Antenatal Care Extra Questions Batch A – MCQ

1. A 32-year-old nulliparous woman sees you in the antenatal clinic at 22 weeks’ gestation. She has just had a transvaginal scan that showed the cervix to be 22 mm in length. She has a past history of a cone biopsy of the cervix six years previously with normal follow-up smears. Which of the following options would you recommend for her?

2. A 29-year-old woman in her first pregnancy presents to the labour ward with some vaginal discharge at 27 weeks and two days. The pregnancy has been uneventful. Speculum examination reveals the cervix to be partially effaced and dilated 3 cm with bulging amniotic membranes. She is not in pain, and her observations are normal. The cardiotocograph (CTG) is reassuring. Which of the following options is the most appropriate in her management?

3. A 35-year-old healthy woman in her second pregnancy at 27 weeks presents to the labour ward with abdominal pain. She had a normal vaginal delivery at term in her first pregnancy three years previously. All observations are within normal limits. A CTG shows one to two irregular contractions every 10 minutes. The fetal heart trace is normal. Vaginal examination reveals the cervix to be 50% effaced but closed. Which of the following is the most appropriate management option?

4. A 35-year-old healthy woman in her second pregnancy at 30+6 weeks presents to the labour ward with abdominal pain. She had a normal vaginal delivery at term in her first pregnancy three years previously. All observations are within normal limits. A CTG shows one to two irregular contractions every 10 minutes. The fetal heart trace is normal. Vaginal examination reveals the cervix to be 50% effaced but closed.
What should you do next?

5. A 26-year-old woman in her first pregnancy presents to the labour ward at 28 weeks and four days gestation with abdominal pain. Maternal observations are all within normal limits. A CTG reveals she is contracting at a rate of three times in 10 minutes, with a normal fetal heart rate. Speculum examination shows the cervix is effaced and dilated 3 cm. The ST3 obstetric trainee wants to know the correct dose of magnesium sulfate for neuroprotection for the baby. Which of the following statements is the most appropriate answer?

6. A 28-year-old primigravida with monochorionic diamniotic (MCDA) twins undergoes an ultrasound scan at 24 weeks. Twin 1 has an estimated weight at the 20th centile with the deepest pool of liquor of 1.6 cm. Twin 2 is growing at the 80th centile with the deepest pool of liquor measuring 9.5 cm. Doppler studies on both twins are normal. The bladders of both twins are visible. Which of the following options is the most likely diagnosis?

7. A 28-year-old primigravida presents to the antenatal clinic with headache. Which of the following headaches in pregnancy is classified as primary headache?

8. A 29-year-old woman in her first pregnancy presents at the antenatal clinic complaining of recurrent attacks of migraine. She is now 20 weeks pregnant and is concerned as she has these attacks once every 10 days. She is enquiring if there is any medication that she can safely use during the pregnancy to stop these attacks. Which of the following medications would you consider most appropriate?

9. A 28-year-old woman is admitted with slight lower abdominal pains and a watery vaginal discharge. A beta-methasone course is prescribed. By how much will this management reduce the risk of neonatal death?

10. A 36-year-old woman with uncontrolled diabetes and who is 29 weeks pregnant is admitted because of threatened preterm labour. What is your advice regarding steroids for lung maturity?

11. A 32-year-old woman who is 36 weeks pregnant comes to the labour ward because of upper abdominal pain and slight vaginal bleeding. Her two previous pregnancies ended in Caesarean section because of placental abruption. She has a normal blood pressure (BP) and a reactive non-stress test. What are her chances of having another placental abruption?

12. A 29-year-old pregnant woman has just booked for her antenatal care. Her first pregnancy ended in a Caesarean section birth because of placenta previa. What are her risks (odds ratio, OR) for a recurrence?

13. A non-sensitized Rh-negative pregnant woman is admitted at 34 weeks with a moderate amount of vaginal bleeding. She is stable and the bleeding has stopped. What specific test should you request?

14. A 33-year-old woman who is 34 weeks pregnant and under community care is referred to the antenatal clinic because of recurrent mild vaginal spotting over the last week. Her antenatal care has been uneventful. She has a normal fundal placenta. Her history and your clinical examination of her did not reveal any abnormality. Your speculum examination revealed a small ectropion. Her last cervical smear 18 months previously showed mild dyskaryosis. She has screened negative for human papilloma virus (HPV). How will you conduct the rest of her antenatal care and delivery?

15. A 33-year-old woman who is 33 weeks pregnant is admitted with severe abruption and an estimated blood loss of 1500 mL. An emergency ultrasound scan showed a large retro-placental haematoma. Fetal heart pulsations were not seen on the ultrasound scan. She is stabilized with intravenous saline infusions and prepared for an emergency Caesarean section. What is your first line empirical treatment while waiting for the coagulation profile results?

16. A 23-year-old para 2 woman presented with vague abdominal pains when she was 29 weeks pregnant. General and abdominal examination did not reveal any abnormality. She had a normal BP. Fetal Doppler and CTG could not demonstrate the fetal heart. A real-time ultrasound scan augmented with colour Doppler of the fetal heart and umbilical artery confirmed intrauterine fetal demise. It also showed collapse of the fetal skull with overlapping bones. These findings were confirmed by a second scan. She insisted she still feels fetal movements. How will you handle the situation?

17. A 36-year-old woman comes to the labour ward with absent fetal movements for the last six hours. She is 36 weeks pregnant. All investigations confirmed intrauterine death. She has had two previous vaginal births. After counselling, she was still undecided about the period of waiting before active intervention. What is the incidence of the most serious complication if she waits for four or more weeks?

18. A 31-year-old woman presents to the antenatal clinic when she is 22 weeks pregnant. She has had normal antenatal care until her last visit two weeks previously with no medical history or medications. At this visit, her BP is 145/98 mmHg with significant proteinuria. What is your management?

19. You are admitting a 33-year-old woman with a BP of 170/115 mmHg. Her urine dipstick showed 1+ proteinuria. What is the quickest and most convenient method to quantify her proteinuria?

20. A 29-year-old primiparous woman complains of pruritus in the palm of the hands and soles of the feet when 32 weeks pregnant. What is the risk of perinatal mortality because of this obstetric cholestasis?

21. A 38-year-old primigravida undergoes first trimester screening and the result shows a low placental-associated plasma protein (PAPP-A) of <0.4 MoM (multiples of the median). What is the implication of this result?

22. A 32-year-old pregnant woman had a history of a previous small-for-gestational-age baby. Her uterine artery Doppler shows notching at 22 weeks’ gestation, which normalizes when repeated two weeks later. How will you continue her antenatal care?

23. You are caring for a 33-year-old pregnant woman who is diagnosed with a small-forgestational- age fetus. At 31 weeks she showed an umbilical flow plasticity index of >+2 standard deviations (SDs) above the mean for gestational age. What indices should you use to time delivery?

24. A young couple comes to see you at the antenatal clinic. She is 29 years old and 23 weeks pregnant. They have to travel to a ZIKA virus endemic area. She shows you a National Health Service (NHS) advice about how to avoid mosquito bites, but asks you if you have any further advice. What else will you tell her?

25. A 25-year-old, G1 P0 woman attends the antenatal clinic for her 12-week scan. She accepted the offer of undergoing a combined test. However, she has queried the accuracy of the test. Which of the followings best describes the detection rate (DR) and the screen positive rate (SPR) of a combined test?

26. A 37-year-old pregnant woman has been diagnosed with monochorionic diamniotic (MCDA) twins. She agreed to screening for Down syndrome at 13+4 weeks. Which of the following screenings best describes her available option?

27. A 25-year-old has just had her 20-week scan. The fetus is found to have holoprosencephaly and bilateral cleft palate. The cardiac ultrasound scan shows a ventricular septal defect. Which of the following is most likely to be associated with these ultrasound scan findings?

28. A woman has just had her dating ultrasound scan. The sonographer has clearly documented two gestational sacs (T-sign) and confirmed 10-week MCDA viable twins. The woman asks you for further information about MCDA twins. Which of the following statements can you quote in your counselling?

29. A 28-year-old low-risk pregnant woman attends the antenatal clinic for the 18–20- week ultrasound anomaly scan. She asks about the chance of finding a structural abnormality. Which of the following describes best the risk of structural abnormalities in all pregnancies?

30. A 17-year-old woman attends the antenatal clinic for her 20-week scan. The sonographer has confirmed the presence of an isolated large gastroschisis. The woman is committed to her pregnancy. What is your next step?

31. A woman attends the antenatal clinic for her 18–20-week scan. The sonographer has demonstrated ‘lemon and banana’ sign and the baby is diagnosed with Arnold–Chiari syndrome. What is the ‘banana’ sign?

32. A pregnant woman has just had her 20-week anomaly scan. Her baby is diagnosed with ventricular septal defect and its femur length is at the 5th centile. What is the most appropriate next step?

33. A pregnant woman complaining of reduced fetal movements at 26 weeks is referred for an ultrasound scan. The scan shows fetal hydrothorax, ascites and massive skin oedema. She is rhesus positive and all her antibody tests are negative. What is the proportion of this condition as a cause of perinatal mortality?

34. A pregnant woman has just had her 12-week ultrasound scan. The scan shows a live severely hydropic baby.
What is the most appropriate investigation you would like to offer next?

35. A woman has booked her pregnancy at 27 weeks’ gestation. She has an ultrasound scan that shows multiple congenital abnormalities. She is offered amniocentesis and the baby is diagnosed with Edward syndrome (Trisomy 18). She asks for termination of the pregnancy. Based on the 1967 United Kingdom Abortion (amended in 1990), which ground will support her request?

36. A pregnant woman has just had her 12-week scan. She is diagnosed with a dichorionic diamniotic (DCDA) twin pregnancy. She queries the chance of having them prematurely. What proportion of all twins deliver before 37 weeks?

37. A pregnant woman with MCDA twins has just had a scan at 21 weeks in the fetal medicine unit. Twin 1’s estimated weight is 40% less than the estimated weight for twin 2, and is diagnosed with sacral agenesis and right diaphragmatic hernia. No obvious anomaly is seen in twin 2 and it’s growth and amniotic fluid are normal. What is the management option you would like to offer her?

38. A woman has had her scan at 24 weeks as the symphysiofundal height (SFH) height measures more than for the estimated date. The scan demonstrates severe polyhydramnios. The sonographer could not see one of the fetal organs. What is the most likely missing organ/s in the scan?

39. A woman has had her first trimester combined risk calculated as 1:50. Chorionic villus sampling is offered and accepted. An uncomplicated procedure is performed and she is informed that the first result will be within 72 hours. What type of test is usually used to give the first cytogenetic result?

40. A 36-year-old woman with a BMI of 19 kg/m2 has become pregnant following successful second attempt at in vitro fertilization. She is healthy but smokes 5–10 cigarettes a day. The 19-week anomaly scan did not show any obvious abnormality. What further management would you like to recommend?

41. A 26-week pregnant woman is referred for an ultrasound scan after she presented with an episode of reduced fetal movements. The fetal Doppler assessment shows middle cerebral artery peak velocity multiple of the mean (MoM) at 2 and mild fetal ascites. You noted that her booked blood results show anti-K antibodies level of 2 IU/mL. What is the most appropriate management?

42. A pregnant woman has just had her 20-week anomaly scan. There is no obvious fetal anomaly seen on the scan but the umbilical cord contains only two blood vessels. What further management would you like to recommend?

43. The airport authorities are on the phone. A woman has refused to go through the airport body scanner as she is seven weeks pregnant and worried about fetal radiation exposure. What would be your advice?

44. A woman presents at 34 weeks gestation with a sudden onset of severe headache and altered consciousness following an episode of vomiting and diarrhoea. What is the most appropriate imaging technique?

45. A woman attends for a dating ultrasound scan at 12 weeks gestation. Doppler ultrasound identifies tricuspid regurgitation and a reversed A-wave in the ductus venosus (DV). She is at increased risk of which condition?

46. A woman is referred by the community midwife with suspected small for dates pregnancy at 33 weeks gestation. Ultrasound assessment confirms a small for gestation (SGA) fetus with reduced liquor volume and reversed end diastolic flow on umbilical artery (UA) Doppler. Cardiotocograph (CTG) is normal. What is the most appropriate management?

47. What proportion of pre-eclampsia can be predicted by risk assessment from maternal history alone in the first trimester of pregnancy?

48. When aspirin is used to reduce risk of pre-eclampsia in woman at high risk, at what gestation should it be commenced for maximum efficacy?

49. When calcium supplementation is used to reduce the risk of pre-eclampsia in women at high risk, at what gestation should it be commenced?

50. What proportion of pregnant women in the United Kingdom is estimated to take the recommended dose of periconceptual folic acid supplementation?