Maternal-Fetal Medicine Practice Questions

Q: Pregnancy can be terminated at any gestation if the fetus is diagnosed to have:

Anencephaly. ***Anencephaly*** - Anencephaly is a **lethal congenital anomaly** where the brain and skull do not develop properly. - Due to the **incompatible-with-life prognosis**, termination of pregnancy at any gestation is medically justified and often offered. *Duodenal atresia* - **Duodenal atresia** is a treatable condition where the duodenum is blocked. - It is **surgically correctable** after birth and does not warrant termination of pregnancy at any stage. *Bilateral talipes* - **Bilateral talipes** (clubfoot) is a common musculoskeletal birth defect that can be corrected with conservative management (e.g., Ponseti method) or surgery. - It is **not life-threatening** and does not justify termination of pregnancy. *Hydrocephalus* - While hydrocephalus can be severe, its prognosis is variable and often depends on the underlying cause and severity. - Many cases of **hydrocephalus are manageable** with shunting procedures, and it is not universally considered a condition that warrants termination at any gestation.

Q: Which one of the following statements regarding intrauterine growth restriction is NOT correct?

Defined according to biparietal diameter. ***Defined according to biparietal diameter*** - **Intrauterine growth restriction (IUGR)** is primarily defined by estimated fetal weight falling below the **10th percentile** for gestational age, not solely by biparietal diameter (BPD). - While BPD is one of several biometric measurements used to estimate fetal weight, it alone is insufficient to diagnose or define IUGR. Other factors like umbilical artery **Doppler studies** and maternal-fetal risk factors are also considered. *There is danger of fetal asphyxia during delivery* - Fetuses with IUGR are at increased risk of **fetal compromise** due to altered placental function and reduced reserve, making them more susceptible to **asphyxia** during the stress of labor. - This increased risk often necessitates careful monitoring during labor and sometimes leads to earlier intervention such as **cesarean section**. *Generally not seen in women with gestational diabetes* - This statement is correct. While gestational diabetes can lead to various complications, the primary fetal concern is **macrosomia** (large-for-gestational-age infants), rather than IUGR. - IUGR is more commonly associated with conditions causing **placental insufficiency**, while maternal hyperglycemia in gestational diabetes tends to cause excessive fetal growth. *Doppler studies are indicated* - **Doppler velocimetry** of the umbilical artery and other fetal vessels is crucial for monitoring fetuses with IUGR. - These studies assess **placental function** and fetal hemodynamics, helping to determine the severity of IUGR and guide the timing of delivery.

Q: Consider following statements regarding Beta Thalassemia in pregnancy: 1. There is low MCH and MCV 2. Total Iron binding capacity may be elevated or normal 3. HbA2 more than 3.5% is seen in Haemoglobin Electrophoresis Which of the statements given above is/are correct?

1, 2 and 3. ***1, 2 and 3*** - Statement 1 is correct: Patients with **beta thalassemia** typically exhibit **microcytic (low MCV)** and **hypochromic (low MCH)** anemia due to reduced beta-globin chain synthesis. - Statement 2 is correct: **Total iron binding capacity (TIBC)** in beta thalassemia trait is typically **normal or slightly elevated**. Unlike iron deficiency anemia where TIBC is markedly elevated, in thalassemia trait the TIBC remains in the normal range or may be mildly elevated. Importantly, serum ferritin is normal or elevated (unlike iron deficiency where it's low). - Statement 3 is correct: **Hemoglobin electrophoresis** in beta thalassemia trait characteristically shows **HbA2 > 3.5%** (usually 4-6%), which is the key diagnostic criterion that differentiates it from iron deficiency anemia. *2 and 3 only* - This option is incorrect because statement 1 (low MCH and MCV) is a fundamental hematological characteristic of beta thalassemia and is therefore correct. *1 and 2 only* - This option is incorrect because statement 3 (HbA2 > 3.5%) is the definitive diagnostic criterion for beta thalassemia trait and is essential for diagnosis. *1 only* - This option is incorrect because statements 2 and 3 are also accurate. Low MCV and MCH alone cannot distinguish beta thalassemia from iron deficiency anemia; elevated HbA2 and normal/elevated ferritin with normal/slightly elevated TIBC are key differentiating features.

Q: Consider the following statements : Statement-1 : In fetal growth restriction there is always oligohydramnios Statement-2 : In fetal growth restriction there is placental insufficiency leading to redistribution of blood flow to fetal brain shunting it from fetal kidney Which one of the following is correct in respect of the above statements ?

Statement-2 is true but Statement-1 is false. ***Statement-2 is true but Statement-1 is false*** **Statement-1 Analysis**: "In fetal growth restriction there is always oligohydramnios" - This statement is **FALSE** due to the absolute term "always" - Oligohydramnios is a **common** but not universal finding in FGR - It occurs more frequently in asymmetric FGR and severe cases with significant placental insufficiency - Early or mild FGR may present with normal amniotic fluid volume - Other types of FGR (symmetric FGR) may not be associated with oligohydramnios **Statement-2 Analysis**: "In fetal growth restriction there is placental insufficiency leading to redistribution of blood flow to fetal brain shunting it from fetal kidney" - This statement is **TRUE** and accurately describes the pathophysiology of FGR - **Placental insufficiency** impairs oxygen and nutrient delivery to the fetus - This triggers **compensatory blood flow redistribution** (brain-sparing effect) - Blood is preferentially shunted to vital organs (brain, heart, adrenals) - Blood flow is reduced to less critical organs, particularly the **kidneys** - Reduced renal perfusion → decreased fetal urine production → oligohydramnios (when present) **Why Other Options are Incorrect:** *Both Statement-1 and Statement-2 are true and Statement-2 is the correct explanation for Statement-1* - Incorrect because Statement-1 is false (oligohydramnios is not "always" present in FGR) *Statement-1 is true but Statement-2 is false* - Incorrect because Statement-1 is false and Statement-2 is true (reverses the actual truth values) *Both Statement-1 and Statement-2 are true and Statement-2 is not the correct explanation for Statement-1* - Incorrect because Statement-1 is false (the absolute qualifier "always" makes it inaccurate)

Q: Which one of the following statements regarding Rh isoimmunization is correct? 1. Liley's chart identifies anemia better than middle cerebral artery Doppler 2. Indirect Coombs test is positive in mother 3. Baby is at risk of developing anemia 4. Direct Coombs test is positive in baby

2, 3 and 4. ***2, 3 and 4 are correct*** - The **indirect Coombs test** identifies **anti-Rh antibodies** in the mother's serum, indicating she has been sensitized to Rh antigens. - The baby is at risk of developing **hemolytic anemia** due to transplacental passage of maternal anti-Rh antibodies, which destroy fetal red blood cells. - The **direct Coombs test** detects **anti-Rh antibodies** coating the baby's red blood cells, confirming immune-mediated hemolysis in the neonate. *1, 2 and 4* - **Middle cerebral artery (MCA) Doppler** is the preferred non-invasive method for detecting **fetal anemia** because it directly assesses blood flow velocity, which increases with anemia. - While Liley's chart was historically used to assess amniotic fluid bilirubin levels (a breakdown product of hemolysis), **MCA Doppler** is now considered more accurate and less invasive for identifying fetal anemia. *1, 3 and 4* - **Liley's chart** analyzes the **bilirubin levels** in amniotic fluid, which is an indirect indicator of hemolysis and fetal anemia. However, **MCA Doppler** is a more direct and accurate method for assessing fetal anemia. - The indirect Coombs test on the mother is a crucial diagnostic step in Rh isoimmunization, identifying the presence of **maternal antibodies**. *1, 2 and 3* - The **direct Coombs test** on the baby is essential for confirming **hemolytic disease of the newborn**, as it detects antibodies bound to the infant's red blood cells. - **Liley's chart** is less accurate than **MCA Doppler** for assessing fetal anemia, as Doppler measurements provide a real-time assessment of fetal blood flow.

Q: Which of the following are the clinical features of septic abortion? 1. Persistent tachycardia ≥ 90 bpm 2. Impaired mental status 3. Hypothermia

1, 2 and 3. ***1, 2 and 3*** - **Septic abortion** is a severe infection following an abortion, often presenting with systemic inflammatory response syndrome (SIRS) criteria. - Clinical features such as **persistent tachycardia** (heart rate ≥ 90 bpm), **impaired mental status**, and even **hypothermia** (or fever) are indicators of severe infection and sepsis. *1 and 3 only* - While **persistent tachycardia** and **hypothermia** are indeed clinical features of septic abortion, this option is incomplete as it excludes **impaired mental status**. - **Impaired mental status** is a crucial sign of systemic compromise and organ dysfunction in sepsis. *2 and 3 only* - This option incorrectly omits **persistent tachycardia**, which is a common and important sign of systemic infection and fever in septic abortion. - **Tachycardia** is part of the objective criteria for recognizing sepsis and SIRS. *1 and 2 only* - This option is incomplete as it misses **hypothermia**, which can occur in severe sepsis, particularly in immunocompromised patients or those with severe bloodstream infections. - **Hypothermia** indicates a dysregulated host response to infection, just as fever does.

Question 1

Which of the statements regarding anemia in pregnancy is NOT true?

Accepted Answer

If mother is severely anemic, the fetus is also severely anemic

Answer

Iron deficiency anemia is most common in Tropics

Answer

Faulty dietary habit is one of the factors responsible for anemia

Answer

Mild anemia is most common

Question 2

Which one of the following regarding amniotic fluid is true?

Accepted Answer

It reveals information about fetal lung maturity and wellbeing

Answer

It is decreased in gestational diabetes

Answer

The volume is highest at 28 weeks

Answer

It is decreased in duodenal atresia in baby

Question 3

Pregnancy can be terminated at any gestation if the fetus is diagnosed to have:

Accepted Answer

Anencephaly

Answer

Duodenal atresia

Answer

Bilateral talipes

Answer

Hydrocephalus

Question 4

Cardiac diseases in pregnancy which have major risk of maternal mortality are:

1. Pulmonary hypertension
2. Aortic coarctation with valvular involvement
3. Atrial septal defect
4. Mitral stenosis

Select the correct answer using the code given below:

Accepted Answer

1 and 2

Answer

1 and 4

Answer

2 and 3

Answer

3 and 4

Question 5

Which one of the following statements regarding intrauterine growth restriction is NOT correct?

Accepted Answer

Defined according to biparietal diameter

Answer

There is danger of fetal asphyxia during delivery

Answer

Generally not seen in women with gestational diabetes

Answer

Doppler studies are indicated

Question 6

A 20 year old Primigravida, comes at 35 weeks of gestation with complaints of swelling of feet. On examination her blood pressure is 170/110 mm Hg on 2 occasions; urine examination shows proteinuria. Which one of the following statements regarding her management is NOT true?

Accepted Answer

Injection Dexamethasone is to be given for fetal lung maturity

Answer

Can be labelled as Preeclampsia

Answer

Both maternal and fetal monitoring are required

Answer

Requires urgent admission

Question 7

Consider following statements regarding Beta Thalassemia in pregnancy:

1. There is low MCH and MCV
2. Total Iron binding capacity may be elevated or normal
3. HbA2 more than 3.5% is seen in Haemoglobin Electrophoresis
Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1 only

Question 8

Consider the following statements :

Statement-1 : In fetal growth restriction there is always oligohydramnios

Statement-2 : In fetal growth restriction there is placental insufficiency leading to redistribution of blood flow to fetal brain shunting it from fetal kidney

Which one of the following is correct in respect of the above statements ?

Accepted Answer

Statement-2 is true but Statement-1 is false

Answer

Both Statement-1 and Statement-2 are true and Statement-2 is the correct explanation for Statement-1

Answer

Statement-1 is true but Statement-2 is false

Answer

Both Statement-1 and Statement-2 are true and Statement-2 is not the correct explanation for Statement-1

Question 9

Which one of the following statements regarding Rh isoimmunization is correct?

1. Liley's chart identifies anemia better than middle cerebral artery Doppler
2. Indirect Coombs test is positive in mother
3. Baby is at risk of developing anemia
4. Direct Coombs test is positive in baby

Accepted Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Question 10

Which of the following are the clinical features of septic abortion?

1. Persistent tachycardia ≥ 90 bpm
2. Impaired mental status
3. Hypothermia

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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