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.

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

Prenatal Care — MCQs

Prenatal Care — MCQs

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