Prenatal Care Practice Questions

Q: Which of the following is false as physiological change in pregnancy?

Increase total protein. ***Increase total protein*** - During pregnancy, **plasma volume increases disproportionately more than the increase in red blood cell mass**, leading to hemodilution. - This hemodilution results in a **decrease in the concentration of total plasma proteins and albumin**, making this statement false. *Increase GFR* - **Glomerular filtration rate (GFR) increases significantly** during pregnancy (by 30-50%) due to increased renal plasma flow. - This physiological adaptation helps to clear the increased metabolic waste products produced by both the mother and the fetus. *Increase cardiac output* - **Cardiac output increases by 30-50%** during pregnancy, primarily due to increases in both heart rate and stroke volume. - This increased cardiac output ensures adequate blood supply to the uterus, placenta, and other maternal organs. *Increase plasma volume* - **Plasma volume increases substantially (up to 40-50%)** during pregnancy, starting in the first trimester and continuing until term. - This expansion of plasma volume is crucial for meeting the increased circulatory demands of pregnancy and supporting placental perfusion.

Q: DOC of bacterial vaginosis in pregnancy is:

Metronidazole. ***Metronidazole*** - **Metronidazole** is the drug of choice for treating bacterial vaginosis in pregnancy and is effective against the anaerobic bacteria responsible for the condition. - It is considered safe throughout pregnancy, including the first trimester. - Recommended dose: 500 mg orally twice daily for 7 days OR 250 mg orally three times daily for 7 days. *Erythromycin* - **Erythromycin** is a macrolide antibiotic primarily used for respiratory tract infections and is not effective against bacterial vaginosis. - It does not have adequate activity against the anaerobic bacteria (Gardnerella vaginalis, Mobiluncus species) that cause bacterial vaginosis. *Clindamycin* - **Clindamycin** is an effective alternative treatment for bacterial vaginosis in pregnancy and can be used orally or topically. - While equally effective, **metronidazole** is traditionally preferred as the first-line drug of choice in most guidelines and medical education curricula. - Clindamycin is reserved as an alternative for patients who cannot tolerate or have contraindications to metronidazole. *Rovamycin* - **Rovamycin** (spiramycin) is a macrolide antibiotic used primarily for toxoplasmosis in pregnancy. - It has no role in the treatment of bacterial vaginosis and lacks efficacy against the causative anaerobic organisms.

Q: Which of the following markers is not used in quadruple test for antenatal detection of Down syndrome?

Estradiol. ***Estradiol*** - **Estradiol** is a primary **estrogen** produced by the ovaries and placenta but is **not** one of the four markers included in the **quadruple screen** for Down syndrome. - The quadruple screen typically measures levels of **alpha-fetoprotein (AFP)**, **unconjugated estriol (uE3)**, **human chorionic gonadotropin (hCG)**, and **inhibin A**. *Inhibin* - **Inhibin A** is one of the four components of the **quadruple screen** for Down syndrome. - In pregnancies affected by Down syndrome, inhibin A levels are typically **elevated**. *AFP* - **Alpha-fetoprotein (AFP)** is a key component of the **quadruple screen**. - In a Down syndrome pregnancy, maternal serum AFP levels are typically **lower** than normal. *ss-hCG* - **Beta-human chorionic gonadotropin (β-hCG)** is a specific subunit of hCG and is one of the four markers in the **quadruple screen**. - In pregnancies with Down syndrome, maternal serum β-hCG levels are usually **elevated**.

Q: What is the most accurate method for dating pregnancy in the first trimester?

Crown-rump length. ***Crown-rump length*** - This is the **most accurate method** for dating pregnancy in the first trimester (up to 13 weeks 6 days) due to the **consistent growth rate** of the embryo/fetus during this period. - An ultrasound measurement of the **CRL** provides an estimated date of delivery (EDD) with an accuracy of +/- 5-7 days. *Mean sac diameter* - While useful for confirming an **intrauterine pregnancy**, **mean sac diameter (MSD)** is less accurate for dating than CRL, especially after 6 weeks gestation. - Its accuracy for dating is about +/- 1.5 weeks and is primarily used when an **embryo is not yet visible**. *Beta-hCG levels* - **Beta-human chorionic gonadotropin (hCG) levels** increase predictably in early pregnancy but are not a precise dating method due to wide variations between individuals and pregnancies. - They are primarily used to **confirm pregnancy** and monitor its progression, or to investigate complications like ectopic pregnancy or miscarriage. *Last menstrual period* - **Dating by last menstrual period (LMP)** is commonly used, but its accuracy depends on a regular menstrual cycle and the woman's recall, which can be unreliable. - It assumes a standard 28-day cycle with ovulation on day 14 and is **less accurate** than ultrasound measurements.

Q: What is the drug of choice for Bacterial vaginosis in pregnancy?

Metronidazole. ***Metronidazole*** - **Metronidazole** is the drug of choice for **bacterial vaginosis** in pregnancy due to its excellent efficacy against **anaerobic bacteria**, which are causative organisms, and its established safety profile during gestation. - It effectively restores the normal vaginal flora by targeting the overgrowth of **Gardnerella vaginalis** and other **anaerobic bacteria**, reducing symptoms and preventing potential pregnancy complications. *Erythromycin* - **Erythromycin** is a macrolide antibiotic primarily used for **atypical pneumonia**, **pertussis**, and certain **skin infections**, but it is generally not considered the first-line treatment for bacterial vaginosis due to lower efficacy against the specific anaerobic flora involved. - While generally safe in pregnancy, its spectrum of activity is less optimal for bacterial vaginosis compared to metronidazole, and it is reserved for specific situations or allergies. *Rovamycin* - **Rovamycin** is **spiramycin**, another macrolide antibiotic, often used for **toxoplasmosis** in pregnancy to prevent vertical transmission. - It is not typically recommended for the treatment of **bacterial vaginosis** as its efficacy against the causative anaerobic bacteria is not as well-established as that of metronidazole or clindamycin. *Clindamycin* - **Clindamycin** is an alternative treatment for **bacterial vaginosis** in pregnancy, particularly for patients who cannot tolerate metronidazole or have resistant infections. - It is effective against anaerobic bacteria and can be administered orally or as a vaginal cream, but **metronidazole** is usually preferred as the initial treatment.

Q: Which vaccine is contraindicated in pregnancy?

Rubella. ***Rubella*** - The **rubella vaccine** is a **live attenuated vaccine**, which carries a theoretical risk of fetal infection and congenital rubella syndrome if administered during pregnancy. - For this reason, women are usually screened for immunity and vaccinated **pre-conception** or **postpartum**. *Influenza* - The **influenza vaccine** (inactivated form) is **recommended** during pregnancy to protect both the mother and newborn from severe influenza illness. - It is **safe** and **effective** for pregnant women at any stage of gestation. *Tetanus toxoid* - The **tetanus toxoid vaccine** (Tdap or Td) is **recommended** during each pregnancy to provide passive immunity to the newborn against pertussis (whooping cough), as well as protecting the mother from tetanus and diphtheria. - It is considered **safe** and ideally given between 27 and 36 weeks of gestation. *Hepatitis B* - The **hepatitis B vaccine** is **recommended** for pregnant women who are at high risk of hepatitis B infection, as a protective measure for both the mother and the fetus. - It is an **inactivated vaccine** and has not been shown to cause adverse effects in pregnancy.

Q: Which of the following is not a part of the quadruple test for antenatal detection of Down syndrome?

Inhibin B. ***Inhibin B*** - The **quadruple test** uses **Inhibin A**, not Inhibin B, along with AFP, β-hCG, and unconjugated estriol to screen for Down syndrome. - **Inhibin B** is primarily associated with assessing ovarian reserve in non-pregnant women or testicular function in men. *Beta HCG* - **Elevated levels of beta-hCG** are characteristically seen in pregnancies affected by **Down syndrome**, making it a key component of the quadruple test. - This hormone is produced by the placenta and its measurement helps in risk assessment for chromosomal abnormalities. *AFP* - **Alpha-fetoprotein (AFP)** levels are typically **lower** in pregnancies with **Down syndrome**, contrasting with elevated levels in neural tube defects. - It is a fetal-specific protein and its measurement is crucial for the quadruple test's diagnostic accuracy. *Estriol* - **Unconjugated estriol (uE3)** levels are usually **decreased** in pregnancies affected by **Down syndrome**. - This steroid hormone is produced by the placenta and fetal adrenal glands, and its reduced levels are a significant marker in the quadruple test.

Q: 18 weeks pregnant female presents with no high risk of NTD and low risk of trisomy 21 on quad test. What is the most appropriate next step in management?

Perform a detailed fetal ultrasound.. ***Perform a detailed fetal ultrasound.*** - A **detailed fetal ultrasound** (often referred to as an **anatomy scan**) at around 18-22 weeks is a standard component of prenatal care for all pregnant women, regardless of screening test results. - This ultrasound evaluates fetal anatomy for structural anomalies, assesses fetal growth, and confirms gestational age, providing crucial information even with low-risk screening. *Repeat non-invasive screening test.* - Repeating a non-invasive screening test (like another quad screen or NIPT) is generally **not indicated** when initial results show a low risk and there are no other clinical concerns. - Such tests are primarily for screening purposes, and a second low-risk result would offer little additional actionable information, as their positive predictive value is low. *Perform invasive diagnostic testing.* - **Invasive diagnostic testing**, such as **amniocentesis** or **chorionic villus sampling (CVS)**, carries a risk of miscarriage and is reserved for situations with a high risk of chromosomal abnormalities or genetic conditions. - Given the low-risk quad screen results for trisomy 21 and no high risk for NTDs, invasive testing is **not warranted** at this stage. *Perform amniotic fluid analysis.* - **Amniotic fluid analysis** is part of an amniocentesis, an **invasive diagnostic procedure** designed to detect chromosomal abnormalities or genetic disorders. - This procedure is typically reserved for cases where screening tests indicate a high risk or there is a clinical suspicion of a genetic condition; it's **not a routine step** after a low-risk quad screen.

Q: A pregnant woman is diagnosed with iron deficiency anemia during her second trimester. Which of the following interventions is most appropriate to prevent adverse outcomes?

Oral iron supplementation and dietary counseling. ***Oral iron supplementation and dietary counseling*** - **Oral iron supplementation** is the **first-line treatment** for iron deficiency anemia in pregnancy, as it is effective and generally well-tolerated. - **Dietary counseling** helps improve iron intake from food sources and enhance absorption, complementing supplementation. *Only dietary counseling* - While **dietary counseling** is important, it is usually insufficient to correct established **iron deficiency anemia** during pregnancy due to increased iron demands. - Relying solely on diet can lead to prolonged anemia and **adverse maternal and fetal outcomes**. *Blood transfusion immediately* - **Blood transfusion** is reserved for cases of **severe, symptomatic anemia** or **hemodynamic instability**, which is not indicated here. - This intervention carries risks of **transfusion reactions** and is not the standard approach for moderate iron deficiency in pregnancy. *Intravenous iron supplementation* - **Intravenous iron** is considered for women who cannot tolerate or absorb oral iron, have severe anemia in late pregnancy, or in cases of non-compliance. - It is a more invasive option with potential side effects and is not the initial treatment of choice for a woman in her second trimester without severe symptoms.

Question 1

24 yr old mother with 7 week POG presents to ANC OPD with accidental low-dose radiation exposure. What is the most appropriate immediate management?

Accepted Answer

Reassure and continue pregnancy

Answer

Perform detailed fetal anomaly scan

Answer

Advise medical termination of pregnancy

Answer

Advise genetic counseling and testing

Question 2

Which of the following is false as physiological change in pregnancy?

Accepted Answer

Increase total protein

Answer

Increase GFR

Answer

Increase cardiac output

Answer

Increase plasma volume

Question 3

DOC of bacterial vaginosis in pregnancy is:

Accepted Answer

Metronidazole

Answer

Erythromycin

Answer

Clindamycin

Answer

Rovamycin

Question 4

Which of the following markers is not used in quadruple test for antenatal detection of Down syndrome?

Accepted Answer

Estradiol

Answer

Inhibin

Answer

AFP

Answer

ss-hCG

Question 5

What is the most accurate method for dating pregnancy in the first trimester?

Accepted Answer

Crown-rump length

Answer

Mean sac diameter

Answer

Beta-hCG levels

Answer

Last menstrual period

Question 6

What is the drug of choice for Bacterial vaginosis in pregnancy?

Accepted Answer

Metronidazole

Answer

Erythromycin

Answer

Rovamycin

Answer

Clindamycin

Question 7

Which vaccine is contraindicated in pregnancy?

Accepted Answer

Rubella

Answer

Influenza

Answer

Tetanus toxoid

Answer

Hepatitis B

Question 8

Which of the following is not a part of the quadruple test for antenatal detection of Down syndrome?

Accepted Answer

Inhibin B

Answer

Beta HCG

Answer

AFP

Answer

Estriol

Question 9

18 weeks pregnant female presents with no high risk of NTD and low risk of trisomy 21 on quad test. What is the most appropriate next step in management?

Accepted Answer

Perform a detailed fetal ultrasound.

Answer

Repeat non-invasive screening test.

Answer

Perform invasive diagnostic testing.

Answer

Perform amniotic fluid analysis.

Question 10

A pregnant woman is diagnosed with iron deficiency anemia during her second trimester. Which of the following interventions is most appropriate to prevent adverse outcomes?

Accepted Answer

Oral iron supplementation and dietary counseling

Answer

Only dietary counseling

Answer

Blood transfusion immediately

Answer

Intravenous iron supplementation

Prenatal Care — MCQs

Prenatal Care — MCQs

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