Maternal-Fetal Medicine Practice Questions

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: Gestational trophoblastic disease is a spectrum comprising which of the following entities? 1. Complete Hydatidiform mole 2. Partial Hydatidiform mole 3. Invasive mole 4. Choriocarcinoma Select the correct answer using the code given below:

1, 2, 3 and 4. **1, 2, 3 and 4** - **Gestational trophoblastic disease (GTD)** encompasses a spectrum of conditions arising from abnormal proliferation of trophoblastic tissue, including both benign and malignant forms. - This spectrum correctly includes **complete hydatidiform mole**, **partial hydatidiform mole**, **invasive mole**, and **choriocarcinoma**, as well as the rare placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). *1, 2 and 3 only* - This option incorrectly excludes **choriocarcinoma**, which is a highly malignant form of gestational trophoblastic neoplasia (GTN) and a crucial part of the GTD spectrum. - While complete, partial, and invasive moles are part of the spectrum, omitting choriocarcinoma makes this answer incomplete. *1 and 4 only* - This option incompletely covers the spectrum by excluding **partial hydatidiform mole** and **invasive mole**, both of which are common and important entities within GTD. - It highlights two extremes (benign complete mole and malignant choriocarcinoma) but misses intermediate forms. *2, 3 and 4 only* - This option incorrectly omits **complete hydatidiform mole**, which is the most common precursor to gestational trophoblastic neoplasia and a central component of the GTD spectrum. - Excluding complete mole would provide an incomplete understanding of the disease's origins and manifestations.

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 one of the following is NOT a risk factor for pre-eclampsia ?

Placenta previa. ***Placenta previa*** - **Placenta previa** is a condition where the placenta partially or totally covers the mother's cervix, causing **vaginal bleeding** during pregnancy, but it is **not linked to the development of pre-eclampsia**. - It is a placental implantation abnormality characterized by abnormal location, not a risk factor for the systemic vascular and endothelial dysfunction characteristic of pre-eclampsia. - The pathophysiology involves placental position, not the defective placentation or spiral artery remodeling seen in pre-eclampsia. *Pre-existing vascular disease* - Conditions like **chronic hypertension**, **diabetes mellitus**, and **chronic kidney disease** are well-established risk factors for pre-eclampsia. - These diseases impair endothelial function and increase the likelihood of the systemic inflammatory response and vasospasm seen in pre-eclampsia. - Pre-existing vascular dysfunction predisposes to inadequate placental perfusion and abnormal trophoblast invasion. *Obesity* - **Obesity** (BMI ≥30 kg/m²) is a significant risk factor for pre-eclampsia due to its association with **insulin resistance**, chronic inflammation, and endothelial dysfunction. - Maternal obesity leads to heightened oxidative stress, increased inflammatory cytokines, and impaired angiogenesis, contributing to defective placentation. - The risk increases proportionally with increasing BMI. *Primigravida* - Being a **primigravida** (first pregnancy) is an established risk factor for pre-eclampsia, with primiparous women having 2-3 times higher incidence compared to multiparous women. - This is thought to be due to initial exposure to paternal antigens and less robust maternal immune tolerance to placental antigens. - The risk decreases significantly in subsequent pregnancies with the same partner.

Q: Antepartum haemorrhage is defined as bleeding from genital tract occurring:

After 28 weeks of pregnancy. ***After 28 weeks of pregnancy*** - **Antepartum hemorrhage (APH)** is defined as any bleeding from the genital tract occurring from **28 weeks of gestation** until the onset of labour. - This definition helps differentiate it from bleeding in earlier pregnancy, which is typically classified as **threatened abortion**, **miscarriage**, or other early pregnancy complications. *Before 20 weeks of pregnancy* - Bleeding occurring before 20 weeks of pregnancy is generally referred to as **threatened abortion**, **inevitable abortion**, **incomplete abortion**, or **complete abortion**. - These conditions are distinct from antepartum hemorrhage, which pertains to later stages of pregnancy. *Before 24 weeks of pregnancy* - Similar to before 20 weeks, bleeding before 24 weeks would fall under categories related to **early pregnancy loss or complications**, not antepartum hemorrhage. - The viability of the fetus is often still a critical factor in this gestational range, and management differs. *After 34 weeks of pregnancy* - While bleeding after 34 weeks is a form of antepartum hemorrhage, the definition of APH encompasses any bleeding **from 28 weeks onwards**, making "After 28 weeks of pregnancy" the most accurate and comprehensive definition. - Specifying "after 34 weeks" is too narrow and excludes bleeding events that occur between 28 and 34 weeks which are still considered APH.

Q: Which of the following are contra-indications to external cephalic version in antenatal management of breech presentation? 1. Antepartum haemorrhage 2. Multiple pregnancy 3. Reactive Non Stress Test 4. Severe oligohydramnios

1, 2 and 4. ***1, 2 and 4*** * **Antepartum haemorrhage**, **multiple pregnancy**, and **severe oligohydramnios** are all contraindications to external cephalic version (ECV) due to increased risks of fetal distress, placental abruption, and uterine rupture. * These conditions either compromise fetal well-being directly or make the procedure significantly more dangerous for both mother and fetus. *2, 3 and 4* * This option incorrectly includes a **reactive non-stress test** as a contraindication, which actually indicates fetal well-being and is a prerequisite for ECV. * Excluding **antepartum haemorrhage** as a contraindication is also incorrect, as it poses a significant risk. *1, 2, 3 and 4* * This option is incorrect because a **reactive non-stress test** is a sign of fetal health and is a requirement *before* performing an ECV, not a contraindication. * Including it diminishes the specificity of contraindications for this procedure. *1, 2 and 3* * This option erroneously lists a **reactive non-stress test** as a contraindication, when in reality, it's a reassuring finding critical for proceeding with ECV. * It also omits **severe oligohydramnios** which is a significant contraindication due to the inability to safely manipulate the fetus.

Question 1

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 2

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 3

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 4

Gestational trophoblastic disease is a spectrum comprising which of the following entities?

1. Complete Hydatidiform mole
2. Partial Hydatidiform mole
3. Invasive mole
4. Choriocarcinoma

Select the correct answer using the code given below:

Accepted Answer

1, 2, 3 and 4

Answer

1, 2 and 3 only

Answer

1 and 4 only

Answer

2, 3 and 4 only

Question 5

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 6

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 7

Which one of the following statements regarding fetal well being is NOT correct?

Accepted Answer

Modified Biophysical profile includes Non-stress test and fetal breathing

Answer

Mothers perceive 88% of fetal movements

Answer

Daily fetal movement count is a simple reliable method of fetal well being

Answer

Healthy fetus should have minimum of 10 movements in 12 hours period

Question 8

Which one of the following is NOT a risk factor for pre-eclampsia ?

Accepted Answer

Placenta previa

Answer

Pre-existing vascular disease

Answer

Obesity

Answer

Primigravida

Question 9

Antepartum haemorrhage is defined as bleeding from genital tract occurring:

Accepted Answer

After 28 weeks of pregnancy

Answer

Before 20 weeks of pregnancy

Answer

Before 24 weeks of pregnancy

Answer

After 34 weeks of pregnancy

Question 10

Which of the following are contra-indications to external cephalic version in antenatal management of breech presentation?

1. Antepartum haemorrhage
2. Multiple pregnancy
3. Reactive Non Stress Test
4. Severe oligohydramnios

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2, 3 and 4

Answer

1, 2 and 3

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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