Prenatal Care — MCQs

Prenatal Care Indian Medical PG Practice Questions and MCQs

Question 521: Which is the best marker for NTD?

A. Inhibin-A
B. hCG
C. Pseudocholinesterase
D. AFP (Correct Answer)

Explanation: ***AFP*** - **Alpha-fetoprotein (AFP)** is the primary and most widely used biochemical marker for detecting **neural tube defects (NTDs)** during pregnancy. - Elevated levels of **AFP in maternal serum** or amniotic fluid are indicative of an open NTD, such as **spina bifida** or **anencephaly**, where fetal blood leaks into the amniotic fluid. *Inhibin-A* - **Inhibin-A** is typically used in the **quad screen** as a marker for **Down syndrome (Trisomy 21)**, where its levels are typically elevated. - It does not serve as a primary marker for the detection of neural tube defects. *hCG* - **Human Chorionic Gonadotropin (hCG)** is elevated in **Down syndrome** and decreased in **Edwards syndrome (Trisomy 18)** screening. - It is not a reliable marker for the diagnosis of neural tube defects. *Pseudocholinesterase* - **Pseudocholinesterase**, also known as butyrylcholinesterase, is a serum enzyme that can be **elevated in amniotic fluid** in cases of open NTDs. - While it can be a useful confirmatory test, its general utility as a primary marker is less than AFP, as it is less specific and more difficult to implement in routine screening.

Question 522: All of the following conditions are risk factors for urinary tract infections in pregnancy except:

A. Vesicoureteral reflux
B. Diabetes
C. Sickle cell anemia
D. Hypertension (Correct Answer)

Explanation: ***Hypertension*** - While hypertension is a significant pregnancy complication, it is **not directly a risk factor** for developing urinary tract infections. - Its presence does not inherently increase the susceptibility of the urinary tract to bacterial colonization or infection. *Vesicoureteral reflux* - This condition involves the **backward flow of urine** from the bladder into the ureters, sometimes reaching the kidneys. - It creates a reservoir for bacteria and facilitates their ascent, significantly increasing the risk of UTIs during pregnancy. *Diabetes* - Women with diabetes are more prone to UTIs due to **glycosuria** (glucose in urine), which serves as a bacterial growth medium. - Additionally, diabetic neuropathy can lead to **incomplete bladder emptying**, further increasing UTI risk. *Sickle cell anemia* - Patients with sickle cell anemia can experience **renal papillary necrosis** and impaired renal function, which can predispose them to UTIs. - They also tend to have a **compromised immune system**, making them more susceptible to infections in general, including UTIs.

Question 523: Hasse rule is related to

A. Age of fetus
B. Height of fetus (Correct Answer)
C. Severity of burns
D. Weight of fetus

Explanation: ***Height of fetus*** - The **Hasse rule** is a method used to estimate the **crown-heel length** (total length) of a fetus during early gestation. - It uses a simple formula to approximate fetal length in centimeters based on the number of lunar months of gestation. *Age of fetus* - While fetal age is crucial for development, the **Hasse rule directly calculates fetal height**, not age. - Fetal age is often estimated using other parameters like **crown-rump length** in earlier trimesters. *Severity of burns* - The **severity of burns** is assessed using different criteria, such as the **Rule of Nines** or Lund-Browder chart, to determine the percentage of total body surface area affected. - This rule has no relevance to fetal development or estimation. *Weight of fetus* - **Fetal weight** is typically estimated using ultrasound measurements of parameters like **biparietal diameter**, head circumference, abdominal circumference, and femur length, not the Hasse rule. - The Hasse rule specifically estimates the **length** of the fetus.

Question 524: Most commonly used sonological indicator for aneuploidy in first trimester is:

A. Nuchal translucency (Correct Answer)
B. Gestational sac volume
C. Serum PAPP-A level
D. Crown-rump length

Explanation: ***Nuchal translucency*** - **Nuchal translucency (NT)** is the most common and established sonographic marker for **Down syndrome** and other aneuploidies in the first trimester. - Increased NT thickness is directly correlated with a higher risk of **chromosomal abnormalities** and congenital heart defects. *Gestational sac volume* - **Gestational sac volume** is primarily used to assess the viability and proper development of the early pregnancy, not as a direct marker for aneuploidy. - Abnormalities in gestational sac size can indicate a **non-viable pregnancy** or **blighted ovum**, but not specific chromosomal defects. *Serum PAPP-A level* - **Serum PAPP-A (pregnancy-associated plasma protein-A)** is a biochemical marker used in conjunction with NT in first-trimester screening. - While it is part of aneuploidy risk assessment, **PAPP-A is a blood test**, not a sonological indicator itself. *Crown-rump length* - **Crown-rump length (CRL)** is used for **accurate dating of pregnancy** in the first trimester. - While an abnormal CRL can sometimes be associated with adverse pregnancy outcomes, it is not a direct or primary sonological indicator for aneuploidy screening.

Question 525: A pregnant female presents with pain in abdomen. On examination, tenderness is found in right lumbar region. TLC is 12000/cmm and urine examination is normal. The most appropriate diagnostic test is:

A. Laparoscopy
B. Non contrast CT abdomen
C. Chest Xray with abdominal shield
D. Ultrasound abdomen (Correct Answer)

Explanation: ***Ultrasound abdomen*** - This is the **safest and preferred initial imaging modality** for abdominal pain in pregnant women, as it avoids **ionizing radiation**. - It can effectively visualize the **appendix**, **gallbladder**, **kidneys**, and **uterus/adnexa**, helping to identify common causes of right lumbar pain like **appendicitis**, **pyelonephritis**, or **adnexal pathology**. *Laparoscopy* - While diagnostic, laparoscopy is an **invasive surgical procedure** and is typically reserved for cases where non-invasive imaging is inconclusive or if a **therapeutic intervention** is required. - It carries risks such as **anesthesia complications** and **uterine injury** in pregnancy, making it unsuitable as a primary diagnostic test. *Non-contrast CT abdomen* - **CT scans** involve **ionizing radiation**, which should be avoided in pregnancy due to potential risks to the **fetus**, especially if a less harmful alternative is available. - While it offers detailed anatomical information, the risk-benefit ratio for a **pregnant patient with a normal urine analysis** does not justify its initial use over ultrasound. *Chest X-ray with abdominal shield* - A **chest X-ray** primarily evaluates the **lungs and heart** and would not provide adequate visualization of the abdominal organs responsible for the right lumbar pain. - While a shield minimizes fetal exposure, the information gained would be **irrelevant to the presenting abdominal symptoms**, making it an inappropriate diagnostic choice.

Question 526: Double decidual sac sign is indicative of?

A. Ectopic pregnancy
B. H. mole
C. Intrauterine pregnancy (Correct Answer)
D. Twin pregnancy

Explanation: ***Intrauterine pregnancy*** - The **double decidual sac sign** refers to the visualization of two concentric rings of decidua surrounding the gestational sac, which is a characteristic feature of an **early intrauterine pregnancy**. - It signifies the presence of both the **parietal decidua** (lining the uterine cavity) and the **capsular decidua** (surrounding the gestational sac), distinguishing a true gestational sac from a pseudogestational sac. *Ectopic pregnancy* - In an **ectopic pregnancy**, the gestational sac is located outside the uterus, and therefore, the double decidual sac sign will **not be present**. - A pseudogestational sac, which lacks the double decidual sac sign, can sometimes be seen in the uterus in cases of ectopic pregnancy. *H. mole* - A **hydatidiform mole** (H. mole) is characterized by abnormal proliferation of trophoblastic tissue and typically presents as a "snowstorm" appearance on ultrasound, with **no identifiable gestational sac or embryo**. - The double decidual sac sign is a marker of a well-formed gestational sac within the uterus and is absent in molar pregnancies. *Twin pregnancy* - While a twin pregnancy involves two gestational sacs or a single sac with two embryos, the **double decidual sac sign** itself is an indicator of the presence of any single normal gestational sac within the uterus, regardless of the number of fetuses. - The sign confirms the intrauterine location and viability of a pregnancy, but additional features are needed to diagnose a multiple gestation.

Question 527: Retention of urine in a pregnant woman with a retroverted uterus is seen in which week?

A. 20-24 weeks
B. 28-32 weeks
C. 8-10 weeks
D. 12-16 weeks (Correct Answer)

Explanation: ***12-16 weeks*** - Between **12-16 weeks**, the uterus typically rises out of the **pelvis**. A **retroverted uterus** can become trapped, causing pressure on the bladder neck and leading to **urinary retention**. - This period aligns with the timing when the growing uterus in a retroverted position would exert maximum pressure on the urethra, leading to **bladder outflow obstruction**. *20-24 weeks* - By **20-24 weeks**, the uterus is usually well out of the **pelvis**, making urinary retention due to uterine retroversion less likely as a primary cause. - If retained beyond 16 weeks, the uterus would likely have **spontaneously corrected its position** or the problem would have presented earlier. *28-32 weeks* - At **28-32 weeks**, the uterus is much larger and would typically be positioned high in the **abdomen**, far removed from the **pelvic outlet**, preventing entrapment. - Urinary retention at this stage may indicate other complications, such as **urinary tract infection** or **neurogenic bladder**, rather than uterine retroversion. *8-10 weeks* - At **8-10 weeks**, the uterus is generally still small and contained within the **pelvis**, and although retroversion is present, it is often not large enough to cause significant pressure on the **bladder neck** or entrapment. - **Urinary symptoms** at this stage are more commonly related to hormonal changes or increased blood flow to the kidneys, often characterized by **urinary frequency** rather than retention.

Question 528: 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?

A. Reassure and continue pregnancy (Correct Answer)
B. Perform detailed fetal anomaly scan
C. Advise medical termination of pregnancy
D. Advise genetic counseling and testing

Explanation: ***Reassure and continue pregnancy*** - **Low-dose radiation exposure** (typically defined as <50 mGy) during pregnancy is generally associated with a very low risk of fetal anomalies or adverse outcomes. The patient should be reassured that the risk to the fetus is minimal. - The threshold for concern for teratogenic effects from radiation is significantly higher than a low dose, and **medical termination of pregnancy** is not indicated in such cases. - This is the most appropriate **immediate management** for accidental low-dose radiation exposure at 7 weeks gestation. *Perform detailed fetal anomaly scan* - While anomaly scans are part of routine prenatal care, performing an immediate, detailed scan solely due to **low-dose radiation exposure** at 7 weeks is not the most appropriate *immediate* management. The risk of anomalies from such exposure is extremely low and unlikely to be detectable at 7 weeks. - A more detailed scan may be considered at later gestational ages (e.g., 18-20 weeks) as part of standard care, but not as an emergency response to low-dose exposure. *Advise medical termination of pregnancy* - Medical termination is **not indicated** for accidental **low-dose radiation exposure**. Termination is only considered in cases of *extremely high* and confirmed doses (e.g., >100 mGy), which carry a significant risk of severe fetal anomalies or mortality. - Such high doses are rare in accidental exposures and would necessitate a thorough dose assessment by a radiation physicist before considering any drastic measures. - Since the scenario specifies low-dose exposure, termination would be inappropriate and potentially harmful counseling. *Advise genetic counseling and testing* - **Genetic counseling** and testing would be indicated for known genetic risks, advanced maternal age, or suspicion of chromosomal abnormalities, none of which are suggested by accidental **low-dose radiation exposure**. - Radiation-induced effects are typically teratogenic rather than directly causing inheritable genetic mutations that would be detected by standard genetic testing.

Question 529: A 7-week pregnant lady underwent a chest X-ray by mistake. What is to be done?

A. Terminate the pregnancy immediately due to radiation exposure.
B. Perform chromosomal testing to assess fetal damage.
C. Reassure the patient and continue the pregnancy. (Correct Answer)
D. Conduct prenatal invasive diagnostic tests to evaluate fetal health.

Explanation: **Reassure the patient and continue the pregnancy.** - A single chest X-ray delivers a **negligible dose of radiation (around 0.01 mGy)** to the embryo/fetus, which is significantly below the threshold for causing congenital abnormalities or pregnancy loss. - The **teratogenic threshold** for radiation exposure is generally considered to be around **50-100 mGy**, making a single chest X-ray exposure well within safe limits. *Terminate the pregnancy immediately due to radiation exposure.* - There is **no clinical justification** for pregnancy termination based on a single chest X-ray, as the radiation dose is far too low to cause significant harm. - Such an intervention would be based on **misinformation** and could lead to unnecessary emotional distress and ethical concerns. *Perform chromosomal testing to assess fetal damage.* - Chromosomal testing is **not indicated** for low-dose radiation exposure from a single chest X-ray, as this type of exposure is unlikely to cause chromosomal abnormalities. - The radiation dose is simply too low to inflict the kind of damage that would necessitate such invasive and often risky procedures. *Conduct prenatal invasive diagnostic tests to evaluate fetal health.* - Invasive prenatal diagnostic tests, such as **amniocentesis or chorionic villus sampling**, carry their own risks and are not warranted for a benign exposure like a chest X-ray. - These tests are typically reserved for situations with a much higher established risk of fetal anomalies.

Question 530: Rule of Hasse is used to determine:

A. Fetal age estimation (Correct Answer)
B. Adult height measurement
C. Determination of ethnicity
D. General forensic identification

Explanation: ***Fetal age estimation*** - **Rule of Hasse** is specifically used for estimating the **fetal age** in forensic cases involving remains of an unborn fetus. - It relates the crown-heel length of the fetus in centimeters to its age in lunar months (first 5 lunar months) or halves of lunar months (second 5 lunar months). *Adult height measurement* - Adult height is typically measured directly or estimated using long bone lengths, an entirely different set of methods from Hasse's Rule. - This rule is specific to the **developing fetus** and not applicable to adults. *Determination of ethnicity* - Ethnicity determination involves analyzing skeletal features, particularly of the skull and pelvis, and is not related to fetal length or age estimation. - Hasse's Rule provides an age estimate based on size, not ancestral origin. *General forensic identification* - While forensic identification is a broad field, Hasse's Rule is a very specific tool for **fetal age assessment**, not general adult identification. - General forensic identification involves techniques like DNA analysis, fingerprinting, and skeletal remains analysis for adults.

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

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