Prenatal Care Practice Questions

Q: Which of the following vaccines can be given to a pregnant woman ? 1. COVID vaccine 2. Measles, Mumps, Rubella vaccine 3. Hepatitis B vaccine 4. Rabies vaccine Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** The vaccines that can be safely given during pregnancy are: - **COVID-19 vaccine** (mRNA or inactivated virus) is recommended for pregnant women to protect against severe illness. It has been shown to be safe and effective, and provides passive immunity to the newborn. - **Hepatitis B vaccine** is safe during pregnancy as it is an inactivated vaccine. Vaccination can provide protection for both the mother and the newborn, preventing vertical transmission. - **Rabies vaccine** (inactivated) is given in situations of exposure to rabies, as the risk of rabies infection (which is almost 100% fatal) far outweighs any theoretical risk from the vaccine during pregnancy. *1, 2 and 3* This option incorrectly includes the **Measles, Mumps, Rubella (MMR) vaccine**, which is a live attenuated vaccine and is **contraindicated in pregnancy** due to the theoretical risk of congenital infection. While COVID-19 and Hepatitis B vaccines are safe, the inclusion of MMR makes this option incorrect. *2, 3 and 4* This option is incorrect because the **Measles, Mumps, Rubella (MMR) vaccine** is a live attenuated vaccine and is contraindicated during pregnancy. Women should be counseled to avoid pregnancy for at least 4 weeks after receiving MMR vaccine. Hepatitis B and Rabies vaccines are safe, but the presence of MMR makes this choice incorrect. *1, 2 and 4* This option incorrectly includes the **Measles, Mumps, Rubella (MMR) vaccine**, which is a live attenuated vaccine and should not be given to pregnant women. COVID-19 and Rabies vaccines are safe in pregnancy, but the contraindication for MMR makes this selection incorrect.

Q: A typical case of Iron Deficiency Anaemia (IDA) in pregnancy will show which of the following? 1. Hb less than 10 g/dL 2. PCV less than 30% 3. MCHC more than 30% 4. Microcytic hypochromic picture on peripheral blood smear (PBS). Select the correct answer using the code given below:

1, 2 and 4. ***1, 2 and 4*** - All three options (Hb < 10 g/dL, PCV < 30%, and microcytic hypochromic picture on PBS) are characteristic features of **iron deficiency anemia (IDA)** in pregnancy [1]. - While exact thresholds can vary, these values generally indicate significant anemia and the classic morphological changes associated with IDA [1]. *1, 2 and 3* - This option incorrectly includes "MCHC more than 30%." IDA is characterized by **hypochromia**, meaning **MCHC (mean corpuscular hemoglobin concentration)** is typically *less than* 30%, not more [1]. - The other two points (Hb < 10 g/dL and PCV < 30%) are consistent with IDA [1]. *2, 3 and 4* - This option incorrectly includes "MCHC more than 30%," which is contrary to the **hypochromic** nature of IDA [1]. - While PCV < 30% and microcytic hypochromic picture on PBS are correct, the inclusion of incorrect MCHC value makes this choice invalid. *1 and 4 only* - This option correctly identifies Hb less than 10 g/dL and a microcytic hypochromic picture on PBS as features of IDA [1]. - However, it omits **PCV less than 30%**, which is also a common finding in IDA, making it an incomplete answer compared to the most comprehensive correct option.

Q: The daily requirement of iron during second half of pregnancy is :

6 mg per day. ***6 mg per day*** - This represents the **additional absorbed elemental iron** required during the second half of pregnancy (beyond the non-pregnant requirement of ~1-2 mg/day). - The increased demand is due to **fetal growth** (300-400 mg total), **placental development** (50-75 mg), **expansion of maternal red cell mass** (450 mg), and **blood loss at delivery** (150-250 mg). - **Important distinction**: This is the *absorbed* requirement. Since iron absorption from the gut is only 10-20%, the actual **oral supplementation** recommended is much higher: **100-200 mg of elemental iron daily** (as per WHO/ICMR guidelines). - In India, the standard National Iron+ Initiative provides **100 mg elemental iron + 500 mcg folic acid** daily during pregnancy. *2 mg per day* - This represents approximately the **basal iron requirement** for non-pregnant women, which is insufficient for pregnancy. - Would lead to **severe maternal iron-deficiency anemia** and poor fetal outcomes. *20 mg per day* - While higher than baseline, this is still insufficient as absorbed iron requirement. - However, this could represent a fraction of the therapeutic supplementation dose. *10 mg per day* - This exceeds the absorbed requirement but is far below the recommended **oral supplementation dose** of 100-200 mg. - Reflects neither the absorbed requirement nor the standard supplementation protocol. **Clinical Pearl**: When discussing iron in pregnancy, always clarify whether referring to *absorbed* iron (5-6 mg/day additional) or *supplemental* oral iron (100-200 mg/day).

Q: Determination of alpha-fetoprotein levels in maternal serum is a useful screening tool for

neural tube defects. ***Correct: neural tube defects*** - Elevated maternal serum **alpha-fetoprotein (AFP)** is a key indicator for open **neural tube defects** because the fetal tissue leaks AFP into the amniotic fluid and then into the maternal circulation. - This screening tool is sensitive enough to detect conditions like **spina bifida** and **anencephaly**. - Typically performed at **15-20 weeks gestation** as part of the triple or quad screen. *Incorrect: Duchenne muscular dystrophy* - This is a **genetically inherited X-linked recessive disorder** primarily diagnosed through genetic testing or muscle biopsy, not maternal serum AFP levels. - While **creatine kinase (CK)** levels can be elevated in affected individuals, it is not a prenatal AFP screening target. *Incorrect: phenylketonuria* - **Phenylketonuria (PKU)** is an inborn error of metabolism, typically screened for postnatally using a **newborn heel prick test** to detect elevated phenylalanine levels. - Maternal serum AFP is not used for its detection; the condition is managed by a special diet. *Incorrect: congenital hypothyroidism* - **Congenital hypothyroidism** is identified through **newborn screening programs** that measure levels of **thyroid-stimulating hormone (TSH)** or **thyroxine (T4)** from a heel prick. - Maternal serum AFP has no role in the screening or diagnosis of this condition.

Q: Which of the following is NOT a component of the combined prenatal screening test in the first trimester?

2. MS AFP (α-Fetoprotein). ***2. MS AFP (α-Fetoprotein)*** - **MS AFP (maternal serum α-Fetoprotein)** is primarily used in the **second-trimester screening** (quad screen or triple screen) to detect **neural tube defects** and certain chromosomal abnormalities. - It is **NOT part of the first-trimester combined screening test**. - The first trimester combined screening is performed between **11-13+6 weeks** of gestation. *1. β-hCG* - **β-hCG** (beta-human chorionic gonadotropin) is a key biochemical marker used in the first-trimester combined screening. - Abnormal levels of **β-hCG** (elevated in Down syndrome, decreased in Trisomy 18) are integrated with other markers to calculate risk for chromosomal abnormalities. *3. Nuchal translucency* - **Nuchal translucency (NT)** measurement is a crucial ultrasound marker used in the first-trimester combined screening test. - Increased NT thickness (≥3.5 mm) is associated with a higher risk of **aneuploidies** (Down syndrome, Trisomy 18, Trisomy 13) and certain structural cardiac defects. *4. PAPP-A* - **PAPP-A** (Pregnancy-Associated Plasma Protein-A) is a biochemical marker included in the first-trimester combined screening. - Low levels of **PAPP-A** are associated with an increased risk of Down syndrome and other adverse pregnancy outcomes.

Q: Vaccines that can be safely given during pregnancy are the following except

Rubella. ***Rubella*** - The **rubella vaccine** is a **live attenuated vaccine** and is **contraindicated in pregnancy** due to the theoretical risk of congenital rubella syndrome, although no cases have been reported from vaccination during pregnancy. - Women should be vaccinated *before* pregnancy or postpartum, and advised to avoid conception for at least four weeks after vaccination. *Influenza* - The **inactivated influenza vaccine** is highly recommended during **any trimester of pregnancy** to protect both the mother and the newborn from severe influenza-related complications. - Pregnancy alters the immune system and cardiopulmonary function, increasing the risk of severe illness from influenza. *Pneumococcus* - The **pneumococcal polysaccharide vaccine (PPSV23)** and **pneumococcal conjugate vaccine (PCV13)** are considered **safe for pregnant women** who meet the indications for vaccination (e.g., chronic medical conditions). - These vaccines provide protection against serious invasive pneumococcal diseases. *Tetanus* - The **tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine** is **recommended during each pregnancy**, preferably between 27 and 36 weeks gestation. - It provides critical protection against **pertussis** for the newborn and tetanus immunity for the mother.

Q: Consider the following markers: 1. Nuchal translucency 2. PAPP-A 3. GTT 4. Inhibin A Which of the above markers are included in the first trimester screening of Down's syndrome?

1 and 2. ***1 and 2*** - **Nuchal translucency (NT)** measurement and **Pregnancy-associated plasma protein A (PAPP-A)** are the key components of first-trimester screening for Down syndrome (combined test at 11-14 weeks). - Increased NT thickness (≥3.5 mm) and low PAPP-A levels are associated with higher risk of **trisomy 21 (Down syndrome)**. - This is typically combined with free β-hCG for the complete first-trimester combined screening. *2, 3 and 4* - This option incorrectly includes **GTT (Glucose Tolerance Test)**, which screens for **gestational diabetes mellitus**, not chromosomal abnormalities. - **Inhibin A** is a marker used in **second-trimester screening** (quadruple test at 15-20 weeks), not first trimester. - It correctly includes PAPP-A but omits the essential NT measurement. *1 and 4* - This option correctly includes **Nuchal translucency** but incorrectly adds **Inhibin A**. - **Inhibin A** is elevated in Down syndrome but is measured in the **second trimester** as part of the quad screen (AFP, hCG, uE3, Inhibin A). - It omits **PAPP-A**, which is the crucial biochemical marker for first-trimester screening. *2 and 3 only* - This option correctly includes **PAPP-A** but incorrectly includes **GTT**, which is completely unrelated to aneuploidy screening. - It omits **Nuchal translucency**, the most important ultrasound marker in first-trimester Down syndrome screening. - GTT is performed at 24-28 weeks for gestational diabetes screening.

Question 1

Chadwick's sign describes :

Accepted Answer

the dusky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy

Answer

regular and rhythmic uterine contraction which can be elicited during bimanual examination at 4-8 weeks of pregnancy

Answer

softening of cervix at 6th week of pregnancy

Answer

the abdominal and vaginal fingers apposed below the body of the uterus during bimanual examination

Question 2

Which of the following vaccines can be given to a pregnant woman ?

1. COVID vaccine
2. Measles, Mumps, Rubella vaccine
3. Hepatitis B vaccine
4. Rabies vaccine

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 3

A typical case of Iron Deficiency Anaemia (IDA) in pregnancy will show which of the following?

1. Hb less than 10 g/dL
2. PCV less than 30%
3. MCHC more than 30%
4. Microcytic hypochromic picture on peripheral blood smear (PBS).

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1 and 4 only

Question 4

The daily requirement of iron during second half of pregnancy is :

Accepted Answer

6 mg per day

Answer

2 mg per day

Answer

20 mg per day

Answer

10 mg per day

Question 5

Determination of alpha-fetoprotein levels in maternal serum is a useful screening tool for

Accepted Answer

neural tube defects

Answer

Duchenne muscular dystrophy

Answer

phenylketonuria

Answer

congenital hypothyroidism

Question 6

Which of the following is NOT a component of the combined prenatal screening test in the first trimester?

Accepted Answer

2. MS AFP (α-Fetoprotein)

Answer

1. β-hCG

Answer

4. PAPP-A

Answer

3. Nuchal translucency

Question 7

Regarding the phenomenon of ‘lightening’ in primigravida at term pregnancy, which one of the following statements is correct?

Accepted Answer

It is a welcome sign since it indicates descent fetal head into pelvis.

Answer

It occurs earlier in primigravida compared to multigravida.

Answer

There are no bladder or bowel symptoms associated with this phenomenon.

Answer

It is associated with worsening cardiorespiratory embarrassment in mother.

Question 8

Which of the following best defines gestational hypertension?

Accepted Answer

Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 20 weeks of gestation in a previously normotensive woman

Answer

Sustained rise of blood pressure to 140/90 mmHg or more on two occasions 4-6 hours apart with proteinuria after 20 weeks of gestation

Answer

Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 12 weeks of gestation

Answer

Sustained rise of blood pressure to 150/100 mmHg or more on at least two occasions 2 hours apart after 20 weeks of gestation

Question 9

Vaccines that can be safely given during pregnancy are the following except

Accepted Answer

Rubella

Answer

Influenza

Answer

Pneumococcus

Answer

Tetanus

Question 10

Consider the following markers:

1. Nuchal translucency
2. PAPP-A
3. GTT
4. Inhibin A

Which of the above markers are included in the first trimester screening of Down's syndrome?

Accepted Answer

1 and 2

Answer

2, 3 and 4

Answer

1 and 4

Answer

2 and 3 only

Prenatal Care — MCQs

Prenatal Care — MCQs

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