Que. 1. What is the ratio of chest compression and breath for the newborn baby during resuscitation?

Ans. 1. 3:1 (3 compression & one breath).

Que. 2. What is the antenatal care?

Ans. 2. Antenatal care is the systemic supervision of women during pregnancy to monitor the progress of foetal growth and to ascertain the wellbeing of the mother and the foetus.

Que. 3. What are the primary steps in the quality Ante natal Care?

Ans. 3. The primary steps in the quality Ante natal Care are as follows –

• Ensure early registration and first check up within 12 weeks (first 3 months of pregnancy).
• Conduct at least 4 antenatal checkups (Including the first visit for registration), keeping in mind all the essential components.
• Administer two doses of Td injection.
• Provide at least 180 tablets of Iron & Folic Acid.
• Provide two tablets daily of calcium from 14 week onwards.
• Counselling for birth preparedness

Que. 4. What are the essential components of every ante natal checkup?

Ans. 4. The essential components of every ante natal checkups are as follows –

• Take the patients history.
• Conduct a physical examination – measure the weight, BP, Respiratory Rate & check for pallor & oedema
• Conduct abdominal palpation for foetal growth, foetal- lie, auscultation of foetal heart sounds (FHS) according to the stage of pregnancy.
• Carry out Lab investigation such as haemoglobin estimation, blood sugar and urine tests (for sugar and proteins)

Que. 5. What are the desirable components of ante natal checkups?

Ans. 5. The desirable components of ante natal checkups are as follows –

• Determine the blood group including the Rh factor
• Conduct the VDRL/RPR test to rule out the syphilis
• Test the pregnant women for HIV (Human immune deficiency virus)
• Carry out the HBsAg (Hepatitis B surface Antigen)
• Blood sugar test

Que. 6. What are the key points of the counselling during ante natal checkups?

Ans. 6. The Key points of the counselling during antenatal checkups are given below –

• Birth preparedness/ birth micro plan
• Advantages of the institutional deliveries and risks involved in home deliveries
• Emergency birth plan and preparedness
• Signs of labor and danger signs of obstetric complications
• Emphasize the importance of seeking antenatal and postnatal care
• Advise on diet and rest
• Breastfeeding including exclusive breast feeding
• Sex during pregnancy
• Warn against domestic violence
• Family planning
• JSY/JSSK entitlements

Que. 7. When should the registration of pregnancy preferably be done for ANC?

Ans. 7. As soon as the pregnancy is suspected, ideally, within 12 weeks.

Que. 8. Why is early detection of pregnancy important?

Ans. 8. Early detection of pregnancy is important because –

1) It facilitates proper planning and allows for adequate care to be provided during pregnancy for both the mother and the foetus.

2) Helps in recording the date of the Last Menstrual Period (LMP) and calculate the Expected date of delivery (EDD)

3) The health status of the mother can be assessed and any medical illness that she might be suffering from can be detected and provide baseline information (BP, Weight, Hb% etc.)

4) Helps in timely detection of complications at an early stage and manage them appropriately by referrals as and when required.

5) This also helps in providing the woman the option of an early abortion

6) If a pregnancy is detected early and the woman is provided care from the initial stage, it facilitates good interpersonal relationship between service provider and the beneficiaries.

Que. 9. In our country, as per the MTP act, up to what gestational period is abortion legal?

Ans. 9. Up to 24 weeks of pregnancy.

Que. 10. What is the role of folic acid in pre –conceptional and early pregnancy period?

Ans. 10. All women in the reproductive age group should be advised to have folic acid for 2-3 months pre-conception and continue with it during the first 12 weeks of pregnancy which reduces the incidence of neural tube defects in the foetus. A daily dose of 400 micro gram folic acid taken orally is recommended.

Que. 11. Why is regular consumption of iodized salt advised during the pregnancy?

Ans. 11. Low level of iodine during pregnancy can cause cretinism which can lead to mental and physical retardation of the baby.

Que. 12. Which is the simplest way to detect the pregnancy?

Ans. 12. The simplest way to confirm pregnancy in the first trimester is to conduct a urine examination using a pregnancy test kit (Nischay Kit).

Que. 13. How does the pregnancy kit work?

Ans. 13. Pregnancy Test Kit (PTK) detect pregnancy on the basis of the presence of Human Chorionic Gonadotrophins (hcg) hormone in the urine. This test can be performed soon after a missed period and is simple to perform. It requires just five minutes and two drops of the woman’s urine.

Que. 14. What is the suggested schedule for antenatal visits?

Ans.14. Suggested Schedule for antenatal visits are as follows –

• First Visit – – – Within 12 weeks, preferably as soon as pregnancy is suspected.
• Second Visit – Between 14 and 26 weeks
• Third Visit – – Between 28 and 34 weeks
• Fourth Visit – Between 36 weeks and term

It is advisable for the pregnant woman to visit MO at the PHC/CHC for an antenatal checkup during the period of 28-34 weeks (Third Visit). Can be linked with Pradhan Mantri Swasthya Matritva Abhiyaan (PMSMA).

Que. 15. How will you calculate the expected date of delivery (EDD)?

Ans. 15. EDD= Date of last menstrual period (LMP) + 9 months + 7 days.

Que. 16. What are the indications for referral to the 24 hour PHC for ANC and delivery as per the previous Obstetric History?

Ans. 16. The indications for the referral are as follows –

• Still birth or neonatal death
• Three or more spontaneous Consecutive abortions
• Obstructed labor
• Premature births, twins or multiple pregnancies
• Weight of the child <2500 gm or >4.5 Kg
• Admission for Preeclampsia/ eclampsia / Hypertension in the previous pregnancy
• Surgery on the reproductive tract
• Congenital anomaly
• Treatment for infertility
• Spinal deformities such as Scoliosis/ Kyphosis/ polio.
• Rh negative in the previous pregnancy

Que. 17. What is the normal weight gain during the pregnancy?

Ans. 17. 9 – 11 Kg. Ideally after first trimester, a pregnant woman gains around 2 kg every month.

Que. 18. What is the significance of weight gain during the pregnancy?

Ans. 18. Low weight gain usually leads to Intra uterine Growth Retardation (IUGR) and results in a birth of Low Birth Weight baby. Excessive weight gain (more than 3 kg in a month) should raise suspicion of Preeclampsia, Twins (multiple pregnancy) or Diabetes.

Que. 19. What are the components of per abdominal examination in Pregnancy?

Ans. 19. Components of per abdominal examination in pregnancy are as follows –

• Measurement of fundal height
• Determination of foetal lie and presentation by fundal palpation, lateral palpation and pelvic grips.
• Auscultation of FHS
• Inspection of Scars/ any other relevant abdominal findings

Que. 20. What is the normal respiratory rate in pregnancy?

Ans. 20. 18 – 20 breaths per minute.

Que. 21. If a pregnant woman presents with respiratory rate above 30 breaths per minute and associated pallor, what does it signify?

Ans. 21. It indicates the pregnant woman may have severe anaemia, heart disease or associated medical problems.

Que. 22. When does the chances of twin or multiple pregnancy increase?

Ans. 22. When a pregnant woman has taken any drug or treatment for infertility, chances of twin or multiple pregnancy increases.

Que. 23. What does non-pitting oedema in a pregnant woman indicate?

Ans. 23. Hypothyroidism or Filariasis

Que. 24. In a pregnant woman, oedema at what sites is considered as abnormality?

Ans. 24. Any oedema of face, hands, abdominal walls & vulva.

Que. 25. While measuring the fundal height of a pregnant woman, what should be the position of legs?

Ans. 25. Woman’s legs should be kept straight and not flexed.

Que. 26. When height of uterus is more than period of amenorrhoea, what does it indicate?

Ans. 26. It indicates –

• Wrong date of LMP
• Full bladder
• Multiple pregnancy/ large baby
• Polyhydramnios
• Hydrocephalus
• Hydatiform mole

Que. 27. When the height of uterus in a pregnant woman is less than the period of amenorrhoea, what does it indicates?

Ans. 27. It indicates –

1) Wrong date of LMP

2) Intra uterine Growth Retardation (IUGR)

3) Missed Abortion

4) Intrauterine Death (IUD)

5) Transverse lie

Que. 28. When is determining the foetal lie & presentation, relevant?

Ans. 28. Only in late pregnancy i.e. 32 weeks onwards. Before that, it is important to only palpate the foetal parts while conducting an abdominal examination.

Que. 29. Which lie and presentation in a pregnant woman is considered normal?

Ans. 29. Longitudinal lie and cephalic presentation.

Que. 30. Which is method of palpation preferred to determine the lie and presentation of the foetus?

Ans. 30. Pelvic grip (4 in number)

Que. 31. What are the consequences of failure to perform a timely caesarian section in transverse lie?

Ans. 31. The consequences are –

• Obstructed labour
• Rupture of Uterus
• Death of Pregnant women & Fetus

Que. 32. What is the normal foetal heart rate (FHR)?

Ans. 32. 120-160 beats/minute

Que. 33. At what gestational age, checking for the FHS should start in a pregnant woman?

Ans. 33. When the gestational age is more than 24 weeks.

Que. 34. At what gestational age foetal movements (quickening) do begin?

Ans. 34. 18-22 weeks of pregnancy.

Que. 34. When should one suspect multiple pregnancy on abdominal examination of a pregnant lady?

Ans. 35. 1) An unexpectedly large uterus for the estimated gestational age.

2) Multiple foetal parts detected on abdominal palpation.

Que. 36. What are the recommended lab investigations offered to a pregnant woman at the subcenter level?

Ans. 36. 1) Pregnancy detection test

2) Hemoglobin estimation

3) Urine test for sugar and proteins

4) Rapid Malaria test (In endemic zone)

Que. 37. What are the additional lab tests that are recommended at level 24*7 PHC/CHC/ FRU for a pregnant woman?

Ans. 37. 1) Blood group, including Rh factor

2) VDRL/ RPR

3) HIV testing & blood sugar

4) Rapid Malaria test (If not available at HSC)

5) HBsAg

Que. 38. Which foods do increase the absorption of iron?

Ans. 38. Fruits & vegetables containing vitamin C (e.g. Mango, guava, orange, lemon, sweet lime, etc.)

Que. 39. How many tablets of Iron & Folic acid (IFA) are recommended for a pregnant woman for Prophylaxis against iron deficiency?

Ans. 39. 180 tablets of IFA for 6 months after first trimester of pregnancy and before delivery and 180 tablets of IFA for 6 months just after delivery.

Que. 40. What is the significance of the micro birth plan?

Ans. 40. It is necessary to draw up micro birth plan in advance to prepare the pregnant women and her family for any unforeseen complications and to prevent maternal morbidity and mortality due to delays.

Que. 41. What are the components of micro birth planning?

Ans. 41. The components of micro birth planning include –

• Registration of pregnant women and filling of MCP & JSY cards
• Informing the woman about the dates of antenatal visits, schedule for Td injection and expected date of delivery (EDD).
• Identifying the place of delivery and the person who would conduct delivery.
• Identifying a referral facility and mode of referral.
• Taking necessary steps to arrange for transport for the beneficiary
• Making sure that funds are available with ANM/ASHA

Que. 42. In which type of delivery, distribution of Disposable Delivery Kits (DDK) to the pregnant women are important?

Ans. 42. In Home delivery.

Que. 43. In which type of delivery, counselling on and maintaining six cleans are important?

Ans. 43. In Institutional as well as home delivery.

Que. 44. What do you mean by six cleans?

Ans. 44. Six cleans include –

• Clean surface
• Clean hands
• Clean cord cut
• Clean cord tie
• Clean umbilical stump
• Clean perineum

Que. 45. When should a pregnant woman visit health facility for delivery of the baby?

Ans. 45. If pregnant woman has any one of the following clinical features –

• A bloody, sticky discharge from the vagina (show)
• Painful uterine contractions increasing in duration, intensity and frequency with the passage of time.

Que. 46. What do you mean by Supine Hypotension Syndrome?

Ans. 46. All pregnant women should be told to lie on their left side while resting and avoid the supine position (Lying flat on the back) especially in late pregnancy, as it affects both the maternal and fetal circulation. Due to the pressure exerted by the pregnant uterus on the main pelvic veins, a reduced quantity of circulating blood reaches on the right side of the heart. This causes reduced supply of oxygen to brain and can lead to fainting attacks, a condition referred to as supine hypotension syndrome. It can result in abnormal FHR and reduction in placental blood flow.

Que. 47. Enumerate key messages on breastfeeding.

Ans. 47. Key messages on breast feeding are as follows –

• Initiate breast feeding especially colostrum feeding within an hour of birth.
• Don’t give pre-lacteal feeds any.
• Ensure good attachment of the baby to the breast
• Exclusively breast feed the baby for the six months
• Breast feed the baby whenever he/she demands milk
• Follow the practice of rooming in

Que. 48. What are the signs of good attachment during breastfeeding?

Ans. 48. The signs of good attachment during breastfeeding –

• The mouth of the baby is wide open.
• The lower lip of the baby is everted.
• Upper part of areola of mother’s breast is more visible than lower one.
• The chin of the baby is touching the breast.

Que. 49. What are the signs of good positioning during breastfeeding?

Ans. 49. The signs of good positioning during breastfeeding are as follows –

• The body of baby is well supported
• The head, neck & trunk of the baby should be in straight line, neck should not be tilted
• The nose of the baby is opposite the nipple of breast of mother
• The body of new born is close to the mother.

Que. 50. What is normal labour?

Ans. 50. Normal labour is a spontaneous process of expulsion of foetus and placenta.

Que. 51. How will you judge the gestational age by measurement of fundal height?

Ans. 51. At 12 weeks —- Just palpable above the symphysis pubis

16 weeks —- At lower one –third of the distance between the symphysis pubis and umbilicus

20 weeks —- At two –third of the distance between pubic symphysis pubis and umbilicus

24 weeks —- At the level of the umbilicus

28 weeks —- At lower third of the distance between the umbilicus and xiphisternum

32 weeks —- At two thirds of the distance between the umbilicus & xiphisternum

36 weeks —- At the level of the xiphisternum

40 weeks —- Sinks back to the level of the 32nd week, but the flanks are full, unlike that in

                                         32^nd week

Que. 52. What should be ascertained during per vaginal examination in a woman coming with labour pains?

Ans. 52. 1) Pelvic adequacy

2) Progress of labor

3) Stage of labor

Que. 53. During labour, at what frequency should per vaginal examination be done?

Ans. 53. Once every 4 hours to avoid unnecessary infections.

Que. 54. What are the criteria to exclude Cephalo pelvic disproportion on Per Vaginal Examination?

Ans. 54. The Criteria are as follows –

• The Sacral promontory is not reached
• The Sacrum is well curved
• The ischial spines are not prominent and both ischial spines cannot be felt by the finger inserted, at the same time

Que. 55. During Per vaginal examination, how can one monitor the progress of labour?

Ans. 55. By assessing cervical effacement and dilatation.

Que. 56. What do you mean by cervical Effacement?

Ans. 56. Cervical Effacement is progressive shortening and thinning of cervix during the labour.

Que. 57. What do you mean by cervical dilatation?

Ans. 57. Cervical dilatation is an increase in the diameter of the cervical opening in centimeter (distance in centimeter between outer aspects of both examining fingers)

Que. 58. What do you mean by a fully dilated cervix?

Ans. 58. A fully dilated cervix has an opening of 10 cm – at this stage, the cervix is no longer felt on vaginal examination.

Que. 59. How many are stages of labour there?

Ans. 59. 4 stages, 1^st stage to 4^th Stage.

Que. 60. What do you mean by 1^st stage of labour?

Ans. 60. This is the period from the onset of labour pain to the full dilatation of the cervix i.e. 10 cm.

Que. 61. In a pregnant woman, what is the duration of the 1^st stage of labour?

Ans. 61. 1^st stage of labour takes about 12 hours in primigravida and 6-8 hours in multigravidas.

Que. 62. What are the further subdivisions of 1^st stage of Labour?

Ans. 62. 1^st stage of labour is further divided into the latent and active stages.

1. LATENT STAGE (Not in Active labor) –

• Cervix is dilated < 4 cm
• Contractions week (less than 2 contractions per 10 minutes)

1. ACTIVE STAGE –

• Cervix is dilated equal to or > 4 cm

Que. 63. What do you mean by Second Stage of Labour?

Ans. 63. This is the period from full dilatation of cervix to the delivery of the baby.

Que. 64. In a pregnant woman, what is the duration of 2^nd stage of labour?

Ans. 64. This stage takes about two hours for primigravida and about half hour for multigravidas.

Que. 65. What do you mean by 3^rd stage of labour?

Ans. 65. This is the period after delivery of the baby to the delivery of placenta.

Que. 66. What is the duration of the third stage of labour?

Ans. 67. This stage takes 15 to 30 minutes, irrespective of whether the woman is primi-gravida or multigravida.   *(1)

Que. 68. What do you mean by the fourth stage of labour?

Ans. 68. This is the first two hours after the delivery of the placenta. This is a critical period as PPH, a potentially fatal condition, is likely to occur during this stage.

Que. 69. During first stage of labour (Active Stage), what features should be monitored at every 4 hours?

Ans. 69. Features to be monitored in active stage of labour at 4 hourly intervals are –

• Cervical dilatation (in cm) by Per Vaginal examination
• Blood Pressure
•  

Que. 70. During active first stage of Labour, what features should be monitored at every 30 minutes?

Ans. 70. Features to be monitored in active stage of labour at every 30 minutes include –

• Maternal Pulse
• Contractions – frequency & Duration
• Fetal Heart Rate (FHR)
• Presence of signs such as meconium or blood stained amniotic fluid, prolapse cord

Que. 71. When will you advise service providers to prepare partograph?

Ans. 71. In active 1^st stage of labour i.e. equal to or more than 4 cm cervical dilatation.

Que. 72. What is a partograph?

Ans. 72. Partograph is graphic recording of the labour and the condition of the mother and foetus. It is a tool which help assess the need for action and recognizes need for referral at the appropriate time. This facilitates timely referral to save the life of mother and foetus.

Que. 73. What are the indications for referral to the FRU on the basis of the partograph?

Ans. 73. The indications of referral are as follows –

• If the FHR is < 120 beats/min or > 160 beats/min
• If there is meconium or blood stained amniotic fluid
• When the cervical dilatation plotting crosses the alert line (moves towards the right side of the alert line)
• If the contractions do not increase in intensity, duration & frequency
• If the maternal vital signs, i.e. the pulse (>100/min), BP (140/90 mm of Hg) & temperature (>38 degree Celsius) crosses the normal limit.

Que. 74. What are the signs of imminent delivery?

Ans. 74. The signs of imminent delivery are as follows –

• Vulval gaping
• Thinned out and bulging perineum
• Anal pouting
• Visibility of baby’s head at the vulva

Que. 75. Should one wipe off the vernix (White greasy substance covering the baby’s body)?

Ans. 75. No, as it helps to protect the baby’s skin.

Que. 76. With what commodity/consumable, one should wipe both the eyes separately of a new born?

Ans. 76. Sterile Gauze.

Que. 77. How will you assess whether new born is breathing?

Ans. 77. If the baby is breathing well, the chest is rising regularly at the rate of 30-60 times a minute.

Que. 78. When should one clamp and cut the umbilical cord?

Ans. 78. Clamp & cut the umbilical cord when cord pulsation stops. It normally takes about 1-3 minutes for the cord to stop pulsating.

Que. 79. What is the purpose of delayed cord clamping (1-3 minutes)?

Ans. 79. Purpose is to avoid neonatal anemia, as it results in transfusion of an increased amount of the blood into the fetal circulation.

Que. 80. Whether the Active Management of Third Stage of Labour (AMTSL) is recommended for all deliveries?

Ans. 80. Yes, absolutely.

Que. 81. What are the components of AMTSL?

Ans. 81. The components of AMTSL are as follows –

• Uterotonic drugs
• Controlled cord traction (CCT)
• Uterine Massage

Que. 82. Which is the drug of choice among uterotonic drugs for AMTSL?

Ans. 82. Injection Oxytocin is the drug of choice.

Que. 83. Which uterotonic drug is used in facilities where adequate refrigeration is not available?

Ans. 83. Tablet Misoprostol.

Que. 84. Which uterotonic drug is used for community distribution for home deliveries?

Ans. 84. Tablet Misoprostol.

Que. 85. What is the importance of uterotonic drugs?

Ans. 85. An uterotonic drug enhances contraction of the uterine muscles, thereby facilitating expulsion of the placenta and diminishing bleeding. It helps to prevent PPH.

Que. 86. When should the uterotonic drug be given?

Ans. 86. An uterotonic drug should be given within one minute after the delivery of baby.

Que. 87. What will you rule out before giving the uterotonic drug after the delivery of baby?

Ans. 87. Presence of another baby.

Que. 88. What are the storage conditions for oxytocin?

Ans. 88. Oxytocin should be kept at temperature 4-8 degree Celsius but should not be frozen. It should ideally be stored in the refrigerator.

Que. 89. In what doses, should injection Oxytocin be administered after delivery?

Ans. 89. 10 units of Injection Oxytocin intramuscularly in institutional deliveries.

Que. 90. What is the dose of tablet misoprostol after delivery for AMTSL?

Ans. 90. 600 micro grams orally.

Que. 91. What are the common side effects of Misoprostol?

Ans. 91. Shivering and gastro intestinal disturbances.

Que. 92. What do you mean by Controlled Cord Traction (CCT)?

Ans. 92. Controlled Cord Traction (CCT) is a technique that assists in the expulsion of the placenta and helps to reduce the chances of a retained placenta and subsequent bleeding i.e. PPH.

Que. 93. How does the uterine massage help?

Ans. 93. Uterine massage helps in contractions of the uterus and thus prevents PPH.

Que. 94. What do you mean by Uterine Massage?

Ans. 94. Immediately after delivery of the placenta, massage the fundus of uterus through the women’s abdomen until it is well contracted. Repeat the uterine massage every 15 minutes for the first two hours.

Que. 95. In the fourth stage of labor, which vitals should be monitored every 15 minutes?

Ans. 95. Vitals to be monitored are –

• General Condition
• BP & Pulse
• Vaginal bleeding
• Uterus, to make sure that it is well contracted

Que. 96. How one should dispose placenta?

Ans. 96. Dispose of the placenta in the correct, safe and culturally appropriate manner. Use gloves while handling the placenta. Put the placenta into a leak proof bag containing bleach. Incinerate the placenta or bury it at least 10 meters away from water source in a pit that is 2 meter deep.

Que. 97. In immediate postpartum period, when will you ask the birth companion to call for help?

Ans. 97. 1) Excessive bleeding per vaginum

2) Dizziness, severe headache, visual disturbances or epigastric pain

3) Convulsions

4) Increased pain in the perineum

5) Urinary incontinence or inability to pass the urine

Que. 98. Why is it essential to give injection Vitamin K1 to all newborns?

Ans. 98. Vitamin K1 is needed for prevention of haemorrhagic diseases of newborns.

Que. 99. Categorize the babies in which there are an increased risk of breathing problems?

Ans. 99. 1) Pre term

2) Born after a long traumatic labor

3) Born to mothers who received sedation during the last stage of labor.

Que. 100. Which is the most critical period in the entire postpartum period?

Ans. 100. First 48 hours after the delivery.

Que. 101. What is the recommended period of stay in hospital after institutional delivery?

Ans. 101. 48 hours in case of delivery and one week after Caesarian Section.

Que. 102. Minimum how many visits are required for post- partum care?

Ans. 102. Minimum four visits.

Que. 103. What is the schedule of Post- Partum visits?

Ans. 103. The schedule of Post-Partum visits are as follows –

First Visit – 1^st day i.e. within 24 hours (Not applicable in Institutional Delivery)

Second Visit – 3^rd day after delivery

Third Visit – 7^th day after delivery

Fourth Visit – 42^nd day i.e. 6 weeks after delivery

There should be three additional visits in the case of babies born with low birth weight, on day 14, 21 and 28.

Que. 104. What are the danger signs for the mother in post –partum period?

Ans. 104. Maternal danger signs in post-partum period are as follows –

• Excessive bleeding i.e. soaking more than 2-3 pads in 20-30 minutes after delivery.
• Convulsions
• Fever
• Severe abdominal pain
• Difficulty in breathing
• Foul Smelling Lochia

Que. 105. During first PNC visit, what advice/ counselling should be given to woman & her family?

Ans. 105. 1) Postpartum care & Hygiene

2) Nutrition

3) Contraception

4) Breast feeding

5) Danger Signs

Que. 106. How will you assess temperature in a newborn?

Ans. 106. The temperature can be assessed by recording the axillary temperature or feeling the infant abdomen or axilla.

Que. 107. What is the normal temperature of a newborn?

Ans. 107. 36.5 to 37.4 degree Celsius

Que. 108. What are the signs of good attachment while breastfeeding?

Ans. 108. The signs of good attachment while breastfeeding are as follows –

• Chin of baby touching breast (or very close)
• Mouth wide open
• Lower lip turned upwards
• More areola visible above than below the mouth.

Que. 109. What are the features of preeclampsia?

Ans. 109. The features of preeclampsia are as follows –

• Hypertension (BP> 140/90 mm of Hg)
• Proteinuria
• Oedema

Que. 110. What are the Characteristic features of eclampsia?

Ans. 110. The characteristic features of eclampsia are as follows –

• Hypertension
• Proteinuria (+ 2 or more)
• Oedema
• Convulsions

Que. 111. In which condition MgSO4 is used for its treatment?

Ans. 111. Severe Pre-eclampsia & Eclampsia.

Que. 112. What is the Intramuscular dose of MgSO4 in treatment of Eclampsia?

Ans. 112. Inject 10 ml (5 gm) of MgSO4 in each buttock (a total of 20ml or 10 gm I/M using a 22 gauze needle and a 10 cc of syringe).

Que. 113. What are the side effects of MgSO4?

Ans. 113. The side effects of MgSO4 are given below –

• Flushing
• Thirst
• Headache
• Nervousness
• Vomiting

Que. 114. What should be the duration of prophylactic treatment against anaemia during postpartum period?

Ans. 114. Six months.

Que. 115. What do you mean by Postpartum Hemorrhage (PPH)?

Ans. 115. Blood loss of 500 ml or more following and up to 6 weeks after delivery.

Que. 116. What are the types of PPH?

Ans. 116. The types of PPH are as follows –

1. Immediate/ Primary PPH – During and within 24 hours of delivery.
2. Delayed/ Secondary PPH – after 24 hours of delivery until 6 weeks postpartum.

Que. 117. What are the causes of vaginal bleeding in early pregnancy?

Ans. 117. Causes include threatened or spontaneous abortion, an ectopic pregnancy or Hydatiform mole.

Que. 118. What are the signs of incomplete spontaneous abortion?

Ans. 118. The signs of incomplete abortion are given below –

• There is heavy bleeding and lower abdominal pain.
• There is a history of expulsion of the products of conception (POP)
• Abdominal examination shows the presence of uterine tenderness and fundal height is less than the period of gestation.

Que. 119. What are the signs of complete abortion?

Ans. 119. The signs of complete abortion are given below –

• There is light bleeding or there has been heavy bleeding which has now stopped.
• There is lower abdominal pain
• There is history of POC expulsion
• Abdominal examination shows a uterus that is softer than normal, and the fundal height is less than the period of gestation.

Que. 120. What are the signs of threatened abortion?

Ans. 120. The signs of threatened abortion are as follows –

• There is light bleeding
• The woman complains of lower abdominal pain
• There is no history of expulsion of products of conception.
• On abdominal examination, uterus is softer than the normal and fundal height corresponds to the period of gestation
• On per vaginal examination, cervical Os is closed.

Que. 121. What do you mean by Antepartum hemorrhage (APH)?

Ans. 121. Vaginal bleeding any time after 20 weeks of gestation is called APH. Any bleeding (light/heavy) at this time of pregnancy is dangerous.

Que. 122. What are the most serious causes of APH?

Ans. 122. Most serious causes of APH are as follows –

• Placenta previa (Placenta lying at or near the cervix)
• Abruptio placentae (Detachment of placenta before the birth of fetus)
• Ruptured Uterus

Que. 123. What are the causes of primary or immediate PPH?

Ans. 123. The causes of Primary or immediate PPH are given below –

• Atonic uterus
• Tears in lower vagina, cervix or perineum
• Retained placenta or placental fragments
• Inverted or ruptured uterus

Que. 124. In which condition, Bimanual Compression of uterus is used?

Ans. 124. PPH due to atonic uterus.

Que. 125. How do you know that vaginal bleeding is heavy?

Ans. 125. Soaking one pad or cloth in less than 5 minutes.

Que.126. What are the causes of delayed or secondary PPH?

Ans. 126. 1) Retained clots or placental fragments

2) Infection of the uterus

Que. 127. What is Maternal Mortality Ratio (MMR)?

Ans. 127. It is the number of women who die from any cause related to or aggravated by the pregnancy or its management (excluding accidental or incidental causes) during pregnancy or child birth or within 42 days of termination of pregnancy, irrespective of duration and site of pregnancy, per 1 lakh live births.

Que.128. Why is maternal death review (MDR) an important strategy?

Ans. 128. MDR is an important strategy to improve the quality of obstetric care and reduce maternal mortality & morbidity.

Que. 129. What is the rationale of maternal death review (MDR)?

Ans. 129. MDR provides detailed information on various factors at facility, district, community, regional and national level that are needed to be addressed to reduce maternal deaths.

Analysis of these deaths can identify the delays that contributes to maternal death at various level and information used to adopt measures to fill the gaps in service.

Que. 130. What are the different approaches for investigation of maternal deaths?

Ans. 130. The different approaches for the investigation of maternal deaths are given below –

• Community based maternal death review (Verbal Autopsy)
• Facility based maternal death review (FBMDR)
• Confidential enquiries into maternal deaths
• Survey of severe morbidity (Near Miss)
• Clinical Audit

Que. 131. What approaches are preferred by Government of India for maternal death review?

Ans. 131. The preferred approaches are as follows –

• Community based maternal death review (CBMDR)
• Facility based maternal death review (FBMDR)

Que. 132. What do you mean by Community based MDR?

Ans. 132. Community based MDR using a Verbal Autopsy Format is a method of finding out the medical causes of death and ascertaining the personal, family or community factors that may have contributed to the maternal deaths.

Que. 133. What is Verbal Autopsy in MDR?

Ans. 133. The Verbal autopsy consists of interviewing people who are knowledgeable about the events leading to the maternal death such as family members, neighbors and TBAs.

Que. 134. What are the steps of CBMDR & FBMDR?

Ans. 134. 1) Notification           2) Investigation

Que. 135. In CBMDR, within what period should investigation or verbal autopsy be completed following notification?

Ans. 135. Three weeks

Que. 136. Who are the members of the investigating team in CBMDR?

Ans. 136. Ideally should comprise of 3 persons, one for conducting the interview, one for recording and other to coordinate the process.

The investigators could be the BMO/ other MO, Block public health Nurse, sector health nurse, health supervisors, Nurse tutor or ANM.

Que. 137. How much money the primary informant will get on informing a maternal death?

Ans. 137. Primary informants (ASHA/AWW) will get Rs 200/- for reporting one maternal death.

Que. 138. For investigation of maternal death, what is monetary provisions for investigators?

Ans. 138. Rs 100/- per person for conducting the investigation in the field (Subject to a maximum of 3 persons).

Que. 139. In MDR monthly review meetings, what are the types of corrective measures generally proposed?

Ans. 139. The Corrective measures proposed are as follows –

• Corrective measures at the community level.
• Corrective measures needed at the facility level.
• Corrective measures for which state support is needed.

Que. 140. What is Janani Suraksha Yojana (JSY)?

Ans. 140. Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Health Mission (NHM) being implemented with the objective of reducing maternal & neonatal mortality by promoting institutional delivery among the poor pregnant women.

Que. 141. What are the important features of the JSY?

Ans. 141. The important features of the JSY are as follows –

• Each beneficiary registered under this yojana should have a JSY card along with a MCH card.
• ASHA/AWW/ any other identified link worker under the supervision of the ANM & the MO PHC should mandatorily prepare a micro birth plan.
• This will effectively help in monitoring antenatal checkups and the post- delivery care.
• Financial assistance as per norms.

Que. 142. What are the eligibility criteria for financial assistance under JSY?

Ans. 142. All pregnant women delivering in the government health facilities and in accredited private institutions/hospitals.

Que. 143. What is the scale of financial assistance for deliveries in rural India under JSY?

Ans. 143. Mother’s package — 1400/- Rs

ASHA’s Package ——- 600/- Rs

Total Package ———- 2000/- Rs.

Que. 144. What is the scale of financial assistance for deliveries in urban area under JSY?

Ans. 144. Mother’s package ——- 1000/- Rs

ASHA’s package ———- 200/- Rs

Total Package ————- 1200/- Rs

Que. 145. At which hospitals JSY scheme is applicable?

Ans. 145. All government hospitals & HSCs and accredited private hospitals.

Que. 146. How many pregnancies are likely to develop complications in India?

Ans. 146. Nearly 15%.

Que. 147. When was the Janani Shishu Suraksha Karyakram (JSSK) initiative launched?

Ans. 147. June 1, 2011.

Que. 148. What are the objectives of JSSK initiative?

Ans. 148. The objectives of JSSK are as follows –

• Eliminating out of pocket expenses for families of pregnant women and sick infants, who seek care in government health facilities.
• Reaching the unreached pregnant women (Many still deliver at home)
• Timely access to care for sick infants

Thereby to reduce MMR & IMR.

Que. 149. What are the JSSK entitlements for pregnant women?

Ans. 149. The JSSK entitlements for pregnant women are given below –

• Free or cashless delivery
• Free C –section
• Free drug and consumables
• Free diagnostics
• Free diet during stay in health institution (Up to 3 days for normal delivery & 7 days for c-section)
• Free provision of blood
• Free transport from home to health institution, between health institutions in case of referral, and drop back home after delivery.
• Exemption from all kinds of user charges, including for seeking hospital care up to 6 weeks post- delivery (for postnatal complications)

Que. 150. What are the JSSK entitlements for sick newborn till one year after birth?

Ans. 150. The JSSK entitlements for sick new born are given below –

• Free treatment at the public health institutions
• Free drugs & consumables
• Free diagnostics
• Free provision of blood
• Free transport from home to health institution, between health institutions in case of referral, and drop back home after treatment
• Exemption from all kind of user charges

Que. 151. What is the daily recommended dietary allowances (RDA) for calcium in pregnancy & lactation?

Ans. 151. 1200 mg/day.

Que. 152. Which are the target population for calcium supplementation?

Ans. 152. All pregnant women in the community.

Que. 153. What is the dose and period of calcium supplementation in Pregnancy & Lactation?

Ans. 153. Calcium tablets to be taken orally twice a day (total 1 gm/day) starting from 14^th week of pregnancy up to six months postpartum. Both tablets to be taken with meals.

Que. 154. What is the formulation of calcium in its supplementation program?

Ans. 154. Each calcium tablet should contain 500 mg elemental calcium and 250 IU Vitamin D3. The preferred formulation for calcium is calcium carbonate.

Que. 155. What are the side effects of calcium supplementation?

Ans. 155. None, within the recommended limit (1gm/day). A small proportion of women may experience mild gastritis, so calcium tablets should be taken with meals.

Que. 156. How many tablets of calcium are recommended in pregnancy and during lactation?

Ans. 156. Total 360 tablets of Calcium in pregnancy & 360 tablets in lactation.

Que. 157. How many strips of calcium tablets has to be distributed during pregnancy?

Ans. 157. At 2^nd ANC ———– 12 strips (15 tablets per strip)

3^rd ANC ————— 12 strips (15 tablets per strip)

Que. 158. How many strips of calcium tablets has to be distributed during lactation and when?

Ans. 158. At the time of zero dose of polio for the newborn —- 12 strips (15 tablets per strip)

At the time of 3^rd dose of pentavalent vaccine for the infants — 12 strips (15 tablets per strip)

Que. 159. Which are the foods rich in calcium?

Ans. 159. The foods rich in calcium are as follows –

• Milk & Milk products e.g. Yogurt, Cheese, ice cream, butter milk etc.
• Green leafy vegetables e.g., Spinach Fenugreek.
• Ragi & Sesame seeds
• Sweet potatoes.

Que. 160. Name the most common STH parasites.

Ans. 160. Ascaris Lumbricoides (roundworm), Trichuris Trichura (whip worm), Ancylostoma duodenale & Necator americanus (Hook worm).

Que. 161. What are the consequences of STH infestations on health?

Ans. 161. Consequences of STH infestations on health are as follows –

• Anaemia
• Malnutrition
• Growth faltering
• Impaired cognitive development

Que. 162. What are the effects of Anaemia in pregnant women?

Ans. 162. The effects of Anaemia in Pregnant women are as follows –

• Increased morbidity and mortality
• Pre term birth
• Intra uterine growth retardation (IUGR)
• Low Birth Weight (LBW)
• Poor iron status in the infants

Que. 163. Name the common available anthelminthic drugs used to treat STH.

Ans. 163. Drugs used to treat STH are as follows –

• Albendazole
• Mebendazole
• Pyrantel Palmoate
• Levamisole
• Diethyl Carbamazepine (DEC)
• Praziquantel
• Ivermectin

Que. 164. What is the objective of deworming program during pregnancy?

Ans. 164. To reduce the incidence of anaemia in pregnancy by deworming during pregnancy.

Que. 165. Which is the target group for deworming program during pregnancy?

Ans. 165. All pregnant women in STH endemic area (Prevalence more than 20%). Deworming is recommended routinely during pregnancy even in absence of prevalence data.

Que. 166. Which is the recommended drug of choice for deworming of pregnant women?

Ans. 166. Albendazole.

Que. 167. What is the recommended dose of Albendazole in deworming program of pregnant women?

Ans. 167. A single dose of 400 mg of albendazole.

Que. 168. When should deworming be done in pregnant women?

Ans. 168. Deworming should be done after the first trimester of pregnancy, preferably during 2^nd trimester of pregnancy.

Que. 169. Which are the side effects of Albendazole?

Ans. 169. No specific side effects except nausea, vomiting, rash, abdominal pain & urticarial in some cases.

Que. 170. What is the responsibility of State & District program managers in deworming program for pregnant women?

Ans. 170. The responsibility of State & District Program Managers are as follows –

• Constant supply of albendazole & its distribution
• Reflecting adequate budget in Program Implementation Plan (PIP) and ensuring timely release of funds
• Monitoring of outcome and progress

Que. 171. What advices will you give to reduce worm infestation load in the community?

Ans. 171. The suggested advices are as follows –

• The disposal of all human faeces (including that of young children) in water seal latrines in order to minimize environmental contamination.
• Use of footwear to prevent hookworm infestations
• Washing of vegetables and fruits before consumption
• Drinking safe potable water
• Personal hygiene and handwashing before meals and after using the toilet.
• Environmental sanitation

Que. 172. What is Gestational Diabetes Mellitus (GDM)?

Ans. 172. Gestational Diabetes Mellitus (GDM) is defined as impaired glucose tolerance (IGT) with onset or first recognition during pregnancy.

Que. 173. What are the consequences of GDM on maternal health?

Ans. 173. The consequences of GDM on maternal health are given below –

• Polyhydramnios
• Pre-eclampsia
• Prolonged labor
• Obstructed labor
• Caesarean section
• Uterine atony
• PPH
• Infections

Que. 174. What are the fetal consequences of GDM?

Ans. 174. The fetal consequences of GDM are as follows –

• Spontaneous Abortion
• Intrauterine death
• Still birth
• Congenital malformation
• Shoulder dystocia
• Birth injuries
• Neonatal hypoglycemia
• Infant respiratory distress syndrome

Que. 175. Which is the target population for testing and management of GDM?

Ans. 175. All pregnant women in the community.

Que. 176. What are the pre-requisites for testing and management of GDM in a facility?

Ans. 176. The pre-requisites are as follows –

• Availability of supply & testing facility
• Trained Human resources to manage the case after diagnosis
• Appropriate referral linkages

Que. 177. When should the testing of GDM be carried out in pregnant women in ANC period?

Ans. 177. The first testing should be done during first antenatal contact as early as possible. The second testing should be done during 24-28 weeks of pregnancy if the first test is negative. There should be at least 4 weeks gap between the two tests.

Que. 178. What is the methodology of testing for GDM?

Ans. 178. Single step testing using 75gm glucose taken orally and measuring plasma glucose 2 hours after ingestion.

Que. 179. What is threshold plasma glucose level as cut off for diagnosis of GDM?

Ans. 179. More than or equal to 140 mg/dL.

Que. 180. How will you manage the GDM?

Ans. 180. All pregnant women who test positive for GDM for the first time should be started on Medical Nutrition Therapy (MNT) for 2 weeks. After two weeks of MNT, a 2 hours post prandial plasma glucose (post meal) should be done.

If 2 hours PPPG < 120 mg/ dl, repeat test every 2 weeks in 2^nd trimester and every week in 3^rd trimester. If 2 hours PPPG is equal to or more than 120 mg/dl, medical treatment (Insulin Therapy) to be started as per guidelines.

Que. 181. What is Medical Nutrition Therapy (MNT) for GDM?

Ans. 181. MNT for GDM primarily involves a carbohydrate controlled balanced meal plan which promotes –

• Optimal nutrition for maternal & fetal health
• Adequate energy for appropriate gestational weight gain
• Achievement and maintenance of normoglycemia

Que. 182. Whether hypocaloric diets in obese women with GDM can be given?

Ans. 182. Hypocaloric diets in obese women with GDM can result in ketonemia and ketonuria. However, moderate caloric restriction (reduction by 30% of estimated energy needs) in obese women with GDM may increase glycemic control without ketonemia and reduce maternal weight gain.

Que. 183. What are the sites of insulin injection?

Ans. 183. Front/lateral aspect of the thigh or over abdomen. Insulin injection is to be given subcutaneously only.

Que. 184. When insulin injection is to be given during management of GDM?

Ans. 184. Should be given once a day, 30 minutes before breakfast. Fasting blood glucose and 2 hours PPPG should be done every 3^rd day.

Que. 185. How will you calculate dose of insulin based on blood glucose level?

Ans. 185. If blood glucose level is between 120-160 mg/dl —— 4 units of Insulin is required.

For blood glucose level between 160-200 ———– 6 units of Insulin is required and

For blood glucose level more than 200 mg/dl ——- 8 units of Insulin is required.

Que. 186. How will you define primary maternal hypothyroidism?

Ans. 186. Primary maternal hypothyroidism is defined as the presence of elevated Thyroid Stimulating Hormone (TSH) levels during pregnancy.

Que. 187. How will you diagnose overt hypothyroidism (OH) and subclinical hypothyroidism (SCH)?

Ans. 187. In overt hypothyroidism, TSH elevated and Serum T4/ Free T4 low. Serum TSH equal to or more than 10 ml U/L is taken as OH irrespective of free T4 levels.

In SCH, TSH level is elevated (equal to or less than 10 ml U/L) with normal serum T4/ free T4 levels.

Que. 188. What are consequences of untreated hypothyroidism on mother’s health?

Ans. 188. The consequences of untreated hypothyroidism on mother’s health are as follows –

• Miscarriages in early pregnancy
• Recurrent pregnancy losses
• Anaemia
• Pre-eclampsia
• Gestational diabetes
• Abruptio placentae
• PPH
• Increased caesarean section due to fetal distress

Que. 189. What are consequences of untreated hypothyroidism on foetal health?

Ans. 189. The consequences of untreated hypothyroidism on foetal health are as follows –

• Preterm birth
• Intrauterine growth retardation
• Intrauterine fetal demise
• Respiratory distress
• Increased perinatal mortality (PNM)
• Cognitive, neurological and developmental impairment in newborns

Que. 190. What is the estimated prevalence of hypothyroidism in pregnancy?

Ans. 190. 2-3% globally. OH —- 0.3-0.5 %; SCH —– 2-2.5 %.

In India ——— 4.8 to 12%.

Que. 191. Which is the target population for screening of hypothyroidism in pregnancy?

Ans. 191. Screening for hypothyroidism is recommended in high risk pregnant women.

Que. 192. What are the pregnancy-specific and trimester-specific reference levels for TSH?

Ans. 192. 1^st trimester ——– 0.1 to 2.5 m IU/L

2^nd trimester ——- 0.2 to 3 m IU/L

3^rd trimester ——– 0.3 to 3 m IU/L

Que. 193. When should the screening of hypothyroidism be done during pregnancy?

Ans. 193. At the time of first visit of pregnant woman to the facility (Recommendation of Indian Thyroid Society).

Que. 194. Which is the drug of choice for management of Hypothyroidism?

Ans. 194. Levothyroxine.

Que. 195. How levothyroxine has to be taken?

Ans. 195. Orally in the morning, empty stomach. The client should not take anything orally for at least half an hour after intake of medicine.

Que. 196. How many tablets of Levothyroxine tablets should be provided to patient at a time?

Ans. 196. A complete bottle of levothyroxine tablets should be provided to patient (25/50/75 mcg).

Que. 197. Which indicator is a critical indicator to assess the quality of services provided by a health care system?

Ans. 197. Maternal mortality.

Que. 198. What are the advantages of investigating near miss (MNM review) events?

Ans. 198. The advantages of investigating near miss events are as follows –

• Near miss cases are more common than maternal deaths
• The major reasons and causes are same for both MDR & MNM, so review of MNM case is likely to yield valuable information regarding severe morbidity, which could lead to death of the mother, if not intervened properly and in time.
• Investigating the instances of severe morbidity may be less threatening to providers because the women survived.
• One can learn from the women themselves since they survived and are available for interview about the care they received.
• All near misses should be interpreted as free lessons and opportunities to improve the quality of service provision.

Que. 199. What is maternal near miss (MNM)?

Ans. 199. A woman who survives life threatening conditions during pregnancy, abortion and child birth or within 42 days of pregnancy termination, irrespective of receiving emergency medical/surgical interventions, is called Maternal Near Miss (MNM).

Que. 200. What is the process of MNM review?

Ans. 200. The process of Maternal Near Miss (MNM) review involves –

• Notification (MO/HOD – if case meets inclusion criteria)
• Data transmission (Institution to district to state)
• Review (Institutional and district level)
• Analysis and feedback for initiating necessary action.

Que. 201. What do you know about Syphilis?

Ans. 201. Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema Pallidum. The primary route of transmission is through sexual contact; it may also be transmitted from mother to foetus during pregnancy or at birth resulting in congenital syphilis.

Que. 202. Which are the different stages of Syphilis?

Ans. 202. Four stages in syphilis infection are found –

• Primary Syphilis – Single chancre (a firm, painless, non-itchy skin ulceration)
• Secondary Syphilis – diffuse rash (commonly on palms and soles)
• Latent Syphilis – Little or no symptom
• Tertiary Syphilis – With gummas, neurological or cardiac symptoms

Que. 203. What is the average serological prevalence of syphilis among the ANC attendees in India?

Ans. 203. 0.38% (HIV Sentinel Surveillance 2010-11).

Que. 204. Which are the objectives of screening for and management of syphilis during pregnancy?

Ans. 204. The objectives are as follows –

• To ensure early screening of all pregnant women for syphilis, preferably in the first trimester
• To detect and manage syphilis infection in pregnant women and their partners
• To ensure institutional delivery at FRUs/ Higher level institutions of all syphilis positive PW
• To prevent the transmission of syphilis from mother to child.

Que. 205. What is the protocol of testing for syphilis in pregnant woman?

Ans. 205. All PW should be tested for syphilis in the first ANC visit itself, which should be as early as possible, by a point of care (POC) test at the sub-center level or any other facility where woman visits for ANC, where lab facilities for RPR are not available, irrespective of her previous syphilitic status. Those women who go for ANC checkup at health care facilities where testing for RPR is available, should be tested by RPR method.

Que. 206. Which women should be screened for syphilis again in third trimester or at the time of delivery?

Ans. 206. Those women are as follows –

• Women who are at high risk for syphilis
• Women who live in areas of high prevalence of syphilis
• Women who have had adverse outcomes of pregnancy previously or
• Women who were untested earlier

Que. 207. When newborns have to be hospitalized to initiate penicillin treatment?

Ans. 207. All newborns showing four-fold rise in titer compared to that of mother’s need to be hospitalized to initiate penicillin treatment for 10 days.

Que. 208. Which pregnant women are considered to be at high risk for acquiring STIs, including syphilis?

Ans. 208. Those women are as follows –

• Women with current or past history of STI
• Women with multiple partners
• Sex workers
• Injecting drug users

Que. 209. Which is the drug of choice for the treatment of maternal syphilis?

Ans. 209. Benzathine benzyl penicillin.

Que. 210. What is the treatment of maternal syphilis in the early stage?

Ans. 210. In the early stage (primary & secondary syphilis of < 2 years duration; RPR titer < 1:8 approximately), a single intramuscular injection of 2.4 million IU Benzathine benzyl penicillin is sufficient.

Que. 211. What is the treatment of maternal syphilis in late stage?

Ans. 211. In the late stage (tertiary syphilis > 2 years or unknown duration; RPR titer > 1: 8 approximately), a total of 3 I/M injections of 2.4 million IU benzathine benzyl penicillin once a week for 3 weeks need to be given.

Que. 212. What are the alternate regimen for the treatment of maternal syphilis in penicillin allergic pregnant women?

Ans. 212. Regimen 1 –

• Early stage syphilis: Erythromycin 500 mg PO 4 times daily for 15 days
• Late stage syphilis: Erythromycin 500 mg PO 4 times daily for 30 days

Regimen 2 –

• Primary Syphilis (Syphilitic Chancre): Azithromycin, 2 gm PO as a single dose.

Que. 213. Which are the three delays responsible for maternal deaths indirectly?

Ans. 213. The three known delays are as follows –

• Delay in making a decision on the need for medical care
• Delay in reaching the appropriate facility in time
• Delay in initiating correct treatment at the health facility

Que. 214. Enumerate minimum signal functions that BEmOC health facility should provide.

Ans. 214. The minimal signal functions that BEmOC health facility should provide include –

• Administer parenteral antibiotics
• Administer uterotonic drugs (i.e. parenteral oxytocin)
• Administer parental antibiotics
• Administer parental anticonvulsants for PE & E (i.e. MgSO4)
• Manual removal of placenta
• Remove retained products (e.g. Manual Vacuum Extraction, Dilatation and curettage)
• Perform Assisted Vaginal Delivery (e.g. Vacuum Extractions, Forceps delivery)
• Perform neonatal resuscitation (e.g. with bag and mask)

Que. 215. Define minimal signal functions that CEmOC health facilities should perform.

Ans. 215. Perform all signal functions of BEmOC health facility plus

• Perform Surgery (e.g. C-Section)
• Perform Blood Transfusion

Que. 216. What do you mean by Level 3 (L3) MCH centers?

Ans. 216. All FRU CHC/ SDH/DH /Area Hospital/ RH/Tertiary Hospitals where complications are managed including c –section & blood transfusion. A FRU should have Newborn Stabilization Unit (NBSU) at CHC/ SDH/others while a SNCU at DH and above.

Que. 217. What do you mean by Level 2 (L2) MCH Centers?

Ans. 217. All 24* 7 facilities (PHC/Non-FRU CHC /others) providing BEmOC services and have either a NBSU or NBCC.

Que. 218. What do you mean by Level 1 (L1) MCH Centers?

Ans. 218. All sub centers and non-24*7 PHC where deliveries are conducted by a skilled birth attendant (SBA) and have established NBCC.

Que. 219. Where does the concept of Birth Waiting Homes apply?

Ans. 219. Birth Waiting Home concept applies in remote/ inaccessible hilly and tribal areas, with poor road connectivity and poor access to health facilities.

Que. 220. What is the criteria to define L1 delivery point?

Ans. 220. Minimum 3 normal deliveries per month.

Que. 221. As per MNH tool kit, what is the minimum bed requirement for L1, L2 & L3 facility?

Ans. 221. L1 ——- 2-6 beds

L2 ——- 6-30 beds

L3 ——- 30 or more beds

Que. 222. Which are the minimum necessary lab tests to be conducted at L1 facility?

Ans. 222. The minimum lab tests are as follows –

• Hemoglobin
• Urine for albumin & Sugar
• Rapid diagnostic kit for Malaria
• Pregnancy test

Que. 223. List the lab tests that should be done at L2 facility.

Ans. 223. Lab tests that should be done at L2 facility are as follows –

• Hemoglobin
• Urine for albumin and sugar
• RDK for malaria
• Urine for pregnancy test
• CBC
• Bleeding time, Clotting time
• Routine and m/e of stool
• Sputum for TB
• Peripheral Smear for Malarial parasite
• HIV screening
• Hepatitis B/ Australia Antigen
• Blood grouping and RH Typing
• Wet mount
• RPR/VDRL
• Serum bilirubin for sick newborn

Que. 224. Which specific additional lab tests are to be performed at L3 facility apart from those at L1 facility?

Ans. 224. Additional tests at L3 facility are as follows –

• Liver function test
• Kidney function test
• Glucose tolerance test
• Platelet count
• Thyroid profile
• Gram staining and
• Pap smear

Que. 225. Which are the critical steps for mother and baby friendly environment?

Ans. 225. The critical steps are given below –

• Respecting the right of every mother and baby to stay in the facility with dignity.
• Designing the infrastructure for easy mobility and comfortable stay.
• Training the service providers for necessary behavioral and technical skills.
• Providing integrated maternal newborn & child health services in accordance with protocols and required competency.
• Practice of infection prevention and bio-medical waste management as per the guidelines.
• Establishing assured referral linkages.
• Monitoring quality of service delivery and establishing a process for improvement of quality.
• Ensuring functional grievance redressal system both for client & service providers.
• Assessing client satisfaction periodically.
• For smooth planning at each level of facility, the plan should take care of infrastructure, equipment, drugs & supplies, reporting and monitoring.

Que. 226. How many trays has to be kept ready in a labor room of L3 facility?

Ans. 226. Seven trays.

Que. 227. Name the trays to be kept ready in a labor room of L3 facility.

Ans. 227. The name of seven trays are as follows –

• Delivery Tray
• Episiotomy tray
• Baby tray
• Medicine tray
• Emergency Drug tray
• MVA/EVA tray
• PPIUCD tray

Que. 228. What are the contents of the delivery tray?

Ans. 228. Contents of delivery tray are as follows –

• Scissors
• Artery forceps
• Sponge holding forceps
• Speculum
• Urinary catheter
• Bowl for antiseptic lotion
• Kidney Tray
• Gauge piece
• Cotton swabs
• Sanitary pads
• Gloves

Que. 229. What are the contents of baby tray?

Ans. 229. Contents of baby tray are as follows –

• Two pre-warmed towels/sheets
• Mucus extractor
• Bag & mask
• Sterilized thread/ cord clamp
• Needle (26 Gauze)
• Syringes (1ml)
• Vitamin K1
• Gloves

Que. 230. What are the contents of a PPIUCD tray?

Ans. 230. Contents of PPIUCD tray are as follows –

• PPIUCD insertion tray
• Syme’s speculum
• Ring/sponge holding forceps
• Cu IUCD 375/380 A
• Cotton swabs
• Betadine solution.

Que. 231. What are the indicators for keeping baby in radiant warmer?

Ans. 231. The indications for keeping baby in radiant warmer are as follows –

• Meconium stained liquor and preterm labor
• Baby not crying and limp/flaccid limbs/floppy baby
• As per doctor’s advice

Que. 232. What is the recommended dedicated staffing for a 12 bed SNCU (plus 4 beds for step down areas)?

Ans. 232. Staff are as follows –

• Staff Nurse – 10-12
• Pediatrician / MO – 3-4 (trained in FBNC)
• Support staff – 4+1.

Que. 233. What is the recommended dedicated staffing for a NBSU?

Ans. 233. Staff are as follows –

• MO/ Pediatrician (Trained in F- IMNCI)
• A dedicated nursing staff per shift. Total 4 dedicated staff.

Que. 234. How will you clean floor and sink in LR or OT?

Ans. 234. Clean the floor and sinks with detergent (soap solution) and keep floor dry.

Que. 235. How will you clean electric monitors in LR or OT?

Ans. 235. Clean electric monitors with 70% alcohol.

Que. 236. What are the principles on which infection prevention practices base?

Ans. 236. The principles on which infection prevention practices base are as follows –

• Every person (patient or health care worker) is considered infectious.
• Every person is considered at risk of infection.
• Handwashing is the most practical procedure to prevent the spread of infection.
• Gloves are worn on both hands before touching broken skin, mucus membrane, blood or other body fluids; and before performing an invasive procedure.
• Protective barriers such as goggles, face mask, aprons etc. are worn
• Antiseptic agents are used to clean the skin and mucus membrane before certain procedures, or for cleaning wounds.
• All health care workers and facility staff follow safe work practices (e.g. not recapping or bending needles, properly processing instruments and suturing with blunt needles when appropriate)
• The sites for providing care and examination of patients are cleaned regularly and waste is properly disposed.
• Color coded bins are available as per norms and requirements.

Que. 237. What is needed in a facility for successful implementation of infection prevention system?

Ans. 237. Following is needed for successful implementation of infection prevention system –

• Knowledge and skills of service providers including grade III & IV staff
• Availability of consumables and equipment
• Adherence to the protocols
• Segregation of waste
• Transportation & disposal of waste.

Que. 238. Which safety guidelines should be followed when handling sharp instruments such as needles and syringes?

Ans. 238. Safety guidelines are as follows –

• Sharp instruments should never be passed from one hand directly to another person’s hand.
• A needle holder should be used when suturing; the needle should never be held with the finger.
• After use, needles and syringes should be decontaminated by flushing them with a 0.5% chlorine solution three times.
• All needles/sharp/ IV cannula/ broken ampules/blades should be handled properly and disposed in a puncture proof container.
• Needles must be destroyed immediately using hub cutter.
• Sharps should be disposed immediately in a puncture-resistant container. Needles should not be recapped, bent, broken or disassembled before disposal.
• In case of needle stick injuries (used needles), please follow the pose exposure prophylaxis (PEP) protocols for prevention of HIV.

Que. 239. What is the purpose of decontamination?

Ans. 239. Decontamination makes inanimate objects safe to handle before cleaning and involves soaking soiled items in 0.5% chlorine solution for 10 minutes and wiping soiled surfaces such as examination tables with a 0.5% chlorine solution.

Que. 240. What is the purpose of cleaning?

Ans. 240. Cleaning after instruments and other reusable items have been decontaminated, need to be done to remove visible dirt and debris, including blood and body fluids. Cleaning is the most effective way to reduce the number of micro-organisms on soiled instruments and equipment.

Que. 241. What are the steps of used instrument processing?

Ans. 241. Steps are as follows –

• Decontamination
• Cleaning
• Sterilization/ High level disinfection (HLD)

Que. 242. Which are the four main components for safe waste disposal plan?

Ans. 242. Following are the four main components –

• Segregation at source
• Disinfection
• Proper storage before transportation
• Safe disposal

Que. 243. What do you mean by medical waste/contaminated waste?

Ans. 243. Waste generated during examination, immunization, investigations, diagnosis and treatment such as bandages or surgical sponges, blood, blood products, human tissues and other body fluids.

Que. 244. How will you ensure quality of care?

Ans. 244. Ensuring quality requires –

• Adherence to professional standards
• Following of standardized processes and procedure to deliver services
• Improving the service quality by focusing on identified gaps
• Reviewing continuously to resolve the identified problems.

Que. 245. How will you define maternal mortality rate?

Ans. 245. Maternal Mortality Rate is the number of maternal deaths occurring in a given period per 1 Lakh women of reproductive age during the same time period.

Que. 246. Define Maternal Mortality Ratio?

Ans. 246. MMR is the ratio of the number of maternal deaths per 1 lakh live births.

Que. 247. Define still birth.

Ans. 247. Death of a fetus having birth weight > 500 grams (or gestation 22 weeks or crown heel length 25 cm) or more.

Que. 248. How will you classify birth weight?

Ans. 248. Normal birth weight = equal to or >2500 grams

Low birth weight (LBW) = < 2500 grams

Very LBW = <1500 grams

Extreme LBW   = <1000 grams

Que. 249. How many pairs of gloves will be needed for 100 deliveries /month in a facility?

Ans. 249. Number of deliveries * 4 = 100*4 = 400 pairs of gloves.

Que. 250. How many sanitary pads will be needed for 100 delivery/month in a facility?

Ans. 250. Number of deliveries*6 =100*6 = 600 (100 packs containing 6 each).

Que. 251. How many cord clamps will be needed for 100 delivery/month in a facility?

Ans. 251. 100 Cord clamps.

Que. 252. What do you mean by obstetric ICU?

Ans. 252. An obstetric ICU is an ICU which is dedicated to obstetric patients who have developed multi-organ failure necessiating specialized care by super specialists.

Que. 253. What do you mean by obstetric HDU?

Ans. 253. HDU is an area in a hospital where patients can be cared more extensively than in a normal ward, but not to the point of intensive care.

Que. 254. Out of total pregnancy related complications, what is the incidence of high-risk pregnancy?

Ans. 254. 7 to 8 %

Que. 255. Where should the HDU be located?

Ans. 255. Obstetric HDU should be a part of the maternity wing and located near the LR & OT, for easy and prompt shifting of the patients whenever required.

Que. 256. Where should obstetric HDU & ICU be set up?

Ans. 256. To start with, it is suggested that all District Hospitals (DHs) should have an obstetric HDU and all Medical Colleges should have both an obstetric HDU & an obstetric ICU (or ICU with dedicated obstetric beds).

Que. 257. What should be the course of management of pregnancy after maternal triage?

Ans. 257. After maternal triage, it is suggested that, all pregnancies with complications may be managed in the obstetric HDU by an obstetrician or EmOC trained medical officer below the district level.

All normal cases identified after triaging, can be delivered by SBA (preferably with a back up support of an obstetrician /EmOC trained MO).

Que. 258. How many HDU beds will be required in a facility with delivery load up to 250 per month?

Ans. 258. Four.

Que. 259. How many HDU beds will be required in a facility with delivery load 250-500 per month?

Ans. 259. Eight.

Que. 260. What is the recommendation of exit/entry point to obstetric HDU & obstetric ICU?

Ans. 260. Should be single entry/exit point. Isolation room should have a separate entry.

Que. 261. What should be the ideal space allocated to each bed in obstetric HDU?

Ans. 261. 120-130 square feet per bed.

Que. 262. What should be the ideal space allocated to each bed in obstetric ICU?

Ans. 262. 130-150 square feet per bed.

Que. 263. What should be the staff requirements for the 8 bedded HDU per shift?

Ans. 263. 4 dedicated nurses and 2 EmOC/MOs

Que. 264. What should be the staff requirements for a 4 bedded HDU per shift?

Ans. 264. 2 dedicated nurses and 1 EmOC/ MO.

Que. 265. What should be the staff requirements for a 4 bedded Obstetric ICU per shift?

Ans. 265. 4 dedicated nurses and 1 intensivist.

Que. 266. How many toilets are required for an 8 bedded obstetric HDU as per space?

Ans. 266. Two toilets.

Que. 267. How will you calculate bed requirements in obstetric HDU?

Ans. 267. 10% of obstetric patients.

Que. 268. How will you calculate bed requirements in obstetric ICU?

Ans. 268. 0.9% of obstetric patients.

Que. 269. What is the nurse: patient ratio in obstetric HDU & ICU?

Ans. 269. 1:2 in obstetric HDU & 1:1 in obstetric ICU.

Que. 270. Which important areas should be focused for up-gradation of labor rooms?

Ans. 270. The 5 important areas that should be focused are as follows –

• Space & layout
• Equipment and accessories
• Consumables
• Human resources
• Practices & Protocols e.g. Assessment protocols, Safe childbirth Checklist etc.

Que. 271. Which are the types of labor rooms being recommended by GoI?

Ans. 271. Two types of LRs are being recommended –

• LR with Labor-delivery-recovery (LDR) room concept (a PW spends the duration of labor, delivery and 4 hours postpartum in the same bed).
• Conventional labor rooms (a PW is admitted to LR only at or near full dilatation of cervix and is shifted to the postpartum ward after 2 hours).

Que. 272. What is the recommendation regarding LDR room concept?

Ans. 272. It is recommended that, if there is adequate space available without any significant resource constraints, all the DHs, AHs, SDHs, FRU CHCs and any facility with more than 500 deliveries in a month should be upgraded to have LRs as per the LDR concept.

Que. 273. What is the recommended no. of labor tables in a health facility with delivery load < 100 per month?

Ans. 273. Two.

Que. 274. What is the recommended number of labor tables in a health facility with delivery load 100-199 per month?

Ans. 274. Four.

Que. 275. What is the recommended number of labor tables in a health facility with delivery load 200-499 per month?

Ans. 275. Six.

Que. 276. How will you calculate no. of LDR beds, if LDR concept is being used?

Ans. 276. No. of LDR beds = Projected LDR events per year*Average length of stay/ 365*Occupancy rate.

Where, Average length of stay = 0.67 days or 16 hours (12 hours for labor and delivery, 4 hours recovery)

Occupancy rate = 75% or 0.75

No. of LDR events = Normal deliveries + Unplanned C -sections.

Que. 277. How will you calculate no. of LDR units, if LDR concept is being used?

Ans. 277. No. of LDR units = No. of LDR beds/4.

Que. 278. How will you calculate no. of labor table/labor beds for a conventional LR?

Ans. 278. No. of labor tables/ labor beds can be calculated by the same formula for LDR beds. Only average length of stay will be different i.e. 0.33 or 8 hours.

Que. 279. Which are the components of LDR based Labor room complex?

Ans. 279. LDR based LR complex will have 2 main components –

• Core LDR unit and
• Support areas.

Que. 280. Which are the components of each standard LDR unit?

Ans. 280. Each standard LDR unit will have following components –

4 labor areas with one labor table each, one nursing station, one newborn care area, 2 toilets and 2 washing areas.

Que. 281. What are the contents of newborn care area in the LDR unit?

Ans. 281. Each LDR unit should have one centrally located Newborn Care area (NBCA) with the following

• Radiant warmer
• Resuscitation kit with functional bag & mask
• Mucus extractor
• Pre-warmed baby receiving towels
• Shoulder roll
• Pediatric stethoscope
• A clock with seconds hand on the wall near the NBCA
• An oxygen cylinder / oxygen concentrator in the vicinity of the NBCA

Que. 282. Which equipment and accessories should be present in LDR unit in the ratio of one per 4 labor table?

Ans. 282. Radiant warmer

Hand held fetal doppler

Fetoscope

Stethoscope

Digital BP instrument

Adult digital thermometer

Baby digital thermometer

Pediatric resuscitation bag with masks

Que. 283. What are the norms recommended for autoclaved delivery tray per labor table?

Ans. 283. 1 extra for SC/PHC/non FRU CHCs per day

2 extra for FRU CHCs/AH/SDH per day

4 extra for DH per day

Que. 284. What are the norms recommended for protein urea test kits in LR?

Ans. 284. No. of deliveries/365+ 20% extra.

Que. 285. Which kind of wastes are generally found in the health facility?

Ans. 285. There are 3 kinds of wastes generally found in the health facilities –

• General wastes
• Medical wastes
• Hazardous chemical wastes

Que. 286. When can improvement in quality of health care services take place?

Ans. 286. If the health care delivery system has technically competent health professionals able to provide effective RMNCH+A services.

Que. 287. What is the purpose of skill labs?

Ans. 287. The purpose of skill labs is as follows –

• Serve as prototype demonstration and learning facilities for health care providers and focus on competency-based training.
• Skill labs provide the opportunity for repetitive skill practice, simulation of clinical scenario and training under the supervision of a qualified trainer.

Que. 288. Which are the waste items to be segregated into yellow bag?

Ans. 288. Human tissue, placenta, products of conception, used swab/gauze/bandage, other items (surgical waste) contaminated with blood.

Que. 289. Which are the items to be segregated into red bag?

Ans. 289. Used mutilated catheters, IV bottles and tubes, syringes, disinfected plastic gloves, other plastic materials.

Que. 290. Which are the waste items to be segregated into black bag?

Ans. 290. Kitchen waste, paper bag, waste paper, thermocol, disposable glasses & leftover food.

Que. 291. Which items should ideally be in puncture proof container?

Ans. 291. All needles, sharps, IV cannula, broken ampules & blades.

Que. 292. In which sequence, should one wear PPE?

Ans. 292. Put on PPE in following sequence –

• Shoe covers
• Waterproof aprons
• Eye cover
• Cap
• Mask
• Gown
• Gloves

Que. 293. What are the steps of handwashing?

Ans. 293. Step 1 – Remove rings, bracelets and watch.

Step 2 – Wet hands in clean running water then apply soap.

Step 3 – Vigorously rub hands on both sides in the following manner –

• Palms, fingers & web spaces
• Back of hands
• Fingers & Knuckles
• Thumbs
• Fingertips & creases
• Wrist

Step 4 – Thoroughly rinse hands in clean running water

Step 5 – Dry hands using a clean towel or a paper towel, or allow them to airdry, keep the hands above waist level.

Que. 294. Whether can we use alcohol rub for hand washing?

Ans. 294. Yes, it can also be used if the hands are not soiled by blood or any other secretions following same protocol mentioned above for hand washing.

Que. 295. Where one should store the bleaching powder?

Ans. 295. One should store the bleaching powder in an airtight container away from the sunlight.

Que. 296. When will you change the chlorine solution?

Ans. 296. Change the chlorine solution after 24 hours or if it appears turbid due to multiple/frequent use and prepare a fresh solution.

Que. 297. Whether sterilization method is preferred over HLD?

Ans. 297. Definitely Yes.

Que. 298. How will you sterilize instruments chemically?

Ans. 298. For chemical sterilization, completely immerse instruments like bag and mask etc. in 2% glutaraldehyde solution for at least 10 hours.

Que. 299. How will you sterilize the instrument by autoclave?

Ans. 299. Keep the items wrapped for 30 mins and unwrapped for 20 mins at 15 lbs./sq. inch at 121 degree Celsius.

Que. 300. If the lid container is not opened after sterilization, up to what period can instruments be used?

Ans. 300. Within 7 days.

Que. 301. If the lid container is opened, up to what time period can instruments be used?

Ans. 301. Within 24 hours.

Que. 302. What is the treatment modality for Haemoglobin (HB) test findings?

Ans. 302. The treatment modality for HB test findings are as follows –

• If HB >11 gm% – 1 IFA tab once a day for 180 days
• If HB 7-11 gm% – 2 IFA tab per day
• If HB <7 gm% – Iron sucrose injection / blood transfusion

Que. 303. What is the recommendation of insecticide treated bed nets in the malaria endemic areas?

Ans. 303. Insecticide treated bed nets or long-lasting insecticidal nets (LLINs) should be given on a priority basis to pregnant women in malaria endemic areas as per the state recommendations.

Que. 304. How will you interpret the result for monovalent RDT kit?

Ans. 304. 1) Negative Result – If only one line/band appears, the test has worked and the patient is negative for malaria.

2)Positive Result – If two lines/bands appear within 15-20 mins, the person is suffering from P. falciparum malaria.

3)Invalid Results – If no line appears within 15-20 mins, discard & repeat the test.

Que. 305. How will you interpret the result of bivalent RDT kit?

Ans. 305. One will interpret the result of bivalent RDT kit –

• Negative Result – If only one line /band appears at C (control), the test has worked and the patient is negative for malaria.
• If 2 lines/bands appear within 15-20 mins at C (control) & T1, the person is suffering from P. falciparum malaria.
• If 2 lines/bands appear within 15-20 mins at C (control) & T2, the person is suffering from P. vivax malaria.
• If 3 lines/bands appear within 15-20 mins at C (control), T1 & T2, the person is suffering from both P. Falciparum & P. Vivax malaria.
• If no line appears within 15-20 mins, discard and repeat the test.

Que. 306. What are the contraindications of using a bag & mask in a newborn?

Ans. 306. The contraindications are as follows –

• Congenital diaphragmatic hernia
• Meconium aspiration syndrome (Relative)

Que. 307. Which are the types of masks available for newborn resuscitation?

Ans. 307. Three types of masks are available –

• 00 – for extremely preterm newborn
• 0 – for preterm newborn
• 1 – for term newborn

Que. 308. How will you clean the rubber lid of fluid collection jar?

Ans. 308. Wash thoroughly with soap and water, rinse, reassemble when dry.

Que. 309. What should be the maximum oxygen rate with nasal prongs in a newborn?

Ans. 309. With nasal prongs, oxygen rate should not exceed 2 L /min.

Que. 310. What should be the maximum oxygen rate with oxygen hood in a newborn?

Ans. 310. For oxygen hood, maximum rate is 5 L /min.

Que. 311. What should be the minimum oxygen flow to a newborn?

Ans. 311. For oxygen hood — 3 L /min

For nasal prongs —————– 0.5 L /min

Que. 312. What should be the ideal oxygen saturation in a newborn and in a older child?

Ans. 312. For newborn —– 90-95%

For older children ———— 95-100%

Que. 313. Whether one should avoid routine augmentation of labor before delivery without indication?

Ans. 313. Definitely yes.

Que. 314. What do you understand by intravenous replacement therapy in shock?

Ans. 314. Preferred solution —— Normal Saline or Ringer Lactate (Crystalloid fluid).

Volume required is three times the volume lost. NS/RL is rapidly infused at the rate of 1 L in the first 15 mins followed by 1 L in next 30-45 mins. In case of heavy bleeding, blood transfusion will be required.

Que. 315. When should the IV fluids be started?

Ans. 315. IV fluids should normally be given when losses amount to 700 ml i.e. 15% of the circulating blood volume at which stage subtle or no signs of hypovolemia will be apparent in the presence of hypovolemia.

Que. 316. What are the different types of cannula, used in maternal shock treatment?

Ans. 316. 20 gauge (pink) ——- can run 1 L in 15 min.

18 gauge (green) —————– can run 1 L in 10 mins

16 gauge (grey) ——————- can run 1 L in 5 mins.

Que. 317. When should the blood transfusion be given?

Ans. 317. Blood transfusion should be given when maternal losses exceed 1.5 L i.e. 30% of the circulating blood volume.

Que. 318. What immediate management will you do for severe preeclampsia or eclampsia?

Ans. 318. Following immediate management will be done –

• Keep her in quiet room in bed with padded rails on sides
• Position her on left side, oropharyngeal airway to be keep patent.
• Ensure preparedness to manage maternal and foetal complications.
• Oxygen by mask 6-8 L/min
• Start IV line – RL/NS at 60 ml/hour
• Catheterize with indwelling catheter

Que. 319. When will you give anti hypertensives to a pregnant woman with severe pre-eclampsia or eclampsia?

Ans. 319. If diastolic BP is 100 mm of Hg or more. Further monitor BP strictly.

Que. 320. Which anticonvulsant is drug of choice for severe pre-eclampsia or eclampsia in a pregnant woman?

Ans. 320. Mag Sulf (Mg SO4).

Que. 321. What is the loading dose of MgSO4?

Ans. 321. The loading dose of MgSO4 is as follows –

• 50% of 4 gm diluted to 20% (8 ml drug with 12 ml NS) to be given slowly IV in 5 mins.
• 5 gm IM (50%) each buttock within 1 ml of 2% xylocaine (total 10 gm).
• If recurrent seizures after 30 mins of loading dose – repeat 2 gm 20% (4 ml drug with 6 ml NS) slow IV in 5 mins.

Que. 322. What is the maintenance dose of MgSO4 in management of severe preeclampsia & eclampsia?

Ans. 322. 5 gm IM (50%) alternate buttocks after monitoring every 4 hourly.

Que. 323. How will you monitor the side effect of high doses of magnesium sulfate?

Ans. 323. – Presence of patellar jerks

• Respiratory rate (RR) – 16/min
• Urine output – 30 ml/hour in last 4 hours.

Que. 324. What will you do if patellar jerks absent or urine output <30 ml/hour in treatment with MgSO4?

Ans. 324. Withhold MgSO4 and monitor hourly. Restart the maintenance dose if criteria fulfilled.

Que. 325. What will you do if respiratory rate <16 /min in treatment with MgSO4?

Ans. 325. Withhold MgSO4, give antidote – Calcium Gluconate 1 gm IV 10 ml of 10% solution in 10 mins.

Que. 326. How will you manage high BP in severe pre-eclampsia or eclampsia?

Ans. 326. By giving oral nifedipine 10 mg stat, repeat after 30 mins if needed. OR

By giving Inj. Labetalol 20 mg IV bolus, repeat 40 mg after 10 mins again repeat 80 mg every 10 mins if needed (max. 220 mg) with cardiac monitoring.

Que. 327. Which are the vaccines contraindicated during pregnancy?

Ans. 327. Live virus vaccines (rubella, measles, mumps, varicella, yellow fever) are contraindicated.

Que. 328. What are the three methods of sterilization?

Ans. 328. Three methods of sterilization are as follows –

• Steam sterilization/autoclaving/ pressure cooker autoclaving
• Dry heat sterilization
• Chemical/cold sterilization

Que. 329. What are the three methods of high-level disinfection (HLD)?

Ans. 329. Three methods of high-level disinfection are as follows –

• Boiling
• Chemical HLD
• Steaming

Que. 330. Why is processing of equipment important?

Ans. 330. – to minimize risk of microbial and parasitic infection including HIV, Hepatitis B & C.

• To prevent cross infection from soiled and used instruments
• To lower the cost of health care

Que. 331. While autoclaving, how do we know that sterilization is satisfactory?

Ans. 331. The change in color of the steam indicator strips indicates that the sterilization is complete.

Que. 332. Why augmentation of labor using oxytocic drugs is not preferred?

Ans. 332. It adversely impacts natural secretion of hormones and physiological mechanisms that contributes to cognitive development.

Que. 333. What are the objectives of LaQshya Program?

Ans. 333. The objectives are as follows –

• To reduce maternal and newborn mortality & morbidity.
• To improve quality of care during delivery and immediate postpartum care, stabilization of complications & ensure timely referral, and enable an effective two way follow up system.
• To enhance satisfaction of the beneficiaries visiting the health facilities and provide respectful maternity care to all pregnant women attending the public health facility.

Que. 334. Which facilities would be taken under LaQshya initiative on priority?

Ans. 334. – all government medical college hospitals.

• All district hospitals and equivalent health facilities.
• All designated FRUs and high case load CHCs with over 100 deliveries/month or 60 deliveries /month in hills and desert areas.

Que. 335. Why pregnant women have striae gravidarum & hyperpigmentation?

Ans. 335. This is caused by hormonal changes in pregnancy.

Que. 336. Why is lateral position preferred during late pregnancy?

Ans. 336. To prevent supine hypotension syndrome. During late pregnancy gravid uterus compresses the inferior vena cava when the patient is in supine position.

Que. 337. What do you mean by polyhydramnios & oligohydramnios?

Ans. 337. Polyhydramnios is used to describe an excess of amniotic fluid. It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm.

Oligohydramnios is a condition in pregnancy characterized by a deficiency of amniotic fluid (AFI < 5 cm).

Que. 338. What do you mean by secondary arrest?

Ans. 338. It is defined as non-progress of labor either due to inadequate cervical dilatation or due to CPD or malposition in a woman who was progressing well in labor.

Que. 339. Which act does prohibit the diagnosis of sex of foetus, making it an illegal activity?

Ans. 339. PC-PNDT Act.

Que. 340. Which kit is being supplied by Government of India for early diagnosis of pregnancy?

Ans. 340. Nischay pregnancy kit.

Que. 341. What does an oedema of legs in pregnancy signify that appears in evening & disappears in morning after a full night sleep?

Ans. 341. Normal physiological oedema of pregnancy.

Que. 342. When Foetal heart sound (FHS) can be heard through the abdomen in a pregnant woman?

Ans. 342. Not before 24 weeks of pregnancy.

Que. 343. What does decreased foetal movements in a pregnant woman signify?

Ans. 343. Possibility of foetal distress.

Que. 344. Why should iron tablets not be consumed with coffee, tea, milk or calcium?

Ans. 344. As these items reduce the absorption of iron from gastro-intestinal tract.

Que. 345. What is the recommendation for malaria screening at every ANC visit?

Ans. 345. Rapid diagnostic kit (RDT) for malaria should be used for testing pregnant women during each ANC visit whether or not she has any symptoms of malaria.

Que. 346. Who is responsible for micro-birth planning for each pregnant woman in the given area?

Ans. 346. ANMs.

Que. 347. At what period of pregnancy does gestational age (in weeks) and fundal height (in cm) correspond?

Ans. 347. After 24 weeks of gestation.

Que. 348. Will you like to give soap & water enema to a pregnant woman?

Ans. 348. Never, as an enema should not be routinely given during labour.

Que. 349. What suggestion will you give to a pregnant woman when her cervix is fully dilated and foetal head distending perineum?

Ans. 349. Suggest & encourage her to take deep breaths and push down.

Que. 350. What suggestion will you give to a pregnant woman who feel the urge to push down before the cervix is fully dilated?

Ans. 350. She will be suggested not to push as it can result in the oedema of cervix that may delay the progress of labour.

Que. 351. What will you do very first after delivery of baby?

Ans. 351. Note the time of birth & put identification tag on the baby wrist or ankle.

Que. 352. How many arteries & vein are present in umbilical cord?

Ans. 352. Normally, 2 arteries & 1 vein are present in the umbilical cord.

Que. 353. What is the significance of one artery in the umbilical cord?

Ans. 353. Congenital malformations in the newborn.

Que. 354. If uterus remains soft & flabby even after uterine massage; what does it indicate?

Ans. 354. Woman may be suffering from atonic uterus.

Que. 355. What will you do in a pregnant woman with severe pre-eclampsia, if delivery is imminent?

Ans. 355. Deliver the baby after giving the first dose of MgSO4 injection.

Que. 356. What is the minimum interval between onset of PPH to death of the pregnant woman?

Ans. 356. It can be 2 hours depending upon amount of the blood lost and care of PPH received.

Que. 357. What is Janani Suraksha Yojana (JSY)?

Ans. 357. It integrates financial assistance with antenatal care, delivery & postnatal care.

Que. 358. If the mother or husband, of their own will, undergo sterilization, immediately after the delivery of the child, for which entitlement they become eligible?

Ans. 358. Become eligible for compensatory money offered under the existing family welfare scheme.

Que. 359. What is the advantage of adequate calcium intake during pregnancy and lactation?

Ans. 359. Calcium supplementation during pregnancy & lactation has the potential to prevent pre-eclampsia (by 50%), pre-term birth (by 24%), improve maternal bone mineral content, breast milk concentration and bone development of neonates.

Que. 360. Why calcium & iron tablets should not be taken together?

Ans. 360. As calcium reduces absorption of iron.

Que. 361. Why calcium tablet should not be taken empty stomach?

Ans. 361. As it causes gastritis.

Que. 362. What is the correct time of intake of Iron & folic acid (IFA) tablets?

Ans. 362. Preferably 2 hours after meal.

Que. 363. Which vitamin does increase absorption of calcium?

Ans. 363. Vitamin D.

Que. 364. What is the drawback of excessive consumption of calcium (>3 gm/day)?

Ans. 364. The drawbacks are as follows –

• May increase the risk of urinary stones.
• Urinary tract infection increases
• Reduces the absorption of essential micronutrients e.g. Iron etc.

Que. 365. Who has the responsibility to deliver calcium tablets to the beneficiary home; if pregnant woman or nursing mother does not turn up for ANC/PNC visits?

Ans. 365. ASHAs.

Que. 366. Which worm infestation is one of the commonest soil transmitted helminths (STH) infestation contributing to the burden of anaemia in world?

Ans. 366. Hookworm infestation.

Que. 367. When a pregnant woman can use Albendazole for deworming?

Ans. 367. In the 2^nd trimester, Albendazole should be given as directly observed treatment (DOT).

Que. 368. During ANC, how many times testing for gestational Diabetes Mellitus (GDM) is recommended?

Ans. 368. Two times.

Que. 369. What are the testing guidelines for GDM if pregnant woman presents for the first time beyond 28 weeks of pregnancy?

Ans. 369. Only one test of GDM to be done at the time of first contact.

Que. 370. What should be done if vomiting occurs within 30 minutes of oral glucose intake?

Ans. 370. Repeat the test next day.

Que. 371. What should be done if vomiting occurs after 30 minutes of oral glucose intake?

Ans. 371. Nothing to do. The test continues.

Que. 372. What is the basis of weight gain targets for pregnancy in a woman with GDM?

Ans. 372. Based on woman’s pre-pregnancy BMIs.

Que. 373. If 2 hours Post parendial plasma glucose (PPPG) is more than 200 mg/dl at diagnosis, what should be the starting dose of Insulin?

Ans. 373. 8 units of pre-mixed insulin.

Que. 374. Which is the choice insulin during management of GDM?

Ans. 374. Only inj. Human pre-mix insulin 30/70 is to be administered.

Que. 375. When opened, within how much time duration, insulin vial should be used?

Ans. 375. Within one month.

Que. 376. Which hormone is critical for foetal brain development?

Ans. 376. Thyroid hormone.

Que. 377. What are the drawbacks of overt hypothyroidism in pregnancy?

Ans. 377. 60% risk of foetal loss & 22% risk of gestational hypertension.

Que. 378. Whether Levothyroxine Sodium can be used safely during pregnancy and lactation?

Ans. 378. Yes, can be used safely without any adverse effect on mother & foetus or newborn.

Que. 379. During treatment of hypothyroidism in pregnancy, if dose is missed on the day, what advice will you give to pregnant woman?

Ans. 379. The patient may take the L-thyroxine in same day as soon as she remembers and should not eat anything for the next 30-45 minutes.

Que. 380. During treatment of hypothyroidism in pregnancy, if the entire day pregnant woman could not take medicine, what advice will you give to her?

Ans. 380. She should take double the dose next morning.

Que. 381. What advice will you give to the pregnant woman that test positive for syphilis through Point of care (POC) test?

Ans. 381. She should be advised to undergo RPR testing for confirmation of diagnosis & assessment of antibody titers.

Que. 382. Who else in the family should be tested for syphilis if pregnant woman test positive either by POC or RPR?

Ans. 382. In this case both husband/partner and newborn should be tested by RPR.

Que. 383. Which erythromycin compound is contraindicated in the treatment of syphilis?

Ans. 383. Erythromycin estolate because of drug related hepatotoxicity.

Que. 384. How much space one labour table will require for smooth working of the Labour Room?

Ans. 384. 10*10 square feet of space.

Que. 385. At what interval will you advice to mop the floor in labour room?

Ans. 385. Every 3 hours with disinfectant solution.

Que. 386. What advice will you give in case of spillage of blood, body fluids on floor in Labour Room?

Ans. 386. Absorb with newspaper (discard in yellow bin), soak with bleaching solution for 10 minutes & then mop the floor in the labour room.

Que. 387. What should be the ideal space between two beds in maternity ward?

Ans. 387. At least 4 feet.

Que. 388. What is the recommended optimum floor size of an OT with two tables in it?

Ans. 388. 400 square feet (200 square feet for each table).

Que. 389. What is a high dependency unit (HDU)?

Ans. 389. It is a step up/step down and intermediate care unit between labour room and obstetric ICU.

Que. 390. When will you say progress of labour to be satisfactory on a partograph?

Ans. 390. When the cervical dilatation plotting falls on the left of the alert line.

Que. 391. Which nasal catheter will you select to give oxygen through nasal catheter in an infant?

Ans. 391. 8 fr catheters.

Que. 392. Till when, you will continue treatment with MgSO4 in pregnant woman with severe pre-eclampsia or eclampsia?

Ans. 392. Till 24 hours after last seizure or delivery whichever is later.

Que. 393. How will you clean radiant warmer?

Ans. 393. By using only soap and water wipes.

Suggested Further Readings –

• Guidelines for Antenatal care and skilled attendance at birth by ANMs/LHVs/ SNs, 2010, by Ministry of Health & Family Welfare, Government of India.
• Guidelines for Janani-Shishu Suraksha Karyakram (JSSK), 2011, by Ministry of Health & Family Welfare, Government of India.
• Operational Guidelines for implementation of Janani Suraksha Yojana by Ministry of Health & Family Welfare, Government of India.
• Maternal Death Review Guidebook by Ministry of Health & Family Welfare, Government of India.
• Guidance note on prevention and Management of Post-partum Hemorrhage (PPH), 2015, by Ministry of Health & Family Welfare, Government of India.
• Maternal Near Miss review, Operational Guidelines, 2014, by Ministry of Health & Family Welfare, Government of India.
• National Guidelines for Calcium Supplementation during Pregnancy & Lactation, 2014, by Ministry of Health & Family Welfare, Government of India.
• National Guidelines for deworming in Pregnancy, 2014, by Ministry of Health & Family Welfare, Government of India.
• National Guidelines for diagnosis & management of Gestational Diabetes Mellitus, 2014, by Ministry of Health & Family Welfare, Government of India.
• National Guidelines on screening of Hypothyroidism during Pregnancy, 2014, by Ministry of Health & Family Welfare, Government of India.
• Guidelines on screening for Syphilis during Pregnancy, 2014, by Ministry of Health & Family Welfare, Government of India.
• Operational Guideline & reference manual for Misoprostol for PPH, 2013, by Ministry of Health & Family Welfare, Government of India.
• Maternal & Newborn Health Toolkit, November 2013, by Ministry of Health & Family Welfare, Government of India.
• Guidelines for standardization of Labor Rooms at delivery points April 2016 by Maternal Health Division, Ministry of Health & Family Welfare, Government of India.
• Guideline for Obstetric HDU & ICU March 2016 by Maternal Health Division, Ministry of Health & Family Welfare, Government of India.
• LAQSHYA, Labor Room Quality Improvement Initiative 2017 by NHM, Ministry of Health & Family Welfare, Government of India.
• DAKSH skill lab For RMNCH+A services, Training module for Participants, by Government of India.