Antenatal Care Extra Questions Batch B – MCQ

1. What is the incidence of red cell antibodies in pregnancy?

2. In the presence of anti-c red cell antibodies in pregnancy, which additional red cell antibody increases the risk of fetal anaemia?

3. A woman attends the antenatal clinic following a scan at 36 weeks gestation in her fourth pregnancy, which identifies an anterior placenta previa. She has had three previous caesarean births. What is the risk of placenta accreta?

4. What proportion of pregnant women in paid employment require time off work due to nausea and vomiting of pregnancy (NVP)?

5. What is the incidence of acute appendicitis in pregnancy?

6. A 21-year-old woman is admitted at 22 weeks gestation in her first pregnancy with suspected appendicitis. She has a low grade pyrexia with a leucocytosis and a mildly elevated C reactive protein level. Abdominal ultrasound is inconclusive. What imaging technique is the most appropriate subsequent investigation?

7. What is the risk of serious neonatal infection associated with prelabour rupture of membranes (PROM) at term?

8. A women in her first trimester scores more than 3 in the 2-item Generalized Anxiety Disorder scale (GAD-2) used to identify anxiety disorders in pregnancy. What is the best plan of care?

9. Women suffer from various anxieties in pregnancy. What is tokophobia?

10. What vitamin should women be advised to be taken throughout pregnancy and also while breastfeeding?

11. An 18-year-old woman books into the antenatal clinic at 12 weeks of gestation. She is fit and well but is noted to have an increased body mass index (BMI) but no other risk factors for diabetes. What BMI and above should she be offered screening for diabetes?

12. An anxious woman attends the antenatal clinic. She is planning an afternoon picnic and has a list of her favourite foods including UHT milk, cottage cheese sandwiches, vegetable pate, lambs kidneys and baked oily fish. Which of these food products is not recommended in pregnancy due to the risk of listeriosis?

13. A woman is advised to avoid drinking all alcohol in pregnancy but she declines. She enjoys wine but no more than 250 ml per week. She is keen to understand the safe limits of alcohol intake. What is acceptable with regard to alcohol intake during pregnancy?

14. A woman presents with vaginal candidiasis at 23 weeks pregnancy. What treatment should you offer her?

15. You have been asked to review a full blood test results of a woman at 28 weeks of gestation. At what threshold level of haemoglobin concentration would you define anaemia at this gestation?

16. A pregnant woman undergoes a routine anomaly ultrasound scan at 18 weeks of gestation. No ultrasound soft markers are present. At what nuchal translucency measurement is it recommended to refer the woman to fetal medicine services?

17. A woman is noted to have a low-lying placenta at her 20-week anomaly scan. At what gestational age should you arrange the next scan to assess placental localisation?

18. A woman declines an induction of labour at 42 weeks of gestation, the indication being ‘post-dates’. What is the recommended for assessment of ‘fetal wellbeing’ in this situation?

19. A woman at 36 weeks of gestation presents with an uncomplicated breech presentation and consents to undergo an external cephalic version (ECV) after consultation. Unfortunately, due to logistics, this service will not be available when she is 37 weeks. What management is most appropriate?

20. A pregnant woman at 34 weeks gestation is complaining of severe chronic sleep problem. What would be the most appropriate pharmacological intervention?

21. A woman undergoes a successful external cephalic version at 37 weeks gestation. What is the chance of spontaneous reversion to breech?

22. Which tocolytic agent has been proven to increase the success of an ECV?

23. A Gravida 3, Para 2 (both full term normal deliveries) is diagnosed with breech presentation at 35+1 weeks of gestation and is keen to have an external cephalic version. At what gestation is external cephalic version recommended for this mother?

24. A primigravida aged 26 is admitted with threatened preterm labour at 30 weeks and seeks counselling with regards to antenatal corticosteroids. What are the three recognised fetal benefits associated with antenatal corticosteroid administration in the case of premature delivery?

25. A woman who had a previous second trimester miscarriage is currently undergoing a serial ultrasound assessment of cervical length. With what cervical ultrasound feature would cervical cerlage be recommended?

26. A woman at 32 weeks gestation is admitted with severe falciparum malaria. What is the pharmacological treatment of choice?

27. A woman who is in the second trimester of pregnancy is planning to travel to an area endemic for chloroquine-resistant malaria. What would you recommend as the drug of choice for prophylaxis?

28. The velocimetry measurement of blood vessels can be used to improve perinatal outcomes in high-risk pregnancies. Which vessel is assessed?

29. A gravida 2 Para 0+1 molar pregnancy is diagnosed with Rhesus isoimmunisation. Doppler assessment of which vessel is used to monitor fetal anaemia during pregnancy

30. A woman presents at 26+5 weeks of gestation in her first pregnant with reduced fetal movements. What is the most appropriate initial investigation to carry out?

31. Domestic violence during pregnancy increases the risk of maternal mortality.      What is the increase in homicide risk when there is domestic violence during pregnancy?

32. A woman who is 28 weeks pregnant in her first pregnancy attends the antenatal clinic. She has no medical problems, but on routine questioning, she discloses domestic abuse. She insists that this information has not been disclosed to anyone else. What is the first action that should be undertaken?

33. A course of antenatal corticosteroids is associated with a significant reduction in neonatal morbidity and mortality in women who are at risk of preterm birth. What is the reduction in risk of intraventricular haemorrhage?

34. What proportion of twin pregnancies have monochorionic placentation?

35. What proportion of monchorionic twin pregnancies are complicated by twin to twin transfusion syndrome (TTTS)?

36. A woman with a monchorionic diamniotic twin pregnancy at 25 weeks gestation is assessed at the regional fetal medicine service. She is found to have severe TTTS (Quintero stage III). What is the optimal treatment?

37. A 30-year-old primagravida with a BMI of 28 is seen in the antenatal clinic at 36 weeks gestation following referral from the community midwife with suspected ‘large-for dates’. An ultrasound scan is arranged, which confirms the fetus to be large for gestational age. An oral glucose tolerance test is arranged a few days later, which is normal. What is the correct management?

38. A healthy 35-year-old woman attends the antenatal clinic at 37 weeks gestation in her third pregnancy. She has had two previous caesarean sections for breech presentation, but the current pregnancy has a cephalic presentation and she would like to have a vaginal birth after caesarean (VBAC). What would be the risk of uterine rupture if she labours with such a history?

39. A 41-year-old woman with a BMI of 36 kg/m2, but otherwise healthy, attends the antenatal clinic at 14 weeks gestation and is found to have a dichorionic diamniotic twin pregnancy. What supplementation would you advise to reduce her risk of developing pre-eclampsia?

40. During pregnancy, how much calcium is accumulated by the fetus?

41.1A 26-year-old primagravida with a singleton pregnancy at 23 weeks gestation attends for an ultrasound scan following a small amount of vaginal bleeding. It is noted that the cervical length is 21mm. What is the appropriate management?

42. Which protein is the most important biomarker for the detection of PPROM (Preterm Prelabour Rupture of Membranes)?

43. What is the usual method of diagnosing placental abruption?

44. A primigravida with a low-risk pregnancy is admitted at 30 weeks with an antepartum haemorrhage (APH). A diagnosis of placental abruption has been made. The bleeding settled with conservative management and she is discharged home. What is the most appropriate plan for her further antenatal care?

45. A 35-year-old primigravida is seen in the antenatal clinic for booking. She had been diagnosed with breast cancer at the age of 32 and received adjuvant chemotherapy with doxorubicin following surgery. What is the most appropriate management?

46. You receive a telephone call from a community midwife. A 22-year- old primigravida, currently 15 weeks pregnant, has developed chickenpox and the rash had developed 72 hours ago. The mother is very anxious and the midwife requests advice with regard to further management. What would you advise?

47. A 22- year- old Sudanese Asylum seeker is seen for booking in the antenatal clinic at 12 weeks. She is a primigravida and an ultrasound scan revealed a singleton pregnancy appropriate for gestation. She has history of female genital mutilation (FGM) and examination reveals Type II FGM. What would be the he most appropriate management?

48. A gravida 2 Para 1+0 attends the antenatal clinic for booking at 14 weeks. Her previous pregnancy was an emergency caesarean section for abruption at 38 weeks. Dating scan confirms a live fetus with a low risk for Down’s syndrome. Routine bloods indicate her to have blood group B Rh negative and the antibody titre performed 2 weeks prior to the appointment reveals the anti-D level to be 5 IU/ml. With regards to hemolytic disease of the fetus and newborn (HDFN), what is the optimal management?

49. A primigravida complains of recurrent herpes at 32 weeks gestation. She has been treated with Aciclovir at 20 weeks for a primary episode of genital herpes. She would opt for caesarean section if Herpes lesions are detected at the onset of labour. What would you advise?

50. A primigravida is seen for booking. She is 40 years and has conceived through IVF. Ultrasound scan has confirmed a twin pregnancy. Her BMI is 36 kg/m2. What treatment would you advise to reduce the risk of pre-eclampsia?