Prenatal Care Practice Questions

Q: A pregnant woman at 32 weeks presents with recurrent bacterial vaginosis despite multiple treatments. She has history of preterm labor in previous pregnancy. Current symptoms include discharge and burning. Partner is untreated. Which management approach is most appropriate?

Extended oral clindamycin with probiotics. ***Extended oral clindamycin with probiotics*** - Given the **recurrent BV** and history of **preterm labor**, an extended course of oral clindamycin (or metronidazole) is the most appropriate management to eradicate the infection and reduce risk of preterm birth. - **Extended/suppressive therapy** (typically 10-14 days followed by twice weekly suppression) is recommended for recurrent BV in pregnancy, especially with preterm labor history. - **Probiotics** (particularly Lactobacillus) may help restore healthy vaginal flora and reduce recurrence, though evidence is mixed. - **Partner treatment is NOT routinely recommended** for BV as studies show it does not reduce recurrence rates. *Topical azole cream only* - **Topical azole creams** are used for fungal infections (candidiasis), not bacterial vaginosis. - This treatment would be **ineffective** against BV and would not address the serious risk of preterm birth. *Single dose metronidazole with observation* - A **single dose of metronidazole** is insufficient for recurrent bacterial vaginosis and does not provide adequate suppression. - Given the history of **preterm labor**, extended/suppressive therapy rather than mere observation is essential to prevent recurrence and complications. *Delay treatment until postpartum* - **Delaying treatment** is inappropriate and dangerous given the **recurrent BV** and history of **preterm labor**. - Untreated BV during pregnancy significantly increases the risk of **preterm birth**, premature rupture of membranes, and chorioamnionitis.

Q: A 23-year-old primigravid woman comes to the physician for an initial prenatal visit at 13 weeks' gestation. She has had episodic headaches over the past month. She has no history of serious illness. Her immunizations are up-to-date. Her temperature is 37°C (98.6°F) and pulse is 90/min. Repeated measurements show a blood pressure of 138/95 mm Hg. Pelvic examination shows a uterus consistent in size with a 13-week gestation. The remainder of the examination shows no abnormalities. Urinalysis is within normal limits. Serum creatinine is 0.8 mg/dL, serum ALT is 19 U/L, and platelet count is 210,000/mm3. Which of the following is the most likely condition in this patient?

Chronic hypertension. ***Chronic hypertension*** - The patient has **elevated blood pressure (138/95 mm Hg)** detected at her initial prenatal visit at **13 weeks' gestation**, which is **prior to 20 weeks**, a key diagnostic criterion for chronic hypertension in pregnancy. - Importantly, there are **no signs of proteinuria or other end-organ damage**, ruling out preeclampsia, and the early presentation points away from gestational hypertension. *Eclampsia* - Eclampsia is defined by the development of **grand mal seizures** in a woman with preeclampsia, which is absent in this patient. - It usually occurs after 20 weeks' gestation and involves more severe symptoms and complications than seen here. *High normal blood pressure* - **High normal blood pressure** (e.g., 120-129 / <80 mm Hg) is a lower range than the patient's readings of 138/95 mm Hg, which is clearly stage 1 hypertension. - This term does not accurately describe the patient's elevated blood pressure readings which meet diagnostic criteria for hypertension. *Gestational hypertension* - Gestational hypertension is characterized by **new-onset hypertension after 20 weeks of gestation** in the absence of proteinuria or other end-organ damage. - This patient's elevated blood pressure was noted at **13 weeks' gestation**, making gestational hypertension an unlikely diagnosis. *Preeclampsia* - Preeclampsia involves **new-onset hypertension after 20 weeks of gestation** with proteinuria or signs of end-organ dysfunction (e.g., elevated creatinine, transaminases, low platelets). - This patient is at **13 weeks' gestation** and has no proteinuria or other signs of organ compromise, ruling out preeclampsia.

Q: Which of the following is the most sensitive and specific test during antenatal check-up for a pregnant lady with family history of Thalassemia?

High performance liquid chromatography. ***High performance liquid chromatography*** - **HPLC** is considered the most sensitive and specific test for diagnosing thalassemia and other hemoglobinopathies due to its ability to accurately quantify different hemoglobin fractions. - It provides a detailed **hemoglobin profile**, allowing for precise identification of abnormal hemoglobins and accurate assessment of thalassemia carrier status. *P. smear and reticulocyte count* - A **peripheral smear** can show microcytic, hypochromic red blood cells, which are characteristic of thalassemia, but this finding is not specific. - A **reticulocyte count** can indicate increased red blood cell production, but it is a general indicator of hemolysis or bone marrow activity and not specific for thalassemia. *Hemoglobin electrophoresis* - **Hemoglobin electrophoresis** separates different hemoglobin types based on their electrical charge, which is useful for identifying hemoglobinopathies. - While it can detect abnormal hemoglobins, its resolution and quantitative accuracy are generally lower than that of HPLC, making it less sensitive for detecting subtle variations or quantifying small amounts of abnormal hemoglobin. *NESTROFT* - **NESTROFT** (Naked eye single tube red cell osmotic fragility test) is a screening test used to detect beta-thalassemia carriers by assessing red cell osmotic fragility. - It is a good, inexpensive screening tool but lacks the sensitivity and specificity of definitive diagnostic tests like HPLC, and positive results require confirmation with other methods.

Q: A grand multipara is defined as a woman who has had how many viable pregnancies (≥20 weeks):

>=5. ***>=5*** - A **grand multipara** is defined as a woman who has delivered **five or more** viable fetuses (live births or stillbirths after 20 weeks of gestation). - This classification is important clinically due to the increased risks associated with grand multiparity, such as **postpartum hemorrhage** and complications during labor. *>2* - This definition is too broad, as a woman with 3 or 4 live births is considered a **multipara**, but not specifically a grand multipara. - The term **multipara** generally applies to women who have had two or more live births. *>3* - This definition includes women with 4 live births, who are considered **multipara** but do not meet the stricter criteria for **grand multipara**. - The term **grand multipara** specifically denotes a higher number of deliveries with associated increased obstetric risks. *>4* - While close, this definition would include a woman with 5 live births, but it does not specify "five or more." - The precise definition of a **grand multipara** is five or more, which carries specific clinical implications for pregnancy management.

Q: A lady with 12-week pregnancy presents with bleeding. On examination, vagina is normal, internal os is closed, and USG shows fetal viability with fundal height of 13 weeks. What is the diagnosis?

Threatened abortion. ***Threatened abortion*** - This diagnosis is characterized by **vaginal bleeding** in the first half of pregnancy with a **closed internal os** and evidence of fetal viability on ultrasound. - The fundal height being consistent with gestational age also indicates ongoing pregnancy, despite the bleeding. *Inevitable abortion* - This condition is indicated by vaginal bleeding accompanied by a **dilated cervix (open internal os)**, suggesting that the pregnancy cannot be salvaged. - While bleeding is present, the **closed internal os** in the given scenario rules out inevitable abortion. *Incomplete abortion* - This involves vaginal bleeding, an **open internal os**, and the **partial expulsion of pregnancy tissue**, with some products of conception remaining in the uterus. - The presentation does not include an open os or retained products of conception, as the fetus is viable and the os is closed. *Complete abortion* - This occurs when **all products of conception have been expelled** from the uterus, characterized by an initially open os that subsequently closes, and often a decrease in bleeding. - The presence of a **viable fetus** and a closed os clearly rules out a complete abortion.

Q: EDD ( Expected Date of Delivery) is calculated by:

Naegele's formula. ***Naegele's formula*** - **Naegele's formula** is the most common and widely accepted method for calculating the estimated date of delivery (EDD). - It involves adding one year, subtracting three months, and adding seven days to the **first day of the last menstrual period (LMP)**. *Cardiff Formula* - The **Cardiff Formula** is a method used for assessing fetal movements, particularly for monitoring fetal well-being, not for calculating EDD. - It establishes a baseline of fetal movements over a specific period to detect any significant decrease. *McDonald's rule* - **McDonald's rule** is a clinical method used to estimate the gestational age based on fundal height measurements. - While it helps in estimating gestational age, it is not primarily used for calculating the precise EDD. *Hadlock Formula* - The **Hadlock Formula** refers to a set of widely used ultrasound-based formulas for estimating fetal weight and gestational age, typically involving biometry measurements like BPD, HC, AC, and FL. - While accurate for gestational age estimation, it's an imaging-based method, not a direct calculation of EDD from the LMP like Naegele's.

Q: What is the Triple screen test (Triple marker test)?

HCG + AFP + Unconjugated Estriol. ***HCG + AFP + Unconjugated Estriol*** - A BA test, more commonly known as the **triple screen**, measures **human chorionic gonadotropin (HCG)**, **alpha-fetoprotein (AFP)**, and **unconjugated estriol (uE3)**. - This prenatal screening test is used to assess the risk of certain **chromosomal abnormalities** (like Down syndrome) and **neural tube defects** during pregnancy. *AFP + Uric acid + LDH* - This combination of markers is **not a standard prenatal screening test** for chromosomal abnormalities; **uric acid** and **LDH (lactate dehydrogenase)** are general markers for liver damage or cell turnover. - While **AFP** is part of prenatal screening, its combination with **uric acid** and **LDH** does not constitute the BA test. *HCG + AFP + PAPP-A* - This combination represents components of the **first-trimester combined test**, specifically **HCG**, **AFP** (though typically used in the second trimester), and **Pregnancy-Associated Plasma Protein-A (PAPP-A)**. - While useful for prenatal screening, the BA test (triple screen) specifically includes **unconjugated estriol** rather than PAPP-A in the primary second-trimester panel. *HCG + AFP + Placental alkaline phosphatase* - While **HCG** and **AFP** are part of prenatal screening, **placental alkaline phosphatase** is **not a standard component** of the BA test (triple screen). - Placental alkaline phosphatase can be elevated in various conditions but is not routinely measured for the same purposes as unconjugated estriol in prenatal screening.

Q: Which of the following is the MOST accurate test for detecting neural tube defects?

USG. ***USG (Ultrasound)*** - **High-resolution ultrasound** is the **gold standard and most accurate imaging modality** for detecting **neural tube defects (NTDs)** due to its ability to directly visualize anatomical structures of the fetus. - **Diagnostic accuracy**: Detection rate >95% for anencephaly and 80-90% for open spina bifida with targeted anomaly scan at 18-20 weeks. - Can identify specific features such as **lemon sign** (frontal bone scalloping), **banana sign** (cerebellar compression), direct visualization of **spina bifida**, **anencephaly**, or **encephalocele**. - **Non-invasive, safe, and widely available**, making it the primary diagnostic tool in clinical practice. *Amniocentesis* - **Amniocentesis** measures **alpha-fetoprotein (AFP)** and **acetylcholinesterase (AChE)** in amniotic fluid, which are elevated in open NTDs. - While highly accurate as a **confirmatory test** (near 99% sensitivity with both markers), it is **invasive** with risk of miscarriage (0.1-0.3%). - Used primarily when ultrasound findings are **equivocal** or for **biochemical confirmation**, not as the first-line diagnostic test. - In modern practice, ultrasound has largely replaced amniocentesis for NTD diagnosis due to superior imaging technology. *Chromosomal analysis* - **Chromosomal analysis** (karyotyping) detects **chromosomal abnormalities** like trisomies (Down syndrome, Edwards syndrome). - NTDs are **structural malformations**, not chromosomal abnormalities, though some chromosomal disorders may have associated structural defects. - Does not directly diagnose NTDs. *Placentography* - **Placentography** is used to localize the **placenta** in cases of suspected **placenta previa** or for guiding invasive procedures. - Provides no information about **fetal anatomy** and is not used for detecting NTDs.

Q: Internationally accepted definition of abortion is the expulsion of the products of conception:

Before 20th week of gestation or 500 gms (weight of foetus). ***Before 20th week of gestation or 500 gms (weight of foetus)*** - The internationally accepted definition of abortion, as per organizations like the **World Health Organization (WHO)**, is the expulsion of products of conception before **20 weeks of gestation** or when the fetal weight is less than **500 grams**. - This threshold is used because fetuses weighing less than 500 grams or born before 20 weeks are generally considered non-viable, meaning they have a negligible chance of survival outside the womb. *Before 28th week of gestation or 1 kg (weight of foetus)* - While 28 weeks of gestation is an important milestone for fetal viability, defining abortion at this stage would include many late preterm births that are often viable. - A fetal weight of **1 kg (1000g)** is generally associated with a much higher probability of survival, signifying a preterm birth rather than an abortion by international standards. *Before 20 week of gestation or 750 gms (weight of foetus)* - The gestational age of **20 weeks** is correct, but a fetal weight of **750 grams** is higher than the internationally accepted cutoff of 500 grams for defining abortion. - Fetuses at 750 grams, especially at 20 weeks, are still considered non-viable, but the weight criterion in this option is not the standard international definition. *Before 24th week of gestation or 750 gms (weight of foetus)* - While **24 weeks of gestation** is often considered the threshold of viability in many countries, and is used in some legal definitions, it is not the internationally recognized standard for abortion, which generally uses 20 weeks. - A fetal weight of **750 grams** at 24 weeks would indicate a very early preterm birth with a low but possible chance of survival, whereas the international definition of abortion focuses on absolute non-viability.

Q: Which is the best marker for NTD?

AFP. ***AFP*** - **Alpha-fetoprotein (AFP)** is the primary and most widely used biochemical marker for detecting **neural tube defects (NTDs)** during pregnancy. - Elevated levels of **AFP in maternal serum** or amniotic fluid are indicative of an open NTD, such as **spina bifida** or **anencephaly**, where fetal blood leaks into the amniotic fluid. *Inhibin-A* - **Inhibin-A** is typically used in the **quad screen** as a marker for **Down syndrome (Trisomy 21)**, where its levels are typically elevated. - It does not serve as a primary marker for the detection of neural tube defects. *hCG* - **Human Chorionic Gonadotropin (hCG)** is elevated in **Down syndrome** and decreased in **Edwards syndrome (Trisomy 18)** screening. - It is not a reliable marker for the diagnosis of neural tube defects. *Pseudocholinesterase* - **Pseudocholinesterase**, also known as butyrylcholinesterase, is a serum enzyme that can be **elevated in amniotic fluid** in cases of open NTDs. - While it can be a useful confirmatory test, its general utility as a primary marker is less than AFP, as it is less specific and more difficult to implement in routine screening.

Question 1

A pregnant woman at 32 weeks presents with recurrent bacterial vaginosis despite multiple treatments. She has history of preterm labor in previous pregnancy. Current symptoms include discharge and burning. Partner is untreated. Which management approach is most appropriate?

Accepted Answer

Extended oral clindamycin with probiotics

Answer

Topical azole cream only

Answer

Single dose metronidazole with observation

Answer

Delay treatment until postpartum

Question 2

A 23-year-old primigravid woman comes to the physician for an initial prenatal visit at 13 weeks' gestation. She has had episodic headaches over the past month. She has no history of serious illness. Her immunizations are up-to-date. Her temperature is 37°C (98.6°F) and pulse is 90/min. Repeated measurements show a blood pressure of 138/95 mm Hg. Pelvic examination shows a uterus consistent in size with a 13-week gestation. The remainder of the examination shows no abnormalities. Urinalysis is within normal limits. Serum creatinine is 0.8 mg/dL, serum ALT is 19 U/L, and platelet count is 210,000/mm3. Which of the following is the most likely condition in this patient?

Accepted Answer

Chronic hypertension

Answer

Eclampsia

Answer

High normal blood pressure

Answer

Gestational hypertension

Answer

Preeclampsia

Question 3

Which of the following is the most sensitive and specific test during antenatal check-up for a pregnant lady with family history of Thalassemia?

Accepted Answer

High performance liquid chromatography

Answer

P. smear and reticulocyte count

Answer

Hemoglobin electrophoresis

Answer

NESTROFT

Question 4

A grand multipara is defined as a woman who has had how many viable pregnancies (≥20 weeks):

Accepted Answer

>=5

Answer

>2

Answer

>3

Answer

>4

Question 5

A lady with 12-week pregnancy presents with bleeding. On examination, vagina is normal, internal os is closed, and USG shows fetal viability with fundal height of 13 weeks. What is the diagnosis?

Accepted Answer

Threatened abortion

Answer

Incomplete abortion

Answer

Complete abortion

Answer

Inevitable abortion

Question 6

EDD ( Expected Date of Delivery) is calculated by:

Accepted Answer

Naegele's formula

Answer

Cardiff Formula

Answer

McDonald's rule

Answer

Hadlock Formula

Question 7

What is the Triple screen test (Triple marker test)?

Accepted Answer

HCG + AFP + Unconjugated Estriol

Answer

HCG + AFP + PAPP-A

Answer

AFP + Uric acid + LDH

Answer

HCG + AFP + Placental alkaline phosphatase

Question 8

Which of the following is the MOST accurate test for detecting neural tube defects?

Accepted Answer

USG

Answer

Placentography

Answer

Chromosomal analysis

Answer

Amniocentesis

Question 9

Internationally accepted definition of abortion is the expulsion of the products of conception:

Accepted Answer

Before 20th week of gestation or 500 gms (weight of foetus)

Answer

Before 28th week of gestation or 1 kg (weight of foetus)

Answer

Before 24th week of gestation or 750 gms (weight of foetus)

Answer

Before 20th week of gestation or 750 gms (weight of foetus)

Question 10

Which is the best marker for NTD?

Accepted Answer

AFP

Answer

Inhibin-A

Answer

hCG

Answer

Pseudocholinesterase

Prenatal Care — MCQs

Prenatal Care — MCQs

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