Maternal-Fetal Medicine Practice Questions

Q: Abortions in the second trimester mainly occur due to

congenital anomalies of the foetus. ***congenital anomalies of the foetus*** - Among the given options, **fetal congenital anomalies** (chromosomal abnormalities and structural malformations) are a significant cause of second-trimester pregnancy loss. - These anomalies often become apparent during routine prenatal screenings or ultrasounds performed in the second trimester, leading to spontaneous loss or termination. - **Note:** In clinical practice, **cervical incompetence** is actually the most common cause of second-trimester abortion, but it is not listed among the options in this question. *congenital anomalies of the uterus* - **Uterine anomalies** like septate or bicornuate uterus are more commonly associated with **recurrent first-trimester miscarriages** or **preterm labor** in the third trimester. - While they can contribute to pregnancy loss, they are less frequently the primary cause of second-trimester abortions compared to fetal anomalies. *retroflected gravid uterus* - A **retroflected gravid uterus** typically resolves spontaneously as the uterus grows and rises out of the pelvis by 12-14 weeks. - If it remains retroverted and becomes incarcerated, it can cause **pelvic pain** and **urinary retention**, but this is a very rare cause of miscarriage, especially in the second trimester. *hormonal deficiencies* - **Hormonal deficiencies**, such as insufficient **progesterone** production by the corpus luteum, are a more common cause of **first-trimester miscarriages**. - By the second trimester, the placenta has taken over progesterone production (by 8-10 weeks), making hormonal deficiencies a much less common cause of abortion during this period.

Q: The fetal well-being can be assessed by all of the following, except

Kleihauer-Betke test. ***Kleihauer-Betke test*** - The **Kleihauer-Betke test** is used to quantify the amount of **fetal hemoglobin** that has entered the maternal circulation, typically in cases of **fetomaternal hemorrhage**. - It does assess fetal red blood cells in maternal circulation but does not directly assess current fetal well-being in terms of **cardiac activity**, **movement**, or **oxygenation**. *non-stress test* - The **non-stress test (NST)** monitors **fetal heart rate (FHR)** accelerations in response to fetal movement as an indicator of adequate **fetal oxygenation** and **autonomic nervous system function**. - A **reactive NST** with appropriate accelerations is considered a sign of **fetal well-being**. *ultrasound* - **Ultrasound** is a versatile tool for assessing fetal well-being, providing information on **fetal growth**, **anatomy**, **amniotic fluid volume**, and **biophysical profile (BPP)**. - The BPP, which includes ultrasound observations of **fetal breathing**, **movement**, **muscle tone**, and **amniotic fluid volume**, along with an **NST**, offers a comprehensive assessment of fetal status. *contraction stress test* - The **contraction stress test (CST)** evaluates the response of the **fetal heart rate** to uterine contractions, which temporarily reduce placental blood flow. - A **negative CST** (no late decelerations) indicates good **fetal oxygen reserve** and is a reliable sign of **fetal well-being**.

Q: Serum AFP (alpha fetoprotein) levels are increased at 16 weeks of pregnancy in all the following conditions, except

Down's syndrome. ***Down's syndrome*** - This condition is associated with **decreased** levels of maternal serum alpha-fetoprotein (MSAFP), not increased. - Decreased MSAFP, along with elevated human chorionic gonadotropin (hCG) and unconjugated estriol, forms part of the **triple screen** for Down's syndrome. *Gastroschisis* - **Gastroschisis** involves a defect in the abdominal wall allowing fetal intestines to float freely in the amniotic fluid. - This direct exposure of fetal blood vessels in the bowel to amniotic fluid leads to a significant leakage of **AFP**, resulting in markedly elevated maternal serum levels. *Multiple pregnancies* - In **multiple gestations** (e.g., twins or triplets), there are multiple fetuses producing AFP. - The combined production of AFP from all fetuses leads to a proportionally **higher total MSAFP** level, which is a normal finding for such pregnancies. *Neural tube defects* - **Neural tube defects** (NTDs) like anencephaly or spina bifida result from incomplete closure of the neural tube. - This allows **fetal CSF** and neural tissue to leak into the amniotic fluid, leading to significantly elevated levels of AFP in both amniotic fluid and maternal serum.

Q: Monoamniotic monochorionic twins develop when the division of cell mass occurs

after 8th day of fertilization. ***after 8th day of fertilization*** - If division occurs **after the 8th day** post-fertilization, the twins will share both the **amnion** and **chorion**, leading to monoamniotic monochorionic twins. - This late division stage means the **amniotic cavity** has already formed for both embryos, and they share the same amniotic fluid and placenta. *after 2 weeks of development of embryonic disc* - Division this late (after 2 weeks, or day 14) would be extremely rare and usually results in **conjoined twins**, as the embryonic disc has already significantly developed. - At this stage, the primitive streak has formed, and further division would likely involve shared organs or structures. *within 72 hours after fertilization* - Division within the first 72 hours (days 0-3) typically results in **dichorionic diamniotic twins**, meaning each twin has its own placenta and amniotic sac. - This early division occurs before the formation of the inner cell mass and trophoblast differentiate into distinct structures. *between 4th and 8th day of fertilization* - Division between days 4 and 8 most commonly leads to **monochorionic diamniotic twins**, where the twins share a placenta but have separate amniotic sacs. - This timing corresponds to the formation of a common chorion before the development of separate amniotic cavities.

Q: Multiple pregnancy is associated with an increased incidence of the following EXCEPT:

Post date pregnancy. ***Post date pregnancy*** - **Multiple pregnancies** are instead associated with a significantly **increased risk of preterm birth** due to uterine overdistension and increased fetal-placental hormonal signaling. - Due to the high risk of complications for both mother and fetuses, multiple pregnancies are often delivered before the estimated due date or by **elective induction**/ **cesarean section**, making post-date pregnancy extremely rare. *Congenital malformations* - The incidence of **congenital malformations** is **increased in multiple pregnancies**, particularly in **monochorionic twins**, partly due to increased vascular anastomoses and potential for discordant growth or twin-to-twin transfusion syndrome (TTTS). - Both **monozygotic** and **dizygotic twins** have a higher risk of various malformations compared to singletons, including neural tube defects and cardiac anomalies. *Hyperemesis gravidarum* - **Hyperemesis gravidarum (severe nausea and vomiting)** is more common in multiple pregnancies due to higher levels of pregnancy hormones, especially **beta-human chorionic gonadotropin (β-hCG)**. - The increased placental mass in multiple gestations leads to **elevated hCG** levels, which are strongly correlated with the severity of nausea and vomiting. *Pregnancy induced hypertension* - **Pregnancy-induced hypertension (PIH)**, including **gestational hypertension** and **preeclampsia**, is significantly more prevalent in multiple pregnancies. - The **larger placental mass** and increased maternal physiological burden contribute to a higher risk of developing PIH, often with **earlier onset** and **increased severity**.

Q: Medical management of tubal ectopic pregnancy can be done in the following EXCEPT:

β HCG level more than 10,000 IU. ***β HCG level more than 10,000 IU*** - A **β-HCG level greater than 5,000-10,000 IU/L** is generally considered a contraindication for successful medical management of ectopic pregnancy with methotrexate. - Higher β-hCG levels are associated with a **larger ectopic mass**, making it less likely to respond to medical treatment and increasing the risk of rupture. *Period of gestation 5 weeks* - A **gestational age of 5 weeks** is often within the timeframe where medical treatment with methotrexate can be highly effective. - Early diagnosis and intervention within the first 6-7 weeks of gestation are crucial for successful medical management. *Absent foetal cardiac activity* - The **absence of fetal cardiac activity** is a favorable prognostic indicator for medical management, as it suggests the tissue is less viable and more likely to respond to methotrexate. - Methotrexate targets rapidly dividing cells, and the lack of a heartbeat indicates less metabolic activity. *Gestational sac diameter 3 cm.* - An **ectopic sac diameter of 3 cm** (or less than 3.5-4 cm) is generally within the size limits for successful medical management. - Larger sac diameters increase the risk of treatment failure and rupture, pushing towards surgical intervention.

Q: Prophylactic intravenous methergin should not be given in cases of:

Heart disease complicating pregnancy. **Heart disease complicating pregnancy** - **Methergine** (methylergonovine) is an **ergot alkaloid** that causes generalized **vasoconstriction**, leading to an increase in blood pressure. - In patients with **heart disease**, particularly those with conditions sensitive to increased afterload or blood pressure elevation, Methergine can precipitate **cardiac decompensation**, **myocardial ischemia**, or **hypertensive crises**. *Anaemia* - **Anaemia** itself is not a contraindication to **Methergine** use. - The medication primarily affects uterine contractility and vascular tone, with no direct adverse effects on red blood cell production or function. *Hydramnios* - **Hydramnios** (polyhydramnios) is not a contraindication for **Methergine**. - While it may be associated with increased risk of postpartum hemorrhage due to uterine overdistension, Methergine can still be safely used to promote uterine contraction and prevent excessive bleeding. *Multipara* - **Multiparity** is not a contraindication to **Methergine** use. - In fact, multiparous women may have a slightly increased risk of uterine atony and postpartum hemorrhage, making prophylactic uterotonics like Methergine potentially beneficial to prevent excessive bleeding.

Q: Which one of the following cardiovascular parameters decreases during pregnancy?

Arterial blood pressure. ***Arterial blood pressure*** - During pregnancy, **arterial blood pressure** typically decreases, particularly in the **second trimester**. - **Diastolic blood pressure** falls by 10-15 mmHg, while systolic BP remains relatively stable or decreases slightly (0-10 mmHg). - This decrease is primarily due to a significant reduction in **systemic vascular resistance (20-30% decrease)** caused by vasodilatory effects of **progesterone**, prostacyclin, and nitric oxide. - Blood pressure gradually returns toward pre-pregnancy levels in the third trimester. *Blood volume* - **Blood volume** increases significantly during pregnancy by **30-50%**, with plasma volume increasing more than red cell mass. - This hypervolemia is essential to meet increased metabolic demands and accommodate uteroplacental circulation. *Cardiac output* - **Cardiac output** increases by **30-50%** during pregnancy, peaking around 28-32 weeks. - This rise is achieved through increased **stroke volume** (30%) and **heart rate** (10-20 bpm). *Red cell mass* - **Red cell mass** increases by approximately **20-30%** during pregnancy due to increased erythropoietin production. - The proportionally greater increase in plasma volume leads to physiological anemia of pregnancy (dilutional effect).

Question 1

Abortions in the second trimester mainly occur due to

Accepted Answer

congenital anomalies of the foetus

Answer

congenital anomalies of the uterus

Answer

retroflected gravid uterus

Answer

hormonal deficiencies

Question 2

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→3  B→4  C→1  D→2

Answer

A→1  B→4  C→3  D→2

Answer

A→2  B→4  C→1  D→3

Answer

A→4  B→1  C→3  D→2

Question 3

The fetal well-being can be assessed by all of the following, except

Accepted Answer

Kleihauer-Betke test

Answer

non-stress test

Answer

ultrasound

Answer

contraction stress test

Question 4

Serum AFP (alpha fetoprotein) levels are increased at 16 weeks of pregnancy in all the following conditions, except

Accepted Answer

Down's syndrome

Answer

gastroschisis

Answer

multiple pregnancies

Answer

neural tube defects

Question 5

Monoamniotic monochorionic twins develop when the division of cell mass occurs

Accepted Answer

after 8th day of fertilization

Answer

after 2 weeks of development of embryonic disc

Answer

within 72 hours after fertilization

Answer

between 4th and 8th day of fertilization

Question 6

With reference to the transmission of HIV from mother to child, which one of the following statements is not correct?

Accepted Answer

Single dose of 200 mg nevirapine at the onset of labour eliminates the risk of HIV transmission to the newborn

Answer

The rate of transmission of HIV from mother to child is between 15-48%

Answer

HIV is transmitted through breast milk

Answer

In majority of cases, transmission of virus occurs during intrapartum period

Question 7

Multiple pregnancy is associated with an increased incidence of the following EXCEPT:

Accepted Answer

Post date pregnancy

Answer

Congenital malformations

Answer

Hyperemesis gravidarum

Answer

Pregnancy induced hypertension

Question 8

Medical management of tubal ectopic pregnancy can be done in the following EXCEPT:

Accepted Answer

β HCG level more than 10,000 IU

Answer

Period of gestation 5 weeks

Answer

Absent foetal cardiac activity

Answer

Gestational sac diameter 3 cm.

Question 9

Prophylactic intravenous methergin should not be given in cases of:

Accepted Answer

Heart disease complicating pregnancy

Answer

Anaemia

Answer

Hydramnios

Answer

Multipara

Question 10

Which one of the following cardiovascular parameters decreases during pregnancy?

Accepted Answer

Arterial blood pressure

Answer

Blood volume

Answer

Cardiac output

Answer

Red cell mass

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?