Prenatal Care Practice Questions

Q: The daily requirement of iron during second half of pregnancy is :

6 mg per day. ***6 mg per day*** - This represents the **additional absorbed elemental iron** required during the second half of pregnancy (beyond the non-pregnant requirement of ~1-2 mg/day). - The increased demand is due to **fetal growth** (300-400 mg total), **placental development** (50-75 mg), **expansion of maternal red cell mass** (450 mg), and **blood loss at delivery** (150-250 mg). - **Important distinction**: This is the *absorbed* requirement. Since iron absorption from the gut is only 10-20%, the actual **oral supplementation** recommended is much higher: **100-200 mg of elemental iron daily** (as per WHO/ICMR guidelines). - In India, the standard National Iron+ Initiative provides **100 mg elemental iron + 500 mcg folic acid** daily during pregnancy. *2 mg per day* - This represents approximately the **basal iron requirement** for non-pregnant women, which is insufficient for pregnancy. - Would lead to **severe maternal iron-deficiency anemia** and poor fetal outcomes. *20 mg per day* - While higher than baseline, this is still insufficient as absorbed iron requirement. - However, this could represent a fraction of the therapeutic supplementation dose. *10 mg per day* - This exceeds the absorbed requirement but is far below the recommended **oral supplementation dose** of 100-200 mg. - Reflects neither the absorbed requirement nor the standard supplementation protocol. **Clinical Pearl**: When discussing iron in pregnancy, always clarify whether referring to *absorbed* iron (5-6 mg/day additional) or *supplemental* oral iron (100-200 mg/day).

Q: Determination of alpha-fetoprotein levels in maternal serum is a useful screening tool for

neural tube defects. ***Correct: neural tube defects*** - Elevated maternal serum **alpha-fetoprotein (AFP)** is a key indicator for open **neural tube defects** because the fetal tissue leaks AFP into the amniotic fluid and then into the maternal circulation. - This screening tool is sensitive enough to detect conditions like **spina bifida** and **anencephaly**. - Typically performed at **15-20 weeks gestation** as part of the triple or quad screen. *Incorrect: Duchenne muscular dystrophy* - This is a **genetically inherited X-linked recessive disorder** primarily diagnosed through genetic testing or muscle biopsy, not maternal serum AFP levels. - While **creatine kinase (CK)** levels can be elevated in affected individuals, it is not a prenatal AFP screening target. *Incorrect: phenylketonuria* - **Phenylketonuria (PKU)** is an inborn error of metabolism, typically screened for postnatally using a **newborn heel prick test** to detect elevated phenylalanine levels. - Maternal serum AFP is not used for its detection; the condition is managed by a special diet. *Incorrect: congenital hypothyroidism* - **Congenital hypothyroidism** is identified through **newborn screening programs** that measure levels of **thyroid-stimulating hormone (TSH)** or **thyroxine (T4)** from a heel prick. - Maternal serum AFP has no role in the screening or diagnosis of this condition.

Q: Which of the following is NOT a component of the combined prenatal screening test in the first trimester?

2. MS AFP (α-Fetoprotein). ***2. MS AFP (α-Fetoprotein)*** - **MS AFP (maternal serum α-Fetoprotein)** is primarily used in the **second-trimester screening** (quad screen or triple screen) to detect **neural tube defects** and certain chromosomal abnormalities. - It is **NOT part of the first-trimester combined screening test**. - The first trimester combined screening is performed between **11-13+6 weeks** of gestation. *1. β-hCG* - **β-hCG** (beta-human chorionic gonadotropin) is a key biochemical marker used in the first-trimester combined screening. - Abnormal levels of **β-hCG** (elevated in Down syndrome, decreased in Trisomy 18) are integrated with other markers to calculate risk for chromosomal abnormalities. *3. Nuchal translucency* - **Nuchal translucency (NT)** measurement is a crucial ultrasound marker used in the first-trimester combined screening test. - Increased NT thickness (≥3.5 mm) is associated with a higher risk of **aneuploidies** (Down syndrome, Trisomy 18, Trisomy 13) and certain structural cardiac defects. *4. PAPP-A* - **PAPP-A** (Pregnancy-Associated Plasma Protein-A) is a biochemical marker included in the first-trimester combined screening. - Low levels of **PAPP-A** are associated with an increased risk of Down syndrome and other adverse pregnancy outcomes.

Q: Vaccines that can be safely given during pregnancy are the following except

Rubella. ***Rubella*** - The **rubella vaccine** is a **live attenuated vaccine** and is **contraindicated in pregnancy** due to the theoretical risk of congenital rubella syndrome, although no cases have been reported from vaccination during pregnancy. - Women should be vaccinated *before* pregnancy or postpartum, and advised to avoid conception for at least four weeks after vaccination. *Influenza* - The **inactivated influenza vaccine** is highly recommended during **any trimester of pregnancy** to protect both the mother and the newborn from severe influenza-related complications. - Pregnancy alters the immune system and cardiopulmonary function, increasing the risk of severe illness from influenza. *Pneumococcus* - The **pneumococcal polysaccharide vaccine (PPSV23)** and **pneumococcal conjugate vaccine (PCV13)** are considered **safe for pregnant women** who meet the indications for vaccination (e.g., chronic medical conditions). - These vaccines provide protection against serious invasive pneumococcal diseases. *Tetanus* - The **tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine** is **recommended during each pregnancy**, preferably between 27 and 36 weeks gestation. - It provides critical protection against **pertussis** for the newborn and tetanus immunity for the mother.

Q: Consider the following markers: 1. Nuchal translucency 2. PAPP-A 3. GTT 4. Inhibin A Which of the above markers are included in the first trimester screening of Down's syndrome?

1 and 2. ***1 and 2*** - **Nuchal translucency (NT)** measurement and **Pregnancy-associated plasma protein A (PAPP-A)** are the key components of first-trimester screening for Down syndrome (combined test at 11-14 weeks). - Increased NT thickness (≥3.5 mm) and low PAPP-A levels are associated with higher risk of **trisomy 21 (Down syndrome)**. - This is typically combined with free β-hCG for the complete first-trimester combined screening. *2, 3 and 4* - This option incorrectly includes **GTT (Glucose Tolerance Test)**, which screens for **gestational diabetes mellitus**, not chromosomal abnormalities. - **Inhibin A** is a marker used in **second-trimester screening** (quadruple test at 15-20 weeks), not first trimester. - It correctly includes PAPP-A but omits the essential NT measurement. *1 and 4* - This option correctly includes **Nuchal translucency** but incorrectly adds **Inhibin A**. - **Inhibin A** is elevated in Down syndrome but is measured in the **second trimester** as part of the quad screen (AFP, hCG, uE3, Inhibin A). - It omits **PAPP-A**, which is the crucial biochemical marker for first-trimester screening. *2 and 3 only* - This option correctly includes **PAPP-A** but incorrectly includes **GTT**, which is completely unrelated to aneuploidy screening. - It omits **Nuchal translucency**, the most important ultrasound marker in first-trimester Down syndrome screening. - GTT is performed at 24-28 weeks for gestational diabetes screening.

Q: Consider the following statements: 1. The placenta is usually located in the upper uterine segment. 2. The placenta is usually located in the lower uterine segment. 3. The placenta is usually located in the fundus. 4. The placenta is usually located in the anterior uterine wall. Which one of the statements given above are correct ?

1 and 3 only. ***1 and 3 only*** - The placenta typically implants in the **upper uterine segment** and often extends to the **fundus**, providing a robust blood supply and optimal conditions for fetal growth. - An implantation in the **upper uterine segment** or **fundus** ensures that as the uterus grows, the placenta moves away from the cervix, reducing the risk of placenta previa. *1, 3 and 4* - While the placenta can be located in the **anterior uterine wall**, this is not a universal characteristic as it can also be posterior, lateral, or even fundal. - The core locations for healthy placental implantation are the **upper uterine segment** and **fundus**, which are accurately captured in statements 1 and 3. *1, 2 and 3* - The statement that the placenta is usually located in the **lower uterine segment** (statement 2) is incorrect; this location is associated with **placenta previa**, a complication [1]. - Healthy placental implantation avoids the **lower uterine segment** to prevent issues during labour and delivery. *2 and 3 only* - This option incorrectly states that the placenta is usually located in the **lower uterine segment** (statement 2), which is generally considered abnormal. - While location in the **fundus** (statement 3) is correct, combining it with an incorrect primary location makes this option invalid.

Q: During pregnancy, vaccination can be given against all these diseases except :

Mumps. ***Mumps*** - The **mumps vaccine** is a **live attenuated vaccine**, meaning it contains a weakened form of the virus. - Live attenuated vaccines are generally **contraindicated in pregnancy** due to the theoretical risk of transmitting the vaccine virus to the fetus. *Hepatitis A* - The **Hepatitis A vaccine** is an **inactivated (killed) vaccine**. - Inactivated vaccines are generally considered **safe during pregnancy** if there's a significant risk of exposure. *Tetanus* - The **tetanus toxoid vaccine (Tdap)** is recommended during every pregnancy to protect the newborn from **pertussis (whooping cough)** and provide maternal protection against tetanus. - It is an **inactivated vaccine** and is very safe for both mother and fetus. *Hepatitis B* - The **Hepatitis B vaccine** is a **recombinant vaccine**, meaning it's made from a component of the virus. - It is considered **safe in pregnancy** and is recommended for pregnant women at risk of acquiring hepatitis B.

Q: Which of the following haematological parameters does not undergo a physiological increase during normal pregnancy?

Platelet count. ***Platelet count*** - The **platelet count** typically **decreases** or remains stable during normal pregnancy due to hemodilution and increased consumption. - A significant increase in platelet count can be indicative of **pathological conditions** rather than a physiological adaptation. *Blood volume* - **Blood volume** physiologically **increases** during pregnancy by approximately 30-50% to meet the metabolic demands of the fetus and placenta. - This expansion primarily involves an increase in **plasma volume**, contributing to physiological anemia. *Red cell volume* - The **red cell volume** also **increases** during pregnancy, though usually to a lesser extent (around 18-30%) than plasma volume. - This increase is due to elevated **erythropoietin levels** stimulating red blood cell production, helping to increase oxygen-carrying capacity. *Leukocyte count* - The **leukocyte (white blood cell) count** physiologically **increases** during pregnancy, particularly neutrophils, often peaking in the third trimester. - This mild leukocytosis is a normal response to the physiological stress of pregnancy and is not indicative of infection.

Question 1

The daily requirement of iron during second half of pregnancy is :

Accepted Answer

6 mg per day

Answer

2 mg per day

Answer

20 mg per day

Answer

10 mg per day

Question 2

Determination of alpha-fetoprotein levels in maternal serum is a useful screening tool for

Accepted Answer

neural tube defects

Answer

Duchenne muscular dystrophy

Answer

phenylketonuria

Answer

congenital hypothyroidism

Question 3

Which of the following is NOT a component of the combined prenatal screening test in the first trimester?

Accepted Answer

2. MS AFP (α-Fetoprotein)

Answer

1. β-hCG

Answer

4. PAPP-A

Answer

3. Nuchal translucency

Question 4

Regarding the phenomenon of ‘lightening’ in primigravida at term pregnancy, which one of the following statements is correct?

Accepted Answer

It is a welcome sign since it indicates descent fetal head into pelvis.

Answer

It occurs earlier in primigravida compared to multigravida.

Answer

There are no bladder or bowel symptoms associated with this phenomenon.

Answer

It is associated with worsening cardiorespiratory embarrassment in mother.

Question 5

Which of the following best defines gestational hypertension?

Accepted Answer

Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 20 weeks of gestation in a previously normotensive woman

Answer

Sustained rise of blood pressure to 140/90 mmHg or more on two occasions 4-6 hours apart with proteinuria after 20 weeks of gestation

Answer

Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 12 weeks of gestation

Answer

Sustained rise of blood pressure to 150/100 mmHg or more on at least two occasions 2 hours apart after 20 weeks of gestation

Question 6

Vaccines that can be safely given during pregnancy are the following except

Accepted Answer

Rubella

Answer

Influenza

Answer

Pneumococcus

Answer

Tetanus

Question 7

Consider the following markers:

1. Nuchal translucency
2. PAPP-A
3. GTT
4. Inhibin A

Which of the above markers are included in the first trimester screening of Down's syndrome?

Accepted Answer

1 and 2

Answer

2, 3 and 4

Answer

1 and 4

Answer

2 and 3 only

Question 8

Consider the following statements:
1. The placenta is usually located in the upper uterine segment.
2. The placenta is usually located in the lower uterine segment.
3. The placenta is usually located in the fundus.
4. The placenta is usually located in the anterior uterine wall.

Which one of the statements given above are correct ?

Accepted Answer

1 and 3 only

Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2 and 3 only

Question 9

During pregnancy, vaccination can be given against all these diseases except :

Accepted Answer

Mumps

Answer

Hepatitis A

Answer

Tetanus

Answer

Hepatitis B

Question 10

Which of the following haematological parameters does not undergo a physiological increase during normal pregnancy?

Accepted Answer

Platelet count

Answer

Blood volume

Answer

Red cell volume

Answer

Leukocyte count

Prenatal Care — MCQs

Prenatal Care — MCQs

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