Prenatal Care Practice Questions

Q: Blood volume increases during pregnancy above nonpregnant level at 30-34 weeks by:

by 40-50 per cent. ***by 40-50 per cent*** - During pregnancy, **blood volume significantly increases**, primarily due to hormonal changes, to support the growing fetus and uteroplacental unit, with the peak increase typically occurring around the third trimester. - This expansion involves both **plasma volume (greater increase)** and **red blood cell mass**, leading to a state of physiologic hemodilution. *Blood volume does not increase at all* - This statement is incorrect as a substantial **increase in blood volume is a hallmark of normal pregnancy physiology** to meet increased metabolic demands. - Failure of blood volume to increase would imply a pathologic state, potentially compromising both maternal and fetal well-being. *by 25-30 per cent* - While a significant increase, **25-30% is generally an underestimation** of the full extent of blood volume expansion that occurs in a healthy pregnancy. - The total increase often reaches higher values, particularly when considering the combined rise in plasma and red blood cells. *by 10-20 per cent* - An increase of **10-20% is considerably less** than what is typically observed during a normal pregnancy. - This level of increase would likely be insufficient to adequately support the physiological demands of the mother and fetus.

Q: Ideal weight gain during pregnancy for a woman with normal BMI should be

11-16 kg. ***11-16 kg*** - For a woman with a **normal Body Mass Index (BMI)** (18.5-24.9), the recommended total weight gain during pregnancy is **11.5 to 16 kg (25 to 35 lbs)**. - This range supports optimal fetal growth and maternal health, reducing risks associated with both inadequate and excessive weight gain. *More than 18 kg* - Gaining more than **18 kg (40 lbs)** during pregnancy, especially for women with a normal BMI, is generally considered **excessive**. - This can increase the risk of complications such as **gestational diabetes**, **hypertension**, **macrosomia**, and **cesarean delivery**. *7 kg* - A total weight gain of only **7 kg (15 lbs)** for a woman with a normal BMI during pregnancy is typically considered **insufficient**. - Inadequate weight gain can lead to a higher risk of delivering a **low birth weight infant** or one who is **small for gestational age**. *18 kg* - A weight gain of **18 kg (approximately 40 lbs)** **exceeds the recommended range** for women with a normal BMI (11.5-16 kg). - This represents the **upper limit** of recommended weight gain for **underweight women** (BMI <18.5), whose target range is 12.5-18 kg (28-40 lbs). - For normal BMI women, 18 kg is considered **excessive** and may increase risks of maternal and fetal complications.

Q: The gestational sac is first visible on transvaginal USG by:

35 days. ***35 days*** - A **gestational sac** can first be reliably visualized via **transvaginal ultrasonography** at approximately **35 days** after the last menstrual period (around **5 weeks gestational age**). - At this stage, it appears as a small, anechoic (fluid-filled) structure within the **endometrial cavity**, indicating an early intrauterine pregnancy. - This corresponds to a **β-hCG level** of approximately **1000-2000 mIU/mL**, which is the discriminatory zone for transvaginal ultrasound. *30 days* - At **30 days** (approximately 4 weeks + 2 days gestational age), the gestational sac is typically **too small** to be consistently visualized even with transvaginal ultrasound. - While some early sacs may be detected, **30 days** is generally considered **too early** for reliable detection in most cases. - Detection at this stage would be inconsistent and not the standard timeframe cited in obstetric practice. *42 days* - By **42 days** (6 weeks gestational age), the gestational sac is well-established and clearly visible. - At this point, a **yolk sac** is almost always present within the gestational sac, and often a **fetal pole** may be identified. - This represents a later stage, not the *first* time the gestational sac can be detected. *49 days* - By **49 days** (7 weeks gestational age), not only is the **gestational sac** clearly visible, but a **yolk sac** and **fetal pole** with **cardiac activity** are typically identifiable. - This time frame represents a much later stage of pregnancy visualization, well beyond the initial appearance of the gestational sac.

Q: Match List-I with List-II and select the correct answer using the code given below the Lists:

A→4 B→2 C→3 D→1. ***A→4 B→2 C→3 D→1*** - **Palmer's sign** refers to **rhythmic uterine contractions** felt by bimanual examination in the **first trimester** of pregnancy. This is often an early sign used to detect pregnancy. - **Braxton Hicks contractions** are characterized by **rhythmic, painless uterine contractions** that are felt per abdomen and typically occur in the **second and third trimesters** of pregnancy. They are often called "practice contractions." - **Goodell's sign** describes the **softening of the cervix** in early pregnancy due to increased vascularity and edema. - **Chadwick's sign** is the **bluish coloration of the vagina and cervix** in pregnancy, also due to increased vascularity and blood flow. *A→1 B→2 C→3 D→4* - This option incorrectly matches Palmer's sign with bluish coloration of the vagina, which is **Chadwick's sign**. - It also incorrectly matches Chadwick's sign with rhythmic uterine contractions in the first trimester, which is **Palmer's sign**. *A→3 B→2 C→1 D→4* - This option incorrectly matches Palmer's sign with softening of the cervix (**Goodell's sign**) and Goodell's sign with bluish coloration of the vagina (**Chadwick's sign**). - It also incorrectly matches Chadwick's sign with rhythmic uterine contractions in the first trimester (**Palmer's sign**). *A→2 B→3 C→1 D→4* - This option incorrectly matches Palmer's sign with Braxton Hicks contractions and Braxton Hicks sign with softening of the cervix, which is **Goodell's sign**. - It also incorrectly matches Goodell's sign with bluish coloration of the vagina (**Chadwick's sign**) and Chadwick's sign with rhythmic contractions in the first trimester (**Palmer's sign**).

Q: Abnormally low alpha-fetoprotein in maternal serum indicates:

Down's syndrome. ***Down's syndrome*** - Abnormally **low alpha-fetoprotein (AFP)** levels in maternal serum are a key indicator for increased risk of **Down's syndrome (Trisomy 21)**. - This is often part of a quad screen (AFP, hCG, unconjugated estriol, inhibin A) used for **prenatal screening** for chromosomal abnormalities. *Meningocele* - This is a type of **spina bifida** where the meninges protrude through a defect in the vertebrae. - While a neural tube defect, it typically results in **elevated AFP** levels in maternal serum due to leakage of fetal protein. *Encephalocele* - An encephalocele is a **neural tube defect** where a sac-like protrusion of the brain and its surrounding membranes occurs through an opening in the skull. - Similar to other open neural tube defects, it is usually associated with **elevated levels of AFP** in maternal serum. *Anencephaly* - This is a severe **neural tube defect** characterized by the absence of a major portion of the brain, skull, and scalp. - Anencephaly invariably leads to very **high levels of AFP** in maternal serum due to direct leakage from exposed neural tissue.

Q: Which one of the following is NOT done as screening test in pregnancy?

Serum cholesterol. ***Serum cholesterol*** - **Serum cholesterol** levels are not routinely measured as a screening test during pregnancy. - While lipid metabolism changes during pregnancy, monitoring cholesterol levels specifically for screening purposes is not standard practice. *Neural tube defects (NTDs)* - Screening for **neural tube defects** is a crucial part of antenatal care, typically involving maternal serum alpha-fetoprotein (**MSAFP**) screening and targeted ultrasound. - Early detection allows for counseling and management options for the pregnancy due to conditions like **spina bifida** or **anencephaly**. *Syphilis-VDRL* - Screening for **syphilis** using tests like **VDRL** (Venereal Disease Research Laboratory) or RPR (Rapid Plasma Reagin) is a mandatory part of antenatal screening in many regions. - This is done to prevent congenital syphilis, which can cause severe fetal and neonatal complications. *Diabetes* - All pregnant women are screened for **gestational diabetes mellitus (GDM)**, typically between 24 and 28 weeks of gestation, using a **glucose challenge test** followed by an oral glucose tolerance test if screening is positive. - Undiagnosed and untreated GDM can lead to adverse maternal and fetal outcomes, including macrosomia, pre-eclampsia, and neonatal hypoglycemia.

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: The Maternal serum α-fetoprotein level is elevated in all EXCEPT:

Down syndrome. ***Down syndrome*** - In **Down syndrome (Trisomy 21)**, the maternal serum **alpha-fetoprotein (MSAFP) level is typically decreased**, not elevated. - This characteristic **low MSAFP** is a key marker used in screening for Down syndrome in the second trimester. *Omphalocele* - **Omphalocele** involves the protrusion of abdominal organs through an umbilical defect, covered by a membrane. - Due to the **exposed fetal gut**, there is leakage of **alpha-fetoprotein** into the amniotic fluid and maternal circulation, leading to **elevated MSAFP**. *Intra uterine death* - In cases of **intrauterine fetal death**, there can be a release of fetal alpha-fetoprotein into the maternal circulation due to **fetal tissue breakdown**. - This often results in a **transient elevation of MSAFP levels**. *Neural tube defect* - **Neural tube defects (NTDs)**, such as **anencephaly** and **spina bifida**, are characterized by incomplete closure of the neural tube. - The **exposed neural tissue** allows **alpha-fetoprotein** to leak directly into the amniotic fluid and then into the maternal bloodstream, causing a significant **elevation of MSAFP**.

Q: In pregnancy with Down syndrome consider the following biomarkers: 1. β HCG is raised 2. α FP is raised 3. Inhibin A is decreased Which of the above statements is/are correct?

1 only. ***1 only*** - In pregnancies affected by **Down syndrome (Trisomy 21)**, the levels of **β-hCG** (human chorionic gonadotropin) are typically found to be **elevated**. This is a well-established biochemical marker used in prenatal screening. - The increased production of β-hCG is thought to be from the **placenta**, which may be functioning differently in pregnancies with Down syndrome. *1, 2 and 3* - This option is incorrect because while **β-hCG is raised**, **α-fetoprotein (αFP)** is typically **decreased** in pregnancies with Down syndrome, not raised. - Furthermore, **inhibin A** is usually **raised**, not decreased, making both statements 2 and 3 false for Down syndrome. *1 and 2 only* - This option is incorrect because although **β-hCG is raised**, **α-fetoprotein (αFP)** is characteristically **decreased** in pregnancies with Down syndrome, making statement 2 inaccurate. - The elevated αFP is usually associated with **neural tube defects** or other fetal anomalies. *2 and 3 only* - This option is incorrect as both statements 2 and 3 are factually wrong for Down syndrome. **α-fetoprotein (αFP)** is typically **decreased**, not raised, in pregnancies with Down syndrome. - Similarly, **inhibin A** levels are typically **raised**, not decreased, in such pregnancies, often incorporated into the quad screen for prenatal screening.

Q: Which one of the following statements regarding pre-conceptional counseling is NOT correct?

It is needed only in selected complicated pregnancies. ***It is needed only in selected complicated pregnancies*** - Pre-conceptional counseling is important for **all women of reproductive age**, especially those planning a pregnancy, not just for complicated cases. - Its purpose is to **optimize maternal health before conception** to prevent adverse outcomes, regardless of initial perceived risk. *It helps in early detection of risk factors* - Pre-conceptional counseling identifies **maternal and fetal risk factors** such as chronic medical conditions, genetic predisposition, and lifestyle choices before pregnancy. - Early detection allows for ** timely interventions** to mitigate these risks. *It is a part of preventive medicine* - Counseling before pregnancy focuses on **prevention of adverse pregnancy outcomes** by optimizing health and addressing potential issues. - This proactive approach aligns directly with the principles of **preventive healthcare**. *It helps in reducing maternal morbidity and mortality* - By addressing risk factors, optimizing health, and educating women about healthy behaviors, pre-conceptional counseling can significantly **lower the incidence of complications** during pregnancy. - This ultimately contributes to a **reduction in maternal illness and death**.

Question 1

Blood volume increases during pregnancy above nonpregnant level at 30-34 weeks by:

Accepted Answer

by 40-50 per cent

Answer

Blood volume does not increase at all

Answer

by 25-30 per cent

Answer

by 10-20 per cent

Question 2

Ideal weight gain during pregnancy for a woman with normal BMI should be

Accepted Answer

11-16 kg

Answer

More than 18 kg

Answer

7 kg

Answer

18 kg

Question 3

The gestational sac is first visible on transvaginal USG by:

Accepted Answer

35 days

Answer

49 days

Answer

30 days

Answer

42 days

Question 4

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→4  B→2  C→3  D→1

Answer

A→1  B→2  C→3  D→4

Answer

A→3  B→2  C→1  D→4

Answer

A→2  B→3  C→1  D→4

Question 5

Abnormally low alpha-fetoprotein in maternal serum indicates:

Accepted Answer

Down's syndrome

Answer

Meningocele

Answer

Encephalocele

Answer

Anencephaly

Question 6

Which one of the following is NOT done as screening test in pregnancy?

Accepted Answer

Serum cholesterol

Answer

Neural tube defects

Answer

Syphilis-VDRL

Answer

Diabetes

Question 7

The most common cause of early spontaneous abortion is:

Accepted Answer

Chromosomal abnormality

Answer

Teratogens

Answer

Endocrine disorder

Answer

Infection

Question 8

The Maternal serum α-fetoprotein level is elevated in all EXCEPT:

Accepted Answer

Down syndrome

Answer

Omphalocele

Answer

Intra uterine death

Answer

Neural tube defect

Question 9

In pregnancy with Down syndrome consider the following biomarkers:

1. β HCG is raised
2. α FP is raised
3. Inhibin A is decreased
Which of the above statements is/are correct?

Accepted Answer

1 only

Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Question 10

Which one of the following statements regarding pre-conceptional counseling is NOT correct?

Accepted Answer

It is needed only in selected complicated pregnancies

Answer

It helps in early detection of risk factors

Answer

It is a part of preventive medicine

Answer

It helps in reducing maternal morbidity and mortality

Prenatal Care — MCQs

Prenatal Care — MCQs

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