Fetal Assessment Techniques — MCQs

10 questions

A 3-4 month old baby with heart rate 250/min, QRS complex less than 0.07 sec and no P wave, Diagnosis will be :

All of the following statements are true regarding non-invasive prenatal screening (NIPT) test except:

In an antepartum cardiotocogram, consider the following findings: absence of deceleration and a sinusoidal pattern. Which of the following findings indicates fetal well-being?

A woman presents to you at 36 weeks of gestation with complaints of breathlessness and excessive abdominal distension. Fetal movements are normal. On examination, fetal parts are not easily felt and fetal heartbeat is heard but it is muffled. Her symphysis fundal height is 41 cm. Her abdomen is tense but not tender. What is the most likely diagnosis?

In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?

In modern obstetrics, for a sensitized Rh-negative mother, what should be done to evaluate the fetal condition?

A 32-year-old pregnant woman presents with mild bleeding and pain. On examination, the uterus is tender, and fetal heart sounds are absent. What is the most likely diagnosis?

Which hepatitis is most dangerous in pregnancy?

What is the recommended management for jaundice due to obstetric cholestasis in the third trimester?

Q10

A G2P1L1 female presents at 28 weeks of gestation with a 1:4 anti-D titre. What is the most appropriate management option?

Fetal Assessment Techniques Indian Medical PG Practice Questions and MCQs

Question 1: A 3-4 month old baby with heart rate 250/min, QRS complex less than 0.07 sec and no P wave, Diagnosis will be :

A. VT
B. PSVT with block
C. SVT (Correct Answer)
D. Sinus tachycardia

Explanation: **SVT** - A heart rate of 250/min in a 3-4 month old infant, along with a **narrow QRS complex (<0.07 sec)**, is highly indicative of **supraventricular tachycardia (SVT)**. - The **absence of visible P waves** suggests that the atrial activity is either too rapid to be clearly distinguished or is retrograde and hidden within the QRS complex. *VT* - **Ventricular tachycardia (VT)** is characterized by **wide QRS complexes** (typically >0.09-0.10 sec in adults, proportionally less in infants) because the impulse originates in the ventricles. - The patient's QRS complex is **narrow (<0.07 sec)**, ruling out typical VT. *PSVT with block* - **Paroxysmal supraventricular tachycardia (PSVT) with block** would still present with a rapid atrial rate, and while there might be block to the ventricles, the dominant rhythm would stem from supraventricular activity causing narrow QRS, but the term "with block" usually implies some degree of AV nodal block which would lead to a ventricular rate slower than the atrial rate, unlike the observed 250/min. - The absence of P waves makes identification of a specific "block" pattern difficult, and the high ventricular rate favors a direct conduction rather than a blocked rhythm limiting ventricular response. *Sinus tachycardia* - **Sinus tachycardia** is usually characterized by discernible **P waves** preceding each QRS complex and a heart rate that typically doesn't exceed 220 bpm in infants unless under extreme physiological stress. - A heart rate of 250/min is generally above the physiological limit for sinus tachycardia in infants, and the **absence of P waves** further distinguishes it from sinus tachycardia.

Question 2: All of the following statements are true regarding non-invasive prenatal screening (NIPT) test except:

A. High negative predictive value
B. Positive test needs further confirmation
C. Used in screening for aneuploidies
D. Evaluates fetal blood taken by cordocentesis for fetal abnormalities (Correct Answer)

Explanation: ***Evaluates fetal blood taken by cordocentesis for fetal abnormalities*** - NIPT evaluates **cell-free fetal DNA** from a maternal blood sample, not fetal blood obtained via cordocentesis. - **Cordocentesis** is an invasive diagnostic procedure used to obtain fetal blood, typically for rapid karyotyping or hematologic studies, and is not part of NIPT. *Positive test needs further confirmation* - NIPT is a **screening test**, and a positive result indicates an increased risk, not a definitive diagnosis. - Any positive NIPT result requires **confirmatory diagnostic testing**, such as amniocentesis or chorionic villus sampling (CVS), due to the possibility of false positives. *High negative predictive value* - NIPT has a **very high negative predictive value (NPV)**, meaning that a negative result reliably indicates a very low likelihood of the screened aneuploidies being present. - This high NPV makes NIPT an effective tool for **reassuring patients** with negative results and reducing the need for invasive diagnostic procedures. *Used in screening for aneuploidies* - NIPT is primarily used to screen for common **fetal aneuploidies**, such as **Trisomy 21 (Down syndrome)**, Trisomy 18 (Edwards syndrome), and Trisomy 13 (Patau syndrome). - It analyzes fragments of fetal DNA circulating in the maternal bloodstream to detect chromosomal dosage imbalances.

Question 3: In an antepartum cardiotocogram, consider the following findings: absence of deceleration and a sinusoidal pattern. Which of the following findings indicates fetal well-being?

A. Both findings indicate fetal well-being
B. Absence of deceleration only (Correct Answer)
C. Absence of deceleration and sinusoidal pattern
D. Sinusoidal pattern only

Explanation: ***Absence of deceleration only*** - The **absence of decelerations** (late or variable) on a cardiotocogram (CTG) is generally considered a sign of **fetal well-being**, indicating adequate placental perfusion and oxygenation. - This suggests that the fetus is not experiencing significant hypoxic stress during contractions or in response to umbilical cord compression. *Both findings indicate fetal well-being* - A **sinusoidal pattern** is a sign of severe fetal compromise, not well-being, and indicates urgent intervention is needed. - Therefore, combining it with the absence of decelerations does not result in an overall indication of fetal well-being. *Absence of deceleration and sinusoidal pattern* - This option incorrectly groups the **absence of decelerations** (fetal well-being) with a **sinusoidal pattern** (fetal distress). - A sinusoidal pattern is a distinct, ominous finding associated with severe fetal anemia, hypoxemia, and acidosis. *Sinusoidal pattern only* - A **sinusoidal pattern** on a CTG is a highly abnormal and concerning finding, indicative of severe **fetal anemia**, **hypoxemia**, or **acidosis**. - It is a strong indicator of **fetal distress** and requires immediate assessment and intervention, not fetal well-being.

Question 4: A woman presents to you at 36 weeks of gestation with complaints of breathlessness and excessive abdominal distension. Fetal movements are normal. On examination, fetal parts are not easily felt and fetal heartbeat is heard but it is muffled. Her symphysis fundal height is 41 cm. Her abdomen is tense but not tender. What is the most likely diagnosis?

A. Abruptio placenta
B. Hydrocephalus of fetus
C. Polyhydramnios (Correct Answer)
D. Oligohydramnios

Explanation: ***Polyhydramnios*** - The patient's symptoms of **breathlessness**, **excessive abdominal distension**, a **symphysis fundal height of 41 cm at 36 weeks** (indicating a significantly larger than expected uterus), and **muffled fetal heart tones** are classic signs of polyhydramnios. - **Difficulty feeling fetal parts** is also consistent with excess amniotic fluid, which cushions the fetus and makes palpation harder. *Abruptio placenta* - This condition typically presents with sudden onset of **painful vaginal bleeding**, uterine tenderness, and fetal distress, none of which are described here. - While the abdomen might be tense due to uterine contractions or concealed bleeding, the lack of pain and bleeding makes this diagnosis unlikely. *Hydrocephalus of fetus* - Fetal hydrocephalus would primarily manifest as an **abnormally large fetal head** upon ultrasound, potentially leading to a higher fundal height. - However, it wouldn't directly explain the generalized excessive abdominal distension or the difficulty in feeling fetal parts due to fluid, though it could be a cause of polyhydramnios itself, it is not the most likely primary diagnosis from the given options directly addressing the symptoms. *Oligohydramnios* - This condition is characterized by **too little amniotic fluid**, which would result in a **smaller than expected symphysis fundal height** and an easily palpable fetus. - The patient's symptoms, particularly the excessive distension and high fundal height, directly contradict the features of oligohydramnios.

Question 5: In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?

A. Biophysical profile
B. Amniotic fluid spectrophotometry
C. Middle cerebral artery Doppler wave forms (Correct Answer)
D. Fetal blood sampling

Explanation: ***Middle cerebral artery Doppler wave forms*** - This is currently the most widely accepted and **non-invasive** method for monitoring **fetal anemia** in Rh-sensitized pregnancies. - An increase in the **peak systolic velocity (PSV)** in the middle cerebral artery indicates that the fetus is increasing cardiac output to compensate for a reduced oxygen-carrying capacity due to anemia. *Biophysical profile* - The biophysical profile assesses various fetal parameters like **movement**, **tone**, **breathing**, and **amniotic fluid volume**, which are often altered late in the course of severe fetal anemia. - It is a **less sensitive** indicator of early or moderate fetal anemia compared to MCA Doppler. *Amniotic fluid spectrophotometry* - This method measures the **bilirubin levels** in amniotic fluid, which correlates with the severity of hemolysis. - It is an **invasive procedure** (amniocentesis) and has largely been replaced by non-invasive MCA Doppler due to associated risks and better predictive value of Doppler. *Fetal blood sampling* - Fetal blood sampling (cordocentesis) provides a direct measurement of **fetal hemoglobin** and other blood parameters. - While definitive, it is a **highly invasive procedure** with significant risks, reserved primarily for confirmation of severe anemia or for direct transfusion, not for routine monitoring.

Question 6: In modern obstetrics, for a sensitized Rh-negative mother, what should be done to evaluate the fetal condition?

A. Fetal blood sampling
B. Amniocentesis for genetic testing
C. MCA Doppler peak systolic velocity (Correct Answer)
D. Biophysical profile assessment

Explanation: ***MCA Doppler peak systolic velocity*** - An elevated **Middle Cerebral Artery (MCA) Doppler peak systolic velocity (PSV)** is a highly sensitive and non-invasive indicator of **fetal anemia**, which can result from Rh-sensitization. - This measurement allows for early detection of significant anemia, guiding decisions for further interventions like **intrauterine blood transfusions**. *Fetal blood sampling* - While fetal blood sampling (cordocentesis) can directly diagnose fetal anemia and guide treatment, it is an **invasive procedure** with increased risks, including **fetal loss** and **trauma**. - Due to its invasiveness, MCA Doppler PSV is preferred as the **initial screening tool** for evaluating fetal anemia in sensitized Rh-negative mothers. *Amniocentesis for genetic testing* - **Amniocentesis** is used primarily for **genetic testing** and historically for **Liley curve** assessments of amniotic fluid bilirubin levels (a breakdown product of red blood cells) to detect fetal anemia. - However, it is an **invasive procedure**, carries risks to the fetus and mother, and has largely been replaced by non-invasive methods like MCA Doppler. *Biophysical profile assessment* - The **biophysical profile (BPP)** assesses overall fetal well-being through parameters like **fetal breathing, movement, tone, amniotic fluid volume**, and a **non-stress test**. - While useful for general fetal assessment, BPP is **not specific for detecting fetal anemia** from Rh-sensitization until anemia is severe, making MCA Doppler PSV a more appropriate and sensitive initial screening tool for this specific condition.

Question 7: A 32-year-old pregnant woman presents with mild bleeding and pain. On examination, the uterus is tender, and fetal heart sounds are absent. What is the most likely diagnosis?

A. Abruptio placenta (Correct Answer)
B. Uterine rupture
C. Ectopic pregnancy
D. Placenta previa

Explanation: ***Abruptio placenta*** - This condition involves the **premature detachment of the placenta** from the uterine wall, leading to bleeding and severe abdominal pain due to uterine contractions and irritation. - The **tender uterus** is a characteristic finding, often described as a "woody hard" uterus in severe cases. - The absence of fetal heart sounds suggests **fetal demise**, which is a common and severe complication of placental abruption due to oxygen deprivation. *Uterine rupture* - **Uterine rupture** can present with abdominal pain, vaginal bleeding, and loss of fetal heart tones, making it an important differential. - However, it typically occurs during **active labor**, especially in women with previous cesarean sections or uterine surgery. - The presentation usually includes **sudden severe pain**, loss of uterine contractions, and the fetus may be palpable abdominally if completely extruded. *Ectopic pregnancy* - This occurs when the **fertilized egg implants outside the uterus**, most commonly in the fallopian tube. - Symptoms typically appear much earlier in pregnancy **(first trimester)** and the pain is usually localized, often presenting with a smaller, non-tender uterus. - Not consistent with the clinical picture of an obviously pregnant uterus. *Placenta previa* - **Placenta previa** is characterized by the placenta covering the cervical opening, leading to **painless vaginal bleeding**, often bright red. - The uterus is typically **soft and non-tender**, in contrast to the tender uterus described in the case. - This is the key differentiating feature from placental abruption.

Question 8: Which hepatitis is most dangerous in pregnancy?

A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis E (Correct Answer)

Explanation: ***Hepatitis E*** - **Hepatitis E infection** during pregnancy is associated with a significantly higher risk of **acute liver failure**, **maternal mortality**, and adverse fetal outcomes, particularly in the third trimester. - The mortality rate can be as high as **15-25%** in pregnant women, making it the most dangerous form of hepatitis in this population. *Hepatitis A* - **Hepatitis A** during pregnancy typically has a course similar to that in non-pregnant individuals, with **low maternal-fetal transmission** and generally good outcomes. - It does not significantly increase the risk of severe maternal disease or fetal complications beyond the general population. *Hepatitis B* - While chronic **Hepatitis B** can be transmitted **perinatally** from mother to child and lead to chronic infection in the infant, it rarely causes more severe maternal disease during pregnancy. - The primary concern with Hepatitis B in pregnancy is preventing **vertical transmission** to the neonate through vaccination and immunoglobulin. *Hepatitis C* - **Hepatitis C** primarily poses a risk of **vertical transmission** to the infant, which can lead to chronic infection in the child. - It does not typically exacerbate maternal liver disease or significantly increase maternal mortality during pregnancy itself.

Question 9: What is the recommended management for jaundice due to obstetric cholestasis in the third trimester?

A. Induction of labour at 37 weeks
B. Induction of labour at 42 weeks
C. Induction of labour at 38 weeks (Correct Answer)
D. Wait for spontaneous labour

Explanation: ***Induction of labour at 38 weeks*** - **Obstetric cholestasis (Intrahepatic Cholestasis of Pregnancy)** is associated with increased risk of **stillbirth**, particularly beyond 37-38 weeks gestation. - Induction at **37-38 weeks** is recommended to balance reducing stillbirth risk while minimizing prematurity complications. - **Current practice**: Timing depends on **bile acid levels** - delivery at 37-38 weeks for bile acids >40 μmol/L, or 38-39 weeks for milder cases (19-39 μmol/L). - This option represents the standard management approach for most cases of obstetric cholestasis. *Induction of labour at 37 weeks* - Delivery at 37 weeks is also acceptable and increasingly preferred, particularly for **severe disease** (bile acids >40 μmol/L) or when there are additional risk factors. - Both 37 and 38 weeks are within the recommended window; the choice depends on **disease severity** and individual risk assessment. - This is not incorrect, but 38 weeks represents a slightly more conservative approach balancing risks. *Induction of labour at 42 weeks* - Waiting until 42 weeks significantly increases the risk of **intrauterine fetal death (IUFD)** in pregnancies complicated by obstetric cholestasis. - Prolonged exposure to **elevated bile acids** is toxic to the fetus and increases stillbirth risk, especially after 37-38 weeks. - This approach is **contraindicated** in obstetric cholestasis. *Wait for spontaneous labour* - Expectant management beyond 38 weeks is considered **unsafe** due to the unpredictable and progressive risk of **sudden intrauterine death**. - Active management with planned delivery at 37-38 weeks is the standard of care to prevent stillbirth. - Waiting for spontaneous labor exposes the fetus to unacceptable risks.

Question 10: A G2P1L1 female presents at 28 weeks of gestation with a 1:4 anti-D titre. What is the most appropriate management option?

A. MCA Doppler (Correct Answer)
B. Caesarean section
C. Induction of labour
D. Amniocentesis

Explanation: ***MCA Doppler*** - The presence of anti-D antibodies in a pregnant woman indicates **Rh isoimmunization**, which can lead to **hemolytic disease of the fetus and newborn (HDFN)**. - Even though a titre of **1:4 is below the critical threshold** (usually 1:16 or 1:32), any detectable anti-D titre at 28 weeks warrants **fetal surveillance** to detect early signs of fetal anemia. - **Middle cerebral artery (MCA) Doppler** is the **non-invasive gold standard** for detecting fetal anemia by measuring peak systolic velocity (PSV), which increases in anemic fetuses due to hyperdynamic circulation. - Serial MCA Doppler monitoring allows timely intervention if fetal anemia develops, avoiding unnecessary invasive procedures. *Caesarean section* - This is a mode of delivery and would only be considered if there were severe **fetal compromise** or other obstetric indications after proper monitoring and management. - At 28 weeks gestation with a low anti-D titre, immediate delivery is **not indicated** and would result in significant prematurity risks. *Induction of labour* - Induction of labour is a delivery method that would only be planned at term or for specific indications like severe fetal compromise unresponsive to other interventions. - At **28 weeks gestation**, the focus should be on **monitoring and prolonging pregnancy** while ensuring fetal wellbeing, not on delivery. *Amniocentesis* - Historically used to assess **bilirubin levels (ΔOD450)** in amniotic fluid as an indirect measure of fetal hemolysis, but it is an **invasive procedure** with risks (miscarriage ~1%, infection, worsening sensitization). - **MCA Doppler has largely replaced amniocentesis** for initial and serial assessment of fetal anemia due to its non-invasive nature, high sensitivity, and ability to be repeated safely.

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