Prenatal Care — MCQs
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Which of the following is NOT a sign of early pregnancy?
A 30-year-old woman, G4P3L3, at 32 weeks of gestation, presents with a 3-month history of increasing fatigability and weakness, significantly impacting her daily activities. She also reports exertional dyspnea for the past 15 days, becoming breathless after climbing two flights of stairs. These symptoms are not associated with palpitations, chest pain, pedal edema, sudden onset dyspnea, cough, decreased urine output, asthma, chronic cough, fever, chills, rigors, gastrointestinal symptoms, bleeding tendencies, or jaundice. She has not taken iron or folate prophylaxis during her pregnancy. Her blood work reveals Hb 7.4 g/dL, Hct 22%, MCV 72 fL, MCH 25 pg, MCHC 30%, and peripheral smear showing microcytic hypochromic RBCs with anisopoikilocytosis. The Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) is negative. What is the most probable diagnosis?
Which of the following laboratory findings is known as a biochemical marker of pre-eclampsia?
What is the approximate percentage decrease in the chance of transmission of HIV to a fetus during pregnancy with the use of antiretroviral prophylaxis?
In which period of pregnancy is cordiocentesis typically performed?
USG examination of an 8-week pregnant female shows a gestational sac with an absent fetal pole. What is the diagnosis?
What is the recommended daily dose of folic acid for treating megaloblastic anemia in pregnancy?
A pregnant patient at 14 weeks gestation tests positive for HBsAg during routine antenatal screening. What is true about her condition?
Estimation of fetal maturity by biparietal diameter measurement is accurate to within + or -:
A 25-year-old woman is G5, P0, Ab4. All of her previous pregnancies ended in spontaneous abortion in the first or second trimester. She is now in the 16th week of her fifth pregnancy and has had no prenatal problems. Laboratory findings include maternal blood type of A positive, negative serologic test for syphilis, and immunity to rubella. Which of the following laboratory studies would be most useful for determining a potential cause of recurrent fetal loss in this patient?
Prenatal Care Indian Medical PG Practice Questions and MCQs
Question 241: Which of the following is NOT a sign of early pregnancy?
- A. Goodell's sign
- B. Hegar's sign
- C. Cullen's sign (Correct Answer)
- D. Palmer's sign
Explanation: **Explanation:** The correct answer is **Cullen’s sign** because it is not a sign of a normal early pregnancy; rather, it is a clinical sign of **intraperitoneal hemorrhage**. It manifests as bluish discoloration (ecchymosis) around the umbilicus and is most commonly associated with a **ruptured ectopic pregnancy** or acute pancreatitis. **Analysis of Options:** * **Goodell’s Sign:** Refers to the significant **softening of the cervix**, typically occurring around 6 weeks of gestation. This is due to increased vascularity and hypertrophy of the cervical glands. * **Hegar’s Sign:** A classic sign where the **lower uterine segment (isthmus) becomes soft** and compressible on bimanual examination. It is usually demonstrable between 6–10 weeks of pregnancy. * **Palmer’s Sign:** Characterized by **rhythmic, regular uterine contractions** felt during a pelvic examination as early as 4–8 weeks. These are painless and occur before the uterus becomes large enough to be felt abdominally. **High-Yield Clinical Pearls for NEET-PG:** * **Chadwick’s Sign:** Bluish discoloration of the cervix, vagina, and labia due to venous congestion (6–8 weeks). * **Osiander’s Sign:** Increased pulsations felt in the lateral vaginal fornices due to increased vascularity (8 weeks). * **Piskacek’s Sign:** Asymmetrical enlargement of the uterus if implantation occurs near one of the cornua (7–8 weeks). * **Cullen’s Sign vs. Grey Turner’s Sign:** While Cullen’s is periumbilical, Grey Turner’s sign involves discoloration of the flanks, both indicating retroperitoneal or intraperitoneal bleeding.
Question 242: A 30-year-old woman, G4P3L3, at 32 weeks of gestation, presents with a 3-month history of increasing fatigability and weakness, significantly impacting her daily activities. She also reports exertional dyspnea for the past 15 days, becoming breathless after climbing two flights of stairs. These symptoms are not associated with palpitations, chest pain, pedal edema, sudden onset dyspnea, cough, decreased urine output, asthma, chronic cough, fever, chills, rigors, gastrointestinal symptoms, bleeding tendencies, or jaundice. She has not taken iron or folate prophylaxis during her pregnancy. Her blood work reveals Hb 7.4 g/dL, Hct 22%, MCV 72 fL, MCH 25 pg, MCHC 30%, and peripheral smear showing microcytic hypochromic RBCs with anisopoikilocytosis. The Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) is negative. What is the most probable diagnosis?
- A. Thalassemia
- B. Iron deficiency anemia (Correct Answer)
- C. Megaloblastic anemia
- D. Vitamin B12 deficiency anemia
Explanation: **Explanation:** The clinical presentation and laboratory findings point directly to **Iron Deficiency Anemia (IDA)**, the most common cause of anemia in pregnancy worldwide. **1. Why Iron Deficiency Anemia is Correct:** * **Clinical History:** The patient is a multiparous woman (G4P3) in her third trimester who has not taken iron prophylaxis. Pregnancy increases iron demand significantly, and lack of supplementation leads to depletion of stores. * **Hematological Indices:** A hemoglobin of 7.4 g/dL indicates moderate anemia. The low **MCV (72 fL)** and **MCH (25 pg)** signify microcytic hypochromic anemia. * **Peripheral Smear:** Anisopoikilocytosis (variation in size and shape) is a hallmark of IDA. * **NESTROFT:** A **negative NESTROFT** is a crucial high-yield finding; it effectively rules out Thalassemia trait, which typically presents with a positive result. **2. Why Other Options are Incorrect:** * **Thalassemia:** While it also presents with microcytic hypochromic indices, the negative NESTROFT and the presence of anisopoikilocytosis (rather than target cells and a normal RDW) make it unlikely. * **Megaloblastic Anemia / Vitamin B12 Deficiency:** These are **macrocytic** anemias. They would present with an **elevated MCV (>100 fL)** and hypersegmented neutrophils on a peripheral smear, which contradicts this patient's low MCV. **Clinical Pearls for NEET-PG:** * **WHO Definition:** Anemia in pregnancy is defined as Hb < 11 g/dL. * **Gold Standard:** Bone marrow iron staining (Prussian blue) is the gold standard for IDA diagnosis, though Serum Ferritin (<15–30 ng/mL) is the most sensitive biochemical test. * **Prophylaxis:** Under the *Anemia Mukt Bharat* guidelines, pregnant women should receive 60 mg elemental iron and 500 mcg folic acid daily for 180 days starting from the second trimester.
Question 243: Which of the following laboratory findings is known as a biochemical marker of pre-eclampsia?
- A. Low platelets
- B. Raised serum Na
- C. Elevated liver enzymes
- D. Serum uric acid (Correct Answer)
Explanation: **Explanation:** **Serum uric acid** is considered a classic biochemical marker for pre-eclampsia. The underlying pathophysiology involves reduced renal perfusion and a decrease in the glomerular filtration rate (GFR). Specifically, pre-eclampsia causes functional changes in the renal tubules, leading to **decreased clearance and increased reabsorption of uric acid**. Hyperuricemia often precedes the clinical onset of hypertension and proteinuria, and its levels correlate significantly with the severity of the disease and adverse perinatal outcomes. **Analysis of Incorrect Options:** * **A & C (Low platelets & Elevated liver enzymes):** While these are critical components of the **HELLP syndrome** (a severe complication of pre-eclampsia), they are considered diagnostic criteria for "pre-eclampsia with severe features" rather than primary biochemical markers used for early identification or screening of the disease process itself. * **B (Raised serum Na):** Sodium levels are generally not used as markers for pre-eclampsia. In fact, due to the activation of the Renin-Angiotensin-Aldosterone System (RAAS) and subsequent edema, there is often water retention, but serum sodium typically remains within the normal range. **High-Yield Clinical Pearls for NEET-PG:** * **Hyperuricemia (>4.5 mg/dL)** is one of the earliest laboratory signs of pre-eclampsia. * **Soluble fms-like tyrosine kinase-1 (sFlt-1)** and **Placental Growth Factor (PlGF)** ratio is the modern "gold standard" biochemical marker for predicting pre-eclampsia. * The most common cause of death in pre-eclampsia is **Cerebral Hemorrhage**, while the most common cause of death in HELLP syndrome is **Hepatic Rupture**.
Question 244: What is the approximate percentage decrease in the chance of transmission of HIV to a fetus during pregnancy with the use of antiretroviral prophylaxis?
- A. 35%
- B. 45%
- C. 50%
- D. 65% (Correct Answer)
Explanation: The correct answer is **D. 65%**. ### **Explanation** The risk of vertical transmission of HIV from mother to child without any intervention is approximately **25–30%**. The landmark **PACTG 076 trial** established that the administration of Zidovudine (AZT) monotherapy during pregnancy, labor, and to the newborn reduces this risk by approximately **two-thirds (66-67%)**, bringing the transmission rate down to about 8%. In modern clinical practice, with Highly Active Antiretroviral Therapy (HAART) and viral load suppression to undetectable levels, the risk can be further reduced to **less than 1%**. However, in the context of standard prophylaxis (as often tested in exams based on classic trials), the 65% reduction is the benchmark figure. ### **Analysis of Incorrect Options** * **A, B, and C:** These percentages (35%, 45%, 50%) underestimate the efficacy of antiretroviral prophylaxis. While any ART provides some benefit, the established clinical standard for the *decrease in risk* is significantly higher than 50%. ### **High-Yield Clinical Pearls for NEET-PG** * **Most common route of transmission:** Intrapartum (during labor and delivery) is the period of highest risk. * **Preferred Regimen (India/WHO):** TLE regimen (Tenofovir + Lamivudine + Efavirenz) was the standard; however, newer guidelines favor **Dolutegravir (DTG)** based regimens. * **Breastfeeding:** In resource-limited settings (like India), exclusive breastfeeding for the first 6 months is recommended if the mother is on ART, as the benefits of nutrition/immunity outweigh the risk of HIV transmission. * **Mode of Delivery:** Elective Cesarean Section (at 38 weeks) is indicated if the maternal viral load is **>1000 copies/mL** near term to further reduce transmission. * **Neonatal Prophylaxis:** Nevirapine syrup is typically given to the infant for 6 weeks (extendable to 12 weeks in high-risk cases).
Question 245: In which period of pregnancy is cordiocentesis typically performed?
- A. 11-14 weeks
- B. 18-20 weeks (Correct Answer)
- C. 22-26 weeks
- D. 28-30 weeks
Explanation: **Explanation:** **Cordocentesis**, also known as Percutaneous Umbilical Blood Sampling (PUBS), is an invasive prenatal diagnostic procedure used to obtain fetal blood directly from the umbilical vein. **Why 18-20 weeks is the correct answer:** The procedure is typically performed after **18 weeks** of gestation. Before this period, the umbilical vein is technically too small and fragile to puncture safely, and the risk of procedure-related pregnancy loss is significantly higher. By 18–20 weeks, the vessel diameter is sufficient to allow for ultrasound-guided needle insertion (usually at the placental insertion site of the cord) with a higher success rate and lower risk of fetal bradycardia or hemorrhage. **Analysis of Incorrect Options:** * **A. 11-14 weeks:** This is the window for Chorionic Villus Sampling (CVS) and Nuchal Translucency (NT) scans. Cordocentesis is not feasible here due to the minute size of the umbilical cord. * **C & D. 22-30 weeks:** While cordocentesis *can* be performed later in pregnancy (e.g., for fetal anemia or late-onset growth restriction), it is not the "typical" or earliest recommended window for primary diagnostic purposes. Non-invasive methods or amniocentesis are often preferred if possible during these stages. **High-Yield Clinical Pearls for NEET-PG:** * **Indications:** Rapid karyotyping (results in 48–72 hours), diagnosis of fetal infections (e.g., Toxoplasmosis, CMV), and management of Rh-isoimmunization (fetal hemoglobin/hematocrit assessment and intrauterine transfusion). * **Complication:** The most common complication is **fetal bleeding** from the puncture site. * **Comparison:** Amniocentesis is typically done at 15–20 weeks; CVS at 10–13 weeks. Cordocentesis has the highest procedure-related loss rate (~1-2%) among the three.
Question 246: USG examination of an 8-week pregnant female shows a gestational sac with an absent fetal pole. What is the diagnosis?
- A. Ectopic pregnancy
- B. Missed abortion
- C. Threatened abortion
- D. Blighted ovum (Correct Answer)
Explanation: ### Explanation **Correct Option: D. Blighted Ovum (Anembryonic Pregnancy)** A **Blighted Ovum** occurs when a fertilized egg attaches to the uterine wall, but the embryo fails to develop. On ultrasonography (USG), the diagnostic hallmark is a **gestational sac (GS) that is empty**, meaning it lacks a fetal pole (embryo) or a yolk sac despite the sac reaching a certain size. According to current criteria, a diagnosis of anembryonic pregnancy is made when the **Mean Sac Diameter (MSD) is ≥25 mm** without a visible embryo on transvaginal scan (TVS). At 8 weeks of gestation, a fetal pole should normally be clearly visible; its absence confirms the diagnosis. **Why other options are incorrect:** * **A. Ectopic pregnancy:** This refers to implantation outside the uterine cavity (most commonly in the ampulla of the fallopian tube). The question specifies the presence of a gestational sac, implying an intrauterine location. * **B. Missed abortion:** In a missed abortion, the embryo/fetus has formed but has died in utero. USG would typically show a fetal pole with **absent cardiac activity**. In a blighted ovum, the fetal pole never develops. * **C. Threatened abortion:** This is a clinical diagnosis characterized by vaginal bleeding in the presence of a **viable** intrauterine pregnancy with a closed cervical os. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause:** Chromosomal abnormalities (usually autosomal trisomies) are responsible for ~50% of blighted ova. * **Discriminatory Zone:** On TVS, a yolk sac should appear when MSD is **16-20 mm**, and a fetal pole must be seen when MSD is **>25 mm**. * **Management:** Options include expectant management, medical evacuation (Misoprostol), or surgical suction and evacuation.
Question 247: What is the recommended daily dose of folic acid for treating megaloblastic anemia in pregnancy?
- A. 400 μg
- B. 1 mg (Correct Answer)
- C. 5 mg
- D. 2 mg
Explanation: **Explanation:** The correct answer is **1 mg (Option B)**. **Understanding the Medical Concept:** Megaloblastic anemia in pregnancy is most commonly caused by **folate deficiency** due to increased fetal demand and maternal physiological changes. While the prophylactic dose for a healthy pregnancy is much lower, the **therapeutic dose** required to treat established megaloblastic anemia is **1 mg of folic acid daily**. This dose is sufficient to induce a hematologic response (reticulocytosis) and replenish depleted stores, even in the presence of mild malabsorption. **Analysis of Options:** * **Option A (400 μg):** This is the **prophylactic dose** recommended for all low-risk pregnant women to prevent Neural Tube Defects (NTDs). It is insufficient for treating active megaloblastic anemia. * **Option C (5 mg):** This is the high-dose prophylaxis recommended for women at **high risk of NTDs** (e.g., previous child with NTD, maternal diabetes, or women on anti-epileptic drugs). While safe, it exceeds the standard therapeutic requirement for simple megaloblastic anemia. * **Option D (2 mg):** This is not a standard recommended dose in international or national (FOGSI/IAP) guidelines for this specific condition. **High-Yield Clinical Pearls for NEET-PG:** * **Prophylaxis (Low Risk):** 400 μg (0.4 mg) daily starting 1 month pre-conception until 12 weeks of gestation. * **Prophylaxis (High Risk):** 5 mg daily. * **Treatment of Megaloblastic Anemia:** 1 mg daily + Iron supplementation (as iron deficiency often co-exists, termed "dimorphic anemia"). * **Diagnosis:** Look for hypersegmented neutrophils on peripheral smear and macrocytosis (MCV >100 fL). * **Caution:** Always rule out Vitamin B12 deficiency before giving high-dose folic acid to avoid precipitating subacute combined degeneration of the spinal cord (though B12 deficiency is rarer in pregnancy than folate deficiency).
Question 248: A pregnant patient at 14 weeks gestation tests positive for HBsAg during routine antenatal screening. What is true about her condition?
- A. This condition significantly increases maternal morbidity.
- B. There is a high risk of intrauterine growth restriction (IUGR) and intrauterine death (IUD).
- C. Hepatitis B surface antigen (HBsAg) is the earliest serological marker of infection. (Correct Answer)
- D. Lamivudine is the first-line treatment.
Explanation: **Explanation:** **1. Why Option C is correct:** Hepatitis B surface antigen (HBsAg) is the hallmark of HBV infection. It is the **earliest serological marker** to appear in the blood, typically detectable 1 to 10 weeks after exposure and well before the onset of clinical symptoms or elevation of liver enzymes (ALT). Its persistence for more than 6 months defines chronic hepatitis B. **2. Why the other options are incorrect:** * **Option A:** In most cases, asymptomatic chronic HBV infection does **not** significantly increase maternal morbidity or mortality during pregnancy. Pregnancy does not worsen the course of the disease unless the patient has pre-existing cirrhosis. * **Option B:** HBV infection is generally not associated with an increased risk of teratogenicity, IUGR, or IUD. The primary concern is vertical transmission to the neonate, not fetal growth restriction. * **Option D:** While Lamivudine was used historically, **Tenofovir (TDF)** is now the first-line antiviral agent for pregnant women with high viral loads (>200,000 IU/mL) due to its superior efficacy and lower risk of resistance. **High-Yield Clinical Pearls for NEET-PG:** * **Vertical Transmission:** Most transmissions occur **intrapartum** (during delivery). * **HBeAg Status:** If the mother is HBeAg positive, the risk of vertical transmission is ~90%; if HBeAg negative, it is ~10-20%. * **Neonatal Prophylaxis:** Infants born to HBsAg+ mothers must receive both the **HBV vaccine** and **Hepatitis B Immunoglobulin (HBIG)** within 12 hours of birth. This reduces transmission risk by >90%. * **Breastfeeding:** Is **not** contraindicated in HBV-positive mothers, provided the infant receives the appropriate immunoprophylaxis at birth.
Question 249: Estimation of fetal maturity by biparietal diameter measurement is accurate to within + or -:
- A. 3-7 days (Correct Answer)
- B. 7-10 days
- C. 10-15 days
- D. 14-20 days
Explanation: **Explanation:** The estimation of gestational age (GA) via ultrasound relies on different biometric parameters depending on the trimester. The **Biparietal Diameter (BPD)** is most accurate when measured between **12 and 20 weeks** of gestation. During this window, fetal growth is rapid and biological variation is minimal, allowing for an accuracy of **± 3 to 7 days**. * **Why Option A is correct:** In the early second trimester (specifically 14–20 weeks), the BPD is the standard parameter for dating. The predictive value is highest here because the brain growth is consistent across fetuses. As pregnancy advances, individual genetic potential and environmental factors (like IUGR or macrosomia) increase variability. * **Why Options B, C, and D are incorrect:** These ranges (7–20 days) represent the decreasing accuracy of BPD in the later stages of pregnancy. By the third trimester (after 26–30 weeks), the accuracy of BPD drops significantly to ± 2 to 3 weeks due to variations in fetal head shape (dolichocephaly or brachycephaly) and growth rates. **High-Yield Clinical Pearls for NEET-PG:** 1. **Best Overall Parameter:** Crown-Rump Length (CRL) in the first trimester (7–12 weeks) is the most accurate method for dating, with an accuracy of **± 3 to 5 days**. 2. **BPD Landmarks:** To ensure accuracy, BPD must be measured at the level of the **thalami** and **cavum septum pellucidum**. 3. **Transcerebellar Diameter (TCD):** This is the only parameter that remains reliable even in cases of IUGR, as the cerebellum is "spared" from growth restriction. 4. **Rule of Thumb:** The later the ultrasound is performed, the less accurate it is for dating the pregnancy.
Question 250: A 25-year-old woman is G5, P0, Ab4. All of her previous pregnancies ended in spontaneous abortion in the first or second trimester. She is now in the 16th week of her fifth pregnancy and has had no prenatal problems. Laboratory findings include maternal blood type of A positive, negative serologic test for syphilis, and immunity to rubella. Which of the following laboratory studies would be most useful for determining a potential cause of recurrent fetal loss in this patient?
- A. Amniocentesis with chromosomal analysis (Correct Answer)
- B. Genetic analysis of the CFTR gene
- C. Maternal serum antibody screening
- D. Maternal serum a-fetoprotein determination
Explanation: ### Explanation **Correct Option: A. Amniocentesis with chromosomal analysis** The patient presents with **Recurrent Pregnancy Loss (RPL)**, defined as two or more failed clinical pregnancies. Genetic abnormalities, particularly **balanced translocations** in parents or **fetal aneuploidy**, are leading causes of recurrent loss. Since the patient is currently at 16 weeks gestation, amniocentesis is the most appropriate diagnostic tool to perform fetal karyotyping. This helps determine if the current fetus has a chromosomal abnormality that explains the previous losses or indicates a parental carrier state (like a Robertsonian translocation). **Why Incorrect Options are Wrong:** * **B. Genetic analysis of the CFTR gene:** This is used to screen for Cystic Fibrosis. While important for carrier screening, CFTR mutations do not typically cause recurrent first or second-trimester spontaneous abortions. * **C. Maternal serum antibody screening:** This is primarily used to detect Rh isoimmunization or atypical antibodies. Since the patient is **A positive**, Rh incompatibility is not the concern, and these antibodies cause fetal hydrops/anemia rather than recurrent early abortions. * **D. Maternal serum α-fetoprotein (MSAFP):** This is a screening tool for neural tube defects (NTDs) and certain chromosomal trisomies (when part of a quadruple screen). It does not provide a definitive diagnosis for the *cause* of recurrent pregnancy loss. **Clinical Pearls for NEET-PG:** * **Definition of RPL:** ≥2 consecutive pregnancy losses (ASRM criteria). * **Most common cause of sporadic abortion:** Autosomal trisomy (Trisomy 16 is most common). * **Investigation of RPL:** Should include parental karyotyping, uterine anatomy evaluation (HSG/Hysteroscopy), and screening for **Antiphospholipid Syndrome (APLA)**—the most common treatable cause. * **Timing:** Amniocentesis is ideally performed between **15–20 weeks** of gestation.
Practice by Chapter
Preconception Counseling
Practice Questions
Pregnancy Diagnosis and Dating
Practice Questions
Routine Antenatal Assessments
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Maternal Physiological Changes
Practice Questions
Nutrition in Pregnancy
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Screening Tests in Pregnancy
Practice Questions
Fetal Growth Assessment
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High-Risk Pregnancy Identification
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Antenatal Complications Management
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Psychosocial Aspects of Pregnancy
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