Prenatal Care Practice Questions

Q: Match List-I (Signs of pregnancy) with List-II (Anatomical sites) and select the correct answer using the code given below the Lists:

A→3 B→4 C→2 D→1. ***A→3 B→4 C→2 D→1*** This question has inherent issues as the anatomical sites in List-II do not perfectly correspond to the signs in List-I. Based on the image provided and available options: - **A (Jacquemier's sign) → 3**: Jacquemier's sign refers to the **bluish-purple discoloration of the vagina and cervix** due to increased vascularity. While primarily a vaginal/cervical sign, if the list groups this under broader "uterine/pelvic" changes, this may be the intended match, though medically it is most specific to the vagina (which would be option 4). - **B (Chloasma gravidarum) → 4**: Chloasma gravidarum is the **hyperpigmentation of facial skin** (mask of pregnancy). This does NOT occur on the vagina. This matching appears incorrect unless List-II's option 4 refers to something other than "vagina" in the original source. - **C (Striae gravidarum) → 2**: Striae gravidarum are **stretch marks that typically appear on the abdomen** (also breasts, thighs). This match is **correct**. - **D (Montgomery's tubercles) → 1**: Montgomery's tubercles are **enlarged sebaceous glands on the areola of the breast**. This match is **correct**. *Other options are incorrect as they mismatch the anatomical sites for these well-established signs of pregnancy. The correct answer reflects the intended matching from the original UPSC-CMS 2010 examination, though some matches may not align perfectly with anatomical specificity.*

Q: In pregnancy, there is a physiological increase of the

cardiac output. ***cardiac output*** - **Cardiac output** increases significantly in pregnancy, by approximately 30-50%, to meet the increased metabolic demands of the growing fetus and maternal tissues. - This increase is primarily due to increases in both **heart rate** and **stroke volume**. *blood viscosity* - **Blood viscosity** actually decreases in pregnancy due to a greater increase in **plasma volume** compared to the increase in red blood cell mass, leading to hemodilution. - This reduction in viscosity can contribute to a lower peripheral vascular resistance. *peripheral resistance of the blood vessels* - **Peripheral resistance** typically decreases in pregnancy due to the vasodilatory effects of hormones like **progesterone** and the establishment of the low-resistance uteroplacental circulation. - This vasodilation helps accommodate the increased blood volume and cardiac output without a significant rise in blood pressure. *blood pressure in the third trimester* - **Blood pressure** usually decreases or remains stable in the first and second trimesters, with a slight rise towards pre-pregnancy levels in the third trimester. - A significant increase in blood pressure, especially in the third trimester, is *not* physiological and can indicate complications like **gestational hypertension** or **preeclampsia**.

Q: Which of the following vaccines is/are contraindicated in pregnancy? 1. Rubella 2. Hepatitis-B 3. Diphtheria 4. Mumps 5. Measles Select the correct answer using the code given below:

1, 4 and 5 only. ***1, 4 and 5 only*** - **Rubella, Mumps, and Measles** vaccines are **live attenuated vaccines**, which are **contraindicated during pregnancy** due to the theoretical risk of congenital infection. - The live viral components could potentially cross the placenta and cause fetal harm or **congenital anomalies**. *1, 2, 3, 4 and 5* - This option incorrectly includes **Hepatitis B** and **Diphtheria** vaccines as contraindicated during pregnancy. - Both **Hepatitis B** (inactivated) and **Diphtheria** (toxoid) vaccines are considered safe and often recommended during pregnancy if indicated. *1 only* - This option is incomplete as it only lists **Rubella** as contraindicated, while **Mumps and Measles** are also **live attenuated vaccines** and thus contraindicated. - It misses other important live vaccines also contraindicated in pregnancy. *2 and 3 only* - This option is incorrect because **Hepatitis B** and **Diphtheria** vaccines are generally considered **safe during pregnancy** and are not contraindicated. - **Hepatitis B** is an inactivated vaccine, and **Diphtheria** is a toxoid vaccine, both of which do not pose a risk of active infection to the fetus.

Q: A multipara with 8 gm% haemoglobin at 30 weeks’ gestation should be treated by:

Oral iron therapy. ***Oral iron therapy*** - A hemoglobin level of 8 g/dL at 30 weeks' gestation indicates **moderate anemia**, which is typically manageable with oral iron supplementation in the first instance. - Oral iron is the **least invasive**, most cost-effective, and generally safest treatment for iron-deficiency anemia in pregnancy, allowing time for correction before delivery. *Packed cell transfusion* - **Blood transfusions** are generally reserved for severe anemia (Hb < 7 g/dL), acute hemorrhage, or when rapid correction is necessary due to maternal or fetal compromise. - Transfusions carry risks such as **transfusion reactions** and **infection**, making them less preferable for moderate, stable anemia. *Parenteral iron* - **Intravenous iron** is indicated for moderate to severe anemia when oral iron is not tolerated, absorbed poorly, or when a faster correction is needed than oral iron can provide (e.g., closer to term). - While faster than oral iron, it is more invasive and carries a higher risk of **adverse reactions** compared to oral iron. *Whole blood transfusion* - **Whole blood transfusions** are rarely used in modern obstetric practice. - They are typically reserved for massive hemorrhage with significant blood loss and hypovolemic shock, which is not the case here.

Q: Which one of the following cardiovascular parameters decreases during pregnancy?

Arterial blood pressure. ***Arterial blood pressure*** - During pregnancy, **arterial blood pressure** typically decreases, particularly in the **second trimester**. - **Diastolic blood pressure** falls by 10-15 mmHg, while systolic BP remains relatively stable or decreases slightly (0-10 mmHg). - This decrease is primarily due to a significant reduction in **systemic vascular resistance (20-30% decrease)** caused by vasodilatory effects of **progesterone**, prostacyclin, and nitric oxide. - Blood pressure gradually returns toward pre-pregnancy levels in the third trimester. *Blood volume* - **Blood volume** increases significantly during pregnancy by **30-50%**, with plasma volume increasing more than red cell mass. - This hypervolemia is essential to meet increased metabolic demands and accommodate uteroplacental circulation. *Cardiac output* - **Cardiac output** increases by **30-50%** during pregnancy, peaking around 28-32 weeks. - This rise is achieved through increased **stroke volume** (30%) and **heart rate** (10-20 bpm). *Red cell mass* - **Red cell mass** increases by approximately **20-30%** during pregnancy due to increased erythropoietin production. - The proportionally greater increase in plasma volume leads to physiological anemia of pregnancy (dilutional effect).

Q: Consider the following statements regarding changes in pregnancy: 1. Plasma volume increases up to 30–50% 2. Pregnancy is a hypercoagulable state 3. Hematocrit is decreased 4. Total plasma protein concentration increases Which of the statements given above is/are correct?

1, 2 and 3 only. ***1, 2 and 3 only*** - **Statement 1 is correct**: Plasma volume increases significantly by **30-50%** during pregnancy, representing a key physiological adaptation. - **Statement 2 is correct**: Pregnancy is inherently a **hypercoagulable state** due to increased clotting factors (I, VII, VIII, IX, X, fibrinogen), decreased protein S, and reduced fibrinolysis—an adaptive mechanism to prevent excessive bleeding during delivery. - **Statement 3 is correct**: Hematocrit **decreases** due to physiological hemodilution; plasma volume increases proportionally more (40-50%) than red blood cell mass (20-30%), resulting in physiological anemia of pregnancy. - **Statement 4 is incorrect**: Total plasma protein concentration actually **decreases** during pregnancy (not increases) due to the hemodilution effect; albumin typically decreases from ~4.0 to ~3.0 g/dL. *1 and 2 only* - While statements 1 and 2 are correct, this option incorrectly excludes **statement 3 (decreased hematocrit)**, which is a well-established physiological change during pregnancy caused by hemodilution. *1 only* - Statement 1 is correct, but this option excludes both the **hypercoagulable state (statement 2)** and **decreased hematocrit (statement 3)**, which are both fundamental pregnancy-related changes. *1, 2, 3 and 4* - Statements 1, 2, and 3 are all correct. However, **statement 4 is incorrect** because total plasma protein concentration **decreases** (not increases) during pregnancy due to the disproportionate increase in plasma volume compared to protein synthesis. *3 and 4 only* - Statement 3 is correct, but **statement 4 is incorrect** (plasma protein concentration decreases, not increases). Additionally, this option incorrectly excludes statements 1 and 2, which are both correct and represent important physiological adaptations in pregnancy.

Q: Consider the following hemodynamic changes occurring during pregnancy: 1. Increase in cardiac output 2. Increase in stroke volume 3. Increase in colloid oncotic pressure 4. Increase in pulse rate Which of the statements given above are correct?

1, 2 and 4. ***Correct Answer: 1, 2 and 4*** **Statement 1: Increase in cardiac output** - CORRECT - Cardiac output increases by **30-50% during pregnancy**, peaking at 28-32 weeks - This increase is driven by increased blood volume (40-50% increase), higher metabolic demands, and the need to perfuse the uteroplacental unit **Statement 2: Increase in stroke volume** - CORRECT - Stroke volume increases by **20-30% during pregnancy**, particularly in the first and second trimesters - This contributes significantly to the overall increase in cardiac output alongside increased heart rate **Statement 3: Increase in colloid oncotic pressure** - INCORRECT - Colloid oncotic pressure actually **decreases during pregnancy** from normal values of 25-28 mmHg to approximately 22-24 mmHg - This occurs due to **hemodilution** (plasma volume increases more than red cell mass) and **decreased serum albumin concentration** (dilutional hypoalbuminemia) - The reduced oncotic pressure contributes to the **increased tendency for peripheral edema** in pregnant women **Statement 4: Increase in pulse rate** - CORRECT - Heart rate increases by **10-20 beats per minute** during pregnancy - This tachycardia helps maintain adequate cardiac output to meet the increased circulatory demands of pregnancy *Incorrect Options:* *1, 3 and 4* - Statement 3 is incorrect as colloid oncotic pressure decreases, not increases *2, 3 and 4* - Statement 3 is incorrect as colloid oncotic pressure decreases during pregnancy *1, 2 and 3* - Statement 3 is incorrect; colloid oncotic pressure falls due to hemodilution and hypoalbuminemia

Q: The clinical feature of physiological edema in pregnancy is:

disappears or markedly reduced on rest. ***disappears or markedly reduced on rest*** - **Physiological edema** in pregnancy is typically mild and **dependent**, meaning it tends to accumulate in the lower extremities due to **gravity** and increased venous pressure. - When the pregnant individual rests, especially in an elevated position, the gravitational pressure on the lower limbs is reduced, allowing for the **redistribution of fluid** and a decrease in visible swelling. *is usually of moderate or severe grade* - **Physiological edema** is typically **mild** and localized to the ankles and feet. - **Moderate or severe edema**, especially if sudden in onset, generalized, or associated with other symptoms, might indicate a pathological condition like **preeclampsia** or **cardiac dysfunction**. *is associated with cardiac or renal pathology* - **Physiological edema** is a normal part of pregnancy, resulting from hormonal changes, increased blood volume, and uterine pressure, and is **not indicative** of underlying cardiac or renal disease. - Edema linked to **cardiac** or **renal pathology** would typically be more severe, generalized, and accompanied by other specific symptoms or laboratory abnormalities related to the respective organ systems. *is present on both lower limbs and abdomen* - **Physiological edema** predominantly affects the **lower limbs** (ankles, feet, sometimes hands and face) due to gravity and venous stasis, becoming more noticeable later in the day. - While some mild abdominal swelling can occur due to uterine growth, significant **abdominal wall edema** is not a characteristic feature of physiological edema and could suggest other causes.

Q: During pregnancy iron supplementation is needed for

all pregnant mothers from 16 weeks onwards. ***all pregnant mothers from 16 weeks onwards*** - **Physiological anemia** of pregnancy typically manifests around the **second trimester**, necessitating prophylactic iron supplementation. - Starting at **16 weeks** ensures adequate iron stores before the greatest increase in maternal red cell mass and fetal iron demands. *all pregnant mothers since 6 weeks of pregnancy* - Iron requirements do not significantly increase until the **second trimester**, so starting supplementation at **6 weeks** is unnecessarily early for most women. - Early supplementation can lead to side effects like **nausea and constipation** in the first trimester, potentially reducing compliance. *only those pregnant mothers who have Hb < 10 gm%* - Waiting until **hemoglobin levels drop below 10 gm/dL** indicates **established anemia**, which should ideally be prevented. - **Prophylactic supplementation** is recommended for all pregnant women to prevent iron deficiency before it becomes clinically apparent. *only those pregnant mothers who are not eating green vegetables* - While green vegetables are a source of **non-heme iron**, the bioavailability is lower than heme iron, and adequate intake is often insufficient to meet the significantly increased demands of pregnancy. - Dietary intake alone is often **not enough to prevent iron deficiency** in pregnancy, regardless of vegetable consumption patterns.

Question 1

Match List-I (Signs of pregnancy) with List-II (Anatomical sites) and select the correct answer using the code given below the Lists:

Accepted Answer

A→3  B→4  C→2  D→1

Answer

A→3  B→5  C→2  D→1

Answer

A→3  B→1  C→4  D→2

Answer

A→2  B→4  C→1  D→3

Question 2

In pregnancy, there is a physiological increase of the

Accepted Answer

cardiac output

Answer

blood viscosity

Answer

peripheral resistance of the blood vessels

Answer

blood pressure in the third trimester

Question 3

Which of the following vaccines is/are contraindicated in pregnancy?

1. Rubella

2. Hepatitis-B

3. Diphtheria

4. Mumps

5. Measles
Select the correct answer using the code given below:

Accepted Answer

1, 4 and 5 only

Answer

1, 2, 3, 4 and 5

Answer

1 only

Answer

2 and 3 only

Question 4

A multipara with 8 gm% haemoglobin at 30 weeks’ gestation should be treated by:

Accepted Answer

Oral iron therapy

Answer

Packed cell transfusion

Answer

Parenteral iron

Answer

Whole blood transfusion

Question 5

Which one of the following cardiovascular parameters decreases during pregnancy?

Accepted Answer

Arterial blood pressure

Answer

Blood volume

Answer

Cardiac output

Answer

Red cell mass

Question 6

Consider the following statements regarding changes in pregnancy:

1. Plasma volume increases up to 30–50%
2. Pregnancy is a hypercoagulable state
3. Hematocrit is decreased
4. Total plasma protein concentration increases

Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3 only

Answer

1 and 2 only

Answer

1 only

Answer

1, 2, 3 and 4

Answer

3 and 4 only

Question 7

Consider the following hemodynamic changes occurring during pregnancy:

1. Increase in cardiac output
2. Increase in stroke volume
3. Increase in colloid oncotic pressure
4. Increase in pulse rate
Which of the statements given above are correct?

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Question 8

The clinical feature of physiological edema in pregnancy is:

Accepted Answer

disappears or markedly reduced on rest

Answer

is usually of moderate or severe grade

Answer

is associated with cardiac or renal pathology

Answer

is present on both lower limbs and abdomen

Question 9

During pregnancy iron supplementation is needed for

Accepted Answer

all pregnant mothers from 16 weeks onwards

Answer

all pregnant mothers since 6 weeks of pregnancy

Answer

only those pregnant mothers who have Hb < 10 gm%

Answer

only those pregnant mothers who are not eating green vegetables

Question 10

Which of the following statements are correct with respect to antenatal USG examination?

1. It helps in detecting gross fetal anomalies
2. It helps in identifying multiple pregnancies
3. It helps in identifying viable pregnancy
4. Best dating is possible with third trimester ultrasound scan

Accepted Answer

1, 2 and 3 only

Answer

3 and 4 only

Answer

1 and 2 only

Answer

1, 2, 3 and 4

Prenatal Care — MCQs

Prenatal Care — MCQs

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