PPROM – 10 Hardest Case-Based MCQs

1. MCQ 1. A 28-year-old woman at 30+3 weeks presents with intermittent watery leakage. Speculum exam shows no pooling. Nitrazine is positive but fern test is negative. Ultrasound shows AFI 11 cm. What is the next best step?

   • A. Diagnose PPROM and start steroids
   • B. Repeat sterile speculum exam after 30 minutes
   • C. Perform digital examination
   • D. Rule out PPROM because AFI is normal
   • E. Diagnose PPROM based on nitrazine only
   Answer & Explanation

   Correct Answer: B
   Discordant tests + no pooling + normal AFI → repeat speculum exam. Digital exam is contraindicated.

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2. MCQ 2. A 26-year-old at 29 weeks has PPROM for 48 hours. She is stable but suddenly develops maternal tachycardia, uterine tenderness, and fetal tachycardia without fever. What does this most likely represent?

   • A. Latency antibiotics failure
   • B. Early chorioamnionitis
   • C. Normal physiological changes
   • D. Magnesium toxicity
   • E. Impending placental abruption
   Answer & Explanation

   Correct Answer: B
   Fever is not mandatory; tachycardia + tenderness + fetal tachycardia = early chorioamnionitis → deliver immediately.

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3. MCQ 3. A 19-year-old primigravida at 23 weeks presents with PPROM and severe oligohydramnios. Which fetal complication is MOST likely?

   • A. Neonatal RDS only
   • B. Pulmonary hypoplasia
   • C. Shoulder dystocia
   • D. Neural tube defects
   • E. Hypertrophic cardiomyopathy
   Answer & Explanation

   Correct Answer: B
   PPROM < 24 weeks + severe oligohydramnios → pulmonary hypoplasia → major mortality cause.

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4. MCQ 4. A 33+5 week PPROM patient is stable and afebrile. She received a complete steroid course 10 days ago. What is the best management?

   • A. Continue pregnancy until 37 weeks
   • B. Induce labour now
   • C. Give another course of steroids
   • D. Start tocolysis to prolong pregnancy
   • E. Perform cesarean immediately
   Answer & Explanation

   Correct Answer: B
   After 34 weeks → induction recommended. Repeat steroids usually not needed.

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5. MCQ 5. A 27-year-old with PPROM at 30 weeks asks why antibiotics are given when she has no infection. What is the correct explanation?

   • A. To reduce maternal blood pressure
   • B. To prolong latency & reduce neonatal sepsis risk
   • C. To assist cervical maturation
   • D. To prevent preeclampsia
   • E. To improve lung maturity
   Answer & Explanation

   Correct Answer: B
   Latency antibiotics reduce chorioamnionitis & neonatal sepsis and prolong pregnancy.

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6. MCQ 6. A patient at 31 weeks with PPROM and mild contractions needs steroids. Which statement about tocolysis is correct?

   • A. Absolutely contraindicated
   • B. Short-term tocolysis may be used for 48h to complete steroids
   • C. Long-term tocolysis improves fetal outcome
   • D. Use only after 37 weeks
   • E. Use only if cervix is dilated > 3 cm
   Answer & Explanation

   Correct Answer: B
   Short tocolysis (≤48h) allowed to finish steroids if NO infection.

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7. MCQ 7. A PPROM patient (30 weeks) develops maternal pulse 120, foul discharge, and WBC 18,000. What is the immediate management?

   • A. Continue expectant management
   • B. Start tocolytics
   • C. Immediate delivery + broad spectrum antibiotics
   • D. Repeat ultrasound
   • E. Give high-dose steroids
   Answer & Explanation

   Correct Answer: C
   Chorioamnionitis → deliver regardless of gestational age.

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8. MCQ 8. A 29-week PPROM patient is stable. What is the MOST sensitive and specific test to confirm ruptured membranes?

   • A. Nitrazine test
   • B. Fern test
   • C. PAMG-1 (AmniSure)
   • D. Vaginal pH measurement
   • E. CRP levels
   Answer & Explanation

   Correct Answer: C
   PAMG-1 is the most sensitive and specific test.

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9. MCQ 9. A pregnant woman presents with PPROM at 30 weeks and severe oligohydramnios. What is the most important parameter to monitor daily?

   • A. BP and urine protein
   • B. Temperature, pulse, fetal heart rate, uterine tenderness
   • C. Ultrasound twice daily
   • D. Glucose tolerance test
   • E. Serum electrolytes
   Answer & Explanation

   Correct Answer: B
   These detect early chorioamnionitis, the biggest threat.

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10. MCQ 10. A 35-year-old at 28 weeks presents with suspected PPROM. Nitrazine is positive. Which of the following can cause a false positive?

    • A. Candidiasis
    • B. Semen or blood
    • C. Low vaginal pH
    • D. Thick mucus plug
    • E. Urine contamination
    Answer & Explanation

    Correct Answer: B
    Semen, blood, and BV make the vagina alkaline → false positive nitrazine.