Maternal-Fetal Medicine Practice Questions

Q: Life-threatening complications of recalcitrant Hyperemesis Gravidarum include all except:

Hyperprothrombinemia. **Explanation:** Hyperemesis Gravidarum (HG) is a severe form of nausea and vomiting in pregnancy that leads to dehydration, electrolyte imbalance, and nutritional deficiencies. **Why Option B is the Correct Answer:** The correct answer is **Hyperprothrombinemia** because HG actually causes the opposite: **Hypoprothrombinemia**. Severe vomiting leads to a deficiency of Vitamin K (a fat-soluble vitamin). Since Vitamin K is essential for the synthesis of clotting factors II, VII, IX, and X, its deficiency results in a prolonged Prothrombin Time (PT) and decreased prothrombin levels, potentially leading to coagulopathy. **Analysis of Incorrect Options:** * **A. Esophageal rupture:** Forceful, repeated vomiting can lead to linear mucosal lacerations at the gastroesophageal junction (**Mallory-Weiss tears**) or, more rarely, full-thickness esophageal rupture (**Boerhaave syndrome**). * **C. Thiamine deficiency:** This is a critical complication of recalcitrant HG. Severe depletion of Vitamin B1 (Thiamine) can lead to **Wernicke’s Encephalopathy**, characterized by the triad of ataxia, ophthalmoplegia, and confusion. * **D. Hyperalimentation complications:** Patients with recalcitrant HG often require parenteral nutrition (TPN). This carries risks such as catheter-related sepsis, air embolism, and metabolic derangements like **Refeeding Syndrome**. **High-Yield Clinical Pearls for NEET-PG:** * **Wernicke’s Encephalopathy:** Always give Thiamine supplementation *before* intravenous glucose in HG patients to prevent precipitating acute encephalopathy. * **Electrolyte Triad:** HG typically presents with **Hypokalemic, Hypochloremic, Metabolic Alkalosis**. * **Liver Function:** HG can cause a mild rise in serum transaminases (usually <300 U/L) and serum bilirubin. * **Thyroid:** HG is often associated with transient gestational hyperthyroidism due to high hCG levels (hCG mimics TSH).

Q: Which of the following conditions shows a "snowstorm appearance" on ultrasonography?

Hydatidiform mole. **Explanation:** The **"snowstorm appearance"** is the classic ultrasonographic hallmark of a **Hydatidiform Mole** (specifically a complete molar pregnancy). This appearance is caused by the presence of multiple small, hydropic (fluid-filled) chorionic villi that undergo cystic degeneration. On ultrasound, these vesicles appear as a complex pattern of numerous small, low-level echoes (hyperechoic areas) interspersed with tiny sonolucent (anechoic) spaces, resembling a snowstorm or "bunches of grapes." **Analysis of Options:** * **Hydatidiform Mole (Correct):** The absence of a fetus and the presence of a heterogeneous mass filling the uterine cavity with characteristic cystic spaces confirm this diagnosis. * **Tubal Pregnancy:** Typically presents as an adnexal mass (e.g., "blob sign" or "bagel sign") with an empty uterus. * **Abdominal Pregnancy:** Characterized by a fetus located outside the uterus, often with an empty uterine cavity and oligohydramnios. * **Fibroid:** Usually appears as a well-defined, hypoechoic, solid mass with whorled patterns and posterior acoustic shadowing. **High-Yield Clinical Pearls for NEET-PG:** * **Complete Mole:** 46 XX (most common), paternal origin, "snowstorm" appearance, no fetal parts, high risk of choriocarcinoma. * **Partial Mole:** 69 XXY (triploidy), fetal parts may be present, focal cystic changes in the placenta. * **Theca Lutein Cysts:** Often seen bilaterally in the ovaries due to extremely high levels of β-hCG associated with molar pregnancies. * **Clinical Triad:** Painless vaginal bleeding, uterus larger than gestational age, and hyperemesis gravidarum.

Q: Which of the following statements regarding twining is true?

After embryonic disc fusion, conjoint twin is formed.. **Explanation:** The timing of zygotic division determines the type of monozygotic (MZ) twinning. If division occurs **after the 13th day** of fertilization (when the embryonic disc has already begun to form), the separation is incomplete, resulting in **conjoint twins**. This is the underlying embryological basis for the correct option. **Analysis of Options:** * **Option A (Correct):** Incomplete division of the embryonic disc after day 13 leads to conjoint twins (e.g., thoracopagus, craniopagus). * **Option B & C (Incorrect):** The incidence of **monozygotic twins** is remarkably constant worldwide (approx. 1 in 250 births) and is independent of race, age, or parity. Conversely, the incidence of **dizygotic (DZ) twins** varies significantly based on race (highest in Nigerians, lowest in Japanese), maternal age, and the use of assisted reproductive technologies. * **Option D (Incorrect):** The frequencies are not the same. While MZ rates are constant, DZ rates fluctuate. According to **Hellin’s Rule**, the general frequency of twins is 1 in 80 pregnancies, but this refers to total twinning, not an equal split between zygosity types. **High-Yield Clinical Pearls for NEET-PG:** * **Timing of Division:** * 0–72 hours: Dichorionic Diamniotic (DCDA) * 4–8 days: Monochorionic Diamniotic (MCDA) — *Most common MZ type (75%)* * 8–13 days: Monochorionic Monoamniotic (MCMA) * >13 days: Conjoint twins * **Lambda (λ) Sign:** Seen in DCDA (thick membrane). * **T-sign:** Seen in MCDA (thin membrane). * **Most common variety of conjoint twins:** Thoracopagus (joined at the chest).

Q: Which of the following complications is NOT associated with an increased risk in multifetal pregnancy?

Post-term pregnancy. **Explanation:** In multifetal pregnancies, the primary physiological challenge is uterine overdistension and increased metabolic demand. **Post-term pregnancy** is not associated with multifetal gestations because these pregnancies are characterized by a significantly higher risk of **preterm labor and delivery**. The average duration of pregnancy decreases as the number of fetuses increases (approx. 37 weeks for twins, 33 weeks for triplets). Consequently, the clinical concern is prematurity rather than post-term complications. **Analysis of Incorrect Options:** * **Maternal Death:** Multifetal pregnancies carry a 2-to-3-fold higher maternal mortality rate compared to singletons, primarily due to complications like hemorrhage and embolism. * **Preeclampsia:** The increased placental mass in multifetal gestations leads to higher levels of anti-angiogenic factors (like sFlt-1), making hypertensive disorders 2–3 times more common and often more severe. * **Hysterectomy:** There is a significantly higher risk of peripartum hysterectomy due to **postpartum hemorrhage (PPH)** caused by uterine atony (from overdistension) or abnormal placentation (e.g., placenta previa). **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication:** Preterm labor/prematurity. * **Most common presentation:** Vertex-Vertex (approx. 40-50%). * **Weight Gain:** Recommended weight gain for a woman with a normal BMI carrying twins is **17–25 kg** (37–54 lbs). * **Iron Deficiency Anemia:** Risk is significantly higher due to increased fetal demand and expanded maternal plasma volume.

Q: What is the exclusive complication of monochorionic twins?

Twin-to-twin transfusion syndrome. **Explanation:** The defining feature of **monochorionic (MC) placentation** is the presence of **vascular anastomoses** (arterio-venous, arterio-arterial, or veno-venous) on the placental surface that connect the circulations of the two fetuses. **Twin-to-Twin Transfusion Syndrome (TTTS)** is the correct answer because it is caused specifically by an imbalance in these deep **arterio-venous (AV) anastomoses**. Blood is shunted from a "donor" twin to a "recipient" twin, leading to a sequence of polyhydramnios-oligohydramnios. This hemodynamic complication cannot occur in dichorionic twins because their placentas are separate and lack these shared vascular connections. **Analysis of Incorrect Options:** * **A. Cord entanglement:** This is an exclusive complication of **monoamniotic** twins (a subset of monochorionic twins where both fetuses share one amniotic sac). While all monoamniotic twins are monochorionic, not all monochorionic twins are monoamniotic. * **C. Discordant growth:** This refers to a significant weight difference between twins. It can occur in **both** monochorionic (due to TTTS or unequal placental sharing) and dichorionic twins (due to genetic factors or individual placental insufficiency). * **D. Abortion:** Spontaneous pregnancy loss can occur in any pregnancy, whether singleton, dichorionic, or monochorionic. **High-Yield Clinical Pearls for NEET-PG:** * **Quintero Staging** is used to classify the severity of TTTS (Stage I: Oligo/Polyhydramnios to Stage V: Death of one or both fetuses). * **TAPS (Twin Anemia Polycythemia Sequence):** Another MC-exclusive complication caused by slow transfusion through tiny diameter anastomoses. * **TRAP (Twin Reversed Arterial Perfusion) Sequence:** Also exclusive to MC twins, involving an "acardiac" twin. * **Lambda sign (T-sign):** On ultrasound, the absence of the Lambda sign (presence of **T-sign**) confirms monochorionicity.

Q: What are the effects of smoking during pregnancy?

Intrauterine Growth Restriction (IUGR). **Explanation:** Smoking during pregnancy is a high-yield topic in NEET-PG, primarily associated with adverse perinatal outcomes due to chronic placental insufficiency. **Why Option A is Correct:** The primary mechanism behind **Intrauterine Growth Restriction (IUGR)** in smokers is twofold: 1. **Carbon Monoxide (CO):** CO has a higher affinity for hemoglobin than oxygen, forming carboxyhemoglobin. This reduces the oxygen-carrying capacity of maternal blood, leading to fetal hypoxia. 2. **Nicotine:** Nicotine acts as a potent vasoconstrictor, reducing uterine blood flow and impairing the transfer of essential nutrients across the placenta. Collectively, these factors lead to a significant reduction in birth weight (on average 150–200g less) and increased risk of Small for Gestational Age (SGA) infants. **Why Other Options are Incorrect:** * **Option B (PIH):** Interestingly, smoking is statistically associated with a *decreased* risk of preeclampsia/PIH, likely due to the inhibition of certain inflammatory pathways, though this is not a reason to encourage smoking. * **Option C (Malpresentation):** This is typically associated with factors like placenta previa, uterine anomalies, or polyhydramnios, rather than smoking. * **Option D (PPH):** While smoking increases the risk of Abruptio Placentae and Placenta Previa (which can cause antepartum hemorrhage), it is not a direct primary cause of Postpartum Hemorrhage (PPH). **High-Yield Clinical Pearls for NEET-PG:** * **Placental Complications:** Smoking is a major risk factor for **Placenta Previa** and **Abruptio Placentae**. * **Membranes:** It is strongly linked to **Preterm Premature Rupture of Membranes (PPROM)** and preterm labor. * **Long-term:** Increased risk of **Sudden Infant Death Syndrome (SIDS)** and childhood respiratory infections. * **Congenital Anomalies:** Specifically associated with an increased risk of **Orofacial clefts**.

Q: What is the risk of mother-to-child HIV transmission in a pregnant woman at the time of delivery and after delivery in a non-breastfeeding woman?

15-30%. **Explanation:** The risk of Mother-to-Child Transmission (MTCT) of HIV occurs in three distinct phases: in-utero (antenatal), during labor and delivery (intranatal), and through breastfeeding (postnatal). **1. Why 15-30% is correct:** In the absence of any medical intervention (Antiretroviral Therapy - ART) and assuming the mother **does not breastfeed**, the cumulative risk of transmission is approximately **15-30%**. * **Antenatal risk:** ~5-10% * **Intranatal risk:** ~10-20% (The majority of transmission occurs during labor due to exposure to infected maternal blood and vaginal secretions). Combining these two phases results in the 15-30% range. If breastfeeding were included, the risk would increase to 30-45%. **2. Analysis of Incorrect Options:** * **Option A (5-10%):** This represents only the antenatal (in-utero) risk or the risk in a woman on highly effective ART with a suppressed viral load. * **Option B (10-15%):** This is too low for a woman not receiving any intervention; it underestimates the significant risk during the intrapartum period. * **Option D (>50%):** This is an overestimation. Even without treatment, the majority of infants born to HIV-positive mothers do not contract the virus. **3. NEET-PG High-Yield Pearls:** * **Most common timing of transmission:** Intrapartum (during labor/delivery). * **Effect of ART:** With effective ART and viral suppression ( 1000 copies/mL or unknown. * **Feeding:** In India, exclusive breastfeeding is recommended for the first 6 months if replacement feeding is not "Acceptable, Feasible, Affordable, Sustainable, and Safe" (AFASS). However, the question specifically specifies a **non-breastfeeding** woman.

Question 1

Life-threatening complications of recalcitrant Hyperemesis Gravidarum include all except:

Accepted Answer

Hyperprothrombinemia

Answer

Esophageal rupture

Answer

Thiamine deficiency

Answer

Hyperalimentation complications

Question 2

Which of the following conditions shows a "snowstorm appearance" on ultrasonography?

Accepted Answer

Hydatidiform mole

Answer

Tubal pregnancy

Answer

Abdominal pregnancy

Answer

Fibroid

Question 3

Which of the following statements regarding twining is true?

Accepted Answer

After embryonic disc fusion, conjoint twin is formed.

Answer

Incidence of monozygotic twin varies with race.

Answer

Incidence of dizygotic twin is constant.

Answer

The frequency of monozygosity and dizygosity is the same.

Question 4

In a pregnant woman with heart disease, all of the following are to be done except?

Accepted Answer

Administer IV methergine after delivery

Answer

Provide prophylactic antibiotics

Answer

Administer IV frusemide postpartum

Answer

Shorten the second stage of labor

Question 5

A 30-year-old G2P1L1 at 37 weeks gestational age presents for a routine visit. Her first delivery was a vaginal delivery of a 4.3 kg baby boy after 30 minutes of pushing. This fetus is breech. A vaginal examination shows that the cervix is 50% effaced and 1 to 2 cm dilated. The presenting breech is high out of the pelvis. The estimated fetal weight is approximately 3.2 kgs. A sonogram confirms a fetus with a frank breech presentation, normal amniotic fluid, and the head is well flexed. Which of the following is NOT a possible management plan?

Accepted Answer

Perform a cesarean section immediately.

Answer

Allow the patient to attempt a vaginal breech delivery when she goes into labor.

Answer

Pinard's maneuver can be utilized for the delivery of extended legs.

Answer

Schedule an external cephalic version in the next few days.

Question 6

Which of the following complications is NOT associated with an increased risk in multifetal pregnancy?

Accepted Answer

Post-term pregnancy

Answer

Maternal death

Answer

Preeclampsia

Answer

Hysterectomy

Question 7

What is the exclusive complication of monochorionic twins?

Accepted Answer

Twin-to-twin transfusion syndrome

Answer

Cord entanglement

Answer

Discordant growth

Answer

Abortion

Question 8

What are the effects of smoking during pregnancy?

Accepted Answer

Intrauterine Growth Restriction (IUGR)

Answer

Pregnancy-Induced Hypertension (PIH)

Answer

Malpresentation

Answer

Postpartum Hemorrhage (PPH)

Question 9

What is the risk of mother-to-child HIV transmission in a pregnant woman at the time of delivery and after delivery in a non-breastfeeding woman?

Accepted Answer

15-30%

Answer

5-10%

Answer

10-15%

Answer

More than 50%

Question 10

A pregnant mother presents with a history of delivering a previous child with Congenital Adrenal Hyperplasia (CAH). What is the best management protocol for the current pregnancy?

Accepted Answer

Start dexamethasone as soon as pregnancy is confirmed

Answer

Start prednisolone after establishing whether the fetus is affected by Chorionic Villous Sampling

Answer

Start dexamethasone after determining the sex of the fetus by Karyotyping

Answer

Start prednisolone after determining the sex of the fetus with USG

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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