Intranatal Care — MCQs
Active management of 3rd stage of labour involves all EXCEPT:
APGAR score 3 at 1 minute indicates:
A 32 year old pregnant woman presents with 36 week pregnancy with complaints of pain abdomen and decreased fetal movements. Upon examination PR= 96/min, BP = 156/100 mm Hg, FHR = 128 bpm. On per-vaginum examination there is altered blood seen and cervix is soft 1 cm dilated. What is the preferred management?
Which of the following statements is false regarding postpartum hemorrhage and pelvic hematomas?
Which of the following statements about the contraction stress test (CST) is MOST accurate?
Given the following partogram data, identify the most likely diagnosis: Cervical dilation curve shows a prolonged labor with the cervical dilation falling to the right of the alert line.
True about ASHA are all except -
Under the Pradhan Mantri Surakshit Matritva Abhiyan, the beneficiaries are being provided with a minimum package of antenatal care including certain investigations and drugs on a fixed day of every month. Which day of the month is specified for this purpose?
What is the composition of IFA tablets given during pregnancy?
What is the unmet need for contraception in a 35-year-old female?
Intranatal Care Indian Medical PG Practice Questions and MCQs
Question 1: Active management of 3rd stage of labour involves all EXCEPT:
- A. IV oxytocin
- B. Delayed cord clamping
- C. Controlled cord traction
- D. Uterine massage (Correct Answer)
Explanation: ***Uterine massage*** - **Uterine massage** is performed *after* the delivery of the placenta to promote sustained uterine contraction and prevent **postpartum hemorrhage**. - While it's a crucial step in preventing excessive bleeding, it is not considered part of the *active management of the third stage of labor* as defined by WHO guidelines, which focuses on interventions *during* placental separation and expulsion. - Uterine massage is part of **routine postpartum care** rather than AMTSL itself. *IV oxytocin* - Administering **prophylactic uterotonic** (oxytocin 10 IU IM/IV) *immediately* after birth of the baby (within 1 minute) is a **core component** of active management. - Oxytocin stimulates uterine contractions to aid placental separation and significantly **reduces postpartum hemorrhage** risk. *Delayed cord clamping* - **Delayed cord clamping** (clamping the umbilical cord between 1-3 minutes after birth) is recommended by **current WHO guidelines** as part of active management. - This practice provides neonatal benefits (improved iron stores, better hemoglobin levels) while not increasing maternal hemorrhage risk. - This replaced the older practice of early cord clamping in modern AMTSL protocols. *Controlled cord traction* - **Controlled cord traction** with **counter-traction on the uterus** (Brandt-Andrews maneuver) is performed to facilitate placental delivery once signs of placental separation appear. - This maneuver **reduces the duration of third stage**, blood loss, and risk of retained placenta.
Question 2: APGAR score 3 at 1 minute indicates:
- A. Mildly depressed
- B. Normal
- C. Severely depressed (Correct Answer)
- D. Further resuscitation not needed
Explanation: ***Severely depressed*** - An **APGAR score of 3** at 1 minute indicates that the infant is **severely depressed** and requires immediate medical intervention. - This score reflects significant compromise in at least three of the five APGAR criteria (Activity, Pulse, Grimace, Appearance, Respiration). *Mildly depressed* - A score between **4-6** is typically considered **moderately (or mildly) depressed**, indicating some need for intervention but not as critical as a score of 3. - Infants in this range may respond to simple measures like stimulation or oxygen. *Normal* - A score of **7 or higher** is considered **normal** or reassuring, indicating the infant is in good condition and adapting well to extrauterine life. - These infants usually require no special intervention. *Further resuscitation not needed* - An APGAR score of 3 indicates a **severely depressed** infant who most certainly requires **further resuscitation** and immediate medical attention. - Resuscitation efforts are crucial to improve the infant's condition and prevent adverse outcomes.
Question 3: A 32 year old pregnant woman presents with 36 week pregnancy with complaints of pain abdomen and decreased fetal movements. Upon examination PR= 96/min, BP = 156/100 mm Hg, FHR = 128 bpm. On per-vaginum examination there is altered blood seen and cervix is soft 1 cm dilated. What is the preferred management?
- A. Observation and monitoring
- B. Perform cesarean section (Correct Answer)
- C. Initiate labor induction
- D. Administer medications to delay labor
Explanation: ***Perform cesarean section*** - The clinical presentation strongly suggests **placental abruption**: abdominal pain, decreased fetal movements, hypertension (risk factor), and altered blood per vaginum - **Decreased fetal movements** with FHR at 128 bpm (lower end of normal) indicates **potential fetal compromise** - At **36 weeks gestation**, the fetus is viable and immediate delivery is warranted when abruption is suspected with fetal distress - **Emergency cesarean section** is the preferred management for placental abruption with signs of fetal compromise, as it provides the fastest route to delivery - Attempting vaginal delivery in suspected abruption with fetal distress risks further compromise and maternal hemorrhage *Initiate labor induction* - Labor induction is **contraindicated** in suspected placental abruption with fetal compromise - Induction takes hours to achieve delivery, during which time the fetus may deteriorate further and maternal bleeding may worsen - The presence of altered blood, decreased fetal movements, and hypertension makes this a **high-risk scenario** requiring immediate delivery, not a gradual process - Induction might be considered only in very mild, stable cases of abruption without fetal distress, which is not the case here *Observation and monitoring* - The clinical findings indicate an **obstetric emergency** (suspected placental abruption), not a condition suitable for expectant management - **Decreased fetal movements** are a warning sign of fetal hypoxia requiring immediate action - Progressive abruption can lead to **maternal hemorrhage, DIC, and fetal death** if not managed promptly - At 36 weeks with concerning features, continued observation risks catastrophic outcomes *Administer medications to delay labor* - **Tocolytics are absolutely contraindicated** in placental abruption - Delaying delivery when abruption is suspected and fetal compromise is present would worsen both maternal and fetal outcomes - At 36 weeks gestation, the fetus has adequate maturity and there is no benefit to prolonging pregnancy - The goal is **expedited delivery**, not pregnancy prolongation
Question 4: Which of the following statements is false regarding postpartum hemorrhage and pelvic hematomas?
- A. The vulva is the most common site for pelvic hematoma. (Correct Answer)
- B. Hematomas less than 5 cm can often be managed conservatively.
- C. Uterine atony is the most common cause of postpartum hemorrhage.
- D. The most common artery to form a vulvar hematoma is the pudendal artery.
Explanation: ***The vulva is the most common site for pelvic hematoma.*** - While vulvar hematomas are common, the **vagina is actually the most common site** for puerperal hematomas. - **Retroperitoneal hematomas** are the least common but most dangerous type, often associated with a higher mortality rate due to delayed diagnosis. *Hematomas less than 5 cm can often be managed conservatively.* - **Small, stable hematomas** (typically less than 2-5 cm) that are not expanding can often be managed with observation, pain control, and ice packs. - Close monitoring for continued bleeding, signs of infection, or hemodynamic instability is crucial even with conservative management. *Uterine atony is the most common cause of postpartum hemorrhage.* - **Uterine atony** (failure of the uterus to contract after birth) accounts for approximately 70-80% of all cases of postpartum hemorrhage. - This condition leads to excessive bleeding from the placental site due to the inability of uterine muscle fibers to compress blood vessels effectively. *The most common artery to form a vulvar hematoma is the pudendal artery.* - Vulvar hematomas primarily arise from injury to branches of the **pudendal artery**, particularly during lacerations or episiotomies. - Trauma to the **perineum** during childbirth can cause these arteries or their venous counterparts to bleed into the surrounding loose connective tissue.
Question 5: Which of the following statements about the contraction stress test (CST) is MOST accurate?
- A. Invasive method
- B. Detects fetal well being
- C. Negative test is associated with good fetal outcome (Correct Answer)
- D. Oxytocin is never used in the test
Explanation: ***Negative test is associated with good fetal outcome*** - A **negative CST** indicates that there are no late or significant variable decelerations in response to uterine contractions, suggesting the fetus can tolerate labor. - This finding is strongly correlated with **fetal well-being** and a low likelihood of fetal distress in the near future, with a **negative predictive value of approximately 99%**. *Invasive method* - The CST is considered a **non-invasive test**, as it involves external monitoring of fetal heart rate and uterine contractions. - No instruments are inserted into the body, differentiating it from truly invasive procedures like **amniocentesis**. *Detects fetal well being* - While the CST provides valuable information, it specifically assesses **uteroplacental function and fetal oxygenation reserve** during the stress of contractions, rather than comprehensive fetal well-being. - It identifies fetuses at risk for **uteroplacental insufficiency** but does not evaluate other parameters of fetal health. - Other tests like the **biophysical profile** offer a more comprehensive assessment of fetal well-being, including parameters like fetal breathing, movement, tone, and amniotic fluid volume. *Oxytocin is never used in the test* - **Oxytocin** is frequently used to induce uterine contractions if spontaneous contractions are insufficient for the test (oxytocin challenge test or OCT). - Alternatively, **nipple stimulation** can be used to achieve adequate contractions for the CST.
Question 6: Given the following partogram data, identify the most likely diagnosis: Cervical dilation curve shows a prolonged labor with the cervical dilation falling to the right of the alert line.
- A. Cephalopelvic Disproportion (CPD) (Correct Answer)
- B. Rupture of the uterus during labor
- C. Inadequate uterine contractions
- D. Maternal exhaustion
Explanation: ***Cephalopelvic Disproportion (CPD)*** - A cervical dilation curve that crosses the **alert line** and approaches or crosses the **action line** on a partogram indicates **prolonged labor** or **arrest of labor**. This pattern is highly suggestive of CPD, where the fetal head is too large to pass through the maternal pelvis. - While other factors can cause prolonged labor, CPD is a common cause of **protracted active phase disorders** and **labor arrest**, characterized by a cervix that fails to dilate adequately despite sufficient contractions. *Inadequate uterine contractions* - While inadequate uterine contractions (hypotonic contractions) can lead to **prolonged labor**, the partogram does not provide direct information about the frequency or intensity of contractions to conclusively make this diagnosis. - If contractions were primarily the issue, augmenting labor with oxytocin would be expected to improve the dilation curve, which is not indicated as the primary problem here. *Rupture of the uterus during labor* - Uterine rupture is a catastrophic event typically presenting with sudden **severe pain**, **vaginal bleeding**, **fetal heart rate abnormalities**, and potentially **maternal shock**. - While it can lead to cessation of labor progress, the partogram pattern of a slowly deviating dilation curve over time is not characteristic of an acute uterine rupture. *Maternal exhaustion* - Maternal exhaustion is a common consequence of **prolonged labor** but is not a primary cause of labor arrest or a specific diagnosis reflected by the cervical dilation curve alone. - It often accompanies other underlying issues like CPD or inefficient uterine contractions, rather than being the sole etiology for the observed partogram.
Question 7: True about ASHA are all except -
- A. Skilled birth attendant (Correct Answer)
- B. Mobiliser of antenatal care
- C. Female voluntary worker
- D. One per 1000 rural population
Explanation: ***Skilled birth attendant*** - An **ASHA (Accredited Social Health Activist)** receives basic training to facilitate healthcare access and community-level interventions, but they are **NOT skilled birth attendants (SBAs)**. - **Skilled birth attendants** are health professionals with midwifery skills (ANMs, nurses, doctors) who can manage normal deliveries and identify complications. - ASHAs' role focuses on **support, counseling, and referral** for maternal and child health, rather than directly conducting deliveries. - This is the **correct answer** as it is the statement that is **NOT true** about ASHAs. *Mobiliser of antenatal care* - ASHAs play a crucial role in **mobilizing and encouraging pregnant women** to attend antenatal care (ANC) services. - They provide information about the importance of regular check-ups, nutrition, and institutional deliveries to improve maternal and child health outcomes. - This is a **true statement** about ASHAs. *Female voluntary worker* - The ASHA program specifically recruits **women from the community** they serve. - They are considered **voluntary workers** who receive **performance-based incentives** rather than a fixed salary. - This is a **true statement** about ASHAs. *One per 1000 rural population* - In India, an ASHA is typically appointed for every **1000 population in rural areas**, or for each village, depending on the population size. - This structure ensures that there is a community-level health worker accessible to a defined population. - This is a **true statement** about ASHAs.
Question 8: Under the Pradhan Mantri Surakshit Matritva Abhiyan, the beneficiaries are being provided with a minimum package of antenatal care including certain investigations and drugs on a fixed day of every month. Which day of the month is specified for this purpose?
- A. 1st day of the month
- B. 9th day of the month (Correct Answer)
- C. 7th day of the month
- D. 15th day of the month
Explanation: ***9th day of the month*** - The **Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)** specifies the **9th of every month** as the day for providing comprehensive antenatal care to pregnant women. - This fixed day ensures that women can reliably access free antenatal health check-ups and necessary services. *1st day of the month* - The 1st day of the month is not designated for the PMSMA check-ups; a specific date was chosen to streamline the program's implementation. - While other health initiatives may occur on the 1st, **antenatal care under PMSMA** is not among them. *7th day of the month* - The 7th day of the month is not the designated date for the **PMSMA antenatal care package**. - No specific national maternal health program utilizes the 7th day for regular check-ups. *15th day of the month* - The PMSMA program does not specify the 15th day for its antenatal care services; the focus is on a consistent, predictable schedule for beneficiaries. - While mid-month check-ups are generally important, this specific initiative uses a distinct date.
Question 9: What is the composition of IFA tablets given during pregnancy?
- A. 60mg elemental iron and 500ug Folic acid
- B. 100mg elemental iron and 400ug Folic acid
- C. 60mg elemental iron and 400ug Folic acid
- D. 100mg elemental iron and 500ug Folic acid (Correct Answer)
Explanation: ### Explanation The correct composition of Iron and Folic Acid (IFA) tablets for pregnant women under the **Anemia Mukt Bharat (AMB)** strategy and the National Iron Plus Initiative (NIPI) is **100 mg elemental iron and 500 µg (0.5 mg) folic acid**. **1. Why Option D is Correct:** The goal of supplementation during pregnancy is to meet the increased physiological demands of the fetus and prevent maternal anemia. The standard prophylactic regimen involves one tablet daily for **180 days**, starting from the second trimester (after the first 12 weeks of pregnancy), followed by another 180 days postpartum during lactation. 100 mg of elemental iron (often provided as 300 mg Ferrous Sulfate) is the therapeutic threshold required to maintain hemoglobin levels in an average pregnant woman. **2. Analysis of Incorrect Options:** * **Option A & C (60 mg elemental iron):** This dosage is used for **non-pregnant/non-lactating women** of reproductive age (15–49 years) and **adolescents** (10–19 years) as part of the weekly supplementation program (WIFS). * **Option B (400 µg Folic acid):** While 400 µg is the dosage recommended for women planning pregnancy to prevent Neural Tube Defects (NTDs) *pre-conceptionally*, the national program for pregnant women standardizes the dose at 500 µg. **3. High-Yield Clinical Pearls for NEET-PG:** * **Prophylactic Dose:** 1 IFA tablet daily for 180 days (6 months) during pregnancy + 180 days postpartum. * **Therapeutic Dose (if Hb <11 g/dL):** 2 IFA tablets daily until Hb levels normalize, then revert to the prophylactic dose. * **Pediatric Dose (6–59 months):** 20 mg elemental iron + 100 µg folic acid (bi-weekly). * **School Children (5–9 years):** 45 mg elemental iron + 400 µg folic acid (weekly). * **Color Coding:** IFA tablets for pregnant/lactating women are **Red** in color.
Question 10: What is the unmet need for contraception in a 35-year-old female?
- A. Spacing births
- B. Limiting births (Correct Answer)
- C. Improving maternal health
- D. Improving family health
Explanation: **Explanation:** The concept of **Unmet Need for Contraception** refers to the percentage of fecund, sexually active women who do not want to become pregnant but are not using any method of contraception. This is broadly categorized into two types based on the woman's reproductive intention: 1. **Unmet Need for Spacing:** This applies to women who want to delay their next pregnancy for at least two years. This is typically seen in younger women (low parity). 2. **Unmet Need for Limiting:** This applies to women who do not want any more children. **Why "Limiting Births" is correct:** In the context of a **35-year-old female**, demographic trends and reproductive life cycles indicate that by this age, most women have achieved their desired family size. Therefore, if she is not using contraception despite wanting to avoid pregnancy, her need is classified as "limiting" rather than "spacing." **Analysis of Incorrect Options:** * **A. Spacing births:** This is the unmet need for women who want to postpone the next birth. It is more characteristic of younger age groups (e.g., 15–24 years). * **C & D. Improving maternal/family health:** While contraception certainly improves maternal and family health by preventing high-risk pregnancies, these are *benefits* or *outcomes* of contraceptive use, not the definition of "unmet need." **High-Yield Clinical Pearls for NEET-PG:** * **Total Unmet Need** = Unmet need for spacing + Unmet need for limiting. * **NFHS-5 Data:** The total unmet need in India has declined to approximately **9.4%**. * **Age Correlation:** As age and parity increase, the unmet need shifts from "spacing" to "limiting." * **Formula:** Unmet need is calculated using the number of women who are not using contraception divided by the total number of women in the reproductive age group (15–49 years) who are at risk of pregnancy.
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