fever (Group A streptococcal-triggered autoimmune response); the commonest cause of cardiac disease in pregnancy in India, predominantly mitral stenosis.

A rifamycin antibiotic used off-label for refractory pruritus in ICP at 150–300 mg/day; it is a pregnane X receptor (PXR) activator that induces bile acid detoxification enzymes; second-line after UDCA.

Pain in the right iliac fossa elicited by palpation of the left iliac fossa; indicative of appendicitis in the non-pregnant patient, but unreliable in pregnancy due to displacement of the appendix from the right iliac fossa.

Home capillary blood glucose monitoring used to assess glycaemic control; targets in pregnancy: fasting <95 mg/dL, 1-h postprandial <140 mg/dL, 2-h postprandial <120 mg/dL.

Any obstetric event that causes fetomaternal haemorrhage of D-positive fetal red cells into an Rh-negative maternal circulation, potentially triggering sensitisation; includes miscarriage ≥12 weeks, ectopic pregnancy, amniocentesis, chorionic villus sampling, external cephalic version, antepartum haemorrhage, abdominal trauma, and delivery.

Cholate and chenodeoxycholate salts excreted in bile; normally <10 µmol/L fasting; accumulate in ICP due to transporter failure; levels ≥10 µmol/L are diagnostic of ICP; ≥40 µmol/L define severe ICP with increased fetal risk.

Criteria indicating high-severity pre-eclampsia: BP ≥160/110 mmHg, thrombocytopaenia (<100 × 10⁹/L), renal insufficiency (creatinine >97 µmol/L), elevated transaminases (×2 normal), pulmonary oedema, or new unresponsive neurological symptoms.

An anti-angiogenic factor secreted in excess by the ischaemic placenta in pre-eclampsia; it acts as a circulating decoy receptor that neutralises VEGF and PlGF, causing endothelial dysfunction.

Birth weight below the 10th centile for gestational age; a descriptive term that includes both constitutionally small normal fetuses and truly growth-restricted fetuses — it does not imply pathology unless growth velocity is also abnormal.

Terminal branches of the uterine arteries that supply the intervillous space of the placenta; in normal pregnancy they are remodelled by trophoblast invasion into wide, low-resistance conduits.

IV antibiotics (amoxicillin + gentamicin) at delivery in patients with moderate-to-high risk cardiac lesions; protects against bacteraemia-seeded infection of damaged or prosthetic valve surfaces.

Low-dose nightly antibiotic (nitrofurantoin 50–100 mg or cefalexin 500 mg nocte) prescribed for the remainder of pregnancy after recurrent bacteriuria (≥2 episodes) or a first episode of pyelonephritis, to prevent recurrence.

A validated 14-item clinical and laboratory scoring system for diagnosing AFLP without liver biopsy; ≥6 of 14 features (including vomiting, abdominal pain, hypoglycaemia, coagulopathy, elevated transaminases, encephalopathy, renal impairment, and echogenic liver on ultrasound) confirms the diagnosis.

Type of IUGR with proportionate reduction of all biometric parameters (HC, AC, FL), normal HC/AC ratio, no brain sparing, typically early onset (<28 weeks), usually caused by chromosomal anomalies, genetic syndromes, or TORCH infections.

Clinical measurement from the upper border of the symphysis pubis to the fundus of the uterus in centimetres; approximates gestational age in weeks (±2 cm); the primary screening tool for IUGR in antenatal clinics.

Tenofovir disoproxil fumarate + lamivudine + efavirenz — the first-line antiretroviral regimen for HIV in pregnancy under NACO 2021; available as a single fixed-dose combination tablet taken once daily.

A classification system for HELLP syndrome: platelets <100×10⁹/L + LDH >600 IU/L + AST/ALT >70 IU/L; the Mississippi modification grades severity into Class 1 (platelets <50), Class 2 (50–100), Class 3 (100–150) to guide management intensity.

Nucleoside reverse transcriptase inhibitor (NRTI) — the TDF component of TDF+3TC+EFV; inhibits HIV reverse transcriptase; also active against hepatitis B; monitor renal function (tubular toxicity) during pregnancy.

Mid-stream urine culture performed 1–2 weeks after completion of antibiotic therapy for ASB or UTI in pregnancy; confirms microbiological eradication and identifies treatment failures requiring alternative antibiotic.

Life-threatening exacerbation of hyperthyroidism typically triggered by delivery, infection, surgery, or stress; presents with extreme tachycardia (>140 bpm), fever >38.5°C, agitation, vomiting, diarrhoea, and high-output cardiac failure; maternal mortality up to 25%; emergency treatment: PTU + Lugol's iodine (1 h after PTU) + propranolol + dexamethasone.

The principal plasma carrier protein for thyroid hormones; levels double in pregnancy due to oestrogen-stimulated hepatic synthesis and increased sialylation (prolonged half-life); increased TBG binds more T4, reducing free fractions and driving a compensatory increase in thyroid hormone production and total T4.

Measures the blood's capacity to bind iron via transferrin; elevated (>360 µg/dL) in iron deficiency as the body upregulates transferrin production.

Pharmacological suppression of uterine contractions using agents such as betamimetics (salbutamol) or NSAIDs (indomethacin, safe before 32 weeks); used perioperatively to prevent preterm labour triggered by surgical stress and manipulation.

Auto-antibody characteristic of Graves' disease that binds and stimulates the TSH receptor, causing autonomous thyroid hormone overproduction; crosses the placenta (IgG) and can stimulate the neonatal thyroid for 3–12 weeks after birth; TRAb >3× ULN at 36 weeks warrants neonatal Graves' surveillance.

Percentage of transferrin binding sites occupied by iron (serum iron/TIBC × 100); below 16% indicates iron-restricted erythropoiesis.

Concept that ART-achieved viral suppression prevents HIV transmission to sexual partners and to infants; validated by the HPTN 052 trial (96% reduction in linked transmission in sero-discordant couples on early ART); the scientific rationale for Option B+ lifelong ART.

The correct reference ranges for TSH in pregnancy (ATA 2017): T1 = 0.1–2.5 mIU/L; T2 = 0.2–3.0 mIU/L; T3 = 0.3–3.0 mIU/L; lower than non-pregnant (0.4–4.0) due to hCG-mediated TSH suppression in T1 and TBG-driven compensatory adjustments; using non-pregnant ranges leads to diagnostic errors.

The process by which cytotrophoblast cells migrate into the uterine decidua and remodel the spiral arteries during early pregnancy; defective invasion is the initiating lesion of pre-eclampsia.

Trial of Umbilical and Fetal Flow in Europe; enrolled preterm IUGR fetuses 26–32 weeks; compared CTG short-term variability vs ductus venosus PI vs DV a-wave as delivery triggers; found that DV a-wave trigger associated with best 2-year neurodevelopmental outcome.

Ultrasound-based measurement of blood flow velocimetry in the umbilical artery; elevated S/D ratio or pulsatility index reflects increased placental resistance; absent end-diastolic flow (AEDF) and reversed end-diastolic flow (REDF) indicate severe placental compromise.

Systemic sepsis arising from a urinary source; in pregnancy, pyelonephritis is the most common non-obstetric cause; characterised by fever, tachycardia, hypotension, and positive blood cultures (in 20% of pyelonephritis cases).

A hydrophilic bile acid used to treat ICP at 10–15 mg/kg/day; it competitively displaces toxic bile acids, restores hepatic transporter expression, reduces pruritus, and lowers serum bile acid levels; it is the standard of care for ICP in pregnancy.

Inadequate transfer of oxygen and nutrients from the maternal circulation to the fetus due to impaired trophoblastic invasion and spiral artery remodelling; the most common cause of asymmetrical IUGR.

Maternal HIV viral load at 36 weeks: <1,000 copies/mL = vaginal delivery acceptable; ≥1,000 copies/mL or unknown = elective LSCS at 38 weeks recommended to minimise intrapartum infant HIV exposure.

Classification by Priscilla White: Class A1 = GDM controlled by diet alone; Class A2 = GDM requiring pharmacological therapy (insulin or oral agents); higher classes relate to duration, vascular complications in PGDM.

WHO modified classification of cardiovascular disease in pregnancy; risk-stratifies lesions from mWHO I (no increased risk) to mWHO IV (extremely high risk; pregnancy contraindicated or requires ICU management).

The IV MgSO4 protocol: loading 4 g IV infusion over 15–20 minutes; maintenance 1 g/h continuous IV infusion; requires IV infusion pump, used in well-equipped settings.