Prenatal Care — MCQs

Prenatal Care Indian Medical PG Practice Questions and MCQs

Question 91: Alpha-fetoprotein (AFP) is increased in maternal serum in all except:

A. Open neural tube defects
B. Meningomyelocele
C. Spina bifida
D. Trisomy (Correct Answer)

Explanation: **Explanation:** Maternal Serum Alpha-Fetoprotein (MSAFP) is a crucial screening marker produced initially by the yolk sac and later by the fetal liver. The correct answer is **Trisomy** because chromosomal abnormalities, specifically **Trisomy 21 (Down Syndrome)** and **Trisomy 18 (Edwards Syndrome)**, are characteristically associated with **decreased** levels of MSAFP. **Why the other options are incorrect:** Options A, B, and C (**Open Neural Tube Defects, Meningomyelocele, and Spina Bifida**) are all conditions where the fetal skin coverage is incomplete. This allows AFP to leak from the fetal circulation into the amniotic fluid and subsequently into the maternal serum, leading to **elevated** MSAFP levels. * **Open Neural Tube Defects (ONTDs):** General term for failure of neural tube closure. * **Meningomyelocele & Spina Bifida:** Specific types of ONTDs where the spinal cord/meninges protrude through a vertebral defect. **High-Yield Clinical Pearls for NEET-PG:** * **Causes of Increased MSAFP:** Multiple pregnancy (most common cause of "apparent" elevation), Omphalocele, Gastroschisis, Renal anomalies (Finnish-type nephrosis), and Underestimation of gestational age. * **Causes of Decreased MSAFP:** Trisomies (21, 18), Gestational Trophoblastic Disease (Molar pregnancy), and Overestimation of gestational age (Obesity). * **The Triple Test:** In Down Syndrome, the typical pattern is **decreased MSAFP**, **decreased Estriol (uE3)**, and **increased hCG**. * **Timing:** The ideal time for MSAFP screening is between **15–20 weeks** of gestation.

Question 92: A patient is at 20 weeks of gestation. The patient's last menstrual period (LMP) was on January 9th. What is the estimated date of delivery?

A. January 9th
B. September 16th
C. October 16th (Correct Answer)
D. October 9th

Explanation: **Explanation:** The estimated date of delivery (EDD) is calculated using **Naegele’s Rule**, which is a standard clinical tool used in obstetrics. According to this rule, the EDD is determined by adding **9 months and 7 days** to the first day of the patient’s last menstrual period (LMP). **Calculation for this case:** * **LMP:** January 9th * **Add 7 days:** January 9 + 7 = January 16th * **Add 9 months:** January + 9 months = **October 16th** **Analysis of Options:** * **Option C (Correct):** Follows Naegele’s Rule correctly (Jan 9 + 9 months + 7 days). * **Option A:** This is simply the date of the LMP, not the delivery date. * **Option B:** This date is exactly 36 weeks from the LMP, which is premature. * **Option D:** This adds 9 months but forgets to add the 7 days required by the formula. **Clinical Pearls for NEET-PG:** 1. **Naegele’s Rule Assumptions:** It assumes a standard 28-day menstrual cycle with ovulation occurring on day 14. 2. **Cycle Adjustment:** If a patient has a longer cycle, add the extra days (e.g., for a 30-day cycle, add 9 days instead of 7). If shorter, subtract the difference. 3. **Alternative Formula:** You can also calculate EDD by subtracting 3 months from the LMP and adding 7 days and 1 year. 4. **Gold Standard:** While Naegele’s Rule is used for LMP, **First Trimester Ultrasound (Crown-Rump Length)** is the most accurate method for dating a pregnancy.

Question 93: Which of the following is NOT associated with carbimazole use in pregnancy?

A. Choanal atresia
B. Cleft lip and palate (Correct Answer)
C. Scalp defect
D. Neck swelling

Explanation: **Explanation:** The question tests your knowledge of **Carbimazole/Methimazole Embryopathy**. Carbimazole is a pro-drug of Methimazole, and its use during the first trimester (organogenesis) is associated with specific congenital malformations. **Why "Cleft lip and palate" is the correct answer:** While cleft lip and palate are common congenital anomalies, they are **not** specifically linked to Carbimazole exposure. They are more commonly associated with other anti-epileptic drugs like Phenytoin or Sodium Valproate. **Analysis of Incorrect Options (Associated with Carbimazole):** * **Choanal atresia (Option A):** This is a classic feature of Methimazole embryopathy, involving a narrowing or blockage of the posterior nasal passage. * **Scalp defect (Option C):** Specifically known as **Aplasia Cutis Congenita**, this is a hallmark sign where there is a localized absence of skin on the scalp. * **Neck swelling (Option D):** Thionamides (Carbimazole/PTU) cross the placenta and can inhibit the fetal thyroid gland, leading to **fetal hypothyroidism and goiter** (neck swelling). **High-Yield Clinical Pearls for NEET-PG:** 1. **Drug of Choice:** **Propylthiouracil (PTU)** is the preferred drug in the **first trimester** because it is more protein-bound, crosses the placenta less readily, and is not associated with aplasia cutis. 2. **Switching:** Many guidelines recommend switching from Carbimazole to PTU during the first trimester and switching back to Carbimazole in the second/third trimester to avoid PTU-induced maternal hepatotoxicity. 3. **Other Embryopathy features:** Esophageal atresia and dysmorphic facial features (teardrop-shaped nostrils).

Question 94: High levels of maternal serum alpha-fetoprotein are seen in all of the following conditions, EXCEPT:

A. Cardiac anomaly
B. Skeletal deformity
C. Trisomy 21 (Correct Answer)
D. Neural tube defect

Explanation: **Explanation:** Maternal Serum Alpha-Fetoprotein (MSAFP) is a glycoprotein produced initially by the yolk sac and later by the fetal liver. It is a crucial screening marker used between 15–20 weeks of gestation. **Why Trisomy 21 is the correct answer:** In pregnancies affected by **Trisomy 21 (Down Syndrome)**, MSAFP levels are characteristically **decreased** (typically <0.5 MoM), not increased. This is often accompanied by low unconjugated estriol (uE3) and elevated Beta-hCG and Inhibin-A (the "Quad Screen" pattern). **Analysis of incorrect options (Conditions with HIGH MSAFP):** * **Neural Tube Defects (NTDs):** Conditions like anencephaly and spina bifida allow AFP to leak from the fetal circulation into the amniotic fluid and maternal serum through the exposed neural tissue. * **Skeletal Deformities:** Defects such as **Abdominal Wall Defects** (Omphalocele, Gastroschisis) or Osteogenesis Imperfecta lead to increased protein leakage into the amniotic cavity. * **Cardiac Anomalies:** Certain congenital heart defects and fetal arrhythmias can lead to fetal distress or hydrops, which are associated with elevated MSAFP levels. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of elevated MSAFP:** Gestational age error (underestimation of dates). * **Other causes of High MSAFP:** Multiple pregnancy, Renal anomalies (Finnish-type nephrosis), Rh isoimmunization, and Fetal demise. * **Causes of Low MSAFP:** Trisomy 21, Trisomy 18 (Edwards Syndrome), Molar pregnancy, and Maternal obesity. * **Mnemonic for Down Syndrome Screen:** "HI" is High (hCG and Inhibin-A are elevated); the rest (AFP, uE3) are low.

Question 95: What is the ideal number of antenatal visits recommended?

A. 4 (Correct Answer)
B. 8
C. 6
D. 10

Explanation: The correct answer is **A (4)**. ### **Explanation** The "Ideal" number of antenatal visits is a frequently tested concept in NEET-PG, often leading to confusion between WHO and National guidelines. 1. **Why Option A is Correct:** According to the **WHO (Focussed Antenatal Care model)** and the **Ministry of Health and Family Welfare (MoHFW), India**, the minimum recommended number of antenatal visits for a healthy pregnant woman is **4**. These are scheduled as follows: * **1st Visit:** Within 12 weeks (Registration/First trimester). * **2nd Visit:** Between 14–26 weeks (Second trimester). * **3rd Visit:** Between 28–34 weeks (Third trimester). * **4th Visit:** Between 36 weeks and term. 2. **Why Other Options are Incorrect:** * **Option B (8):** In 2016, the WHO updated its "Antenatal Care Model" to recommend a minimum of **8 contacts** to reduce perinatal mortality. However, in the context of standard Indian guidelines and traditional NEET-PG questions, **4** remains the "ideal minimum" unless "WHO 2016 guidelines" are specifically mentioned. * **Options C & D:** These do not correspond to any standard global or national protocol for routine antenatal care. ### **High-Yield Clinical Pearls for NEET-PG** * **Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA):** Conducted on the **9th of every month** to ensure at least one check-up by a specialist. * **Weight Gain:** Average weight gain during pregnancy is **11 kg**. * **Tetanus Prophylaxis:** Two doses of Td (Tetanus-diphtheria) are given; the first at registration and the second 4 weeks later. If the woman was immunized within the last 3 years, only one **booster dose** is required. * **Iron-Folic Acid (IFA):** 100mg elemental iron and 500mcg folic acid for 180 days (starting from the second trimester).

Question 96: Which of the following defines a high-risk mother?

A. Height less than 150 cm
B. Weight less than 45 kg
C. Age greater than 35 years and twin pregnancy
D. All of the above (Correct Answer)

Explanation: **Explanation:** A **high-risk pregnancy** is one in which the mother, fetus, or newborn is at an increased risk of adverse health outcomes before, during, or after delivery. Identification of these factors during antenatal screening is crucial for reducing maternal and neonatal mortality. **Why "All of the Above" is correct:** Each option represents a significant risk factor that necessitates specialized obstetric care: * **Short Stature (Height <145–150 cm):** A maternal height of less than 150 cm (specifically <145 cm in many guidelines) is a strong predictor of a **small pelvis**. This increases the risk of **Cephalopelvic Disproportion (CPD)** and obstructed labor, often requiring a Cesarean section. * **Low Maternal Weight (<45 kg):** Low pre-pregnancy weight or poor weight gain is associated with **Intrauterine Growth Restriction (IUGR)** and Low Birth Weight (LBW) babies due to nutritional deficiencies. * **Advanced Maternal Age (>35 years) & Twin Pregnancy:** Women over 35 are at higher risk for gestational diabetes, pre-eclampsia, and chromosomal abnormalities (e.g., Trisomy 21). **Twin pregnancy** is inherently high-risk due to complications like preterm labor, polyhydramnios, and postpartum hemorrhage (PPH). **High-Yield Clinical Pearls for NEET-PG:** * **Primi-elderly:** A woman pregnant for the first time at age ≥35. * **Grand Multipara:** A woman who has had 5 or more previous pregnancies (increased risk of PPH and placenta previa). * **Other High-Risk Criteria:** Previous C-section, malpresentations (breech/transverse), pregnancy-induced hypertension (PIH), and severe anemia (Hb <7 g/dL). * **The "Rule of Too":** Too young (<18), too old (>35), too many (>4), and too soon (spacing <2 years).

Question 97: Air travel in pregnancy is not recommended after what gestational age?

A. 12 weeks
B. 22 weeks
C. 30 weeks
D. 36 weeks (Correct Answer)

Explanation: **Explanation:** The correct answer is **36 weeks**. According to the American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG), air travel is generally considered safe for healthy pregnant women up to 36 weeks of gestation. **Why 36 weeks?** The primary concern with air travel in late pregnancy is not the cabin environment itself, but the risk of **spontaneous labor or obstetric emergencies** (like premature rupture of membranes) occurring while in flight, away from specialized medical facilities. Most commercial airlines restrict travel after 36 weeks for singleton pregnancies and after **32 weeks** for uncomplicated multiple pregnancies. **Analysis of Incorrect Options:** * **12 weeks (A):** This is the end of the first trimester. While nausea and vomiting (morning sickness) are common, there is no contraindication to flying. * **22 weeks (B):** This is near the limit of viability. Travel is generally safest during the second trimester (14–28 weeks) because the risks of miscarriage and preterm labor are lowest. * **30 weeks (C):** Travel is still permitted at this stage; however, patients are advised to carry their prenatal records. **High-Yield Clinical Pearls for NEET-PG:** * **DVT Prophylaxis:** Pregnancy is a hypercoagulable state. For long-haul flights (>4 hours), pregnant women should wear graduated compression stockings, perform calf exercises, and maintain hydration to prevent Deep Vein Thrombosis (DVT). * **Safety Measures:** The seatbelt should be fastened **"low and tight"** across the pelvis (below the abdomen) to avoid fetal injury during turbulence. * **Contraindications:** Air travel should be avoided in pregnancies complicated by severe anemia, sickle cell disease (due to low oxygen tension), unstable placenta previa, or pre-eclampsia.

Question 98: Glycosuria found during routine antenatal investigations indicates the need for what further evaluation?

A. Gestational diabetes treatment
B. Dietary control
C. Insulin treatment
D. Glucose tolerance test (Correct Answer)

Explanation: **Explanation:** In pregnancy, the **renal threshold for glucose decreases** significantly due to an increase in the Glomerular Filtration Rate (GFR) and a reduction in the tubular reabsorption of glucose. Consequently, glycosuria (glucose in the urine) is a common finding in healthy pregnant women and is not diagnostic of diabetes. However, because it can be an early indicator of underlying carbohydrate intolerance, it necessitates further definitive testing. * **Why Option D is correct:** The **Glucose Tolerance Test (GTT)** or a Glucose Challenge Test (GCT) is the gold standard for diagnosing Gestational Diabetes Mellitus (GDM). Since glycosuria is a screening finding with low specificity, a formal biochemical evaluation of blood glucose levels is required to confirm or rule out GDM. * **Why Options A, B, and C are incorrect:** Treatment (Insulin), dietary modifications, or labeling a patient with GDM cannot be initiated based on a urine dipstick alone. These interventions are only started *after* a diagnosis is confirmed via blood glucose testing (GTT). **High-Yield Clinical Pearls for NEET-PG:** * **Renal Threshold:** In non-pregnant adults, the renal threshold for glucose is ~180 mg/dL; in pregnancy, it can drop to as low as 110–120 mg/dL. * **DIPSI Criteria:** In India, the Diabetes in Pregnancy Study Group India (DIPSI) recommends a 75g oral glucose load regardless of the last meal; a 2-hour plasma glucose **≥140 mg/dL** diagnoses GDM. * **Timing:** Routine screening for GDM is typically performed between **24–28 weeks** of gestation.

Question 99: All of the following are biochemical markers included for the triple test except?

A. Alpha-fetoprotein (AFP)
B. Human chorionic gonadotropin (hCG)
C. Human placental lactogen (HPL) (Correct Answer)
D. Unconjugated estriol

Explanation: **Explanation:** The **Triple Test** is a second-trimester screening tool performed between **15 and 20 weeks** of gestation (ideally 16–18 weeks) to screen for fetal chromosomal abnormalities and neural tube defects. **Why Option C is the correct answer:** **Human placental lactogen (HPL)** is a hormone produced by the syncytiotrophoblast that promotes maternal lipolysis and insulin resistance. While it reflects placental function, it is **not** a component of the standard triple, quadruple, or integrated screening tests for aneuploidy. **Analysis of Incorrect Options (Components of the Triple Test):** 1. **Alpha-fetoprotein (AFP):** Produced by the fetal yolk sac and liver. Low levels are associated with Down syndrome, while high levels suggest Open Neural Tube Defects (ONTD) or abdominal wall defects. 2. **Human chorionic gonadotropin (hCG):** Produced by the placenta. Levels are characteristically **elevated** in pregnancies affected by Down syndrome. 3. **Unconjugated estriol (uE3):** Produced by the synergistic action of the fetal adrenals, fetal liver, and the placenta. Levels are typically **low** in Down syndrome and Edward syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Quadruple Test:** Includes the Triple Test markers plus **Inhibin-A**. Inhibin-A is **increased** in Down syndrome. * **Down Syndrome Pattern (HI):** In Down syndrome, **H**CG and **I**nhibin-A are **High**, while AFP and uE3 are low. * **Edward Syndrome (Trisomy 18):** All markers (AFP, hCG, uE3) are typically **decreased**. * **Combined Test (First Trimester):** Includes Nuchal Translucency (NT), PAPP-A, and free β-hCG.

Question 100: A woman in her second trimester is found to have an overdistended uterus. What are the common causes of uterine overdistension?

A. Incorrect gestational dating
B. Hydramnios
C. Distended bladder and twins
D. All of the above (Correct Answer)

Explanation: **Explanation:** The clinical finding of a **"uterus larger than dates"** or uterine overdistension occurs when the symphysis-fundal height (SFH) exceeds the expected measurement for the calculated period of gestation by 2 cm or more. **1. Why "All of the above" is correct:** Uterine overdistension is a multifactorial clinical sign. It can be caused by an actual increase in intrauterine volume or an error in the baseline assessment. * **Incorrect gestational dating:** This is the **most common cause**. If the patient’s Last Menstrual Period (LMP) is unreliable or if she conceived sooner than expected (e.g., immediately after stopping OCPs), the uterus will appear "large for dates" simply because the pregnancy is further along than calculated. * **Hydramnios (Polyhydramnios):** An excessive accumulation of amniotic fluid (Amniotic Fluid Index >25 cm) physically distends the uterine walls beyond normal limits. * **Twins (Multiple Pregnancy):** The presence of more than one fetus and their respective placentas/sacs naturally increases uterine volume. * **Distended Bladder:** A full bladder can displace the uterus superiorly, leading to a false measurement of overdistension during physical examination. **2. Clinical Pearls for NEET-PG:** * **Differential Diagnosis:** Other high-yield causes include **Molar pregnancy** (Hydatidiform mole), **Macrosomia** (often associated with Gestational Diabetes), and **Uterine Fibroids** complicating pregnancy. * **Initial Investigation:** The first step in management when a "large for dates" uterus is suspected is an **Obstetric Ultrasound** to confirm viability, dating, and fetal number. * **Complications:** Uterine overdistension is a major risk factor for **Postpartum Hemorrhage (PPH)** due to uterine atony and **Preterm Labor** due to excessive stretching of the myometrium.

Practice by Chapter

Preconception Counseling

Practice Questions

Pregnancy Diagnosis and Dating

Practice Questions

Routine Antenatal Assessments

Practice Questions

Maternal Physiological Changes

Practice Questions

Nutrition in Pregnancy

Practice Questions

Screening Tests in Pregnancy

Practice Questions

Fetal Growth Assessment

Practice Questions

High-Risk Pregnancy Identification

Practice Questions

Antenatal Complications Management

Practice Questions

Psychosocial Aspects of Pregnancy

Practice Questions

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