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: 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: 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.

Q: Match List-I with List-II and select the correct answer using the code given below the Lists:

A→4 B→2 C→3 D→1. ***A→4 B→2 C→3 D→1*** - **Palmer's sign** refers to **rhythmic uterine contractions** felt by bimanual examination in the **first trimester** of pregnancy. This is often an early sign used to detect pregnancy. - **Braxton Hicks contractions** are characterized by **rhythmic, painless uterine contractions** that are felt per abdomen and typically occur in the **second and third trimesters** of pregnancy. They are often called "practice contractions." - **Goodell's sign** describes the **softening of the cervix** in early pregnancy due to increased vascularity and edema. - **Chadwick's sign** is the **bluish coloration of the vagina and cervix** in pregnancy, also due to increased vascularity and blood flow. *A→1 B→2 C→3 D→4* - This option incorrectly matches Palmer's sign with bluish coloration of the vagina, which is **Chadwick's sign**. - It also incorrectly matches Chadwick's sign with rhythmic uterine contractions in the first trimester, which is **Palmer's sign**. *A→3 B→2 C→1 D→4* - This option incorrectly matches Palmer's sign with softening of the cervix (**Goodell's sign**) and Goodell's sign with bluish coloration of the vagina (**Chadwick's sign**). - It also incorrectly matches Chadwick's sign with rhythmic uterine contractions in the first trimester (**Palmer's sign**). *A→2 B→3 C→1 D→4* - This option incorrectly matches Palmer's sign with Braxton Hicks contractions and Braxton Hicks sign with softening of the cervix, which is **Goodell's sign**. - It also incorrectly matches Goodell's sign with bluish coloration of the vagina (**Chadwick's sign**) and Chadwick's sign with rhythmic contractions in the first trimester (**Palmer's sign**).

Q: Abnormally low alpha-fetoprotein in maternal serum indicates:

Down's syndrome. ***Down's syndrome*** - Abnormally **low alpha-fetoprotein (AFP)** levels in maternal serum are a key indicator for increased risk of **Down's syndrome (Trisomy 21)**. - This is often part of a quad screen (AFP, hCG, unconjugated estriol, inhibin A) used for **prenatal screening** for chromosomal abnormalities. *Meningocele* - This is a type of **spina bifida** where the meninges protrude through a defect in the vertebrae. - While a neural tube defect, it typically results in **elevated AFP** levels in maternal serum due to leakage of fetal protein. *Encephalocele* - An encephalocele is a **neural tube defect** where a sac-like protrusion of the brain and its surrounding membranes occurs through an opening in the skull. - Similar to other open neural tube defects, it is usually associated with **elevated levels of AFP** in maternal serum. *Anencephaly* - This is a severe **neural tube defect** characterized by the absence of a major portion of the brain, skull, and scalp. - Anencephaly invariably leads to very **high levels of AFP** in maternal serum due to direct leakage from exposed neural tissue.

Q: Which one of the following is NOT done as screening test in pregnancy?

Serum cholesterol. ***Serum cholesterol*** - **Serum cholesterol** levels are not routinely measured as a screening test during pregnancy. - While lipid metabolism changes during pregnancy, monitoring cholesterol levels specifically for screening purposes is not standard practice. *Neural tube defects (NTDs)* - Screening for **neural tube defects** is a crucial part of antenatal care, typically involving maternal serum alpha-fetoprotein (**MSAFP**) screening and targeted ultrasound. - Early detection allows for counseling and management options for the pregnancy due to conditions like **spina bifida** or **anencephaly**. *Syphilis-VDRL* - Screening for **syphilis** using tests like **VDRL** (Venereal Disease Research Laboratory) or RPR (Rapid Plasma Reagin) is a mandatory part of antenatal screening in many regions. - This is done to prevent congenital syphilis, which can cause severe fetal and neonatal complications. *Diabetes* - All pregnant women are screened for **gestational diabetes mellitus (GDM)**, typically between 24 and 28 weeks of gestation, using a **glucose challenge test** followed by an oral glucose tolerance test if screening is positive. - Undiagnosed and untreated GDM can lead to adverse maternal and fetal outcomes, including macrosomia, pre-eclampsia, and neonatal hypoglycemia.

Q: In pregnancy with Down syndrome consider the following biomarkers: 1. β HCG is raised 2. α FP is raised 3. Inhibin A is decreased Which of the above statements is/are correct?

1 only. ***1 only*** - In pregnancies affected by **Down syndrome (Trisomy 21)**, the levels of **β-hCG** (human chorionic gonadotropin) are typically found to be **elevated**. This is a well-established biochemical marker used in prenatal screening. - The increased production of β-hCG is thought to be from the **placenta**, which may be functioning differently in pregnancies with Down syndrome. *1, 2 and 3* - This option is incorrect because while **β-hCG is raised**, **α-fetoprotein (αFP)** is typically **decreased** in pregnancies with Down syndrome, not raised. - Furthermore, **inhibin A** is usually **raised**, not decreased, making both statements 2 and 3 false for Down syndrome. *1 and 2 only* - This option is incorrect because although **β-hCG is raised**, **α-fetoprotein (αFP)** is characteristically **decreased** in pregnancies with Down syndrome, making statement 2 inaccurate. - The elevated αFP is usually associated with **neural tube defects** or other fetal anomalies. *2 and 3 only* - This option is incorrect as both statements 2 and 3 are factually wrong for Down syndrome. **α-fetoprotein (αFP)** is typically **decreased**, not raised, in pregnancies with Down syndrome. - Similarly, **inhibin A** levels are typically **raised**, not decreased, in such pregnancies, often incorporated into the quad screen for prenatal screening.

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

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 3

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 4

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 5

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 6

The gestational sac is first visible on transvaginal USG by:

Accepted Answer

35 days

Answer

49 days

Answer

30 days

Answer

42 days

Question 7

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→4  B→2  C→3  D→1

Answer

A→1  B→2  C→3  D→4

Answer

A→3  B→2  C→1  D→4

Answer

A→2  B→3  C→1  D→4

Question 8

Abnormally low alpha-fetoprotein in maternal serum indicates:

Accepted Answer

Down's syndrome

Answer

Meningocele

Answer

Encephalocele

Answer

Anencephaly

Question 9

Which one of the following is NOT done as screening test in pregnancy?

Accepted Answer

Serum cholesterol

Answer

Neural tube defects

Answer

Syphilis-VDRL

Answer

Diabetes

Question 10

In pregnancy with Down syndrome consider the following biomarkers:

1. β HCG is raised
2. α FP is raised
3. Inhibin A is decreased
Which of the above statements is/are correct?

Accepted Answer

1 only

Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Prenatal Care — MCQs

Prenatal Care — MCQs

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