Prenatal Care — MCQs
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Use of folic acid to prevent congenital malformations should be best initiated:
Which of the following sonographic findings is most indicative of an intrauterine pregnancy?
Average extra caloric requirement during second and third trimesters of pregnancy is:
What is the preferred timing for routine urine sample collection in a pregnant female?
What is the obstetric score of a 26-year-old woman who is 36 weeks pregnant, has had one previous delivery of twins, and is certain of her dates?
Prenatal Care Indian Medical PG Practice Questions and MCQs
Question 621: Use of folic acid to prevent congenital malformations should be best initiated:
- A. During 1st trimester of pregnancy
- B. During 2nd trimester of pregnancy
- C. During 3rd trimester of pregnancy
- D. Before conception (Correct Answer)
Explanation: ***Before conception*** - **Neural tube defects (NTDs)**, such as spina bifida and anencephaly, occur very early in pregnancy, often before a woman even knows she is pregnant. - Adequate folate levels are crucial for **neural tube closure**, which happens between 21 and 28 days after conception. Therefore, supplementation needs to start before this period. *During 1st trimester of pregnancy* - While still helpful, initiating folic acid during the first trimester might be **too late** to prevent all NTDs. - The critical period for neural tube formation has largely passed, meaning the **maximum preventive effect** may not be achieved. *During 2nd trimester of pregnancy* - This is **too late** for primary prevention of NTDs, as neural tube closure is completed in the first few weeks of gestation. - At this stage, folic acid supplementation would primarily benefit the ongoing **fetal growth and development**, but not the prevention of NTDs. *During 3rd trimester of pregnancy* - This timing is **ineffective** for the prevention of congenital malformations like NTDs, which have already occurred or been avoided by this point. - Folic acid at this stage primarily supports continued fetal growth and maternal health, but offers no additional benefit regarding **early developmental defects**.
Question 622: Which of the following sonographic findings is most indicative of an intrauterine pregnancy?
- A. A double decidual sign with two concentric echogenic rings.
- B. A gestational sac with a yolk sac. (Correct Answer)
- C. A gestational sac without any accompanying structures.
- D. An echogenic rim along one side of the decidua.
Explanation: ***A gestational sac with a yolk sac.*** - The presence of a **yolk sac** within a **gestational sac** definitively confirms an **intrauterine pregnancy (IUP)**, as a yolk sac is fetal tissue. - This finding is typically visible around **5-6 weeks gestational age** via transvaginal ultrasound. *A double decidual sign with two concentric echogenic rings.* - The **double decidual sign** is suggestive of an IUP but is not definitive, as it can occasionally be mimicked by a **pseudogestational sac** in **ectopic pregnancies**. - It represents the decidua parietalis and decidua capsularis, which are maternal tissues. *A gestational sac without any accompanying structures.* - A **gestational sac without a yolk sac** is often referred to as a **"fluid-filled sac"** and can be present in both normal early IUPs and **pseudogestational sacs** of ectopic pregnancies. - While it warrants follow-up, it is not definitive for an IUP on its own. *An echogenic rim along one side of the decidua.* - This description is too vague and does not provide specific enough details to indicate an intrauterine pregnancy. - It could be a normal endometrial fold or an artifact, but lacks definitive embryonic structures.
Question 623: Average extra caloric requirement during second and third trimesters of pregnancy is:
- A. +150 Kcal/day
- B. +350 Kcal/day (Correct Answer)
- C. +520 Kcal/day
- D. +600 Kcal/day
Explanation: ***Correct: +350 Kcal/day*** - The **recommended average extra caloric intake** during pregnancy is approximately **300-350 kcal/day** in the second and third trimesters. - Specifically, **second trimester requires +340 kcal/day** and **third trimester requires +452 kcal/day** (average ~350 kcal/day). - This additional energy is needed to support **fetal growth, placental development, and increased maternal metabolic demands**. - **First trimester** requires minimal increase (0-100 kcal/day). *Incorrect: +150 Kcal/day* - This amount is generally **insufficient** for the increased metabolic demands of the second and third trimesters. - While caloric needs do not significantly increase in the first trimester, they rise substantially in later pregnancy. *Incorrect: +520 Kcal/day* - An extra intake of 520 kcal/day is **higher than the generally recommended** guidelines for most pregnant women. - This level of intake could potentially lead to **excessive gestational weight gain**, increasing risks of gestational diabetes and complications. *Incorrect: +600 Kcal/day* - An additional 600 kcal/day is **significantly above the average recommendation** for caloric intake during pregnancy. - Such high intake is typically **not necessary** and may contribute to **unhealthy weight gain** for both mother and fetus.
Question 624: What is the preferred timing for routine urine sample collection in a pregnant female?
- A. Early morning sample (Correct Answer)
- B. Suprapubic puncture
- C. Mid-stream collection
- D. Catheterization
Explanation: ***Early morning sample*** - An **early morning urine sample** is preferred because it is the most concentrated, increasing the likelihood of detecting abnormalities. - This concentration allows for accurate assessment of substances like **blood cells**, **protein**, and **bacteria**, which might be diluted in samples collected later in the day. *Mid-stream collection* - **Mid-stream collection** aims to reduce contamination from the periurethral area but does not provide the same concentration as an early morning sample. - While important for reducing contaminants, it's not the primary factor determining the optimal collection time for diagnosing pregnancy-related conditions. *Suprapubic puncture* - **Suprapubic puncture** is an invasive procedure generally reserved for situations where a clean catch is impossible or contamination is a significant concern, typically in infants or critically ill patients. - It carries risks such as **pain**, **hematuria**, and potential **bowel perforation**, making it unsuitable for routine urine collection in pregnant women. *Catheterization* - **Catheterization** is an invasive method that carries a risk of introducing infection into the bladder. - It is usually performed only when a clean-catch sample cannot be obtained or when precise measurement of residual urine is necessary, not for routine screening in pregnant women.
Question 625: What is the obstetric score of a 26-year-old woman who is 36 weeks pregnant, has had one previous delivery of twins, and is certain of her dates?
- A. G2P1L2 (2 live births) (Correct Answer)
- B. G3P2L2 (3 pregnancies, 2 live births)
- C. G2P2L2 (2 pregnancies, 2 live births)
- D. G3P3L2
Explanation: ***G2P1L2 (2 live births)*** - **Gravida (G)** refers to the total number of pregnancies, including the current one. This woman is currently pregnant and has had one previous pregnancy, making her G2. - **Parity (P)** refers to the number of pregnancies that reached viability (>20 weeks gestation or >500g), *regardless of the number of fetuses*. She had one previous delivery (twins) that reached viability, so her P is 1. The current pregnancy is not included in parity until after delivery. - **Live births (L)** refers to the number of live children delivered. Her previous pregnancy resulted in twins, meaning 2 live births. *G3P2L2 (3 pregnancies, 2 live births)* - This option incorrectly counts the number of pregnancies (**G**) as 3. She has had one previous pregnancy and is currently pregnant, totaling 2 pregnancies. - It also incorrectly counts the parity (**P**) as 2. Parity refers to the number of deliveries that reached viability, not the number of fetuses. Her previous delivery was a single event, making P1. *G2P2L2 (2 pregnancies, 2 live births)* - While the Gravida (G2) and Live births (L2) are correct, the Parity (**P**) is incorrectly stated as 2. Parity refers to the number of viable pregnancies delivered, and she has only had one previous delivery. - The number of fetuses (twins) does not increase the parity count for a single delivery event. *G3P3L2 (3 pregnancies, 3 live births)* - This option incorrectly states the number of pregnancies (**G**) as 3 and the parity (**P**) as 3. - The woman has only had one previous pregnancy and is currently pregnant, for a total of G2 and P1.
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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