Prenatal Care Practice Questions

Q: Use of folic acid to prevent congenital malformations should be best initiated:

Before conception. ***Before conception*** - **Neural tube defects (NTDs)**, such as spina bifida and anencephaly, occur very early in pregnancy, often before a woman even knows she is pregnant. - Adequate folate levels are crucial for **neural tube closure**, which happens between 21 and 28 days after conception. Therefore, supplementation needs to start before this period. *During 1st trimester of pregnancy* - While still helpful, initiating folic acid during the first trimester might be **too late** to prevent all NTDs. - The critical period for neural tube formation has largely passed, meaning the **maximum preventive effect** may not be achieved. *During 2nd trimester of pregnancy* - This is **too late** for primary prevention of NTDs, as neural tube closure is completed in the first few weeks of gestation. - At this stage, folic acid supplementation would primarily benefit the ongoing **fetal growth and development**, but not the prevention of NTDs. *During 3rd trimester of pregnancy* - This timing is **ineffective** for the prevention of congenital malformations like NTDs, which have already occurred or been avoided by this point. - Folic acid at this stage primarily supports continued fetal growth and maternal health, but offers no additional benefit regarding **early developmental defects**.

Q: Average extra caloric requirement during second and third trimesters of pregnancy is:

+350 Kcal/day. ***Correct: +350 Kcal/day*** - The **recommended average extra caloric intake** during pregnancy is approximately **300-350 kcal/day** in the second and third trimesters. - Specifically, **second trimester requires +340 kcal/day** and **third trimester requires +452 kcal/day** (average ~350 kcal/day). - This additional energy is needed to support **fetal growth, placental development, and increased maternal metabolic demands**. - **First trimester** requires minimal increase (0-100 kcal/day). *Incorrect: +150 Kcal/day* - This amount is generally **insufficient** for the increased metabolic demands of the second and third trimesters. - While caloric needs do not significantly increase in the first trimester, they rise substantially in later pregnancy. *Incorrect: +520 Kcal/day* - An extra intake of 520 kcal/day is **higher than the generally recommended** guidelines for most pregnant women. - This level of intake could potentially lead to **excessive gestational weight gain**, increasing risks of gestational diabetes and complications. *Incorrect: +600 Kcal/day* - An additional 600 kcal/day is **significantly above the average recommendation** for caloric intake during pregnancy. - Such high intake is typically **not necessary** and may contribute to **unhealthy weight gain** for both mother and fetus.

Q: What is the preferred timing for routine urine sample collection in a pregnant female?

Early morning sample. ***Early morning sample*** - An **early morning urine sample** is preferred because it is the most concentrated, increasing the likelihood of detecting abnormalities. - This concentration allows for accurate assessment of substances like **blood cells**, **protein**, and **bacteria**, which might be diluted in samples collected later in the day. *Mid-stream collection* - **Mid-stream collection** aims to reduce contamination from the periurethral area but does not provide the same concentration as an early morning sample. - While important for reducing contaminants, it's not the primary factor determining the optimal collection time for diagnosing pregnancy-related conditions. *Suprapubic puncture* - **Suprapubic puncture** is an invasive procedure generally reserved for situations where a clean catch is impossible or contamination is a significant concern, typically in infants or critically ill patients. - It carries risks such as **pain**, **hematuria**, and potential **bowel perforation**, making it unsuitable for routine urine collection in pregnant women. *Catheterization* - **Catheterization** is an invasive method that carries a risk of introducing infection into the bladder. - It is usually performed only when a clean-catch sample cannot be obtained or when precise measurement of residual urine is necessary, not for routine screening in pregnant women.

Q: What is the obstetric score of a 26-year-old woman who is 36 weeks pregnant, has had one previous delivery of twins, and is certain of her dates?

G2P1L2 (2 live births). ***G2P1L2 (2 live births)*** - **Gravida (G)** refers to the total number of pregnancies, including the current one. This woman is currently pregnant and has had one previous pregnancy, making her G2. - **Parity (P)** refers to the number of pregnancies that reached viability (>20 weeks gestation or >500g), *regardless of the number of fetuses*. She had one previous delivery (twins) that reached viability, so her P is 1. The current pregnancy is not included in parity until after delivery. - **Live births (L)** refers to the number of live children delivered. Her previous pregnancy resulted in twins, meaning 2 live births. *G3P2L2 (3 pregnancies, 2 live births)* - This option incorrectly counts the number of pregnancies (**G**) as 3. She has had one previous pregnancy and is currently pregnant, totaling 2 pregnancies. - It also incorrectly counts the parity (**P**) as 2. Parity refers to the number of deliveries that reached viability, not the number of fetuses. Her previous delivery was a single event, making P1. *G2P2L2 (2 pregnancies, 2 live births)* - While the Gravida (G2) and Live births (L2) are correct, the Parity (**P**) is incorrectly stated as 2. Parity refers to the number of viable pregnancies delivered, and she has only had one previous delivery. - The number of fetuses (twins) does not increase the parity count for a single delivery event. *G3P3L2 (3 pregnancies, 3 live births)* - This option incorrectly states the number of pregnancies (**G**) as 3 and the parity (**P**) as 3. - The woman has only had one previous pregnancy and is currently pregnant, for a total of G2 and P1.

Q: What is the MOST common cause of elevated maternal serum alpha-fetoprotein in routine prenatal screening?

Open neural tube defect. ***Open neural tube defect*** - **Open neural tube defects (NTDs)**, such as anencephaly or spina bifida, lead to direct leakage of **alpha-fetoprotein (AFP)** from the fetal circulation into the amniotic fluid and then into maternal blood. - Among **pathological fetal causes**, NTDs are the **most significant and commonly screened** condition associated with markedly elevated AFP in prenatal screening. - Note: Incorrect gestational age dating and multiple gestation are actually more common overall causes of elevated AFP, but among the fetal anomalies, **NTDs are the most important**. *Maternal diabetes mellitus* - Poorly controlled **maternal diabetes mellitus** is not a typical cause of elevated AFP. - While diabetes increases risk of fetal anomalies including **neural tube defects**, diabetes itself does not directly elevate AFP levels. *Trisomy 21* - **Trisomy 21 (Down syndrome)** is typically associated with **low maternal serum AFP levels**, not elevated levels. - Elevated AFP would suggest other conditions like NTDs rather than Trisomy 21. *Maternal hypertension* - **Maternal hypertension** is not directly associated with elevated maternal serum AFP. - While it can be linked to placental complications like **intrauterine growth restriction**, it does not typically cause significant AFP elevation.

Question 1

Use of folic acid to prevent congenital malformations should be best initiated:

Accepted Answer

Before conception

Answer

During 1st trimester of pregnancy

Answer

During 2nd trimester of pregnancy

Answer

During 3rd trimester of pregnancy

Question 2

All of the following statements are true regarding non-invasive prenatal screening (NIPT) test except:

Accepted Answer

Evaluates fetal blood taken by cordocentesis for fetal abnormalities

Answer

High negative predictive value

Answer

Positive test needs further confirmation

Answer

Used in screening for aneuploidies

Question 3

Average extra caloric requirement during second and third trimesters of pregnancy is:

Accepted Answer

+350 Kcal/day

Answer

+150 Kcal/day

Answer

+520 Kcal/day

Answer

+600 Kcal/day

Question 4

What is the preferred timing for routine urine sample collection in a pregnant female?

Accepted Answer

Early morning sample

Answer

Suprapubic puncture

Answer

Mid-stream collection

Answer

Catheterization

Question 5

What is the obstetric score of a 26-year-old woman who is 36 weeks pregnant, has had one previous delivery of twins, and is certain of her dates?

Accepted Answer

G2P1L2 (2 live births)

Answer

G3P2L2 (3 pregnancies, 2 live births)

Answer

G2P2L2 (2 pregnancies, 2 live births)

Answer

G3P3L2

Question 6

What is the MOST common cause of elevated maternal serum alpha-fetoprotein in routine prenatal screening?

Accepted Answer

Open neural tube defect

Answer

Maternal diabetes mellitus

Answer

Trisomy 21

Answer

Maternal hypertension

Question 7

Fetal nuchal translucency is useful in detecting:

Accepted Answer

Down syndrome

Answer

Fetal infection

Answer

Anencephaly

Answer

Hydrops fetalis

Prenatal Care — MCQs

Prenatal Care — MCQs

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