Prenatal Care Practice Questions

Q: Which of the following is a sign that is not typically associated with pregnancy?

Dalrymple sign. ***Dalrymple sign*** - **Dalrymple sign** is the **widening of the palpebral fissure** (eyelid retraction), typically associated with **Grave's disease** and hyperthyroidism, not pregnancy. - Its presence suggests a thyroid disorder rather than a normal physiological change of pregnancy. *Chadwick's sign (bluish discoloration of the vagina or cervix)* - **Chadwick's sign** is a common **early presumptive sign of pregnancy**, caused by increased vascularity and blood flow to the pelvic organs. - This bluish discoloration is due to venous congestion in the cervix and vagina. *Braxton Hicks contractions (irregular uterine contractions)* - **Braxton Hicks contractions** are **intermittent, painless uterine contractions** that occur throughout pregnancy, especially in the third trimester. - They are considered "practice contractions" and are a normal physiological finding as the uterus prepares for labor. *Hegar's sign (softening of the lower part of the uterus)* - **Hegar's sign** is a probable sign of pregnancy, characterized by the **softening of the lower uterine segment**, allowing it to be easily compressed. - This sign is typically detectable between 6 and 12 weeks of gestation due to hormonal changes.

Q: Uterine height is greater than gestational age of the patient in a case of all except -

IUGR. ***IUGR*** - In **Intrauterine Growth Restriction (IUGR)**, the fetus is smaller than expected for gestational age, leading to a **fundal height** that measures less than the actual gestational age. - This condition is characterized by a **restricted growth rate** of the fetus, causing the uterine size to be disproportionately small. *Fibroid uterus* - The presence of **uterine fibroids** (leiomyomas) can increase the overall size of the uterus beyond what would be expected for a given gestational age. - These benign tumors add bulk to the uterine wall, leading to a **larger-than-expected uterine height**. *Wrong dates* - Incorrect estimation of the **Last Menstrual Period (LMP)** or date of conception can lead to a miscalculation of gestational age. - If the gestational age is **underestimated**, the actual uterine height will appear greater than the calculated gestational age. *Polyhydramnios* - **Polyhydramnios** is a condition characterized by an **excessive accumulation of amniotic fluid**, which distends the uterus. - Increased amniotic fluid volume leads to a significantly **larger uterine size** and a fundal height greater than the gestational age.

Q: A 28-year-old primigravida with 32 weeks of gestation presents with profuse vaginal discharge since yesterday. She was advised USG, which showed a single live intrauterine gestational sac with FL and AC corresponding to the weeks of gestation and AFI as adequate. What is the diagnosis?

Normal vaginal discharge. ***Normal vaginal discharge*** - Profuse vaginal discharge is a common and **physiological occurrence** in pregnancy due to increased estrogen levels and blood flow to the vagina. - The ultrasound findings of **adequate amniotic fluid index (AFI)** rule out rupture of membranes, and no other symptoms of infection are reported. *Preterm Premature Rupture of Membranes (PPROM)* - PPROM would present with a significant reduction in the **amniotic fluid index (AFI)** on ultrasound, which is noted as adequate in this case. - The discharge in PPROM is typically **amniotic fluid**, which is clear and watery, unlike mere profuse vaginal discharge. *Trichomoniasis* - This infection typically causes a **frothy, greenish-yellow discharge** with a foul odor, along with vulvar itching and irritation. - These characteristic symptoms are not mentioned in the patient's presentation. *Candidiasis* - Vaginal candidiasis usually presents with a **thick, white, cottage cheese-like discharge** accompanied by intense itching and burning. - The patient's description of discharge is simply "profuse," without these specific characteristics.

Q: Cardiac output in pregnancy shows significant increase from which week of gestation

15 weeks. ***15 weeks*** - Cardiac output shows a **significant and clinically measurable increase around 10-15 weeks of gestation**, which continues to rise, peaking between **20-28 weeks**. - This rise is primarily due to an increase in both **stroke volume** (increased by 25-30%) and **heart rate** (increased by 10-15 bpm) to meet the metabolic demands of the growing fetus and placenta. - By 15 weeks, cardiac output has typically increased by approximately **20-30% above pre-pregnancy levels**. *5 weeks* - While cardiac output does begin to rise very early in pregnancy (as early as 5-8 weeks), the increase at this stage is **subtle and not yet significant**. - At 5 weeks, the **placental circulation is still in early development**, and the hemodynamic changes are just beginning. - The question asks about **significant increase**, which is not yet established at 5 weeks. *25 weeks* - By 25 weeks, cardiac output has already completed its major rise and is at or near its **peak levels** (40-50% above baseline). - The **significant increase had already occurred** much earlier, around 10-15 weeks. - This timing represents the plateau phase rather than the initial significant increase. *35 weeks* - At 35 weeks, cardiac output remains elevated at near-peak levels but the **major increase happened much earlier** in pregnancy. - By this gestational age, the cardiovascular system has been adapted for months. - There may be minor positional variations (e.g., aortocaval compression in supine position) but no new significant increase occurs.

Q: After taking MMR live vaccine, conception should not occur within ?

4 weeks. ***4 weeks*** - The **MMR (measles, mumps, and rubella) vaccine** is a **live attenuated vaccine**, meaning it contains weakened forms of the viruses. - To minimize any theoretical risk of congenital rubella syndrome, women are advised to **avoid conception for at least 4 weeks** (or one month) after receiving the MMR vaccine. *2 weeks* - This period is generally considered too short for ensuring the complete clearance of the attenuated live virus from the woman's system before conception. - The standard recommendation for live attenuated vaccines like MMR is typically longer due to potential, though rare, viral transmission risks to the fetus. *8 weeks* - While a longer waiting period like 8 weeks would certainly be safe, it is **not the minimum recommended duration** by public health guidelines. - Waiting 4 weeks (one month) is sufficient and a more practical guideline for most women planning conception. *10 weeks* - This duration is significantly longer than the standard recommendation and is not necessary to ensure safety after an MMR vaccination. - The 4-week guideline balances safety with practicality for reproductive planning.

Q: What percentage of women typically deliver on their Estimated Due Date (EDD)?

5%. ***5%*** - Only about **5% of women** deliver on their **exact Estimated Due Date (EDD)**. - The EDD is calculated using **Naegele's rule** (280 days from LMP) and serves as an **approximation** rather than a precise prediction. - Most women deliver within a **37-42 week window**, with the majority occurring in the **2 weeks before or after** the EDD. - This reflects the **natural biological variation** in pregnancy duration. *10%* - This percentage is **higher than the actual rate** of delivery on the exact EDD. - While 10% might seem plausible for deliveries within a few days of the EDD, it overestimates delivery on that specific date. *15%* - This percentage **significantly overestimates** the likelihood of delivering precisely on the EDD. - The probability of birth on one specific day out of a several-week delivery window is relatively low. *20%* - This is a substantial **overestimation** of the probability of delivering on the EDD. - The EDD represents a **single day** in a term pregnancy window (37-42 weeks), making such a high percentage statistically unlikely.

Q: At how many weeks does the amniotic fluid volume usually start to plateau or slightly decrease?

38-40. ***38-40*** - The **amniotic fluid volume** typically peaks around **36-38 weeks gestation** and then begins to plateau or slightly decrease towards term. - At **38-40 weeks**, as a woman approaches her due date, the volume of amniotic fluid naturally lessens. *16* - At **16 weeks**, the amniotic fluid volume is still actively increasing and is crucial for **fetal development** and movements. - This period is well before the peak volume and certainly not a point of plateau or decrease. *30* - At **30 weeks**, the amniotic fluid volume is still in its increasing phase, contributing to the healthy growth and protection of the fetus. - The decline or plateau does not typically begin until closer to term. *12* - At **12 weeks**, the formation and increase of amniotic fluid is in its early stages as the fetus and membranes develop. - This is a period of rapid growth in fluid volume, not a plateau or decrease.

Q: What is Hegar's sign in obstetrics?

Softening of the uterine isthmus. ***Softening of the uterine isthmus*** - **Hegar's sign** is an early presumptive sign of pregnancy characterized by the **softening of the lower uterine segment (isthmus)**, which can be palpated during a bimanual examination. - This softening makes the fundus and cervix feel like separate entities, indicating increased vascularity and changes due to hormonal influence. *Uterine contractions* - While contractions do occur during pregnancy (e.g., **Braxton Hicks contractions**), they are not what defines Hegar's sign. - **Uterine contractions** are typically associated with labor or placental abruption, not the specific softening of the isthmus. *Fetal movement* - **Fetal movement** (quickening) is a positive sign of pregnancy perceived by the mother, usually after 16-20 weeks gestation. - This is entirely distinct from Hegar's sign, which is a physical finding upon examination of the uterus. *Cyanosis of the vagina* - **Cyanosis of the vagina** and cervix is known as **Chadwick's sign**, another presumptive sign of pregnancy. - Chadwick's sign is due to increased vascularity and venous congestion, causing a bluish discoloration, but it's not the softening described in Hegar's sign.

Q: Which of the following is the most common genital infection in pregnancy?

Vaginal candidiasis. ***Vaginal candidiasis*** - **Vaginal candidiasis**, commonly known as a yeast infection, is the **most frequent genital infection** during pregnancy due to hormonal changes that alter the vaginal microenvironment. - Pregnancy increases susceptibility through **elevated estrogen levels**, **increased vaginal glycogen**, and **altered vaginal pH**. - While generally not harmful to the fetus, it can cause significant maternal discomfort with symptoms like **itching**, burning, and a **thick, white, cottage cheese-like discharge**. *Gonorrhea* - Gonorrhea is a **sexually transmitted infection (STI)** that, although possible, is not the most common genital infection in pregnancy. - It carries a risk of serious complications for both mother and infant, including **preterm birth**, **chorioamnionitis**, and **neonatal conjunctivitis** (ophthalmia neonatorum). *Chlamydia* - Chlamydia is another **STI** that can occur during pregnancy but is not as common as candidiasis. - Untreated chlamydia can lead to **preterm rupture of membranes**, **preterm labor**, and **postpartum endometritis** in the mother, and **conjunctivitis** or **pneumonia** in the newborn. *Bacterial vaginosis* - Bacterial vaginosis (BV) is a common vaginal infection caused by an **imbalance in normal vaginal flora**, with overgrowth of anaerobic bacteria. - While BV is the most common vaginal infection in **non-pregnant women**, vaginal candidiasis is more frequently encountered during pregnancy due to hormonal changes. - BV in pregnancy is associated with increased risk of **preterm birth**, **preterm rupture of membranes**, and **postpartum endometritis**, making screening and treatment important.

Q: Which of the following methods is used for prenatal diagnosis of Down Syndrome?

Karyotyping for chromosomal analysis. ***Karyotyping for chromosomal analysis*** - **Karyotyping** is the gold standard definitive diagnostic method for Down syndrome (trisomy 21) as it directly visualizes and counts all chromosomes, identifying the presence of an extra copy of chromosome 21. - This cytogenetic method provides a clear genetic diagnosis with 100% accuracy, confirming the chromosomal abnormality responsible for Down syndrome. - Karyotyping can be performed on cells obtained via amniocentesis or chorionic villus sampling (CVS). *Triple test for biomarker screening* - The **triple test** measures biochemical markers (alpha-fetoprotein, unconjugated estriol, and hCG) to assess the risk of Down syndrome, but it is a **screening tool**, not a diagnostic method. - It has a detection rate of approximately 69% with a 5% false-positive rate. - Abnormal results require confirmatory diagnostic testing with karyotyping or other chromosomal analysis methods. *Fetal ultrasonography for physical feature assessment* - Fetal ultrasonography can detect **soft markers** such as increased nuchal translucency, absent/hypoplastic nasal bone, echogenic intracardiac focus, or structural anomalies that raise suspicion for Down syndrome. - However, ultrasound findings are **not diagnostic** on their own and have limited sensitivity and specificity. - Positive findings necessitate genetic testing like karyotyping for definitive diagnosis. *Non-invasive prenatal testing (NIPT) for cell-free DNA analysis* - **NIPT** analyzes cell-free fetal DNA in maternal blood and has high sensitivity (>99%) and specificity (>99%) for detecting trisomy 21. - Despite its excellent screening performance, NIPT is still classified as a **screening test**, not a diagnostic test. - Positive NIPT results require confirmation with diagnostic testing (karyotyping) before making clinical decisions regarding the pregnancy.

Question 1

Which of the following is a sign that is not typically associated with pregnancy?

Accepted Answer

Dalrymple sign

Answer

Chadwick's sign (bluish discoloration of the vagina or cervix)

Answer

Braxton Hicks contractions (irregular uterine contractions)

Answer

Hegar's sign (softening of the lower part of the uterus)

Question 2

Uterine height is greater than gestational age of the patient in a case of all except -

Accepted Answer

IUGR

Answer

Fibroid uterus

Answer

Wrong dates

Answer

Polyhydramnios

Question 3

A 28-year-old primigravida with 32 weeks of gestation presents with profuse vaginal discharge since yesterday. She was advised USG, which showed a single live intrauterine gestational sac with FL and AC corresponding to the weeks of gestation and AFI as adequate. What is the diagnosis?

Accepted Answer

Normal vaginal discharge

Answer

Candidiasis

Answer

Trichomoniasis

Answer

Preterm Premature Rupture of Membranes (PPROM)

Question 4

Cardiac output in pregnancy shows significant increase from which week of gestation

Accepted Answer

15 weeks

Answer

25 weeks

Answer

35 weeks

Answer

5 weeks

Question 5

After taking MMR live vaccine, conception should not occur within ?

Accepted Answer

4 weeks

Answer

8 weeks

Answer

2 weeks

Answer

10 weeks

Question 6

What percentage of women typically deliver on their Estimated Due Date (EDD)?

Accepted Answer

5%

Answer

15%

Answer

20%

Answer

10%

Question 7

At how many weeks does the amniotic fluid volume usually start to plateau or slightly decrease?

Accepted Answer

38-40

Answer

16

Answer

12

Answer

30

Question 8

What is Hegar's sign in obstetrics?

Accepted Answer

Softening of the uterine isthmus

Answer

Uterine contractions

Answer

Fetal movement

Answer

Cyanosis of the vagina

Question 9

Which of the following is the most common genital infection in pregnancy?

Accepted Answer

Vaginal candidiasis

Answer

Gonorrhea

Answer

Chlamydia

Answer

Bacterial vaginosis

Question 10

Which of the following methods is used for prenatal diagnosis of Down Syndrome?

Accepted Answer

Karyotyping for chromosomal analysis

Answer

Non-invasive prenatal testing (NIPT) for cell-free DNA analysis

Answer

Triple test for biomarker screening

Answer

Fetal ultrasonography for physical feature assessment

Prenatal Care — MCQs

Prenatal Care — MCQs

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