UPSC-CMS 2019 - Obstetrics and Gynecology Practice Questions

Q: Which one of the following is NOT a common cause of recurrent abortions?

Maternal diabetes. ***Maternal diabetes*** - While uncontrolled diabetes can increase the risk of **miscarriage** and **birth defects** in general, it is typically not considered a common or direct cause of *recurrent abortions* (defined as three or more consecutive pregnancy losses). - Its effects are often seen in isolated miscarriages or specific fetal anomalies rather than a pattern of repeated losses. *Antiphospholipid syndrome* - This is a well-established cause of recurrent abortions due to the formation of **thrombi** in the placental circulation, leading to impaired blood flow and fetal demise. - It involves the presence of **antiphospholipid antibodies** that interfere with normal pregnancy progression. *Chromosomal abnormality* - Both parental and embryonic chromosomal abnormalities are a very common cause of recurrent pregnancy loss, particularly in the **first trimester**. - These abnormalities often result in non-viable embryos, leading to spontaneous abortion. *TORCH group of infections* - Infections like **Toxoplasmosis, Other (syphilis, parvovirus), Rubella, Cytomegalovirus (CMV), and Herpes simplex virus (HSV)** can cause significant fetal damage and pregnancy loss. - While they can lead to miscarriage, they are generally associated with sporadic miscarriages or specific fetal syndromes rather than recurring abortions in consecutive pregnancies.

Q: The most common cause of early spontaneous abortion is:

Chromosomal abnormality. ***Chromosomal abnormality*** - **Chromosomal abnormalities**, such as aneuploidy (e.g., trisomy, monosomy), are responsible for approximately 50-70% of all **early spontaneous abortions**. - These abnormalities often result in **non-viable embryos** or fetuses, leading to pregnancy loss before 12-20 weeks of gestation. *Teratogens* - **Teratogens** are agents that can cause birth defects, but they are a less common cause of **early spontaneous abortion** compared to chromosomal abnormalities. - While they can lead to fetal demise, their primary impact is often on **fetal development** rather than embryonic non-viability. *Endocrine disorder* - **Endocrine disorders** like uncontrolled diabetes or thyroid disease can increase the risk of spontaneous abortion, but they are not the **most common cause**. - These factors tend to contribute to a smaller percentage of **early pregnancy losses** compared to genetic errors. *Infection* - Certain **infections** (e.g., TORCH infections, bacterial vaginosis) can cause spontaneous abortion, especially if systemic or severe. - However, similar to endocrine disorders, infections are a less frequent cause of **early spontaneous abortion** than chromosomal abnormalities.

Q: Cause of Fetal growth restriction may be: 1. Chromosomal abnormality 2. Congenital abnormality 3. Abnormal cord insertion Which of the statements given above is/are correct?

1, 2 and 3. ***Correct: 1, 2 and 3*** All three statements represent established causes of **Fetal Growth Restriction (FGR)**: - **Chromosomal abnormalities** (trisomy 13, 18, 21, Turner syndrome) cause **intrinsic poor growth potential** of the fetus by disrupting normal cellular development and metabolism, directly leading to FGR. - **Congenital abnormalities** (cardiac defects, renal malformations, CNS anomalies) impair fetal development and nutrient utilization through structural and functional deficits, resulting in FGR. - **Abnormal cord insertion** (velamentous or marginal cord insertion) compromises the efficiency of **nutrient and oxygen transfer** from the placenta to the fetus by reducing vascular support, thus causing placental insufficiency and FGR. *Incorrect: 1 and 3 only* This incorrectly excludes **congenital abnormalities**, which are a well-established independent cause of FGR. Structural malformations directly impair fetal growth through metabolic and functional deficits. *Incorrect: 1 and 2 only* This incorrectly excludes **abnormal cord insertion**, which directly impacts placental function and nutrient supply—a key pathway for uteroplacental insufficiency leading to FGR. *Incorrect: 2 and 3 only* This incorrectly excludes **chromosomal abnormalities**, which are a major genetic cause of intrinsic FGR. Chromosomal defects (e.g., trisomies) are fundamental causes of impaired fetal growth potential.

Q: Which one of the following regarding fetal growth restriction is NOT true?

Delivery always at 34 weeks. ***Delivery always at 34 weeks*** - The timing of delivery in **fetal growth restriction (FGR)** is highly **individualized** and depends on several factors, including the severity of FGR, gestational age, and results of fetal surveillance tests like Doppler studies and biophysical profiles. It is not an absolute rule to deliver all FGR fetuses at 34 weeks. - Early delivery, especially before term, carries risks of **prematurity**, and the decision is made when the risks of continuing the pregnancy outweigh the risks of early delivery. *Biophysical profile is done* - The **biophysical profile (BPP)** is a common method of fetal surveillance used in pregnancies complicated by FGR to assess fetal well-being, including **fetal movements, tone, breathing, amniotic fluid volume,** and **non-stress test results**. - It helps in making decisions about the timing of delivery and ongoing management. *Umbilical artery Doppler studies are done* - **Umbilical artery Doppler studies** are crucial for monitoring FGR, as they assess placental function and fetal compromise by measuring blood flow in the umbilical artery. - Abnormal Doppler findings, such as **absent** or **reversed end-diastolic flow**, indicate increased placental resistance and are important in guiding management and determining the optimal timing of delivery. *Daily fetal movement count is advised* - **Daily fetal movement counting**, or "kick counts," is an important and simple method of fetal surveillance that women can perform at home to monitor fetal well-being. - A significant decrease in fetal movements can signal **fetal compromise** and warrants further evaluation.

Q: Which one of the following statements regarding contraception is NOT true?

Vaginal ring is a barrier method. ***Vaginal ring is a barrier method*** - The **vaginal ring** (e.g., NuvaRing) is a **hormonal contraceptive** that releases estrogen and progestin, not a barrier method. - Its mechanism of action involves **inhibiting ovulation** and altering cervical mucus, unlike barrier methods that physically block sperm. *Copper T can be inserted just after delivery* - The **Copper T (IUD)** can be safely inserted immediately after delivery, ideally within **48 hours**, as a **postpartum IUD insertion**. - This timing is often preferred as the cervix is still dilated, and the woman is already in a healthcare setting. *Implanon is a hormonal contraceptive* - **Implanon** (now Nexplanon) is indeed a **hormonal contraceptive**, containing etonogestrel, a progestin. - It is an implantable rod that provides **long-acting reversible contraception (LARC)** for up to three years. *Copper T can be used as post coital contraception* - The **Copper T IUD** is highly effective as **emergency contraception** when inserted within **5 days** of unprotected intercourse. - It works by preventing fertilization or implantation, making it more effective than emergency contraceptive pills.

Q: A 26 year old P2L2 has just had delivery. What are the contraceptive choices she has at present? 1. Post placental insertion of IUCD 2. Post partum ligation 3. Oral contraceptive pill 4. Lap ligation Select the correct answer using the code given below:

1 and 2 only. **1 and 2 only** - **Post-placental insertion of an IUCD** (Intrauterine Contraceptive Device) is a safe and effective immediate contraception option after delivery, as the cervix is still dilated, facilitating insertion. - **Postpartum ligation** (tubal ligation) is a common and highly effective permanent contraception method that can be performed shortly after delivery, often before discharge from the hospital. *2 only* - This option is incomplete as **post-placental IUCD insertion** is also a viable and often preferred immediate post-delivery contraceptive choice. - Limiting options to only postpartum ligation overlooks another readily available and effective method. *1, 2 and 4* - This option includes **lap ligation**, which typically refers to a laparoscopic procedure and is usually not performed immediately postpartum due to the enlarged uterus and increased vascularity, making it less ideal than ligation performed via mini-laparotomy shortly after delivery. - While laparoscopic approaches are possible later, **postpartum mini-laparotomy ligation** (which '2' likely refers to in this context) is the more immediate and common surgical approach. *1 and 3* - This option includes **oral contraceptive pills**, which are generally not recommended for immediate use in the postpartum period, especially for breastfeeding mothers, due to the potential impact on lactation and an increased risk of thromboembolism in the initial weeks after delivery. - **Progestin-only pills** can be considered later in the postpartum period, but combined oral contraceptives are typically delayed.

Q: A 22 year old woman comes with complaints of pain and discomfort in vaginal region. On examination there is unilateral tender swelling in the posterior half of labium majus, overlying skin is red and edematous. What is the most probable diagnosis?

Bartholin's abscess. ***Bartholin's abscess*** - The presentation of a **unilateral, tender swelling** in the **posterior half of the labium majus (not minus)**, with overlying **red and edematous skin**, is highly characteristic of a **Bartholin's abscess**. - This occurs when the **Bartholin's gland duct** becomes obstructed and infected, leading to pus accumulation and inflammation. *Trichomoniasis* - This is a **sexually transmitted infection** that causes **vaginitis**, characterized by a **frothy, foul-smelling discharge**, itching, and dysuria. - It does not present as a **localized, tender swelling** in the labia. *Utero vaginal prolapse* - This condition involves the **descent of the uterus and/or vagina** from their normal position, often causing a **feeling of pressure or a bulge** in the vagina. - It does not manifest as an acute, **unilateral, tender inflammatory swelling** of the labia. *Inversion of uterus* - **Uterine inversion** is a rare and life-threatening obstetric emergency, typically occurring **postpartum**, where the uterus turns inside out. - Its symptoms include **severe pain, hemorrhage, and shock**, and it is not related to a localized labial swelling.

Q: A 29 year old woman is noted to have three consecutive first trimester spontaneous abortions. Examination reveals fibroid uterus. Which of the following types of uterine fibroids would most likely lead to recurrent abortions?

Submucosal. ***Submucosal*** - **Submucosal fibroids** are located directly beneath the **endometrium** and can protrude into the uterine cavity, disrupting the normal implantation site and early fetal development. - Their presence significantly increases the risk of **implantation failure** and **recurrent first-trimester spontaneous abortions** due to mechanical distortion and altered uterine blood flow. *Cervical* - **Cervical fibroids** are rare and located in the uterine cervix; while they can cause symptoms like bleeding or difficulty with delivery, they are less likely to directly impact **early implantation** or cause **recurrent first-trimester abortions**. - Their primary impact is often related to labor and delivery complications rather than early pregnancy loss. *Intramural* - **Intramural fibroids** are located within the muscular wall of the uterus and are the most common type. While large or numerous intramural fibroids can sometimes contribute to pregnancy complications, their direct impact on **recurrent first-trimester abortions** is generally less significant compared to submucosal fibroids. - Their effect on fertility often depends on their size, number, and proximity to the **endometrial cavity**. *Subserosal* - **Subserosal fibroids** are located on the outer surface of the uterus, beneath the serosa, and typically grow outwards. - They usually have **minimal to no impact** on implantation or early pregnancy development, thus they are unlikely to be a cause of **recurrent first-trimester abortions**.

Q: A 25 year old infertile woman is noted to have blocked fallopian tubes on Hysterosalpingography. Which of the following is the best next step for this woman?

Laparoscopy. ***Laparoscopy*** - A **blocked fallopian tube** identified on hysterosalpingography (HSG) requires direct visualization to confirm the diagnosis, assess the extent of the blockage, identify any associated pelvic pathology (adhesions, endometriosis), and potentially perform surgical correction (e.g., salpingostomy, fimbrioplasty, adhesiolysis). - Laparoscopy allows for **definitive diagnosis** of tubal pathology and can be therapeutic. It is particularly indicated when there is suspicion of correctable pathology or when the patient prefers attempting natural conception. - **Note**: In modern practice, IVF is increasingly considered as first-line for bilateral tubal disease, but laparoscopy remains important for diagnostic purposes and when surgical correction is feasible. *Clomiphene citrate therapy* - This therapy is primarily used to induce **ovulation** in anovulatory infertility, which is not the primary issue when blocked fallopian tubes are identified. - It would be ineffective in overcoming a physical **tubal obstruction**, as sperm and egg cannot meet regardless of ovulation status. *Intrauterine insemination* - IUI involves placing sperm directly into the uterus, bypassing cervical factors, but it still requires at least one **patent fallopian tube** for fertilization to occur. - With blocked fallopian tubes, IUI would not address the problem of the egg and sperm being unable to meet, making it an inappropriate choice. *Gonadotropin therapy* - Gonadotropins (FSH and LH) are used to stimulate **follicle development** and ovulation, similar to clomiphene but often for more resistant cases or controlled ovarian hyperstimulation. - This therapy does not resolve **tubal blockages** and would not be effective in achieving pregnancy in the presence of blocked fallopian tubes without patent tubes for fertilization.

Question 1

Which one of the following is NOT a common cause of recurrent abortions?

Accepted Answer

Maternal diabetes

Answer

Antiphospholipid syndrome

Answer

Chromosomal abnormality

Answer

TORCH group of infections

Question 2

Contraindications to Uterine Cerclage for Incompetent os are all EXCEPT:

Accepted Answer

Previous history suggestive of abortion due to incompetent os

Answer

Bulging membrane

Answer

History of vaginal bleeding

Answer

Ruptured membrane

Question 3

The most common cause of early spontaneous abortion is:

Accepted Answer

Chromosomal abnormality

Answer

Teratogens

Answer

Endocrine disorder

Answer

Infection

Question 4

Cause of Fetal growth restriction may be:

1. Chromosomal abnormality
2. Congenital abnormality
3. Abnormal cord insertion

Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

1 and 2 only

Answer

2 and 3 only

Question 5

Which one of the following regarding fetal growth restriction is NOT true?

Accepted Answer

Delivery always at 34 weeks

Answer

Biophysical profile is done

Answer

Umbilical artery Doppler studies are done

Answer

Daily fetal movement count is advised

Question 6

Which one of the following statements regarding contraception is NOT true?

Accepted Answer

Vaginal ring is a barrier method

Answer

Copper T can be inserted just after delivery

Answer

Implanon is a hormonal contraceptive

Answer

Copper T can be used as post coital contraception

Question 7

A 26 year old P2L2 has just had delivery. What are the contraceptive choices she has at present?

1. Post placental insertion of IUCD
2. Post partum ligation
3. Oral contraceptive pill
4. Lap ligation

Select the correct answer using the code given below:

Accepted Answer

1 and 2 only

Answer

2 only

Answer

1, 2 and 4

Answer

1 and 3

Question 8

A 22 year old woman comes with complaints of pain and discomfort in vaginal region. On examination there is unilateral tender swelling in the posterior half of labium majus, overlying skin is red and edematous. What is the most probable diagnosis?

Accepted Answer

Bartholin's abscess

Answer

Trichomoniasis

Answer

Utero vaginal prolapse

Answer

Inversion of uterus

Question 9

A 29 year old woman is noted to have three consecutive first trimester spontaneous abortions. Examination reveals fibroid uterus. Which of the following types of uterine fibroids would most likely lead to recurrent abortions?

Accepted Answer

Submucosal

Answer

Cervical

Answer

Intramural

Answer

Subserosal

Question 10

A 25 year old infertile woman is noted to have blocked fallopian tubes on Hysterosalpingography. Which of the following is the best next step for this woman?

Accepted Answer

Laparoscopy

Answer

Clomiphene citrate therapy

Answer

Intrauterine insemination

Answer

Gonadotropin therapy

UPSC-CMS 2019 — Obstetrics and Gynecology