Antenatal Complications Management Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Antenatal Complications Management. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Antenatal Complications Management Indian Medical PG Question 1: Mr. Murali has 126 mg/dl of fasting plasma glucose. His venous plasma glucose 2h after ingestion of 75g oral glucose load is 149 mg/dl. This patient comes under which stage of WHO diagnostic criteria of diabetes & intermediate hyperglycemia?
- A. Decreased glucose resistance
- B. IFG - Impaired fasting glucose
- C. Diagnosis of diabetes (Correct Answer)
- D. Impaired glucose tolerance
Antenatal Complications Management Explanation: **Diagnosis of diabetes**
- The **fasting plasma glucose (FPG)** of 126 mg/dL meets the WHO criterion for **diabetes**, which is FPG ≥ 126 mg/dL [1].
- Although the 2-hour post-glucose load (149 mg/dL) falls within the **impaired glucose tolerance (IGT)** range (140-199 mg/dL), the elevated fasting glucose alone is sufficient for a diabetes diagnosis according to WHO guidelines.
*Decreased glucose resistance*
- This term is not a standard diagnostic category recognized by the WHO for glucose metabolism disorders.
- Glucose resistance is more commonly associated with conditions like **insulin resistance** rather than a specific diagnostic stage [1].
*IFG - Impaired fasting glucose*
- **Impaired fasting glucose (IFG)** is defined by a fasting plasma glucose level between 100 mg/dL and 125 mg/dL.
- Mr. Murali's fasting glucose of 126 mg/dL is higher than the upper limit for IFG [1].
*Impaired glucose tolerance*
- **Impaired glucose tolerance (IGT)** is defined by a 2-hour post-glucose load plasma glucose level between 140 mg/dL and 199 mg/dL.
- While Mr. Murali's 2-hour reading of 149 mg/dL falls within this range, the elevated fasting glucose level takes precedence for the overall diagnosis [1].
Antenatal Complications Management Indian Medical PG Question 2: Placenta previa risk increases with the following except:
- A. Maternal age >35 yrs
- B. Multiparity
- C. Contraceptive use (Correct Answer)
- D. Previous cesarean section
Antenatal Complications Management Explanation: ***Contraceptive use***
- There is currently **no scientific evidence** to suggest that contraceptive use increases the risk of **placenta previa**.
- Contraceptive use is not associated with placental implantation abnormalities in subsequent pregnancies.
*Maternal age >35 yrs*
- **Advanced maternal age** is a well-established risk factor for placenta previa, as the uterine lining may be less favorable for normal implantation in older women.
- The risk of placental abnormalities, including **placenta previa**, increases with each decade of maternal age beyond 35 years.
*Multiparity*
- **Multiparity**, or having had multiple previous pregnancies, increases the risk of placenta previa.
- This is thought to be due to **scarring or changes in the uterine lining** from previous pregnancies and deliveries, leading to preferential implantation in the lower uterine segment.
*Previous cesarean section*
- **Prior cesarean delivery** is one of the **most significant risk factors** for placenta previa.
- Uterine scarring from cesarean section damages the endometrium, leading to abnormal placental implantation.
- The risk increases with the **number of previous cesarean sections** and may lead to placenta previa with accreta spectrum disorders.
Antenatal Complications Management Indian Medical PG Question 3: What is the definitive treatment for preeclampsia?
- A. Delivery of the baby (Correct Answer)
- B. Use of antihypertensive medications
- C. Dietary modifications
- D. Increased rest and monitoring
Antenatal Complications Management Explanation: ***Delivery of the baby***
- **Preeclampsia** is a multisystem disorder of pregnancy; its pathogenesis is directly linked to the **placenta**.
- **Removal of the placenta** through delivery is the only definitive cure for preeclampsia, leading to the resolution of symptoms.
*Use of antihypertensive medications*
- Antihypertensive medications are used to **manage blood pressure** in preeclampsia, preventing complications like stroke.
- They **do not address the underlying cause** of the disease and are not a curative treatment.
*Dietary modifications*
- While a healthy diet is important during pregnancy, **dietary modifications** alone cannot resolve the pathological processes of preeclampsia.
- There is **no specific diet** proven to cure or prevent preeclampsia.
*Increased rest and monitoring*
- **Increased rest and close monitoring** are supportive measures that can help manage symptoms and detect complications.
- These interventions **do not reverse the disease process** and are not a definitive treatment.
Antenatal Complications Management Indian Medical PG Question 4: Female with 41 wk gestation confirmed by radiological investigation, very sure of her LMP, no uterine contractions, no effacement and no dilatation. What should be done to induce labor?
- A. PGE1 tab (Correct Answer)
- B. PGE2 gel
- C. PGF2alpha
- D. Intracervical foley’s
Antenatal Complications Management Explanation: ***PGE1 tab***
- **Misoprostol (PGE1)** is an effective agent for **cervical ripening** and labor induction in cases of an unfavorable cervix (no effacement, no dilatation).
- It is cost-effective, stable at room temperature, and widely used in resource-limited settings.
- Can be administered orally or vaginally with good efficacy for cervical ripening at term.
- In this post-term pregnancy with unfavorable cervix, pharmacological ripening is appropriate.
*PGE2 gel*
- **PGE2 (dinoprostone)** gel or cervical insert is also an effective option for cervical ripening.
- Both PGE1 and PGE2 are acceptable first-line agents; the choice may depend on availability, cost, and institutional protocols.
- PGE2 formulations are FDA-approved and widely used, though may be more expensive than misoprostol.
*PGF2alpha*
- **PGF2alpha (carboprost)** is primarily used for the **management of postpartum hemorrhage** due to its potent myometrial contracting effect.
- It is **not indicated** for induction of labor at term as its strong uterine contractions can cause excessive uterine stimulation and fetal distress.
*Intracervical foley's*
- An **intracervical Foley catheter** is a mechanical method that causes cervical ripening through direct pressure and stimulation of local prostaglandin release.
- It is an evidence-based alternative with lower risk of uterine hyperstimulation compared to pharmacological methods.
- Both mechanical and pharmacological methods are acceptable first-line options for cervical ripening in post-term pregnancy with unfavorable cervix.
Antenatal Complications Management Indian Medical PG Question 5: Which of the following statements about gestational diabetes mellitus (GDM) is true?
- A. It is always associated with a previous history of IUGR.
- B. There is no recurrence of GDM in future pregnancies.
- C. There is no risk of developing overt diabetes in the future.
- D. Gestational diabetes mellitus is first recognized during pregnancy. (Correct Answer)
Antenatal Complications Management Explanation: ***Gestational diabetes mellitus is first recognized during pregnancy.***
- GDM is defined as **glucose intolerance** that is first recognized or diagnosed during pregnancy, regardless of whether it requires insulin or persists after pregnancy.
- This definition distinguishes it from **pre-existing type 1 or type 2 diabetes** diagnosed before conception.
*It is always associated with a previous history of IUGR.*
- GDM is primarily associated with an increased risk of **macrosomia** (large-for-gestational-age babies) due to high maternal glucose levels stimulating fetal insulin production and growth.
- While other pregnancy complications can occur, **intrauterine growth restriction (IUGR)** is not a typical or consistent association with GDM.
*There is no recurrence of GDM in future pregnancies.*
- Women who have had GDM in one pregnancy have a **significantly increased risk** (30-50%) of developing it again in subsequent pregnancies.
- This recurrence risk highlights the underlying predisposition to glucose intolerance.
*There is no risk of developing overt diabetes in the future.*
- A history of GDM is a strong predictor for developing **type 2 diabetes** later in life, with up to 50% of women developing it within 5-10 years post-delivery.
- It also carries a small increased risk of developing **type 1 diabetes** in some individuals.
Antenatal Complications Management Indian Medical PG Question 6: A 32-year-old primigravida at 39 weeks of gestational age has a blood pressure reading of 150/100 mmHg obtained during a routine visit, which is an elevation from her baseline blood pressure of 120/70 mmHg. She denies any headache, visual changes, nausea, vomiting, or abdominal pain. Her repeat BP is 160/90 mmHg, and urinalysis is negative for protein. Which of the following is the most likely diagnosis?
- A. Preeclampsia
- B. Chronic hypertension with superimposed preeclampsia
- C. Eclampsia
- D. Gestational hypertension (Correct Answer)
Antenatal Complications Management Explanation: ***Gestational hypertension***
- This patient presents with **new-onset hypertension** (BP > 140/90 mmHg) after 20 weeks of gestation, without **proteinuria** or signs of **end-organ damage**.
- The absence of proteinuria and severe features distinguishes it from preeclampsia, making gestational hypertension the most likely diagnosis.
*Preeclampsia*
- Preeclampsia requires new-onset hypertension combined with **proteinuria** (≥300 mg in 24 hours or protein/creatinine ratio ≥0.3) or signs of **end-organ dysfunction**, neither of which are described here.
- While hypertension is present, the **lack of proteinuria** or other severe features rules out this diagnosis.
*Chronic hypertension with superimposed preeclampsia*
- This diagnosis applies to women with **pre-existing hypertension** (diagnosed before pregnancy or before 20 weeks) who then develop new-onset proteinuria or worsening hypertension with severe features.
- The patient's baseline blood pressure was normal (120/70 mmHg), indicating no chronic hypertension, and no proteinuria or severe features are present.
*Eclampsia*
- Eclampsia is defined by the occurrence of **generalized tonic-clonic seizures** in a woman with preeclampsia, which is a life-threatening obstetric emergency.
- The patient described has no signs of seizures or even severe preeclampsia.
Antenatal Complications Management Indian Medical PG Question 7: The net effect of antenatal care has been the following EXCEPT:
- A. Reduction in maternal morbidity
- B. Reduction in perinatal mortality
- C. Reduction in the incidence of institutional delivery (Correct Answer)
- D. Reduction in maternal mortality
Antenatal Complications Management Explanation: ***Reduction in the incidence of institutional delivery***
- Antenatal care aims to increase awareness of safe delivery practices and encourage women to deliver in health facilities, thereby **increasing institutional deliveries**, not reducing them.
- Improved access to and understanding of obstetric care through ANC promotes safer childbirth environments.
*Reduction in maternal morbidity*
- Antenatal care plays a crucial role in the early detection and management of **pregnancy-related complications** such as pre-eclampsia, gestational diabetes, and infections.
- This proactive management minimizes the severity and impact of these conditions on maternal health.
*Reduction in perinatal mortality*
- Regular antenatal visits allow for monitoring of fetal growth and well-being, identification of **fetal distress**, and intervention for conditions like intrauterine growth restriction.
- Early detection and management of issues affecting the fetus significantly improve perinatal outcomes and reduce **stillbirths** and **neonatal deaths**.
*Reduction in maternal mortality*
- ANC provides essential health education, nutritional advice, and timely vaccinations, which are vital for a healthy pregnancy.
- It also facilitates preparedness for childbirth and potential complications, thereby **reducing the risk of maternal death** from preventable causes.
Antenatal Complications Management Indian Medical PG Question 8: Which of the following are contra-indications to external cephalic version in antenatal management of breech presentation?
1. Antepartum haemorrhage
2. Multiple pregnancy
3. Reactive Non Stress Test
4. Severe oligohydramnios
- A. 1, 2 and 4 (Correct Answer)
- B. 2, 3 and 4
- C. 1, 2, 3 and 4
- D. 1, 2 and 3
Antenatal Complications Management Explanation: ***1, 2 and 4***
* **Antepartum haemorrhage**, **multiple pregnancy**, and **severe oligohydramnios** are all contraindications to external cephalic version (ECV) due to increased risks of fetal distress, placental abruption, and uterine rupture.
* These conditions either compromise fetal well-being directly or make the procedure significantly more dangerous for both mother and fetus.
*2, 3 and 4*
* This option incorrectly includes a **reactive non-stress test** as a contraindication, which actually indicates fetal well-being and is a prerequisite for ECV.
* Excluding **antepartum haemorrhage** as a contraindication is also incorrect, as it poses a significant risk.
*1, 2, 3 and 4*
* This option is incorrect because a **reactive non-stress test** is a sign of fetal health and is a requirement *before* performing an ECV, not a contraindication.
* Including it diminishes the specificity of contraindications for this procedure.
*1, 2 and 3*
* This option erroneously lists a **reactive non-stress test** as a contraindication, when in reality, it's a reassuring finding critical for proceeding with ECV.
* It also omits **severe oligohydramnios** which is a significant contraindication due to the inability to safely manipulate the fetus.
Antenatal Complications Management Indian Medical PG Question 9: Regarding hypertensive disorders of pregnancy, the following are true except:
- A. Significant proteinuria is more than/equal to 0.3 g/24hr
- B. Eclampsia may present in the absence of hypertension
- C. A protein:creatinine ratio more than 30 mg/mmol is considered significant
- D. Urinary dipstick result of +1 is equivalent to urinary protein concentration of 300 mg/dl (Correct Answer)
Antenatal Complications Management Explanation: ***Urinary dipstick result of +1 is equivalent to urinary protein concentration of 300 mg/dl***
- A protein dipstick result of **+1** is typically considered to represent a protein concentration of **30 mg/dL**, not 300 mg/dL.
- A protein concentration of **300 mg/dL** on a dipstick usually corresponds to a result of **+3** or higher.
*Significant proteinuria is more than/equal to 0.3 g/24hr*
- This statement is **true** according to major guidelines (e.g., ACOG) for the diagnosis of **preeclampsia**.
- A 24-hour urine collection yielding **300 mg (0.3 g)** or more of protein is the gold standard for defining significant proteinuria.
*Eclampsia may present in the absence of hypertension*
- This statement is **true**; while eclampsia typically involves hypertension, seizures can occur with **mild hypertension** or even in its **absence**, especially in women with underlying neurological conditions or atypical presentations.
- This highlights the importance of considering eclampsia in pregnant or postpartum women with new-onset seizures, regardless of blood pressure readings.
*A protein:creatinine ratio more than 30 mg/mmol is considered significant*
- This statement is **true**; a **protein:creatinine ratio (PCR)** of **≥ 30 mg/mmol** (or 0.3 mg/mg) is a reliable and convenient alternative to the 24-hour urine collection for diagnosing significant proteinuria.
- This threshold is widely accepted for identifying proteinuria indicative of **preeclampsia** or other renal pathologies.
Antenatal Complications Management Indian Medical PG Question 10: Indoor management of anorexia nervosa is done on priority patients with:-
- A. Depression
- B. Amenorrhea
- C. Binging episodes
- D. Weight for height less than 75% of normal (Correct Answer)
Antenatal Complications Management Explanation: ***Weight for height less than 75% of normal***
- A **weight for height less than 75% of normal** (or **BMI <15 kg/m²**) indicates severe **malnutrition** and a high risk of medical complications, necessitating urgent inpatient care.
- This level of **underweight** is a critical indicator for hospital admission in **anorexia nervosa** to prevent severe organ dysfunction, refeeding syndrome, and even death.
*Depression*
- While **depression** is a common comorbidity with **anorexia nervosa** and often requires treatment, it does not, by itself, warrant immediate inpatient management unless there are acute **suicidal risks**.
- **Depression** is usually managed in an outpatient setting initially, with hospitalization being reserved for severe cases where safety is compromised.
*Amenorrhea*
- **Amenorrhea** (absence of menstruation) is a common symptom of **anorexia nervosa** due to hormonal imbalances caused by low body weight.
- Though an indicator of significant caloric restriction, **amenorrhea** alone is not typically an immediate criterion for inpatient admission unless accompanied by other severe physical complications.
*Binging episodes*
- While **binging episodes** can occur in **anorexia nervosa** (specifically the binge-purging subtype) and can lead to electrolyte imbalances or medical complications, they are not the primary, stand-alone trigger for immediate inpatient admission.
- The severity of **binging** and associated **purging behaviors** must be evaluated in the context of overall medical stability and weight to determine the appropriate level of care.
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