Maternal-Fetal Medicine Practice Questions

Q: A 26 year old primigravida presents with blood pressure of 160/110 mmHg, proteinurea and congestive heart failure. Which drug is not useful in this situation?

Diuretics. ***Diuretics*** - In uncomplicated pre-eclampsia, **diuretics** are generally **avoided** because they can reduce plasma volume and placental perfusion, potentially worsening maternal hypovolemia. - However, in this case with **congestive heart failure**, the situation is complex. Traditional teaching suggests diuretics should be avoided in pre-eclampsia, and they are considered "not useful" as a primary antihypertensive. - In pre-eclampsia, the priority is to control blood pressure with safer agents and deliver the baby, rather than manage fluid overload with diuretics, which may worsen the underlying pathophysiology. - The question tests knowledge that diuretics are not considered a standard or useful treatment for pre-eclampsia, even when CHF is present. *Nifedipine* - **Nifedipine** is a calcium channel blocker that is highly effective and commonly used to manage severe hypertension in pregnancy, including pre-eclampsia. - It causes **vasodilation**, rapidly lowering blood pressure while maintaining placental blood flow. - It is a **useful** first-line agent in this scenario. *Methyl-dopa* - **Methyl-dopa** is an alpha-2 adrenergic agonist considered safe and effective for managing hypertension in pregnancy. - While more commonly used for chronic hypertension, it can be **useful** in pre-eclampsia management. - It has an excellent safety profile for both mother and fetus. *Labetalol* - **Labetalol** is a combined alpha- and beta-blocker that is a preferred agent for acute severe hypertension in pregnancy. - It rapidly reduces blood pressure with minimal impact on uterine blood flow. - It is highly **useful** in this high-risk scenario and is commonly used in pre-eclampsia with severe features.

Q: A 30 year old G2P1L0 with history of anencephaly in previous pregnancy has a nuchal fold thickness of 2.5 mm with other normal fetal parameters. She may be having:

Normal pregnancy. ***Normal pregnancy*** - **Nuchal fold thickness (NFT)** of 2.5 mm is **well within the normal range** (normal cutoff: < 6 mm). - NFT is measured in the **second trimester (15-22 weeks)** as a marker for chromosomal abnormalities, particularly **Trisomy 21**. - A measurement of 2.5 mm with **other normal fetal parameters** indicates a **normal pregnancy**. - The history of anencephaly (a neural tube defect) in the previous pregnancy does not increase the risk of chromosomal abnormalities in the current pregnancy, though **folic acid supplementation** and careful monitoring are recommended. *Trisomy 21* - Trisomy 21 (Down syndrome) is associated with **increased nuchal fold thickness > 6 mm** in the second trimester. - First trimester markers include **increased nuchal translucency (NT) > 3.0 mm**, hypoplastic nasal bone, and abnormal ductus venosus flow. - The current NFT of 2.5 mm is **normal** and does not suggest Trisomy 21. *Spina bifida* - **Spina bifida** is a **neural tube defect** that would be detected by elevated maternal serum **alpha-fetoprotein (MSAFP)** and specific ultrasound findings. - Characteristic ultrasound signs include the **lemon sign** (frontal bone scalloping) and **banana sign** (cerebellar abnormality). - **Nuchal fold thickness is not a marker for spina bifida** - it is used for aneuploidy screening. - While the patient has a history of anencephaly (another neural tube defect), the current fetal parameters are normal. *Trisomy 18* - Trisomy 18 (Edwards syndrome) is associated with **increased nuchal translucency in the first trimester** (often > 5.0 mm) and increased NFT in the second trimester. - Multiple severe fetal anomalies are typically present: **intrauterine growth restriction (IUGR)**, **cardiac defects**, **clenched hands**, **rocker-bottom feet**, and **choroid plexus cysts**. - The **normal nuchal fold thickness** (2.5 mm) and **normal other fetal parameters** make Trisomy 18 unlikely.

Q: A 24 year old married lady presents with sudden onset right iliac fossa pain. On examination she has marked pallor and is hypotensive. What is the most likely diagnosis?

Ruptured ectopic pregnancy. ***Ruptured ectopic pregnancy*** - The sudden onset of **right iliac fossa pain** in a young, married woman, accompanied by **marked pallor** and **hypotension**, strongly suggests **hypovolemic shock** due to internal bleeding. - This clinical picture is classic for a **ruptured ectopic pregnancy**, which is a life-threatening obstetric emergency, often presenting with collapse. *Small bowel perforation* - While small bowel perforation can cause sudden abdominal pain and may lead to shock, it typically presents with signs of **peritonitis** (e.g., rebound tenderness, guarding) and often **fever**, not primarily with marked pallor and hypotension indicating severe internal bleeding. - The pain is usually more generalized initially and may be associated with signs of **sepsis** rather than immediate hemorrhagic shock. *Twisted ovarian cyst* - A twisted ovarian cyst causes sudden, severe **unilateral lower abdominal pain**, often with nausea and vomiting. - While it can cause significant pain, it typically does not lead to rapid, profound **hypotension** and **marked pallor** indicative of massive blood loss, as seen with a ruptured ectopic pregnancy. *Appendicular perforation* - Appendicular perforation is a complication of appendicitis, usually preceded by periumbilical pain migrating to the **right iliac fossa**, often with **fever**, anorexia, and localized peritonitis. - While it can cause shock due to sepsis, it is less likely to present with such rapid and severe signs of **hemorrhagic shock** (marked pallor and hypotension) without preceding appendicitis symptoms.

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.

Question 1

On ultrasonography low-lying placenta is labelled when implantation in the lower uterine segment is such that:

Accepted Answer

Placental edge does not reach the internal os and remains 2 cm wide perimeter around the os

Answer

Placental edge does not reach the internal os and remains 3 cm wide perimeter around the os

Answer

Placental edge does not reach the internal os and remains 4 cm wide perimeter around the os

Answer

Internal os is covered partially or fully by the placenta

Question 2

A woman presents with abdominal pain and nausea with amenorrhea of 5-6 weeks. Ectopic pregnancy can be diagnosed if:

Accepted Answer

Beta hCG > 2000 IU/L with no gestational sac in the uterus on transvaginal sonography

Answer

Beta hCG ˂1000 IU/L with endometrial thickness of 14mm

Answer

Beta hCG >3000 IU/L with empty uterus on transvaginal sonography

Answer

Serum progesterone > 25 ng/ml

Question 3

A pregnant woman with 30 weeks gestation presents with BP 166/110 mmHg with pulmonary edema with convulsions. The woman is given magnesium sulphate. The following drug should be avoided:

Accepted Answer

Sublingual Nifedipine

Answer

Intravenous Labetalol

Answer

Intravenous Hydralazine

Answer

Intravenous Frusemide

Question 4

A 26 year old primigravida presents with blood pressure of 160/110 mmHg, proteinurea and congestive heart failure. Which drug is not useful in this situation?

Accepted Answer

Diuretics

Answer

Nifedipine

Answer

Methyl-dopa

Answer

Labetalol

Question 5

A 30 year old G2P1L0 with history of anencephaly in previous pregnancy has a nuchal fold thickness of 2.5 mm with other normal fetal parameters. She may be having:

Accepted Answer

Normal pregnancy

Answer

Trisomy 21

Answer

Spina bifida

Answer

Trisomy 18

Question 6

A 24 year old married lady presents with sudden onset right iliac fossa pain. On examination she has marked pallor and is hypotensive. What is the most likely diagnosis?

Accepted Answer

Ruptured ectopic pregnancy

Answer

Small bowel perforation

Answer

Twisted ovarian cyst

Answer

Appendicular perforation

Question 7

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 8

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 9

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 10

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

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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