Prenatal Care — MCQs

A female patient presents to you with six weeks of amenorrhea, associated with abdominal pain and vaginal bleeding with normal blood pressure. Investigations revealed beta-hCG to be 1400 mIU/mL. An ultrasound scan was done which showed a trilaminar endometrium with normal adnexa. What is the next best step in the management of this patient?

Q566

A primigravida presents to you with anemia early in her pregnancy. She is 7 weeks pregnant as seen on ultrasound. Her hemoglobin level is 9 g/dL. When should the iron supplements be started for her?

Q567

A pregnant woman comes to the clinic. She has previously delivered twins. What is the correct representation of her obstetric score?

Q568

During which trimester is the double decidua sign typically observed?

Q569

A 36-week pregnant lady with previous twin delivery. What is the Obstetric score?

Q570

A woman with an obstetric score of G2P1 comes to the clinic at 14 weeks of gestation for her antenatal checkup. A uterine artery doppler was suggested by the doctor. What would it detect?

Prenatal Care Indian Medical PG Practice Questions and MCQs

Question 561: Which of the following is a physiological change of pregnancy in the urinary bladder?

A. Stress incontinence
B. Pressure on bladder in late pregnancy (Correct Answer)
C. Edematous mucosa
D. Increased frequency at 14 weeks

Explanation: ***Pressure on bladder in late pregnancy*** - This is a **normal physiological change** during the third trimester when the enlarged gravid uterus descends into the pelvis and exerts mechanical pressure on the bladder. - The **fetal presenting part** (usually the head) and the expanding uterus compress the bladder, reducing its effective capacity and causing increased urinary frequency and urgency. - This is an **expected anatomical change** in late pregnancy, not a pathological condition. - The pressure is maximal when the fetal head engages in the pelvis, typically **after 36 weeks** in primigravidas. *Increased frequency at 14 weeks* - While increased urinary frequency does occur during pregnancy, **14 weeks is not the typical time** for this symptom. - Frequency is most common in **early pregnancy (6-12 weeks)** due to hormonal effects and increased renal blood flow, and again in **late pregnancy (>28 weeks)** due to mechanical compression. - At 14 weeks (early second trimester), the uterus has typically **risen out of the pelvis** into the abdomen, and urinary frequency often temporarily improves. - The specificity of "14 weeks" makes this option less accurate as a physiological change. *Stress incontinence* - **Stress incontinence** is a common but **pathological symptom** during pregnancy, not a normal physiological change. - It results from weakening of pelvic floor muscles and increased intra-abdominal pressure, causing **involuntary urine leakage** with coughing, sneezing, or physical exertion. - While common, it represents pelvic floor dysfunction rather than an expected anatomical adaptation. *Edematous mucosa* - Significant **edema of the bladder mucosa** is not a typical physiological change in normal pregnancy. - While increased vascularity occurs throughout the urogenital tract (as seen with **Chadwick's sign** in the cervix), frank mucosal edema of the bladder would suggest **pathology** such as cystitis or urinary tract infection. - This is not considered a normal pregnancy adaptation.

Question 562: At which gestational week does the maximum volume of amniotic fluid occur?

A. 32 weeks
B. 34 weeks
C. 36 weeks (Correct Answer)
D. 40 weeks

Explanation: ***36 weeks*** - The volume of **amniotic fluid** gradually increases during pregnancy, reaching its **peak** around **36 weeks** of gestation. - After 36 weeks, the volume of amniotic fluid typically begins to **decrease** as the pregnancy approaches term. *32 weeks* - At 32 weeks, the amniotic fluid volume is still **increasing** and has not yet reached its maximum level. - The fetus is actively growing and contributing to fluid production, but the peak is still several weeks away. *34 weeks* - Although significant, the amniotic fluid volume at 34 weeks has not yet reached its **maximum**. - The volume will continue to rise for another two weeks before plateauing and then declining. *40 weeks* - By 40 weeks, a normal-term pregnancy, the volume of amniotic fluid has typically **decreased** from its peak at 36 weeks. - A declining amniotic fluid volume (oligohydramnios) can be a concern at term if it's too low.

Question 563: Fetal heart sounds (FHS) can usually be heard by Pinard's stethoscope at?

A. 14 weeks
B. 18 weeks (Correct Answer)
C. 22 weeks
D. 26 weeks

Explanation: ***18 weeks*** - Fetal heart sounds (FHS) can typically be heard with a **Pinard's stethoscope (fetoscope)** between **18 and 20 weeks** of gestation. - This timing allows for sufficient fetal development and sound transmission through the uterine wall for auscultation by this conventional method. - This is an important milestone in routine prenatal care and examination. *14 weeks* - At 14 weeks, fetal heart sounds are generally **not audible** with a Pinard's stethoscope or fetoscope. - A **Doppler ultrasound** is usually required to detect fetal heart activity at this early stage (typically from 10-12 weeks). *22 weeks* - While FHS are audible at 22 weeks, **18 weeks represents the earliest typical timeframe** for detection with a Pinard's stethoscope. - By 22 weeks, FHS would be more readily heard, but this option does not reflect the usual initial detection window. *26 weeks* - FHS are clearly audible at 26 weeks, but this is **later than the typical initial detection** period. - Early detection around 18-20 weeks is important for routine prenatal care and clinical assessment.

Question 564: At 20 weeks of gestation amniotic fluid volume is?

A. 600 ml
B. 400 ml
C. 200 ml (Correct Answer)
D. 800 ml

Explanation: ***200 ml*** - At **20 weeks of gestation**, the average amniotic fluid volume is approximately **200 ml**, primarily derived from fetal urination. - This volume is crucial for **fetal development**, protecting against trauma and allowing for lung maturation. *400 ml* - An amniotic fluid volume of 400 ml is typically observed later in gestation, often around **24-28 weeks**, as fetal urination increases. - While still within a normal range for some stages, it's generally higher than the average at 20 weeks. *600 ml* - A volume of 600 ml is characteristic of the **late second trimester** to early third trimester, around **28-32 weeks**, when the fetus is significantly larger and producing more urine. - This value would be considered high for a 20-week gestation and could indicate **polyhydramnios** if significantly elevated. *800 ml* - This volume is usually seen in the **third trimester**, often peaking around **33-34 weeks**, reflecting maximal fetal urine output. - An amniotic fluid volume of 800 ml at 20 weeks would be a clear indication of **severe polyhydramnios**, which can be associated with various fetal anomalies.

Question 565: A female patient presents to you with six weeks of amenorrhea, associated with abdominal pain and vaginal bleeding with normal blood pressure. Investigations revealed beta-hCG to be 1400 mIU/mL. An ultrasound scan was done which showed a trilaminar endometrium with normal adnexa. What is the next best step in the management of this patient?

A. Repeat beta – hCG after 48 hours (Correct Answer)
B. Laparoscopy
C. Repeat ultrasound after 5 days
D. Measurement of serum progesterone

Explanation: ***Repeat beta – hCG after 48 hours*** - With a beta-hCG of 1400 mIU/mL and no intrauterine pregnancy visible on ultrasound, repeating **beta-hCG after 48 hours** is crucial to assess its doubling time, which helps differentiate between a normal intrauterine pregnancy, ectopic pregnancy, or miscarriage. - An hCG level of 1400 mIU/mL is below the discriminatory zone (typically 1500-2000 mIU/mL) where an intrauterine gestational sac should be visible, making serial measurements essential. *Repeat ultrasound after 5 days* - While a repeat ultrasound may eventually be necessary, waiting 5 days without an interim hCG measurement could delay diagnosis and management, especially if the hCG levels are rising rapidly or are in a concerning range. - The current beta-hCG level is below the **discriminatory zone**, meaning a gestational sac would likely still not be visible even after 5 days, making hCG follow-up a more immediate and informative step. *Measurement of serum progesterone* - **Serum progesterone** levels can indicate overall pregnancy viability, but they do not specifically localize the pregnancy or differentiate between an intrauterine pregnancy and an ectopic pregnancy as effectively as serial hCG levels. - A single low progesterone level could indicate a non-viable pregnancy (either intrauterine or ectopic), but it does not guide immediate management for distinguishing between locations. *Laparoscopy* - **Laparoscopy** is an invasive surgical procedure and is not the first diagnostic step unless there are signs of ruptured ectopic pregnancy or hemodynamic instability, which are not present in this patient (normal blood pressure, mild symptoms). - It would be premature to proceed with laparoscopy without further biochemical or sonographic evidence of an ectopic pregnancy or clear signs of clinical deterioration.

Question 566: A primigravida presents to you with anemia early in her pregnancy. She is 7 weeks pregnant as seen on ultrasound. Her hemoglobin level is 9 g/dL. When should the iron supplements be started for her?

A. 8 to 10 weeks
B. Immediately upon diagnosis (Correct Answer)
C. After 14 weeks
D. After 20 weeks

Explanation: ***Correct Option: Immediately upon diagnosis*** - **Iron deficiency anemia** in pregnancy (Hb <11 g/dL in first trimester) should be addressed promptly to prevent adverse maternal and fetal outcomes - Initiating treatment at 7 weeks ensures sustained **iron stores** throughout pregnancy - WHO and ACOG guidelines recommend **immediate supplementation** when anemia is diagnosed during antenatal screening - Early treatment prevents worsening due to physiological plasma volume expansion in second trimester *Incorrect Option: 8 to 10 weeks* - Delaying treatment for 1-3 weeks after diagnosis at 7 weeks is not justified medically - Any delay in treatment allows anemia to worsen and depletes maternal iron stores - Recommended practice is **immediate supplementation** if hemoglobin count is less than 11 g/dL during first two antenatal visits *Incorrect Option: After 14 weeks* - Waiting until second trimester (after 14 weeks) would allow the **anemia to worsen**, making it harder to correct before physiological drop in hemoglobin due to plasma volume expansion - Fetal development, particularly **neurological development**, is rapid in first trimester and iron is crucial during this period - Delaying 7 weeks after diagnosis risks maternal complications and suboptimal fetal development *Incorrect Option: After 20 weeks* - Starting supplementation this late (13 weeks after diagnosis) would result in severe maternal iron deficiency - Significant **fetal iron demands** increase by third trimester, making it difficult to replete maternal stores if supplementation starts this late - **Severe anemia** poses risks such as **preterm birth**, low birth weight, and **postpartum hemorrhage**

Question 567: A pregnant woman comes to the clinic. She has previously delivered twins. What is the correct representation of her obstetric score?

A. G3P1 (3 pregnancies, 1 delivery)
B. G2P1 (2 pregnancies, 1 delivery) (Correct Answer)
C. G3P2 (3 pregnancies, 2 deliveries)
D. G2P2 (2 pregnancies, 2 deliveries)

Explanation: ***G2P1 (2 pregnancies, 1 delivery)*** - **Gravidity (G)** refers to the total number of times a woman has been pregnant, regardless of outcome. This patient has been pregnant **twice**: once previously (resulting in twins) and once currently. - **Parity (P)** refers to the number of deliveries after 20 weeks gestation. Multiple gestation (twins, triplets) counts as **ONE delivery**, not separate deliveries. Therefore, her previous twin delivery = **P1**. - Current pregnancy status: She is currently pregnant (contributes to gravidity) but has not yet delivered this pregnancy (does not contribute to parity yet). *G3P1 (3 pregnancies, 1 delivery)* - This incorrectly counts the current pregnancy as if she has been pregnant three times total. - The parity is correct (1 delivery), but gravidity is overestimated. *G3P2 (3 pregnancies, 2 deliveries)* - This makes two errors: incorrectly counting three total pregnancies AND incorrectly counting the twin delivery as two separate deliveries. - Remember: multiple gestation = one delivery event, not multiple deliveries. *G2P2 (2 pregnancies, 2 deliveries)* - Gravidity is correct (2 pregnancies total), but this incorrectly counts the twin delivery as two separate deliveries. - Parity should be 1, not 2, because delivering twins is a single delivery event.

Question 568: During which trimester is the double decidua sign typically observed?

A. Early second trimester
B. Late second trimester
C. Third trimester
D. First trimester (Correct Answer)

Explanation: ***First trimester*** - The **double decidua sign** is a classic sonographic finding seen in the **first trimester** that helps confirm an intrauterine pregnancy. - It results from the visualization of the **decidua capsularis** and the **decidua parietalis** separated by a small amount of intrauterine fluid. *Early second trimester* - By the early second trimester, the **placenta** is usually well-formed, and the **chorion laeve** fuses with the decidua parietalis, causing the double decidua sign to no longer be clearly visible. - At this stage, other markers like **fetal anatomy** scans are more diagnostically relevant. *Late second trimester* - The late second trimester is well beyond the period when the double decidua sign is identifiable. - **Fetal growth** and **organ development** are the primary focus of sonography during this time. *Third trimester* - In the third trimester, the pregnancy is advanced, and the double decidua sign has long since disappeared. - Sonography focuses on **fetal well-being**, **growth**, and **placental position**.

Question 569: A 36-week pregnant lady with previous twin delivery. What is the Obstetric score?

A. G2P1 (Correct Answer)
B. G2P2
C. G3P2
D. G3P3

Explanation: ***G2P1*** - **Gravida (G)** refers to the total number of pregnancies, including the current one, so the current pregnancy (1) plus the previous twin delivery (1) equals **G2**. - **Parity (P)** refers to the number of times a woman has given birth to a fetus (or fetuses) beyond 20 weeks gestation, irrespective of whether the baby was born alive or is now living. A **twin delivery counts as one parity event** because it was one pregnancy that resulted in a delivery. *G2P2* - This option incorrectly counts the twin delivery as two separate parity events, whereas **parity is counted per pregnancy event** resulting in live birth or stillbirth beyond 20 weeks. - While G2 is correct (current pregnancy + previous pregnancy), P2 incorrectly implies two separate delivery events. *G3P2* - This option correctly identifies the parity as P2, but incorrectly states the gravida as G3. - **Gravida is 2** (current pregnancy + previous twin pregnancy), not 3. *G3P3* - This option is incorrect for both gravida and parity. - The patient has had **two pregnancies** (G2) and **one delivery event** (P1).

Question 570: A woman with an obstetric score of G2P1 comes to the clinic at 14 weeks of gestation for her antenatal checkup. A uterine artery doppler was suggested by the doctor. What would it detect?

A. Risk of early-onset preeclampsia (Correct Answer)
B. Risk of late-onset preeclampsia
C. Risk of placenta accreta
D. Fetal growth restriction risk

Explanation: **Risk of early-onset preeclampsia** - **Uterine artery Doppler** at 11-14 weeks of gestation is used to screen for **preeclampsia risk**, particularly **early-onset preeclampsia**, which is associated with impaired placental development. - An increased **pulsatility index (PI)** or presence of **bilateral notching** in the uterine arteries indicates high resistance to blood flow, suggesting a higher risk of developing this condition. *Risk of late-onset preeclampsia* - While uterine artery Doppler can indicate a general risk for preeclampsia, its predictive value is significantly lower for **late-onset preeclampsia** (after 34 weeks). - Late-onset preeclampsia often has different underlying causes, not solely related to abnormal **trophoblast invasion** detectable by early Doppler. *Risk of placenta accreta* - **Placenta accreta** is typically associated with previous **cesarean sections** or other uterine surgeries, leading to abnormal placental implantation. - It is diagnosed by the absence of a clear retroplacental hypoechoic zone and features such as **lacunae** on **ultrasound**, not primarily by uterine artery Doppler. *Fetal growth restriction risk* - Uterine artery Doppler at 11-14 weeks can offer some indication of **fetal growth restriction (FGR)** risk, particularly if severe and related to **placental insufficiency**. - However, the primary surveillance for FGR later in pregnancy often involves **umbilical artery Doppler** and fetal biometry, not solely early uterine artery Doppler.

Practice by Chapter

Preconception Counseling

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Pregnancy Diagnosis and Dating

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Routine Antenatal Assessments

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Maternal Physiological Changes

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Nutrition in Pregnancy

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Screening Tests in Pregnancy

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Fetal Growth Assessment

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High-Risk Pregnancy Identification

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Antenatal Complications Management

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Psychosocial Aspects of Pregnancy

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