Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs

Question 1001: Abortions in the second trimester mainly occur due to

A. congenital anomalies of the uterus
B. retroflected gravid uterus
C. congenital anomalies of the foetus (Correct Answer)
D. hormonal deficiencies

Explanation: ***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.

Question 1002: Match List-I with List-II and select the correct answer using the code given below the Lists:

A. A→1 B→4 C→3 D→2
B. A→2 B→4 C→1 D→3
C. A→4 B→1 C→3 D→2
D. A→3 B→4 C→1 D→2 (Correct Answer)

Explanation: ***A→3 B→4 C→1 D→2*** - **Anti-phospholipid syndrome** in pregnancy is managed with **low-dose aspirin and heparin** (usually LMWH) to prevent thrombotic complications and recurrent pregnancy loss. This is the established standard of care supported by multiple clinical trials. - **Acute toxoplasmosis** in pregnancy is treated with **spiramycin** to reduce the risk of vertical transmission to the fetus. Spiramycin concentrates in the placenta without crossing it significantly, thereby limiting parasitic dissemination. If fetal infection is confirmed (after 18 weeks), pyrimethamine plus sulfadiazine is added. - **Unexplained recurrent pregnancy losses** may be managed with **intravenous immunoglobulins (IVIG)** in select cases, particularly when an immunological etiology is suspected. However, the evidence remains controversial and IVIG is not universally recommended as first-line therapy. This answer reflects practices at the time of this examination (2010). - **Cholestatic jaundice** during pregnancy (intrahepatic cholestasis of pregnancy/ICP) is treated with **ursodeoxycholic acid (UDCA)** to improve liver function, reduce maternal serum bile acid levels, and alleviate pruritus. UDCA is the only pharmacological treatment proven to improve biochemical parameters in ICP. *A→1 B→4 C→3 D→2* - This incorrectly associates **Anti-phospholipid syndrome** with IVIG instead of aspirin and heparin, which are the evidence-based treatments for preventing thrombotic complications and pregnancy loss in APS. - Low-dose aspirin and heparin are not indicated for all cases of unexplained pregnancy losses without documented thrombophilia. *A→2 B→4 C→1 D→3* - This incorrectly associates **Anti-phospholipid syndrome** with ursodeoxycholic acid, which is specific for cholestasis of pregnancy, not for thrombophilic conditions. - Aspirin and heparin for **Cholestatic jaundice** would be inappropriate as ICP requires bile acid reduction, not anticoagulation. *A→4 B→1 C→3 D→2* - This incorrectly associates **Anti-phospholipid syndrome** with spiramycin, an antibiotic for toxoplasmosis that has no role in thrombophilia management. - It also incorrectly links **Acute toxoplasmosis** with intravenous immunoglobulins, which have no role in treating this parasitic infection.

Question 1003: The fetal well-being can be assessed by all of the following, except

A. non-stress test
B. ultrasound
C. contraction stress test
D. Kleihauer-Betke test (Correct Answer)

Explanation: ***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**.

Question 1004: Serum AFP (alpha fetoprotein) levels are increased at 16 weeks of pregnancy in all the following conditions, except

A. gastroschisis
B. Down's syndrome (Correct Answer)
C. multiple pregnancies
D. neural tube defects

Explanation: ***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.

Question 1005: Monoamniotic monochorionic twins develop when the division of cell mass occurs

A. after 2 weeks of development of embryonic disc
B. after 8th day of fertilization (Correct Answer)
C. within 72 hours after fertilization
D. between 4th and 8th day of fertilization

Explanation: ***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.

Question 1006: With reference to the transmission of HIV from mother to child, which one of the following statements is not correct?

A. The rate of transmission of HIV from mother to child is between 15-48%
B. HIV is transmitted through breast milk
C. In majority of cases, transmission of virus occurs during intrapartum period
D. Single dose of 200 mg nevirapine at the onset of labour eliminates the risk of HIV transmission to the newborn (Correct Answer)

Explanation: ***Single dose of 200 mg nevirapine at the onset of labour eliminates the risk of HIV transmission to the newborn*** - A single dose of **nevirapine** significantly reduces the risk of mother-to-child transmission (MTCT) but **does not eliminate it completely**. - Elimination of risk would require a comprehensive ART regimen and other preventative measures, which is a significant overstatement. *The rate of transmission of HIV from mother to child is between 15-48%* - The **reported rates** of mother-to-child transmission (MTCT) of HIV, especially in the absence of interventions, generally fall within this range. - This statement is **accurate** regarding the natural history of HIV MTCT without preventative measures. *HIV is transmitted through breast milk* - **Breast milk** is a known route of HIV transmission from mother to child due to the presence of the virus in maternal secretions. - This is why **avoiding breastfeeding** or using antiretroviral prophylaxis is recommended in high-resource settings to prevent transmission. *In majority of cases, transmission of virus occurs during intrapartum period* - The **majority of HIV transmission** from mother to child occurs during **labor and delivery** (intrapartum period) due to exposure to maternal blood and bodily fluids. - A smaller proportion occurs during pregnancy (in utero) or through breastfeeding (postpartum).

Question 1007: Multiple pregnancy is associated with an increased incidence of the following EXCEPT:

A. Post date pregnancy (Correct Answer)
B. Congenital malformations
C. Hyperemesis gravidarum
D. Pregnancy induced hypertension

Explanation: ***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**.

Question 1008: Medical management of tubal ectopic pregnancy can be done in the following EXCEPT:

A. Period of gestation 5 weeks
B. Absent foetal cardiac activity
C. Gestational sac diameter 3 cm.
D. β HCG level more than 10,000 IU (Correct Answer)

Explanation: ***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.

Question 1009: Prophylactic intravenous methergin should not be given in cases of:

A. Anaemia
B. Hydramnios
C. Heart disease complicating pregnancy (Correct Answer)
D. Multipara

Explanation: **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.

Question 1010: Which one of the following cardiovascular parameters decreases during pregnancy?

A. Blood volume
B. Cardiac output
C. Arterial blood pressure (Correct Answer)
D. Red cell mass

Explanation: ***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).

Practice by Chapter

Fetal Assessment Techniques

Practice Questions

Hypertensive Disorders in Pregnancy

Practice Questions

Intrauterine Growth Restriction

Practice Questions

Multiple Gestation

Practice Questions

Rh Isoimmunization and Other Blood Group Incompatibilities

Practice Questions

Intrauterine Fetal Therapy

Practice Questions

Prenatal Diagnosis and Genetic Counseling

Practice Questions

Placental Abnormalities

Practice Questions

Preterm Labor and Delivery

Practice Questions

Management of Medical Disorders in Pregnancy

Practice Questions

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