Prenatal Care Practice Questions

Q: A multipara with 8 gm% haemoglobin at 30 weeks’ gestation should be treated by:

Oral iron therapy. ***Oral iron therapy*** - A hemoglobin level of 8 g/dL at 30 weeks' gestation indicates **moderate anemia**, which is typically manageable with oral iron supplementation in the first instance. - Oral iron is the **least invasive**, most cost-effective, and generally safest treatment for iron-deficiency anemia in pregnancy, allowing time for correction before delivery. *Packed cell transfusion* - **Blood transfusions** are generally reserved for severe anemia (Hb < 7 g/dL), acute hemorrhage, or when rapid correction is necessary due to maternal or fetal compromise. - Transfusions carry risks such as **transfusion reactions** and **infection**, making them less preferable for moderate, stable anemia. *Parenteral iron* - **Intravenous iron** is indicated for moderate to severe anemia when oral iron is not tolerated, absorbed poorly, or when a faster correction is needed than oral iron can provide (e.g., closer to term). - While faster than oral iron, it is more invasive and carries a higher risk of **adverse reactions** compared to oral iron. *Whole blood transfusion* - **Whole blood transfusions** are rarely used in modern obstetric practice. - They are typically reserved for massive hemorrhage with significant blood loss and hypovolemic shock, which is not the case here.

Q: Which one of the following cardiovascular parameters decreases during pregnancy?

Arterial blood pressure. ***Arterial blood pressure*** - During pregnancy, **arterial blood pressure** typically decreases, particularly in the **second trimester**. - **Diastolic blood pressure** falls by 10-15 mmHg, while systolic BP remains relatively stable or decreases slightly (0-10 mmHg). - This decrease is primarily due to a significant reduction in **systemic vascular resistance (20-30% decrease)** caused by vasodilatory effects of **progesterone**, prostacyclin, and nitric oxide. - Blood pressure gradually returns toward pre-pregnancy levels in the third trimester. *Blood volume* - **Blood volume** increases significantly during pregnancy by **30-50%**, with plasma volume increasing more than red cell mass. - This hypervolemia is essential to meet increased metabolic demands and accommodate uteroplacental circulation. *Cardiac output* - **Cardiac output** increases by **30-50%** during pregnancy, peaking around 28-32 weeks. - This rise is achieved through increased **stroke volume** (30%) and **heart rate** (10-20 bpm). *Red cell mass* - **Red cell mass** increases by approximately **20-30%** during pregnancy due to increased erythropoietin production. - The proportionally greater increase in plasma volume leads to physiological anemia of pregnancy (dilutional effect).

Q: Consider the following statements regarding changes in pregnancy: 1. Plasma volume increases up to 30–50% 2. Pregnancy is a hypercoagulable state 3. Hematocrit is decreased 4. Total plasma protein concentration increases Which of the statements given above is/are correct?

1, 2 and 3 only. ***1, 2 and 3 only*** - **Statement 1 is correct**: Plasma volume increases significantly by **30-50%** during pregnancy, representing a key physiological adaptation. - **Statement 2 is correct**: Pregnancy is inherently a **hypercoagulable state** due to increased clotting factors (I, VII, VIII, IX, X, fibrinogen), decreased protein S, and reduced fibrinolysis—an adaptive mechanism to prevent excessive bleeding during delivery. - **Statement 3 is correct**: Hematocrit **decreases** due to physiological hemodilution; plasma volume increases proportionally more (40-50%) than red blood cell mass (20-30%), resulting in physiological anemia of pregnancy. - **Statement 4 is incorrect**: Total plasma protein concentration actually **decreases** during pregnancy (not increases) due to the hemodilution effect; albumin typically decreases from ~4.0 to ~3.0 g/dL. *1 and 2 only* - While statements 1 and 2 are correct, this option incorrectly excludes **statement 3 (decreased hematocrit)**, which is a well-established physiological change during pregnancy caused by hemodilution. *1 only* - Statement 1 is correct, but this option excludes both the **hypercoagulable state (statement 2)** and **decreased hematocrit (statement 3)**, which are both fundamental pregnancy-related changes. *1, 2, 3 and 4* - Statements 1, 2, and 3 are all correct. However, **statement 4 is incorrect** because total plasma protein concentration **decreases** (not increases) during pregnancy due to the disproportionate increase in plasma volume compared to protein synthesis. *3 and 4 only* - Statement 3 is correct, but **statement 4 is incorrect** (plasma protein concentration decreases, not increases). Additionally, this option incorrectly excludes statements 1 and 2, which are both correct and represent important physiological adaptations in pregnancy.

Q: Consider the following hemodynamic changes occurring during pregnancy: 1. Increase in cardiac output 2. Increase in stroke volume 3. Increase in colloid oncotic pressure 4. Increase in pulse rate Which of the statements given above are correct?

1, 2 and 4. ***Correct Answer: 1, 2 and 4*** **Statement 1: Increase in cardiac output** - CORRECT - Cardiac output increases by **30-50% during pregnancy**, peaking at 28-32 weeks - This increase is driven by increased blood volume (40-50% increase), higher metabolic demands, and the need to perfuse the uteroplacental unit **Statement 2: Increase in stroke volume** - CORRECT - Stroke volume increases by **20-30% during pregnancy**, particularly in the first and second trimesters - This contributes significantly to the overall increase in cardiac output alongside increased heart rate **Statement 3: Increase in colloid oncotic pressure** - INCORRECT - Colloid oncotic pressure actually **decreases during pregnancy** from normal values of 25-28 mmHg to approximately 22-24 mmHg - This occurs due to **hemodilution** (plasma volume increases more than red cell mass) and **decreased serum albumin concentration** (dilutional hypoalbuminemia) - The reduced oncotic pressure contributes to the **increased tendency for peripheral edema** in pregnant women **Statement 4: Increase in pulse rate** - CORRECT - Heart rate increases by **10-20 beats per minute** during pregnancy - This tachycardia helps maintain adequate cardiac output to meet the increased circulatory demands of pregnancy *Incorrect Options:* *1, 3 and 4* - Statement 3 is incorrect as colloid oncotic pressure decreases, not increases *2, 3 and 4* - Statement 3 is incorrect as colloid oncotic pressure decreases during pregnancy *1, 2 and 3* - Statement 3 is incorrect; colloid oncotic pressure falls due to hemodilution and hypoalbuminemia

Q: The clinical feature of physiological edema in pregnancy is:

disappears or markedly reduced on rest. ***disappears or markedly reduced on rest*** - **Physiological edema** in pregnancy is typically mild and **dependent**, meaning it tends to accumulate in the lower extremities due to **gravity** and increased venous pressure. - When the pregnant individual rests, especially in an elevated position, the gravitational pressure on the lower limbs is reduced, allowing for the **redistribution of fluid** and a decrease in visible swelling. *is usually of moderate or severe grade* - **Physiological edema** is typically **mild** and localized to the ankles and feet. - **Moderate or severe edema**, especially if sudden in onset, generalized, or associated with other symptoms, might indicate a pathological condition like **preeclampsia** or **cardiac dysfunction**. *is associated with cardiac or renal pathology* - **Physiological edema** is a normal part of pregnancy, resulting from hormonal changes, increased blood volume, and uterine pressure, and is **not indicative** of underlying cardiac or renal disease. - Edema linked to **cardiac** or **renal pathology** would typically be more severe, generalized, and accompanied by other specific symptoms or laboratory abnormalities related to the respective organ systems. *is present on both lower limbs and abdomen* - **Physiological edema** predominantly affects the **lower limbs** (ankles, feet, sometimes hands and face) due to gravity and venous stasis, becoming more noticeable later in the day. - While some mild abdominal swelling can occur due to uterine growth, significant **abdominal wall edema** is not a characteristic feature of physiological edema and could suggest other causes.

Q: During pregnancy iron supplementation is needed for

all pregnant mothers from 16 weeks onwards. ***all pregnant mothers from 16 weeks onwards*** - **Physiological anemia** of pregnancy typically manifests around the **second trimester**, necessitating prophylactic iron supplementation. - Starting at **16 weeks** ensures adequate iron stores before the greatest increase in maternal red cell mass and fetal iron demands. *all pregnant mothers since 6 weeks of pregnancy* - Iron requirements do not significantly increase until the **second trimester**, so starting supplementation at **6 weeks** is unnecessarily early for most women. - Early supplementation can lead to side effects like **nausea and constipation** in the first trimester, potentially reducing compliance. *only those pregnant mothers who have Hb < 10 gm%* - Waiting until **hemoglobin levels drop below 10 gm/dL** indicates **established anemia**, which should ideally be prevented. - **Prophylactic supplementation** is recommended for all pregnant women to prevent iron deficiency before it becomes clinically apparent. *only those pregnant mothers who are not eating green vegetables* - While green vegetables are a source of **non-heme iron**, the bioavailability is lower than heme iron, and adequate intake is often insufficient to meet the significantly increased demands of pregnancy. - Dietary intake alone is often **not enough to prevent iron deficiency** in pregnancy, regardless of vegetable consumption patterns.

Q: Blood volume increases during pregnancy above nonpregnant level at 30-34 weeks by:

by 40-50 per cent. ***by 40-50 per cent*** - During pregnancy, **blood volume significantly increases**, primarily due to hormonal changes, to support the growing fetus and uteroplacental unit, with the peak increase typically occurring around the third trimester. - This expansion involves both **plasma volume (greater increase)** and **red blood cell mass**, leading to a state of physiologic hemodilution. *Blood volume does not increase at all* - This statement is incorrect as a substantial **increase in blood volume is a hallmark of normal pregnancy physiology** to meet increased metabolic demands. - Failure of blood volume to increase would imply a pathologic state, potentially compromising both maternal and fetal well-being. *by 25-30 per cent* - While a significant increase, **25-30% is generally an underestimation** of the full extent of blood volume expansion that occurs in a healthy pregnancy. - The total increase often reaches higher values, particularly when considering the combined rise in plasma and red blood cells. *by 10-20 per cent* - An increase of **10-20% is considerably less** than what is typically observed during a normal pregnancy. - This level of increase would likely be insufficient to adequately support the physiological demands of the mother and fetus.

Q: Ideal weight gain during pregnancy for a woman with normal BMI should be

11-16 kg. ***11-16 kg*** - For a woman with a **normal Body Mass Index (BMI)** (18.5-24.9), the recommended total weight gain during pregnancy is **11.5 to 16 kg (25 to 35 lbs)**. - This range supports optimal fetal growth and maternal health, reducing risks associated with both inadequate and excessive weight gain. *More than 18 kg* - Gaining more than **18 kg (40 lbs)** during pregnancy, especially for women with a normal BMI, is generally considered **excessive**. - This can increase the risk of complications such as **gestational diabetes**, **hypertension**, **macrosomia**, and **cesarean delivery**. *7 kg* - A total weight gain of only **7 kg (15 lbs)** for a woman with a normal BMI during pregnancy is typically considered **insufficient**. - Inadequate weight gain can lead to a higher risk of delivering a **low birth weight infant** or one who is **small for gestational age**. *18 kg* - A weight gain of **18 kg (approximately 40 lbs)** **exceeds the recommended range** for women with a normal BMI (11.5-16 kg). - This represents the **upper limit** of recommended weight gain for **underweight women** (BMI <18.5), whose target range is 12.5-18 kg (28-40 lbs). - For normal BMI women, 18 kg is considered **excessive** and may increase risks of maternal and fetal complications.

Q: The gestational sac is first visible on transvaginal USG by:

35 days. ***35 days*** - A **gestational sac** can first be reliably visualized via **transvaginal ultrasonography** at approximately **35 days** after the last menstrual period (around **5 weeks gestational age**). - At this stage, it appears as a small, anechoic (fluid-filled) structure within the **endometrial cavity**, indicating an early intrauterine pregnancy. - This corresponds to a **β-hCG level** of approximately **1000-2000 mIU/mL**, which is the discriminatory zone for transvaginal ultrasound. *30 days* - At **30 days** (approximately 4 weeks + 2 days gestational age), the gestational sac is typically **too small** to be consistently visualized even with transvaginal ultrasound. - While some early sacs may be detected, **30 days** is generally considered **too early** for reliable detection in most cases. - Detection at this stage would be inconsistent and not the standard timeframe cited in obstetric practice. *42 days* - By **42 days** (6 weeks gestational age), the gestational sac is well-established and clearly visible. - At this point, a **yolk sac** is almost always present within the gestational sac, and often a **fetal pole** may be identified. - This represents a later stage, not the *first* time the gestational sac can be detected. *49 days* - By **49 days** (7 weeks gestational age), not only is the **gestational sac** clearly visible, but a **yolk sac** and **fetal pole** with **cardiac activity** are typically identifiable. - This time frame represents a much later stage of pregnancy visualization, well beyond the initial appearance of the gestational sac.

Question 1

A multipara with 8 gm% haemoglobin at 30 weeks’ gestation should be treated by:

Accepted Answer

Oral iron therapy

Answer

Packed cell transfusion

Answer

Parenteral iron

Answer

Whole blood transfusion

Question 2

Which one of the following cardiovascular parameters decreases during pregnancy?

Accepted Answer

Arterial blood pressure

Answer

Blood volume

Answer

Cardiac output

Answer

Red cell mass

Question 3

Consider the following statements regarding changes in pregnancy:

1. Plasma volume increases up to 30–50%
2. Pregnancy is a hypercoagulable state
3. Hematocrit is decreased
4. Total plasma protein concentration increases

Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3 only

Answer

1 and 2 only

Answer

1 only

Answer

1, 2, 3 and 4

Answer

3 and 4 only

Question 4

Consider the following hemodynamic changes occurring during pregnancy:

1. Increase in cardiac output
2. Increase in stroke volume
3. Increase in colloid oncotic pressure
4. Increase in pulse rate
Which of the statements given above are correct?

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Question 5

The clinical feature of physiological edema in pregnancy is:

Accepted Answer

disappears or markedly reduced on rest

Answer

is usually of moderate or severe grade

Answer

is associated with cardiac or renal pathology

Answer

is present on both lower limbs and abdomen

Question 6

During pregnancy iron supplementation is needed for

Accepted Answer

all pregnant mothers from 16 weeks onwards

Answer

all pregnant mothers since 6 weeks of pregnancy

Answer

only those pregnant mothers who have Hb < 10 gm%

Answer

only those pregnant mothers who are not eating green vegetables

Question 7

Which of the following statements are correct with respect to antenatal USG examination?

1. It helps in detecting gross fetal anomalies
2. It helps in identifying multiple pregnancies
3. It helps in identifying viable pregnancy
4. Best dating is possible with third trimester ultrasound scan

Accepted Answer

1, 2 and 3 only

Answer

3 and 4 only

Answer

1 and 2 only

Answer

1, 2, 3 and 4

Question 8

Blood volume increases during pregnancy above nonpregnant level at 30-34 weeks by:

Accepted Answer

by 40-50 per cent

Answer

Blood volume does not increase at all

Answer

by 25-30 per cent

Answer

by 10-20 per cent

Question 9

Ideal weight gain during pregnancy for a woman with normal BMI should be

Accepted Answer

11-16 kg

Answer

More than 18 kg

Answer

7 kg

Answer

18 kg

Question 10

The gestational sac is first visible on transvaginal USG by:

Accepted Answer

35 days

Answer

49 days

Answer

30 days

Answer

42 days

Prenatal Care — MCQs

Prenatal Care — MCQs

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