24 - AIIMS november 2008 obstetrics mcqs with answers

1. in Mc roberts manoeuvre hip is flexed against mothers abdomen. this leads to injury of which nerve?

a. lumbosacral trunk
b. obturator n
c. femoral n.
d. lateral cutaneous n of thigh

answer will post soon

2. all are done in management of shoulder dystocia except?

a. fundal pressure
b. mc roberts manoeuvre
c. suprapubic pressure
d. woods manoeuvre

answer will post soon

3. a 25 year old married nullipara undergoes laproscopic cystectomy for ovarian cyst which on histopath reveals serous ovarian adenocarcinoma.what should be the next management?

a. serial Ca-125 and follow up
b. hysterectomy and salpingooophorectomy
c. hysterectomy + radiotherapy
d. radiotherapy

answer will post soon

4. safest vasopressor in pregnancy is?

a. ephedrine
b. phenylephrine
c. methoxamine
d. mephentine

answer will post soon

5. fallopian tube dysmotility is seen in?

a. noonan syn
b. turner syn
c. kartagener syn
d. marfan syn

answer c . kartageners syndrome

6. all of the following investigations are used in FIGO staging of carcinoma cervix except?

a. CECT
b. IVP
c. cystoscopy
c. proctosigmoidoscopy

answer will post soon

7. clue cells are found in?

a. candidial vaginosis
b. bacterial vaginosis
c. trichomoniasis
d. non specific vaginitis

answer b . bacterial vaginosis

8. Best indicator of ovarian reserve is?

a. FSH
b. Estradiol
c. LH
d. FSH/LH ratio

answer will post soon

9. A pregnant lady acquires chicken pox 3 days prior to delivery.she delivers by normalvaginal route.which of the following statements is true?

a. Both mother and baby are safe
b. Give antiviral TT to mother before delivery
c. Give antiviral TT to baby
d. Baby will develop congenital varicella syndrome

answer will post soon

10. Earliest detectable congenital malformation by USG is?

a. Anencephaly
b. Spina bifida
c. Meningocoele
d. Cystic hygroma

answer a . anencephaly

11. all of the following should be done to prevent the transmission of HIV from mother to baby except?

a. Vit A supplementation to mother
b. No breast feeding
c. Vaginal delivery
d. Zidovudine to mother

answer c . vaginal delivery

12. a 45yr old lady with dub has 8mm thickness of endometrium.next step in management?

a. Histopathology’
b. Hysterectomy
c. Progesterone
d. OCP

answer will post soon

13. All are true about PCOD except?

a. Persistently elevated LH
b. Increased LH/FSH ratio
c. Increased DHEAS
d. Increased prolactin

answer will post later

14. A female at 37 wks of gestation has mild labour pain for 10 hours and cervix is persistently 1cm dialated non efficed.what will be next appropriate management?

a. sedation and wait
b. augmentation with syntocinon
c. cesarean section
d. amniotomy

answer c . cesarean section

15. a woman comes with obstructed labour and is grossly dehydrated . investigations reveal fetal demise.what will be the management?

a. craniotomy
b. decapitation
c. cesarean section
d. forceps extraction

answer c . cesarean section

16. investigation of choice in cholestasis of pregnancy?

a. bilirubin
b. bile acids
c. alk phosphatase
d. ALT & AST

answer will post soon

17. a female has history of 6 weeks amenorrhoea, USG shows empty sac,serum beta HCG -1000 IU .what would be next management?

a. medical management
b. repeat HCG after 48 hours
c. repeat HCG after 1 week
d. none

answer b. repeat HCG after 48 hours

to view all the 200 mcqs of AIIMS november 2008 click here 

23 - abdominal pregnancy

Which of the following statements concerning abdominal pregnancy
is correct?
a. Gastrointestinal symptoms are quite often severe
b. Fetal survival is approximately 50%
c. Aggressive attempts should be made to remove the placenta at the time of initial
surgery
d. It may result in infectious morbidity prior to the diagnosis
e. It is usually the result of a primary abdominal implantation

The answer is d. (Schwartz, 7/e, pp 1838–1843. Ransom, 2000, pp
36–37.)

Abdominal pregnancy usually follows a tubal pregnancy with either
tubal rupture or spontaneous passage through the fimbriated end. Although
women with abdominal pregnancy usually report an increase in gastrointestinal
symptoms, these are rarely severe enough to lead to investigation.
Fetal death rates are reported to be above 90% with abdominal pregnancies.
Infection of the gestational products can occur especially when the placenta
adheres to the intestines. This can lead to abscess formation and the possibility
of rupture. Although leaving the placenta in the abdomen following
surgical delivery predisposes to postoperative coagulation problems as well
as the need for subsequent surgery, these complications can be less severe
than the hemorrhage associated with attempts at removal at the time of primary
delivery. If the placenta cannot easily be removed, recommendations
are to leave it in place at the time of the first surgery.

22 - obstetrics cases - MCQ1

MCQ: A 24-year-old woman is in a car accident and is taken to an emergency

room, where she receives a chest x-ray and a film of her lower spine. It is

later discovered that she is 10 weeks pregnant. She should be counseled that

a. The fetus has received 50 rads

b. Either chorionic villus sampling (CVS) or amniocentesis is advisable to check

for fetal chromosomal abnormalities

c. At 10 weeks, the fetus is particularly susceptible to derangements of the central

nervous system

d. The fetus has received less than the assumed threshold for radiation damage

e. The risk that this fetus will develop leukemia as a child is raised

The answer is d. (Gleicher, 3/e, p 163.) While a 50-rad exposure in the

first trimester of pregnancy would be expected to entail a high likelihood

of serious fetal damage and wastage, the anticipated fetal exposure for

chest x-ray and one film of the lower spine would be less than 1 rad. This

is well below the threshold for increased fetal risk, which is generally

thought to be 10 rads. High doses of radiation in the first trimester primarily

affect developing organ systems such as the heart and limbs; in

later pregnancy, the brain is more sensitive. The chromosomes are determined

at the moment of conception. Radiation does not alter the karyotype,

and determination of the karyotype is not normally indicated for a

24-year-old patient. The incidence of leukemia is raised in children receiving

radiation therapy or those exposed to the atomic bomb, but not from

such a minimal exposure as here.

21 - OCPs - contraindications - absolute and relative

ABSOLUTE CONTRAINDICATION OF ORAL CONTRACEPTIVE PILLS :

1. carcinoma of breast and genitals
2. cardiac abnormalities
3. liver diseases , hepatoma or history of jaundice during past pregnancy
4. undiagnosed uterine bleeding
5. porphyria
6. previous or present history of thromboembolism
7. moderate to severe hypertension
8. congenital hyperlipidemia
9. impending major surgery to avoid post operative thromboembolism

RELATIVE CONTRAINDICATIONS OF ORAL CONTRACEPTIVE PILLS :

1. amenorrhea
2. age over 40 years
3. bronchial asthma
4. chronic renal disease
5. depression and fluctuation of mood
6. diabetes mellitus
7. epilepsy
8. fibroid
9. gall bladder disease
10. hypertension ( mild )
11. infrequent bleeding history
12. migraine
13. mentally ill
14. nursing mother in the first 6 months
15. obesity
16. smoking and age over 35 years
17. varicosities

20 - non-stress test - interpretation

1. Interpretation
1. Reactive (Normal)
1. Two or more Fetal Heart Rate increases in 20 minutes
2. Accelerations increase by 15 beats for 15 seconds
3. Related to fetal movement
2. Non-reactive
1. Monitoring for two 20 minute periods
2. Neither period yields adequate accelerations
3. Adjuncts to assist fetal activity fail
1. Acoustic stimulation
2. Manual stimulation
3. Glucose drink
2. Management
1. Reactive Nonstress Test
1. Reassuring for fetal well being for 3-4 days
2. Follow daily Fetal Kick Counts
2. Non-Reactive Nonstress Test
1. Perform Oxytocin Challenge Test (OCT)
2. Perform Biophysical Profile

19 - maternal risks to the fetus

1. Maternal Medical Conditions
1. Pregnancy Induced Hypertension
2. Gestational Diabetes
2. Infections
1. TORCH Infections
3. Drug and medication use
1. Tobacco Abuse
1. Low birth weight infant
2. Increased carbon monoxide load to fetus
3. Increased fetal Hematocrit
2. Drug Withdrawal Syndrome
1. Newborn jittery and irritable
2. Vomiting and Diarrhea
3. Seizures
3. Alcohol Abuse
1. Fetal Alcohol Syndrome
2. Congenital malformations
4. Cocaine, Heroin or Methadone
1. Intrauterine Growth Retardation
5. Stadol, Demerol, Morphine and barbiturates
1. Neonatal depression
6. Methamphetamine
1. Sudden Infant Death Syndrome Risk (SIDS)

18 - biophysical profile

1. See Also
1. Fetal Assessment
2. Fetal Testing Indications
3. Fetal Heart Tracing
2. Cost: $275
3. Criteria (2 points for each)
1. Fetal Breathing
1. Thirty seconds sustained breathing in 30 minutes
2. Fetal Tone
1. Episode extremity extension and flexion
3. Body Movement
1. Three episodes body movement over 30 minutes
4. Amniotic Fluid Volume
1. More than 1 pocket amniotic fluid greater than 2 cm in depth
5. Non-Stress Test
1. Reactive
4. Scoring
1. Give 2 points for each positive above
5. Interpretation
1. Biophysical Profile: 8-10
1. Low risk or Normal result
2. Repeat Biophysical Profile weekly
3. Indications to repeat Biophysical Profile bi-weekly
1. Gestational Diabetes
2. Gestational age greater than 42 weeks
2. Biophysical Profile: 8
1. Delivery Indications: Oligohydramnios
3. Biophysical Profile: 6
1. Suspect asphyxia
2. Repeat Biophysical Profile in 24 hours
3. Delivery Indications
1. Repeat Biophysical Profile less than or equal to 6
4. Biophysical Profile: 4
1. Suspect asphyxia
2. Delivery Indications
1. Gestational age greater than 36 weeks
2. Lung Maturity Tests positive (L/S ratio greater than 2)
5. Biophysical Profile: 0-2
1. Likely asphyxia
2. Continue monitoring for 2 hours
3. Delivery Indications
1. Biophysical Profile less than 4

17 - fetal macrosomia ( large for gestational age )

1. Also See
1. Gestational Diabetes
2. Labor Dystocia
3. Shoulder Dystocia
2. Definition
1. Macrosomia
1. Fetal weight 4500 grams (ranges from 4000-5000 grams)
2. Large for Gestational Age
1. Birth weight above 90th percentile
3. Risk Factors for macrosomia
1. Maternal Diabetes Mellitus or Glucose Intolerance
2. Multiparity
3. Prior history of macrosomic infant
4. Post-Dates Gestation
5. Maternal Obesity or excessive weight gain
6. Male fetus
7. Parental stature
8. Labor Dystocia
1. Labor Augmentation needed
2. Prolonged second stage
4. Pathophysiology
1. Fetal Growth
1. Overgrowth
1. Hallmark of Diabetes Mellitus
2. No concurrent vascular disease present
2. Intrauterine Growth Retardation
1. Long standing Diabetes Mellitus
2. Vascular Disease with decreased placental perfusion
2. Control of Fetal Growth
1. First half of pregnancy: Genetics
2. Second half of pregnancy: Multifactorial
1. Nutrients
2. Oxygen
3. Insulin as growth factor
3. Selective Macrosomia
1. Insulin sensitive tissue
1. Heart
2. Liver and Spleen
3. Thymus
4. Adrenal
5. Subcutaneous fat
6. Shoulders
2. Insulin insensitive tissues
1. Water content
2. Brain mass (relative to rest of body)
5. Signs: Classic infant of Diabetic Mother
1. Gigantism
2. Visceromegaly
3. Plump, sleek liberally coated with vernix
4. Full faced and plethoric
6. Diagnosis
1. Clinician's fetal weight estimate (Leopold's Maneuvers)
1. Error in weight estimation: 300 grams
2. More accurate than Obstetric Ultrasound estimate
3. Estimate altered by physiologic characteristics
1. Amniotic fluid volume
2. Uterine Size and configuration
3. Mother's body habitus
2. Obstetric Ultrasound
1. Error in weight estimation: 300 to 550 grams
2. Estimated fetal weight and Abdominal circumference
3. Correlates 88% with diagnosis of macrosomia
7. Efficacy of fetal macrosomia prediction and prevention
1. Methods proven ineffective at complication prevention
1. Elective cesarean section
1. Analysis based on permanent Brachial Plexus Injury
2. C/S for EFW 4500g prevents 1 case/3700 treated
3. U.S. cost: $8.7 Million/case prevented
2. Early induction
1. Increases rate of cesarean section
2. Does not favorably alter perinatal outcomes
3. Sanchez-Ramos (2002) Obstet Gynecol 100:997
2. Specific population targeting is also ineffective
1. Vaginal Birth after Cesarean section
2. Maternal Diabetes Mellitus
1. Optimal Blood Glucose management is paramount
2. Other intervention strategies are unproven
3. Previous Shoulder Dystocia
8. Management
1. Tight glycemic control
1. Decreased fetal macrosomia
2. Decreased Neonatal Hypoglycemia
3. Decreased perinatal mortality
2. Elective Cesarean Section (no support in literature)
1. Indications per ACOG
1. Estimated fetal weight greater than 4500 grams
2. Possible Indications if Estimated fetal weight greater than 4000g
1. Pelvic architecture
2. Prior cesarean section
3. Prior Shoulder Dystocia
4. Evidence of Cephalopelvic Disproportion
5. History of poor progress of labor
9. Complications
1. Shoulder Dystocia
2. Perinatal asphyxia
3. Birth injury
4. Respiratory distress syndrome
5. Hypoglycemia
10. References
1. Combs (1993) Obstet Gynecol 81:492
2. Rouse (1996) JAMA 276:1480
3. Weeks (1995) Am J Obstet Gynecol 173:1215
4. Zamorski (2001) Am Fam Physician 63(2):302

16 - intrauterine growth retardation ( IUGR )

1. Definitions
1. Intrauterine Growth Retardation (IUGR)
1. Estimated fetal weight less than 10% per gestational age
2. Some suggest cutoff of 5% to reduce false positives
2. Small for Gestational Age (SGA)
1. Normal small infants without adverse risks
2. Evaluation
1. Indicators of IUGR
1. Poor Maternal Weight gain
1. Most sensitive indicator for IUGR
2. Fundal Height less than expected for gestational age
2. Consider environmental and comorbid factors
1. Tobacco abuse (most significant individual risk)
2. Poor Nutrition
3. Illicit Drug Use
4. Alcohol Abuse
5. Minimal to no prenatal care
6. Traumatic stress
3. Fetal Assessment
1. Follow Fetal Movement Counts (kick) counts
2. Follow Non-Stress Test
3. Serial Obstetric Ultrasounds for growth
4. Biophysical Profile
3. Diagnosis
1. Detection rate in-utero: 70%
2. Indications for Obstetric Ultrasound
1. Low risk fetus smaller than expected size
2. High risk monitoring
3. Ultrasound interpretation
1. Head Circumference to Abdominal Circumference ratio
1. Most useful in assessing Asymmetric IUGR
4. Management
1. Address risk factors
1. Tobacco Cessation
2. Eliminate other negative habits
3. Ensure adequate maternal weight gain
4. Maximize prenatal care
5. Reduce environmental stressors
2. Perinatology Consultation Indications
1. Poor Nonstress Test
2. Decreasing Biparietal diameter
3. Oligohydramnios
4. Abdominal circumference 4 weeks less than BPD
3. Early Delivery Indications
1. Doppler diastolic flow 0 mmHg in umbilical artery
5. Peripartum Risks of IUGR
1. Meconium aspiration
2. Intrauterine Asphyxia
3. Polycythemia
4. Hypoglycemia
6. Causes of IUGR
1. Symmetric IUGR (Head and body growth retarded)
2. Asymmetric IUGR (head growth spared)
7. References
1. Gabbe (1996) Obstetrics, Churchill, p. 863-886
2. Ahluwalia (2001) Obstet Gynecol 97:649

15 - uterine size in pregnancy

1. Indications
1. Pregnancy Dating
2. Pre-procedure (e.g. D&C)
2. Changes that decrease accuracy of measurement
1. Obesity
2. Uterine Fibroids or other tumor
3. Retroverted uterus
3. Estimating uterine size in pregnancy
1. Week 6: Plum or golf ball size
2. Week 8: Tennis ball size
3. Week 10: Large orange or softball size
4. Week 12: Grapefruit size (palpable at suprapubic area)
5. Week 14: Cantaloupe size

14 - bishop score

1. Scoring
1. Cervical Dilation
1. Cervix dilated less than 1 cm: 0
2. Cervix dilated 1-2 cm: 1
3. Cervix dilated 2-4 cm: 2
4. Cervix dilated greater than 4 cm: 3
2. Cervical Length (Effacement)
1. Cervical Length greater than 4 cm (0% effaced): 0
2. Cervical Length 2-4 cm (0 to 50% effaced): 1
3. Cervical Length 1-2 cm (50 to 75% effaced): 2
4. Cervical Length less than 1 cm (greater than 75% effaced): 3
3. Cervical Consistency
1. Firm cervical consistency: 0
2. Average cervical consistency: 1
3. Soft cervical consistency: 2
4. Cervical Position
1. Posterior cervical position: 0
2. Middle or anterior cervical position: 1
5. Zero Station Notation (presenting part level)
1. Presenting part at ischial spines -3 cm: 0
2. Presenting part at ischial spines -1 cm: 1
3. Presenting part at ischial spines +1 cm: 2
4. Presenting part at ischial spines +2 cm: 3
2. Modifiers
1. Add 1 point to score for:
1. Preeclampsia
2. Each prior vaginal delivery
2. Subtract 1 point from score for:
1. Postdates Pregnancy
2. Nulliparity
3. Premature or prolonged Rupture of Membranes
3. Interpretation
1. Indications for Cervical Ripening with prostaglandins
1. Bishop Score less than 5
2. Membranes intact
3. No regular contractions
2. Indications for Labor Induction with Pitocin
1. Bishop Score greater than or equal to 5
2. Rupture of Membranes

13 - leopold's maneuvers

1. See Also
1. Fetal Malpresentation
2. Leopold's Maneuvers
1. First Maneuver (Upper pole)
1. Examiner faces woman's head
2. Palpate uterine fundus
3. Determine what fetal part is at uterine fundus
2. Second Maneuver (Sides of maternal abdomen)
1. Examiner faces woman's head
2. Palpate with one hand on each side of abdomen
3. Palpate fetus between two hands
4. Assess which side is spine and which extremities
3. Third Maneuver (Lower pole)
1. Examiner faces woman's feet
2. Palpate just above symphysis pubis
3. Palpate fetal presenting part between two hands
4. Assess for Fetal Descent
4. Fourth Maneuver (Presenting part evaluation)
1. Examiner faces woman's head
2. Apply downward pressure on uterine fundus
3. Hold presenting part between index finger and thumb
4. Assess for cephalic versus Breech Presentation
3. Focus areas for abdominal palpation
1. Assess Fundal Height
1. Fundal height (cm) approximates weeks of gestation
2. Assess Fetal Lie
1. Longitudinal (Normal)
2. Transverse
3. Oblique
3. Assess Fetal Presentation
1. Breech Presentation
2. Cephalic Presentation
1. Vertex Presentation (Normal attitude: Full flexion)
2. Face Presentation (Abnormal attitude: Head extends)
4. Assess Fetal Vertex Position
1. Left Occiput Lateral (LOL) 40%
2. Left Occiput Anterior (LOA) 12%
3. Left Occiput Posterior (LOP) 3%
4. Right Occiput Lateral (ROL) 25%
5. Right Occiput Anterior (ROA) 10%
6. Right Occiput Posterior (ROP) 10%
5. Assess Fetal Descent
1. Is Vertex engaged?
4. Other methods of determining fetal orientation
1. Obstetric Ultrasound
2. Digital cervical exam

12 - pelvimetry

Caldwell-Moloy Classification

1. Gynecoid Pelvis (50%)
1. Pelvic brim is a transverse ellipse (nearly a circle)
2. Most favorable for delivery
2. Android Pelvis (Male type)
1. Pelvic brim is triangular
2. Convergent Side Walls (widest posteriorly)
3. Prominent ischial spines
4. Narrow subpubic arch
5. More common in white women
3. Anthropoid Pelvis
1. Pelvic brim is an anteroposterior ellipse
1. Gynecoid pelvis turned 90 degrees
2. Narrow ischial spines
3. Much more common in black women
4. Platypelloid Pelvis (3%)
1. Pelvic brim is transverse kidney shape
2. Flattened gynecoid shape
1. Determination of an Adequate Pelvis
1. Diagonal conjugate
1. Distance from sacral promontory to symphysis pubis
2. Approximate length of fingers introitus to sacrum
3. Adequate diagonal conjugate > 11.5cm
4. Images
5. 
1. 
2. Intertuberous Diameter
1. Distance between Ischial tuberosities
2. Approximately width of fist
3. Adequate intertuberous diameter > 10 cm
4. Images
5. 
1. 
3. Prominence of ischial spines

11 - pregnancy signs and symptoms

1. See Also
1. Pregnancy Dating
2. Week 4
1. Symptoms
1. Amenorrhea
2. Nausea (See Morning Sickness)
3. Fatigue
2. Labs
1. Quantitative bhCG: 250
3. Week 5 (8 to 9 days after missed menstrual period)
1. Labs
1. Urine Pregnancy Test is positive
2. Quantitative bhCG: 1000
2. Transvaginal Ultrasound
1. Gestational Sac visible
4. Week 6-8
1. Symptoms
1. Urinary frequency onset at 6 weeks
2. Signs
1. Areola darkens by 6-8 weeks
2. Breasts engorge by 6-8 weeks
3. Transvaginal Ultrasound
1. Fetus visible at 6-7 weeks
2. Fetal heart activity by 8 weeks
5. Week 10 to 12
1. Symptoms
1. Irregular contractions start
2. Signs
1. Uterus is size of Orange by 10 weeks
2. Uterus is size of Grapefruit by 12 weeks
3. Fetal Heart Tones auscultated by Doppler
6. Week 15 to 20
1. Symptoms
1. Quickening in multiparous patients by 15 to 17 weeks
2. Quickening in nulliparous patients by 18 to 20 weeks
2. Signs
1. Fetal Heart Tones by Fetoscope by 16 to 20 weeks
2. Irregular Contractions palpable by 20 weeks
7. Other signs of pregnancy
1. Chadwick's Sign
1. Darkened vulva and vagina
2. Chloasma (Mask of pregnancy)
1. Dark under eyes, bridge nose
3. Linea Nigra
1. Dark midline low abdomen
4. Hegar's Sign
1. Softened low uterine segment on bimanual exam

10 - pregnancy dating

1. Definitions
1. Actual Fetal age dated from time of conception
2. Menstrual Age (gestational age) = Conception + 14 days
2. Naegele's Rule for calculating EDC
1. Start with the First Day of LMP
2. Add 7 days
3. Subtract 3 months
3. Pregnancy history accuracy for dating
1. In vitro fertilization: accurate to +/- 1 day
2. Single recorded Intercourse accurate to +/- 3 days
3. Basal Body Temp Record accurate to +/- 4 days
4. Recorded first day of LMP accurate to +/- 2-3 weeks
5. Quickening accurate to +/- 4-6 weeks
4. Exam
1. Fundal Height
1. Indicated for pregnancy beyond 20 weeks gestation
2. Accurate to 4-6 weeks gestation
2. Detection Fetal Heart Tones accurate to +/- 4-6 weeks
1. Doppler (first heard at 7-12 weeks)
2. Fetoscope (first heard at 18-21 weeks)
3. First trimester bimanual exam accurate to +/- 1-2 weeks
1. Assumes normal uterus
5. Radiology: Obstetric Ultrasound
1. Accurate to +/- 8% of estimated gestational age

9 - hegar's sign

1. Indication
1. Diagnosis of early pregnancy
2. Physiology
1. Occurs during first trimester of pregnancy
2. Softening of uterus at junction with cervix (isthmus)
3. Signs
1. Softened lower uterine segment on bimanual exam
1. Cervix may seem to separate from fundus
2. Contrast with firmness of uterine fundus

8 - fetal foot measurement

1. Indications
1. Intrauterine Fetal Demise dating
2. Subarachnoid Hemorrhage demise dating
3. Most accurate method for dating gestational age
2. Fetal Foot Measurements
1. Week 8.5: Foot Length: 3 mm
2. Week 9.0: Foot Length: 4 mm
3. Week 9.5: Foot Length: 5 mm
4. Week 10.0: Foot Length: 6 mm
5. Week 11.0: Foot Length: 7-8 mm
6. Week 12.0: Foot Length: 9 mm
7. Week 13.0: Foot Length: 11 mm
8. Week 14.0: Foot Length: 14 mm
9. Week 15.0: Foot Length: 18 mm
10. Week 16.0: Foot Length: 20 mm
11. Week 17.0: Foot Length: 23 mm
12. Week 18.0: Foot Length: 26 mm
13. Week 19.0: Foot Length: 29 mm
14. Week 20.0: Foot Length: 33 mm
15. Week 21.0: Foot Length: 36 mm
16. Week 22.0: Foot Length: 39 mm
17. Week 23.0: Foot Length: 42 mm
18. Week 24.0: Foot Length: 45 mm