Prenatal Care — MCQs

Prenatal Care Indian Medical PG Practice Questions and MCQs

Question 551: Among the following sites, which is the most common location for implantation within the uterine cavity?

A. Fallopian tube ampullary part
B. Fallopian tube isthmus
C. Cornu of uterus
D. Fundus of uterus (Correct Answer)

Explanation: ***Fundus of uterus*** - Among the given options, the **fundus of the uterus** is the correct answer as it represents normal **intrauterine implantation**. - The blastocyst typically implants in the **upper part of the uterine body**, which includes the fundal and upper anterior/posterior wall regions, where there is a thick **endometrial lining** and rich **blood supply**. - Implantation in the uterine body/fundus ensures proper **placentation** and minimizes risks of complications like **placenta previa**. - Note: The most common specific site is the upper/middle posterior wall, but fundal implantation is within the normal range. *Fallopian tube ampullary part* - The **ampulla** is the most common site for **fertilization**, not implantation. - If implantation occurs here, it results in an **ectopic pregnancy** (ampullary tubal pregnancy), which is pathological and requires intervention. - This is the most common location for ectopic pregnancies, but not normal implantation. *Fallopian tube isthmus* - Implantation in the **isthmus** of the fallopian tube is another form of **ectopic pregnancy**. - This location has a higher risk of early **tubal rupture** and life-threatening hemorrhage due to the narrow diameter of the isthmus. - This is a dangerous ectopic site, not a normal implantation location. *Cornu of uterus* - The **cornu** (uterine horn/angle) is a rare and high-risk site for implantation within the uterus. - **Cornual/interstitial pregnancy** carries significant risks including uterine rupture as pregnancy progresses due to the thinner myometrium in this region. - While technically intrauterine, it is considered an abnormal and dangerous location compared to the main uterine body/fundus.

Question 552: Ideal time to do Glucose challenge test in pregnancy is?

A. 12-16 weeks
B. 20-24 weeks
C. 24-28 weeks (Correct Answer)
D. 30-34 weeks

Explanation: ***24-28 weeks*** - This is the **standard screening window** for gestational diabetes mellitus (GDM) using the 50-gram glucose challenge test. - During this period, **insulin resistance** in pregnancy typically becomes more pronounced, making it the optimal time to detect GDM. *12-16 weeks* - This early gestational period is usually **too soon** to reliably detect gestational diabetes in most women. - Significant insulin resistance associated with late pregnancy often has not yet developed. *20-24 weeks* - While sometimes considered, this window is **still a bit early** for routine GDM screening. - The sensitivity for detecting gestational diabetes is generally lower compared to the 24-28 week period. *30-34 weeks* - Screening during this period is generally **too late** for initial detection and management of GDM. - Delayed diagnosis could lead to adverse maternal and fetal outcomes that might have been prevented with earlier intervention.

Question 553: Goodell's sign is ?

A. Dusky hue of the vestibule
B. Softening of the cervix (Correct Answer)
C. Increased pulsations felt through the lateral fornices
D. Softening of the lower uterine segment

Explanation: ***Softening of the cervix*** - **Goodell's sign** refers to the noticeable softening of the cervix due to increased vascularity and edema in early pregnancy. - This change is an important clinical indicator of **early pregnancy**, typically observed from around 6-8 weeks of gestation. *Dusky hue of the vestibule* - This description corresponds to **Chadwick's sign**, which is the bluish or purplish discoloration of the vagina and vestibule during early pregnancy. - It also results from increased vascularity but specifically refers to the color change, not the cervical texture. *Increased pulsations felt through the lateral fornices* - This is known as **Osiander's sign**, caused by increased blood flow in the vaginal arteries during pregnancy. - It indicates increased pelvic vascularity, but unlike Goodell's sign, it describes a pulsating sensation, not cervical softening. *Regular and rhythmic contractions during bimanual examination* - This effect is referred to as **Hegar's sign**, involving the softening of the isthmus of the uterus (the portion between the cervix and the uterine body). - Hegar's sign is about the uterine consistency and shape during palpation, distinct from the cervical softening of Goodell's sign.

Question 554: What is the most conclusive clinical sign of pregnancy?

A. Uterine enlargement
B. Cervical softening
C. Amenorrhea
D. Fetal heart sound auscultation (Correct Answer)

Explanation: ***Fetal heart sound auscultation*** - The **direct auscultation of fetal heart sounds** is an unequivocal sign of a living fetus and, therefore, conclusive proof of pregnancy. - This sign confirms the presence of a **viable intrauterine pregnancy** and cannot be caused by other conditions. *Uterine enlargement* - While typically associated with pregnancy, uterine enlargement can also be caused by **fibroids**, adenomyosis, or other pelvic masses. - It is a **presumptive sign** as it needs further confirmation to rule out alternative causes. *Cervical softening* - Known as **Hegar's sign** or **Goodell's sign**, cervical softening is a probable sign of pregnancy due to increased vascularity and edema. - However, it can also be observed in conditions like **inflammation** or **pelvic congestion**, making it not conclusive. *Amenorrhea* - The absence of menstruation is often the **first presumptive sign** of pregnancy, prompting a woman to seek testing. - However, it can be caused by various factors unrelated to pregnancy, such as **stress**, hormonal imbalances, or underlying medical conditions.

Question 555: If the size of the fetus is 20 mm, according to Hasse’s rule, what is the gestational age of the fetus?

A. 2 weeks
B. 4 weeks
C. 8 weeks (Correct Answer)
D. 14 weeks

Explanation: ***8 weeks*** - **Hasse's rule** for early pregnancy (6-12 weeks) states that the **gestational age in weeks = Crown-Rump Length (CRL) in cm + 6.5** - Given a CRL of **20 mm = 2 cm**, applying Hasse's rule: Gestational age = 2 + 6.5 = **8.5 weeks**, which approximates to **8 weeks** - This rule is a classical method for estimating gestational age in the first trimester based on fetal crown-rump length measurements - At 8 weeks, the typical CRL is approximately **15-20 mm**, which aligns with the given measurement *2 weeks* - At **2 weeks gestational age**, the conceptus is still a blastocyst undergoing implantation with **no measurable crown-rump length** (microscopic size) - A CRL of **20 mm** is far too large for this early stage of development - This gestational age precedes the embryonic period when CRL measurements become meaningful *4 weeks* - At **4 weeks gestational age**, the embryo measures approximately **2-3 mm** in crown-rump length - A measurement of **20 mm** is significantly larger, indicating a more advanced gestational age - This would represent nearly 10 times the expected size at 4 weeks *14 weeks* - At **14 weeks gestational age**, the fetus has a crown-rump length of approximately **80-90 mm** (8-9 cm) - A CRL of only **20 mm** is far too small for 14 weeks, representing less than one-quarter of the expected size - This measurement would suggest a much earlier gestational age

Question 556: Deficiency of which vitamin during pregnancy predisposes to meningomyelocele?

A. Folic acid (Correct Answer)
B. Biotin
C. Pyridoxine
D. Thiamine

Explanation: ***Folic acid*** - **Folic acid** (Vitamin B9) is crucial for **neural tube closure** during early embryonic development. - Deficiency leads to neural tube defects such as **meningomyelocele** and **anencephaly**. *Biotin* - **Biotin** (Vitamin B7) plays a role in **metabolism** of carbohydrates, fats, and proteins. - Deficiency is rare and not primarily associated with neural tube defects. *Pyridoxine* - **Pyridoxine** (Vitamin B6) is important for amino acid metabolism and neurotransmitter synthesis but not directly linked to neural tube closure. - Deficiency can lead to **neurological symptoms** and **anemia**. *Thiamine* - **Thiamine** (Vitamin B1) is essential for energy metabolism and nerve function. - Deficiency causes **beriberi** and is not associated with neural tube defects.

Question 557: In a 34-week pregnancy with low-lying placenta previa and a floating head, with a hemoglobin level of 11 gm%, what should be the further line of management?

A. Expectant management (Correct Answer)
B. Cesarean section
C. Blood transfusion
D. Induction of labor

Explanation: ***Expectant management*** - With a 34-week pregnancy, **placenta previa**, and no active bleeding or severe maternal/fetal compromise, **expectant management** is generally preferred to allow for fetal lung maturity. - The hemoglobin level of 11 gm% is within a reasonable range for pregnancy and does not immediately warrant intervention. *Induction of labor* - **Induction of labor** is contraindicated in placenta previa due to the risk of severe hemorrhage as the cervix dilates. - This approach would significantly endanger both the mother and the fetus. *Cesarean section* - While a **cesarean section** is likely the eventual mode of delivery for placenta previa, performing it at 34 weeks without evidence of fetal distress or active bleeding would be premature. - It would increase the risk of neonatal complications associated with prematurity. *Blood transfusion* - A hemoglobin level of **11 gm%** is considered mild anemia in pregnancy and does not typically warrant a **blood transfusion** unless there is active, significant blood loss or symptoms of severe anemia. - Transfusing blood without an immediate need carries its own risks.

Question 558: Gestational sac can be seen using ultrasonography at the earliest by:

A. 3rd week
B. 4th week
C. 5th week (Correct Answer)
D. 8th week

Explanation: ***5th week*** - The **gestational sac** is typically the **first sonographic sign of an intrauterine pregnancy**. - It becomes reliably visible via **transvaginal ultrasound** when its mean diameter reaches 2-3 mm, which usually occurs around **5 weeks' gestational age**. *3rd week* - At **3 weeks' gestation**, the embryo is still at a very early stage of development, often a **blastocyst** or undergoing **implantation**. - It is **too small** to be visualized on routine ultrasound, and the gestational sac has not yet sufficiently developed. *4th week* - While implantation is usually complete by the end of the 4th week, the gestational sac is typically **not yet visible** or is **just barely perceptible** as a tiny fluid collection. - Visualization at this stage is often inconsistent and can be challenging, making the 5th week a more reliable earliest detection point. *8th week* - By **8 weeks' gestation**, the gestational sac would be **clearly visible** and much larger, often containing a fetal pole with a visible heartbeat. - This is well past the earliest time it can be detected.

Question 559: At how many weeks of gestation is the anomaly scan typically performed?

A. 14
B. 16
C. 18
D. 20 (Correct Answer)

Explanation: ***Correct: 20 weeks*** - The **anomaly scan**, also known as the **mid-pregnancy scan** or **fetal anomaly ultrasound**, is typically performed between **18 and 22 weeks of gestation**, with **20 weeks** being the most common and optimal time. - This timing allows for optimal visualization of fetal anatomy to detect potential **structural abnormalities** while still providing options for further investigation or management, if needed. - At 20 weeks, fetal organs and structures are sufficiently developed and large enough for comprehensive evaluation. *Incorrect: 14 weeks* - A scan at 14 weeks is generally too early for a comprehensive anomaly assessment, as many fetal organs and structures are still developing or too small to be clearly visualized. - This period is more commonly associated with the **nuchal translucency scan** (11-13+6 weeks), which screens for chromosomal abnormalities like Down syndrome. *Incorrect: 16 weeks* - While some gross anomalies might be detectable, 16 weeks is still considered suboptimal for a full and detailed anomaly scan. - Many structures necessary for a thorough evaluation are not fully developed or large enough for reliable assessment. *Incorrect: 18 weeks* - Eighteen weeks falls within the acceptable range for an anomaly scan (18-22 weeks), but **20 weeks** often provides better visualization due to further fetal growth and development. - Some institutions may start anomaly screening from 18 weeks, but 20 weeks is widely considered the ideal time for detailed evaluation of all fetal structures including the heart, brain, spine, kidneys, and limbs.

Question 560: At 20 weeks of gestation amniotic fluid volume is?

A. 600 ml
B. 400 ml
C. 200 ml (Correct Answer)
D. 800 ml

Explanation: ***200 ml*** - At **20 weeks of gestation**, the average amniotic fluid volume is approximately **200 ml**, primarily derived from fetal urination. - This volume is crucial for **fetal development**, protecting against trauma and allowing for lung maturation. *400 ml* - An amniotic fluid volume of 400 ml is typically observed later in gestation, often around **24-28 weeks**, as fetal urination increases. - While still within a normal range for some stages, it's generally higher than the average at 20 weeks. *600 ml* - A volume of 600 ml is characteristic of the **late second trimester** to early third trimester, around **28-32 weeks**, when the fetus is significantly larger and producing more urine. - This value would be considered high for a 20-week gestation and could indicate **polyhydramnios** if significantly elevated. *800 ml* - This volume is usually seen in the **third trimester**, often peaking around **33-34 weeks**, reflecting maximal fetal urine output. - An amniotic fluid volume of 800 ml at 20 weeks would be a clear indication of **severe polyhydramnios**, which can be associated with various fetal anomalies.

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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