Prenatal Care — MCQs

A pregnant woman visits a medical officer for an antenatal check up. The woman mentions that she had received two doses of Tetanus Toxoid vaccine four years ago. Which of the following steps should the medical officer take with regard to administration of Tetanus Toxoid vaccine as per the Government of India recommended schedule?

Q489

Which of the following statements is false?

Q490

Which of the following vaccines is/are contraindicated in pregnancy? 1. Rubella 2. Hepatitis-B 3. Diphtheria 4. Mumps 5. Measles Select the correct answer using the code given below:

Prenatal Care Indian Medical PG Practice Questions and MCQs

Question 481: Which of the following best defines gestational hypertension?

A. 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
B. 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
C. Sustained rise of blood pressure to 150/100 mmHg or more on at least two occasions 2 hours apart after 20 weeks of gestation
D. 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 (Correct Answer)

Explanation: **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** - **Gestational hypertension** is defined by a new onset of **hypertension** (≥140/90 mmHg) occurring for the first time **after 20 weeks of gestation**, without accompanying **proteinuria** or other systemic signs of preeclampsia. - The elevated blood pressure must be recorded on at least **two occasions 4-6 hours apart** to ensure it's a sustained elevation and not a transient spike. - The woman must be **previously normotensive** (normal blood pressure before pregnancy). *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* - The presence of **proteinuria** along with hypertension after 20 weeks of gestation defines **preeclampsia**, not gestational hypertension. - Gestational hypertension specifically excludes proteinuria or other signs of end-organ damage. *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* - The onset of hypertension defining gestational hypertension must occur **after 20 weeks of gestation**. Hypertension before this period is typically considered **chronic hypertension**. - While the blood pressure criteria and timing are otherwise correct, the gestational age onset is incorrect for gestational hypertension. *Sustained rise of blood pressure to 150/100 mmHg or more on at least two occasions 2 hours apart after 20 weeks of gestation* - The threshold for hypertension in pregnancy is **140/90 mmHg**, not 150/100 mmHg; blood pressure at or above 160/110 mmHg indicates **severe hypertension**. - While recordings 2 hours apart might be relevant in some contexts, the standard for diagnosis of gestational hypertension usually specifies **4-6 hours apart** to confirm sustained elevation.

Question 482: Vaccines that can be safely given during pregnancy are the following except

A. Rubella (Correct Answer)
B. Influenza
C. Pneumococcus
D. Tetanus

Explanation: ***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.

Question 483: During pregnancy, vaccination can be given against all these diseases except :

A. Hepatitis A
B. Mumps (Correct Answer)
C. Tetanus
D. Hepatitis B

Explanation: ***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.

Question 484: The daily requirement of calcium during normal pregnancy is

A. 500 mg
B. 2000 mg
C. 250 mg
D. 1000 mg (Correct Answer)

Explanation: ***1000 mg*** - This is the daily calcium requirement for **pregnant women aged 19 years and above** according to **ACOG** and many international guidelines. - Some guidelines, including **ICMR (2020)**, recommend **1200 mg/day** for all pregnant women, making both 1000-1200 mg acceptable ranges. - Adequate calcium intake supports **fetal skeletal development** and helps prevent complications such as **gestational hypertension** and **preeclampsia**. - This answer is accepted as the standard recommendation for normal pregnancy in most textbooks. *500 mg* - This amount is the recommended daily intake for **pre-school children**, not pregnant women. - Grossly insufficient during pregnancy, as the **fetus requires approximately 200-300 mg/day** for skeletal development, primarily drawn from maternal calcium stores. - Would lead to **maternal bone demineralization** and increased risk of pregnancy complications. *2000 mg* - This represents the **tolerable upper intake level (UL)** for calcium during pregnancy. - While not harmful in most cases, this higher dose is **unnecessarily excessive** for routine supplementation. - May cause side effects including **constipation, kidney stones**, and interference with absorption of other minerals like iron and zinc. *250 mg* - This is **significantly below the requirement** for both pregnant and non-pregnant adults (who need ~600-800 mg/day). - Such severe deficiency would result in **mobilization of maternal bone calcium** to meet fetal demands. - Would increase risk of **osteoporosis, pre-eclampsia**, and impaired fetal bone development.

Question 485: During a normal pregnancy, the changes occurring in the urinary tract include the following except

A. Hypertonicity of the ureteric smooth muscle (Correct Answer)
B. Dilatation of the ureters
C. Elevation and thickening of the trigone
D. Increase in the Glomerular filtration rate

Explanation: ***Hypertonicity of the ureteric smooth muscle*** - Ureteric smooth muscle actually exhibits **reduced tone** and **hypoactivity** during pregnancy due to the relaxing effects of **progesterone**. - This **hypoactivity** contributes to ureteral dilatation and urinary stasis, making **hypertonicity** an incorrect statement. *Dilatation of the ureters* - **Progesterone** causes relaxation of smooth muscle throughout the body, including the ureters, leading to their **dilatation** and hydronephrosis. - Mechanical compression of the ureters by the gravid uterus, especially the right ureter, also contributes to this dilatation. *Elevation and thickening of the trigone* - The increased vascularity and hormonal influences during pregnancy cause the bladder trigone to become **edematous and elevated**. - This anatomical change can make the trigone more prominent during cystoscopic examination. *Increase in the Glomerular filtration rate* - Renal blood flow and GFR **increase by 30-50%** during pregnancy, primarily due to increased cardiac output and renal vasodilation. - This physiological adaptation is crucial for excreting fetal and maternal waste products.

Question 486: A pregnant woman presents at 28 weeks of gestation with haemoglobin level of 7 gm%; and peripheral smear reveals it to be of microcytic hypochromic type. What would be the correct option of therapy?

A. Blood transfusion
B. Oral iron and folic acid therapy
C. Injectable iron therapy (Correct Answer)
D. Oral iron therapy

Explanation: ***Injectable iron therapy*** - With a hemoglobin of **7 gm%** at **28 weeks of gestation**, the patient has **severe anemia** that requires a rapid increase in hemoglobin. - **Injectable iron therapy** provides a swift and effective way to replenish iron stores and improve hemoglobin levels, especially when oral iron absorption is insufficient or time is critical. *Blood transfusion* - While blood transfusions rapidly increase hemoglobin, they are generally reserved for **acute hemodynamic instability**, severe symptomatic anemia, or when immediate delivery is anticipated. - This patient, though severely anemic, does not present with criteria for **immediate transfusion**. *Oral iron and folic acid therapy* - **Oral iron therapy** is the standard treatment for moderate anemia, but for a hemoglobin of **7 gm%**, it may be too slow to raise hemoglobin levels quickly enough. - While folic acid is important in pregnancy, it doesn't directly address the **iron deficiency** indicated by microcytic hypochromic anemia. *Oral iron therapy* - **Oral iron therapy** is usually the first-line treatment for **iron deficiency anemia**. - However, at **7 gm% hemoglobin** in the **third trimester**, oral iron may not increase hemoglobin levels fast enough, and compliance or absorption issues could further delay recovery.

Question 487: Match List-I (Signs of pregnancy) with List-II (Anatomical sites) and select the correct answer using the code given below the Lists:

A. A→3 B→4 C→2 D→1 (Correct Answer)
B. A→3 B→5 C→2 D→1
C. A→3 B→1 C→4 D→2
D. A→2 B→4 C→1 D→3

Explanation: ***A→3 B→4 C→2 D→1*** This question has inherent issues as the anatomical sites in List-II do not perfectly correspond to the signs in List-I. Based on the image provided and available options: - **A (Jacquemier's sign) → 3**: Jacquemier's sign refers to the **bluish-purple discoloration of the vagina and cervix** due to increased vascularity. While primarily a vaginal/cervical sign, if the list groups this under broader "uterine/pelvic" changes, this may be the intended match, though medically it is most specific to the vagina (which would be option 4). - **B (Chloasma gravidarum) → 4**: Chloasma gravidarum is the **hyperpigmentation of facial skin** (mask of pregnancy). This does NOT occur on the vagina. This matching appears incorrect unless List-II's option 4 refers to something other than "vagina" in the original source. - **C (Striae gravidarum) → 2**: Striae gravidarum are **stretch marks that typically appear on the abdomen** (also breasts, thighs). This match is **correct**. - **D (Montgomery's tubercles) → 1**: Montgomery's tubercles are **enlarged sebaceous glands on the areola of the breast**. This match is **correct**. *Other options are incorrect as they mismatch the anatomical sites for these well-established signs of pregnancy. The correct answer reflects the intended matching from the original UPSC-CMS 2010 examination, though some matches may not align perfectly with anatomical specificity.*

Question 488: A pregnant woman visits a medical officer for an antenatal check up. The woman mentions that she had received two doses of Tetanus Toxoid vaccine four years ago. Which of the following steps should the medical officer take with regard to administration of Tetanus Toxoid vaccine as per the Government of India recommended schedule?

A. No Tetanus Toxoid vaccine is required
B. Only one dose of Tetanus Toxoid vaccine is required (Correct Answer)
C. Two doses of Tetanus Toxoid vaccine should be administered with an interval of four weeks between the two doses
D. Tetanus Immunoglobulin should be administered in the third trimester of pregnancy

Explanation: ***Only one dose of Tetanus Toxoid vaccine is required*** - As per the Government of India's antenatal care guidelines, a pregnant woman who has received **two doses of Tetanus Toxoid (TT) vaccine previously** should receive a **single booster dose** during pregnancy. - Since the woman received two doses **four years ago** (more than 3 years), a booster dose is necessary to ensure adequate protection, as immunity may have waned over time. - This single booster dose is sufficient to **reactivate immune memory** and ensure adequate protection for both the mother and the newborn against tetanus during the current pregnancy. *No Tetanus Toxoid vaccine is required* - This is incorrect because even with two prior doses, the **4-year interval** means immunity levels may have declined below protective thresholds. - A booster dose is essential to ensure **optimal antibody levels** during pregnancy and at delivery for protection against neonatal and maternal tetanus. *Two doses of Tetanus Toxoid vaccine should be administered with an interval of four weeks between the two doses* - This schedule (TT1 and TT2) is recommended for women who have **never been vaccinated** or have received **less than 2 doses** previously. - Since this woman has already completed a **primary series of 2 doses**, she only requires a **single booster dose**, not a repeat of the full primary series. - Administering two doses would be unnecessary overtreatment given her vaccination history. *Tetanus Immunoglobulin should be administered in the third trimester of pregnancy* - **Tetanus Immunoglobulin (TIG)** provides passive immunity and is used for **post-exposure prophylaxis** in high-risk situations (contaminated wounds) with uncertain vaccination status. - TIG is **not part of routine antenatal immunization** in India for women with documented prior TT vaccination. - Active immunization with TT vaccine is the standard preventive approach during pregnancy.

Question 489: Which of the following statements is false?

A. Gestational diabetes is always transient and cured after delivery. (Correct Answer)
B. Gestational diabetes is a risk factor for diabetes in children born to mothers with GDM.
C. Screening for gestational diabetes should be included in antenatal care.
D. Gestational diabetes can lead to Type-II diabetes after delivery.

Explanation: ***Gestational diabetes is always transient and cured after delivery*** - While **gestational diabetes** often resolves after delivery, it is **not always cured**; many women are at a significantly increased risk of developing **Type 2 diabetes** later in life. - The condition also reflects underlying **insulin resistance**, which can persist or worsen over time, even if blood glucose levels normalize post-partum. *Gestational diabetes is a risk factor for diabetes in children born to mothers with GDM* - Children born to mothers with **gestational diabetes** are at an increased risk of developing **obesity** and **Type 2 diabetes** themselves later in life. - This is partly due to **intrauterine exposure** to high glucose levels, which can program the fetal metabolism. *Screening for gestational diabetes should be included in antenatal care* - Routine **screening for gestational diabetes** is a standard component of **antenatal care** to identify and manage the condition early, preventing adverse maternal and fetal outcomes. - Screening typically occurs between **24 and 28 weeks of gestation** using a glucose challenge test. *Gestational diabetes can lead to Type-II diabetes after delivery* - Women who develop **gestational diabetes** have a substantially higher risk (up to 70%) of developing **Type 2 diabetes** within 5-10 years after delivery. - This is because gestational diabetes often unmasks a pre-existing predisposition to **insulin resistance** and beta-cell dysfunction.

Question 490: Which of the following vaccines is/are contraindicated in pregnancy? 1. Rubella 2. Hepatitis-B 3. Diphtheria 4. Mumps 5. Measles Select the correct answer using the code given below:

A. 1, 2, 3, 4 and 5
B. 1, 4 and 5 only (Correct Answer)
C. 1 only
D. 2 and 3 only

Explanation: ***1, 4 and 5 only*** - **Rubella, Mumps, and Measles** vaccines are **live attenuated vaccines**, which are **contraindicated during pregnancy** due to the theoretical risk of congenital infection. - The live viral components could potentially cross the placenta and cause fetal harm or **congenital anomalies**. *1, 2, 3, 4 and 5* - This option incorrectly includes **Hepatitis B** and **Diphtheria** vaccines as contraindicated during pregnancy. - Both **Hepatitis B** (inactivated) and **Diphtheria** (toxoid) vaccines are considered safe and often recommended during pregnancy if indicated. *1 only* - This option is incomplete as it only lists **Rubella** as contraindicated, while **Mumps and Measles** are also **live attenuated vaccines** and thus contraindicated. - It misses other important live vaccines also contraindicated in pregnancy. *2 and 3 only* - This option is incorrect because **Hepatitis B** and **Diphtheria** vaccines are generally considered **safe during pregnancy** and are not contraindicated. - **Hepatitis B** is an inactivated vaccine, and **Diphtheria** is a toxoid vaccine, both of which do not pose a risk of active infection to the fetus.

Practice by Chapter

Preconception Counseling

Practice Questions

Pregnancy Diagnosis and Dating

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Routine Antenatal Assessments

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Maternal Physiological Changes

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Nutrition in Pregnancy

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Screening Tests in Pregnancy

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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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