{"id":37098,"date":"2026-06-25T13:48:42","date_gmt":"2026-06-25T08:18:42","guid":{"rendered":"https:\/\/atsixty.com\/?p=37098"},"modified":"2026-06-25T13:49:30","modified_gmt":"2026-06-25T08:19:30","slug":"high-risk-pregnancy-obstetric-law","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/obg\/high-risk-pregnancy-obstetric-law\/","title":{"rendered":"High-Risk Pregnancy &amp; Obstetric Law"},"content":{"rendered":"\n\n\n<meta charset=\"UTF-8\">\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\">\n<title>Morning Rounds \u00b7 High-Risk Pregnancy &amp; Obstetric Law<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&#038;family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&#038;display=swap\" rel=\"stylesheet\">\n<style>\n#obs07 *,#obs07 *::before,#obs07 *::after{box-sizing:border-box;margin:0;padding:0}\n#obs07{\n  --ob:#4B3A6E;\n  --ob-light:#5F4D85;\n  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font-family=\"Georgia,serif\" font-weight=\"bold\">MTP Act 2021 (Amendment) \u2014 Gestational Bands<\/text>\n      <rect x=\"10\" y=\"26\" width=\"172\" height=\"22\" rx=\"3\" fill=\"#4B3A6E\"\/>\n      <text x=\"96\" y=\"41\" text-anchor=\"middle\" fill=\"#F3EFFA\" font-size=\"8\" font-family=\"Georgia,serif\" font-weight=\"bold\">Up to 20 weeks<\/text>\n      <rect x=\"194\" y=\"26\" width=\"172\" height=\"22\" rx=\"3\" fill=\"#4B3A6E\"\/>\n      <text x=\"280\" y=\"41\" text-anchor=\"middle\" fill=\"#F3EFFA\" font-size=\"8\" font-family=\"Georgia,serif\" font-weight=\"bold\">20&ndash;24 weeks<\/text>\n      <rect x=\"378\" y=\"26\" width=\"172\" height=\"22\" rx=\"3\" fill=\"#4B3A6E\"\/>\n      <text x=\"464\" y=\"41\" text-anchor=\"middle\" fill=\"#F3EFFA\" font-size=\"8\" font-family=\"Georgia,serif\" font-weight=\"bold\">Beyond 24 weeks<\/text>\n      <rect x=\"10\" y=\"50\" width=\"172\" height=\"50\" rx=\"2\" fill=\"#eaf4f0\"\/>\n      <text x=\"96\" y=\"64\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"7.3\" font-family=\"Georgia,serif\">Opinion of<\/text>\n      <text x=\"96\" y=\"74\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"7.3\" font-family=\"Georgia,serif\" font-weight=\"bold\">1 Registered Medical<\/text>\n      <text x=\"96\" y=\"84\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"7.3\" font-family=\"Georgia,serif\" font-weight=\"bold\">Practitioner (RMP)<\/text>\n      <text x=\"96\" y=\"95\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"6.8\" font-family=\"Georgia,serif\">Available to any woman<\/text>\n      <rect x=\"194\" y=\"50\" width=\"172\" height=\"50\" rx=\"2\" fill=\"#fdf6e4\"\/>\n      <text x=\"280\" y=\"64\" text-anchor=\"middle\" fill=\"#8a6d1a\" font-size=\"7.3\" font-family=\"Georgia,serif\">Opinion of<\/text>\n      <text x=\"280\" y=\"74\" text-anchor=\"middle\" fill=\"#8a6d1a\" font-size=\"7.3\" font-family=\"Georgia,serif\" font-weight=\"bold\">2 RMPs required<\/text>\n      <text x=\"280\" y=\"85\" text-anchor=\"middle\" fill=\"#8a6d1a\" font-size=\"6.8\" font-family=\"Georgia,serif\">Special categories: rape\/incest<\/text>\n      <text x=\"280\" y=\"95\" text-anchor=\"middle\" fill=\"#8a6d1a\" font-size=\"6.8\" font-family=\"Georgia,serif\">survivors, minors, change in<\/text>\n      <rect x=\"378\" y=\"50\" width=\"172\" height=\"50\" rx=\"2\" fill=\"#fdf0f0\"\/>\n      <text x=\"464\" y=\"64\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"7.3\" font-family=\"Georgia,serif\">Opinion of a<\/text>\n      <text x=\"464\" y=\"74\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"7.3\" font-family=\"Georgia,serif\" font-weight=\"bold\">State-level Medical Board<\/text>\n      <text x=\"464\" y=\"85\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"6.8\" font-family=\"Georgia,serif\">Only for substantial fetal<\/text>\n      <text x=\"464\" y=\"95\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"6.8\" font-family=\"Georgia,serif\">abnormality; no upper limit fixed<\/text>\n      <rect x=\"194\" y=\"100\" width=\"172\" height=\"20\" rx=\"2\" fill=\"#fdf6e4\"\/>\n      <text x=\"280\" y=\"113\" text-anchor=\"middle\" fill=\"#8a6d1a\" font-size=\"6.6\" font-family=\"Georgia,serif\">marital status (SC, 2022)<\/text>\n      <text x=\"14\" y=\"138\" fill=\"#4A3D63\" font-size=\"7.3\" font-family=\"Georgia,serif\" font-style=\"italic\">\"Married\" replaced by \"any woman or her partner\" &mdash; marital status is no longer a bar to any ground, including contraceptive failure.<\/text>\n      <text x=\"14\" y=\"155\" fill=\"#4A3D63\" font-size=\"7.3\" font-family=\"Georgia,serif\" font-style=\"italic\">Medical Board: composition and functions prescribed by State govt; convened specifically for &gt;24-week fetal-anomaly cases.<\/text>\n    <\/svg>\n  <\/figure>\n<\/div>\n\n<div id=\"obs07\">\n\n  <div class=\"mr-header\">\n    <div class=\"mr-eyebrow\">Morning Rounds &middot; Obstetrics Series &middot; Round 07<\/div>\n    <div class=\"mr-title\">\n      High-Risk Pregnancy &amp;<br><em>Obstetric Law<\/em>\n    <\/div>\n    <div class=\"mr-subtitle\">Five cases &middot; MTP Act, PCPNDT Act &amp; Rh isoimmunization &middot; Trust your instinct<\/div>\n    <div class=\"mr-chips\">\n      <span class=\"mr-chip\">5 Cases<\/span>\n      <span class=\"mr-chip\">+4 \/ &minus;1 scoring<\/span>\n      <span class=\"mr-chip\">Options reshuffled<\/span>\n    <\/div>\n  <\/div>\n\n  <div class=\"mr-sentinel\" id=\"obs07-sentinel\"><\/div>\n\n  <div class=\"mr-progress\" id=\"obs07-progress\">\n    <div class=\"mr-prog-inner\">\n      <div class=\"mr-pips\" id=\"obs07-pips\"><\/div>\n    <\/div>\n  <\/div>\n\n  <div class=\"mr-body\">\n    <div id=\"obs07-cases\"><\/div>\n    <div class=\"mr-submit-wrap\">\n      <button class=\"mr-btn\" id=\"obs07-submit\">Submit for Debrief<\/button>\n    <\/div>\n    <div class=\"mr-score\" id=\"obs07-score\">\n      <div class=\"mr-score-in\">\n        <div class=\"mr-score-ey\">Round Complete<\/div>\n        <div class=\"mr-ring\" id=\"obs07-ring\">\n          <div class=\"mr-ring-in\">\n            <span class=\"mr-ring-pct\" id=\"obs07-pct\">0%<\/span>\n            <span class=\"mr-ring-sub\">net<\/span>\n          <\/div>\n        <\/div>\n        <div class=\"mr-score-title\">Your Debrief<\/div>\n        <div class=\"mr-score-net\" id=\"obs07-net\"><\/div>\n        <div class=\"mr-verdict\" id=\"obs07-verdict\"><\/div>\n        <div class=\"mr-bands\">\n          <span class=\"mr-band mr-band-c\" id=\"obs07-ct-c\"><\/span>\n          <span class=\"mr-band mr-band-w\" id=\"obs07-ct-w\"><\/span>\n          <span class=\"mr-band mr-band-s\" id=\"obs07-ct-s\"><\/span>\n        <\/div>\n        <button class=\"mr-retry\" id=\"obs07-retry\">&#8635; New Round<\/button>\n      <\/div>\n    <\/div>\n  <\/div>\n\n<\/div><!-- end #obs07 -->\n\n<script>\n(function () {\n  'use strict';\n\n  var NS    = 'obs07';\n  var TOTAL = 5;\n  var MAX   = 20;\n  var LTRS  = ['A','B','C','D'];\n\n  var QS = [\n\n    {\n      id:      1,\n      tag:     'Obstetric Law &mdash; MTP Act 2021',\n      stem:    'A <strong>19-year-old unmarried woman<\/strong> presents at <strong>22 weeks gestation<\/strong> seeking termination after contraceptive failure. She is an adult, mentally competent, and accompanied by her partner. As per the MTP Act 2021 amendment and subsequent judicial interpretation, what is the correct legal pathway?',\n      correct: 'Termination requires the opinion of two registered medical practitioners, and is permissible here because the Supreme Court\\'s 2022 ruling extended \"change of marital status\" and contraceptive-failure grounds to unmarried women, placing her in the 20&ndash;24 week category',\n      opts: [\n        'Termination is permitted only up to 20 weeks for unmarried women; beyond this, the pregnancy must continue regardless of circumstances, since contraceptive failure as a ground was originally worded to apply only to married couples',\n        'Termination requires the opinion of two registered medical practitioners, and is permissible here because the Supreme Court\\'s 2022 ruling extended \"change of marital status\" and contraceptive-failure grounds to unmarried women, placing her in the 20&ndash;24 week category',\n        'Termination requires the opinion of only one registered medical practitioner, since contraceptive failure is treated as a standard ground available to all women up to 24 weeks under the 2021 amendment, without distinction by gestational band',\n        'Termination cannot proceed without consent from her parents or legal guardian, since unmarried women are treated under the Act as requiring guardian authorization for termination decisions, similar to minors'\n      ],\n      exp:     'The MTP (Amendment) Act, 2021 replaced the word <strong>\"married woman\"<\/strong> with <strong>\"any woman or her partner\"<\/strong> for the contraceptive-failure ground, but the Rules initially retained \"married couple\" wording for the 20&ndash;24 week special category, creating ambiguity. In <strong>X v. Union of India (2022)<\/strong>, the Supreme Court held that restricting the contraceptive-failure ground to married women alone <strong>violates Article 14<\/strong> and is artificial &mdash; unmarried women cannot be excluded. <br><br>So at <strong>22 weeks<\/strong>, she falls in the <strong>20&ndash;24 week band<\/strong>, which requires the opinion of <strong>two RMPs<\/strong> (not one &mdash; that\\'s only for &le;20 weeks). Her marital status is irrelevant to eligibility. <strong>No guardian consent<\/strong> is required &mdash; she is an adult and competent; guardian consent applies only to minors or those of unsound mind. <br><br><strong>Quick gestational map:<\/strong> &le;20 weeks &rarr; 1 RMP; 20&ndash;24 weeks &rarr; 2 RMPs (special categories: rape\/incest survivors, minors, change of marital status\/widowhood during pregnancy, women with disabilities, fetal abnormality, humanitarian settings); &gt;24 weeks &rarr; State-level Medical Board, fetal abnormality cases only.',\n      imgId:   'obs07-img1'\n    },\n\n    {\n      id:      2,\n      tag:     'Obstetric Law &mdash; PCPNDT Act',\n      stem:    'A pregnant woman undergoes a routine sonography. The sonologist discloses the fetus\\'s sex to her husband when he asks directly, despite mandatory anti-disclosure signage displayed in the centre. The woman herself never requested this information and was not present when the disclosure was made. Under the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994, who bears criminal liability for this act?',\n      correct: 'Both the sonologist who disclosed the sex and the husband who sought the disclosure are liable; the pregnant woman is presumed not to have compelled the act unless the prosecution proves otherwise',\n      opts: [\n        'Only the sonologist is liable for disclosing the sex; the husband cannot be prosecuted merely for receiving information that was volunteered to him without his active solicitation',\n        'Both the sonologist who disclosed the sex and the husband who sought the disclosure are liable; the pregnant woman is presumed not to have compelled the act unless the prosecution proves otherwise',\n        'Only the husband is liable for soliciting the disclosure; the sonologist is protected from prosecution as long as no separate fee was charged specifically for revealing the sex',\n        'The pregnant woman is liable along with the sonologist, since she was present at the centre and is presumed under the Act to have benefited from and implicitly authorised the disclosure'\n      ],\n      exp:     'The PCPNDT Act criminalises <strong>both ends<\/strong> of the transaction: Section 23 punishes the <strong>medical professional<\/strong> who conducts or discloses results of sex-determination, and Section 23(3) extends liability to <strong>any person seeking such disclosure<\/strong> (here, the husband who asked). Charging a fee is not a precondition &mdash; disclosure itself, fee or no fee, is the offence. <br><br>Critically, <strong>Section 24<\/strong> creates a <strong>presumption in favour of the pregnant woman<\/strong>: unless the prosecution proves she compelled the disclosure, she is <strong>presumed not guilty<\/strong> of any offence under the Act. This reflects the legislative intent to protect women from being coerced into sex-selective practices by family members, rather than punishing them as primary offenders. <br><br><strong>Common confusion:<\/strong> students often assume only the doctor can be prosecuted, missing that the Act explicitly extends liability to relatives\/seekers (Section 23(3)) precisely because family pressure, not clinician initiative, is the more common real-world driver of sex-selective abortion in India.',\n      imgId:   null\n    },\n\n    {\n      id:      3,\n      tag:     'High-Risk Pregnancy &mdash; Rh Isoimmunization',\n      stem:    'A <strong>26-year-old G2P1<\/strong> woman, blood group <strong>A negative<\/strong>, husband <strong>O positive<\/strong>, had an uncomplicated first pregnancy with normal vaginal delivery of a healthy A-positive baby; she does not recall receiving anti-D after that delivery. She is now <strong>28 weeks<\/strong> into her second pregnancy. Indirect Coombs test (ICT) is <strong>negative<\/strong>. What is the appropriate next step regarding anti-D immunoglobulin prophylaxis?',\n      correct: 'Give anti-D 300 mcg IM at 28 weeks regardless of the negative ICT, and repeat within 72 hours postpartum if the baby is confirmed Rh-positive',\n      opts: [\n        'Give anti-D 300 mcg IM at 28 weeks regardless of the negative ICT, and repeat within 72 hours postpartum if the baby is confirmed Rh-positive',\n        'Withhold anti-D antenatally and administer it only after delivery if the baby is Rh-positive, since a negative ICT at this stage already confirms she does not require antenatal prophylaxis',\n        'Withhold anti-D entirely and instead monitor serial antibody titers, administering anti-D only if the ICT converts to positive, since prophylaxis is only useful once sensitization has measurably begun',\n        'Anti-D would not help this pregnancy since she was likely already sensitized during the first delivery without prophylaxis; the focus should shift to monitoring this fetus for hemolytic disease directly'\n      ],\n      exp:     'A <strong>negative ICT<\/strong> means she has <strong>not yet<\/strong> formed detectable anti-D antibodies &mdash; it does not mean she does not need prophylaxis; it means prophylaxis will still <strong>work<\/strong>. Anti-D is a <strong>passive, prophylactic<\/strong> antibody given to mop up fetal Rh-positive cells before the mother\\'s own immune system mounts a response &mdash; once the ICT turns positive, the mother is already sensitized and anti-D is useless (it cannot reverse active immunization). <br><br><strong>Standard protocol:<\/strong> routine antenatal anti-D 300 mcg IM at <strong>28 weeks<\/strong> (regardless of ICT status, as long as it is negative), and a further dose within <strong>72 hours of delivery<\/strong> if the baby is confirmed Rh-positive. Additional doses are also indicated after any sensitizing event (APH, amniocentesis, abdominal trauma, ECV, miscarriage). <br><br>Her first pregnancy is fortunate, not reassuring: had she been given anti-D postpartum then, this entire antenatal discussion would carry lower stakes. The fact that she escaped sensitization despite a missed dose is luck, not protection &mdash; making this pregnancy\\'s prophylaxis more important, not less.',\n      imgId:   null\n    },\n\n    {\n      id:      4,\n      tag:     'Obstetric Law &mdash; Multifetal Pregnancy Reduction',\n      stem:    'A woman with a <strong>triplet pregnancy<\/strong> at 12 weeks, conceived via IVF, opts for <strong>multifetal pregnancy reduction (MFPR)<\/strong> to a twin gestation on grounds of maternal cardiovascular risk. Which statement correctly describes the legal framework governing this procedure in India?',\n      correct: 'MFPR falls within the MTP Act\\'s definition of \"termination of pregnancy\" when performed by a registered RMP with the woman\\'s consent, and is governed separately from the PCPNDT Act, which would apply only if the reduction were sex-selective',\n      opts: [\n        'MFPR is not legally permitted in India, since the MTP Act only recognises complete termination of a pregnancy and makes no provision for selectively reducing the number of fetuses within an ongoing multifetal gestation',\n        'MFPR falls within the MTP Act\\'s definition of \"termination of pregnancy\" when performed by a registered RMP with the woman\\'s consent, and is governed separately from the PCPNDT Act, which would apply only if the reduction were sex-selective',\n        'MFPR at any gestational age requires prior clearance from a State-level Medical Board, since the procedure involves selectively ending the life of one or more fetuses and is therefore treated identically to late termination for fetal abnormality',\n        'MFPR does not require a registered medical practitioner under the MTP Act, since it is classified as a fertility-management procedure falling exclusively under PCPNDT Act jurisdiction rather than termination law'\n      ],\n      exp:     'The MTP (Amendment) Act, 2021 explicitly clarified that <strong>\"termination of pregnancy\"<\/strong> includes <strong>partial termination<\/strong> in a multifetal pregnancy &mdash; i.e. MFPR is lawful when performed by a <strong>registered RMP<\/strong> with the woman\\'s informed consent, following the same gestational-band and RMP-opinion rules as any other termination under the Act. At 12 weeks, this falls in the &le;20-week band, requiring only one RMP\\'s opinion. <br><br>The <strong>PCPNDT Act<\/strong> becomes relevant only if there is reason to suspect the reduction is being used to <strong>select against a particular sex<\/strong> (e.g. selectively reducing female fetuses in a mixed-sex multifetal pregnancy) &mdash; that scenario invokes PCPNDT liability on top of, not instead of, MTP Act compliance. <br><br>A <strong>Medical Board<\/strong> is required only for terminations <strong>beyond 24 weeks<\/strong> on grounds of substantial fetal abnormality &mdash; not for routine MFPR performed early in pregnancy for maternal-risk reduction. Conflating the two creates unnecessary procedural delay for a time-sensitive first-trimester procedure.',\n      imgId:   null\n    },\n\n    {\n      id:      5,\n      tag:     'Obstetric Law &mdash; Late Termination for Fetal Anomaly',\n      stem:    'A woman at <strong>26 weeks gestation<\/strong> is diagnosed with a fetal anomaly that is incompatible with extrauterine survival. She wishes to terminate the pregnancy. Per the MTP Act 2021 amendment, which statement correctly describes the applicable process?',\n      correct: 'Termination beyond 24 weeks is permitted only on the opinion of a State-level Medical Board confirming \"substantial fetal abnormality,\" and the Act does not fix an upper gestational limit for this specific category',\n      opts: [\n        'Termination beyond 24 weeks is permitted only up to 28 weeks under the 2021 amendment, after which no termination is allowed under any circumstance, irrespective of the severity of the fetal anomaly',\n        'Termination beyond 24 weeks is permitted only on the opinion of a State-level Medical Board confirming \"substantial fetal abnormality,\" and the Act does not fix an upper gestational limit for this specific category',\n        'Termination beyond 24 weeks requires only the opinion of two registered medical practitioners, since fetal-abnormality cases are treated under the same procedural requirement as the standard 20&ndash;24 week special categories',\n        'Termination beyond 24 weeks is prohibited entirely under Indian law regardless of the fetal anomaly\\'s severity, since the 24-week upper limit set by the Act is absolute and admits no further exception'\n      ],\n      exp:     'The MTP (Amendment) Act, 2021 created a distinct, gestational-age-unbound category: termination <strong>beyond 24 weeks<\/strong> is permitted where a <strong>State-level Medical Board<\/strong> (not 1 RMP, not 2 RMPs) certifies <strong>\"substantial fetal abnormality.\"<\/strong> The Act and Rules do <strong>not<\/strong> prescribe a fixed upper gestational cut-off (such as 28 weeks) for this category &mdash; cases well into the third trimester have reached courts and Medical Boards where the anomaly is lethal or severely disabling, and several High Courts have permitted termination on Board recommendation even very late in pregnancy. <br><br>This is a frequent source of error: the <strong>20&ndash;24 week band (2 RMPs)<\/strong> is procedurally distinct from the <strong>&gt;24 week band (Medical Board)<\/strong> &mdash; mixing up the decision-maker (RMP count vs Board) is the most common mistake, as is assuming a hard numerical ceiling exists where the statute deliberately left the upper limit open, tying eligibility to medical severity rather than a fixed week count. <br><br>The Medical Board\\'s composition (gynaecologist, paediatrician, radiologist\/sonologist, plus others as notified) and its mandated turnaround time are prescribed by <strong>State government rules<\/strong> under the Act.',\n      imgId:   null\n    }\n\n  ];\n\n  var answers  = {};\n  var answered = 0;\n  var shuffled = {};\n  var done     = false;\n\n  function byId(id) { return document.getElementById(id); }\n  function gid(suffix) { return byId(NS + '-' + suffix); }\n\n  function shuffleArr(arr) {\n    var a = arr.slice(), i, j, tmp;\n    for (i = a.length - 1; i > 0; i--) {\n      j = Math.floor(Math.random() * (i + 1));\n      tmp = a[i]; a[i] = a[j]; a[j] = tmp;\n    }\n    return a;\n  }\n\n  function countVal(val) {\n    var k, n = 0;\n    for (k in answers) {\n      if (answers.hasOwnProperty(k) && answers[k] === val) n++;\n    }\n    return n;\n  }\n\n  function buildPips() {\n    var cont = gid('pips'), i, q, wLine, wPip, line, pip;\n    cont.innerHTML = '';\n    for (i = 0; i < QS.length; i++) {\n      q = QS[i];\n      if (i > 0) {\n        wLine = document.createElement('div');\n        wLine.className = 'mr-pip-wrap';\n        line = document.createElement('div');\n        line.className = 'mr-pip-line';\n        line.id = NS + '-pl' + q.id;\n        wLine.appendChild(line);\n        cont.appendChild(wLine);\n      }\n      wPip = document.createElement('div');\n      wPip.className = 'mr-pip-wrap';\n      pip = document.createElement('div');\n      pip.className = 'mr-pip';\n      pip.id = NS + '-pip' + q.id;\n      pip.textContent = String(q.id);\n      wPip.appendChild(pip);\n      cont.appendChild(wPip);\n    }\n  }\n\n  function build() {\n    var cont, i, q, opts, card, top, numDiv, meta, tag, stem,\n        rule, optsDiv, expDiv, lbl, txt, imgDiv, imgSrc, j,\n        optEl, ltrSpan, txtSpan;\n\n    cont = gid('cases');\n    cont.innerHTML = '';\n    answers = {}; answered = 0; shuffled = {}; done = false;\n    gid('score').style.display = 'none';\n    buildPips();\n\n    for (i = 0; i < QS.length; i++) {\n      q = QS[i];\n      opts = shuffleArr(q.opts);\n      shuffled[q.id] = opts;\n\n      card = document.createElement('div');\n      card.className = 'mr-case';\n\n      top = document.createElement('div');\n      top.className = 'mr-case-top';\n\n      numDiv = document.createElement('div');\n      numDiv.className = 'mr-num';\n      numDiv.textContent = q.id < 10 ? 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The Medical Board would clear you for practice.'],\n      [4, 'Strong round \\u2014 one statutory nuance to revisit.'],\n      [3, 'Solid base \\u2014 the debrief will sharpen the gestational bands.'],\n      [2, 'Halfway there \\u2014 review the missed sections of the Act carefully.'],\n      [0, 'Obstetric law repays close re-reading \\u2014 the bands and Boards take a second pass.']\n    ];\n    gid('verdict').textContent = verdicts[4][1];\n    for (vi = 0; vi < verdicts.length; vi++) {\n      if (c >= verdicts[vi][0]) {\n        gid('verdict').innerHTML = verdicts[vi][1];\n        break;\n      }\n    }\n\n    gid('ct-c').textContent = '\\u2705 ' + c + ' Correct';\n    gid('ct-w').textContent = '\\u274C ' + w + ' Wrong';\n    gid('ct-s').textContent = '\\u23ED ' + s + ' Skipped';\n\n    sc = gid('score');\n    sc.style.display = 'block';\n    sc.scrollIntoView({ behavior: 'smooth', block: 'center' });\n  }\n\n  function tryInit() {\n    var sentinel = document.getElementById(NS + '-sentinel');\n    var submit   = document.getElementById(NS + '-submit');\n    var retry    = document.getElementById(NS + '-retry');\n    if (!sentinel || !submit || !retry) {\n      setTimeout(tryInit, 80);\n      return;\n    }\n    submit.addEventListener('click', showScore);\n    retry.addEventListener('click', function () {\n      build();\n      window.scrollTo(0, 0);\n    });\n    var bar = document.getElementById(NS + '-progress');\n    if (bar && window.IntersectionObserver) {\n      new IntersectionObserver(function (entries) {\n        bar.className = entries[0].isIntersecting ? 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