Prenatal Care — MCQs

Prenatal Care Indian Medical PG Practice Questions and MCQs

Question 551: Which of the following findings on first trimester ultrasound is indicative of a poor prognosis?

A. Absence of fetal pole at 5 weeks
B. Absence of cardiac activity at 5 weeks
C. Absence of gestational sac at 4 weeks
D. Absence of cardiac activity at 8 weeks of gestation (Correct Answer)

Explanation: ***Absence of cardiac activity at 8 weeks of gestation*** - The absence of **fetal cardiac activity** at 8 weeks of gestation, when a fetal pole of at least **7 mm** should have clearly visible cardiac motion, definitively indicates a **non-viable pregnancy** and a poor prognosis. - At this gestational age, a visible heartbeat is a crucial marker of viability, and its absence strongly suggests a **missed abortion**. *Absence of fetal pole at 5 weeks* - A fetal pole is typically expected to be visualized between **5.5 and 6 weeks gestation**, so its absence at 5 weeks alone is **not necessarily indicative of a poor prognosis**. - The gestational sac should be present, and a follow-up ultrasound is often recommended to assess for further development. *Absence of cardiac activity at 5 weeks* - **Cardiac activity** is usually first detectable around **6 to 6.5 weeks gestation**, when the crown-rump length (CRL) reaches at least 2 mm. - Therefore, its absence at 5 weeks is a **normal finding** and not indicative of a poor prognosis. *Absence of gestational sac at 4 weeks* - A gestational sac is expected to be visible by **4.5 to 5 weeks of gestation** with transvaginal ultrasound. - Its absence at precisely 4 weeks might be due to **early timing** or inaccurate dating, and a repeat scan is often warranted, rather than assuming a poor prognosis immediately.

Question 552: At what week post fertilization does the embryo transition to being called a fetus?

A. 8 weeks (Correct Answer)
B. 6 weeks
C. 10 weeks
D. 12 weeks

Explanation: ***8 weeks*** - The transition from an embryo to a **fetus** occurs at the end of the **8th week post-fertilization**. - By this point, all major organ systems have begun to form, and the developing organism enters a period of growth and maturation. *6 weeks* - At 6 weeks post-fertilization, the developing organism is still considered an **embryo**. - During this stage, critical processes like **neural tube closure** and early heart development are occurring. *10 weeks* - By 10 weeks post-fertilization, the organism is firmly established as a **fetus**. - This period is characterized by further development and refinement of organs and systems. *12 weeks* - At 12 weeks post-fertilization, the developing organism is a **fetus**. - This marks the end of the first trimester, with significant growth and movement becoming possible.

Question 553: What is the recommended daily intake of folic acid during the first trimester of normal pregnancy?

A. 100 micrograms
B. 400-500 micrograms (Correct Answer)
C. 4 milligrams
D. 5 milligrams

Explanation: ***400-500 micrograms*** - The recommended daily intake of **folic acid** for women during their first trimester of pregnancy is **400-500 micrograms**. - This dosage helps prevent **neural tube defects** (NTDs) in the developing fetus, as the neural tube forms early in pregnancy. *100 micrograms* - This dosage is **insufficient** for preventing neural tube defects during pregnancy. - A lower dose may be adequate for general health but does not meet the increased demands during early pregnancy. *4 milligrams* - This dosage is significantly **higher** than the standard recommendation for an uncomplicated pregnancy. - Such a high dose (4 mg or 4000 micrograms) is typically reserved for women with a **history of a previous pregnancy affected by a neural tube defect**, indicating a higher risk. *5 milligrams* - Similar to 4 milligrams, this dosage (5000 micrograms) is also considered a **high dose**. - It is usually prescribed for women with **specific risk factors** for neural tube defects, such as a family history or certain medical conditions, rather than for a normal, uncomplicated pregnancy.

Question 554: 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 555: 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 556: 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 557: 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 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: 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 560: At which gestational age is urinary retention first observed in pregnancy?

A. 10 weeks (Correct Answer)
B. 18 weeks
C. 22 weeks
D. 34 weeks

Explanation: ***10 weeks*** - Urinary retention can first be observed around **10 weeks of gestation** due to the growing uterus impinging on the bladder neck. - This period is also when **uterine retroversion** is more likely to cause urinary obstruction as the uterus ascends out of the pelvis. *18 weeks* - By 18 weeks, the uterus has typically risen out of the pelvis, generally **reducing the risk** of simple uterine impingement causing acute urinary retention. - While other urinary tract issues can arise, acute retention due to uterine position is less common at this stage. *22 weeks* - At 22 weeks, the uterus is significantly larger and well-situated in the abdomen, making mechanical compression of the bladder neck less likely as a primary cause of **acute urinary retention**. - More complex causes would likely be responsible if retention occurred at this gestational age. *34 weeks* - Late-term pregnancy at 34 weeks might present with increased urinary frequency and some overflow incontinence due to the large fetal head putting pressure on the bladder. - However, **acute urinary retention** due to uterine retroversion is typically not seen at this stage, as the uterus is fully abdominal.

Practice by Chapter

Preconception Counseling

Practice Questions

Pregnancy Diagnosis and Dating

Practice Questions

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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