Free NEET PG & INI-CET Obstetrics and Gynaecology MCQs

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Naegele's rule estimates the expected date of delivery by adding 7 days to the first day of the LMP, subtracting 3 months, and adding 1 year. It assumes a regular 28-day cycle.

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Chadwick's sign is the bluish-violet discolouration of the vagina and cervix from increased vascularity in early pregnancy. Hegar's sign is softening of the lower uterine segment, and Goodell's sign is softening of the cervix.

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The uterine fundus reaches the umbilicus at about 20 weeks. At 12 weeks it is just palpable at the pubic symphysis, and by term it reaches the xiphisternum. Symphysis-fundal height roughly matches gestational weeks after 20 weeks.

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Periconceptional folic acid reduces the risk of fetal neural tube defects such as spina bifida and anencephaly. It should ideally start before conception and continue through the first trimester.

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Low maternal serum AFP is associated with Down syndrome, while high AFP suggests neural tube or abdominal wall defects. AFP is part of the combined and quadruple aneuploidy screening tests.

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Anti-D immunoglobulin given to Rh-negative mothers prevents sensitisation to Rh-positive fetal red cells, averting haemolytic disease of the newborn in future pregnancies. It is given routinely antenatally and after any sensitising event.

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Plasma volume increases more than red cell mass in pregnancy, causing a physiological dilutional anaemia. Pregnancy is also a hypercoagulable state with raised fibrinogen and clotting factors, increasing thromboembolism risk.

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The second stage runs from full cervical dilatation (10 cm) to delivery of the baby. The first stage is onset of labour to full dilatation, and the third stage is delivery of the baby to delivery of the placenta.

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Vertex (occipital) presentation, where the head is well flexed, is the most common and most favourable for vaginal delivery. It presents the smallest diameter of the fetal head to the pelvis.

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The partogram plots cervical dilatation and descent against time, with alert and action lines, to monitor labour progress and flag abnormal (prolonged or obstructed) labour early so intervention can be timely.

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Oxytocin is the first-line uterotonic for active management of the third stage, reducing postpartum haemorrhage risk. Ergometrine is avoided in hypertension, and carboprost is a second-line agent for atonic PPH.

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Late decelerations, beginning after the contraction peak and recovering after it ends, suggest uteroplacental insufficiency and fetal hypoxia. Early decelerations reflect head compression (benign), and variable decelerations reflect cord compression.

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Preterm labour is defined as labour before 37 completed weeks of gestation. It is a major cause of neonatal morbidity and mortality; management may include tocolytics, antenatal corticosteroids, and magnesium sulphate for neuroprotection.

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Antenatal corticosteroids (such as betamethasone or dexamethasone) accelerate fetal lung maturation and surfactant production, reducing neonatal respiratory distress syndrome when preterm birth is anticipated.

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Placenta praevia classically causes painless, recurrent, bright-red bleeding as the low-lying placenta separates. Placental abruption, by contrast, causes painful bleeding with a tense, tender uterus. Digital vaginal examination is avoided until praevia is excluded.

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Placental abruption (premature separation of a normally sited placenta) causes painful bleeding with a tense, tender, woody-hard uterus, and may cause fetal distress and maternal shock. Concealed haemorrhage can make blood loss appear less than it is.

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The ampulla of the fallopian tube is the most common site of ectopic pregnancy. It presents with amenorrhoea, abdominal pain, and bleeding, and can rupture causing life-threatening haemorrhage.

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Pre-eclampsia is new-onset hypertension after 20 weeks with proteinuria or other end-organ involvement (renal, hepatic, neurological, or haematological). Definitive treatment is delivery; magnesium sulphate prevents progression to eclampsia.

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Magnesium sulphate is the drug of choice for preventing and treating eclamptic seizures, superior to diazepam and phenytoin. Monitor for toxicity (loss of reflexes, respiratory depression); calcium gluconate is the antidote.

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Uterine atony (failure of the uterus to contract after delivery) is the most common cause of primary postpartum haemorrhage — one of the '4 Ts' (tone, trauma, tissue, thrombin). Management includes uterotonics and uterine massage.

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A hydatidiform mole presents with a large-for-dates uterus, markedly elevated beta-hCG, bleeding, and passage of grape-like vesicles. Management is suction evacuation with hCG follow-up to detect persistent gestational trophoblastic disease.

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The McRoberts manoeuvre — sharp hyperflexion of the maternal hips onto the abdomen — with suprapubic pressure is the first-line response to shoulder dystocia. Fundal pressure is contraindicated as it worsens impaction.

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The oral glucose tolerance test is the standard for diagnosing gestational diabetes, usually performed around 24 to 28 weeks. Untreated GDM increases the risks of macrosomia, shoulder dystocia, and neonatal hypoglycaemia.

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Iron deficiency is the most common cause of anaemia in pregnancy, due to increased iron demand for the expanding red cell mass and the fetus. Routine iron and folic acid supplementation is standard antenatal care.

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ACE inhibitors are contraindicated in pregnancy, causing fetal renal dysgenesis, oligohydramnios, and skull ossification defects. Safe options include labetalol, methyldopa, and nifedipine.

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Hyperemesis gravidarum is severe, intractable vomiting causing dehydration, electrolyte imbalance, ketosis, and weight loss, needing admission for IV fluids and antiemetics. It is more common with molar and multiple pregnancies (high hCG).

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Congenital rubella syndrome classically causes deafness, cataracts, and cardiac defects (often a patent ductus arteriosus), especially with first-trimester infection. This is why rubella immunity is checked and vaccination advised before pregnancy.

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Cervical motion tenderness is a classic sign of pelvic inflammatory disease, along with lower abdominal and adnexal tenderness. PID is usually caused by ascending sexually transmitted infection and treated with broad-spectrum antibiotics.

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Endometriosis (ectopic endometrial tissue) presents with cyclical pelvic pain, dysmenorrhoea, deep dyspareunia, and subfertility. Laparoscopy is the gold standard for diagnosis; 'chocolate cysts' may form on the ovaries.

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Leiomyomas (fibroids) are the most common benign uterine tumours, arising from smooth muscle. They are oestrogen-dependent and may cause menorrhagia, pressure symptoms, or subfertility, though many are asymptomatic.

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The Rotterdam criteria require two of three: oligo-ovulation or anovulation, polycystic ovaries on ultrasound, and clinical or biochemical hyperandrogenism (hirsutism, acne, raised androgens). PCOS is a leading cause of anovulatory infertility.

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Ovarian torsion causes sudden severe unilateral pain, nausea, a tender adnexal mass, and reduced or absent ovarian blood flow on Doppler. It is a surgical emergency; prompt detorsion can save the ovary.

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A cystocele is prolapse of the bladder into the anterior vaginal wall. A rectocele involves the posterior wall (rectum), and procidentia is complete uterine prolapse. Risk factors include childbirth, ageing, and raised intra-abdominal pressure.

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Pregnancy is the most common and first cause to exclude in secondary amenorrhoea. A urine or serum beta-hCG is the initial test before pursuing endocrine or structural causes.

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The levonorgestrel-releasing intrauterine system is a first-line treatment for heavy menstrual bleeding, markedly reducing blood loss. Tranexamic acid and NSAIDs are non-hormonal options; surgery is reserved for failed medical therapy.

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Menopause is diagnosed retrospectively after 12 consecutive months of amenorrhoea. It reflects ovarian follicular depletion, with rising FSH and falling oestrogen causing hot flushes, vaginal dryness, and long-term bone loss.

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Androgen insensitivity syndrome (46,XY with a defective androgen receptor) produces a female phenotype with breast development but absent uterus and primary amenorrhoea, with intra-abdominal testes. Mullerian agenesis has a 46,XX karyotype.

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Persistent infection with high-risk human papillomavirus (especially types 16 and 18) causes most cervical cancers. HPV vaccination and cervical screening (Pap smear and HPV testing) are the mainstays of prevention.

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The Pap (cervical cytology) smear screens for premalignant and early malignant cervical changes, allowing treatment before invasive cancer develops. HPV co-testing further improves detection.

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Postmenopausal bleeding is the hallmark presentation of endometrial carcinoma and must always be investigated with ultrasound and endometrial biopsy. Risk factors include unopposed oestrogen, obesity, nulliparity, and late menopause.

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CA 125 is the standard marker for epithelial ovarian cancer, used to assess treatment response and detect recurrence. It is not specific — it rises in endometriosis, PID, and pregnancy — so it is not used alone for screening.

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Ovarian cancer often presents late because early symptoms — bloating, vague abdominal discomfort, early satiety — are non-specific. Most cases are advanced at diagnosis, contributing to its poor prognosis relative to other gynaecological cancers.

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The combined oral contraceptive pill mainly works by suppressing ovulation through inhibition of the LH surge, with additional effects of thickening cervical mucus and thinning the endometrium.

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Migraine with aura is a contraindication to the combined pill because of the increased risk of ischaemic stroke. Other contraindications include a history of venous thromboembolism, uncontrolled hypertension, and smoking over the age of 35.

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The copper intrauterine device is the most effective emergency contraception, and it provides ongoing contraception. It can be inserted up to 5 days after unprotected intercourse or expected ovulation.

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The copper IUCD releases copper ions that are toxic to sperm and impair fertilisation, and it also creates a sterile inflammatory reaction hostile to implantation. It is a highly effective, hormone-free, long-acting method.

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Semen analysis is the key first-line test in evaluating male infertility, assessing sperm count, motility, and morphology. It is simple, non-invasive, and directs further investigation, as male factors contribute to a large share of infertility.

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A raised mid-luteal serum progesterone, around day 21 of a 28-day cycle, confirms that ovulation has occurred. Tubal patency is assessed by hysterosalpingography or laparoscopy, not by progesterone.

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Hysterosalpingography, an X-ray with contrast, assesses fallopian tube patency and the uterine cavity. Laparoscopy with dye (chromopertubation) is an alternative that also visualises pelvic pathology.

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Clomiphene citrate, a selective oestrogen receptor modulator, and increasingly letrozole, is first-line for ovulation induction in PCOS-related anovulation. Letrozole has shown higher live-birth rates in PCOS in recent evidence.