Obs MCQs PRIMEs

MULTIPLE CHOICE QUESTIONS (OBSTETRICS)
CHAPTER 1: ANATOMY OF FEMALE REPRODUCTIVE ORGANS
EXTERNAL GENITAL ORGANS - Musculature is developed from the mesoderm of the

two fused Müllerian ducts
VULVA ○○ Lower 1/5th, below the hymen is developed from the
endoderm of the urogenital sinus
1. Triangular area between labia minora and clitoris is? ○○ External vaginal orifice is formed from the genital fold
(PGMEE 2014) ectoderm after rupture of the urogenital membrane
a. Sulcus interlabiales b. Vestibule 7. Prepubertal vaginal pH is- (PGMEE 2015)
c. Fourchette d. Urogenital triangle a. 3.5 b. 4.5
[Ref: Dutta’s Obs. 9th/e, pg. 2] c. 7 d. 8
[Ref: Shaw’s Gynaecology 16th/e 4; Jeffcoate’s Principles of
/e
2. Fourchette is formed by? (PGMEE 2014)
a. Joining of labia majora b. Joining of labia minora Gynaecology, 9th/e, pg. 29, 31t]
c. Joining of labia majora with minora 8. Vaginal pH in reproductive age group is?(DNB June’ 2010)
d. Junction of cervix and vagina a. 1–3 b. 4 – 4.5
1.
2.
b
b
,2
[Ref: Dutta’s Obs. 9th/e, pg. 2; Holland Brew’s Obs.4th/e, pg.1;
Shaw’s Gynae. 16th/e, pg. 2; Jeffcoate’s Gynae. 9th/e, pg. 24]
3. Gland homologous to prostate in male is? (PGMEE 2014)
a. Gartner’s gland b. Skene’s gland
c. 4–7 d. 7–8
[Ref: Dutta’s Obs. 9th/e, pg.4; Shaw’s Gynae. 16th/e, pg.4;
Jeffcoate’s Gynae. 9th/e, pg. 31; Novak’s Gynae. 15th/e, pg. 90]
9. Vaginal pH is most acidic during? (DNB June’ 2011)
Es
3. b c. Bartholin’s gland d. Cowper’s gland
a. Puerperium b. Pregnancy
4. d [Ref: Dutta’s Obs. 9th/e, pg. 2; Holland Brew’s Obs.4th/e, pg.1] c. Menstruation d. Newborn
5. c 4. Bartholin’s glands lie in relation to vaginal orifice- [Ref: Jeffcoate’s Gynae. 9th/e, pg. 29, 31t]
6. a (PGMEE 2012-13)
10. Anaerobic bacteria commonly found in cervix or vagina?
7. c a. Posterior b. Anterior
(DNB June’ 2011)
iM
8. b c. Anterolateral d. Posterolateral
a. Lactobacilli b. Clostridium
9. b [Ref: Holland Brew’s Obs.4th/e, pg.1; Shaw’s Gynae. 16th/e, c. Mobilincus d. Gardnerella
pg. 1; Jeffcoate’s Gynae. 9th/e, pg. 25]
10. a [Ref: Shaw’s Gynae. 16th/e, pg.4; Jeffcoate’s Gynae. 9th/e, pg.
11. b 28, 365]
INTERNAL GENITAL ORGANS
PR
12. c 11. Role of lactobacilli in vaginal secretions-

13. a VAGINA (PGMEE 2012-13)
14. a a. To maintain alkaline pH b. To maintain acidic pH
5. Vestibule of the vagina develops from? (DNB June’ 2009) c. Nutrition d. None
a. Genital ridge b. Müllerian duct
[Ref: D.C.Dutta text book of gynecology 7th e.p 4-5; Shaw’s
c. Urogenital sinus d. Wolffian duct
Gynae 16th/e p. 4; Jeffcoate’s Gynae. 9th/e, pg. 28, 365]
[Ref: Dutta’s Obs. 9th/e, pg. 3]
12. pH of vagina is lowest during: (PGMEE 2015-16)
6. Lower 1/5th of vagina is formed by?(PGMEE June’ 2012) a. Puberty b. Pre-puberty
a. Urogenital sinus b. Paramesonephric duct c. Pregnancy d. Menopause
c. Müllerian duct d. Mesonephric duct
[Ref:Dutta’s Obs. 9th/e, pg.4; Shaw’s Gynae. 16th/e, pg.4;
[Ref: Dutta’s Obs. Jeffcoate’s Gynae. 9th/e, pg. 29, 31t]
9th/e, pg.4; Shaw’s Textbook of Gynaecology, 16th/e, pg. 125;
Jeffcoate’s Principles of Gynaecology, 9th/e, pg. 233; Berek & 13. Acidic pH of vagina is due to? (PGMEE 2012)
Novak’s Gynecology, 15th/e, pg. 85] a. Doderlein’s Bacilli b. Gardnerella
c. Glycogen d. Mobilincus
Explanation [Ref: Dutta’s Obs. 9th/e, pg.4; Jeffcoate’s Gynae. 9th/e, pg. 28]
Embryology of vagina: 14. Clue cells are: (PGMEE 2012-13)
Vagina develops from the following sources- a. Epithelial cells b. Lymphocytes
○○ Upper 4/5th, above the hymen c. Neutrophils d. Macrophages
776 - Mucous membrane is derived from the endoderm of the [Ref: Shaw’s Gynae. 16th/e, pg.384; Novak’s Gynae. 15th/e,
canalized sino-vaginal bulbs pg. 558]
Obstetrics Chapter 1 Anatomy of Female Reproductive Organs (MCQs)
CERVIX Explanation
Uterus is normally placed in anteverted and anteflexed
15. The shape of external os of a nulliparous cervix is- position. Uterus is held in this position by the upper tier
(AIIMS 79, DNB 91) system.
a. Circular b. Transverse Upper most supports of the uterus primarily maintain the
c. Longitudinal d. Fimbriated uterus in anteverted position. Responsible factor are :
[Ref: Dutta’s Obs. 9th/e, pg.67] ○○ Endopelvic fascia covering the uterus
○○ Round ligaments
16. Palm leaf appearance of cervical mucus is caused by-
○○ Broad ligament with intervening pelvic cellular tissue.
(PGMEE 2012-13)
a. Oestrogen b. Progesterone 20. What is cochleate uterus- (PGMEE 2013-14)
c. FSH d. Testosterone a. Anteflex uterus
b. Retroverted uterus
[Ref: Shaw’s Gynae. 16th/e, pg.35]
c. Uterine inversion
17. Elasticity of cervical mucus max in: (PGMEE 2015) d. Mullerian agenesis
a. Pre follicular phase b. Post ovulatory phase
c. Ovulatory phase d. Menstrual phase [Ref: Jeffcoate’s Gynae. 9th/e, pg. 254, 255f, 349 f]
[Ref: Shaw’s Gynae 16th/e p. 256] 21. Size of uterus in inches is (PGMEE 2012-13)
/e
a. 5 X 4 X 2 b. 4 X 3 X 1
UTERUS c. 3 X 2 X 1 d. 4 X 2 X 1
[Ref: Jeffcoate’s Gynae. 9th/e, pg. 32]
,2
18. Structure preventing retroversion of uterus is?
(DNB June’ 2011) FALLOPIAN TUBE
a. Uterosacral b. Mackenrodt’s ligament
c. Round ligament d. Broad ligament 22. Thinnest part of fallopian tube is?(PGMEE Nov.12 Pattern) 15. a
[Ref: Shaw’s Gynae. 16th/e, pg. 365-367; Jeffcoate’s Gynae. a. Infundibulum b. Ampulla 16. a
Es
9th/e, pg. 349-353] c. Cornual d. Interstitium 17. c
[Ref: Shaw’s Gynae. 16th/e, pg. 10; Jeffcoate’s Gynae. 9th/e, 18. c
Explanation
pg. 36] 19. d
Supports of uterus: 23. ‘Peg Cells’ are seen in: 20. a
Usual position of the uterus is of anteversion & anteflexion a. Vagina b. Vulva 21. c
iM
○○ Version- refers to the direction of the cervical canal c. Ovary d. Tubes 22. d
○○ Flexion- refers to the inclination of the body of the uterus [Ref: Dutta’s Obs. 9th/e, pg. 7; Jeffcoate’s Gynae. 9th/e, pg. 23. d
on the cervix 37; Shaw’s Gynae. 16th/e, pg. 11] 24. d
Retroversion: the axis of the cervix is directed upwards &
25. b
backwards in relation to a line drawn through the long axis OVARY
PR
of the trunk. 26. a

Retroflexion: the long axis of the corpus is bent backwards 24. Provided that one secondary oocyte is produced in each
on the axis of the cervix. menstrual cycle. How many secondary oocytes are on an
In clinical practice, both retroversion & retroflexion average produced during the reproductive life of a human
usually occur together & are collectively referred to as female? (PGMEE June’ 2012)
retrodisplacement of the uterus.
a. 4,20,000 b. 42,000
Retrodisplacement of the uterus is found in ≈ 15% of
c. 4200 d. 420
women.
It is most often a developmental anomaly & not congenital [Ref: Dutta’s Obs. 9th/e, pg. 16; Jeffcoate’s Gynae. 9th/e, pg.
because uterus is without version & flexion at birth. 59; Shaw’s Gynae. 16th/e, pg.26]
The round ligaments although do not maintain the position 25. Number of follicles in female newborn is?
of anteversion & anteflexion, they are used in the surgical (PGMEE 2012)
correction of retroversion by- a. 1 million b. 2 million
○○ Ventrosuspension c. 3 million d. 4 million
○○ Plication of round ligaments
○○ Baldy-Webster operation [Ref: Dutta’s Obs. 9th/e, pg. 16; Shaw’s Gynae. 16th/e, pg.25;
Jeffcoate’s Gynae. 9th/e, pg. 59]
19. Angle of anteversion of uterus is maintained by:
a. Uterosacral ligament and Broad ligament (PGMEE 2018) 26. Volume of ovary after menopause is:- (PGMEE 2015)
b. Pubocervical ligament and transverse cervical ligament a. 3.0 cm2 b. 5.4 cm2
c. Uterosacral and Transverse cervical ligament c. 6.5 cm
2
d. 7.8 cm2
d. Round ligament and broad ligament [Ref: Ultrasound in obstetrics and gynaecology Vol. 2 by 777
[Ref: D.C. dutta text book of gynecology p.165-166 7th e] MERZ p. 105]
CHAPTER 2: PHYSIOLOGY OF FEMALE REPRODUCTIVE SYSTEM
PHYSIOLOGY OF OVULATION ○○ An ↑ of 0.5 - 1.00 F occurs in immediate postovulatory

period → indicative of ovulation
1. Ovulation can be evaluated by? (DNB Dec’ 2009) ○○ Uses * for detection of ovulation in treatment of infertility
a. Cervical mucous b. Cervical effacement patients
c. Cervical dilatation d. Cervical colour ○○ As a natural family planning (NFP) method
[Ref: Shaw’s Gynae. 16th/e, pg.255-257; Jeffcoate’s Gynae. ○○ Limitation : febrile illness
9th/e, pg.111] 4. LH Surge occurs how many hours before ovulation?
2. Which is not a test for ovulation? (DNB June’ 2010) (PGMEE June’ 2012)
a. Fern test b. LH surge a. 6-8 hours b. 10-16 hours
c. Hysteroscopy d. Basal body temperature c. 18-24 hours d. More than 24 hours
[Ref: Shaw’s Gynae. 16th/e, pg.255-257; Jeffcoate’s Gynae. [Ref: Shaw’s Gynae.16th/e, pg. 39, 255-257; Jeffcoate’s
9th/e, pg. 109 - 111] Gynae. 9th/e, pg. 67, 111]
3. Ovulation is associated most commonly with? 5. Spinbarkeit is maximum at which phase-(PGMEE 2012-13;
Jeffcoate’s Gynae. 9th/e, pg. 94)
/e
a. LH surge (DNB Dec’ 2010)
a. Menstrual phase b. Ovulatory
b. Increase in progesterone
c. Post ovulatory d. Pre follicular
c. Increase in basal body temperature
d. Increase in FSH [Ref: Shaw’s Gynae. 16th/e, pg.256; Jeffcoate’s Gynae. 9th/e,
,2
pg. 94]
[Ref: Dutta’s Obs. 9th/e, pg. 18; Shaw’s Gynae. 16th/e, pg.255-
257; Jeffcoate’s Gynae. 9th/e, pg. 65-68, 110] 6. For hormonal assessment, vaginal smear is taken from-
1. a (PGMEE 2012-13)
Explanation a. Anterior wall b. Lateral wall
2. c
Definition of ovulation – a process in which an ovum, in c. Posterior wall d. Fornix
Es
3. a
the form of a secondary oocyte, escapes from the ovary [Ref: Jeffcoate’s Gynae. 9th/e, pg.111]
4. d following rupture of a mature Graafian follicle & becomes
5. b available for conception. 7. Size of ovarian follicle at ovulation is?
6. b (PGMEE Aug 13 Pattern)
4 Ps responsible for ovulation are: a. 0.5 to 1 cm b. 1 to 1.5 cm
7. d
iM
○○ Proteolytic enzymes – activity increased by progesterone c. 1.5 to 2 cm d. 2 to 2.5 cm

8. b (produced in granulosa layer under the effect of LH)
[Ref: Dutta’s Obs. 9th/e, pg. 17;Shaw’s Gynae.16th/e, pg. 28;
9. a ○○ Progesterone induced midcycle rise in FSH → oocyte
Jeffcoate’s Gynae. 9th/e, pg. 67]
10. d gets free from its follicular attachments
○○ Plasminogen activators → activation of plasmin → 8. Mittelschemerz is- (PGMEE 2013-14)
11. b
PR
generation of active colllagenase → degeneration of a. Pain just before menstruation

collagen in cell wall especially at the follicular apex or b. Pain at the time of ovulation
stigma c. Pain 5 days after ovulation
○○ Prostaglandins (ovarian content increased by LH) → d. Pain during menstruation
contraction of micromuscle cells in theca externa & [Ref: Jeffcoate’s Gynae. 9th/e, pg.109]
stroma → follicular rupture
9. In a 40 day cycle, when does ovulation takes place-
LH surge – Most important physiological marker of
(PGMEE 2013-14)
imminent ovulation
a. 26 day b. 14 day
○○ Midcycle preovulatory LH surge precedes ovulation by
c. 20 day d. 28 day
34- 36 hours
○○ LH peak precedes ovulation by 10-12 hours (peak S. LH [Ref: Shaw’s Gynae. 16th/e, pg.28; Jeffcoate’s Gynae. 9th/e,
level of 75 ng / ml required for ovulation) pg. 58, 61]
○○ Effects of LH surge- completion of meiosis of ovum, 10. Ovulation after LH surge is seen within-(PGMEE 2013-14)
ovulation & development of corpus luteum a. 01-2 hrs b. 12-24 hrs
○○ Urinary LH detection kits available for prediction of c. 24-28 hrs d. 24-36 hrs
ovulation [Ref: Shaw’s Gynae.16th/e, pg. 39; Jeffcoate’s Gynae. 9th/e,
Increase in progesterone & increase in FSH do contribute pg. 67, 111]
to the process of ovulation, but it is the LH surge which is
central to this process. 11. Most common cause of LH surge:- (PGMEE 2016-17)
Increase in basal body temperature occurs because of a. ↓ FSH b. Estradiol peak
thermogenic effect of progesterone c. Increase FSH d. Increase progesterone
778 ○○ Measured in morning after waking up but before rising [Ref: Shaw’s Gynae.16th/e, pg. 39; Jeffcoate’s Gynae. 9th/e,
from bed pg. 67]
Obstetrics Chapter 2 Physiology of Female Reproductive System (MCQs)
12. High estrogen leads to :- (PGMEE 2016-17) 21. At what time after fertilization the product of conception is
a. Inhibition of LH b. Inhibition of FSH called as “Embryo”? (PGMEE Aug. 12 Pattern)
c. Secretion of prolactin d. Increased TSH a. 72 hours b. 1 week
[Ref: Shaw’s Gynae.16th/e, pg. 39; Jeffcoate’s Gynae. 9th/e, c. 3 weeks d. 8 weeks
pg. 67] [Ref: Dutta’s Obs. 9th/e, pg. 37]
13. Final maturation of follicle, ovulation is done by:- 22. What forms the embryo - (PGMEE 2016-17)
(PGMEE 2016-17) a. Syncytiotrophoblast b. Cytotrophoblast,
a. FSH b. LH c. Inner cell mass d. Zona pellucida
c. Oestrogen d. Oestrogen & Progesterone
[Ref: Shaw’s Gynae.16th/e, pg. 39; Jeffcoate’s Gynae. 9th/e,
pg. 67] 23. Post fertilization, implantation occurs on:-
(PGMEE 2016-17)
14. Menstrual cycle is 29 day regular, day of ovulation in cycle a. D5 b. D6
would be:- (PGMEE 2015) c. D8 d. D3
a. 11th b. 13th
[Ref: Dutta’s Obs. 9th/e, pg. 20; Holland Brew’s Obs.4th/e,
c. 15th d. 17th
pg.17]
[Ref: Shaw’s Gynae.16th/e, pg. 28; Jeffcoate’s Gynae. 9th/e,
/e
pg. 58, 61] 24. In pregnancy heart starts contracting earliest at:-
(PGMEE 2018)
PHYSIOLOGY OF FERTILIZATION AND a. 7 weeks b. 20-22 days
c. 20-22 weeks d. 10-12 weeks

IMPLANTATION
15. Most common site of fertilization is:
a. Cervix
c. Fimbriae
b. Uterus
d. Ampulla
,2
(DNB Dec’ 2010, PGMEE 2016-17)

Explanation
Ref: Dutta’s Obs. 8th / e, pg. 30, 46 734; Williams Obs.
24th / e, pg. 128, 170
12.
13.
b
b
Es
Embryonic cardiac activity appears at MSD of 15-18 mm & 14. c
[Ref: Dutta’s Obs. 9th/e, pg. 18; Holland Brew’s Obs.4th/e, embryonic CRL ≥ 4 mm. 15. d
pg.16; Shaw’s Gynae. 16th/e, pg.10] 16. b
Gestational age & fetal structures identified by TVS
16. Capacitation of sperm proceeds in- (PGMEE 2015) 17. b
a. Testis b. Female genital tract Gestational age (wks) Fetal structures 18. a
iM
c. Fallopian tubes d. Epididymis 19. d

4 Choriodecidual thickness, chorionic sac
[Ref: Dutta’s Obs. 9th/e, pg. 17; Shaw’s Textbook of 20. b
Gynaecology, 16th/e, pg. 240] 5 Gestation sac, yolk sac
21. c
6 Fetal pole, cardiac activity
17. Velocity of sperms in female genital tract is? 22. c
PR
(PGMEE 2012) 7 Lower limb buds, midgut herniation

23. b
a. 0-1 mm/min b. 1-2 mm/min (physiological)
24. b
c. 4-5 mm/min d. 5-6 mm/min 8 Upper limb buds, stomach
25. b
[Ref: Ganong 22nd/e p. 427; Guyton 11th/e p. 999] 9 Spine, choroid plexus
18. Decidual reaction is due to which hormone- Embryonic movements are identified as early as by 7 weeks
(PGMEE 2012-13) The formation of 4 chambered primitive heart & the
a. Progesterone b. Estrogen appearance of first heart beat occurs by 21-28 days post
c. LH d. FSH conception i.e. by 35-42 days (or 5-6 wks) of menstrual age.
[Ref: Dutta’s Obs. 9th/e, pg. 21; Holland Brew’s Obs.4th/e, pg.19] Hence, the fetal cardiac activity can be detected by TVS as
early as 6 weeks.
19. Implantation occurs on which day of menstrual cycle-
(PGMEE 2012-13) PHYSIOLOGY OF REPRODUCTION
a. 6th day b. 10th day
c. 15th day d. 20th day CHANGES IN REPRODUCTIVE TRACT DURING
[Ref: Dutta’s Obs. 9th/e, pg. 20; Holland Brew’s Obs.4th/e, PREGNANCY
pg.17]
20. Implantation normally occurs in- (PGMEE 2012-13) 25. The weight of nulliparous uterus is? (DNB Dec’ 2011)
a. Ampulla b. Body of uterus a. 30 to 40 gm b. 40 to 60 gm
c. Cervix d. Ovaries c. 60 to 80 gm d. 80 to 100 gm
[Ref: Dutta’s Obs. 9th/e, pg. 20] [Ref: Dutta’s Obs. 9th/e, pg. 42; William’s Obs. 24th/e pg. 46]
779
PRIMES (Volume II)
WEIGHT GAIN DURING NORMAL PREGNANCY PHYSIOLOGICAL CHANGES IN CVS DURING

PREGNANCY
26. Weight gain in normal pregnancy is? (PGMEE Dec’ 2011)
a. 1 to 3 kg b. 5 to 7 kg 30. By what time post delivery does the cardiac output return
c. 10 to 12 kg d. 12 to 15 kg to pre pregnancy state? (PGMEE June’ 2012)
[Ref: Dutta’s Obs. 9th/e, pg. 46; William’s Obs. 24th/e pg. 51, a. 4 hours b. 4 weeks
177; Holland Brew’s Obs.4th/e, pg.41] c. 6 weeks d. 8 weeks
HAEMATOLOGICAL CHANGES DURING
31. Maximum cardiac output during pregnancy is seen at ?
PREGNANCY (PGMEE 2014)
a. 20 weeks b. 30 weeks
27. Plasma volume is maximum in which week of pregnancy? c. 34 weeks d. 36 weeks
(DNB June’ 2009)
a. 24-28 weeks b. 28-32 weeks
pg.39; William’s Obs. 24th/e pg. 59, 60]
c. 30-32 weeks d. 34-36 weeks
[Ref: Dutta’s Obs. 9th/e, pg. 47; Holland Brew’s Obs.4th/e, Explanation
/e
pg.40; William’s Obs. 24th/e pg. 55]
Cardiac output (CO)-
Explanation Blood volume, plasma vol. & cardiac output start to
Pregnancy is a state of hyperdynamic circulation with an increase by 5th – 6th weeks of pregnancy. Max. level by
26.
27.
c
c
Hb.
,2
increase in blood volume, plasma volume, RBC mass &
Blood volume, plasma vol. & cardiac output start to

increase by 5th – 6th weeks of pregnancy. Max. level by
30 – 34 weeks.
30 – 34 weeks remains static till term
Increase in CO is due to increase in blood volume & basal
metabolic rate
Lowest in sitting or supine position, highest in right or left
lateral or knee chest position
Es
28. b Increase in blood volume, plasma volume & RBC mass is Increases further during labour (+ 50%) & immediately
29. a by 30-40%, 40-50% & 20-30% respectively above the non- following delivery (+70%) due to auto transfusion of blood
30. b pregnant level. from the uterus into the maternal circulation
31. c Disproportionate increase in plasma volume & RBC mass → Rises soon after delivery to about 60% above the pre-labour
32. b relative haemodilution → apparent fall in Hb concentration values
iM
(should not be below 11.0 gm/dl) & haematocrit → Returns to - the pre-labour values by 1 hour following
33. a
physiological anaemia delivery
Importat functions of pregnancy-induced hypervolemia: The pre-pregnant level by another 4 weeks time.
○○ Diminished blood viscosity → optimum gaseous The pregnancy-induced increase is lost after delivery
exchange between maternal & fetal circulation In multiple pregnancies, as compared to singletons, CO is
PR
○○ To meet the ↑ed metabolic demands of the enlarged increased further by another ≈ 20% due to greater stroke
uterus with its greatly hypertrophied vascular system volume (15%) & heart rate (3.5%). Left atrial diameter &
○○ To provide abundant nutrients & elements to support the left ventricular end-diastolic diameter are also increased
rapidly growing placenta & fetus due to augmented preload. This implies that cardiovascular
○○ To protect the mother & in turn the fetus against the reserve is reduced in multiple pregnancies.
deleterious effects of impaired venous return in the 32. Cardiovascular change in pregnancy is- (PGMEE 2012-13)
supine & erect positions a. Slight right axis deviation in ECG
○○ To safeguard the mother against the adverse effects of b. Slight left axis deviation in ECG
blood loss during delivery c. Diastolic murmur
28. Clotting factor that decreases during pregnancy is? d. Pulse rate is decreased
(DNB Dec’ 2009) [Ref: Dutta’s Obs. 9th/e, pg. 48; Holland Brew’s Obs.4th/e,
a. Fibrinogen b. Factor XIII pg.40; William’s Obs. 24th/e pg. 58]
c. Factor VIII d. Factor X
[Ref: Dutta’s Obs. 9th/e, pg. 48; Holland Brew’s Obs.4th/e, PHYSIOLOGICAL CHANGES IN RESPIRATORY
SYSTEM DURING PREGNANCY
29. Changes in clotting factors in pregnancy- (PGMEE 2012-13)
a. Fibrinogen level is increased 33. Which of the following is seen during pregnancy?
b. Platelet level is increased a. Respiratory alkalosis (DNB June’ 2009)
c. Factor XII level is decreased b. Metabolic acidosis
d. Factor XI level is increased c. Metabolic alkalosis
780 [Ref: Dutta’s Obs. 9th/e, pg. 47; Holland Brew’s Obs.4th/e, d. Respiratory acidosis
pg.40-41; William’s Obs. 24th/e pg. 57] [Ref: Dutta’s Obs. 9th/e, pg. 50; William’s Obs. 24th/e pg. 63]
Obstetrics Chapter 2 Physiology of Female Reproductive System (MCQs)
IRON AND FOLIC ACID METABOLISM DURING 36. Folic acid supplementation leads to decreased incidence of
which defect- (PGMEE 2013-14)
PREGNANCY a. Neural tube defect b. Anemia
c. Megaloblastic anemia d. Septate uterus
34. Total iron requirement during pregnancy is?
[Ref: Dutta’s Obs. 9th/e, pg. 252, 383; Holland Brew’s Obs.
(DNB Dec’ 2011)
4th/e pg. 553; William’s Obs. 24th/e pg. 284]
a. 500 mg b. 750 mg
c. 1000 mg d. 1500 mg
ENDOCRINE CHANGES DURING PREGNANCY
pg.41; William’s Obs. 24th/e pg. 55, 179; Progress in 37. True about thyroid function test in pregnancy
Obstetrics & Gynaecology, John Studd, Vol.15, Ch.7, pg.108] (PGMEE 2018)
a. Increase in Free T3 b. Increase in free T4
35. Daily dose of folic acid for women with history of NTDs in
c. Increase in total T3 d. Increase in TSH
previous pregnancy is? (DNB Dec’ 2010)
a. 0.4 mg b. 40 micro gm Ref: Dutta’s Obs. 8th / e, pg.70-71; Holland Brew’s
c. 400 micro gm d. 4 mg Obs.4th / e, pg.138-139; Williams Obs. 24th / e, pg. 68-69
[Ref: Dutta’s Obs. 9th/e, pg. 90, 252, 383, 589; Holland Brew’s Explanation
/e
Obs. 4th/e pg. 71, 435, 553; William’s Obs. 24th/e pg. 284] Physiological Changes in Thyroid Gland During Pregnancy:
Explanation Total volume of thyroid gland increases (12 ml in 1st
trimester → 15 ml at the time of delivery)
Folic acid supplementation in pregnancy -
,2
A minimum of 400 micro gm (= 0.4 mg) of folic acid
supplementation with or without a multivitamin decreases
the risk of fetal malformations such as neural tube
defects or NTDs (anencephaly, spina bifida, meningocele
There is ↑ in –
○○ S. protein bound iodine (from 4-8 μg% to 6.2-11.2
μg%, due to estrogenic stimulation of its synthesis and
decreased hepatic clearance)
○○ Thyroxine binding globulin (reaching a plateau at 20
34.
35.
c
d
Es
36. a
or meningomyelocele), miscarriages & cardiac weeks)
37. c
malformations ○○ Total T3 and T4 (beginning at 6-9 weeks, reaching a
To be taken at least 1-2 months prior to conception plateau at 18 weeks) 38. d
& continued through the 1st trimester of pregnancy ○○ Levels of free T3 and free T4 remain unchanged
(periconceptional supplementation) There is ↓ in TRH (due to negative feedback effect of TSH
iM
Higher doses recommended for special risk groups simulating α subunit of hCG)
○○ 1 mg/ day for women with DM & epilepsy Transient ↓ in TSH (or may remain normal)
○○ 4 mg/ day for women with history of NTDs in previous TRH and T4 cross the placenta freely but TSH crosses very
pregnancy minimally
○○ Women with multiple fetuses also require daily
PR
supplementation of folic acid throughout pregnancy. 38. Level of prolactin in pregnancy are usually more than?
○○ Because of its requirement in DNA synthesis, folic acid a. 50 ng/mL b. 100 ng/mL
plays an important role in erythropoiesis; deficiency c. 150 ng/mL d. 200 ng/mL
results in development of megaloblastic anaemia. Ref: Williams obstretrics 24th/e page 1291
○○ Deficiency of folic acid has also been found to be
associated with abruptio placentae. Explanation
Hyperprolactinaemia is the presence of abnormally high
levels of prolactin in the blood.
States Level of prolactin
Nonpregnant 0–20 ng/mL
1st trimester 36–213 ng/mL
2nd trimester 110–330 ng/mL
3rd trimester 137–372 ng/mL
781
CHAPTER 3: PLACENTAL PHYSIOLOGY AND AMNIOTIC FLUID
PLACENTA AND UMBILICAL CORD UMBILICAL CORD AND ITS ABNORMALITIES

PLACENTA AND ITS ABNORMALITIES 8. Umbilical cord contains- (PGMEE 2013-14)
a. 2 artery 1 vein
1. The ratio of fetal weight and placental weight at term is? b. 1 artery 2 vein
(PGMEE 2011) c. 1 artery 1 vein
a. 4 : 1 b. 5 : 1 d. 2 artery 2 vein
c. 6 : 1 d. 7 : 1 [Ref: Dutta’s Obs. 9th/e, pg. 35; William’s Obs. 24th/e pg.
[Ref: Dutta’s Obs. 9th/e, pg. 26; Holland Brew’s Obs.4th/e, 100,122; Holland Brew’s Obs.4th/e, pg.20]
9. Length of umbilical cord is? (PGMEE June’ 2009)
2. Placenta develops from? (PGMEE 2011) a. 25-40 cm b. 30-100 cm
a. Chorion frondosum b. Decidua basalis c. 40-50 cm d. 60-120 cm
c. Chorion leave d. Both A and B
/e
[Ref: Dutta’s Obs. 9th/e, pg. 25; Holland Brew’s Obs.4th/e, pg.20; William’s Obs. 24th/e pg. 121]
pg.19; William’s Obs. 24th/e pg. 87, 93]
3. Uteroplacental circulation is established by ____ weeks Explanation
,2
post fertilization - (PGMEE Aug.12 Pattern)
a. 1 b. 2 Umbilical cord:
c. 3 d. 4 Normal length of umbilical cord 40-50 cms (usual variation
1. c
[Ref: Dutta’s Obs. 9th/e, pg. 24; Holland Brew’s Obs.4th/e, 30-100 cms)
2. d Average diameter of umbilical cord 1.5 cms (usual variation
Es
3. b 1-2.5 cms)
4. Normal weight of term placenta in gms is-
4. b There is a spiral twist from the left to right starting as early
(PGMEE 2012-13, 2016-17)
5. a as 12th week due to spiral turn of the vessels – vein around
a. 300 b. 500
6. a the arteries
c. 700 d. 1000
7. a Initially, the cord has 4 vessels – 2 arteries & 2 veins, but by
iM
the end of the 4th month the right vein disappears & only
8. a pg.20; William’s Obs. 24th/e pg. 116] left vein is left
9. c Normally, the insertion of the cord on the fetal surface of
5. Which of the following is not true of placenta?
10. a (PGMEE 2014) the placenta is eccentric (somewhere between the centre &
11. b a. Number of cotyledons increases with gestational age the margin of the placenta). The insertion may be central,
PR
b. Weight of fetus and placenta equal at 4 months marginal or velamentous.

c. After delivery weight of placenta is 500 gm The fetal attachment of the cord initially is to the ventral
d. At term about one fifth of placenta is of maternal origin surface of the embryo close to the caudal extremity but later
[Ref: Dutta’s Obs. 9th/e, pg. 26; Holland Brew’s Obs.4th/e, on it moves permanently to the centre of the abdomen at
pg.200; William’s Obs. 24th/e pg. 95, 116] 4th month.
6. Cells seen at the junction between two layers of placenta 10. Battledore insertion of cord to placenta-(PGMEE 2013-14)
are? (PGMEE 2014)
a. Cord attached to the margin of placenta
a. Hofbauer cells
b. Placenta attached to the margin
b. Hofmann cells
c. Cord attached to the membranes
c. Amniogenic cells
d. Placenta attached to the centre
d. Uterine natural killer cells (UNK)
[Ref: Dutta’s Obs. 9th/e, pg. 28; William’s Obs. 24th/e pg. 95]
7. True about circumvallate placenta is?
11. Placenta in which vessels separate before reaching margin
(PGMEE Nov.12 Pattern)
is? (DNB June’ 2009, PGMEE 2013)
a. Fetal plate smaller than basal plate
a. Battledore placenta
b. Basal plate smaller than fetal plate
b. Velamentous placenta
c. Has accessory lobes
d. Is membraneous c. Circumvallate placenta
d. Placenta marginata
pg.22; William’s Obs. 24th/e pg. 118] [Ref: Dutta’s Obs. 9th/e, pg. 206; Holland Brew’s Obs.4th/e,
782
Obstetrics Chapter 3 Placental Physiology and Amniotic Fluid (MCQs)
12. Vasa previa may lead to- (PGMEE 2012-13) AMNIOTIC FLUID AND ITS ABNORMALITIES
a. Antepartum haemorrhage b. Fetal exsanguination
c. Fetal death. d. All of the above AMNIOTIC FLUID
pg.22-23; William’s Obs. 24th/e pg. 123] 13. Amniotic fluid at 36-38 weeks- (PGMEE 2012-13)
a. 500 ml
Explanation b. 1000 ml
c. 1500 ml
A. Abnormalities of cord insertion:
d. 2000 ml
Battledore placenta:
○○ Marginal insertion of the cord on the placenta
○○ If such type of placenta is low lying → chance of cord
compression in vaginal delivery → fetal anoxia, IUFD 14. Amniotic fluid quantity at birth (ml) - (PGMEE 2012-13)
Velamentous placenta: a. 500
○○ Cord inserted on the membranes instead of the placenta b. 1000
○○ Branching vessels traverse between the membranes c. 1500
before they reach & supply the placenta d. 2000
/e
○○ Vasa previa – branching vessels traverse through [Ref: Dutta’s Obs. 9th/e, pg. 34; Holland Brew’s Obs.4th/e,
the membranes overlying the internal os, in front pg.26; William’s Obs. 24th/e pg. 100]
of the presenting part → vaginal bleeding → fetal
exsanguination → IUFD 15. Rate of turnover of amniotic fluid is- (PGMEE 2013-14)
,2
○○ Urgent delivery (by emergency caesarean section) a. 500 cc/h b. 1L/hr
indicated in case of fetal bleeding c. 1500 cc/h d. 2L/h
○○ In IUFD, vaginal delivery is awaited. [Ref: Dutta’s Obs. 8th/e, pg. 43; Holland Brew’s Obs. 4th/e pg.
12. d
B. Abnormalities of cord length: 26; Williams Obs., 23rd/e, pg. 94]
13. b
Short cord:
Es
POLYHYDRAMNIOS 14. b
○○ Shortening may be true (10 cm or < 8”) or relative (due to 15. a
entanglement of cord around any fetal part)
16. At 34 weeks pregnancy, polyhydramnios is present when 16. a
○○ Acordia – absent cord, placenta may be attached to the
volume is greater when- (PGMEE 2012-13) 17. d
liver as in exomphalos
a. 2000cc b. 150cc
○○ Complications: failure of external version, malpresenta- 18. a
iM
c. 1000cc d. 500cc
tions, separation of a normally situated placenta, preven-
tion of descent of the presenting part & fetal distress in [Ref: Dutta’s Obs. 9th/e, pg. 200; Holland Brew’s Obs.4th/e,
labour pg.241]
Long cord:
○○ The cord may be unduly long (300 cm) OLIGOHYDRAMNIOS
PR
○○ Complications: ↑ed chance of cord prolapse, cord

entanglement around the neck (20-30%) or the body, 17. Causes of olighydramnios include - (PGMEE 2012-13)
true knot (rare, 1%), false knot (due to accumulation of a. DM
Wharton’s jelly) b. Esophagal atresia
c. Rh isoimmunisation
C. Abnormalities of cord vessels:
d. Renal agenesis
Single umbilical artery
○○ Incidence 1-2%
○○ Due to failure of development of one artery or due to its
atrophy in later months 18. Oligohydraminos is associated with all except-
○○ More common in twins & in babies born to women with (PGMEE 2012-13)
diabetes, epilepsy, oligohydramnios, polyhydramnios, a. Sacral agenesis
pre-eclampsia, APH. b. Polycystic kidney
○○ 20-25% cases associated with congenital malformation c. Renal agenesis
of the fetus (renal & genital anomalies) d. PROM
○○ Complications: ↑ed chance of abortion, fetal aneuploidy [Ref: Dutta’s Obs. 9th/e, pg. 203; Holland Brew’s Obs.4th/e,
(trisomy 18), prematurity, IUGR, ↑ed perinatal mortality pg.243; William’s Obs. 24th/e pg. 237]
783
PRIMES (Volume II)
ENDOCRINOLOGY OF PREGNANCY 21. Precursor of progesterone from placenta is:-

(PGMEE 2016-17)
PLACENTAL ENDOCRINOLOGY a. LDL cholesterol b. VLDL cholesterol
c. HDL cholesterol d. Pregnanediol
Progesterone [Ref: Dutta’s Obs. 9th/e, pg. 55, 56 b; Williams Obs., 23rd/e, P.
67-68]
19. At what gestational age does placenta takes over progesterone
production? (PGMEE 2014) HUMAN CHORIONIC GONADOTROPIN (hCG)
a. 4 weeks b. 6-8 weeks
c. 10-12 weeks d. 15-18 weeks 22. Peak hCG levels are seen by what intrauterine age?
(DNB Dec’ 2011, PGMEE June’ 2012)
[Ref: Dutta’s Obs. 9th/e, pg. 56; Holland Brew’s Obs.4th/e, a. 7–9 weeks
pg.47; William’s Obs. 24th/e pg. 106] b. 11–13 weeks
20. Hormone secreted by placenta:- (PGMEE 2016-17) c. 20 weeks
a. Progesterone b. Estradiol d. 25 weeks
c. Estrone d. All of the above [Ref: Dutta’s Obs. 9th/e, pg. 54; Holland Brew’s Obs.4th/e, pg.
[Ref: Dutta’s Obs. 9th/e, pg. 55-56; Holland Brew’s Obs. 4th/e 45; Williams Obs., 23rd/e, P. 64]
/e
pg. 46-47; William’s Obs. 24th/e pg. 106, 107]
19.
20.
b
a
,2
Es
21. a
22. a
iM
PR
784
CHAPTER 4: DIAGNOSIS OF PREGNANCY
DIAGNOSIS OF PREGNANCY DIAGNOSTIC SIGNS IN RELATION TO

PREGNANCY
CLINICAL ASSESSMENT OF A PREGNANT
WOMAN 5. Palmer’s sign seen in pregnancy is?
(PGMEE June’ 2012, PGMEE 2012-13)
1. Fetal heart sound can be auscultated at-(PGMEE 2013-14) a. Pulsation in lateral fornix
a. 10 weeks b. 24 weeks b. Rhythmic contraction of uterus
c. 18-20 weeks d. 6 weeks c. Softening of uterus
[Ref: Dutta’s Obs. 9th/e, pg. 64; Holland Brew’s Obs. 4th/e pg. d. Bluish discolouration of vagina
50; William’s Obs. 24th/e pg. 176] [Ref: Dutta’s Obs. 9th/e, pg. 61; Holland Brew’s Obs.4th/e,
pg. 50]
2. Fetal trunk movements in third trimester-(PGMEE 2012-13)
a. Less perceived by nullipara 6. Jacquemier’s sign is- (PGMEE 2012-13)
b. Increased in IUGR a. Softening of cervix
/e
c. Are more pronounced b. Bluish discoloration of anterior vaginal wall
d. None of the above c. Mucous discharge
[Ref: Dutta’s Obs. 9th/e, pg. 65; Holland Brew’s Obs.4th/e, pg. d. Increased pulsations in lateral fornix
51; Williams Obs., 24th/e, P. 335] [Ref: Dutta’s Obs. 9th/e, pg. 60; Holland Brew’s Obs. 4th/e,

3. Most common position of fetus near term is:-

a. LOA
c. LOP
b. ROA
d. ROP
,2
(PGMEE 2016-17)

pg. 50]
7. Regarding Hegar’s sign all are true except-
a. Bimanual palpation method
b. Difficult in obese
(PGMEE 2012-13)
1.
2.
c
c
Es
c. Can be done at 14 weeks 3. a
d. Present in 2/3rd of cases 4. c
4. A patient presented at 20 weeks of gestation. The patient’s 5. b
LMP was 9th January. What will be the estimated date of
pg. 50] 6. b
delivery. (AIIMS Nov’ 2017)
a. 9th January b. 16th September 8. Softening of lower uterine segment on bimanual examina- 7. c
iM
c. 16th October d. 9th October tion is known as:- (PGMEE 2015-16) 8. b

a. Goodell’s sign b. Hegar’s sign 9. d
Ref: Dutta’s Obs. 8th / e, pg. 83; Holland Brew’s Obs.4th / e, pg.
c. Osiander’s sign d. Chadwick’s sign 10. c
52; Williams Obs. 24th / e, pg. 127
[Ref: Dutta’s Obs. 9th/e, pg. 61; Holland Brew’s Obs.4th/e, 11. a
PR
Explanation pg. 50]

Calculation of expected date of delivery
VARIOUS IMMUNOLOGICAL TESTS FOR
Naegele’s formula
○○ Calculated from 1st day of last menstrual period (LMP)
DIAGNOSIS OF PREGNANCY
in a woman with regular cycles
9. Minimum hCG level that a urine pregnancy test can detect
○○ By adding 280 days or 9 calender months and 7 days to
is? (DNB June’ 2010, PGMEE 2016-17)
the 1st day of LMP
a. 5 m IU/ml b. 10 – 20 m IU/ml
○○ A quick estimate can be made by adding 7 days to the 1st
c. 20 – 30 m IU/ml d. 35 m IU/ml
day of LMP and subtracting 3 months
○○ Accuracy of prediction 50% within 7 days on either side [Ref: Dutta’s Obs. 9th/e, pg. 62; William’s Obs. 24th/e pg. 170]
○○ Limitations – irregular cycles, conception during 10. Most sensitive test to diagnose hCG is? (PGMEE 2014)
lactational amenorrhoea, conception immediately a. Direct agglutination test b. Radio immunoassay
following stoppage of oral contraceptives c. Immune radiometric assay
Pregnancy following single act of fruitful coitus – by adding d. ELISA
266 days to the date of coitus
[Ref: Dutta’s Obs. 9th/e, pg. 62, 63; William’s Obs. 24th/e pg.
Pregnancy following ovulation induction and infertility
169]
treatment – add 266 days to date of intrauterine insemination
(IUI) or in vitro fertilization- embryo transfer (IVF-ET) 11. Urine pregnancy test detects- (PGMEE 2013-14)
Date of quickening – by adding 22 weeks in a primigravida a. hCG b. Estrogen
and 24 weeks in a multipara to the date 1st appreciating c. Progesterone d. HPL
fetal movements. Limitation – all women not equally [Ref: Dutta’s Obs. 9th/e, pg. 61; Holland Brew’s Obs.4th/e, pg.
sensitive to quickening 785
50; William’s Obs. 24th/e pg. 169]
PRIMES (Volume II)
12. Minimum level of β-hCG for the earliest detection of Explanation

intrauterine gestation sac by TVS should be:- For definite sonographic diagnosis of pregnancy (at the
(PGMEE 2016-17) earliest) -
a. 1500 mIU/mL b. 5000 mIU/mL
c. 2500 mIU/mL d. 4500 mIU/mL TVS Vs TAS
[Ref: Dutta’s Obs. 9th/e, pg. 601] Dia. of intrauterine GS 2-3 mm 5 mm
Menstrual age at detection 4.5 wks 5 wks
S. β hCG level (mIU/ml) 1000-1200 6000
Advantages of TVS over TAS-

○○ Enhanced resolution & ↑ed proximity to pelvic organs
○○ Earlier visualization of the gestational sac (GS) & its
contents
○○ Earlier identification of embryonic cardiac activity
○○ Improved visualization of embryonic & fetal structures
/e
12. a
,2
Es
iM
PR
786
CHAPTER 5: ANTENATAL ASSESMENT OF FETAL WELL-BEING
ANTEPARTUM AND INTRAPARTUM 8. Which of the following is not a prerequisite for transvaginal
sonography (TVS) ? (PGMEE 2014)
ASSESSMENT OF FETAL WELL-BEING a. Consent
b. Full bladder
OBSTETRIC ULTRASOUND c. Empty bladder
d. Lithotomy position
1. Father of obstetric ultrasound is?(PGMEE Nov.12 Pattern) [Ref: Holland Brew’s Obs.4th/e, pg. 452]
a. Jhon Wild b. Mc Roberts
c. Mc Donald d. Ian Donald 9. Increased nuchal translucency at 14 weeks gestation is
seen in- (PGMEE 2010)
[Ref: Dutta’s Obs. 9th/e, pg. 599] a. Anencephaly
2. Fetal cardiac activity is detected with Transvaginal USG as b. Down’s syndrome
early as? (DNB June’ 2010) c. Hydrocephalus
a. 6 weeks b. 8 weeks d. Spina bifida
/e
c. 10 weeks d. 12 weeks [Ref: Dutta’s Obs. 9th/e, pg. 601, 604; Holland Brew’s
[Ref: Dutta’s Obs. 9th/e, pg. 63, 601; William’s Obs. 24th/e Obs.4th/e, pg. 464; William’s Obs. 24th/e pg. 196]
pg. 196] 10. Biophysical profile includes all except- (PGMEE 2012-13)
a. NST b. Muscle tone
,2
3. Best parameter to estimate age in 1st trimester is?
c. Amniotic fluid d. Acetyl choline level
(DNB June’ 2011)
a. Crown rump length b. Head circumference [Ref: Dutta’s Obs. 9th/e, pg. 98; Holland Brew’s Obs. 4th/e pg.
84t, 460t; William’s Obs. 24th/e pg. 342t] 1. d
c. Corrected BPD d. BPD
2. a
[Ref: Dutta’s Obs. 9th/e, pg. 63, 601; Holland Brew’s Obs.4th/e, 11. Modified biophysical profile includes- (PGMEE 2012-14)
Es
3. a
pg. 50; Arias 3rd/e, pg.9; William’s Obs. 24th/e pg. 195]
a. Non stress test (NST) b. Amniotic fluid index (AFI) 4. c
4. Gestational sac on USG in first seen at _____ weeks from c. Both d. None
5. b
LMP- (PGMEE 2012-13) [Ref: Dutta’s Obs. 9th/e, pg. 98, 601; William’s Obs. 24th/e 6. b
a. 2 b. 4 pg. 343]
7. c
c. 5 d. 6
iM
12. Fetal weight at 20 weeks - (PGMEE 2012-13) 8. b

[Ref: Dutta’s Obs. 9th/e, pg. 63, 601; Holland Brew’s Obs. a. 150 g b. 200 g 9. b
4th/e, pg. 50; William’s Obs. 24th/e pg. 196] c. 300 g d. 400 g
10. d
5. Most accurate and safest method to diagnose viable [Ref: William’s Obs. 24th/e pg. 129]
11. c
PR
pregnancy at 6 weeks- (AIIMS Nov 13) 13. Best parameter for estimation of fetal age by ultrasound in 12. c
a. Doppler assessment of fetal cardiac activity 3rd trimester is- (PGMEE 2013-14) 13. a
b. USG for fetal cardiac activity a. Femur length b. BPD
c. Urinary β hCG determination 14. a
c. Abdominal circumference d. Interocular distance
d. Per vaginal examination of uterine size corresponding to 6 [Ref: Arias’ Obs. 3rd /e, pg. 10]
weeks gestation
[Ref: Dutta’s Obs. 9th/e, pg. 600, 601; Holland Brew’s Obs.4th/e, Explanation
pg. 50; William’s Obs. 24th/e pg. 195, 196] Femur length:
6. At 9 weeks best measure to calculate the gestational age- Not significantly affected by fetal growth alterations,
(PGMEE 2012-13) hence best parameter for gestational age estimation in 3rd
a. BPD b. CRL trimester.
c. Fetal femer length d. Embryonic movements Measured from the upper to the lower end of the bone’s
[Ref: Dutta’s Obs. 9th/e, pg. 63, 601; Holland Brew’s Obs. shaft, in the bone closer to the transducer
4th/e, pg. 50; William’s Obs. 24th/e pg. 195] Head of the femur and distal epiphysis not included in the
measurement
7. Gestational sac is seen on TVS at the earliest? 14. Anencephaly is earliest diagnosed sonographically by?
(PGMEE 2014) (PGMEE 2014)
a. 18 days b. 21 days a. 10-12 weeks b. 14-16 weeks
c. 35 days d. 42 days c. 16-18 weeks d. 18-20 weeks
[Ref: Dutta’s Obs. 9th/e, pg. 63, 601; Holland Brew’s Obs. [Ref: Dutta’s Obs. 9th/e, pg. 383, 602; Holland Brew’s Obs.
4th/e, pg. 50; William’s Obs. 24th/e pg. 196] 4th/e pg. 50, 335; William’s Obs. 24th/e pg.195t, 196] 787
PRIMES (Volume II)
15. Which one of the following congenital malformation of the ELECTRONIC FETAL MONITORING
fetus can be diagnosed in first trimester by ultrasound?
(PGMEE 2006) 18. Antepartum assessment of fetal distress is indicated by all
a. Anencephaly b. Inencephaly except- (PGMEE 2009)
c. Microcephaly d. Holoprosencephaly a. Acceleration of 15 beats/min
[Ref: Dutta’s Obs. 9th/e, pg. 383, 602; Holland Brew’s Obs. b. Deceleration of 30 beats//min
4th/e pg. 50, 335; William’s Obs. 24th/e pg.195t, 196, 201, c. Variable deceleration 5-25 beats/min
203; Internet] d. Fetal HR < 80 beats/min
Explanation [Ref: Dutta’s Obs. 9th/e, pg. 98, 566]

19. Conditions associated with decreased variability of fetal
Anencephaly: heart rate are all except: (DNB Dec’ 2010)
Deficient development of vault of skull & brain tissue with a. Fetal movement b. Acidemia
normal development of facial portion. c. Sleep d. Chronic hypoxia
Skull base & orbits covered by angiomatous stroma. [Ref: Dutta’s Obs. 9th/e, pg. 569; Holland Brew’s Obs.4th/e,
Can be detected sonographically as early as 10 weeks of pg. 473; Arias 3rd/e, pg. 53-55; William’s Obs. 24th/e pg. 479]
pregnancy.
/e
Incidence – 1 in 1000 births. 20. Late deceleration is due to? (PGMEE 2011)
a. Cord compression
Microcephaly: b. Uteroplacental insufficiency
Head size is smaller than normal head, d/t under c. Head compression
15.
16.
a
a
development of brain.
,2
May be present at birth or may develop later, in first few
years of life.
May occur as part of syndromes d/t aneuploidy.
Affected babies have poor intellectual & motor functions,
d. All
[Ref: Dutta’s Obs. 9th/e, pg. 569; Holland Brew’s Obs.4th/e, pg.
470; Arias 3rd/e, pg. 179; William’s Obs. 24th/e pg. 483, 484]
21. Regarding contraction stress test false is-
Es
17. d a. Oxytocin not used (PGMEE 2012-13)
poor speech, abnormal facial development, seizure
18. a b. Invasive method
disorders and dwarfism.
19. a c. Detects fetal well being
20. b Holoprosencephaly: d. Negative test is associated with good fetal outcome
21. a Failure of prosencephalon or forebrain to divide completely [Ref: Dutta’s Obs. 9th/e, pg. 466; Arias’ Obs. 3rd /e, pg. 19;
iM
22. d into 2 separate cerebral hemispheres & diencephalon. William’s Obs. 24th/e pg. 338]
23. b May be associated with abnormal development of facial
22. All are related to NST except- (PGMEE 2012-13)
structures (hypotelorism, cyclopia, micro - ophthalmia,
24. c a. Variability b. Acceleration
ethmocephaly, arhinia with proboscis, median cleft lip).
c. Time period d. Oxytocin
30 – 40 % cases found to have aneuploidy (trisomy 13).
PR
Birth prevalence – 1 in 10000 to 15000. [Ref: Dutta’s Obs. 9th/e, pg. 98, Holland Brew’s Obs.4th/e, pg.
Extremely lethal, found in 1 in 250 of early abortuses. 469; Arias’ Obs. 3rd /e, pg. 10; William’s Obs. 24th/e pg. 338]
16. Fetal marker of growth in USG is? 23. NST is said to be reactive when:- (PGMEE 2016-17)
a. Abdominal girth (PGMEE Aug. 12 Pattern) a. Acceleration > 10 bpm for > 10 s
b. Amniotic fluid index b. Acceleration > 15 bpm for > 15 s
c. Femur length c. Acceleration > 10 bpm for > 15 s
d. Regular serial USG bony measurements d. Acceleration > 15 bpm for > 10 s
[Ref: Dutta’s Obs. 9th/e, pg. 99, 605; William’s Obs. 24th/e pg. [Ref: Dutta’s Obs. 9th/e, pg. 98; Holland Brew’s Obs.4th/e, pg.
199; Arias’ Obs. 3rd /e, pg. 10] 469; Arias’ Obs. 3rd /e, pg. 10; William’s Obs. 24th/e pg. 339]
17. Single best parameter to assess fetal wellbeing is? PRENATAL GENETIC DIAGNOSIS
a. Femur length (PGMEE Aug 13 Pattern)
b. Head circumference SCREENING OF DOWN’S SYNDROME
c. Abdominal circumference
d. Amniotic fluid volume 24. Quadruple test does not include (PGMEE 2012-13)
[Ref: Dutta’s Obs. 9th/e, pg. 35; Holland Brew’s Obs. 4th/e pg. a. MSAFP b. Total hCG
26; William’s Obs. 24th/e pg. 199, 233] c. PAPP-A d. Inhibin A
pg. 464; Arias 3rd/e, pg. 38-41; William’s Obs. 24th/e pg.
289t, 291]
788
Obstetrics Chapter 5 Antenatal Assesment of Fetal Well Being (MCQs)
25. Quadruple test in pregnancy is performed at:- ALPHA FETO PROTEIN

(PGMEE 2018)
a. Between 8-12 weeks b. Between 15-18 weeks 31. Alpha feto protein levels are increased in all except:
c. Between 20-22 week d. Between 12-14 weeks (DNB June’ 2009, DNB Dec’ 2011)
Ref: Dutta’s Obs. 8th / e, pg.129; Holland Brew’s Obs.4th a. Open neural tube defects b. Intrauterine death
/e, pg.73; Arias 3rd / e, pg. 41; Williams Obs. 24th / e, pg.293 c. Down’s syndrome d. Twin pregnancy
Explanation [Ref: Dutta’s Obs. 9th/e, pg. 103; Holland Brew’s Obs. 4th/e,
pg. 464; Arias 3rd/e, pg. 53-55; William’s Obs. 24th/e pg. 285]
Quadruple test
32. Most effective in detecting neural tube defect-
Also known as Quad test (PGMEE 2012-13)
Serological screening test for Down’s syndrome or trisomy a. AFP b. MRI
21 c. CT d. Ultrasound
Performed between 15 – 22 weeks of pregnancy
Involves detection of levels of following 4 biochemical
4th/e pg. 457, 463, 464; William’s Obs. 24th/e pg. 285, 286;
analytes in Down’s syndrome-
Arias 3rd/e, pg. 53-55]
○○ Maternal serum alpha feto protein (MSAFP) - ↓
/e
○○ Human chorionic gonadotrophin (hCG-free β subunit) - ↑ Explanation
○○ Unconjugated estriol (uE3) - ↓
Measurement of Alpha fetoprotein (AFP) in maternal
○○ Inhibin A (InhA) - ↑
Detection rate – 85%, false-positive rate 0.9% serum or amniotic fluid is a screening test for fetal neural
tube defects, elevated in ~ 85 % of fetuses with NTDs.

all EXCEPT:
a. Inhibin A
c. Alpha fetoprotein
b. hCG
d. PAPP-A ,2
26. In Down’s syndrome, 2nd trimester quadruple test includes
(DNB June’ 2011)
[Ref: Dutta’s Obs. 9th/e, pg. 103; Holland Brew’s Obs.4th/e, pg.

USG (targeted anomaly scan) in 2nd trimester can detect ~
99% of fetuses with open NTDs having elevated MSAFP.
33. True about Alfa feto protein (AFP) are all except:-
a. It is a glycoprotein (PGMEE 2016-17)
25.
26.
b
d
Es
b. Produced by placenta 27. d
464; Arias 3rd/e, pg. 38-41; William’s Obs. 24th/e pg. 289t, 291]
c. Produced by fetal liver 28. b
27. Soft markers for screening of Down’s syndrome are all d. Concentration of AFP in maternal serum reaches its peak 29. b
except :- (PGMEE 2016-17) at 32 weeks of gestation 30. d
a. Increased nuchal translucency
[Ref: Dutta’s Obs. 9th/e, pg. 103; William’s Obs. 24th/e pg. 31. c
b. Absence of nasal bone
iM
284, 285] 32. d

c. Cardiac defects
d. Rockerbottom foot 33. b
FETAL PULMONARY MATURITY
[Ref: Dutta’s Obs. 9th/e, pg. 104t, 106t; Holland Brew’s 34. b
Obs.4th/e, pg. 465; Arias 4th /e, pg. 5-8; William’s Obs. 24th/e 34. Best method for the diagnosis of lung maturity is?
PR
pg. 292-294, 293t]

a. L/S ratio in amniotic fluid (DNB June’ 2011)
b. Phosphtidyl glycerorl estimation in amniotic fluid
AMNIOCENTESIS c. Amniotic fluid creatinine level
d. Bilirubin estimation in amniotic fluid
28. Amniocentesis is done at what intrauterine age?
(DNB Dec’ 2011, PGMEE Aug. 12 Pattern) [Ref: Dutta’s Obs. 9th/e, pg. 100; Holland Brew’s Obs. 4th/e,
a. 10–12 weeks b. 12–20 weeks pg. 466; William’s Obs. 24th/e pg. 655; Internet]
c. 20–25 weeks d. 25–30 weeks Explanation
[Ref: Dutta’s Obs. 9th/e, pg. 105, 607; Holland Brew’s
Obs.4th/e, pg. 466; Arias 3rd/e, pg. 46-47; William’s Obs. Various tests for assessment of fetal pulmonary
24th/e pg. 297] maturity:
29. Early amniocentesis done at- (PGMEE 2012-13) Estimation of pulmonary surfactant by amniotic fluid
a. 5-10 weeks b. 10-15 weeks Lecithin / Sphingomyelin (L /S) ratio-
c. 15-20 weeks d. 20-24 weeks ○○ Amniotic fluid L/S ratio at 31-32 wks is 1, at 35 wks is 2.
○○ L/S ratio ≥ 2 indicates pulmonary maturity.
[Ref: Dutta’s Obs. 9th/e, pg. 105, 607; William’s Obs. 24th/e
Shake test or bubble test (Clement’s)-
pg. 299; Arias 3rd/e, pg. 46-47]
○○ Increasing dilutions of AF mixed with 96% ethanol,
30. Amniocentesis is used to diagnose:- (PGMEE 2016-17) shaken for 15 seconds & inspected after 15 minutes → if
a. Chromosomal disorders b. Non-immune hydrops fetalis a complete ring of bubbles present at the meniscus → test
c. Neural tube defects d. All of the above is positive & indicates pulmonary maturity.
[Ref: Dutta’s Obs. 9th/e, pg. 462, 607; Holland Brew’s Obs.4th/e, Foam Stability Index (FSI)- 789
pg. 466; William’s Obs. 24th/e pg. 286, 287, 297, 850] ○○ > 47 virtually excludes the risk of RDS.
PRIMES (Volume II)
Presence of phosphatidyl glycerorl (PG) in amniotic fluid- 37. Surfactant appears in amniotic fluid at? (PGMEE 2013)
○○ Reliably indicates pulmonary maturity. a. 20 weeks b. 32 weeks
Saturated phosphatidyl choline- c. 28 weeks d. 30 weeks
○○ > 500 ng / ml indicates pulmonary maturity. [Ref: Dutta’s Obs. 9th/e, pg. 443]
Fluorescence polarization-
○○ Polarized light used to quantitate surfactant in the AF MISCELLANEOUS
& the ratio of surfactant to albumin is measured by an
automatic analyser. 38. Pre-implantation genetic testing (PIGT) is done:-
○○ Presence of 55 mg of surfactant per gram of albumin a. At the time of ovulation (PGMEE 2018)
indicates pulmonary maturity. b. After ovulation but before fertilization
Amniotic fluid optical density- c. After fertilization but before implantation of ovum
○○ At 650 mμ > 0.15 indicates pulmonary maturity. d. 1 week after implantation of ovum
Lamellar body count in amniotic fluid –
○○ > 30,000 / μl indicates pulmonary maturity. [Ref: Speroff 8th e p.1362; speroff 8th e p.1199]
Orange coloured cells in amniotic fluid- Explanation
○○ Presence of orange coloured desquamated fetal cells
(stained with 0.1% Nileblue sulphate) > 50% s/o Pre-Implantation Genetic Testing
/e
pulmonary maturity. The technique requires one or more cells that may
Amniotic fluid tubidity- be obtained at different stages of development. The
○○ During 1st & 2nd trimesters, AF is yellow & clear. chromosomal composition of the oocyte may be inferred
○○ At term it is turbid d/t vernix. from that of the extruded polar bodies. One or two
,2
Amniotic fluid L/S (Lecithin /Sphingomyelin)ratio was blastomeres may be removed from cleavage stage embryos.
considered to be “Gold standard test “ in past for fetal lung Biopsy of the trophoectoderm can also be performed at the
maturity. blastocyst stage. In the most common scenario (cleavage
35. a Concentration of both in the amniotic fluid is same before stage embryo biopsy), a laser or a dilute solution of acid
36. a 34 weeks, but at 32 – 34 weeks the concentration of lecithin Tyrode’s solution is used to create a small hole in the zona
Es
37. c begins to rise as compared to sphingomyelin. pellucida and one or two cells are aspirated, typically on
38. c Although L/S ratio > 2 is indicative of fetal lung maturity, the third day after oocyte retrieval and fertilization when
in pregnant patients with diabetes concentration of embryos are at the 6–8 cell stage.
phosphatidyl glycerol in amniotic fluid is a better predictor. PGD can be performed on polar bodies removed from
35. Fetal lung maturity is signified by- (PGMEE 2012-13) oocytes before fertilization (preconception diagnosis) or
iM
a. L:S > 2 on blastomeres or trophoectoderm removed from embryos

b. > 37 weeks gestation before transfer.
c. Level of phosphatidyl choline To detect abnormalities in embryos, one or two nucleated
d. Non reactive NST cells are removed, typically on the third day after
[Ref: Dutta’s Obs. 9th/e, pg. 100] fertilization (the 6–8 cell stage), before compaction when
PR
the blastomeres become more tightly adherent

36. Which does not indicate fetal lung maturity-
a. Reactive NST (PGMEE 2012-13)
b. Gestation 37 weeks
c. Presence of phosphatidyl choline
d. L/S ratio
790
CHAPTER 6: OBSTETRIC COMPLICATIONS IN PREGNANCY
HEMORRHAGE IN PREGNANCY implicated in 15% of cases of RPL. These can be diagnosed

by HSG or hysteroscopy. Operative hysteroscopy plays
ABORTIONS a role in the management also (e.g. septal resection,
adhesiolysis).
1. Most common cause of spontaneous abortion is? Routine TORCH infection screening should be abandoned.
a. Chromosomal abnormality (DNB June’ 2009) Infections particularly speculated to play a role in
b. Infection RPL include Ureaplasma, Chlamydia trachomatis, L.
c. Immunological monocytogenes, & Herpes simplex virus.
d. Uterine malformations Usually investigations for chronic infections is warranted
only in immunocompromised patient with RPL & with a
h/o sexually transmitted infections.
pg. 197; William’s Obs. 24th/e pg. 351]
7. Most common cause of abortion in first trimester is-
2. In case of 2nd trimester recurrent abortions, most common a. Uterine anomaly (PGMEE 2013-14)
uterine malformation seen is? (DNB June’ 2011) b. Infection
/e
a. Mullerian fusion defects b. Uterine agenesis c. Chromosomal abnormality
c. Unicornuate uterus d. Uterine synecchiae d. Hormonal disturbance
[Ref: Dutta’s Obs. 9th/e, pg. 160; William’s Obs. 24th/e pg. [Ref: Dutta’s Obs. 9th/e, pg. 151; Holland Brew’s Obs.4th/e,
358, 359t]
,2
3. In 1st trimester recurrent abortions all tests are to be done 8. Most common cause of abortion is- (PGMEE 2014)
except: (DNB Dec’ 2011) a. Infection 1. a
a. Parental cytogenetics b. Luteal phase defect
b. TORCH infection screening 2. a
c. Immunological cause
Es
c. Antiphospholipid antibodies 3. b
d. Defective embryo
d. Thyroid profile 4. d
[Ref: Dutta’s Obs. 9th/e, pg. 159, 160; Holland Brew’s 5. b
Obs.4th/e, pg. 202; William’s Obs. 24th/e pg. 358, 359] 6. d
9. The method of choice for termination of pregnancy
4. Decidual cast or carneous mole expelled per vaginum is 7. c
iM
between 7 and 12 weeks is (PGMEE 2014)

suggestive of- (PGMEE 2004) 8. d
a. Mifepristone and misoprostol
a. Inevitable abortion b. Threatened abortion b. Dilatation and curettage 9. c
c. Tubal abortion d. Missed abortion c. Suction evacuation 10. c
[Ref: Dutta’s Obs. 9th/e, pg. 156] d. Menstrual regulation 11. c
PR
5. Recurrent abortion not due to- (PGMEE 2012-13) [Ref: Dutta’s Obs. 9th/e, pg. 165; Holland Brew’s Obs. 4th/e
a. Chromosomal defects b. TORCH infection pg. 580]
c. Luteal phase defects d. Poorly controlled diabetes
10. A woman with 20 weeks pregnancy presents with bleeding
[Ref: Dutta’s Obs. 9th/e, pg. 159, 160; Holland Brew’s per vaginum. On speculum examination, the os is open but
Obs.4th/e, pg. 202; William’s Obs. 24th/e pg. 358, 359] no products have come out. The most likely diagnosis is-
6. Investigation not validated for recurrent pregnancy loss (AIIMS Nov 2013)
is? (PGMEE Nov 13 Pattern) a. Incomplete abortion b. Complete abortion
a. TSH b. Hysteroscopy c. Inevitable abortion d. Missed abortion
c. Hysterosalphingography d. TORCH test [Ref: Dutta’s Obs. 9th/e, pg. 154; Holland Brew’s Obs.4th/e,
[Ref: Dutta’s Obs. 9th/e, pg. 159, 160; Holland Brew’s Obs. pg. 200-201]
4th/e, pg. 202; William’s Obs. 24th/e pg. 353, 358, 359]
MTP
Explanation
Endocrinopathies such as uncontrolled diabetes, overt 11. MTP allowed till how many days as per MTP act:-
hypothyroidism & severe iodine deficiency have been (PGMEE 2015-16)
found to be associated with RPL (12% of cases). Hence, a. 70 days b. 120 days
screening for diabetes & hypothyroidism is required. c. 140 days d. 160 days
Structural abnormalities of uterus, congenital (septate [Ref: Dutta’s Obs. 9th/e, pg. 165; Holland Brew’s Obs.4th/e,
uterus) or acquired (Asherman’s syndrome), have been pg. 580]
791
PRIMES (Volume II)
ECTOPIC PREGNANCY Explanation
Etiological factors for ectopic pregnancy:

12. The following drug is not helpful in the treatment of ectopic
pregnancy- (PGMEE 2005) Any tubal surgery (for prev. tubal preg./tubal ligation -
a. Methotrexate 15 to 50% chance of ectopic preg. in case of sterilization
b. Misoprostol failure / reversal of sterilization) will cause tubal damage,
c. Actinomycin-D conferring highest risk of ectopic pregnancy
d. RU 486 PID / salpingitis - 6 to 10 times increased risk of ectopic due
to peritubal & intraluminal adhesions
Contraceptives - IUCD (7 times increased risk, no protection
pg. 209]
against tubal implantation) > tubal ligation (failures) >
13. Most common symptom in ectopic pregnancy- progesterone only pills (diminished tubal motility). Least
a. Abdominal pain (PGMEE 2012-13) chance of ectopic with combined OCPs
b. Bleeding per vagina ART - 5 to 7 % increased risk (with ovulation induction,
c. Amenorrhoea IVF-ET, GIFT)
d. Fainting attacks 19. Most of ectopic pregnancies are at ampulla as-
[Ref: Dutta’s Obs. 9th/e, pg. 171; Holland Brew’s Obs.4th/e, a. It is narrowest part (PGMEE 2012-13)
/e
pg. 207; William’s Obs. 24th/e pg. 379] b. Tubal movements are least here
c. Salpingitis produces least crypts here
14. Which is associated with least chances of ectopic pregnancy-
d. Plicae are most numerous here
(PGMEE 2012-13)
[Ref: Shaw’s Gynae. 16th/e pg.295]
,2
a. Tubectomy
b. IUCD 20. Best modality to diagnose unruptured ectopic pregnancy-
c. Oral contraceptive (PGMEE 2012-13)
12. b d. Tubal ligation a. Laparoscopy b. UPT
13. a c. USG d. Culdocentesis
[Ref: Dutta’s Obs. 9th/e, pg. 169; William’s Obs. 24th/e pg.
Es
14. c 377, 378; Berek & Novak’s Gynecology, 15th/e, pg. 623 - 625; [Ref: Dutta’s Obs. 9th/e, pg. 173; Holland Brew’s Obs.4th/e,
15. a Holland Brew’s Obs.4th/e, pg. 206] pg. 208; William’s Obs. 24th/e pg. 382, 383]
16. c
15. Methotrexate is used in ectopic pregnancy when- 21. A patient comes with 6 weeks’ amenorrhoea and features
17. b,d a. Patient is hemodynamically stable (PGMEE 2012-13) of shock, most likely diagnosis is- (PGMEE 2012-13)
18. b b. Serum β hCG level > 3000 IU/L a. Ectopic pregnancy b. H. Mole
iM
19. d c. Tubal diameter > 4cm without fetal cardiac activity c. Twin pregnancy d. None of the above
20. a d. When there is intraabdominal haemorrhage
[Ref:Dutta’s Obs. 9th/e, pg. 171; Holland Brew’s Obs.4th/e,
21. a [Ref: Dutta’s Obs. 9th/e, pg. 174; Holland Brew’s Obs.4th/e, pg. 207-208; William’s Obs. 24th/e pg. 379]
22. b pg. 209; William’s Obs. 24th/e pg. 384]
22. Earliest rupture in tubal pregnancy is seen in which part of
PR
23. c 16. Medical management for ectopic pregnancy is indicated tube? (PGMEE 2013-14)
24. a in? a. Ampulla b. Isthmus
25. c a. Detectable fetal cardiac activity c. Interstitial d. Fimbrial
b. Tubal diameter > 4cm
c. Serum β hCG level < 3000 IU/L [Ref: Dutta’s Obs. 9th/e, pg. 170; Holland Brew’s Obs.4th/e,
d. Hemodynamically unstable patient pg. 207]
[Ref: Dutta’s Obs. 9th/e, pg. 174; Holland Brew’s Obs.4th/e, 23. Drugs used in ectopic pregnancy- (PGMEE 2013-14)
pg. 209; William’s Obs. 24th/e pg. 385] a. PGE2 b. PGI
c. PGF2α d. PGE1
17. Highest likely cause of ectopic pregnancy-
a. IUCD (PGMEE 2012-13) [Ref: Dutta’s Obs. 9th/e, pg. 174; Holland Brew’s Obs.4th/e,
b. PID pg. 209]
c. Artificial fertility technique 24. M/c site of ectopic pregnancy is (PGMEE 2016-17)
d. Tubal damage a. Ampulla b. Isthmus
[Ref: Dutta’s Obs. 9th/e, pg. 169; William’s Obs. 24th/e pg. c. Interstitium d. Cornu
377, 378; Berek & Novak’s Gynecology, 15th/e, pg. 623 - 625] [Ref: Dutta’s Obs. 9th/e, pg. 168f; Holland Brew’s Obs. 4th/e,
207f]
18. Most common cause of ectopic pregnancy-
(PGMEE 2012-13) 25. Least common site for extra uterine pregnancy:-
a. IUCD b. PID (PGMEE 2016-17)
c. POP d. Peritubal adhesions a. Tubal b. Fimbrial
[Ref: Dutta’s Obs. 9th/e, pg. 169; William’s Obs. 24th/e pg. c. Ovarian d. Interstitial
792
377, 378; Berek & Novak’s Gynecology, 15th/e, pg. 623 - 625; [Ref: Dutta’s Obs. 9th/e, pg. 168f; Holland Brew’s Obs. 4th/e,
Holland Brew’s Obs.4th/e, pg. 206] 207f]
Obstetrics Chapter 6 Obstetric Complications in Pregnancy (MCQs)
MOLAR PREGNANCY/HYDATIFORM MOLE 33. Placenta praevia, false is- (PGMEE 2012-13)
a. Most common cause of APH
26. Treatment for a 16 weeks hydatidiform mole is? b. Painful vaginal bleeding
(DNB June’ 2009) c. USG is the investigation of choice
a. Hysterectomy b. Suction evacuation d. Increased maternal age is a risk factor
c. LSCS d. Hysterotomy [Ref: Dutta’s Obs. 9th/e, pg. 228, 229b, 230, 231, 232t, 238;
[Ref: Dutta’s Obs. 9th/e, pg. 184; William’s Obs. 24th/e pg. Holland Brew’s Obs.4th/e, pg. 230-232]
400; Holland Brew’s Obs.4th/e, pg. 254] 34. Which of the following predisposes to placenta previa?
27. Most common presenting feature of complete mole is- a. Primigravida (PGMEE Aug 13 Pattern)
(PGMEE 2013-14) b. Singleton pregnancy
a. Vomiting b. Amenorrhoea d. Diabetes mellitus
c. Headache d. Bleeding per vaginum d. Previous cesarean section
[Ref: Dutta’s Obs. 9th/e, pg. 182; Holland Brew’s Obs.4th/e, [Ref: Dutta’s Obs. 9th/e, pg. 229b; Holland Brew’s Obs.4th/e,
pg. 251; William’s Obs. 24th/e pg. 398] pg. 230; William’s Obs. 24th/e pg. 801]
28. A 28 year old female presents with a pregnancy of 12 weeks 35. Maximum chance of placental remnant is in:-
a. Placenta accreta (PGMEE 2016-17)
/e
(corrected LMP). However on examination, the fundal height
corresponds to 14 weeks. A brownish discharge is seen on b. Placenta increta
vaginal examination. Likely diagnosis is:-(PGMEE 2016-17) c. Placenta percreta
a. Missed abortion b. Pelvic infection d. Placenta previa
,2
c. Molar pregnancy d. Meconium stained liquor [Ref: Dutta’s Obs. 9th/e, pg. 235, 395; Holland Brew’s Obs.
4th/e, 233t; William’s Obs. 24th/e pg. 804 - 807]
pg. 251; William’s Obs. 24th/e pg. 398] 26. b
ANTEPARTUM HEMORRHAGE:
29. Which contraceptive should not be used after molar 27. d
PLACENTAL ABRUPTION
Es
pregnancy? (PGMEE 2013) 28. c
a. Barrier b. Hormonal contraceptives 29. c
36. A pregnant patient presents with abdominal pain with twin
c. IUCD d. Natural method 30. c
gestation of 34 weeks and bleeding PV. The most probable
[Ref: Dutta’s Obs. 9th/e, pg. 186; William’s Obs. 24th/e pg. diagnosis is? (DNB June’ 2009) 31. d
401] a. Abruptio placentae 32. a
iM
[GTDs DISCUSSED IN DETAILS IN GYNAE SECTION] b. Abortion 33. b

c. Ectopic pregnancy 34. d
ANTEPARTUM HEMORRHAGE: d. Placenta previa
35. c
PLACENTA PRAEVIA [Ref: Dutta’s Obs. 9th/e, pg. 232t] 36. a
PR
37. Drug causing abruptio placentae - (PGMEE 2012-13) 37. b

30. All are true about placenta previa except:(DNB Dec’ 2010) a. Methadone 38. c
a. Bright red blood loss b. Cocaine 39. b
b. Malpresentations usually found c. Amphetamine
c. Increased uterine tone d. Fluoxetine
d. Painless vaginal bleeding
[Ref: Dutta’s Obs. 9th/e, pg. 230; Holland Brew’s Obs.4th/e, pg. 236; William’s Obs. 24th/e pg. 796]
pg. 230-231]
38. Couvelaire uterus is seen in (PGMEE 2013-14)
31. Woman with 37 week of pregnancy comes with grade a. Vasa previa
3 placenta previa, bleeding per vaginum with uterine b. Placenta previa
contractions. Treatment of choice is -(PGMEE June’ 2012) c. Abruptio placentae
a. Wait and watch b. Bed rest & sedation d. Placenta accreta
c. Dexamethasome and nifedipine
d. Emergency LSCS [Ref: Dutta’s Obs. 9th/e, pg. 238, 239; Holland Brew’s Obs.
[Ref: Dutta’s Obs. 9th/e, pg. 235; Holland Brew’s Obs.4th/e, 4th/e, 237t; William’s Obs. 24th/e pg. 797]
pg. 235; William’s Obs. 24th/e pg. 803] 39. The term Couvelaire uterus is used in relation to:-
32. 35 weeks pregnancy, painless blood discharge, most likely a. Pregnancy induced Hypertension (PGMEE 2015-16)
diagnosis is- (PGMEE 2012-13) b. Uteroplacental Apoplexy
a. Placenta previa b. Abruptio placenta c. Postpartum Haemorrhage
c. Ectopic pregnancy d. None d. Placenta Previa
793
[Ref: Dutta’s Obs. 9th/e, pg. 230; Holland Brew’s Obs.4th/e, [Ref: Dutta’s Obs. 9th/e, pg. 238; Holland Brew’s Obs. 4th/e,
pg. 230-231; William’s Obs. 24th/e pg. 801] 237t; William’s Obs. 24th/e pg. 797]
PRIMES (Volume II)
PRETERM LABOR 48. Radiological sign in intrauterine fetal death:-

(PGMEE 2016-17)
40. Risk of preterm delivery is increased if cervical length is- a. Spalding sign b. Robert’s sign
(PGMEE 2005, Nov 13 Pattern) c. A and B both d. Palmer’s sign
a. 2.5 cm b. 3.0 cm
c. 3.5 cm d. 4.0 cm
[Ref: Dutta’s Obs. 9th/e, pg. 294; Holland Brew’s Obs.4th/e, MULTIPLE PREGNANCY
49. Exclusive complication of monochorionic twins-
41. A 34 weeks pregnant female presented with uterine contrac- (PGMEE 2012-13)
tions, with no other risk factors. Steps in management are a. Cord entanglement b. Twin to twin transfusion
all except - (DNB Dec’ 2010) c. Discordant growth d. Abortion
a. Dexamethasone should be given [Ref: Dutta’s Obs. 9th/e, pg. 194; Holland Brew’s Obs. 4th/e,
b. Tocolytic for 3 more weeks pg. 223; William’s Obs. 24th/e pg. 904]
c. Vacuum assisted delivery
d. Expectant management 50. Monochorionic monoamniotic placenta develops if division
takes place- (PGMEE 2012-13)
[Ref: Dutta’s Obs. 9th/e, pg. 296, 539; Holland Brew’s Obs. a. Before 72 hrs b. Between 4th & 8th day
/e
4th/e, 358t] c. After 8th day d. After 2 weeks
42. Drug that does not prevent preterm labor is: [Ref: Dutta’s Obs. 9th/e, pg. 189t, 190f; Holland Brew’s Obs.
(DNB Dec’ 2010) 4th/e, pg. 220; William’s Obs. 24th/e pg. 892]
a. Ritodrine b. Nitroglycerine patch
40.
41.
a
c
c. Dexamethasone d. Atosiban
,2
4th/e, 359, 360t; William’s Obs. 24th/e pg. 852, 853]
43. Preterm baby is born before? (PGMEE Nov 13 Pattern)

51. Least common presentation of twins-
a. Both vertex
b. Both breech
c. Both transverse
d. First vertex and 2nd transverse
(PGMEE 2012-13)
Es
42. c
a. 28weeks b. 32 weeks [Ref: Holland Brew’s Obs. 4th/e, pg. 223f]
43. d
c. 34 weeks d. 37 weeks 52. In which condition internal podalic version is done-
44. a
[Ref: Dutta’s Obs. 9th/e, pg. 294, 427] a. Transverse lie in 2nd twin (PGMEE 2012-13)
45. a
b. Breech presentation
46. b POSTDATED PREGNANCY c. Both
iM
47. a d. None
44. Investigation of choice for confirming postdatism?
48. c [Ref: Dutta’s Obs. 9th/e, pg. 197, 542; Holland Brew’s
(PGMEE Aug. 12 Pattern)
49. b a. USG b. Spectrophotometry Obs.4th/e, pg. 225; William’s Obs. 24th/e pg. 918]
50. c c. Amniocentesis d. X-ray 53. Least common type of twins- (PGMEE 2012-13)
PR
51. c a. Diamniotic-dichorionic twins

52. a pg. 245; William’s Obs. 24th/e pg. 862] b. Diamniotic-monochorionic twins
53. d c. Monoamniotic-monochorionic twins
54. c INTRAUTERINE FETAL DEATH d. Conjoined twins
55. b [Ref: Dutta’s Obs. 9th/e, pg. 189t; William’s Obs. 24th/e pg.
45. IUFD causes all except- (PGMEE 2008)
902]
a. PIH b. DIC
c. Psychological upset d. Infection 54. Sign seen in USG in monochorionic diamniotic twins is?
[Ref: Dutta’s Obs. 9th/e, pg. 304; Holland Brew’s Obs. 4th/e, (PGMEE Aug. 12 Pattern)
pg. 247] a. Twin peak sign b. Lambda sign
c. T sign d. Membrane thickness > 2 mm
46. 1st sign of IUD - (PGMEE 2012-13)
[Ref: Dutta’s Obs. 9th/e, pg. 192f; William’s Obs. 24th/e pg.
a. Spalding sign
897f]
b. Air in heart
c. Hyper flexion of spine 55. Division of eggs taking place on 7th day leads to which type
d. Egg shell cracking feel of the fetal head of twins? (PGMEE 2012, 2015-16)
[Ref: Dutta’s Obs. 9th/e, pg. 303; Holland Brew’s Obs.4th/e, a. Dichorionic diamnionic
pg. 247] b. Monochorionic diamnionic
c. Monochorionic monoamnionic
47. Earliest sign in IUD is:- (PGMEE 2016-17) d. Conjoined twins
a. Robert’s sign b. Spalding sign
[Ref: Dutta’s Obs. 9th/e, pg. 189t; Holland Brew’s Obs.4th/e,
c. Hyperflexion of spine d. Ball sign
794 pg. 220; William’s Obs. 24th/e pg. 892]
pg. 247]
Obstetrics Chapter 6 Obstetric Complications in Pregnancy (MCQs)
56. In dizygotic twin there is? (PGMEE Aug. 12 Pattern) Explanation

a. Always same sex
b. Always different sex Determination of Type of Twin Pregnancy
c. Separate chorion and amnion Twin gestational sacs may be seen sonographically by as
d. None early as 6-7 weeks
Two separate fetuses can be identified 12th week onwards
Best time to determine chorionicity of placenta is 10-13
weeks
57. Twin peak appearance seen in:- (PGMEE 2016-17)
a. Monochorionic monoamniotic Features Dichorionic Monochorionic
b. Dichorionic diamniotic placenta placenta
c. Monochorionic diamniotic Thickness of ≥ 2 mm ≤ 2 mm
d. Conjoined twins inter-twin
[Ref: Dutta’s Obs. 9th/e, pg. 192f; William’s Obs. 24th/e pg. membrane
897f] No. of layers Two layers of Two layers of amnion
58. Commonest complication of assisted reproductive amnion with only
/e
technique:- (PGMEE 2018) intervening chorion
a. Monozygotic twins b. Heterozygotic twins Specific USG “Lambda or twin “ T “ sign –
c. Dizygotic twins d. None of the above sign peak” sign - due to due to 2 layers of amnion
triangular projection being at right angle with
,2
Ref: Speroff 8th e p.1371 of chorionic tissue the placenta, without
Explanation between 2 layers of any placental projection
amnion, at the base or intervening chorion 56. c
When two blastocysts are transferred, the incidenceof of membrane
high-order multiple gestation is markedly reduced but not 57. b
Es
altogether eliminated, because the incidence of monozygotic 58. a
twinning may be increased after blastocyst transfer, and the
MISCELLANEOUS COMPLICATIONS 59. b
incidence of twins is no lower than that associated with 60. c
HYPEREMESIS GRAVIDARUM
transfer of greater numbers of cleavage-stage embryos.
59. Best timing to determine types of twins in case of twin 60. Metabolic changes in hyperemesis gravidarum:-
iM
pregnancy is:- (PGMEE 2018) (PGMEE 2015-16)

a. 6-8 weeks b. 12-14 weeks a. Hyperchloremia b. Hypernatremia
c. 28-32weeks d. 18-21 weeks c. Ketoacidosis d. Hyperkalemia
[Ref: Dutta’s Obs. 8th / e, pg. 237; Holland Brew’s Obs.4th/ e, [Ref: Dutta’s Obs. 9th/e, pg. 148; Holland Brew’s Obs. 4th/e,
PR
pg. 224-225; Williams Obs. 24th / e, pg. 896-897] pg. 38]
795
CHAPTER 7: MEDICAL DISORDERS IN PREGNANCY
HYPERTENSIVE DISORDERS IN PREGNANCY 9. First sign of magnesium sulphate toxicity is?

a. Loss of deep tendon reflexes (PGMEE Nov 13 Pattern)
1. Which of the following is not a predisposing factor for b. Respiratory depression
preeclampsia? (DNB Dec’ 2010) c. Cardiac arrest
a. Molar pregnancy b. Smoking d. Decrease urinary output
c. Gestational diabetes d. Anti-phospholipid antibody
[Ref: Dutta’s Obs. 9th/e, pg. 222b; William’s Obs. 24th/e pg.
[Ref: Dutta’s Obs. 9th/e, pg. 208b; William’s Obs. 24th/e pg. 759; Holland Brew’s Obs.4th/e, pg. 94]
731; Arias 3rd/e, pg. 44]
10. Management of eclampsia at 34 weeks of pregnancy is-
2. Definitive treatment of severe pre eclampsia is?
a. Continuation of convulsions and wait for 37 weeks to
(DNB Dec’ 2010, PGMEE 2012-13)
complete (PGMEE 2013-14)
a. Anticonvulsants b. Termination of pregnancy
b. Wait for spontaneous labour
c. Magnesium sulfate d. Antihypertensives
c. BP monitoring
[Ref: Dutta’s Obs. 9th/e, pg. 216; William’s Obs. 24th/e pg. 750 d. Anti hypertensive, anticonvulsant and termination of
pregnancy
/e
Holland Brew’s Obs.4th/e, pg. 93; Arias 3rd/e, pg. 420-423]
3. Not a feature of HELLP syndrome- [Ref: Dutta’s Obs. 9th/e, pg. 222, 224; William’s Obs. 24th/e
(PGMEE 2012, AIIMS May 14) pg. 758; Holland Brew’s Obs. 4th/e, pg. 93, 96]
a. Hemolysis b. Elevated liver enzymes 11. Not a criteria for diagnosis of superimposed pre eclempsia
1.
2.
3.
b
b
d
c. Low platelet count d. Renal failure
,2
739; Holland Brew’s Obs.4th/e, pg. 97]
4. Therapeutic level of serum magnesium needed to treat

in a pregnant lady with pre existing chronic HTN-
a. Increase in systolic BP by 30 mm Hg and diastolic by 15
mm Hg
b. Platelets less than 70000
c. New onset proteinuria
(AIIMS May 14)
Es
pre-eclempsia- (PGMEE 2012-13)
4. c a. 1-2 mEq / L b. 3-4 mEq / L d. New vascular changes in retinal vessels
5. b c. 4-7 mEq / L d. 7-9 mEq / L [Ref: Dutta’s Obs. 9th/e, pg. 207t; Holland Brew’s Obs.4th/e,
6. d [Ref: Dutta’s Obs. 9th/e, pg. 221; William’s Obs. 24th/e pg. pg. 85]
7. c 759; Holland Brew’s Obs. 4th/e, pg. 94] 12. What feature would be helpful in differentiating chronic
iM
8. c 5. Antihypertensive of choice in pregnancy is- HTN from PIH. (AIIMS Nov’ 2017)
9. a (PGMEE 2012-13) a. Episode of seizure
10. d a. Methyldopa b. Labetolol b. Hypertension nephropathy
c. Hydralazine d. CCB c. Hypertensive retinopathy
11. a
d. HTN at 10 weeks of gestation
PR
12. d [Ref: Dutta’s Obs. 9th/e, pg. 471; William’s Obs. 24th/e pg.
762; Holland Brew’s Obs.4th/e, pg. 93] [Ref: Dutta’s Obs. 8th / e, pg. 255; Holland Brew’s Obs.4th / e,
pg. 85, 97; Williams Obs. 24th / e, pg. 730, 1002]
6. Antihypertensive contraindicated is pregnancy-
(PGMEE 2012-13) Explanation
a. Labetalol b. Hydralazine
c. Methyl dopa d. ACE inhibitors Hypertensive disorders in pregnancy
[Ref: Dutta’s Obs. 9th/e, pg. 471; Holland Brew’s Obs.4th/e, Hypertension – BP ≥ 140/90 mm Hg (Korotkoff phase V
pg. 94] taken as diastolic BP) measured on two occasions at least
6 hours apart)
7. DOC for eclampsia is- (PGMEE 2012-13) Delta hypertension – a sudden rise in mean arterial BP (≥
a. Methyl dopa b. Labetalol 105 mm Hg) in later pregnancy
c. Magnesium Sulphate d. Hydralazine Gestational hypertension - BP ≥ 140/90 mm Hg for the first
[Ref: Dutta’s Obs. 9th/e, pg. 221; William’s Obs. 24th/e pg. time after midpregnancy (20 weeks), without proteinuria
758; Holland Brew’s Obs.4th/e, pg. 96] Preeclampsia - gestational hypertension with proteinuria
8. In a case of pre eclampsia Doppler USG will show? Eclampsia – preeclampsia complicated with convulsions
(PGMEE Nov 13 Pattern) that cannot be attributed to any other cause
a. Reversed blood flow in ductus venosus at 22 weeks Chronic hypertension – known hypertension before
b. Absent blood flow in umbilical artery at 22 weeks pregnancy or diagnosed for the first time before 20 weeks
c. Diastolic notch in uterine artery at 22 weeks of pregnancy
d. Increased peak systolic flow velocity in middle cerebral Chronic hypertension with superimposed preeclampsia
artery – new onset proteinuria in pregnant woman with chronic
796 hypertension
pg. 746; Holland Brew’s Obs.4th/e, pg. 86]
Obstetrics Chapter 7 Medical Disorders in Pregnancy (MCQs)
GESTATIONAL DIABETES MELLITUS 20. Cause of big baby in GDM patients- (PGMEE 2013-14)
a. Hyperglycemia b. Hyperinsulinemia
13. Morbidities expected in baby of diabetic mother are all c. Multiparity d. Post maturity
except: (DNB June’ 2009)
a. Macrosomia b. Hyperglycemia [Ref: Dutta’s Obs. 9th/e, pg. 265; William’s Obs. 24th/e pg.
c. Caudal regression d. Cardiac anomalies 1129; Holland Brew’s Obs. 4th/e, pg. 129-130]
[Ref: Dutta’s Obs. 9th/e, pg. 265, 266t; William’s Obs. 24th/e Explanation
pg. 1128, 1140; Holland Brew’s Obs.4th/e, pg. 130]
According to Pederson’s hypothesis -
14. One step screening test for gestational diabetes (DIPSI
Maternal hyperglycemia → fetal hyperglycemia →
criteria) is? (DNB Dec’ 2009)
hypertrophy & hyperplasia of islets of Langerhan’s of
a. Glycosylated haemoglobin measurement
fetal pancreas → fetal hyperinsulinemia → increased
b. Fasting blood sugar
c. Oral glucose tolerance test carbohydrate utilization & fat accumulation → excessive
d. Random glucose (75 gms) challenge fetal growth & adiposity (esp. on trunk & shoulders leading
to shoulder dystocia)
[Ref: Dutta’s Obs. 9th/e, pg.; 263; William’s Obs. 24th/e pg.; Hence, hyperinsulinemia is the direct cause of macrosomia
Holland Brew’s Obs.4th/e, pg. 131] or big baby in GDM patients, but hyperglycemia (maternal
/e
15. All are the effects of gestational diabetes on fetus except: as well as fetal) is the indirect one.
a. Increased perinatal mortality (DNB Dec’ 2010) 21. First maneuver to be done in case of shoulder dystocia is?
b. Hypoglycemia (PGMEE Aug 13 Pattern)
c. Congenital malformations a. Mc Roberts b. Wood’s corkscrew
d. Macrosomia
,2
pg. 1141, 1142; Holland Brew’s Obs. 4th/e, pg. 130]
16. Glucose challenge test done with ___ grams of glucose and is
c. Lovset d. Zavanelli
[Ref: Dutta’s Obs. 9th/e, pg. 381; William’s Obs. 24th/e pg. 542f]
ANEMIA IN PREGNANCY
13.
14.
b
d
Es
seen at ___ hours according to DIPSI criteria? 22. Minimum hemoglobin level in pregnancy below which 15. c
(PGMEE Nov 12 Pattern) anaemia occurs is? (DNB June’ 2009, DNB Dec’ 2009) 16. c
a. 50 gm and 1 hour b. 75 gm and 1 hour a. 9 gm % b. 10 gm % 17. a
c. 75 gm and 2 hours d. 100 gm and 2 hours c. 11 gm % d. 12 gm % 18. c
[Ref: Dutta’s Obs. 9th/e, pg. 263; Holland Brew’s Obs.4th/e, [Ref: Dutta’s Obs. 9th/e, pg. 245 ; William’s Obs. 24th/e pg. 19. a
iM
pg.131] 1101; Holland Brew’s Obs.4th/e, pg. 104]

20. a,b
17. Oral hypoglycemic agent safely given in pregnancy is? 23. A women comes to hospital with 32 weeks of pregnancy and 21. a
(PGMEE Aug 13 Pattern) hemoglobin level 6.2 gm%. Most appropriate management 22. c
a. Metformin b. Glimepride is? (PGMEE Aug. 12 Pattern)
c. Sitagliptin d. Pioglitazone 23. d
PR
a. Intramuscular iron b. Iron and folic acid tablets

[Ref: Holland Brew’s Obs.4th/e, pg. 135; Dutta’s Obs. 9th/e, c. Intravenous iron d. Blood transfusion
pg. 267 ; William’s Obs. 24th/e pg. 1142] [Ref: Dutta’s Obs. 9th/e, pg.250-251; William’s Obs. 24th/e
18. True about gestational diabetes is- (PGMEE 2013-14) pg. 1103; Holland Brew’s Obs.4th/e, pg. 111]
a. These are increased chances of congenital malformations
b. Only 2% of women present with overt diabetes Explanation
c. There is chance of macrosomia Anaemia in pregnancy – Hb < 11 gm /dl and Hct < 33 %
d. Usually diagnosed in early pregnancy ICMR grading of anaemia-
[Ref: Dutta’s Obs. 9th/e, pg. 262 - 265; Holland Brew’s Obs.
4th/e, pg. 126 - 129; William’s Obs. 24th/e pg. 1136] Severtiy of anaemia Hb level (gm/dl)
Mild 10 – 10.9
Explanation
Moderate 7 – 9.9
If gestational diabetes is ‘first detected’ during pregnancy,
then fetal congenital malformations may be present if blood Severe 4 – 6.9
sugar levels are elevated during first trimester. Hence option
Very severe <4
‘a’ in this ques. may also be correct in addition to option ‘c’.
19. Gestational diabetes mellitus- (PGMEE 2013-14) Blood transfusion is recommended for women with severe
a. Is first recognized during pregnancy or very severe anaemia at any period of gestation. Benefits
b. Previous history of IUGR are as follows –
c. There is no recurrence of GDM in future pregnancy ○○ Rapid correction of anaemia
d. No risk of overt diabetes ○○ Improvement of oxygen carrying capacity of blood
797
[Ref: Dutta’s Obs. 9th/e, pg. 262 ; William’s Obs. 24th/e pg. ○○ Patient can bear the strain of labour & blood loss
1136; Holland Brew’s Obs. 4th/e, pg. 130-131;] following delivery
PRIMES (Volume II)
24. First sign of recovery after iron therapy- (PGMEE 2013-14) ○○ Progressive dyspnoea
a. Reticulocytosis b. ↑ MCV ○○ Orthopnoea
c. ↑ MCH d. ↑ Ferritin ○○ Cough with / without haemoptysis
[Ref: Dutta’s Obs. 9th/e, pg. 28; Holland Brew’s Obs.4th/e, ○○ Syncopal attacks
pg. 109] ○○ Cyanosis
○○ Clubbing
HEART DISEASE IN PREGNANCY ○○ Distended neck veins
○○ Persistent arrhythmia
25. About NYHA grade III, IV heart disease in pregnancy ○○ Persistently split S2
which is not true regarding management? (PGMEE 2016) ○○ Systolic murmur grade 3/6 or more
a. Delivery should be done in specialised hospitals ○○ Diastolic murmur
b. Poorly tolerate major surgery ○○ Cardiomegaly
c. Vaginal delivery is C/I ○○ Pulmonary artery hypertension (gp II disorders secondary
d. Surgery (Cesarean section) done only for obstetrical to pulmonary venous hypertension d/t left-sided atrial,
indications ventricular or venous disorders are most common in
[Ref: Dutta’s Obs. 9th/e, pg. 259, 260; Holland Brew’s Obs. pregnancy)
4th/e, pg. 120, 121; William’s Obs. 24th/e pg. 978] 30. Peripartum cardiomyopathy can present at:
/e
26. Highest maternal mortality is seen in following congenital a. Within 3 months of pregnancy (PGMEE 2018)
heart disease- (AIIMS Nov 07, PGMEE 2012-13) b. Within 5 months of pregnancy
a. Eisenmenger’s complex b. Pulmonary stenosis c. Within 5 months of delivery
c. Coarctation of aorta d. VSD d. After 5 months of delivery
24.
25.
a
c
,2
27. Which of the following drugs should not be used in the

conduct of labour in a woman with rheumatic heart
[Ref: Dutta’s Obs. 8th / e, pg. 325; Holland Brew’s Obs. 4th/e,
pg. 425; Williams Obs. 24th / e, pg. 988-990]
Explanation
Peripartum Cardiomyopathy
Es
26. a disease- (PGMEE 2011)
27. a a. Methylergometrine b. Misoprostol Diagnostic criteria –
28. b c. Synctocin d. Carboprost ○○ Cardiac failure in the last month of pregnancy or within
29. a [Ref: Dutta’s Obs. 9th/e, pg. 134, 260; Holland Brew’s 5 months of delivery
Obs.4th/e, pg. 122] ○○ No identifiable cause for cardiac failure
30. c
○○ No recognizable heart disease prior to last month of
iM
28. Heart disease with worst prognosis in pregnancy is? pregnancy

a. Aortic Stenosis (PGMEE 2013) ○○ Left ventricular systolic dysfunction as evidenced by
b. Pulmonary Hypertension echocardiography-
c. Uncorrected tetralogy of Fallot – Ejection fraction < 45%
d. Marfan’s syndrome with normal aorta
PR
– Left ventricular dilatation (end diastolic dimension >

[Ref: Dutta’s Obs. 9th/e, pg. 261; William’s Obs. 24th/e pg. 2.7 cm/m2)
986, 987] Incidence – 1:3500 to 1:5000 deliveries
Etiology –
29. Which of the following is seen in pregnancy with heart
○○ Unknown
disease, which is not seen in normal pregnancy?
○○ Potential causes – viral myocarditis, abnormal immune
(AIIMS Nov 2013)
response to pregnancy, abnormal response to increased
a. Distended neck veins b. Exertional dyspnoea
haemodynamic burden of pregnancy, oxidative stress
c. Pedal edema d. Supine hypotension
during pregnancy, hormonal interactions, antiangiogenic
[Ref: Holland Brew’s Obs.4th/e, pg. 117; William’s Obs. 24th/e factors, malnutrition, inflammation, and apoptosis
pg. 975t] Clinical features-
Explanation ○○ Young (20-35 years) multiparous patients
○○ Symptoms – weakness, breathlessness (at night also),
Symptoms & signs in pregnancy d/t normal physiological palpitation, cough
(esp. cardiovascular) changes are – ○○ Signs – tachycardia, arrhythmia, signs of CHF
○○ Exercise intolerance Treatment – bed rest, digoxin, diuretics, salt restriction,
○○ Easy fatiguability oxygen, ACE inhibitors and β blockers (postpartum),
○○ Pedal edema anticoagulants
○○ Exertional dyspnoea Pregnancy poorly tolerated, vaginal delivery preferred
○○ Functional systolic murmurs
Symptoms & signs suggestive of heart disease in pregnancy–
○○ Chest pain
798
Obstetrics Chapter 7 Medical Disorders in Pregnancy (MCQs)
RH ISOIMMUNIZATION 37. Regarding erythroblastosis fetalis all are true except-

a. Rh haemolytic disease (PGMEE 2012-13)
31. Which is not affected in Rh isoimmunisation? b. Severe anemia
(DNB June’ 2011) c. Hypoplasia of placental tissue
a. Anti C b. Anti D d. Hypoproteinaemia
c. Anti E d. Anti-Lewis
[Ref: Dutta’s Obs. 9th/e, pg. 311; William’s Obs. 24th/e pg. 315; Holland Brew’s Obs.4th/e, pg. 168]
307, 308; Holland Brew’s Obs. 4th/e, pg. 166]
38. At 28 weeks gestation amniocentesis reveals ∆OD 450 in
32. Fetal cells can be detected in maternal blood using- Liley’s zone 3. Which of the following is the best line of
(AIIMS Nov 09) management:- (PGMEE 2015-16)
a. DCT b. Bubble test a. Plasmapheresis b. Immediate delivery
c. Kleihauer - Betke test d. ICT c. Repeat amniocentesis after 1 weeks
[Ref: Dutta’s Obs. 9th/e, pg. 314; William’s Obs. 24th/e pg. d. Intrauterine transfusion
313f; Holland Brew’s Obs.4th/e, pg. 168] [Ref: Dutta’s Obs. 9th/e, pg. 316, 317; William’s Obs. 24th/e
33. Test to detect maternal sensitization- (PGMEE 2012-13) pg. 310]
a. Direct Coomb’s test 39. What should be done during delivery of Rh negative-
/e
b. Indirect Coomb’s test a. IV Fluids (PGMEE 2013-14)
c. Both b. IV Oxytocin
d. None c. Manual removal of placenta should be done gently
[Ref: Dutta’s Obs. 9th/e, pg. 315; William’s Obs. 24th/e pg. d. Ergometrine to be withheld at delivery of anterior shoulder

34. Hydops fetalis due to-
a. Rh mismatch
c. Placental hypoplesia
,2
(PGMEE 2012-13)
b. Hyperproteinemia
d. All of the above
pg. 173]
THYROID DISORDERS IN PREGNANCY

31.
32.
d
c
Es
33. b
[Ref: Dutta’s Obs. 9th/e, pg. 313; William’s Obs. 24th/e pg. 40. Thyroid gland is functional in the embryo by ____ weeks of
pregnancy:- (PGMEE 2016-17) 34. a
315; Holland Brew’s Obs. 4th/e, pg. 168]
a. 8 b. 9 35. a
35. If 300 microgram anti D is given to mother, amount of fetal c. 10 d. 11 36. a
blood it will neutralise- (PGMEE 2012-13)
[Ref: Dutta’s Obs. 9th/e, pg. 39] 37. c
a. 30 ml b. 40 ml
iM
c. 50 ml d. 60 ml 41. DOC for Hyperthyroidism in first trimester of pregnancy 38. d

is :- (PGMEE 2016-17) 39. d
[Ref: Dutta’s Obs. 9th/e, pg. 314;William’s Obs. 24th/e pg.
311; Holland Brew’s Obs. 4th/e, pg. 168] a. Carbimazole b. Methimazole 40. d
c. Lugol’s iodine d. Propylthiouracil 41. d
36. Dose of Anti-D gamma globulin following first trimester
PR
[Ref: Dutta’s Obs. 9th/e, pg. 269; William’s Obs. 24th/e pg. 42. a
abortion is- (DNB pattern 2008)
1149; Holland Brew’s Obs.4th/e, pg. 139] 43. d
a. 50 µg b. 100 µg
c. 200 µg d. 300 µg 44. c
LIVER DISEASES IN PREGNANCY
[Ref: Dutta’s Obs. 9th/e, pg. 314; Holland Brew’s Obs. 4th/e,
pg.169] 42. LCHAD deficiency is associated with? (DNB Dec’ 2011)
a. Fatty liver of pregnancy b. HELLP syndrome
Explanation c. Liver failure d. All
To prevent active immunization of Rh-negative yet [Ref: William’s Obs. 24th/e pg. 1086]
unimmunized mother, Rh anti-D immunoglobin (IgG)
43. Most fatal hepatitis in pregnancy:- (PGMEE 2016-17)
is administered intramuscularly to the mother following
a. A b. C
child birth or abortion. It should be administered within 72
c. B d. E
hours or preferably earlier following delivery or abortion. It
should be given provided the baby born is Rh-positive and [Ref: Dutta’s Obs. 9th/e, pg. 272; William’s Obs. 24th/e pg.
the direct Coomb’s test is negative. 1092; Holland Brew’s Obs.4th/e, pg. 156]
DOSE: 44. Fatty liver of pregnancy usually presents at???:-
○○ Anti D-gamma globulin is administered intramuscularly a. In first trimester of pregnancy (PGMEE 2018)
to the mother 300 microgram following delivery. b. In 2nd trimester of pregnancy
○○ All Rh-negative unsensitised women should receive c. In 3rd trimester of pregnancy
50 microgram of Rh-immune globulin I.M. within 72 d. In peurperium
hours of induced abortion, spontaneous abortion, ectopic Ref: Holland Brew’s Obs.4th / e, pg. 154; Williams Obs. 24th
pregnancy or chorion villus biopsy in the first trimester. / e, pg. 1086-108 799
○○ Women with pregnancy beyond 12 weeks should have
full dose of 300 microgram.
PRIMES (Volume II)
Explanation RENAL DISEASE IN PREGNANCY

Acute Fatty Liver of Pregnancy 45. Most common causative organism of acute pyelonephritis
Rare condition (1 in 10,000) occurring in late 3rd trimester in pregnancy is? (PGMEE 2014)
of pregnancy a. E. coli b. Klebsiella pneumonia
Also called acute fatty metamorphosis or acute yellow c. Enterobacter d. Staphylococcus group
atrophy [Ref: Dutta’s Obs. 9th/e, pg. 279]
Commonest cause of acute hepatic failure during pregnancy
with a high maternal and perinatal mortality EPILEPSY IN PREGNANCY
Liver is small, soft, yellow and greasy with deposition 46. Which anti-epileptic is relatively safer during pregnancy?
of microvesicular fat droplets that ‘crowds out’ normal (DNB Dec’ 2009)
hepatocyte function a. Levetiracetam b. Valproate
May be due to deficiency of long chain 3-hydroxyacyl-Co c. Phenytoin d. Carbamazepine
A dehydrogenase (LCHAD) due to genetic mutations on
chromosome 2 → accumulation of medium and long chain [Ref: Dutta’s Obs. 9th/e, pg. 273; William’s Obs. 24th/e pg.
fatty acids 1190, 1191; Holland Brew’s Obs.4th/e, pg. 101]
Autosomal recessive inheritance, heterozygous mothers 47. Which vitamin deficiency is most commonly seen in a
/e
with homozygous fetuses pregnant woman who is on phenytoin therapy for epilepsy?
Clinical features – (PGMEE 2006)
○○ Non-specific – upper abdominal pain, persistent nausea a. Vitamin B6 b. Vitamin B12
and vomiting, anorexia, progressive jaundice c. Vitamin A d. Folic acid
,2
○○ Specific – rapid deterioration, profound hypoglycemia,
hepatic encephalopathy, hepatic failure, renal failure, [Ref: Dutta’s Obs. 9th/e, pg. 273; William’s Obs. 24th/e pg.
severe coagulopathy and haemorrhages, coma and death 158; Holland Brew’s Obs.4th/e, pg. 101]
45. a
Differential diagnosis –
46. a THROMBOPHILIA IN PREGNANCY
Es
47. d Param- Acute Acute Intra HELLP 48. Anti-phospholipid antibodies are not tested in?
48. d eters viral fatty hepatic syndrome (DNB Dec’ 2010)
49. a hepatitis liver of cholestasis a. Recurrent abortion b. Mild Pre eclampsia
50. a pregnancy of c. IUGR d. Polyhydramnios
pregnancy
51. a [Ref: Dutta’s Obs. 9th/e, pg. 160, 322; William’s Obs. 24th/e
iM
S. transam- 400-4000 200-800 < 200 IU/L < 300 IU/L

pg. 1175; Holland Brew’s Obs.4th/e, pg. 584, 585]
inases IU/L IU/L
S. bilirubin 5-20 mg/ 4-10 mg/dl 1-5 mg/dl 2-4 mg/dl COAGULOPATHY IN PREGNANCY
dl
49. Consumptive coagulopathy is most commonly found in ?
PR
Coagu- - + - + a. Abruption (DNB Dec’ 2010)

lopathy b. IUCD
Other Pruritus, Hyperten- c. Retained products of conception
specific Viral Hypoglyce- elevated sion, pro- d. Dead fetus
features markers mia, renal bile acids teinuria,
positive failure, edema,
pg. 391; William’s Obs. 24th/e pg. 797, 811]
coma thrombo-
cytopenia, 50. Consumption coagulopathy is seen with- (PGMEE 2012-13)
hyperuri- a. Abruptio placentae b. Placenta previa
cemia c. Placenta accreta d. Retained placenta
Treatment – early diagnosis and aggressive supportive care pg. 391; William’s Obs. 24th/e pg. 797, 811]
Definitive treatment – delivery → arrests hepatic function
deterioration 51. Pregnant women going for long journey & prolonged
sitting is associated with danger of- (PGMEE 2013-14)
a. Thromboembolism b. Seat belt compression
c. Preterm labor d. Bleeding
[Ref: Dutta’s Obs. 9th/e, pg. 412; Williams Obs. 23rd/e, pg.
1024, 1027]
800
CHAPTER 8: INFECTIONS IN PREGNANCY
INFECTIONS IN PREGNANCY 8. Maximum transmission of HIV occurs during-

(PGMEE 2012-13)
1. Indicative of intra uterine infection is presence of:- a. Near term b. Antepartum
(PGMEE 2016-17) c. Labour d. Breast feeding
a. Ig M b. Ig G
[Ref: Dutta’s Obs. 9th/e, pg, 242; Williams Obstetrics, 24th/e,
c. Ig A d. Ig E
pg. 1278, 1279]
[Ref: Dutta’s Obs. 9th/e, pg.38; Williams Obs. 24th/e, pg. 1239]
Explanation
TUBERCULOSIS
Transmission of HIV
○○ Near term → 50%
2. Antitubercular drug contraindicated in pregnancy-
○○ Antepartum → 20–36%
(PGMEE 2001, 2005)
○○ Labour → 30%
a. Streptomycin b. Rifampicin
○○ Breast feeding → 30–40%
c. INH d. Ethambutol
9. If untreated, percentage of mother to child transmission of
/e
e. Pyrazinamide
HIV during delivery without intervention in a non-breast
[Ref: Williams Obs. 24th/e, pg. 1021; Dutta’s 9th/e, pg.275;] fed child is- (AIIMS Nov 2013)
HEPATITIS B a. 40-50% b. 10-15%
c. 15-30% d. 5%

a. BCG
c. OPV
b. Yellow fever
d. Hepatitis B
,2
3. Vaccines contraindicated in pregnancy are all EXCEPT:
(DNB June’ 2010)
[Ref: Arias, 3rd/e, pg. 142-150, 155-156; Williams Obstetrics,
24th/e, pg. 1278]
10. A pregnant woman has been detected with HIV in 1st
trimester of pregnancy. Which of the following statements
1.
2.
a
a
Es
3. d
[Ref: Dutta’s Obs. 9th/e, pg, 272; Arias, 3rd/e, pg. 158, 543; is correct according to NACO guidelines for ART for this
women:- with HIV in early pregnancy, NACO guidelines 4. b
Williams Obstetrics, 24th/e, pg. 208 & 1091]
suggest the use of:- (PGMEE 2018) 5. d
PARVOVIRUS B 19 a. Started immediately and continued in whole pregnancy, 6. d
puerperium and taken life long 7. b
iM
4. Non immune hydrops fetalis is associated with? b. ART started after first trimester and continued lifetime 8. a
(DNB June’ 2010) c. ART started after 1st trimester, continued throughout 9. c
a. Hepatitis B b. Parvovirus B19 pregnancy and stopped 6 weeks after delivery
c. Tuberculosis d. Malaria 10. a
d. ART started immediately, continued throughout pregnancy
[Ref: Dutta’s Obs. 9th/e, pg, 462; Arias, 3rd/e, pg. 95-96; and stopped 6 weeks after delivery
PR
Williams Obstetrics, 24th/e, pg. 315, 317, 1245] Ref: Holland Brew’s Obs.4th / e, pg.177
5. Non immune hydrops fetalis is caused by all except-
Explanation
(PGMEE 2007)
a. Parvo virus B19 b. Chromosomal abnormalities NACO Guidelines
c. Alpha thalassaemia d. ABO incompatibility For Prevention of Parent to Child Transmission (PPTCT) of
[Ref: Dutta’s Obs. 9th/e, pg, 462 Arias, 3rd/e, pg. 95-96; HIV using Multidrug Anti-retroviral Regimen
Williams Obstetrics, 24th/e, pg. 315, 316, 317, 1245] Updated in December 2013, effective from 1st January
2014
HIV Time for starting –
○○ ART should be started immediately after detection
6. Least rates of HIV transmission is seen in?(DNB Dec’ 2010) ○○ ART should be started irrespective of the following-
a. Forceps delivery b. Breast feeding – Gestational age
c. Normal delivery d. Cesarean section – CD4 count
– WHO clinical stage
[Ref: Dutta’s Obs. 9th/e, pg, 282; Williams Obstetrics, 24th/e, Eligible candidates for ART- all HIV positive pregnant and
pg. 1282] lactating women requiring ART for –
7. Least teratogenic potential is of? (PGMEE June’ 2012) ○○ Their own sake
a. CMV b. HIV ○○ Prevention of mother to child transmission
c. Varicella d. Rubella Duration of ART – should be continued lifelong
[Ref: Dutta’s Obs. 9th/e, pg, 282; Williams Obstetrics, 24th/e,
801
pg. 1242, 1243]
PRIMES (Volume II)
CMV Explanation
Vertical transmission of toxoplasmosis
11. Least commonly vertically transmitted organism of the ○○ 1st trimester → 15%
following is? (DNB June’ 2011) ○○ 2nd trimester → 30%
a. Herpes simplex b. CMV ○○ 3rd trimester → 60%
c. Human papilloma virus d. Rubella ○○ During delivery → 0%
[Ref: Dutta’s Obs. 9th/e, pg, 280, 282; Arias 3rd/e, pg. 142-
150; Williams Obstetrics, 24th/e, P. 1243, 1247, 1271, 1275]
MALARIA
RUBELLA 15. Malaria in pregnancy doesn’t cause? (PGMEE 2014)

a. HELLP syndrome b. IUGR
c. IUD d. Preterm
12. Maximum transmission of rubella occurs in?
(PGMEE Nov.12 Pattern) [Ref: Dutta’s Obs. 9th/e, pg, 278b]
a. 1st trimester b. 2nd trimester
c. 3rd trimester d. Labour GYNECOLOGICAL COMPLICATIONS IN
[Ref: Dutta’s Obs. 9th/e, pg, 280; Arias 3rd/e, pg. 142-150; PREGNANCY
/e
Williams Obstetrics, 24th/e, P. 1243]
VAGINITIS
VARICELLA
16. Most common vaginal infection in pregnancy is?
,2
13. 6 year old son of a pregnant woman is suffering from (DNB June’ 2011, PGMEE Aug. 12 Pattern)
chicken pox. Which of the following should be given to the a. Gonorrhea b. Trichomoniasis
pregnant woman- (PGMEE 2012-13) c. Candidiasis d. Bacterial vaginosis
11. b
a. Acyclovir [Ref: Dutta’s Obs. 9th/e, pg, 287; Williams Obs., 24th/e,
12. a b. Vaccination pg.1276]
Es
13. c c. Only immunoglobulin
14. c d. Acyclovir + immunoglobulin FIBROID
15. a [Ref: Dutta’s Obs. 9th/e, pg, 281; Arias 3rd/e, pg. 142-150;
16. c Williams Obstetrics, 24th/e, P. 1241] 17. Red degeneration of fibroid is seen in- (PGMEE 2013-14)
17. b a. Early pregnancy b. Mid pregnancy
iM
TOXOPLASMOSIS c. Multiparous women d. Nulliparous women

[Ref: Dutta’s Obs. 9th/e, pg, 289]
14. Vertical transmission of toxoplasmosis most commonly
occurs in? (DNB June’ 2011)
a. 1st trimester b. 2nd trimester
PR
c. 3rd trimester d. During delivery

[Ref: Dutta’s Obs. 9th/e, pg, 278; Arias 3rd/e, pg. 160-163;
Williams Obstetrics, 24th/e, P. 1255]
802
CHAPTER 9: FETAL SKULL AND MATERNAL PELVIS
FETAL SKULL 9. The dimension of fetal skull which is not 9.5 cm:-
(PGMEE 2016-17)
1. Longest diameter of fetal skull is? a. Biparietal b. Occipitofrontal
(DNB June’ 2009, 2011, PGMEE 2013) c. Suboccipitobregmatic d. Submentobregmatic
a. Submentobregmatic b. Mentovertical
c. Suboccipitofrontal d. Occipitofrontal [Ref: Dutta’s Obs. 9th/e, pg. 77, 78t; Holland Brew’s Obs. 4th/e,
pg. 56t]
[Ref: Dutta’s Obs. 9th/e, pg. 78t; Holland Brew’s Obs. 4th/e,
pg. 56t] MATERNAL PELVIS
2. Largest presenting diameter of brow presentation is? 10. Least diameter of gynecoid pelvis is- (PGMEE 2012-13)
(DNB June’ 2010) a. Transverse b. Oblique
a. Submentobregmatic b. Mentovertical c. Diagonal conjugate d. Obstetric conjugate
c. Submentovertical d. Suboccipitofrontal
4th/e, pg. 10, 11t]
pg. 56t]
/e
11. Which of the following is most commonly clinically used-
3. Markedly deflexed head of baby causes which diameter to
a. Diagonal conjugate (PGMEE 2012-13)
engage- (PGMEE 2012-13)
b. Ant post diameter of inlet
a. Occipitofrontal b. Suboccipitofrontal
,2
c. Transverse diameter of outlet
c. Mentovertical d. Submentovertical
d. Oblique diameter of pelvis
[Ref: Dutta’s Obs. 9th/e, pg. 81; Holland Brew’s Obs.4th/e, 1. b
pg. 56t]
pg. 10]
2. b
4. Mentovertical diameter of fetal skull is-
12. Smallest diameter of pelvis is? (DNB Dec’ 2009)
Es
(PGMEE 2012-13) 3. a
a. Interspinous diameter b. Intertuberous diameter 4. d
a. 9.5 cm b. 10 cm
c. Diagonal conjugate d. True conjugate
c. 11.5 cm d. 14 cm 5. d
[Ref: Dutta’s Obs. 9th/e, pg. 80-83; Holland Brew’s Obs.4th/e, 6. a
[Ref:Dutta’s Obs. 9th/e, pg. 78t; Holland Brew’s Obs. 4th/e,
pg. 10-11] 7. c
pg. 56t]
iM
13. Interspinous diameter- (PGMEE 2012-13) 8. d

5. Maximum diameter of fetal skull that passes through
a. 10.5 cm b. 11 cm 9. b
maternal pelvis- (PGMEE 2013-14)
c. 11.5 cm d. 12 cm 10. d
a. Suboccipitobregmatic b. Biparietal
c. Suboccipitofrontal d. Occipitofrontal [Ref: Dutta’s Obs. 9th/e, pg. 82; Holland Brew’s Obs.4th/e, 11. a
PR
pg. 10-11] 12. a

[Ref: Dutta’s Obs. 9th/e, pg. 77, 78t; Holland Brew’s Obs.
4th/e, pg. 56t] 13. a
CONTRACTED PELVIS 14. c
6. The widest transverse diameter of the fetal skull is-
15. a
a. Biparietal diameter (PGMEE 2014) 14. Triradiate pelvis is seen in- (PGMEE 2097)
b. Bitemporal diameter 16. b
a. Rickets b. Chondrodystrophy
c. Suboccipitobregmatic diameter c. Osteomalacia d. Hyperparathyroidism
d. Occipitofrontal diameter
[Ref: Dutta’s Obs. 9th/e, pg. 77; Holland Brew’s Obs. 4th/e, pg.
56t] 15. Dystocia dystrophia syndrome is seen in- (PGMEE 2006)
a. Android pelvis b. Platypelloid pelvis
7. Which of the following is transverse diameter of fetal c. Anthropoid d. Gynaecoid pelvis
skull? (PGMEE 2016-17)
a. Occipitofrontal b. Suboccipitofrontal [Ref: Dutta’s Obs. 9th/e, pg. 327]
c. Biparietal d. Mentovertical 16. Deep transverse arrest is most commonly seen in?
[Ref: Dutta’s Obs. 9th/e, pg. 77; Holland Brew’s Obs. 4th/e, pg. (DNB June’ 2011, PGMEE 2014)
56] a. Anthropoid pelvis b. Android pelvis
c. Gynaecoid pelvis d. Platypelloid pelvis
8. In extended head, engaging diameter is:-(PGMEE 2016-17)
a. Submentovertical b. Mentovertical [Ref: Dutta’s Obs. 9th/e, pg. 325t, 327; Holland Brew’s Obs.
c. Suboccipitobregmatic d. Submentobregmatic 4th/e, pg. 12, 13t]
803
[Ref: Dutta’s Obs. 9th/e, pg. 78t; Holland Brew’s Obs. 4th/e, pg. 56t]
PRIMES (Volume II)
Explanation 17. Antero-posteriorly oval pelvic inlet is seen in-

Deep Transverse Arrest (DTA) – head is arrested deep (PGMEE 2012-13)
into the pelvis with sagittal suture in transverse bispinous a. Android pelvis b. Platypelloid pelvis
diameter of the pelvis for > 2 hrs inspite of good uterine c. Anthropoid pelvis d. Gynaecoid pelvis
contractions, fully dilated cervix and ruptured membranes. [Ref: Dutta’s Obs. 9th/e, pg. 325t; Holland Brew’s Obs. 4th/e,
In android pelvis – pg. 12, 13t]
○○ The cavity is deep & narrow with convergent side walls.
○○ Oblique occipito-posterior or occipito-lateral positions 18. Most suitable type of pelvis in female- (PGMEE 2012-13)
are common. a. Gynaecoid b. Android
○○ Anterior rotation is difficult → chances of deep transverse c. Anthropoid d. Platypelloid
arrest. [Ref: Dutta’s Obs. 9th/e, pg. 325t; Holland Brew’s Obs. 4th/e,
○○ Nowadays intervention is done earlier, rather than waiting pg. 12, 13t]
for full 2 hrs, to avoid feto-maternal complications and to
lessen morbidity and mortality.
○○ Caesarean section is the preferred mode of intervention
in current obs. Practice rather than difficult instrumental
vaginal delivery.
/e
17. c
18. a ,2
Es
iM
PR
804
CHAPTER 10: NORMAL AND ABNORMAL LABOR
NORMAL LABOR Stage Characteristics

2 Complete cervical dilatation with active expulsive efforts
PARTOGRAPH
by the mother
1. Which is true about normal partography? 3 Delivery of placenta and membranes
(PGMEE June 2012) 4 "The Golden hour"
a. Latent phase is till 5 cm cervical dilation One hour after delivery of baby. The mother should be
b. First stage is till the full cervical dilatation monitored for signs of post partum hemorrhage.
c. Used mainly for maternal BP monitoring
d. Rate of dilatation in latent phase is 1 cm/hr
MECHANISM OF LABOR
[Ref: Dutta’s Obs. 9th/e, pg. 491-493]
2. What is the purpose of partogram? (PGMEE June’ 2012) 6. The cardinal movements during normal labor occur in
a. To monitor progress of labor following order? (PGMEE June’ 2012)
/e
b. To monitor induction of labor a. Engagement, internal rotation, delivery of head, restitution,
c. To assess the female pelvis external rotation
d. To find CPD b. Engagement, internal rotation, restitution, delivery of
[Ref: Dutta’s Obs. 9th/e, pg. 493] head, external rotation
,2
c. Engagement, external rotation, delivery of head, internal
3. Partogram is not used to monitor- (PGMEE 2012-13)
rotation, restitution
a. Cervical dilatation b. Uterine contractions
d. Engagement, delivery of head, internal rotation, restitution,
c. Descent of head d. Fetal lung maturity 1. b
external rotation
[Ref: Dutta’s Obs. 9th/e, pg. 493] 2. a
[Ref: Dutta’s Obs. 9th/e, pg. 121;Holland Brew’s Obs. 4th/e,
Es
4. W.H.O. modified partogram charting starts at cervical 3. d
pg. 273, 276f]
dilatation of? (PGMEE Aug. 12 Pattern) 4. c
a. 2 cm b. 3 cm LABOR EVENTS 5. a
c. 4 cm d. 5 cm 6. a
[Ref: Dutta’s Obs. 9th/e, pg. 491; Holland Brew’s Obs.4th/e, 7. Which of the following is a sure sign of labor? 7. d
iM
pg. 278] a. Bag of waters (PGMEE June’ 2012)

5. Mrs. S (G2 L1) presented to the hospital in labor pains. On b. Cervical effacement
examination she had 3 uterine contractions of 20 seconds c. Show
in 10 minutes, Cervical dilation 6 cm and HR 145 bpm. d. Progressive dilatation of cervix
What is the stage of labor? (AIIMS Nov’ 2017) [Ref: Dutta’s Obs. 9th/e, pg. 113]
PR
a. Stage I b. Stage II
c. Stage III d. Stage IV Explanation
[Ref: Dutta’s Obs. 8th / e, pg. 138; Holland Brew’s Bag of waters:
Obs.4th / e, pg. 270-271; Williams Obs. 24th / e, pg. 412-417]
Bag of waters: Bag of unsupported fetal membranes
Explanation (detached from lower segment due to its stretching)
containing amniotic fluid. Uterine contraction → rise of
Uterine contractions which bring about cervical effacement
intra-amniotic pressure → bag becomes tense & convex,
and dilatation. .
uterine contraction passes off → bulging disappears
Stages of Labour: Diagnostic criteria completely, almost a certain sign of onset of labour
Stage Characteristics Cervical effacement

Cervical effacement: taking up of cervix, muscle fibers
1 From 0 cm to 10 cm dilatation.
Divided into latent phase and active phase.
of cervix pulled upward & merge with the fibers of lower
(A) Latent phase: The point at which mother perceives
uterine segment
regular contractions. Prolonged latent phase is >20 Show
hours in primi and > 14 hours in multigravida Show: expulsion of cervical mucus plug mixed with blood
(B)Active phase: Cervical dilatation of 3 to 5 cm or more
in the presence of uterine contractions. Defined as Progressive dilatation of cervix:
slow if <1.2 cm per hour dilatation or <1 cm descent Progressive dilatation of cervix: actual factors responsible
of head in primigravida and <1.5 cm dilatation per are- uterine contraction & retraction, bag of membranes,
hour or <2 cm descent per hour in multigravida. fetal axis pressure, vis-a-tergo. 805
PRIMES (Volume II)
8. Cervical effacement suggestive of onset of labor is? 15. Vacuum delivery produces- (PGMEE 2012-13)
(PGMEE June’ 2012, PGMEE Aug. 12 Pattern) a. Chingon b. Cephalhaematoma
a. 15 mm b. 25 mm c. Both d. None
c. 30 mm d. 20 mm [Ref: Dutta’s Obs. 9th/e, pg. 540 541]
16. Vacuum cup is placed? (PGMEE Nov. 12 Pattern)
414, 415]
a. Posterior to posterior fontanelle
9. Percentage of women delivering on their EDD is - b. Posterior to anterior fontanelle
(PGMEE 2012-13) c. Anterior to posterior fontanelle
a. 25% b. 50% d. Anterior to anterior fontanelle
c. 4% d. 15%
[Ref: Dutta’s Obs. 9th/e, pg. 108] pg. 496]
10. Pain in early labor is limited to dermatomes- 17. All of the following complications are more common in
(PGMEE 2013-14) ventouse assisted delivery than forceps except-
a. T10-L1 b. S1-S3 a. Subgaleal hemorrhage (AIIMS Nov 2013)
c. L4-L5 d. L2-L3 b. Cephalhaematoma
[Ref: Dutta’s Obs. 9th/e, pg. 479] c. Intracranial hemorrhage
/e
11. Active management of 3rd stage of labor includes all d. Transient lateral rectus palsy
except:- (PGMEE 2016-17) [Ref: Dutta’s Obs. 9th/e, pg. 538, 541; Holland Brew’s Obs.
a. Early cord clamping b. Uterine massage 4th/e, pg. 495]
,2
c. Utererotonic drugs after delivery of anterior shoulder
d. Assisted removal of placenta 18. Use of ventouse is preferred over forceps in the delivery of-
a. Occipito-posterior position (PGMEE 2013)
8. b [Ref: Dutta’s Obs. 9th/e, pg. 134; Holland Brew’s Obs.4th/e,
b. After coming head in breech
9. c pg. 2711
c. Face presentation
Es
10. a d. Fetal distress
11. a
INDUCTION OF LABOR
12. All of the following drugs are effective for cervical ripening [Ref: Dutta’s Obs. 9th/e, pg. 348; Holland Brew’s Obs.4th/e,
12. c pg. 296]
during pregnancy except - (PGMEE 2004)
13. c
a. Prostaglandins E2 b. Oxytocin 19. Contraindication for vacuum delivery:-(PGMEE 2016-17)
14. d c. Progesterone d. Misoprostol a. Fetal distress
iM
15. c b. Prolonged labor

16. c Obs.4th/e, pg. 367-369] c. Premature baby
17. d d. Eclampsia
18. a Explanation
PR
19. c Although oxytocin is less effective in causing cervical pg. 361, 494]
20. a ripening, it is effective for inducing / augmenting labour in
21. c
already ripened cervix. FORCEPS
13. All are true about oxytocin except - (PGMEE 2013)
a. Originates in the supraoptic nucleus of the hypothalamus 20. Nerve block given in forceps delivery- (PGMEE 2013-14)
b. Is essential for the onset of labor a. Pudendal b. Ilio inguinal
c. Stimulates the growth of uterine musculature c. Genitofemoral d. Posterior femoral
d. Not a good cervical ripening agent
pg. 369]
FETAL MALPOSITIONS AND
ASSISTED LABOR MALPRESENTATIONS
VENTOUSE OCCIPITOPOSTERIOR POSITION
14. In Vacuum assisted delivery cup is attached? 21. Assisted head delivery is done in- (PGMEE 2013-14)
a. 2 cm anterior to anterior fontanelle (PGMEE 2014) a. Brow presentation
b. 2 cm anterior to posterior fontanelle b. Face presentation
c. 3 cm anterior to anterior fontanelle c. Persistent occipito posterior position
d. 3 cm anterior to posterior fontanelle d. Twin presentation
[Ref: Dutta’s Obs. 9th/e, pg. 540; Holland Brew’s Obs. 4th/e, [Ref: Dutta’s Obs. 9th/e, pg. 349; Holland Brew’s Obs. 4th/e,
806 pg. 496] pg. 295, 296]
Obstetrics Chapter 10 Normal and Abnormal Labor (MCQs)
Explanation 29. Image showing Mauriceau procedure. The procedure

shown is being done for :- (PGMEE 2016-17)
Mode of delivery depends on station of head -:
If at or above ischial spines - caesaren section
If below ischial spines - face to pubis delivery (forceps
application may be required, liberal mediolateral episiotomy
given)
22. Which of the following is the most common occipito
posterior position:- (PGMEE 2015-16)
a. Left occipitoposterior b. Direct occipitoposterior
c. Indirect occipitoposterior d. Right occipitoposterior
pg. 291] a. Face to pubes delivery b. Second baby in twins
c. Aftercoming head of breech
BREECH d. Impacted shoulder
23. Most common breech presentation is? (DNB June’ 2011)
/e
pg. 308f]
a. Right Sacroanterior b. Left sacroanterior
c. Left sacroposterior d. Right sacroposterior 30. A 30 year old female G2P1, presenting with a 28 weeks
pregnancy. USG scan shows placenta lying partially over
the os. The most common complication associated with this

pg. 304]
24. Least chances of cord prolapse are seen in?
a. Frank breech
c. Footling
b. Knee presentation
d. Complete breech
,2
(DNB June’ 2011, PGMEE 2013)

pregnancy can be:-
a. Vasa praevia
c. Hydramnios
(PGMEE 2016-17)
b. Placenta accreta
d. Breech presentation
22.
23.
d
b
Es
Obs.4th/e, pg. 304] 24. a
[Ref: Dutta’s Obs. 9th/e, pg. 355; Holland Brew’s Obs. 4th/e, 25. b
pg. 303] 31. External cephalic version is done after-(PGMEE 2012-13)
a. 34 weeks b. 36 weeks 26. d
25. Percentage of breech presentation at term is? c. 38 weeks d. 40 weeks 27. a
(PGMEE Aug 13 Pattern, PGMEE 2011, 2016-17) 28. d
iM
a. 1 b. 3 29. c
c. 7 d. 10 32. While carrying out external cephalic version, persistent
foetal bradycardia occurs, how will you proceed:- 30. d
[Ref: Dutta’s Obs. 9th/e, pg. 351; Holland Brew’s Obs.4th/e, pg. 303] a. Emergency LSCS (PGMEE 2016-17) 31. b
26. Not a method for delivery of after-coming head of breech- b. Convert to IPV 32. c
PR
a. Forceps method (PGMEE 2012-13) c. Revert to original position

b. Burns and Marshall method d. Abandon the procedure
c. Malar flexion and shoulder traction [Ref: Dutta’s Obs. 9th/e, pg. 542; Holland Brew’s Obs. 4th/e,
d. Half hand method pg. 482; William’s Obs. 24th/e pg. 570]
[Ref: Dutta’s Obs. 9th/e, pg. 360, 361; Holland Brew’s 33. Primigravida presents at 36 weeks of gestation with
Obs.4th/e, pg. 307-308] complaint of preterm premature rupture of membranes
27. Most common cause of breech presentation is? or leaking per vaginum and the following presentation.
(PGMEE Aug 13 Pattern, PGMEE 2015-16) Management to be followed is? (PGMEE Nov 13 Pattern)
a. Prematurity b. Contracted pelvis
c. Oligohydramnios d. Placenta praevia
pg. 304]
28. Head of baby is delivered in breech presentation by which
maneuver- (PGMEE 2013-14)
a. Lovset’s maneuver
b. Pinard’s maneuver
c. Mc Robert’s maneuver
d. Burns Marshall method
[Ref: Dutta’s Obs. 9th/e, pg. 360; Holland Brew’s Obs.4th/e, 807
pg. 307]
PRIMES (Volume II)
a. ECV b. LSCS 41. Management of shoulder dystocia. Baby is delivered by:-

c. Induction of labor d. IPV (Internal podalic version) a. External cephalic version (PGMEE 2018)
b. Reflexly flex hip and bend thighs over mother’s abdomen
[Ref: Dutta’s Obs. 9th/e, pg. ; Holland Brew’s Obs. 4th/e, pg.]
c. Traction over baby’s head
34. Prague manuever is used for- (PGMEE 2012-13) d. Supra pubic pressure
a. After coming head in breech Ref: Dutta’s Obs. 8th / e, pg.469-470; Williams Obs. 24th
b. Deep transverse assest /e, pg.481-485
c. Extraction of extended arms
d. External cephalic version Explanation
[Ref: Dutta’s Obs. 9th/e, pg. 363; William’s Obs. 24th/e pg. Shoulder dystocia
564, 566f]
Difficulty in delivery of fetal shoulder by gentle traction
35. Burns Marshall method is- (PGMEE 2013-14) after delivery of fetal head.
a. Method of delivering after coming head in breech Due to impaction of anterior shoulder against pubic
b. Head rotation is deflexed head symphysis or posterior shoulder (rarely) against sacral
c. Breech extraction promontory respectively
d. Rotating head in D.T.A. Incidence – 0.2% to 1%
/e
[Ref: Dutta’s Obs. 9th/e, pg. 360; Holland Brew’s Obs.4th/e, Risk of recurrence – 13-25%
pg. 307] Management – shoulder dystocia drill-
○○ Call for help – assistant, anaesthesiologist, paediatrician
TRANSVERSE LIE ○○ Drainage of bladder (if distended)
33.
34.
b
a

the management?
a. External cephalic version
,2
36. A gravida 2 with 1 normal live birth has presented with
transverse lie at 37 weeks. What should be the next step of
(PGMEE June’ 2012)
○○ Generous episiotomy
○○ Traction posteriorly by grasping fetal head and neck
○○ Supra pubic pressure (requires only 1 assistant)
○○ McRoberts maneuver (requires 2 assistants, hyperflexion
of maternal thighs over her abdomen, increases AP
Es
35. a
b. Wait and Watch diameter of the pelvis, successful in ≈ 90% of cases)
36. a
c. Cesarean section When above techniques fail, following may be attempted -
37. a ○○ Wood’s corkscrew maneuver (requires general
d. Internal cephalic version
38. b anaesthesia)
39. c ○○ Extraction of the posterior arm (requires general
iM
pg. 482]
40. a anaesthesia)
41. b 37. Cord prolapse is most commonly associated with- ○○ Gaskin’s maneuver – “All Fours” position (may be
a. Transverse lie (PGMEE 2096) attempted in a mobile thin patient in low resource setting)
42. a
b. Breech Rarely performed techniques are –
43. a ○○ Cleidotomy (deliberate fracture of clavicle – unilateral or
c. Contracted pelvis
PR
d. Prematunity bilateral)
○○ Zavanelli’s maneuver (reposition of fetal head into pelvis
→ cesarean section)
pg. 313] ○○ Symphysiotomy
38. Management of neglected shoulder presentation is -
a. Vaginal delivery (PGMEE 2012-13) FACE PRESENTATION
b. Caesarean section
c. External version 42. Most unfavourable presentation for vaginal delivery is-
d. Internal version (PGMEE 1995)
a. Mento posterior b. Mento anterior
[Ref: Dutta’s Obs. 9th/e, pg. 372; Holland Brew’s Obs.4th/e, c. Occipito posterior d. Deep transverse arrest
pg. 313]
39. Rarest presentation is- (PGMEE 2012-13) pg. 301f]
a. Cephalic b. Breech
c. Shoulder d. Vertex BROW PRESENTATION
43. Presentation when the engaging diameter is Mentovertical
40. Presenting part in transverse lie- (PGMEE 2012-13) is? (PGMEE Aug. 12 Pattern)
a. Shoulder b. Face a. Brow b. Breech
c. Vertex d. Brow c. Vertex d. Face
808 [Ref: Dutta’s Obs. 9th/e, pg. 69, 368; Holland Brew’s Obs. [Ref: Dutta’s Obs. 9th/e, pg. 78t, 367; Holland Brew’s Obs.
4th/e, pg. 312f] 4th/e, pg. 302f]
COMPOUND PRESENTATION 53. Indication of classical caesarean section- (PGMEE 2012-13)

a. Cervical cancer b. Contracted pelvis
44. The commonest cause for cephalic presentation with hand c. Non re-assuring FHR d. None
alongside the head is- [Ref: Dutta’s Obs. 9th/e, pg. 547]
a. Multiple Pregnancy b. Prematurity 54. Chances of uterine rupture are least in- (PGMEE 2013-14)
c. Contracted pelvis d. Polyhydramnios a. LSCS b. Classical
[Ref:Dutta’s Obs. 9th/e, pg. 372; Holland Brew’s Obs. 4th/e, c. Inverted d. Low vertical
pg. 314] [Ref: Dutta’s Obs. 9th/e, pg. 308t]
55. In classical section more chances of rupture of uterus is
LSCS in- (PGMEE 2013-14)
a. Upper uterine segment b. Lower uterine segment
45. Advantage of LSCS as compared to classical C- section are c. Utero cervical junction d. Posterior uterine segment
all except: (DNB June’ 2009)
a. Lateral extension [Ref: Dutta’s Obs. 9th/e, pg. 308t]
b. Less blood loss 56. Incomplete uterine rupture is defined as? (PGMEE 2014)
c. Less chance of gutter formation a. Disruption of part of scar
/e
d. Minimal wound hematoma b. Disruption of entire length of scar
[Ref: Dutta’s Obs. 9th/e, pg. 552t] c. Disruption of scar including peritoneum
d. Disruption of scar with peritoneum intact
46. Incidence of rupture in classical c-section is?
,2
(DNB June’ 2009)
a. 0.5-1.5% b. 2-5% 57. What is the risk of scar rupture in LSCS?
c. 4-9% d. >10% (PGMEE Aug 13 Pattern, PGMEE 2015-16)
44. b
[Ref: Dutta’s Obs. 9th/e, pg. 552t] a. 1-2% b. 2-5%
c. 4-9% d. >10% 45. a
Es
47. Classical caesarean section is done in? 46. c
[Ref: Dutta’s Obs. 9th/e, pg. 308t]
(DNB Dec’ 2010, PGMEE 2012-13) 47. a
a. Carcinoma cervix b. Placenta previa
c. Previous cesarean d. Failed trial of labor
PRECIPITATE LABOR 48. d
49. c
[Ref: Dutta’s Obs. 9th/e, pg. 547] 58. Precipitate labor is said to be when first and second stage
together last for less than? (PGMEE Nov. 13 Pattern) 50. c
iM
48. Which is the commonest indication of classical cesarean a. 2 hours b. 3 hours 51. b
section? (PGMEE June’ 2012) c. 4 hours d. 6 hours 52. b
a. Transverse lie b. Cord prolapse 53. a
c. Placenta praevia
54. a
d. Dense adhesion in lower uterine segment ABNORMAL UTERINE ACTION
PR
55. a
[Ref:Dutta’s Obs. 9th/e, pg. 547] 59. Bandl’s ring is caused by- (AIIMS 94) 56. d
49. Absolute indication of Cesarean Section is?(PGMEE Aug. a. Uterine inertia 57. a
12 Pattern) b. Cephalopelvic disproportion
58. b
a. Placenta Previa b. Breech presentation c. Malepresentation
d. None 59. b
c. Gross CPD d. Previous Cesarean section
60. a
[Ref: Dutta’s Obs. 9th/e, pg. 546t] [Ref: Dutta’s Obs. 9th/e, pg. 339, 379]
50. Indication of caesarean section after previous caesarean 60. A lady presents at 37 weeks of gestation with uterine
section is? (PGMEE Aug. 12 Pattern) contraction and pain suggestive of labor for 20 hours.
a. Hypertension b. Multigravida On examination cervix is persistently 1 cm dilated and
c. CPD d. Type 1 placenta previa uneffaced. What should be the next line of treatment?
a. Sedation and wait (PGMEE 2011))
b. Caesarean section
51. Caesarean section is recommended for-(PGMEE 2012-13) c. Augmentation with Oxytocin & Amniotomy
a. Rubella infected mother b. HSV infected mother d. Induction with rupture of membranes
c. CMV infected mother d. Measles infected mother [Ref:Dutta’s Obs. 9th/e, pg. 378]
[Ref: William’s Obs. 24th/e pg. 1274]
Explanation
52. Definitive indication of LSCS- (PGMEE 2012-13) This case scenario is suggestive of “Prolongation disorder”,a
a. Mento anterior b. Persistent mento posterior type of dystocia or difficult labour.
c. Occipito posterior d. Vertex This type of abnormal labour pattern is d/t prolonged latent 809
[Ref: Dutta’s Obs. 9th/e, pg. 365] phase
PRIMES (Volume II)
67. Ergometrine is contraindicated in- (PGMEE 2012-13)

Primigravida Multipara
a. Third stage of labor with heart disease
Mean duration of latent phase 8 hrs 4 hrs b. Third stage uterine bleeding
Prolonged latent phase > 20 hrs > 14 hrs c. Both
d. None
Causes – [Ref: Dutta’s Obs. 9th/e, pg. 134, 468b]
○○ Cephalopelpic disproportion
68. Role of ergometrine to stop post partum hemorrhage is
○○ Malpositions & malpresentations
due to- (PGMEE 2012-13)
○○ Unfavourable Bishop’s score
a. Increased uterine muscle tone
○○ Premature rupture of membranes
b. Vasoconstriction
○○ Early onset of regional analgesia c. Increased platelet aggregation
Management- d. Increased coagulation
○○ Expectant (rest & analgesia) – preferred treatment if fetal
& maternal conditions reassuring [Ref: Dutta’s Obs. 9th/e, pg. 467]
○○ Augmentation with oxytocin to expedite delivery SOS 69. Commonest cause of PPH is- (PGMEE 2012-13)
○○ Caesarean section for urgent problems (prolonged latent a. Uterine atony b. Traumatic
phase per se is not an indication for caesarean section) c. Retained tissues d. Blood coagulopathy
/e
OBSTRUCTED LABOR
70. Which one of the following is a cause of secondary post-
61. Most common cause of obstructed labor in India
partum hemorrhage:- (PGMEE 2018)
(PGMEE Aug. 12 Pattern)
,2
a. Placenta previa b. Retained bits of placenta
a. Android pelvis b. Anthropoid pelvis
c. Placental abruption d. All of the above
c. Platypelloid pelvis d. Gynecoid pelvis
61. a [Ref: Dutta’s Obs. 8th / e, pg. 474-476; Holland Brew’s
[Ref: Dutta’s Obs. 9th/e, pg. 325t. 327; Holland Brew’s Obs.
62. b Obs.4th / e, pg. 347, 403; Williams Obs. 24th / e, pg. 670-671]
4th/e, pg. 12]
Es
63. b Explanation
62. Uterine rupture is most common in- (PGMEE 2013-14)
64. c a. Ant lower segment scar b. Classical C.S. Secondary Post-partum Hemorrhage
65. a c. Placenta previa d. Normal labor
66. a Also known as delayed or late PPH
[Ref: Dutta’s Obs. 9th/e, pg. 308t] Uterine bleeding 24 hours to 12 weeks after delivery
67. a
(ACOG - 2013b)
iM
63. In obstructed labor most important parameter is-

68. a Common causes –
(PGMEE 2013-14)
69. a a. Diameter of pelvic inlet b. Diameter of pelvic outlet ○○ Retained products of conception (bits of placenta and
70. b c. Biparietal diameter d. Bitemporal diameter membranes)
○○ Infection of genital tract
PR
○○ Trauma to genital tract (lacerations and haematomas)

pg. 12, 13t]
○○ Uterine artery pseudoaneurysm
○○ Placental polyp
COMPLICATION OF 3rd STAGE OF LABOR ○○ Submucous myomas
64. Commonest cause of postpartum hemorrhage in multipara ○○ Chronic inversion of uterus
is- (PGMEE 2012-13) ○○ Trophoblastic disease
a. Fibroid b. Retained placenta ○○ Coagulopathies (including von Willebrand’s disease)
c. Uterine atony d. Uterine perforation Management – clinical assessment and investigations to
[Ref: Dutta’s Obs. 9th/e, pg. 385] establish the cause of secondary PPH
○○ Clinical assessment (vital parameters, pallor, uterine
65. Amount of blood passing through placenta on delayed tenderness and subinvolution, offensive lochia, lower
cord clamping- (PGMEE 2012-13) genital tract examination for signs of trauma, retained
a. 50-100 ml b. 100-200 ml POCs, haematomas, foreign bodies viz. forgotten
c. 120-150 ml d. 150-180 ml sponges)
[Ref: Dutta’s Obs. 9th/e, pg. 131] ○○ Investigations (CBC, coagulation profile, vaginal swab
c/s, pelvic USG to detect retained POCs)
66. Active management of 3rd stage of labor is helpful in ○○ Medical management (with oxytocin, methylergonovine,
prevention of- (PGMEE 2012-13) prostaglandin analogue along with broad spectrum
a. Atonic PPH antibiotic) preferred in a stable patient with USG showing
b. Secondary PPH empty uterine cavity).
c. Uterine inertia ○○ Surgical management (gentle suction curettage) indicated
d. APH in patients with heavy bleeding, recurrent bleeding,
810
[Ref: Dutta’s Obs. 9th/e, pg. 134, 387] sepsis, subinvolution.
71. All are used in the treatment of atonic PPH except - 75. Complete perineal tear occurs in?
(PGMEE 2012-13) a. Assisted breech (PGMEE Nov 13 Pattern)
a. PGE2 b. PGE1 b. External breech
c. PGF2 alpha d. Oxytocin c. Face to pubes delivery
[Ref: Dutta’s Obs. 9th/e, pg. 389] d. Occipito posterior position of head
72. Prophylactic methergine given for- (PGMEE 2012-13)
a. Induction of labor 76. Type of suture used in complete perineal tear repair is-
b. Induction of abortion (PGMEE 2013-14)
c. To stop excess bleeding from uterus a. Catgut b. Silk
d. All of the above c. Vicryl d. Vicryl and catgut
[Ref: Dutta’s Obs. 9th/e, pg. 134, 467] [Ref: Dutta’s Obs. 9th/e, pg. 398]
77. Hematoma during labor is not due to- (PGMEE 2013-14)
INJURIES TO THE BIRTH CANAL a. Improper haemostasis
73. First sign of wound dehiscence in uterine rupture during b. Extension of cervical laceration
pregnancy- (PGMEE 2012-13) c. Rupture of paravaginal venous plexus
a. Tachycardia b. PV discharge d. Obliteration of dead space while suturing vaginal wall
/e
c. Bloody micturition d. Bradycardia [Ref: Dutta’s Obs. 9th/e, pg. 399]
[Ref: ; Dutta’s Obs. 9th/e, pg. 402, 403; Holland Brew’s Obs.
4th/e, pg. 341; Internet]

a. Multiparity
c. Precipitate labor
b. Obstructed labor
d. VBAC ,2
74. Most common cause of rupture uterus in India is?
(PGMEE Nov 13 Pattern)
[Ref: ;Dutta’s Obs. 9th/e, pg. 400; Holland Brew’s Obs. 4th/e,
71.
72.
a
c
Es
73. a
pg. 340]
74. a
75. c
76. c
77. d
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PR
811
CHAPTER 11: NORMAL AND ABNORMAL PUERPERIUM
NORMAL PUERPERIUM ABNORMALITIES OF PUERPERIUM

1. After delivery upto which week is known as puerperium- 8. In puerperal period sepsis is most commonly due to-
(PGMEE 2012-13) (PGMEE 2012-13)
a. 2 weeks b. 4 weeks a. Uterine infection b. Ovarian infection
c. 6 weeks d. 8 weeks c. Vaginal infection d. All of the above
[Ref: Dutta’s Obs. 9th/e, pg. 137] [Ref: Dutta’s Obs. 9th/e, pg. 406]
2. Uterus post pregnancy becomes a pelvic organ in- 9. Commonly involved in puerperal infection are all except-
(PGMEE 2013-14) (PGMEE 2012-13)
a. 4 weeks b. 6 weeks a. Anerobic streptococcus b. Staphylococcus
c. 12 weeks d. 2 weeks c. E. Coli d. None of the above
[Ref: Dutta’s Obs. 9th/e, pg. 138] [Ref: Dutta’s Obs. 9th/e, pg. 407; William’s Obs. 24th/e pg.
683; Holland Brew’s Obs. 4th/e, pg. 415]
3. Weight of uterus at term and just after delivery is-
/e
(PGMEE 2013-14) Explanation
a. 1000, 500 b. 1000, 1000
c. 1500, 1000 d. 500, 500 All these organisms are involved.
,2
10. Puerperal sepsis/infection occurs upto?
4th/e, pg.37, 395] (PGMEE Nov 13 Pattern)
4. Lochia is seen for- (PGMEE 1998) a. 1 week b. 2 week
1. c c. 3 week d. 4 week
a. 1-4 days b. 5-10 days
2. d [Ref: Dutta’s Obs. 9th/e, pg. 406]
c. 10-14 days d. 14-21 days
Es
3. b
[Ref: Dutta’s Obs. 9th/e, pg. 139; William’s Obs. 24th/e pg. 11. After delivery, mother has fever on the next day with
4. c 670; Holland Brew’s Obs.4th/e, pg. 396] temp. > 100.4 F, HR increased. What is the most probable
5. d diagnosis:- (PGMEE 2016-17)
6. c Explanation
a. Chorioamnionitis b. Puerperal pyrexia
7. d Average duration of lochia is 24 - 36 days. c. PID d. Retained placenta
iM
8. a [Ref: Dutta’s Obs. 9th/e, pg. 406]

9. d 5. Which one of the following sets of conditions is attributed
to normal physiology of puerperium- (PGMEE 2016) 12. Organisms involved in breast abscess are all except:-
10. b (PGMEE 2016-17)
a. Tachycardia and weight gain
11. b b. Retention of urine, constipation and weight gain a. Staphylococcus aureus b. Staphylococcus epidermidis
PR
12. d c. Constipation, tachycardia and retention of urine c. Streptococcus viridians d. β hemolytic Streptococcus
13. a d. Retention of urine and constipation [Ref: Dutta’s Obs. 9th/e, pg. 411]
14. b [Ref: Dutta’s Obs. 9th/e, pg. 139; Holland Brew’s Obs.4th/e, 13. Cause of post partum depression:- (PGMEE 2016-17)
pg. 396] a. Changes in the hypothalamo-pituitary-adrenal axis
6. Which of the following is correct order of lochia? b. Decreased tryptophan level
(AIIMS Nov 2013) c. Puerperal pyrexia
a. Serosa, alba, rubra b. Alba, rubra, serosa d. Positive family history
c. Rubra, serosa, alba d. Rubra, alba, serosa [Ref:Dutta’s Obs. 9th/e, pg. 415]
[Ref: Dutta’s Obs. 9th/e, pg. 139; Holland Brew’s Obs.4th/e, 14. Which of the following is not true about puerperal fever
pg. 396] a. Temp > 38 (100.4°F) (PGMEE 2016)
7. Immunological defense to a breastfed infant is provided by b. S. aureus is a most common cause
all these factors in breast milk except:- (PGMEE 2016-17) c. Anaerobic Streptococcus predominant pathogen
a. Interferons b. Lactoferrin d. Instrumental delivery increases risk
c. Immunoglobulins d. Fat globules [Ref: Dutta’s Obs. 9th/e, pg. 406, 407]
[Ref: Dutta’s Obs. 9th/e, pg. 140, 421]
812
CHAPTER 12: MISCELLANEOUS TOPICS IN OBSTETRICS
NEONATOLOGY HESS’S RULE

NORMAL TERM NEWBORN 8. Hess’s formula used in pregnancy to? (DNB June’ 2011)
a. Estimate fetal age
1. New born can be given breast milk after how much time b. Identify fetal blood group
following normal delivery- (PGMEE 2012-13) c. Identify fetal congenital malformations
a. Half hour b. 1 hours d. Identify fetal sex
c. 2 hours d. 3 hours [Ref: Dutta’s Obs. 9th/e, pg. 37; Forensic Medicine &
[Ref: Dutta’s Obs. 9th/e, pg. 421] Toxicology, K.S.N. Reddy 33rd/e pg. 84]
2. Ballard’s score is used to assess- (PGMEE 2012-13) Explanation

a. Brain development of child
b. Gestational age of child Hess’s rule:
c. Lung maturation of the child Used in pregnancy to estimate fetal age from the fetal length.
/e
d. Viability of the child States that the square of the number of calendar months of
[Ref: Dutta’s Obs. 9th/e, pg. 417; Williams Obs., 23rd/e, pg. 600] gestation gives the length of the fetus in centimeters upto
5th month.
3. Caput succedaneum indicates that fetus was alive till- The length of the fetus is determined by-
,2
a. Immediately after birth (PGMEE 2012-13) ○○ Crown-rump length (from the vertex to the coccyx) in
b. Till 2-3 days after birth earlier weeks
c. 2-3 weeks after birth ○○ Crown-heel length (from the vertex to the heel) from the 1. a
d. 2-3 months after birth end of 20th week onwards
2. b
[Ref: Dutta’s Obs. 9th/e, pg. 78] After 5th month, however, the number of months should
Es
be multiplied by 5, which gives the length in centimeters. 3. a
IUGR Thus, the fetal age can be estimated from the fetal length 4. a
as follows- 5. b
4. IUGR babies on delivery are called? (DNB Dec’ 2010) ○○ Upto 5th month or 20th week.- by square root of the 6. d
a. Growth retarded crown-rump length 7. a
iM
b. Preterm ○○ After 5th month – by dividing the crown-heel length by 5

8. a
c. Low birth weight
d. Small for date EPIDEMIOLOGY IN OBSTETRICS 9. a,b
9. True about ANC visit in India is? (PGMEE 2014) 10. c
a. 1st visit at 16 weeks and 3rd in between 20th week and 11. c
PR
5. On Doppler studies, which is an ominous sign of IUGR? term

a. Increase S/D ratio (PGMEE Aug 13 Pattern) b. 1st visit at 16 weeks and 4th in between 36th week and
b. Reverse diastolic flow term
c. Diastolic notch c. 2nd visit at 16 weeks and 3rd in between 20th week and
d. All of the above term
[Ref: Dutta’s Obs. 9th/e, pg. 433] d. 2nd visit at 16 weeks and 4th in between 36th week and
term
BLEEDING PV IN NEONATE [Ref: Dutta’s Obs. 9th/e, pg. 557b]
10. Minimum antenatal visits prescribed by WHO are :-
6. Most common cause of vaginal bleeding in neonate is?
(PGMEE 2016-17)
a. Sarcoma botryoides (DNB Dec’ 2009)
a. 2 b. 3
b. Bleeding disorder
c. 4 d. 5
c. Birth trauma
d. Hormone withdrawal [Ref: Dutta’s Obs. 9th/e, pg. 557b]
MATERNAL MORTALITY
7. Treatment of a neonate with vaginal bleeding is?
a. Wait and watch (DNB Dec’ 2009) 11. Most common cause of maternal mortality in India is?
b. Cryoprecipitate (DNB Dec’ 2010, PGMEE 2014, 2016-17)
c. Progesterone a. Sepsis b. Abortion
d. Estrogen c. Hemorrhage d. Anemia
[Ref: Dutta’s Obs. 9th/e, pg. 419] [Ref: Dutta’s Obs. 9th/e, pg. 560] 813
PRIMES (Volume II)
PERINATAL MORTALITY 20. Mifepristone and misoprostol are effective upto?

(PGMEE Nov 13 Pattern)
12. Most common cause of perinatal mortality in twins is? a. 49 days b. 70 days
(DNB Dec’ 2011, PGMEE 2016-17) c. 90 days d. 120 days
a. Intra uterine growth restriction [Ref: Dutta’s Obs. 9th/e, pg. 165]
b. Twin to twin transfusion syndrome
21. Decreased fetal heart sound is due to which drug-
c. Prematurity
(PGMEE 2013-14)
d. Single fetal demise
a. Oxytocin b. Sodium bicarbonate
[Ref: Dutta’s Obs. 9th/e, pg. 194, 562] c. IV fluids d. Iron
INFANT MORTALITY
22. Which drug is not prescribed in pregnancy-
13. According to registrar society of India commonest cause of (PGMEE 2013-14)
IMR in India is- (PGMEE 1997) a. ACE inhibitors b. Hydralazine
a. Prematurity b. Diarrhoea c. Acetaminophen d. Metronidazole
c. Malnutrition d. Acute Respiratory Infection [Ref: Dutta’s Obs. 9th/e, pg. 471t]
/e
[Ref: Park’s Textbook of Preventive & Social Medicine 23rd/e 23. Not a tocolytic- (PGMEE 2012-13)
pg.569] a. Diazepam
b. Magnesium sulphate
PHARMACOTHERAPEUTICS IN OBSTETRICS c. Indomethacin
12.
13.
c
a

tocolytic therapy EXCEPT-
a. Tachycardia
c. Hyperglycemia
b. Hypotension
d. Fever ,2
14. All of the following are known side effects with the use of
(AIIMS 03)

d. Terbutaline
24. Not given in pregnancy-

a. Enalapril
(PGMEE 2012-13)
Es
14. d [Ref: Dutta’s Obs. 9th/e, pg. 472t]
b. Labetalol
15. a 15. All of the following occur because of prostaglandin use c. Hydralazine
16. d except- (PGMEE 2012-13) d. Nifedipine
17. b,c a. Excess water retention b. Flushes [Ref: Dutta’s Obs. 9th/e, pg. 471t]
18. c c. Increased motility of bowel
iM
d. Nausea [Ref: Dutta’s Obs. 9th/e, pg. 465, 496t] 25. Regarding Atosiban all are true except:-(PGMEE 2016-17)
19. b
a. Inhibitor of the hormone oxytocin
20. a 16. DOC for cholera in pregnancy is- (PGMEE 2012-13)
a. Furazolidone b. Tetracycline b. Used as tocolytic agent
21. a c. Given by intravenous route
c. Doxycycline d. Azithromycin
22. a d. Given after delivery of shoulder of baby
[Ref: Internet]
PR
23. a [Ref:Dutta’s Obs. 9th/e, pg. 472t]

24. a 17. Which antibiotic can be safely used in pregnant women-
25. d (PGMEE 2012-13) MISCELLANEOUS
a. Tetracycline b. Erythromycin
26. a
c. Isoniazid d. Chloremphenicol 26. Fetus most radiosensitive at? (PGMEE Aug. 12 Pattern)
27. d
[Ref: Internet] a. 8-15 weeks b. 10-15 weeks
28. d
c. 15-20 weeks d. > 20 weeks
Explanation
[Ref: William’s Obs. 24th/e pg. 932]
Tetracycline causes permanent staining & discolouration of
baby’s teeth. 27. Which is not true about high risk pregnancy-
Chloramphenicol - category C drug, causes Gray syndrome a. Breech (PGMEE June 14 Pattern)
in neonates. b. Previous LSCS
18. Tocolytics can be given in- (PGMEE 2012-13) c. Previous scar dehiscence
a. Placenta Praevia b. Placenta accreta d. Height of female 150 cm
c. Preterm labour d. Eclampsia [Ref: Dutta’s Obs. 9th/e, pg. 588]
[Ref: Dutta’s Obs. 9th/e, pg. 471] 28. TDAP vaccine is given in between which weeks of
19. Misoprostol is which prostaglandin analogue ? pregnancy- (PGMEE 2012-13)
(PGMEE Aug 12 Pattern) a. 10-16 weeks b. 17-22 weeks
a. PGF2α b. PGE1 c. 22-26 weeks d. 27-30 weeks
c. PGE2 d. PGI2
814 [Ref: Dutta’s Obs. 9th/e, pg. 469]
Obstetrics Chapter 12 Miscellaneous Topics in Obstetrics (MCQs)
29. Antibodies in mother causing congenital heart block in Explanation

fetus- (PGMEE 2013-14)
a. Anti-DNA b. Anti-RNA
c. Anti-RO (SS-a) d. Anti phospholipid
Ref: Internet
INSTRUMENTS
30. Obstetric instrument shown in the photograph:-
a. Jolls retractor b. Czerny retractor
c. Morris retractor d. Deaver’s retractor Dissection scissors
Ref: Internet
/e
Explanation
Stitch scissors
,2 29.
30.
c
c
Es
31. a
32. a
Mayo scissors
Jolls retractor Czerny retractor
32. Which of the following leopold’s grip is shown in the
image: (AIIMS Nov’ 2017)
iM
Morris retractor Deaver’s retractor

PR
31. In the gynae labor room, the scissors shown in the diagram
was used: Identify (AIIMS Nov’ 2017)
a. Pawlik’s grip b. Pelvic

c. Fundal d. Abdominal
[Ref: Dutta’s Obs. 8th/e, pg. 88-89; Holland Brew’s Obs.4th
/ e, pg. 67]
a. Episiotomy scissors b. Dissection scissors
c. Stitch scissors d. Mayo scissors
[Ref: Dutta’s Obs. 8th / e, pg. 755; Holland Brew’s
Obs.4th / e, pg. 646; Internet]
815
PRIMES (Volume II)
Explanation
/e
,2
Es
iM
Leopold’s Maneuvers (Obstetric Grips) Various maneuvers are as follows

PR
A systematic and codified manner of obstetric examination ○○ First maneuver Fundal grip
Described by Leopold and Sporlin in 1894 ○○ Second maneuver - Abdominal grip
Help to identify fetal landmarks and fetomaternal ○○ Third maneuver - Pawlik’s grip
relationships ○○ Fourth maneuver - Pelvic grip
816

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MULTIPLE CHOICE QUESTIONS (OBSTETRICS)

CHAPTER 1: ANATOMY OF FEMALE REPRODUCTIVE ORGANS

EXTERNAL GENITAL ORGANS - Musculature is developed from the mesoderm of the

12. c 11. Role of lactobacilli in vaginal secretions-

of the trunk. 26. a

PHYSIOLOGY OF OVULATION ○○ An ↑ of 0.5 - 1.00 F occurs in immediate postovulatory

○○ Proteolytic enzymes – activity increased by progesterone c. 1.5 to 2 cm d. 2 to 2.5 cm

generation of active colllagenase → degeneration of a. Pain just before menstruation

c. Fallopian tubes d. Epididymis 19. d

 (PGMEE 2012) 7 Lower limb buds, midgut herniation

WEIGHT GAIN DURING NORMAL PREGNANCY PHYSIOLOGICAL CHANGES IN CVS DURING

 Blood volume, plasma vol. & cardiac output start to

PLACENTA AND UMBILICAL CORD UMBILICAL CORD AND ITS ABNORMALITIES

b. Weight of fetus and placenta equal at 4 months marginal or velamentous.

○○ Complications: ↑ed chance of cord prolapse, cord

ENDOCRINOLOGY OF PREGNANCY 21. Precursor of progesterone from placenta is:-

DIAGNOSIS OF PREGNANCY DIAGNOSTIC SIGNS IN RELATION TO

c. 16th October d. 9th October tion is known as:- (PGMEE 2015-16) 8. b

Explanation pg. 50]

12. Minimum level of β-hCG for the earliest detection of Explanation

 Advantages of TVS over TAS-

12. Fetal weight at 20 weeks - (PGMEE 2012-13) 8. b

Explanation  [Ref: Dutta’s Obs. 9th/e, pg. 98, 566]

25. Quadruple test in pregnancy is performed at:- ALPHA FETO PROTEIN

284, 285] 32. d

pg. 292-294, 293t]

a. L:S > 2 on blastomeres or trophoectoderm removed from embryos

the blastomeres become more tightly adherent

HEMORRHAGE IN PREGNANCY implicated in 15% of cases of RPL. These can be diagnosed

between 7 and 12 weeks is (PGMEE 2014)

ECTOPIC PREGNANCY Explanation

Etiological factors for ectopic pregnancy:

[GTDs DISCUSSED IN DETAILS IN GYNAE SECTION] b. Abortion 33. b

37. Drug causing abruptio placentae - (PGMEE 2012-13) 37. b

PRETERM LABOR 48. Radiological sign in intrauterine fetal death:-

51. c a. Diamniotic-dichorionic twins

56. In dizygotic twin there is? (PGMEE Aug. 12 Pattern) Explanation

pregnancy is:- (PGMEE 2018)  (PGMEE 2015-16)

pg. 224-225; Williams Obs. 24th / e, pg. 896-897] pg. 38]

HYPERTENSIVE DISORDERS IN PREGNANCY 9. First sign of magnesium sulphate toxicity is?

pg.131] 1101; Holland Brew’s Obs.4th/e, pg. 104]

a. Intramuscular iron b. Iron and folic acid tablets

27. Which of the following drugs should not be used in the

28. Heart disease with worst prognosis in pregnancy is? pregnancy

–  Left ventricular dilatation (end diastolic dimension >

RH ISOIMMUNIZATION 37. Regarding erythroblastosis fetalis all are true except- 

THYROID DISORDERS IN PREGNANCY

c. 50 ml d. 60 ml 41. DOC for Hyperthyroidism in first trimester of pregnancy 38. d

Explanation RENAL DISEASE IN PREGNANCY

S. transam- 400-4000 200-800 < 200 IU/L < 300 IU/L

Coagu- - + - + a. Abruption  (DNB Dec’ 2010)

INFECTIONS IN PREGNANCY 8. Maximum transmission of HIV occurs during-

RUBELLA 15. Malaria in pregnancy doesn’t cause? (PGMEE 2014)

TOXOPLASMOSIS c. Multiparous women d. Nulliparous women

c. 3rd trimester d. During delivery

13. Interspinous diameter- (PGMEE 2012-13) 8. d

pg. 10-11] 12. a

Explanation 17. Antero-posteriorly oval pelvic inlet is seen in-

NORMAL LABOR Stage Characteristics

pg. 278] a. Bag of waters  (PGMEE June’ 2012)

Stage Characteristics Cervical effacement

15. c b. Prolonged labor

VENTOUSE OCCIPITOPOSTERIOR POSITION

Explanation 29. Image showing Mauriceau procedure. The procedure

EXTERNAL GENITAL ORGANS - Musculature is developed from the mesoderm of the

12. c 11. Role of lactobacilli in vaginal secretions-

(PGMEE 2012) 7 Lower limb buds, midgut herniation

Blood volume, plasma vol. & cardiac output start to

ENDOCRINOLOGY OF PREGNANCY 21. Precursor of progesterone from placenta is:-

c. 16th October d. 9th October tion is known as:- (PGMEE 2015-16) 8. b

Advantages of TVS over TAS-

Explanation [Ref: Dutta’s Obs. 9th/e, pg. 98, 566]

between 7 and 12 weeks is (PGMEE 2014)

37. Drug causing abruptio placentae - (PGMEE 2012-13) 37. b

PRETERM LABOR 48. Radiological sign in intrauterine fetal death:-

56. In dizygotic twin there is? (PGMEE Aug. 12 Pattern) Explanation

pregnancy is:- (PGMEE 2018) (PGMEE 2015-16)

HYPERTENSIVE DISORDERS IN PREGNANCY 9. First sign of magnesium sulphate toxicity is?

– Left ventricular dilatation (end diastolic dimension >

RH ISOIMMUNIZATION 37. Regarding erythroblastosis fetalis all are true except-

Coagu- - + - + a. Abruption (DNB Dec’ 2010)

INFECTIONS IN PREGNANCY 8. Maximum transmission of HIV occurs during-

RUBELLA 15. Malaria in pregnancy doesn’t cause? (PGMEE 2014)

13. Interspinous diameter- (PGMEE 2012-13) 8. d

Explanation 17. Antero-posteriorly oval pelvic inlet is seen in-

pg. 278] a. Bag of waters (PGMEE June’ 2012)

a. Forceps method (PGMEE 2012-13) c. Revert to original position

COMPOUND PRESENTATION 53. Indication of classical caesarean section- (PGMEE 2012-13)

67. Ergometrine is contraindicated in- (PGMEE 2012-13)

63. In obstructed labor most important parameter is-

8. a [Ref: Dutta’s Obs. 9th/e, pg. 406]

2. Ballard’s score is used to assess- (PGMEE 2012-13) Explanation

5. On Doppler studies, which is an ominous sign of IUGR? term

PERINATAL MORTALITY 20. Mifepristone and misoprostol are effective upto?

23. a [Ref:Dutta’s Obs. 9th/e, pg. 472t]

Leopold’s Maneuvers (Obstetric Grips) Various maneuvers are as follows