Pregnancy and Delivery — MCQs
Disputed maternity can be solved by using the following tests, EXCEPT:
In which gestational weeks is Hegar's sign typically observed?
False about MTP is -
A lady with 12-week pregnancy presents with bleeding. On examination, vagina is normal, internal os is closed, and USG shows fetal viability with fundal height of 13 weeks. What is the diagnosis?
Best criterion for determining live birth in suspected infanticide cases?
A 14-year-old victim of sexual assault with 22 weeks gestation has been brought for Medical Termination of Pregnancy (MTP). Which of the following statements is true?
In a macerated baby, the ideal sample for genetic analysis is obtained from:
'Cot death' is associated with
Which of the following statements about Hegar's sign is false?
A mother delivers in a rural area under the guidance of a skilled care attendant. Which of the following statements is incorrect regarding the care provided by the skilled care attendant at birth?
Pregnancy and Delivery Indian Medical PG Practice Questions and MCQs
Question 1: Disputed maternity can be solved by using the following tests, EXCEPT:
- A. Blood grouping
- B. HLA typing
- C. DNA fingerprinting
- D. Precipitin test (Correct Answer)
Explanation: ***Precipitin test*** - The **precipitin test** is used to determine the origin of a **blood sample**, specifically whether it is **human or animal blood**, by detecting species-specific proteins. It is not used for assessing maternity. - This test is primarily employed in **forensic serology** to differentiate between blood from different animal species, making it irrelevant for paternity or maternity disputes. *Blood grouping* - **Blood grouping** (e.g., ABO and Rh systems) can be used to **exclude paternity or maternity** by comparing the blood types of the child, mother, and alleged father. - If the child's blood type is incompatible with the alleged parents based on Mendelian inheritance, one or both can be excluded. *HLA typing* - **HLA typing** (Human Leukocyte Antigen) is a more powerful genetic marker system than ABO/Rh for determining paternity or maternity. - It involves analyzing highly polymorphic genes on chromosome 6 that encode cell surface proteins, providing a more definitive means of **inclusion or exclusion**. *DNA fingerprinting* - **DNA fingerprinting** (also known as **DNA profiling**) is the **most accurate and widely accepted method** for resolving paternity and maternity disputes. - It analyzes highly variable regions of DNA unique to each individual, providing a statistically strong basis for **inclusion or exclusion** by comparing genetic profiles.
Question 2: In which gestational weeks is Hegar's sign typically observed?
- A. 10-14 weeks
- B. 14-18 weeks
- C. 18-22 weeks
- D. 6 to 10 weeks (Correct Answer)
Explanation: ***6 to 10 weeks*** - **Hegar's sign** is a softening of the lower uterine segment, which is a probable sign of pregnancy detected during a **bimanual examination**. - This softening typically becomes noticeable and palpable between **6 and 10 weeks of gestation** due to increased vascularity and edema in the area. *10-14 weeks* - While the uterus continues to soften and enlarge, **Hegar's sign** is usually established earlier, making it less specific or prominent for confirmation in this later window. - At this stage, other signs of pregnancy, such as a **palpable fetal outline** or **fetal heart tones**, become more readily apparent. *14-18 weeks* - By this gestational period, the uterus is significantly larger and has risen out of the pelvic cavity, making the specific assessment of the **lower uterine segment's compressibility** as an isolated sign less relevant. - **Fetal movements** (quickening) may also be felt during this time, serving as a more direct indicator of pregnancy. *18-22 weeks* - At these later weeks, the uterus is distinctly enlarged, and much of the diagnosis relies on **fundal height assessment** and further monitoring of fetal development. - **Hegar's sign** is a very early sign of pregnancy and would not be used for confirmation in this advanced stage.
Question 3: False about MTP is -
- A. Requires opinion of at least two registered medical practitioners when pregnancy exceeds 12 weeks
- B. Consent of husband is must (Correct Answer)
- C. >16 weeks, hysterotomy can be done
- D. Illegal if >20 weeks of pregnancy
Explanation: ***Consent of husband is must*** - The **Medical Termination of Pregnancy (MTP) Act** (amended in 2021) in India explicitly states that **only the consent of the pregnant woman** is required for an abortion. - The husband's consent is **not legally necessary** and cannot be a barrier to accessing MTP services. - **This statement is FALSE**, making it the correct answer to this negation question. *Requires opinion of at least two registered medical practitioners when pregnancy exceeds 12 weeks* - This statement is **TRUE**; for pregnancies between **12 and 20 weeks**, the opinion of **two registered medical practitioners** is required. - For pregnancies between **20 and 24 weeks**, two registered medical practitioners are required for specific vulnerable categories of women. *>16 weeks, hysterotomy can be done* - **Hysterotomy** is a surgical procedure similar to a mini-C-section, used in specific cases for MTP, often in later gestations or when other methods are contraindicated. - While exact gestational limits vary by clinical judgment and local regulations, it is indeed a method considered for **later second-trimester terminations**, including those beyond 16 weeks, under proper medical indication. - **This statement is TRUE**. *Illegal if >20 weeks of pregnancy* - This statement was largely true under the **MTP Act of 1971**, which set the upper limit for MTP at 20 weeks. - However, the **MTP (Amendment) Act of 2021** has expanded this limit, allowing termination up to **24 weeks for specific categories of women** and in cases of substantial fetal abnormalities, there is **no upper gestational limit** for termination. - **This statement is now FALSE** as per the 2021 amendments, though it requires contextual understanding.
Question 4: A lady with 12-week pregnancy presents with bleeding. On examination, vagina is normal, internal os is closed, and USG shows fetal viability with fundal height of 13 weeks. What is the diagnosis?
- A. Incomplete abortion
- B. Complete abortion
- C. Inevitable abortion
- D. Threatened abortion (Correct Answer)
Explanation: ***Threatened abortion*** - This diagnosis is characterized by **vaginal bleeding** in the first half of pregnancy with a **closed internal os** and evidence of fetal viability on ultrasound. - The fundal height being consistent with gestational age also indicates ongoing pregnancy, despite the bleeding. *Inevitable abortion* - This condition is indicated by vaginal bleeding accompanied by a **dilated cervix (open internal os)**, suggesting that the pregnancy cannot be salvaged. - While bleeding is present, the **closed internal os** in the given scenario rules out inevitable abortion. *Incomplete abortion* - This involves vaginal bleeding, an **open internal os**, and the **partial expulsion of pregnancy tissue**, with some products of conception remaining in the uterus. - The presentation does not include an open os or retained products of conception, as the fetus is viable and the os is closed. *Complete abortion* - This occurs when **all products of conception have been expelled** from the uterus, characterized by an initially open os that subsequently closes, and often a decrease in bleeding. - The presence of a **viable fetus** and a closed os clearly rules out a complete abortion.
Question 5: Best criterion for determining live birth in suspected infanticide cases?
- A. Presence of milk or food in stomach
- B. Evidence of external injuries
- C. Examination of umbilical cord changes
- D. Hydrostatic test (lung float test) (Correct Answer)
Explanation: ***Hydrostatic test (lung float test)*** - The **hydrostatic test**, also known as the **lung float test**, is considered the most reliable criterion in forensic pathology for determining if an infant was born alive. - A positive result (lungs float in water) indicates that the infant took at least one breath, suggesting **live birth**, as fetal lungs are solid and sink. *Presence of milk or food in stomach* - While the presence of milk or food indicates a period of survival after birth, it doesn't definitively prove **live birth** over stillbirth if the infant was fed immediately after a perimortem event. - It also doesn't provide information about **respiration**, which is a key indicator of live birth. *Evidence of external injuries* - **External injuries** may indicate foul play or neglect, but they do not confirm that the infant was born alive. - An infant could be **stillborn** and then subjected to injuries, or injuries could occur post-mortem. *Examination of umbilical cord changes* - **Umbilical cord changes**, such as desiccation or mummification, indicate the passage of time after birth but do not differentiate between **live birth** and **stillbirth**. - These changes can occur even if the infant was stillborn, especially if there was an attempt to cut and tie the cord.
Question 6: A 14-year-old victim of sexual assault with 22 weeks gestation has been brought for Medical Termination of Pregnancy (MTP). Which of the following statements is true?
- A. One doctor is involved
- B. MTP done in 2nd trimester only when mother's life is in danger
- C. MTP can be carried out up to 24 weeks (Correct Answer)
- D. MTP cannot be more than 20 weeks
Explanation: ***MTP can be carried out up to 24 weeks*** - The **Medical Termination of Pregnancy (Amendment) Act, 2021**, allows termination of pregnancy up to **24 weeks** for certain vulnerable groups, including survivors of sexual assault and minors. - As a 14-year-old victim of sexual assault, she falls under the category which permits MTP up to 24 weeks. *One doctor is involved* - For pregnancies between 12 and 20 weeks, the opinion of **two registered medical practitioners** is required for MTP. - Beyond 20 weeks up to 24 weeks, as in this case, the opinion of **two registered medical practitioners** is also mandatory. *MTP done in 2nd trimester only when mother's life is in danger* - While danger to the mother's life is a valid reason for MTP, the **MTP Act 2021** has expanded the grounds for MTP in the second trimester (beyond 12 weeks) to include other categories like **sexual assault survivors** and **minors**, even if the mother's life is not immediately in danger. - The primary consideration here is the **vulnerability** of the pregnant person, not solely imminent danger to life. *MTP cannot be more than 20 weeks* - This statement is incorrect as per the **Medical Termination of Pregnancy (Amendment) Act, 2021**. - The Act raised the upper gestation limit from 20 to **24 weeks** for specific categories of women, including victims of sexual assault and minors, aligning with the current case.
Question 7: In a macerated baby, the ideal sample for genetic analysis is obtained from:
- A. Clotted fetal blood
- B. Placental Tissue (Correct Answer)
- C. Fibroblast from skin
- D. Fibroblast from Achilles tendon
Explanation: ***Placental Tissue*** - **Placental tissue** (chorionic villi) is preferred for genetic analysis in macerated fetuses because it is less susceptible to **autolysis** and **bacterial contamination** compared to fetal tissues. - The placenta often retains viable cells with intact DNA even when fetal tissues have significantly degraded, making it a more reliable source for **karyotyping** or **molecular genetic studies**. *Clotted fetal blood* - **Clotted fetal blood** from a macerated fetus is generally unsuitable due to significant **cellular degradation** and **DNA fragmentation** caused by autolysis. - The quality of DNA extracted from such a sample would likely be poor, leading to unreliable or unsuccessful genetic testing. *Fibroblast from skin* - While fibroblasts can be cultured from skin, obtaining a viable biopsy from a **macerated fetus** is challenging due to extensive **tissue degradation** and the high risk of **bacterial contamination**. - Successful culture and growth of fibroblasts would be unlikely given the compromised state of the fetal tissue. *Fibroblast from Achilles tendon* - Similar to skin, obtaining viable fibroblasts from the **Achilles tendon** of a macerated fetus is difficult due to widespread **autolysis** and **tissue degeneration**. - The degradation of cells in macerated fetuses significantly reduces the chances of culturing viable cells needed for genetic analysis from any fetal tissue, including tendons.
Question 8: 'Cot death' is associated with
- A. Negative autopsy (Correct Answer)
- B. Summer season
- C. Age group above 2 years
- D. Female sex
Explanation: ***Negative autopsy*** - **Sudden Infant Death Syndrome (SIDS)**, often referred to as 'cot death', is a diagnosis of exclusion, meaning it is applied when a thorough **investigation** and **autopsy** fail to identify a cause of death. - This characteristic "negative autopsy" is a defining feature, signifying that the death remains unexplained even after exhaustive medical and forensic examination. *Summer season* - SIDS incidence tends to be higher in the **winter months**. This is possibly due to factors like increased respiratory infections or overheating from bundling infants in colder weather. - The **summer season** does not correlate with an increased risk of SIDS. *Age group above 2 years* - SIDS primarily affects infants, with the majority of cases occurring between **2 and 4 months of age**. - It is extremely rare in children older than **1 year**, and virtually unheard of beyond 2 years. *Female sex* - SIDS shows a slight predilection for **male infants**. - While not a strong differentiator, the **female sex** is not considered a risk factor or associated with increased incidence of SIDS.
Question 9: Which of the following statements about Hegar's sign is false?
- A. Bimanual palpation method
- B. Present in 2/3rd of cases (Correct Answer)
- C. Difficult in obese
- D. Can be done at 14 weeks
Explanation: ***Present in 2/3rd of cases*** - This statement is **FALSE** and is the correct answer to this question. - Hegar's sign, while a classic sign of pregnancy, is not consistently present in 2/3rds of cases with such statistical certainty. - Its detectability varies significantly depending on **gestational age** (optimal 6-12 weeks), **uterine position** (retroverted uterus makes it harder), **examiner experience**, and **patient body habitus**. - This specific "2/3rd" frequency claim lacks strong evidence-based support in obstetric literature. *Bimanual palpation method* - This statement is TRUE. - **Hegar's sign** is elicited by **bimanual pelvic examination** where one hand is placed on the abdomen and the other in the vagina to palpate the softening and compressibility of the **lower uterine segment** (isthmus). - The examiner feels the cervix and uterine fundus separately with the soft isthmus compressed between the examining fingers. *Difficult in obese* - This statement is TRUE. - **Obesity** makes any deep abdominal or pelvic palpation more challenging due to increased adipose tissue. - The **softening of the lower uterine segment** is harder to appreciate, reducing the sensitivity of detecting Hegar's sign in obese patients. *Can be done at 14 weeks* - This statement is technically TRUE but represents suboptimal timing. - **Hegar's sign** is most reliably detectable between the **6th and 12th weeks of gestation**. - At **14 weeks**, while the examination can still be performed, the uterus has grown significantly and risen into the abdomen, making the lower uterine segment less compressible and the sign much less prominent or absent. - The statement doesn't claim it's "optimal" at 14 weeks, only that it "can be done," which is technically accurate even if clinically impractical.
Question 10: A mother delivers in a rural area under the guidance of a skilled care attendant. Which of the following statements is incorrect regarding the care provided by the skilled care attendant at birth?
- A. Start breastfeeding as early as possible
- B. Cover the baby's head and body
- C. Bathe the baby with warm water (Correct Answer)
- D. Clear the eyes with a sterile swab
- E. Dry the baby thoroughly and stimulate breathing
Explanation: ***Bathe the baby with warm water*** - **Delaying the first bath** for at least 6-24 hours after birth is recommended to prevent **hypothermia** and promote **skin-to-skin contact** for bonding and breastfeeding. - Early bathing can remove **vernix caseosa**, which provides natural antimicrobial protection and moisturization to the newborn's skin. *Start breastfeeding as early as possible* - **Early initiation of breastfeeding**, ideally within the first hour of birth, is crucial for both mother and baby. - It promotes **uterine contractions** to prevent **postpartum hemorrhage** and provides the newborn with **colostrum**, rich in antibodies. *Cover the baby's head and body* - Covering the newborn's head and body is essential to prevent **heat loss** and maintain a stable **body temperature**, immediately after birth. - Newborns are highly susceptible to **hypothermia** due to their large surface area to mass ratio and immature thermoregulation. *Clear the eyes with a sterile swab* - Clearing the newborn's eyes with a sterile swab is a standard part of immediate newborn care to remove any **mucus or blood** that might have entered during delivery. - This helps prevent **ophthalmia neonatorum**, especially if the mother has an infection like gonorrhea or chlamydia. *Dry the baby thoroughly and stimulate breathing* - **Drying the baby immediately** after birth is a critical first step in newborn resuscitation and care. - It helps prevent **hypothermia** and provides **tactile stimulation** to initiate breathing and crying, which is essential for transitioning from fetal to neonatal circulation.
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