Prenatal Care Practice Questions

Q: All of the following conditions are risk factors for urinary tract infections in pregnancy except:

Hypertension. ***Hypertension*** - While hypertension is a significant pregnancy complication, it is **not directly a risk factor** for developing urinary tract infections. - Its presence does not inherently increase the susceptibility of the urinary tract to bacterial colonization or infection. *Vesicoureteral reflux* - This condition involves the **backward flow of urine** from the bladder into the ureters, sometimes reaching the kidneys. - It creates a reservoir for bacteria and facilitates their ascent, significantly increasing the risk of UTIs during pregnancy. *Diabetes* - Women with diabetes are more prone to UTIs due to **glycosuria** (glucose in urine), which serves as a bacterial growth medium. - Additionally, diabetic neuropathy can lead to **incomplete bladder emptying**, further increasing UTI risk. *Sickle cell anemia* - Patients with sickle cell anemia can experience **renal papillary necrosis** and impaired renal function, which can predispose them to UTIs. - They also tend to have a **compromised immune system**, making them more susceptible to infections in general, including UTIs.

Q: The following changes occur in the urinary system in pregnancy except:

Increased activity of ureters. ***Increased activity of ureters*** - Ureters actually experience **decreased peristaltic activity** and **dilation** during pregnancy due to hormonal influences (progesterone) and mechanical compression. - This leads to **urinary stasis** and an increased risk of urinary tract infections, a common complication of pregnancy. *Increased RBF* - **Renal blood flow (RBF)** significantly **increases** during pregnancy, primarily due to vasodilation induced by hormones like relaxin and nitric oxide. - This increase in RBF is essential to accommodate the increased metabolic demands and waste product excretion during pregnancy. *Increased GFR* - **Glomerular filtration rate (GFR)** also **increases** by 30-50% during pregnancy, reflecting the increased RBF and the need to filter a larger volume of plasma. - This elevated GFR can lead to lower serum creatinine and urea levels compared to the non-pregnant state. *Hypertrophy of bladder musculature* - The **bladder musculature undergoes hypertrophy** during pregnancy as a physiological adaptation to accommodate the growing uterus and maintain bladder function. - This hypertrophy helps the bladder withstand increased pressure and prepare for the demands of labor and delivery.

Q: Most commonly used sonological indicator for aneuploidy in first trimester is:

Nuchal translucency. ***Nuchal translucency*** - **Nuchal translucency (NT)** is the most common and established sonographic marker for **Down syndrome** and other aneuploidies in the first trimester. - Increased NT thickness is directly correlated with a higher risk of **chromosomal abnormalities** and congenital heart defects. *Gestational sac volume* - **Gestational sac volume** is primarily used to assess the viability and proper development of the early pregnancy, not as a direct marker for aneuploidy. - Abnormalities in gestational sac size can indicate a **non-viable pregnancy** or **blighted ovum**, but not specific chromosomal defects. *Serum PAPP-A level* - **Serum PAPP-A (pregnancy-associated plasma protein-A)** is a biochemical marker used in conjunction with NT in first-trimester screening. - While it is part of aneuploidy risk assessment, **PAPP-A is a blood test**, not a sonological indicator itself. *Crown-rump length* - **Crown-rump length (CRL)** is used for **accurate dating of pregnancy** in the first trimester. - While an abnormal CRL can sometimes be associated with adverse pregnancy outcomes, it is not a direct or primary sonological indicator for aneuploidy screening.

Q: Which of the following is false as physiological change in pregnancy?

Increase total protein. ***Increase total protein*** - During pregnancy, **plasma volume increases disproportionately more than the increase in red blood cell mass**, leading to hemodilution. - This hemodilution results in a **decrease in the concentration of total plasma proteins and albumin**, making this statement false. *Increase GFR* - **Glomerular filtration rate (GFR) increases significantly** during pregnancy (by 30-50%) due to increased renal plasma flow. - This physiological adaptation helps to clear the increased metabolic waste products produced by both the mother and the fetus. *Increase cardiac output* - **Cardiac output increases by 30-50%** during pregnancy, primarily due to increases in both heart rate and stroke volume. - This increased cardiac output ensures adequate blood supply to the uterus, placenta, and other maternal organs. *Increase plasma volume* - **Plasma volume increases substantially (up to 40-50%)** during pregnancy, starting in the first trimester and continuing until term. - This expansion of plasma volume is crucial for meeting the increased circulatory demands of pregnancy and supporting placental perfusion.

Q: DOC of bacterial vaginosis in pregnancy is:

Metronidazole. ***Metronidazole*** - **Metronidazole** is the drug of choice for treating bacterial vaginosis in pregnancy and is effective against the anaerobic bacteria responsible for the condition. - It is considered safe throughout pregnancy, including the first trimester. - Recommended dose: 500 mg orally twice daily for 7 days OR 250 mg orally three times daily for 7 days. *Erythromycin* - **Erythromycin** is a macrolide antibiotic primarily used for respiratory tract infections and is not effective against bacterial vaginosis. - It does not have adequate activity against the anaerobic bacteria (Gardnerella vaginalis, Mobiluncus species) that cause bacterial vaginosis. *Clindamycin* - **Clindamycin** is an effective alternative treatment for bacterial vaginosis in pregnancy and can be used orally or topically. - While equally effective, **metronidazole** is traditionally preferred as the first-line drug of choice in most guidelines and medical education curricula. - Clindamycin is reserved as an alternative for patients who cannot tolerate or have contraindications to metronidazole. *Rovamycin* - **Rovamycin** (spiramycin) is a macrolide antibiotic used primarily for toxoplasmosis in pregnancy. - It has no role in the treatment of bacterial vaginosis and lacks efficacy against the causative anaerobic organisms.

Q: Which of the following markers is not used in quadruple test for antenatal detection of Down syndrome?

Estradiol. ***Estradiol*** - **Estradiol** is a primary **estrogen** produced by the ovaries and placenta but is **not** one of the four markers included in the **quadruple screen** for Down syndrome. - The quadruple screen typically measures levels of **alpha-fetoprotein (AFP)**, **unconjugated estriol (uE3)**, **human chorionic gonadotropin (hCG)**, and **inhibin A**. *Inhibin* - **Inhibin A** is one of the four components of the **quadruple screen** for Down syndrome. - In pregnancies affected by Down syndrome, inhibin A levels are typically **elevated**. *AFP* - **Alpha-fetoprotein (AFP)** is a key component of the **quadruple screen**. - In a Down syndrome pregnancy, maternal serum AFP levels are typically **lower** than normal. *ss-hCG* - **Beta-human chorionic gonadotropin (β-hCG)** is a specific subunit of hCG and is one of the four markers in the **quadruple screen**. - In pregnancies with Down syndrome, maternal serum β-hCG levels are usually **elevated**.

Q: What is the most accurate method for dating pregnancy in the first trimester?

Crown-rump length. ***Crown-rump length*** - This is the **most accurate method** for dating pregnancy in the first trimester (up to 13 weeks 6 days) due to the **consistent growth rate** of the embryo/fetus during this period. - An ultrasound measurement of the **CRL** provides an estimated date of delivery (EDD) with an accuracy of +/- 5-7 days. *Mean sac diameter* - While useful for confirming an **intrauterine pregnancy**, **mean sac diameter (MSD)** is less accurate for dating than CRL, especially after 6 weeks gestation. - Its accuracy for dating is about +/- 1.5 weeks and is primarily used when an **embryo is not yet visible**. *Beta-hCG levels* - **Beta-human chorionic gonadotropin (hCG) levels** increase predictably in early pregnancy but are not a precise dating method due to wide variations between individuals and pregnancies. - They are primarily used to **confirm pregnancy** and monitor its progression, or to investigate complications like ectopic pregnancy or miscarriage. *Last menstrual period* - **Dating by last menstrual period (LMP)** is commonly used, but its accuracy depends on a regular menstrual cycle and the woman's recall, which can be unreliable. - It assumes a standard 28-day cycle with ovulation on day 14 and is **less accurate** than ultrasound measurements.

Q: What is the drug of choice for Bacterial vaginosis in pregnancy?

Metronidazole. ***Metronidazole*** - **Metronidazole** is the drug of choice for **bacterial vaginosis** in pregnancy due to its excellent efficacy against **anaerobic bacteria**, which are causative organisms, and its established safety profile during gestation. - It effectively restores the normal vaginal flora by targeting the overgrowth of **Gardnerella vaginalis** and other **anaerobic bacteria**, reducing symptoms and preventing potential pregnancy complications. *Erythromycin* - **Erythromycin** is a macrolide antibiotic primarily used for **atypical pneumonia**, **pertussis**, and certain **skin infections**, but it is generally not considered the first-line treatment for bacterial vaginosis due to lower efficacy against the specific anaerobic flora involved. - While generally safe in pregnancy, its spectrum of activity is less optimal for bacterial vaginosis compared to metronidazole, and it is reserved for specific situations or allergies. *Rovamycin* - **Rovamycin** is **spiramycin**, another macrolide antibiotic, often used for **toxoplasmosis** in pregnancy to prevent vertical transmission. - It is not typically recommended for the treatment of **bacterial vaginosis** as its efficacy against the causative anaerobic bacteria is not as well-established as that of metronidazole or clindamycin. *Clindamycin* - **Clindamycin** is an alternative treatment for **bacterial vaginosis** in pregnancy, particularly for patients who cannot tolerate metronidazole or have resistant infections. - It is effective against anaerobic bacteria and can be administered orally or as a vaginal cream, but **metronidazole** is usually preferred as the initial treatment.

Q: Which vaccine is contraindicated in pregnancy?

Rubella. ***Rubella*** - The **rubella vaccine** is a **live attenuated vaccine**, which carries a theoretical risk of fetal infection and congenital rubella syndrome if administered during pregnancy. - For this reason, women are usually screened for immunity and vaccinated **pre-conception** or **postpartum**. *Influenza* - The **influenza vaccine** (inactivated form) is **recommended** during pregnancy to protect both the mother and newborn from severe influenza illness. - It is **safe** and **effective** for pregnant women at any stage of gestation. *Tetanus toxoid* - The **tetanus toxoid vaccine** (Tdap or Td) is **recommended** during each pregnancy to provide passive immunity to the newborn against pertussis (whooping cough), as well as protecting the mother from tetanus and diphtheria. - It is considered **safe** and ideally given between 27 and 36 weeks of gestation. *Hepatitis B* - The **hepatitis B vaccine** is **recommended** for pregnant women who are at high risk of hepatitis B infection, as a protective measure for both the mother and the fetus. - It is an **inactivated vaccine** and has not been shown to cause adverse effects in pregnancy.

Question 1

All of the following conditions are risk factors for urinary tract infections in pregnancy except:

Accepted Answer

Hypertension

Answer

Vesicoureteral reflux

Answer

Diabetes

Answer

Sickle cell anemia

Question 2

The following changes occur in the urinary system in pregnancy except:

Accepted Answer

Increased activity of ureters

Answer

Increased RBF

Answer

Increased GFR

Answer

Hypertrophy of bladder musculature

Question 3

Most commonly used sonological indicator for aneuploidy in first trimester is:

Accepted Answer

Nuchal translucency

Answer

Gestational sac volume

Answer

Serum PAPP-A level

Answer

Crown-rump length

Question 4

24 yr old mother with 7 week POG presents to ANC OPD with accidental low-dose radiation exposure. What is the most appropriate immediate management?

Accepted Answer

Reassure and continue pregnancy

Answer

Perform detailed fetal anomaly scan

Answer

Advise medical termination of pregnancy

Answer

Advise genetic counseling and testing

Question 5

Which of the following is false as physiological change in pregnancy?

Accepted Answer

Increase total protein

Answer

Increase GFR

Answer

Increase cardiac output

Answer

Increase plasma volume

Question 6

DOC of bacterial vaginosis in pregnancy is:

Accepted Answer

Metronidazole

Answer

Erythromycin

Answer

Clindamycin

Answer

Rovamycin

Question 7

Which of the following markers is not used in quadruple test for antenatal detection of Down syndrome?

Accepted Answer

Estradiol

Answer

Inhibin

Answer

AFP

Answer

ss-hCG

Question 8

What is the most accurate method for dating pregnancy in the first trimester?

Accepted Answer

Crown-rump length

Answer

Mean sac diameter

Answer

Beta-hCG levels

Answer

Last menstrual period

Question 9

What is the drug of choice for Bacterial vaginosis in pregnancy?

Accepted Answer

Metronidazole

Answer

Erythromycin

Answer

Rovamycin

Answer

Clindamycin

Question 10

Which vaccine is contraindicated in pregnancy?

Accepted Answer

Rubella

Answer

Influenza

Answer

Tetanus toxoid

Answer

Hepatitis B

Prenatal Care — MCQs

Prenatal Care — MCQs

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