Multiple Gestation — MCQs
Which of the following is NOT a characteristic of the recipient twin in a monochorionic twin gestation affected by twin-twin transfusion syndrome?
In pregnancies complicated by intrauterine growth restriction (IUGR) with otherwise reassuring fetal surveillance, what is the recommended gestational age for planned delivery to optimize neonatal outcomes?
A 29-year-old G3P2 woman at 34 weeks' gestation is involved in a serious car accident, loses consciousness briefly, and presents to the emergency department awake and alert with a severe headache, abdominal, and pelvic pain. Her vital signs include a blood pressure of 150/90 mm Hg, heart rate of 120/min, temperature of 37.4°C (99.3°F), and respiratory rate of 22/min. Fetal heart rate is 155/min. Physical examination reveals minor bruises on the abdomen and limbs, blood in the vault upon vaginal inspection, and strong, frequent uterine contractions. Which of the following is most likely a complication of her current condition?
Twin pregnancy is least associated with:
What is the concordance rate for schizophrenia in monozygotic twins?
All are cardiovascular system changes in pregnancy except.
Which of the following statements is true regarding twin-to-twin transfusion syndrome?
Which of the following are contra-indications to external cephalic version in antenatal management of breech presentation? 1. Antepartum haemorrhage 2. Multiple pregnancy 3. Reactive Non Stress Test 4. Severe oligohydramnios
USG of 28 weeks gestation showing oligohydramnios is likely to be due to?
The perinatal complications of a diabetic pregnancy include : 1. Small for Gestational Age baby 2. Stillbirth 3. Hypoglycaemia 4. Respiratory distress syndrome Select the correct answer from the code given below :
Multiple Gestation Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is NOT a characteristic of the recipient twin in a monochorionic twin gestation affected by twin-twin transfusion syndrome?
- A. Heart failure
- B. Hypovolemia (Correct Answer)
- C. Thrombosis
- D. Polyhydramnios
Explanation: ***Hypovolemia*** - The recipient twin in twin-twin transfusion syndrome (TTTS) experiences **hypervolemia** due to excessive blood flow from the donor twin, not hypovolemia. - This increased blood volume leads to **polycythemia** and volume overload. - Hypovolemia is actually a characteristic of the **donor twin**, not the recipient. *Thrombosis* - The recipient twin has **polycythemia** and increased blood viscosity due to hypervolemia, which increases the risk of **thrombosis**. - This hyperviscosity can lead to **vascular occlusions** in various organs. *Polyhydramnios* - The recipient twin characteristically develops **polyhydramnios** (excessive amniotic fluid) due to increased urine output from hypervolemia. - This is one of the **classic ultrasound findings** in TTTS, with the recipient showing a large fluid-filled sac. *Heart failure* - The recipient twin's heart has to pump an increased volume of blood, leading to **cardiac overload** and hypertrophy. - This chronic workload can eventually result in **congestive heart failure** and hydrops fetalis.
Question 2: In pregnancies complicated by intrauterine growth restriction (IUGR) with otherwise reassuring fetal surveillance, what is the recommended gestational age for planned delivery to optimize neonatal outcomes?
- A. 39 weeks
- B. 37 weeks
- C. 40 weeks
- D. 38 weeks (Correct Answer)
Explanation: ***38 weeks*** - For pregnancies complicated by **IUGR (Intrauterine Growth Restriction)** with reassuring fetal surveillance, planned delivery at **38-39 weeks** is recommended by **ACOG guidelines** to optimize neonatal outcomes. - Among the given options, **38 weeks** represents the earliest point in this recommended range, balancing the risks of continued intrauterine compromise with the risks of **prematurity** such as **respiratory distress syndrome**. - This timing is appropriate for **mild to moderate IUGR** without concerning Doppler findings or other complications. *39 weeks* - **39 weeks** is actually within the acceptable range (38-39 weeks) for IUGR delivery per current guidelines. - However, many obstetricians prefer **38 weeks** to minimize the risk of continued **fetal compromise** from **placental insufficiency**, making 38 weeks the more commonly cited benchmark. - The distinction between 38 and 39 weeks is nuanced and depends on individual case factors and surveillance findings. *37 weeks* - Delivery at **37 weeks** is considered **early term** and carries higher risk of **neonatal morbidities**, particularly **respiratory complications** and **hypoglycemia**. - This timing may be appropriate for **severe IUGR** with abnormal **umbilical artery Doppler** findings, **absent or reversed end-diastolic flow**, or other concerning features, but not for routine IUGR with reassuring surveillance. - It is not the standard recommendation for uncomplicated IUGR to optimize outcomes. *40 weeks* - Delivering at **40 weeks** in an IUGR pregnancy is **not recommended** due to increased risk of **stillbirth** and complications from ongoing **placental insufficiency**. - The risks of adverse outcomes escalate with expectant management beyond 38-39 weeks in IUGR pregnancies. - Minimal additional fetal growth occurs beyond this point while risks continue to increase.
Question 3: A 29-year-old G3P2 woman at 34 weeks' gestation is involved in a serious car accident, loses consciousness briefly, and presents to the emergency department awake and alert with a severe headache, abdominal, and pelvic pain. Her vital signs include a blood pressure of 150/90 mm Hg, heart rate of 120/min, temperature of 37.4°C (99.3°F), and respiratory rate of 22/min. Fetal heart rate is 155/min. Physical examination reveals minor bruises on the abdomen and limbs, blood in the vault upon vaginal inspection, and strong, frequent uterine contractions. Which of the following is most likely a complication of her current condition?
- A. IUGR
- B. Subarachnoid hemorrhage
- C. Vasa previa
- D. DIC (Correct Answer)
Explanation: ***DIC*** - The combination of **abruptio placentae** (suggested by trauma, pain, vaginal bleeding, and contractions) with potential severe bleeding from uterine rupture or injury from the car accident, significantly increases the risk of **Disseminated Intravascular Coagulation (DIC)**. - **DIC** is a life-threatening condition initiated by massive activation of the coagulation system, leading to widespread microthrombi formation and subsequent consumption of clotting factors and platelets, resulting in simultaneous **bleeding and thrombosis**. *IUGR* - **Intrauterine Growth Restriction (IUGR)** is a chronic complication typically developing over weeks or months, caused by placental insufficiency or fetal conditions. - It is unlikely to be an acute complication directly resulting from a traumatic event at 34 weeks gestation. *Subarachnoid hemorrhage* - While trauma can cause **subarachnoid hemorrhage**, the primary obstetric complications described (abdominal pain, vaginal bleeding, uterine contractions following trauma) point more strongly towards placental or uterine injury. - The patient's **headache** and brief loss of consciousness could be due to concussion, but the obstetric findings are more immediately concerning for distinct complications. *Vasa previa* - **Vasa previa** is an anatomical anomaly where fetal blood vessels within the membranes cross the internal cervical os, unprotected by placental tissue or Wharton's jelly. - This condition presents with painless vaginal bleeding upon rupture of membranes and **fetal distress**, usually in labor, but is not directly caused by trauma.
Question 4: Twin pregnancy is least associated with:
- A. Genetic
- B. Patient receiving fertilization treatment
- C. Young female (Correct Answer)
- D. Multigravida
Explanation: ***Young female*** - **Young maternal age** is generally associated with a *lower* incidence of twin pregnancies, particularly dizygotic twins. - The likelihood of dizygotic twinning *increases with maternal age* up to about 35-39 years. *Multigravida* - **Multiparity** (being a multigravida) is associated with an *increased* likelihood of twin pregnancies. - The chance of having twins increases with each successive pregnancy. *Genetic* - There is a **genetic predisposition** to dizygotic twinning, often running in families. - A family history of twinning, especially on the maternal side, increases the chances of having twins. *Patient receiving fertilization treatment* - **Assisted reproductive technologies (ART)**, such as *in vitro fertilization (IVF)*, significantly *increase* the risk of multiple pregnancies, including twins. - This is due to the transfer of multiple embryos or ovarian stimulation leading to multiple ovulations.
Question 5: What is the concordance rate for schizophrenia in monozygotic twins?
- A. 1%
- B. 10%
- C. 50% (Correct Answer)
- D. 0.10%
Explanation: ***50%*** - The **concordance rate** for schizophrenia in **monozygotic (identical) twins** is approximately **50%**. - This high concordance rate indicates a strong **genetic predisposition** but also highlights the role of **environmental factors**, as it is not 100%. *1%* - A 1% risk is closer to the **general population prevalence** of schizophrenia, not the concordance rate in monozygotic twins. - This low percentage would significantly underestimate the genetic component observed in twin studies for schizophrenia. *10%* - A 10% concordance rate is a significant increase over the general population risk but is still substantially lower than what has been consistently found in studies of monozygotic twins. - This percentage might be more aligned with the risk for first-degree relatives or dizygotic twins, not identical twins. *0.10%* - A 0.10% concordance rate is an extremely low figure, far below the actual observed rate for monozygotic twins. - Such a low percentage would suggest virtually no genetic influence on schizophrenia, which contradicts extensive research findings.
Question 6: All are cardiovascular system changes in pregnancy except.
- A. Increase in blood volume
- B. Increase in heart rate
- C. Increase in peripheral resistance (Correct Answer)
- D. Increase in cardiac output
Explanation: ***Increase in peripheral resistance*** - During normal pregnancy, **peripheral vascular resistance actually decreases** due to the effects of hormones like progesterone and the presence of the low-resistance uteroplacental circulation. - This decrease in resistance helps accommodate the increased blood volume and cardiac output. *Increase in cardiac output* - **Cardiac output increases significantly** during pregnancy (by 30-50%) to meet the metabolic demands of the growing fetus and maternal tissues. - This is primarily achieved through an increase in both stroke volume and heart rate. *Increase in blood volume* - **Blood volume increases substantially** (by 30-50%) during pregnancy, with plasma volume increasing more than red blood cell mass. - This expansion supports the increased cardiac output and placental perfusion. *Increase in heart rate* - **Heart rate increases** during pregnancy, typically by 10-20 beats per minute, contributing to the overall increase in cardiac output. - This physiological adaptation helps maintain adequate circulation.
Question 7: Which of the following statements is true regarding twin-to-twin transfusion syndrome?
- A. The donor twin is more likely to develop widespread thromboses
- B. The donor twin usually suffers from anemia.
- C. Gross differences may be observed between donor and recipient placentas
- D. The recipient twin develops hydramnios more often than does the donor twin. (Correct Answer)
Explanation: **The recipient twin develops hydramnios more often than does the donor twin.** - In **twin-to-twin transfusion syndrome (TTTS)**, the **recipient twin** receives excess blood flow, leading to **polycythemia** and increased urine output, which causes **polyhydramnios/hydramnios** (excess amniotic fluid). - The donor twin, experiencing decreased blood volume and oliguria, typically has **oligohydramnios** (reduced amniotic fluid). - This is the **most characteristic finding** of TTTS, with the classic presentation being **polyhydramnios in one sac and oligohydramnios in the other**. *Gross differences may be observed between donor and recipient placentas* - TTTS occurs in **monochorionic pregnancies**, meaning there is a **single shared placenta** (not separate placentas) with vascular anastomoses connecting both twins. - While there may be size disparities in the umbilical cords or membrane thickness, there are **not separate donor and recipient placentas** to compare. *The donor twin usually suffers from anemia.* - The **donor twin** does lose blood chronically to the recipient twin and can develop **anemia, hypovolemia, and growth restriction**. - However, this statement is **less consistently true** than the polyhydramnios/oligohydramnios pattern, as the severity of anemia varies. - The donor twin's primary features are **oligohydramnios, growth restriction, and stuck twin phenomenon**. *The donor twin is more likely to develop widespread thromboses* - **Widespread thromboses** are more characteristic of the **recipient twin** due to **polycythemia** and hyperviscosity from the increased blood volume. - The donor twin is more likely to experience **growth restriction, hypovolemia, and complications related to reduced blood flow**.
Question 8: Which of the following are contra-indications to external cephalic version in antenatal management of breech presentation? 1. Antepartum haemorrhage 2. Multiple pregnancy 3. Reactive Non Stress Test 4. Severe oligohydramnios
- A. 1, 2 and 4 (Correct Answer)
- B. 2, 3 and 4
- C. 1, 2, 3 and 4
- D. 1, 2 and 3
Explanation: ***1, 2 and 4*** * **Antepartum haemorrhage**, **multiple pregnancy**, and **severe oligohydramnios** are all contraindications to external cephalic version (ECV) due to increased risks of fetal distress, placental abruption, and uterine rupture. * These conditions either compromise fetal well-being directly or make the procedure significantly more dangerous for both mother and fetus. *2, 3 and 4* * This option incorrectly includes a **reactive non-stress test** as a contraindication, which actually indicates fetal well-being and is a prerequisite for ECV. * Excluding **antepartum haemorrhage** as a contraindication is also incorrect, as it poses a significant risk. *1, 2, 3 and 4* * This option is incorrect because a **reactive non-stress test** is a sign of fetal health and is a requirement *before* performing an ECV, not a contraindication. * Including it diminishes the specificity of contraindications for this procedure. *1, 2 and 3* * This option erroneously lists a **reactive non-stress test** as a contraindication, when in reality, it's a reassuring finding critical for proceeding with ECV. * It also omits **severe oligohydramnios** which is a significant contraindication due to the inability to safely manipulate the fetus.
Question 9: USG of 28 weeks gestation showing oligohydramnios is likely to be due to?
- A. Renal pathway obstruction (Correct Answer)
- B. Neuromuscular disorder
- C. Gastrointestinal obstruction
- D. Anencephaly
Explanation: ***Renal pathway obstruction*** - **Oligohydramnios** (low amniotic fluid) in the late second or third trimester is often caused by conditions that impair fetal urine production or outflow. - **Renal pathway obstruction** (e.g., posterior urethral valves, bilateral renal agenesis) prevents the fetus from producing or excreting sufficient urine, a primary source of amniotic fluid. *Gastrointestinal obstruction* - **Gastrointestinal obstruction** is more commonly associated with **polyhydramnios** because it impairs the fetal swallowing of amniotic fluid. - Inability to swallow leads to an *accumulation* of amniotic fluid, not a reduction. *Anencephaly* - **Anencephaly** is typically associated with **polyhydramnios** due to impaired swallowing of amniotic fluid. - The exposed brain tissue can also lead to increased fluid transudation. *Neuromuscular disorder* - **Neuromuscular disorders** can cause **polyhydramnios** if they lead to impaired fetal swallowing due to muscle weakness. - If a neuromuscular disorder affects the renal system, it could potentially cause oligohydramnios, but it is not the primary cause of oligohydramnios itself.
Question 10: The perinatal complications of a diabetic pregnancy include : 1. Small for Gestational Age baby 2. Stillbirth 3. Hypoglycaemia 4. Respiratory distress syndrome Select the correct answer from the code given below :
- A. 1 and 2 only
- B. 1 and 4 only
- C. 1 and 3 only
- D. 2 and 3 only (Correct Answer)
Explanation: ***2 and 3 only*** - **Stillbirth** is a major perinatal complication of diabetic pregnancy due to placental insufficiency, fetal hyperglycemia, and maternal ketoacidosis, occurring in up to 2-5% of poorly controlled cases. - **Neonatal hypoglycemia** occurs in 25-40% of infants of diabetic mothers due to fetal hyperinsulinemia. After delivery, the sudden withdrawal of maternal glucose supply while fetal insulin levels remain elevated leads to profound hypoglycemia within 1-2 hours of birth. - While **respiratory distress syndrome (RDS)** is also a recognized complication (due to delayed surfactant production from hyperinsulinemia), this question focuses on the most characteristic and immediate life-threatening perinatal complications requiring urgent monitoring and intervention. *1 and 2 only* - **Small for Gestational Age (SGA)** is NOT a typical complication of diabetic pregnancy. The classic presentation is **macrosomia** (Large for Gestational Age) due to fetal hyperinsulinemia driving increased glucose uptake and fat deposition. - SGA may occur in pre-gestational diabetes with severe vasculopathy, but this represents a minority of cases and is not the typical pattern. *1 and 4 only* - **Small for Gestational Age** is incorrect for the reasons stated above - diabetic pregnancies characteristically produce macrosomic infants, not growth-restricted ones. - **Respiratory distress syndrome** is indeed a complication, but the inclusion of the incorrect statement 1 makes this option wrong. *1 and 3 only* - **Small for Gestational Age** is fundamentally inconsistent with the pathophysiology of diabetic pregnancy, which involves fetal hyperglycemia and hyperinsulinemia leading to excessive growth. - **Hypoglycemia** is correct, but this option is invalidated by the inclusion of SGA.
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