Prenatal Care — MCQs

Prenatal Care Indian Medical PG Practice Questions and MCQs

Question 591: In a 5-month pregnant female, which of the following statements regarding physiological changes is true?

A. Cardiac output is reduced
B. Systemic vascular resistance is increased
C. Increase in CVP
D. 80-90% have soft systolic murmur (Correct Answer)

Explanation: ***80-90% have soft systolic murmur*** - The **increased blood volume** and **cardiac output** during pregnancy lead to increased flow across the aortic and pulmonic valves, often resulting in a **physiological systolic ejection murmur**. - This murmur is typically heard best at the **left sternal border** and usually resolves after delivery. *Cardiac output is reduced* - **Cardiac output actually increases** significantly during pregnancy, typically by 30-50%, to meet the metabolic demands of the fetus and placenta. - This increase is due to both an **increase in heart rate** and **stroke volume**. *Systemic vascular resistance is increased* - **Systemic vascular resistance (SVR) decreases** during pregnancy, primarily due to the **vasodilating effects of progesterone** and the creation of a **low-resistance placental circulation**. - The drop in SVR contributes to the physiological **decrease in blood pressure** often observed in mid-pregnancy. *Increase in CVP* - **Central venous pressure (CVP) typically remains unchanged or slightly decreases** during normal pregnancy. - While blood volume increases, the accompanying **vasodilation and decreased SVR** usually prevent a significant rise in CVP.

Question 592: In which gestational weeks is Hegar's sign typically observed?

A. 10-14 weeks
B. 14-18 weeks
C. 18-22 weeks
D. 6 to 10 weeks (Correct Answer)

Explanation: ***6 to 10 weeks*** - **Hegar's sign** is a softening of the lower uterine segment, which is a probable sign of pregnancy detected during a **bimanual examination**. - This softening typically becomes noticeable and palpable between **6 and 10 weeks of gestation** due to increased vascularity and edema in the area. *10-14 weeks* - While the uterus continues to soften and enlarge, **Hegar's sign** is usually established earlier, making it less specific or prominent for confirmation in this later window. - At this stage, other signs of pregnancy, such as a **palpable fetal outline** or **fetal heart tones**, become more readily apparent. *14-18 weeks* - By this gestational period, the uterus is significantly larger and has risen out of the pelvic cavity, making the specific assessment of the **lower uterine segment's compressibility** as an isolated sign less relevant. - **Fetal movements** (quickening) may also be felt during this time, serving as a more direct indicator of pregnancy. *18-22 weeks* - At these later weeks, the uterus is distinctly enlarged, and much of the diagnosis relies on **fundal height assessment** and further monitoring of fetal development. - **Hegar's sign** is a very early sign of pregnancy and would not be used for confirmation in this advanced stage.

Question 593: For uterine prolapse in pregnancy, a ring pessary can be inserted up to?

A. 12 weeks
B. 14 weeks
C. 18 weeks (Correct Answer)
D. 16 weeks

Explanation: ***18 weeks*** - A **ring pessary** can be effectively used for uterine prolapse in pregnancy up to **18 weeks** of gestation. - By this time, the uterus usually ascends into the abdominal cavity, naturally relieving the prolapse and making the pessary unnecessary. *12 weeks* - While a pessary can be inserted at this Gestational Age, this is not the **maximum effective period** for its use in relieving uterine prolapse. - The uterus is still largely pelvic at 12 weeks, and the pessary provides support, but the natural ascent that obviates its need hasn't fully occurred. *14 weeks* - This period is also within the effective range for pessary insertion but does not represent the **upper limit** of its utility. - The uterus is progressively becoming abdominal, but the full resolution of prolapse symptoms due to uterine ascent may still be some weeks away. *16 weeks* - While a pessary can certainly be used at this stage, it is not the **absolute limit** for its insertion. - The uterus is significantly larger and largely abdominal by 16 weeks, offering natural relief for many, but the critical 18-week mark is when the uterus is typically fully supported by the abdominal cavity.

Question 594: Which of the following statements about Hegar's sign is false?

A. Bimanual palpation method
B. Present in 2/3rd of cases (Correct Answer)
C. Difficult in obese
D. Can be done at 14 weeks

Explanation: ***Present in 2/3rd of cases*** - This statement is **FALSE** and is the correct answer to this question. - Hegar's sign, while a classic sign of pregnancy, is not consistently present in 2/3rds of cases with such statistical certainty. - Its detectability varies significantly depending on **gestational age** (optimal 6-12 weeks), **uterine position** (retroverted uterus makes it harder), **examiner experience**, and **patient body habitus**. - This specific "2/3rd" frequency claim lacks strong evidence-based support in obstetric literature. *Bimanual palpation method* - This statement is TRUE. - **Hegar's sign** is elicited by **bimanual pelvic examination** where one hand is placed on the abdomen and the other in the vagina to palpate the softening and compressibility of the **lower uterine segment** (isthmus). - The examiner feels the cervix and uterine fundus separately with the soft isthmus compressed between the examining fingers. *Difficult in obese* - This statement is TRUE. - **Obesity** makes any deep abdominal or pelvic palpation more challenging due to increased adipose tissue. - The **softening of the lower uterine segment** is harder to appreciate, reducing the sensitivity of detecting Hegar's sign in obese patients. *Can be done at 14 weeks* - This statement is technically TRUE but represents suboptimal timing. - **Hegar's sign** is most reliably detectable between the **6th and 12th weeks of gestation**. - At **14 weeks**, while the examination can still be performed, the uterus has grown significantly and risen into the abdomen, making the lower uterine segment less compressible and the sign much less prominent or absent. - The statement doesn't claim it's "optimal" at 14 weeks, only that it "can be done," which is technically accurate even if clinically impractical.

Question 595: Tdap vaccine is given in between which weeks of pregnancy?

A. 10-16 weeks
B. 17-22 weeks
C. 22-26 weeks
D. 27-36 weeks (Correct Answer)

Explanation: ***27-36 weeks*** - The **Tdap vaccine** is recommended during this window in **every pregnancy** to maximize the transfer of **maternal antibodies** to the fetus. - This timing provides effective protection against **pertussis (whooping cough)** for the newborn from birth until their own vaccinations begin. *10-16 weeks* - This period is generally too early for optimal **passive immunity transfer** to the fetus against pertussis. - While other vaccines might be considered, **Tdap is specifically timed later** for maximum antibody benefit. *17-22 weeks* - This window is also typically considered too early for the Tdap vaccine to provide the **highest level of antibody transfer** to the newborn. - The goal is to administer the vaccine when **maternal antibody levels peak closer to delivery**. *22-26 weeks* - While closer to the recommended timeframe, this still falls slightly outside the **optimal window (27-36 weeks)** for the Tdap vaccine. - Delaying slightly longer ensures **peak antibody levels** for the longest possible passive immunity.

Question 596: What is the energy requirement in late pregnancy?

A. 2000 calories
B. 2500 calories (Correct Answer)
C. 1400 calories
D. 3000 calories

Explanation: ***2500 calories*** - The energy requirement for women in late pregnancy (third trimester) is approximately **2300-2500 calories per day**, which includes an additional **300-450 calories** above pre-pregnancy needs. - This increased energy intake supports **fetal growth and development**, increased maternal blood volume, uterine growth, and the metabolic demands of pregnancy. - The **2500 calorie** recommendation represents the upper range suitable for most pregnant women with normal activity levels. *2000 calories* - This amount is closer to the **pre-pregnancy energy requirement** for an average woman, but is **insufficient** for late pregnancy. - During the third trimester, failing to meet increased caloric needs can compromise **fetal growth** and lead to **inadequate gestational weight gain**. *1400 calories* - This amount is **severely insufficient** for the increased metabolic demands of late pregnancy. - An inadequate calorie intake can compromise **fetal growth**, lead to **intrauterine growth restriction (IUGR)**, and cause **maternal nutrient deficiencies**. *3000 calories* - This caloric intake is generally **too high** for the average pregnant woman with normal activity levels. - Excessive intake is only justified in cases of **multiple gestation**, unusually high physical activity, or specific medical conditions. - Consuming 3000 calories per day without proper justification can lead to **excessive gestational weight gain**, gestational diabetes, and macrosomia.

Question 597: Which structure do cytotrophoblasts invade during implantation?

A. Decidua capsularis
B. Decidua vera
C. Decidua basalis (Correct Answer)
D. Decidua parietalis

Explanation: ***Decidua basalis*** - The **cytotrophoblasts** invade the maternal **decidua basalis**, which is the portion of the **endometrium** directly underlying the implanted embryo, forming the maternal component of the **placenta**. - This invasion is crucial for establishing the **placenta** and allowing for nutrient and waste exchange between the mother and the fetus. *Decidua parietalis* - The **decidua parietalis** is the portion of the **endometrium** lining the rest of the **uterine cavity**, not directly involved in the immediate implantation site. - It plays a role later in pregnancy, fusing with the **decidua capsularis** as the **embryo** grows. *Decidua capsularis* - The **decidua capsularis** is the portion of the endometrium that overlies the implanted embryo, separating it from the uterine lumen. - It does not undergo invasion by the **cytotrophoblasts** in the same way the **decidua basalis** does. *Decidua vera* - The **decidua vera** is another term for the **decidua parietalis**, referring to the endometrial lining of the uterine cavity that is not involved in the implantation site. - It is not directly invaded by **cytotrophoblasts** during implantation.

Question 598: All of the following are physiological changes that occur during pregnancy, except which of the following?

A. Decrease in renal plasma flow (Correct Answer)
B. Increase in cardiac output
C. Increase in glomerular filtration rate
D. Increase in blood volume

Explanation: ***Decrease in renal plasma flow*** - This statement is incorrect because **renal plasma flow actually increases** significantly during pregnancy due to vasodilation. - The increased renal plasma flow contributes to the elevated **glomerular filtration rate** observed in pregnant women. *Increase in cardiac output* - **Cardiac output increases by 30-50%** during pregnancy to meet the metabolic demands of the growing fetus and maternal tissues. - This increase is primarily due to an increase in both **heart rate** and **stroke volume**. *Increase in glomerular filtration rate* - The **glomerular filtration rate (GFR) increases by 30-50%** during pregnancy, leading to increased renal clearance of waste products. - This physiologic change is partly due to the **increased renal plasma flow** and changes in renal hemodynamics. *Increase in blood volume* - **Blood volume increases by 30-50%** during pregnancy, with a proportionally greater increase in plasma volume compared to red blood cell mass. - This expansion in blood volume is crucial for meeting the demands of the uteroplacental circulation and protecting against hemorrhage during delivery.

Question 599: Which screening test is not performed in pregnant women?

A. VDRL
B. Hep B
C. Hep D (Correct Answer)
D. Hep A

Explanation: ***Hep D*** - **Hepatitis D (HDV) screening is NOT routinely performed** in pregnant women, even in those who are HBsAg-positive. - While HDV can only infect those with Hepatitis B, **routine prenatal screening protocols do not include HDV testing**. - HDV testing may only be considered in specific scenarios such as **severe or fulminant hepatitis** in HBsAg-positive pregnant women, but it is not part of standard antenatal screening. - The **absence of routine HDV screening** reflects its low prevalence and the fact that management focuses primarily on HBV status. *VDRL* - The **Venereal Disease Research Laboratory (VDRL)** test is a **routine universal screening** test for **syphilis** during pregnancy. - Early detection and treatment of syphilis are crucial to prevent **congenital syphilis**, which can cause severe fetal and neonatal complications. - Screening is typically performed in the **first trimester** and may be repeated in the third trimester in high-risk populations. *Hep B* - **Hepatitis B surface antigen (HBsAg)** testing is a **universal screening recommendation** for all pregnant women. - This screening helps identify mothers who could transmit the virus to their infants during birth. - Positive mothers' infants receive **hepatitis B immunoglobulin (HBIG) and HBV vaccine** within 12 hours of birth to prevent vertical transmission. *Hep A* - **Hepatitis A screening** is not routinely performed in all pregnant women as a universal screening measure. - However, it **may be tested** in pregnant women with **specific risk factors** (travel to endemic areas, exposure history), **symptoms** (jaundice, elevated liver enzymes), or during outbreak investigations. - Unlike Hep D, Hep A testing has clinical utility in symptomatic cases and is more readily available in clinical practice.

Question 600: What is the uterine blood flow at term in ml/min?

A. 50 ml/min
B. 450 ml/min
C. 550 ml/min
D. 750 ml/min (Correct Answer)

Explanation: ***750 ml/min*** - At term, **uterine blood flow** significantly increases to meet the metabolic demands of the fetus and placenta. - Approximately **750 ml/min** is delivered to the uterus, representing a substantial portion of the maternal cardiac output. *50 ml/min* - This flow rate is typical for the **non-gravid uterus** and is significantly lower than what is required during pregnancy. - A flow of 50 ml/min would be insufficient to support fetal growth and placental function at term. *450 ml/min* - While significantly higher than non-gravid flow, **450 ml/min** is still below the average blood flow to the uterus at term. - This rate would likely compromise sufficient nutrient and oxygen delivery to the fetus. *550 ml/min* - Similar to 450 ml/min, **550 ml/min** is an underestimate of the typical uterine blood flow at term. - Adequate fetal well-being in late pregnancy requires a higher rate of blood perfusion to the uteroplacental unit.

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

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Screening Tests in Pregnancy

Practice Questions

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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