OG8.1-10 | Antenatal Care — Practice Quiz

Correct. The WHO 2016 model recommends a minimum of 8 contacts, replacing the older 4-visit focused ANC model. The shift to 8 contacts was based on evidence that more frequent contacts reduce perinatal mortality.

The WHO 2016 model of antenatal care requires at least 8 contacts to adequately screen for complications, provide preventive interventions, and ensure health promotion counselling throughout pregnancy.

The WHO 2016 ANC model specifies 8 minimum contacts. The older model recommended 4 visits (focused ANC), but evidence showed 8 contacts reduces perinatal mortality, prompting the update.

Correct. Gravida (G) counts all pregnancies including the current one (3 total). Para (P) counts deliveries beyond 20 weeks — she had one normal delivery and one caesarean section, so P=2. Hence G3P2.

In GPA notation: Gravida (G) = total pregnancies including current; Para (P) = deliveries at 20+ weeks (vaginal and caesarean both count); Abortion (A) = losses before 20 weeks. The current pregnancy is included in G but not yet in P.

Gravida = all pregnancies including the current one = 3. Para = deliveries at or after 20 weeks regardless of outcome (vaginal or caesarean) = 1 normal delivery + 1 caesarean = 2. The correct notation is G3P2.

Correct. A distended bladder can elevate the apparent fundal height by 2–4 cm, falsely suggesting macrosomia or polyhydramnios. Always ensure the bladder is empty before measuring SFH and before drawing any clinical conclusion from an unexpectedly large measurement.

The commonest examination error in obstetrics is measuring SFH with the bladder full. A distended bladder can elevate the apparent fundal height by 2–4 cm. Always ensure the bladder is empty before SFH measurement.

Before ordering investigations or charting, the most important practical step is to confirm the measurement is not artefactually elevated by a full bladder. A distended bladder can raise apparent SFH by 2–4 cm. Ensure the bladder is empty and repeat.

Correct. The BPP uses a hierarchy of fetal CNS maturation to interpret the significance of score reductions. Fetal tone (controlled by the earliest myelinated brainstem centres) persists the longest in hypoxia and is the last parameter to become abnormal. Fetal breathing movements are cortical (higher centre) and are lost first.

BPP uses the hierarchy of fetal CNS maturation: fetal breathing movements (cortical) disappear first with hypoxia; gross movements next; tone (brainstem, earliest myelinated) disappears last. NST becomes non-reactive early. Amniotic fluid reflects chronic (not acute) uteroplacental insufficiency.

The BPP hierarchy follows CNS maturation: fetal tone (brainstem, earliest myelinated) persists longest — it is lost last. Fetal breathing movements (cortical) are lost first. This sequence is clinically important for interpreting BPP scores.

Correct. The obstetric conjugate (the shortest AP diameter of the pelvic inlet through which the fetal head must pass) is estimated by subtracting 1.5–2 cm from the diagonal conjugate. A diagonal conjugate of 13 cm gives an estimated obstetric conjugate of 11–11.5 cm, which is adequate (normal ≥10 cm).

The obstetric conjugate (most clinically important AP diameter of the pelvic inlet; normal ≥10 cm) is not directly measurable. It is derived as: diagonal conjugate minus 1.5–2 cm. The diagonal conjugate is the only AP diameter directly measurable by clinical examination.

The obstetric conjugate cannot be measured directly on clinical examination. It is derived from the diagonal conjugate by subtracting 1.5–2 cm (to account for the thickness of the symphysis pubis and sacral promontory geometry). Subtracting 3 cm is incorrect.

Correct. The NHM standard IFA tablet for pregnancy contains 60 mg elemental iron + 500 µg (0.5 mg) folic acid, prescribed daily for a minimum of 180 days during pregnancy. Note: the preconception/early-pregnancy high-dose folic acid (5 mg) is used only in selected high-risk women (e.g., prior neural tube defect).

The NHM IFA tablet for pregnancy = 60 mg elemental iron + 500 µg folic acid, daily for a minimum of 180 days. The preconception dose (5 mg folic acid) applies only to high-risk women. Anaemia in pregnancy is defined as Hb below 11 g/dL in first and third trimesters and below 10.5 g/dL in the second trimester.

The NHM IFA supplement for pregnancy is 60 mg elemental iron + 500 µg (0.5 mg) folic acid daily for a minimum of 180 days. A common OSCE error is confusing this with the preconception high-dose folic acid (5 mg) which is only for high-risk women.

Correct. Tetanus Toxoid (TT) or its replacement Td (Tetanus-diphtheria) is the universally recommended vaccine for all pregnant women in India under the NHM programme. Maternal antibodies cross the placenta and protect the newborn against neonatal tetanus. Two doses are given (or one booster if previously immunised).

Tetanus Toxoid (TT) or Td is universally recommended for all pregnant women in India. Maternal IgG crosses the placenta, providing passive immunity to the neonate. Live attenuated vaccines (MMR, varicella) are contraindicated in pregnancy. Influenza (inactivated) is recommended but availability varies.

Tetanus Toxoid (TT)/Td is the universally mandated vaccine for all pregnant women in India. Its primary benefit is passive transfer of maternal antibodies to the fetus, protecting the newborn against neonatal tetanus. Influenza vaccine is recommended but not universally mandated in all settings.

Correct. First trimester ultrasound (10–13+6 weeks) is the most accurate time for gestational age dating using crown-rump length (CRL), which has a margin of error of ±5–7 days. Combined with nuchal translucency (NT) measurement, it also screens for chromosomal anomalies. Placenta praevia is only reliably diagnosed after 28–32 weeks when the lower segment has fully formed.

First-trimester ultrasound (10–13+6 weeks) using crown-rump length (CRL) gives the most accurate gestational age dating (±5–7 days). Combined NT screening at 11–13+6 weeks screens for chromosomal anomalies (trisomy 21, 18, 13). Dating is less accurate as pregnancy advances.

First-trimester ultrasound (ideally 11–13+6 weeks) is the gold standard for gestational age dating via CRL (margin ±5–7 days) and also allows NT screening for chromosomal anomalies. Placenta praevia, amniotic fluid index, and fetal lung maturity are assessed in the second and third trimesters.

Correct. After confirming stillbirth by ultrasound and informing the family, management involves compassionate counselling, checking maternal coagulation (DIC risk rises after 4 weeks of fetal death retained in utero), and planning induction of labour. Emergency caesarean is not indicated for intrauterine death. Tocolytics are contraindicated.

Stillbirth management: confirm by real-time ultrasound (never by auscultation alone), counsel sensitively, check coagulation (DIC risk increases after 4+ weeks of retention), arrange induction of labour. Stillbirth is classified as fresh (no maceration, likely intrapartum) vs macerated (antepartum, maceration present). Investigation for cause guides recurrence risk counselling.

Management of confirmed stillbirth involves: (1) counselling the family compassionately; (2) baseline coagulation studies (DIC risk with prolonged retention); (3) planning induction of labour (not emergency caesarean, unless a separate maternal indication exists). Awaiting spontaneous labour indefinitely is not appropriate given coagulopathy risk.

Correct. A single lower-segment transverse scar (LSCS) is the standard indication for TOLAC eligibility (estimated VBAC success 60–80%, uterine rupture risk ~0.5–1%). Classical, inverted-T, J, and low-vertical scars carry a significantly higher rupture risk and are contraindications to TOLAC.

TOLAC eligibility: one previous lower-segment transverse (LSCS) scar is the standard criterion. Classical scar (rupture risk ~4–9%), inverted-T, J, or low-vertical scars are contraindications. Two previous LSCS scars is a relative contraindication (higher rupture risk). The scar type overrides all other factors.

TOLAC eligibility requires a lower-segment transverse scar (LSCS). Classical scars (upper segment), inverted-T or J incisions, and low-vertical incisions all carry a much higher rupture risk and are contraindications to TOLAC regardless of how many prior surgeries the woman has had.