Prenatal Care — MCQs

A 27-year-old pregnant female in her first trimester presents to the OPD for a regular antenatal checkup. During blood type screening, potential ABO incompatibility is discussed. The healthcare provider explains that certain antibody types are less concerning than others during pregnancy. ABO incompatibility does not occur due to which antibody in her case?

Q459

After an initial serum $\beta$-hCG test in a patient with suspected pregnancy, when should the repeat $\beta$-hCG level ideally be checked to assess viability or progression?

Q460

A 24-year-old primigravida presents with painful vaginal bleeding in the first trimester. On USG, a well-formed gestation ring with central echoes from the embryo indicates a healthy fetus, and there is observation of fetal cardiac motion. What is the most probable diagnosis?

Prenatal Care Indian Medical PG Practice Questions and MCQs

Question 451: The double decidual sac sign (DDSS) is the best ultrasound method for diagnosing which of the following?

A. Monoamniotic Dichorionic twins
B. Diamniotic dichorionic twins
C. Ectopic pregnancy
D. Normal intrauterine pregnancy (Correct Answer)

Explanation: **Explanation:** The **Double Decidual Sac Sign (DDSS)** is a classic early ultrasonographic marker used to confirm a **normal intrauterine pregnancy (IUP)** before a yolk sac or embryo is visible. It typically appears around 4.5 to 5 weeks of gestation. **Why it is the correct answer:** The DDSS consists of two concentric echogenic rings surrounding the gestational sac. These rings represent: 1. **Decidua capsularis:** The inner ring (surrounding the chorionic sac). 2. **Decidua parietalis:** The outer ring (lining the uterine cavity). The presence of these two distinct layers helps distinguish a true gestational sac from a "pseudogestational sac" (a collection of fluid or blood in the uterine cavity often seen in ectopic pregnancies). **Analysis of Incorrect Options:** * **Options A & B (Twins):** While ultrasound is used to diagnose chorionicity (e.g., the "Lambda" or "T" sign), the DDSS specifically identifies the presence of an IUP, not the number of amnions or chorions. "Monoamniotic Dichorionic" is also embryologically impossible (dichorionic twins are always diamniotic). * **Option C (Ectopic pregnancy):** The DDSS is used to *rule out* ectopic pregnancy by confirming that the pregnancy is located within the uterus. A pseudogestational sac in an ectopic pregnancy lacks the double-layered decidual appearance. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest sign of IUP:** The "Intrachorionic Sign" or the "Double Decidual Sac Sign." * **Mean Sac Diameter (MSD):** A yolk sac should be visible by transvaginal scan (TVS) when the MSD is **>8 mm**; a fetal pole should be visible when the MSD is **>16–25 mm**. * **Discriminatory Zone:** The level of β-hCG (usually 1,500–2,000 mIU/mL) at which a normal IUP must be visible on TVS. If the uterus is empty at this level, suspect ectopic pregnancy.

Question 452: Which vaccine is routinely given during pregnancy?

A. Influenza
B. Oral polio
C. Tetanus (Correct Answer)
D. Rabies

Explanation: **Explanation:** In prenatal care, the primary goal of vaccination is to provide maternal immunity and ensure the passive transfer of antibodies to the fetus to prevent neonatal infections. **Why Tetanus is Correct:** Routine immunization with **Tetanus Toxoid (TT)** or **Tetanus-Diphtheria-acellular Pertussis (Tdap)** is the standard of care globally. In India, under the National Immunization Schedule, two doses of Tetanus-adult Diphtheria (Td) are administered (or one dose if previously immunized within 3 years) to prevent **Neonatal Tetanus**, a fatal condition caused by unhygienic delivery practices. Current guidelines increasingly favor **Tdap** (given between 27–36 weeks) to also protect the newborn against Pertussis (Whooping cough). **Analysis of Incorrect Options:** * **Oral Polio (OPV):** This is a **live-attenuated vaccine**. Live vaccines are generally contraindicated in pregnancy due to the theoretical risk of viral transmission to the fetus. * **Influenza:** While the *inactivated* influenza vaccine is recommended and safe during pregnancy, it is not yet part of the "routine" universal immunization schedule in all Indian government setups, unlike Tetanus. However, in private practice and specific guidelines, it is highly encouraged. * **Rabies:** This is a **post-exposure prophylaxis** vaccine. It is safe to give during pregnancy if a woman is bitten by a rabid animal, but it is never given "routinely." **NEET-PG High-Yield Pearls:** 1. **Live Vaccines (Contraindicated):** MMR, Varicella, BCG, OPV, and Yellow Fever (unless high risk). 2. **Safe Vaccines:** All killed/inactivated vaccines (Tetanus, Hepatitis B, Inactivated Polio, Rabies). 3. **Timing:** The first dose of Td is given as soon as pregnancy is registered; the second dose is given 4 weeks later. 4. **Passive Immunity:** Maternal IgG antibodies cross the placenta, providing the neonate with crucial protection during the first few months of life.

Question 453: Perception of uterine contraction is known as:

A. Chadwick sign
B. Goodell sign
C. Piskacek sign (Correct Answer)
D. Hegar sign

Explanation: **Explanation:** The correct answer is **Piskacek sign**. This sign refers to the asymmetrical enlargement of the uterus occurring around 7–8 weeks of gestation. It is caused by the implantation of the blastocyst in one of the lateral horns of the uterus, leading to a localized bulge or prominence. This area feels softer than the rest of the uterus, and the irregular consistency can sometimes be perceived as a **uterine contraction** or a tumor during bimanual examination. **Analysis of Incorrect Options:** * **A. Chadwick sign:** This is the bluish discoloration of the cervix, vagina, and labia due to increased vascularity (venous congestion). It is an early sign of pregnancy, usually seen around 6–8 weeks. * **B. Goodell sign:** This refers to the significant softening of the vaginal portion of the cervix due to increased vascularization and hypertrophy of the cervical glands. It is typically noted at 6 weeks. * **C. Hegar sign:** This is the softening of the lower uterine segment (isthmus). On bimanual examination, the upper body of the uterus and the cervix feel like two separate entities because the intervening isthmus is so soft. It is usually present between 6–10 weeks. **High-Yield Clinical Pearls for NEET-PG:** * **Palmer’s Sign:** Regular, rhythmic, painless uterine contractions felt during a pelvic examination as early as 4–8 weeks. (Note: While Piskacek relates to the *perception* of the bulge/contraction due to asymmetry, Palmer's is the specific term for rhythmic contractions). * **Osiander’s Sign:** Increased pulsation felt through the lateral vaginal fornices at 8 weeks. * **Jacquemier’s Sign:** Another name for Chadwick’s sign (bluish discoloration). * **Ladin’s Sign:** Softening of the uterus in the anterior midline at the junction of the uterus and cervix (6 weeks).

Question 454: Perception of uterine contraction is known as:

A. Chadwick sign
B. Goodell sign
C. Palmer sign (Correct Answer)
D. Hegar sign

Explanation: **Explanation:** The correct answer is **Palmer sign**. This clinical sign refers to the perception of rhythmic, regular, and painless uterine contractions during a bimanual examination in early pregnancy (usually between 4–8 weeks). These contractions are spontaneous and can be felt as the uterus hardening and then softening under the examiner's fingers. **Analysis of Options:** * **Chadwick sign (Option A):** This is a presumptive sign of pregnancy characterized by a bluish or purplish discoloration of the cervix, vagina, and labia due to increased pelvic vascularity. It typically appears around 6–8 weeks. * **Goodell sign (Option B):** This refers to the significant softening of the vaginal portion of the cervix, often compared to the consistency of the lips (non-pregnant cervix feels like the tip of the nose). It occurs around 6 weeks. * **Hegar sign (Option C):** This is the softening of the uterine isthmus (the lower part of the uterus). On bimanual examination, the upper body of the uterus and the cervix seem like two separate regions because the isthmus between them is so soft. It is usually present between 6–10 weeks. **High-Yield Clinical Pearls for NEET-PG:** * **Braxton Hicks Contractions:** Unlike Palmer sign (felt by the clinician early on), Braxton Hicks are painless contractions felt by the *mother* later in pregnancy (after 20 weeks). * **Osiander sign:** An early sign of pregnancy characterized by increased pulsation felt in the lateral vaginal fornices due to increased vascularity. * **Piskacek sign:** Asymmetrical enlargement of the uterus if implantation occurs near one of the cornua.

Question 455: Perception of uterine contraction is known as:

A. Chadwick sign
B. Goodell sign
C. Palmer sign (Correct Answer)
D. Hegar sign

Explanation: **Explanation:** The correct answer is **C. Palmer sign**. **Palmer sign** refers to the perception of rhythmic, regular, and symmetrical uterine contractions during a bimanual examination. These contractions can be detected as early as 4 to 8 weeks of gestation. It is a presumptive sign of pregnancy and occurs due to the increased irritability of the uterine musculature. **Analysis of Incorrect Options:** * **A. Chadwick sign:** This is the bluish or purplish discoloration of the cervix, vagina, and labia minora due to increased pelvic vascularity (venous congestion). It is typically seen around 6–8 weeks. * **B. Goodell sign:** This refers to the significant softening of the cervix (often compared to the feel of the lips, whereas a non-pregnant cervix feels like the tip of the nose). It is observable from 6 weeks onwards. * **D. Hegar sign:** This is the softening of the uterine isthmus (the lower segment). On bimanual examination, the upper part of the body of the uterus and the cervix feel like two separate entities because the isthmus between them is so soft. It is usually elicited between 6–10 weeks. **High-Yield Clinical Pearls for NEET-PG:** * **Osiander sign:** Pulsations felt through the lateral vaginal fornices due to increased vascularity (8 weeks). * **Piskacek sign:** Asymmetrical enlargement of the uterus if implantation occurs near one of the cornua (7–8 weeks). * **Jacquemier sign:** Another name for Chadwick sign (bluish discoloration of the vaginal mucosa). * **Braxton Hicks contractions:** These are painless, irregular "false labor" contractions felt later in pregnancy (usually after 20 weeks), unlike the early rhythmic Palmer sign.

Question 456: What is the approximate fetal weight if the height of the uterus above the pubic symphysis is 35 cm and the station of the head is -2?

A. 2.5 kg
B. 3 kg
C. 3.5 kg (Correct Answer)
D. 4 kg

Explanation: The correct answer is **3.5 kg**. ### **Explanation of the Correct Answer** The fetal weight is calculated using **Johnson’s Formula**, a clinical method to estimate fetal weight based on the fundal height and the station of the presenting part. **The Formula:** $\text{Fetal Weight (in grams)} = (H - n) \times 155$ Where: * **H** = Symphysio-fundal height (SFH) in cm. * **n** = 12 if the presenting part is at or above station 0. * **n** = 11 if the presenting part is below station 0 (engaged). **Calculation for this question:** * $H = 35 \text{ cm}$ * $n = 12$ (since the station is -2, which is above station 0) * $\text{Weight} = (35 - 12) \times 155$ * $\text{Weight} = 23 \times 155 = 3,565 \text{ grams} \approx \mathbf{3.5 \text{ kg}}$ ### **Why Other Options are Incorrect** * **Option A (2.5 kg):** This would correspond to an SFH of approximately 28 cm at station -2. * **Option B (3 kg):** This would correspond to an SFH of approximately 31-32 cm at station -2. * **Option D (4 kg):** This would require an SFH of approximately 38 cm at station -2. ### **High-Yield Clinical Pearls for NEET-PG** 1. **Rule of Thumb:** After 24 weeks of gestation, the SFH in centimeters roughly matches the gestational age in weeks (e.g., 30 cm $\approx$ 30 weeks). 2. **Haase’s Rule:** Used to determine fetal length. For the first 5 months, length = $\text{month}^2$. For the last 5 months, length = $\text{month} \times 5$. 3. **Limitations:** Johnson’s formula is less accurate in cases of maternal obesity, polyhydramnios, or multiple pregnancies. 4. **Station 0:** This refers to the level of the **ischial spines**. Any station with a negative value (-1 to -5) indicates the head is not yet engaged.

Question 457: What is uterine souffle?

A. A soft blowing murmur synchronous with foetal heart sounds.
B. Caused by an increase in blood flow through the dilated uterine vessels. (Correct Answer)
C. Caused by active foetal movements.
D. Indicates underlying foetal distress.

Explanation: **Explanation:** **Uterine Souffle** is a soft, blowing, or whistling sound heard on auscultation over the lower segment of the pregnant uterus. It is caused by the **increased blood flow through the dilated and tortuous uterine arteries** to meet the demands of the growing placenta and fetus. It is synchronous with the **maternal pulse** (not the fetal heart rate). **Analysis of Options:** * **Option B (Correct):** The sound is a direct result of the massive increase in uterine blood flow during pregnancy. As blood rushes through the enlarged uterine vessels, it creates a characteristic "souffle" (French for "breath" or "puff"). * **Option A (Incorrect):** This describes **Funic Souffle**, which is a sharp, whistling sound synchronous with the **fetal heart sounds**. It is caused by blood rushing through the umbilical arteries and is often heard when the cord is compressed or coiled. * **Option C (Incorrect):** Fetal movements produce distinct thumping or tapping sounds, but they do not create the rhythmic blowing sound characteristic of a souffle. * **Option D (Incorrect):** Uterine souffle is a normal physiological finding in pregnancy and does not indicate fetal distress. **High-Yield NEET-PG Pearls:** * **Synchronicity:** Uterine Souffle = Maternal Pulse; Funic Souffle = Fetal Heart Rate. * **Timing:** Uterine souffle can be heard as early as 12–16 weeks of gestation. * **Differential Diagnosis:** A similar sound can be heard in cases of large **uterine fibroids** or vascular ovarian tumors due to increased pelvic vascularity. * **Location:** It is best heard over the lower uterine segment using a stethoscope or Doppler.

Question 458: A 27-year-old pregnant female in her first trimester presents to the OPD for a regular antenatal checkup. During blood type screening, potential ABO incompatibility is discussed. The healthcare provider explains that certain antibody types are less concerning than others during pregnancy. ABO incompatibility does not occur due to which antibody in her case?

A. IgG
B. IgD
C. IgA
D. IgM (Correct Answer)

Explanation: ***IgM***- The predominant natural antibodies against **ABO antigens** (anti-A and anti-B) are of the **IgM class**, which are large pentameric molecules. These **IgM antibodies** generally cannot cross the placenta due to their size, meaning they do not reach the fetal circulation and cause significant hemolytic disease of the newborn (HDN). *IgA*- IgA is predominantly found in secretions (mucous membranes, breast milk) and is not generally involved in causing **hemolytic disease of the newborn (HDN)**, as it does not cross the placenta in significant amounts. This antibody class is not the primary mechanism of incompatibility, as the most common non-transmissible antibodies are IgM. *IgG*- **IgG is the only class** of immunoglobulin that efficiently crosses the placenta into the fetal circulation, meaning that any present **IgG anti-A or anti-B antibodies** are the ones responsible for causing **fetal red cell hemolysis** in ABO incompatibility. Though ABO HDN is usually less severe than Rh HDN, the pathology depends entirely on the presence of IgG. *IgD*- IgD antibodies are primarily expressed on the surface of naïve **B lymphocytes** and are involved in B cell activation and signaling. They are not involved in **red blood cell agglutination** or placental transfer relevant to ABO incompatibility.

Question 459: After an initial serum $\beta$-hCG test in a patient with suspected pregnancy, when should the repeat $\beta$-hCG level ideally be checked to assess viability or progression?

A. 48 hours (Correct Answer)
B. 96 hours
C. 24 hours
D. 72 hours

Explanation: ***Correct: 48 hours*** - In a viable, intrauterine pregnancy, serum β-hCG levels typically **double approximately every 48 hours** (or show a rise of at least 35% in 48 hours) during the initial weeks. - This standard **48-hour interval** is critical as it provides the most timely and appropriate benchmark to determine if the required doubling is occurring, aiding in the assessment of viability. - This is the **gold standard timing** for repeat β-hCG testing in early pregnancy monitoring. *Incorrect: 24 hours* - This interval is generally **too short** to observe the significant rise needed to confidently distinguish a normal, viable doubling rate from an abnormal or insufficient rate. - Due to natural variations in hormone secretion, a 24-hour reading often yields an overlapping range, making interpretation of the trend difficult. *Incorrect: 72 hours* - Although a check at 72 hours is sometimes used (as doubling can take up to 72 hours), waiting this long can **delay critical diagnosis** of urgent conditions like a non-ruptured **ectopic pregnancy** or ongoing miscarriage. - The 48-hour check remains the standard benchmark providing the earliest necessary data for management decisions. *Incorrect: 96 hours* - Waiting 96 hours (4 days) is generally **too long** and could significantly delay necessary intervention or further management for a non-viable or **ectopic pregnancy**. - While β-hCG doubling slows down significantly after approximately 6 weeks of gestation, the initial assessment requires the tighter 48-hour timeframe.

Question 460: A 24-year-old primigravida presents with painful vaginal bleeding in the first trimester. On USG, a well-formed gestation ring with central echoes from the embryo indicates a healthy fetus, and there is observation of fetal cardiac motion. What is the most probable diagnosis?

A. Inevitable abortion
B. Threatened abortion (Correct Answer)
C. Complete abortion
D. Incomplete abortion

Explanation: ***Threatened abortion***- This diagnosis applies when there is **vaginal bleeding** (often painful) in the first 20 weeks of pregnancy, but the **cervix is closed** and **fetal viability** (confirmed by fetal cardiac motion) is observed on ultrasound.- It is the most common cause of bleeding in early pregnancy and signifies that while the pregnancy is at risk, it is still continuing with a live fetus.*Inevitable abortion*- This diagnosis is characterized by vaginal bleeding accompanied by cervical changes, specifically **cervical dilation**, making continuation of the pregnancy unlikely.- Viable fetal cardiac activity rules out inevitable or ongoing abortion processes.*Incomplete abortion*- This involves the partial expulsion of the products of conception; USG would show **retained placental tissue** or fetal tissue and the loss of fetal viability.- The existence of **fetal cardiac motion** and a complete gestation ring confirms the pregnancy is still intact and rules out incomplete expulsion.*Complete abortion*- In this scenario, all products of conception have been expelled, resulting in an **empty uterine cavity** on ultrasound.- The presence of a **well-formed gestation ring** and an actively moving embryo/fetus clearly excludes complete abortion.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free