Prenatal Care Practice Questions

Q: A 28-year-old pregnant woman is found to be HBsAg positive with high HBV DNA levels during routine antenatal screening. She has no features of liver failure. What is the most appropriate treatment during pregnancy?

Tenofovir. ### ***Tenofovir*** - **Tenofovir** is the preferred antiviral agent for treating pregnant women with chronic hepatitis B infection who have high viral loads, as it is a pregnancy category B medication with a favorable safety profile. - It effectively reduces **HBV DNA levels**, significantly lowering the risk of **vertical transmission** (mother-to-child) when administered from the second or third trimester onward. *Pegylated interferon* - **Pegylated interferon** is generally contraindicated during pregnancy due to concerns regarding potential **teratogenicity** and anti-proliferative effects on fetal development. - It is typically avoided in women of childbearing age who are planning to conceive or are pregnant because of its known **adverse fetal outcomes**. *Zidovudine* - **Zidovudine** is a nucleoside reverse transcriptase inhibitor used specifically for the treatment of **HIV infection** to prevent vertical transmission. - While it has anti-viral properties, it is not an effective treatment for the **hepatitis B virus** and does not suppress **HBV DNA replication**. *Acyclovir* - **Acyclovir** is an antiviral medication indicated primarily for the treatment of **herpes simplex virus** (HSV) and **varicella-zoster virus** (VZV) infections. - It lacks efficacy against the **hepatitis B virus** and plays no role in the management of chronic HBV infection or the prevention of vertical transmission.

Q: A diabetic female with HbA1c of 8 and retinopathy wants to get pregnant. What is the best advice?

Preconception counselling. ***Preconception counselling*** - This is the most crucial first step for any diabetic woman planning pregnancy to optimize glycemic control, evaluate for **end-organ damage** (like her retinopathy), and adjust medications. - It allows for the identification and management of high-risk factors, such as optimizing **HbA1c levels** to minimize the risk of **congenital malformations** and obstetric complications. *Insulin* - While insulin is indeed the drug of choice during pregnancy, simply starting insulin is not the *first* step before comprehensive assessment and counseling. - The patient needs a holistic management plan, including **ophthalmology screening** for her existing retinopathy, which can worsen during pregnancy. *Metformin* - Metformin is generally considered safe in pregnancy, but patients often need to be transitioned to **insulin** to achieve the tighter glycemic targets required. - It is not the standalone answer as preconception management encompasses much broader care than just selecting a glycemic agent. *Control blood sugar* - Achieving normoglycemia is a goal within the broader framework of management, but it cannot be done effectively without formal counseling and medical supervision. - Simply advising to control blood sugar ignores the necessity of evaluating the severity of her **diabetic retinopathy** and potential **nephropathy**, which are critical pre-pregnancy assessment goals.

Q: A pregnant female at 16th week of gestation is diagnosed with anemia. What is the most appropriate treatment?

100 mg iron, 500 mcg twice daily. ***100 mg iron, 500 mcg twice daily*** - In the context of pregnancy, standard therapeutic guidelines for **iron-deficiency anemia** often recommend higher doses of elemental iron (such as 100-200 mg per day) to replenish **maternal iron stores** and support increased **red blood cell mass**. - The addition of **folic acid** (500 mcg) is critical for preventing **neural tube defects** and supporting rapid fetal erythropoiesis, with twice-daily dosing often utilized to maximize absorption and compliance in symptomatic patients. *100 mg iron, 500 mcg once daily* - While this dosage provides the necessary components, it may be insufficient for a patient with an established diagnosis of **anemia** who requires a more aggressive therapeutic repletion strategy in the **second trimester**. - Sub-therapeutic dosing might fail to adequately elevate **hemoglobin** levels before the third trimester, increasing the risk of preterm delivery and low birth weight. *60 mg iron, 500 mcg twice daily* - Though this regimen provides a total of 120 mg of iron, common therapeutic protocols favor specific elemental iron formulations and dosing frequencies designed to optimize **gastrointestinal tolerance** and iron uptake. - This total daily dosage is often considered a prophylactic or mild therapeutic dose, which might be suboptimal depending on the severity of the patient's diagnosed anemia. *60 mg iron, 50 mcg once daily* - The **folic acid** dosage here (50 mcg) is significantly below the recommended daily requirement for pregnant women, failing to provide adequate prophylaxis against **megaloblastic anemia** and fetal development issues. - The total amount of elemental iron provided is generally reserved for **prophylactic supplementation** in healthy pregnant patients, rather than the active treatment of diagnosed anemia.

Q: Which of the following physiological changes occur during pregnancy?

Increase in cardiac output and plasma volume. ***Increase in cardiac output and plasma volume*** - Physiological adaptation to pregnancy involves a significant **increase in plasma volume** (by approximately 40-50%) to meet metabolic demands of the fetus and provide a reserve for blood loss at delivery. - **Cardiac output** rises due to both increased **stroke volume** and increased **heart rate**, ensuring adequate perfusion of the uteroplacental unit. *Decrease in cardiac output, decrease in plasma volume* - This pattern describes a state of **hypovolemic shock** or severe vascular collapse, which is the opposite of the hyperdynamic state seen in normal pregnancy. - Pregnancy is characterized by **hemodynamic expansion**, not depletion, making this option physiologically incorrect. *Increase in cardiac output, decrease in plasma volume* - While cardiac output does increase, a decrease in plasma volume would lead to **hemoconcentration** and impaired placental perfusion. - Pregnancy is defined by **physiological anemia** due to a greater expansion of plasma volume relative to the red cell mass. *Decrease in cardiac output, increase in plasma volume* - If cardiac output were to decrease while plasma volume increased, the patient would likely be in **decompensated heart failure**. - The cardiovascular system undergoes structural and functional changes specifically to **maintain or increase cardiac output** to support the growing fetus.

Q: Identify the clinical sign shown in the image.

Chadwick sign. ***Chadwick sign*** - This sign describes the **bluish-purple discoloration** of the **vagina, cervix, and vulva**, caused by increased venous congestion and hyperemia associated with early **pregnancy**. - It is one of the classic **presumptive signs of pregnancy**, typically appearing around **6 to 8 weeks** of gestation. *Hegar sign* - This refers to the **softening of the uterine isthmus** (the area between the cervix and the uterine body), which can be felt by bimanual examination. - While also a **probable sign of pregnancy**, it relates to uterine consistency rather than discoloration. *Goodell sign* - This describes the **softening of the cervix** itself, which occurs due to increased vascularity and hypertrophy of the cervical glands. - It is a **probable sign of pregnancy** that is distinct from the color-based changes seen in Chadwick sign. *Osiander sign* - This refers to the **increased pulsation** that can be felt in the **lateral vaginal fornices** during early pregnancy. - This pulsation is due to the increased blood flow through the **uterine arteries** and is a distinct clinical finding from the discoloration of the vaginal mucosa.

Q: Which of the following is classified as a probable sign of pregnancy? A. Hegar's sign B. Goodell's sign C. Braxton Hicks contractions D. Seitz sign

A, B and C only. ***A, B and C only*** - **Hegar’s sign** (softening of the uterine isthmus), **Goodell’s sign** (softening of the cervix), and **Braxton Hicks contractions** are all well-established **probable signs of pregnancy** identified during physical examination. - These signs rely on objective physical findings related to the physiological changes of pregnancy, though they are not considered diagnostic confirmation like a positive ultrasound or fetal heart tones. *A and B only* - While **Hegar’s sign** and **Goodell’s sign** are indeed probable signs, this option incorrectly excludes **Braxton Hicks contractions**, which are also categorized as probable. - Excluding valid clinical indicators makes this answer choice incomplete for identifying the classic group of probable pregnancy signs. *B, C and D only* - This option incorrectly includes **Seitz sign**, which is not a standard recognized clinical sign of pregnancy, and excludes **Hegar’s sign**. - **Hegar’s sign** is a classic physical finding occurring in the first trimester, making its omission scientifically incorrect. *A, B, C and D* - This option incorrectly includes **Seitz sign**; there is no medically recognized diagnostic sign of pregnancy by that name. - The classification of **probable signs** strictly includes physiological physical changes, among which only A, B, and C qualify.

Q: A 34-year-old female, G2P1, with a history of pre-eclampsia in her previous pregnancy, comes for her first ANC visit at 12 weeks. What is the most appropriate intervention for prevention of pre- eclampsia in her current pregnancy?

Low-dose aspirin. ### ***Low-dose aspirin*** - Per ACOG and USPSTF guidelines, **low-dose aspirin** (81 mg/day) is recommended for the prevention of pre-eclampsia in high-risk women starting between 12 and 28 weeks of gestation (ideally before 16 weeks). - A history of **pre-eclampsia** in a previous pregnancy is a high-risk factor that mandates prophylactic treatment to reduce morbidity. *Low-dose aspirin with Low Molecular Weight Heparin (LMWH)* - There is no clinical indication for the routine addition of **LMWH** to aspirin for pre-eclampsia prevention unless the patient has a diagnosed **thrombophilia** or **antiphospholipid syndrome**. - Adding anticoagulation unnecessarily increases the risk of bleeding complications without clear benefit in reducing pre-eclampsia related outcomes. *Low calcium intake* - Current evidence-based guidelines recommend **calcium supplementation** for high-risk populations, specifically in areas with low dietary calcium intake, rather than restricting it. - Studies show that **calcium supplementation** (1–2 g/day) helps reduce the risk of pre-eclampsia, whereas "low" intake is not a therapeutic intervention. *Low salt intake* - Routine **sodium restriction** is not recommended for pregnancy as it does not prevent pre-eclampsia or gestational hypertension. - Maintaining a normal, balanced diet is advised; significant salt restriction may lead to inadequate fetal nutrition without maternal benefit.

Q: Which condition is more common in primigravida than multigravida?

Hyperemesis gravidarum. **Explanation:** **Hyperemesis Gravidarum (HG)** is the correct answer because it is statistically more prevalent in primigravidas. While the exact etiology is multifactorial, it is strongly associated with high levels of Human Chorionic Gonadotropin (hCG) and estrogen. Primigravidas often exhibit a more intense initial hormonal response and may have higher psychological stress or lower physiological adaptation to these surges compared to multigravidas. **Analysis of Incorrect Options:** * **Postpartum Hemorrhage (PPH):** More common in **multigravidas**, especially grand multiparas, due to uterine atony resulting from repeated stretching of the myometrium and reduced muscle tone. * **Placenta Previa:** The risk increases with **parity**. Repeated pregnancies and previous uterine scarring (e.g., from prior deliveries or D&C) increase the likelihood of abnormal placental implantation in the lower segment. * **Malpresentation:** More common in **multigravidas** because the laxity of the abdominal and uterine walls allows the fetus more room to move, preventing the head from engaging early and increasing the risk of transverse or oblique lies. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors for HG:** Primigravida, multiple pregnancy, molar pregnancy (highest hCG levels), and a history of motion sickness. * **Wernicke’s Encephalopathy:** A serious complication of HG due to Vitamin B1 (Thiamine) deficiency; always supplement Thiamine before giving IV glucose. * **Rule of Thumb:** Conditions related to "uterine overdistension" or "laxity" (PPH, Malpresentation, Cord Prolapse) favor multigravidas, while "immunological" or "first-time hormonal exposure" conditions (Pre-eclampsia, HG) favor primigravidas.

Question 1

A 28-year-old pregnant woman is found to be HBsAg positive with high HBV DNA levels during routine antenatal screening. She has no features of liver failure. What is the most appropriate treatment during pregnancy?

Accepted Answer

Tenofovir

Answer

Pegylated interferon

Answer

Zidovudine

Answer

Acyclovir

Question 2

A diabetic female with HbA1c of 8 and retinopathy wants to get pregnant. What is the best advice?

Accepted Answer

Preconception counselling

Answer

Insulin

Answer

Metformin

Answer

Control blood sugar

Question 3

A pregnant female at 16th week of gestation is diagnosed with anemia. What is the most appropriate treatment?

Accepted Answer

100 mg iron, 500 mcg twice daily

Answer

100 mg iron, 500 mcg once daily

Answer

60 mg iron, 500 mcg twice daily

Answer

60 mg iron, 50 mcg once daily

Question 4

Which of the following physiological changes occur during pregnancy?

Accepted Answer

Increase in cardiac output and plasma volume

Answer

Decrease in cardiac output, decrease in plasma volume

Answer

Increase in cardiac output, decrease in plasma volume

Answer

Decrease in cardiac output, increase in plasma volume

Question 5

Identify the clinical sign shown in the image.

Accepted Answer

Chadwick sign

Answer

Hegar sign

Answer

Goodell sign

Answer

Osiander sign

Question 6

Which of the following is classified as a probable sign of pregnancy?
A. Hegar's sign
B. Goodell's sign
C. Braxton Hicks contractions
D. Seitz sign

Accepted Answer

A, B and C only

Answer

A and B only

Answer

B, C and D only

Answer

A, B, C and D

Question 7

A 34-year-old female, G2P1, with a history of pre-eclampsia in her previous pregnancy, comes for
her first ANC visit at 12 weeks. What is the most appropriate intervention for prevention of pre-
eclampsia in her current pregnancy?

Accepted Answer

Low-dose aspirin

Answer

Low-dose aspirin with Low Molecular Weight Heparin (LMWH)

Answer

Low calcium intake

Answer

Low salt intake

Question 8

A 32-year-old G3P2 woman at 34 weeks of gestation presents with sudden onset painless bright-red vaginal bleeding. She has no uterine contractions and the uterus is soft on palpation. Fetal heart rate is 148 bpm and reactive. She is hemodynamically stable and the bleeding has decreased. The transvaginal ultrasound is shown (Image 1). Which of the following is the most appropriate next step in management?

Accepted Answer

A. Administer a single course of intramuscular betamethasone and manage expectantly with hospitalization

Answer

B. Proceed to immediate emergency caesarean section under general anaesthesia

Answer

C. Perform a digital cervical examination to assess Bishop score and consider induction of labour

Answer

D. Administer tocolysis with nifedipine and discharge with outpatient surveillance

Question 9

A 34-year-old G2P1 woman at 38 weeks of gestation with known gestational hypertension is in active labor and is currently receiving intravenous oxytocin augmentation. The midwife notes a change in the fetal heart rate pattern on continuous electronic fetal monitoring and calls for review. The CTG tracing is shown (Image 1), demonstrating recurrent late decelerations — decelerations that begin after the peak of uterine contractions and return to baseline after the contraction ends — occurring with the majority of contractions, along with minimal baseline variability (≤5 bpm) and a baseline fetal heart rate of 145 bpm. Cervical examination reveals 6 cm dilation, fully effaced, with the vertex at station +1. What is the most appropriate immediate next step?

Accepted Answer

B. Reposition the patient to the left lateral position, stop the oxytocin infusion, give an IV fluid bolus, and prepare for urgent delivery if the tracing does not promptly improve

Answer

A. Administer intravenous oxytocin augmentation and reassess in 30 minutes

Answer

C. Commence magnesium sulfate infusion for fetal neuroprotection and continue labor

Answer

D. Apply a fetal scalp electrode for continuous internal monitoring and observe for one hour

Question 10

Which condition is more common in primigravida than multigravida?

Accepted Answer

Hyperemesis gravidarum

Answer

Postpartum hemorrhage (PPH)

Answer

Placenta previa

Answer

Malpresentation

Prenatal Care — MCQs

Prenatal Care — MCQs

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