INI-CET 2025 — Obstetrics and Gynecology

Q: Which of the following is not used in the treatment of postpartum hemorrhage (PPH)?

Dinoprostone. ***Dinoprostone*** - Dinoprostone is a prostaglandin E2 analogue primarily indicated for **cervical ripening** or **induction of labor**. - It is not routinely used in the treatment of PPH because it is less effective than other uterotonics (like **Misoprostol** or **Carboprost**) for emergent control of uterine atony. *Misoprostol* - This is a synthetic **Prostaglandin E1 analogue** and an effective **uterotonic** agent used widely for PPH treatment, especially refractory cases or in low-resource settings. - It is effective when administered by various routes (oral, sublingual, or **rectal**) and is beneficial due to its low cost and **heat stability**. *Carboprost* - Carboprost (15-methyl prostaglandin F2 $\alpha$) is a potent uterotonic agent reserved for treating PPH due to **uterine atony** when the first line (Oxytocin) has failed. - It works by inducing intense **myometrial contractions**, but caution is needed as it is contraindicated in patients with active **asthma**. *Oxytocin* - This is the **most essential** and **first-line** uterotonic drug used for the prevention and treatment of **atonic postpartum hemorrhage**. - It is usually administered intravenously as a bolus followed by an infusion, functioning by increasing the frequency and force of **uterine contractions**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A patient presents with ascites and omental caking. Imaging reveals solid components in an adnexal mass, and there is a long-standing history of symptoms. CA-125 is positive. What is the most probable diagnosis?

Serous ovarian tumor. ***Serous ovarian tumor*** - This is the most common type of epithelial ovarian cancer, often presenting late with extensive **peritoneal dissemination**, causing **ascites** and **omental caking** (carcinomatosis). - High elevation of the tumor marker **CA-125** is characteristic and strongly supports this diagnosis in the setting of advanced disease. *Mucinous ovarian tumor* - These tumors often grow large but are typically confined to the ovary or manifest as **pseudomyxoma peritonei** if ruptured, which is different from typical omental caking. - While they can elevate CA-125, the elevation is less common and less pronounced than in serous carcinoma. *Endometrioid tumor* - This type has a strong association with **endometriosis** and concurrent or preceding **endometrial cancer**, a feature not mentioned in the presentation. - While they are often CA-125 positive, the combined clinical picture of omental caking plus ascites points preferentially to **Serous carcinoma**. *Granulosa cell tumor* - This is a sex-cord stromal tumor that is typically detected earlier due to its **endocrine activity**, often causing signs of **estrogen excess** (e.g., post-menopausal bleeding). - The key tumor marker for this type is **inhibin**, not CA-125. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: What is the most common complication of urinary tract infection (UTI) during pregnancy?

Preterm labor. ***Preterm labor*** - Asymptomatic bacteriuria and symptomatic UTIs (especially **pyelonephritis**) are strongly associated with an increased risk of **preterm labor** and subsequent **preterm delivery**, making it the most common serious complication. - The systemic inflammatory response caused by the infection triggers the release of **prostaglandins** and **cytokines**, which stimulate uterine contractility and lead to cervical changes. *Miscarriage* - While severe infections associated with high fever (like pyelonephritis) *can* increase the risk, miscarriage is primarily a first-trimester event and is a less direct and less common complication of routine UTI than late-pregnancy preterm labor. - The pathogenesis of UTI complications is more focused on the inflammatory pathway that induces uterine irritability rather than primarily affecting early embryonic development. *Chorioamnionitis* - **Chorioamnionitis** (infection of the fetal membranes and amniotic fluid) is a severe complication of ascending infection, but it is less frequently observed than the generalized inflammatory state leading to **preterm labor/delivery**. - This condition is more commonly associated with prolonged rupture of membranes or infections originating from the lower genital tract rather than purely from the urinary tract. *Neonatal mortality* - **Neonatal mortality** is a severe *outcome* or consequence, usually resulting from the preceding complication of **preterm birth** or associated **neonatal sepsis**. - The direct and most common maternal complication that obstetricians aim to prevent by screening and treating UTIs is **preterm labor/delivery**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Use of magnesium sulfate (MgSO4) in pre-eclampsia has all of the following effects except:

Prevent abruption of placenta. ***Prevent abruption of placenta*** - **Magnesium sulfate (MgSO4)** is primarily a **CNS depressant** (anticonvulsant) and a vasodilator, and its use is not directly associated with preventing **placental abruption**. - Placental abruption is linked to factors like short umbilical cord, trauma, and **severe hypertension**, which MgSO4 does not consistently mitigate. ***Neuroprotection*** - Administered to women at high risk of imminent **preterm birth** (less than 32 weeks), MgSO4 has a proven benefit in reducing the risk of developing **cerebral palsy** in the neonate. - This neuroprotective effect is thought to be mediated by stabilizing the blood-brain barrier and its **antioxidant properties**. ***Decrease seizure incidence*** - MgSO4 is the **drug of choice** for both the prophylaxis and treatment of seizures (eclampsia) in women with **severe pre-eclampsia**. - It works by decreasing **acetylcholine release** at the neuromuscular junction and acting as a central anticonvulsant. ***Prevent preterm labour*** - MgSO4 is a weak **tocolytic agent** and can be used to temporarily suppress uterine contractions in women presenting with threatened **preterm labor**. - Although effective for short-term suppression, it is not the primary tocolytic agent and is most famously used for its **neuroprotective** and anti-seizure properties. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Which of the following does not cause fetal bradycardia?

Maternal fever. ***Maternal fever*** - Maternal fever causes **fetal tachycardia** or fetal heart rate acceleration, as the physiological response to fever is increased metabolism and heart rate. - The resulting fetal tachycardia is often a sign of impending or current **maternal infection** (e.g., chorioamnionitis). *Abruptio placenta* - Associated with acute fetal distress due to placental separation, leading to fetal **hypoxia** and **acidosis**. - Fetal hypoxia triggers a reflex bradycardia (late decelerations with bradycardia) to conserve oxygen and energy. *Meconium passage/staining* - Passage of meconium in utero is often a sign of **fetal distress** or hypoxia during labor. - Severe fetal distress and resultant cerebral hypoxia/acidosis can lead to prolonged or terminal **fetal bradycardia**. - Note: Meconium aspiration syndrome occurs postnatally, but meconium-stained amniotic fluid indicates antecedent fetal compromise. *Fetal head compression* - Leads to a transient increase in **intracranial pressure**, stimulating the **vagus nerve** mediated by the baroreceptors. - This **vagal stimulation** results in a brief, reflex slowdown of the fetal heart rate, known as **early decelerations**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

5 Previous Year Questions with Answers & Explanations

Questions

Which of the following is not used in the treatment of postpartum hemorrhage (PPH)?

A patient presents with ascites and omental caking. Imaging reveals solid components in an adnexal mass, and there is a long-standing history of symptoms. CA-125 is positive. What is the most probable diagnosis?

What is the most common complication of urinary tract infection (UTI) during pregnancy?

Use of magnesium sulfate (MgSO4) in pre-eclampsia has all of the following effects except:

Which of the following does not cause fetal bradycardia?

INI-CET 2025 - Obstetrics and Gynecology INI-CET Practice Questions and MCQs

Question 1: Which of the following is not used in the treatment of postpartum hemorrhage (PPH)?

A. Misoprostol
B. Carboprost
C. Dinoprostone (Correct Answer)
D. Oxytocin

Explanation: ***Dinoprostone*** - Dinoprostone is a prostaglandin E2 analogue primarily indicated for **cervical ripening** or **induction of labor**. - It is not routinely used in the treatment of PPH because it is less effective than other uterotonics (like **Misoprostol** or **Carboprost**) for emergent control of uterine atony. *Misoprostol* - This is a synthetic **Prostaglandin E1 analogue** and an effective **uterotonic** agent used widely for PPH treatment, especially refractory cases or in low-resource settings. - It is effective when administered by various routes (oral, sublingual, or **rectal**) and is beneficial due to its low cost and **heat stability**. *Carboprost* - Carboprost (15-methyl prostaglandin F2 $\alpha$) is a potent uterotonic agent reserved for treating PPH due to **uterine atony** when the first line (Oxytocin) has failed. - It works by inducing intense **myometrial contractions**, but caution is needed as it is contraindicated in patients with active **asthma**. *Oxytocin* - This is the **most essential** and **first-line** uterotonic drug used for the prevention and treatment of **atonic postpartum hemorrhage**. - It is usually administered intravenously as a bolus followed by an infusion, functioning by increasing the frequency and force of **uterine contractions**.

Question 2: A patient presents with ascites and omental caking. Imaging reveals solid components in an adnexal mass, and there is a long-standing history of symptoms. CA-125 is positive. What is the most probable diagnosis?

A. Granulosa cell tumor
B. Serous ovarian tumor (Correct Answer)
C. Endometrioid tumor
D. Mucinous ovarian tumor

Explanation: ***Serous ovarian tumor*** - This is the most common type of epithelial ovarian cancer, often presenting late with extensive **peritoneal dissemination**, causing **ascites** and **omental caking** (carcinomatosis). - High elevation of the tumor marker **CA-125** is characteristic and strongly supports this diagnosis in the setting of advanced disease. *Mucinous ovarian tumor* - These tumors often grow large but are typically confined to the ovary or manifest as **pseudomyxoma peritonei** if ruptured, which is different from typical omental caking. - While they can elevate CA-125, the elevation is less common and less pronounced than in serous carcinoma. *Endometrioid tumor* - This type has a strong association with **endometriosis** and concurrent or preceding **endometrial cancer**, a feature not mentioned in the presentation. - While they are often CA-125 positive, the combined clinical picture of omental caking plus ascites points preferentially to **Serous carcinoma**. *Granulosa cell tumor* - This is a sex-cord stromal tumor that is typically detected earlier due to its **endocrine activity**, often causing signs of **estrogen excess** (e.g., post-menopausal bleeding). - The key tumor marker for this type is **inhibin**, not CA-125.

Question 3: What is the most common complication of urinary tract infection (UTI) during pregnancy?

A. Chorioamnionitis
B. Miscarriage
C. Preterm labor (Correct Answer)
D. Neonatal mortality

Explanation: ***Preterm labor*** - Asymptomatic bacteriuria and symptomatic UTIs (especially **pyelonephritis**) are strongly associated with an increased risk of **preterm labor** and subsequent **preterm delivery**, making it the most common serious complication. - The systemic inflammatory response caused by the infection triggers the release of **prostaglandins** and **cytokines**, which stimulate uterine contractility and lead to cervical changes. *Miscarriage* - While severe infections associated with high fever (like pyelonephritis) *can* increase the risk, miscarriage is primarily a first-trimester event and is a less direct and less common complication of routine UTI than late-pregnancy preterm labor. - The pathogenesis of UTI complications is more focused on the inflammatory pathway that induces uterine irritability rather than primarily affecting early embryonic development. *Chorioamnionitis* - **Chorioamnionitis** (infection of the fetal membranes and amniotic fluid) is a severe complication of ascending infection, but it is less frequently observed than the generalized inflammatory state leading to **preterm labor/delivery**. - This condition is more commonly associated with prolonged rupture of membranes or infections originating from the lower genital tract rather than purely from the urinary tract. *Neonatal mortality* - **Neonatal mortality** is a severe *outcome* or consequence, usually resulting from the preceding complication of **preterm birth** or associated **neonatal sepsis**. - The direct and most common maternal complication that obstetricians aim to prevent by screening and treating UTIs is **preterm labor/delivery**.

Question 4: Use of magnesium sulfate (MgSO4) in pre-eclampsia has all of the following effects except:

A. Prevent preterm labour
B. Neuroprotection
C. Prevent abruption of placenta (Correct Answer)
D. Decrease seizure incidence

Explanation: ***Prevent abruption of placenta*** - **Magnesium sulfate (MgSO4)** is primarily a **CNS depressant** (anticonvulsant) and a vasodilator, and its use is not directly associated with preventing **placental abruption**. - Placental abruption is linked to factors like short umbilical cord, trauma, and **severe hypertension**, which MgSO4 does not consistently mitigate. ***Neuroprotection*** - Administered to women at high risk of imminent **preterm birth** (less than 32 weeks), MgSO4 has a proven benefit in reducing the risk of developing **cerebral palsy** in the neonate. - This neuroprotective effect is thought to be mediated by stabilizing the blood-brain barrier and its **antioxidant properties**. ***Decrease seizure incidence*** - MgSO4 is the **drug of choice** for both the prophylaxis and treatment of seizures (eclampsia) in women with **severe pre-eclampsia**. - It works by decreasing **acetylcholine release** at the neuromuscular junction and acting as a central anticonvulsant. ***Prevent preterm labour*** - MgSO4 is a weak **tocolytic agent** and can be used to temporarily suppress uterine contractions in women presenting with threatened **preterm labor**. - Although effective for short-term suppression, it is not the primary tocolytic agent and is most famously used for its **neuroprotective** and anti-seizure properties.

Question 5: Which of the following does not cause fetal bradycardia?

A. Fetal head compression
B. Abruptio placenta
C. Maternal fever (Correct Answer)
D. Meconium passage

Explanation: ***Maternal fever*** - Maternal fever causes **fetal tachycardia** or fetal heart rate acceleration, as the physiological response to fever is increased metabolism and heart rate. - The resulting fetal tachycardia is often a sign of impending or current **maternal infection** (e.g., chorioamnionitis). *Abruptio placenta* - Associated with acute fetal distress due to placental separation, leading to fetal **hypoxia** and **acidosis**. - Fetal hypoxia triggers a reflex bradycardia (late decelerations with bradycardia) to conserve oxygen and energy. *Meconium passage/staining* - Passage of meconium in utero is often a sign of **fetal distress** or hypoxia during labor. - Severe fetal distress and resultant cerebral hypoxia/acidosis can lead to prolonged or terminal **fetal bradycardia**. - Note: Meconium aspiration syndrome occurs postnatally, but meconium-stained amniotic fluid indicates antecedent fetal compromise. *Fetal head compression* - Leads to a transient increase in **intracranial pressure**, stimulating the **vagus nerve** mediated by the baroreceptors. - This **vagal stimulation** results in a brief, reflex slowdown of the fetal heart rate, known as **early decelerations**.