Drugs in pregnancy: ACE inhibitors: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Drugs in pregnancy: ACE inhibitors

Sample item

A pregnant woman on enalapril presents at 28 weeks with oligohydramnios. What is the likely mechanism?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Fetal renal hypoperfusion and reduced urine output due to ACE inhibition

ACE inhibitors and ARBs in the second and third trimesters cause fetal hypotension and renal failure, leading to oligohydramnios, pulmonary hypoplasia, calvarial hypoplasia and neonatal anuria. They should be stopped as soon as pregnancy is detected.

Option by option

  • A. Placental abruption

    Abruption is not the mechanism of ACE-inhibitor fetopathy.

  • B. Premature closure of the foramen ovale

    Premature ductal closure, not foraminal closure, is linked to NSAIDs.

  • C. Fetal polyuria from hyperglycaemia

    Polyuria would cause polyhydramnios, not oligohydramnios.

  • D. Fetal renal hypoperfusion and reduced urine output due to ACE inhibition (correct)

    Correct. Fetal renin-angiotensin blockade reduces glomerular filtration and fetal urine.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Fetal renal hypoperfusion and reduced urine output due to ACE inhibition. ACE inhibitors and ARBs in the second and third trimesters cause fetal hypotension and renal failure, leading to oligohydramnios, pulmonary hypoplasia, calvarial hypoplasia and neonatal anuria.

Why is "Placental abruption" not the answer?

Abruption is not the mechanism of ACE-inhibitor fetopathy.

Why is "Premature closure of the foramen ovale" not the answer?

Premature ductal closure, not foraminal closure, is linked to NSAIDs.

Why is "Fetal polyuria from hyperglycaemia" not the answer?

Polyuria would cause polyhydramnios, not oligohydramnios.

What concept does this question test?

It tests Drugs in pregnancy: ACE inhibitors in OBG. They should be stopped as soon as pregnancy is detected.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Drugs in pregnancy: ACE inhibitors?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.