UPSC-CMS 2023 - Obstetrics and Gynecology Practice Questions

Q: In a gravid woman with placenta praevia, the following fetal complications are known to increase 1. Congenital malformations 2. Intrauterine growth retardation 3. Prematurity Select the correct answer from the code given below :

1, 2 and 3. ***1, 2 and 3*** - **Placenta praevia** is associated with an increased risk of **congenital malformations**, with studies showing a 2-3 fold increased risk compared to normal placentation. This includes CNS anomalies, cardiovascular defects, and musculoskeletal malformations. - **Intrauterine growth retardation (IUGR)** is a known complication due to impaired placental perfusion and suboptimal placental function in the lower uterine segment. - **Prematurity** is significantly increased with placenta praevia, often necessitating early delivery due to antepartum hemorrhage or other maternal-fetal complications. *1 and 2 only* - This option incorrectly excludes **prematurity**, which is one of the most significant fetal complications of placenta praevia. - Preterm delivery is often required due to recurrent bleeding episodes. *1 and 3 only* - This option incorrectly excludes **IUGR**, which is a well-documented complication. - The lower uterine segment has relatively poor vascularization, contributing to placental insufficiency. *2 and 3 only* - This option incorrectly excludes **congenital malformations**. - Multiple population-based studies have demonstrated an association between placenta praevia and increased rates of fetal anomalies, particularly involving the CNS and cardiovascular systems.

Q: A pregnant woman with 10 weeks gestation is diagnosed to have an ovarian cyst of 11 cm diameter. The best timing for the removal of the ovarian cyst is

In the second trimester (14-20 weeks). ***In the second trimester (14-20 weeks)*** - The **second trimester** is the optimal timing for elective surgery during pregnancy as **organogenesis is complete** (reducing teratogenic risk) but the uterus is not yet too large to complicate surgery. - An **11 cm ovarian cyst** is large and unlikely to resolve spontaneously, warranting surgical intervention rather than expectant management. *At the time of caesarean section* - This approach assumes a **planned C-section** is indicated, which is not supported at 10 weeks gestation when mode of delivery cannot be predetermined. - Delaying surgery until an uncertain future C-section risks **complications** like torsion, rupture, or further cyst growth during pregnancy. *Immediately* - **First trimester surgery** carries higher risk of **miscarriage** and potential teratogenic effects during the critical organogenesis period. - While immediate intervention might prevent complications, the risks of surgery at 10 weeks outweigh the benefits for an asymptomatic cyst. *Immediately after delivery* - Post-delivery surgery involves increased **vascularity** and complications related to **uterine involution** and tissue changes. - This timing requires a **separate surgical procedure** and anesthetic exposure, increasing overall morbidity compared to planned second trimester surgery.

Q: The maternal serum alpha-fetoprotein concentration is elevated in the following conditions except

Foetal osteogenesis imperfecta. ***Foetal osteogenesis imperfecta*** - **Maternal serum alpha-fetoprotein (MSAFP)** levels are typically **normal** in cases of fetal osteogenesis imperfecta. - This condition involves **bone fragility and defective collagen synthesis** but does not cause exposure of fetal tissue or increased AFP production. - There is **no mechanism** for AFP leakage into maternal circulation, so MSAFP remains normal. *Foetal neural tube defect* - **Neural tube defects (NTDs)**, such as anencephaly or open spina bifida, cause direct **exposure of fetal neural tissue** to amniotic fluid. - This leads to leakage of **alpha-fetoprotein (AFP)** from the fetal bloodstream into the amniotic fluid and maternal circulation, resulting in **elevated MSAFP**. - This is the most common indication for MSAFP screening. *Multiple gestation* - In pregnancies with **multiple fetuses** (twins, triplets), the total amount of AFP produced by multiple placentas and fetuses is increased. - This naturally leads to **elevated MSAFP** levels compared to singleton pregnancy, even when all fetuses are healthy. - MSAFP values must be adjusted for number of fetuses. *Gestational trophoblastic disease* - Conditions like **complete hydatidiform mole** involve abnormal placental tissue **without a viable fetus**. - Since there is **no fetus to produce AFP**, MSAFP levels are typically **very low or undetectable**. - However, this option asks about conditions with **elevated** MSAFP, and GTD causes low levels, making it technically also an exception. - The **best answer** remains **fetal osteogenesis imperfecta** as the classic structural anomaly that does not elevate MSAFP, whereas GTD is distinguished by absence of a fetus entirely.

Q: In the quadruple test conducted as a part of screening, which is the most likely indicator of maternal-fetal placental unit?

Unconjugated estriol (uE3). ***Unconjugated estriol (uE3)*** - **Unconjugated estriol (uE3)** is the **classic marker of the intact maternal-fetal-placental unit** in the quadruple test - Its production requires coordinated function of **all three components**: - **Fetal adrenal glands** produce DHEA-S (dehydroepiandrosterone sulfate) - **Fetal liver** converts DHEA-S to 16-OH-DHEA-S - **Placenta** converts 16-OH-DHEA-S to estriol - This unique biosynthetic pathway makes **uE3 the most specific indicator** of integrated maternal-fetal-placental unit function - Low uE3 levels can indicate fetal adrenal hypoplasia, placental sulfatase deficiency, or compromised fetal well-being *Inhibin-A* - **Inhibin-A** is a glycoprotein produced primarily by the **placenta** during pregnancy and is part of the quadruple test - While it reflects placental function, it is produced **only by the placenta**, not requiring fetal organ participation - Elevated Inhibin-A is associated with increased risk of Down syndrome and adverse pregnancy outcomes - It does **not** represent the integrated maternal-fetal-placental unit as comprehensively as uE3 *PAPP-A* - **PAPP-A** (Pregnancy-Associated Plasma Protein A) is a placental protein measured in **first trimester screening** (combined test with free β-hCG and nuchal translucency) - It is **not part of the quadruple test**, which is a **second trimester** screening panel - Low PAPP-A in first trimester is associated with chromosomal abnormalities and adverse pregnancy outcomes *Acetylcholinesterase* - **Acetylcholinesterase** is measured in **amniotic fluid**, not maternal serum - It is used as a confirmatory marker for **open neural tube defects (ONTDs)** and ventral wall defects - It is **not part of the quadruple test** and does not indicate overall maternal-fetal-placental unit function - The quadruple test uses **AFP, uE3, hCG, and Inhibin-A** measured in maternal serum

Q: A fourth-gravida with three living children presents at 38 weeks of pregnancy with abdominal pain and vaginal bleeding. On examination, the uterus is tense and tender, and the foetal heart sounds are absent. What is the probable diagnosis?

Accidental haemorrhage. ***Accidental haemorrhage*** - The combination of **abdominal pain**, **vaginal bleeding**, a **tense and tender uterus**, and **absent fetal heart sounds** strongly indicates accidental hemorrhage (placental abruption). - This condition involves the premature separation of the **placenta** from the uterine wall, leading to concealed or revealed bleeding and frequently resulting in fetal demise. *Vasa praevia* - Characterized by **fetal blood vessels** crossing the cervical os, making the fetus vulnerable to hemorrhage. - While it causes **painless vaginal bleeding**, it typically does not present with a **tense and tender uterus** or immediate fetal demise unless there is membrane rupture. *Ectopic pregnancy* - Occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tube. - Presents with **abdominal pain** and **vaginal bleeding**, but this occurs in the **first trimester**, not at 38 weeks of pregnancy. *Placenta praevia* - Involves the placenta covering the cervical os, leading to **painless vaginal bleeding**. - Unlike accidental hemorrhage, the uterus is typically **soft and non-tender**, and fetal heart sounds are usually present.

Q: A 25-year-old woman with a history of three consecutive abortions has been investigated thoroughly to determine the cause of recurrent pregnancy loss. In the absence of a demonstrable cause, what is the chance of a viable birth in subsequent pregnancy?

60%. ***60%*** - In cases of **unexplained recurrent pregnancy loss** (3 consecutive miscarriages with no identifiable cause), approximately **60-70%** of women will achieve a successful live birth in their subsequent pregnancy with supportive care. - This favorable prognosis reflects that many recurrent losses are due to **sporadic chromosomal abnormalities** rather than persistent underlying pathology. - **Unexplained RPL** actually has a better prognosis than explained RPL, as there is no persistent pathological factor. - Supportive care including reassurance, regular monitoring, and psychological support improves outcomes. *40%* - This underestimates the success rate for unexplained recurrent pregnancy loss. - A **40%** success rate would suggest a poorer prognosis more typical of cases with **identified but untreated underlying causes** or more complex pathology. - Current evidence supports a higher success rate (60-70%) for unexplained cases. *20-30%* - This represents a significantly poor prognosis not typical for unexplained recurrent pregnancy loss. - Such low rates might be seen in cases with **severe untreated underlying conditions** such as antiphospholipid syndrome without treatment or structural uterine anomalies. - This does not reflect the natural history of unexplained RPL. *Less than 20%* - This represents an extremely poor prognosis inconsistent with unexplained recurrent pregnancy loss. - Such rates would only be expected in cases with **severe, uncorrectable pathology** or multiple comorbidities. - The question specifically states "absence of a demonstrable cause," making this option incorrect.

Q: In a woman with molar pregnancy with a uterus size of 28 weeks, the treatment of choice is

Suction evacuation. ***Suction evacuation*** - For **molar pregnancy**, especially with a large uterine size (28 weeks in this case), **suction evacuation** is the treatment of choice to remove the abnormal trophoblastic tissue. - This method is preferred due to its safety and efficacy in emptying the uterus while minimizing complications like hemorrhage or uterine perforation. *Hysteroscopy* - **Hysteroscopy** is primarily used for diagnosing and treating intrauterine pathologies such as polyps or fibroids, and for endometrial assessment. It is not the primary treatment for molar pregnancy. - It involves inserting a scope into the uterus and is not designed for the large-volume tissue removal required in a molar pregnancy of this size. *Hysterectomy* - **Hysterectomy** (surgical removal of the uterus) is generally reserved for rare cases of recurrent molar pregnancy, when the patient desires no future fertility, or in the context of invasive molar disease or choriocarcinoma. It is not the initial treatment of choice. - It is an overly aggressive approach for an initial presentation of molar pregnancy, especially if the patient wishes to preserve fertility. *Medical induction with prostaglandins* - **Medical induction** using prostaglandins is typically used for therapeutic abortion or managing missed abortions, but it is contraindicated in molar pregnancy. - Prostaglandins can lead to vigorous uterine contractions and potentially cause a rapid expulsion of molar tissue into the systemic circulation, increasing the risk of **trophoblastic embolization** and choriocarcinoma.

Q: Foetal anaemia can be detected non-invasively by Doppler ultrasonography on the basis of an increase in the

Peak systolic velocity of the middle cerebral artery. ***Peak systolic velocity of the middle cerebral artery*** - **Foetal anaemia** causes increased **cardiac output** and redistribution of blood flow to vital organs, leading to an increase in **peak systolic velocity (PSV)** in the **middle cerebral artery (MCA)**. - This increased velocity indicates **cerebral vasodilation**, a compensatory mechanism to maintain oxygen delivery to the foetal brain in situations of hypoxia due to anaemia. *SD ratio in the anterior cerebral artery* - The **SD ratio (systolic/diastolic ratio)** is more commonly used in umbilical artery flow. A higher SD ratio in cerebral arteries typically suggests increased downstream resistance, which is not characteristic of foetal anaemia. - In foetal anaemia, the cerebral arteries would typically show **decreased resistance**, leading to a lower, not higher, SD ratio. *SD ratio in the umbilical artery* - An increased **SD ratio in the umbilical artery** often indicates **placental insufficiency** or **foetal growth restriction**, not necessarily **foetal anaemia**. - While placental insufficiency can lead to foetal anaemia, the direct Doppler marker for anaemia is the MCA PSV, reflecting the foetal response to hypoxia. *Peak systolic velocity of the anterior cerebral artery* - While both anterior and middle cerebral arteries are part of the cerebral circulation, the **middle cerebral artery (MCA)** is the most widely validated and sensitive vessel for detecting changes in **foetal blood flow** due to **anaemia**. - Changes in the anterior cerebral artery's PSV are not as reliably linked to the diagnosis of foetal anaemia as those in the MCA.

Q: A pregnant mother is referred with a prolonged second stage of labour. On examination, the foetal heart sound is 120/min, and the head is at -1 station with severe moulding. What will be the most appropriate management?

Perform LSCS. ***Perform LSCS*** - The combination of **prolonged second stage of labor**, fetal head at **-1 station**, and **severe molding** strongly suggests **cephalopelvic disproportion** or **obstructed labor**. - **LSCS is the safest option** to prevent maternal complications (uterine rupture, cervical lacerations) and fetal complications (hypoxia, trauma), as the severe molding indicates prolonged compression and failed descent despite adequate time in second stage. *Start pitocin drip* - **Contraindicated** with severe molding and high station as it suggests **cephalopelvic disproportion**. - Increased contractions could lead to **uterine rupture** without achieving delivery and would worsen fetal head molding, potentially causing **fetal distress**. *Apply ventouse and deliver* - **Contraindicated** - Ventouse requires fetal head engagement (preferably **+2 station or below**), but the head is at **-1 station**. - At -1 station with severe molding, ventouse application would be **ineffective and dangerous**, with risk of scalp lacerations, **cephalohematoma**, and failed extraction. *Apply obstetric forceps and deliver* - **Contraindicated** - Forceps require fetal head to be engaged (at least **0 station**), but at **-1 station**, forceps application is **dangerous and inappropriate**. - Attempting forceps at high station risks severe **maternal trauma** (cervical lacerations, uterine rupture) and **fetal injury**, as standard obstetric guidelines prohibit forceps use above 0 station.

Q: Which of the following haematological parameters does not undergo a physiological increase during normal pregnancy?

Platelet count. ***Platelet count*** - The **platelet count** typically **decreases** or remains stable during normal pregnancy due to hemodilution and increased consumption. - A significant increase in platelet count can be indicative of **pathological conditions** rather than a physiological adaptation. *Blood volume* - **Blood volume** physiologically **increases** during pregnancy by approximately 30-50% to meet the metabolic demands of the fetus and placenta. - This expansion primarily involves an increase in **plasma volume**, contributing to physiological anemia. *Red cell volume* - The **red cell volume** also **increases** during pregnancy, though usually to a lesser extent (around 18-30%) than plasma volume. - This increase is due to elevated **erythropoietin levels** stimulating red blood cell production, helping to increase oxygen-carrying capacity. *Leukocyte count* - The **leukocyte (white blood cell) count** physiologically **increases** during pregnancy, particularly neutrophils, often peaking in the third trimester. - This mild leukocytosis is a normal response to the physiological stress of pregnancy and is not indicative of infection.

Question 1

In a gravid woman with placenta praevia, the following fetal complications are known to increase

1. Congenital malformations 
2. Intrauterine growth retardation 
3. Prematurity

Select the correct answer from the code given below :

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

1 and 3 only

Answer

2 and 3 only

Question 2

A pregnant woman with 10 weeks gestation is diagnosed to have an ovarian cyst of 11 cm diameter. The best timing for the removal of the ovarian cyst is

Accepted Answer

In the second trimester (14-20 weeks)

Answer

Immediately

Answer

Immediately after delivery

Answer

At the time of caesarean section

Question 3

The maternal serum alpha-fetoprotein concentration is elevated in the following conditions except

Accepted Answer

Foetal osteogenesis imperfecta

Answer

Foetal neural tube defect

Answer

Multiple gestation

Answer

Gestational trophoblastic disease

Question 4

In the quadruple test conducted as a part of screening, which is the most likely indicator of maternal-fetal placental unit?

Accepted Answer

Unconjugated estriol (uE3)

Answer

PAPP-A

Answer

Inhibin-A

Answer

Acetylcholinesterase

Question 5

A fourth-gravida with three living children presents at 38 weeks of pregnancy with abdominal pain and vaginal bleeding. On examination, the uterus is tense and tender, and the foetal heart sounds are absent. What is the probable diagnosis?

Accepted Answer

Accidental haemorrhage

Answer

Vasa praevia

Answer

Ectopic pregnancy

Answer

Placenta praevia

Question 6

A 25-year-old woman with a history of three consecutive abortions has been investigated thoroughly to determine the cause of recurrent pregnancy loss. In the absence of a demonstrable cause, what is the chance of a viable birth in subsequent pregnancy?

Accepted Answer

60%

Answer

Less than 20%

Answer

40%

Answer

20-30%

Question 7

In a woman with molar pregnancy with a uterus size of 28 weeks, the treatment of choice is

Accepted Answer

Suction evacuation

Answer

Hysteroscopy

Answer

Hysterectomy

Answer

Medical induction with prostaglandins

Question 8

Foetal anaemia can be detected non-invasively by Doppler ultrasonography on the basis of an increase in the

Accepted Answer

Peak systolic velocity of the middle cerebral artery

Answer

SD ratio in the anterior cerebral artery

Answer

Peak systolic velocity of the anterior cerebral artery

Answer

SD ratio in the umbilical artery

Question 9

A pregnant mother is referred with a prolonged second stage of labour. On examination, the foetal heart sound is 120/min, and the head is at -1 station with severe moulding. What will be the most appropriate management?

Accepted Answer

Perform LSCS

Answer

Start pitocin drip

Answer

Apply ventouse and deliver

Answer

Apply obstetric forceps and deliver

Question 10

Which of the following haematological parameters does not undergo a physiological increase during normal pregnancy?

Accepted Answer

Platelet count

Answer

Blood volume

Answer

Red cell volume

Answer

Leukocyte count

UPSC-CMS 2023 — Obstetrics and Gynecology