Maternal-Fetal Medicine Practice Questions

Q: Cause of Fetal growth restriction may be: 1. Chromosomal abnormality 2. Congenital abnormality 3. Abnormal cord insertion Which of the statements given above is/are correct?

1, 2 and 3. ***Correct: 1, 2 and 3*** All three statements represent established causes of **Fetal Growth Restriction (FGR)**: - **Chromosomal abnormalities** (trisomy 13, 18, 21, Turner syndrome) cause **intrinsic poor growth potential** of the fetus by disrupting normal cellular development and metabolism, directly leading to FGR. - **Congenital abnormalities** (cardiac defects, renal malformations, CNS anomalies) impair fetal development and nutrient utilization through structural and functional deficits, resulting in FGR. - **Abnormal cord insertion** (velamentous or marginal cord insertion) compromises the efficiency of **nutrient and oxygen transfer** from the placenta to the fetus by reducing vascular support, thus causing placental insufficiency and FGR. *Incorrect: 1 and 3 only* This incorrectly excludes **congenital abnormalities**, which are a well-established independent cause of FGR. Structural malformations directly impair fetal growth through metabolic and functional deficits. *Incorrect: 1 and 2 only* This incorrectly excludes **abnormal cord insertion**, which directly impacts placental function and nutrient supply—a key pathway for uteroplacental insufficiency leading to FGR. *Incorrect: 2 and 3 only* This incorrectly excludes **chromosomal abnormalities**, which are a major genetic cause of intrinsic FGR. Chromosomal defects (e.g., trisomies) are fundamental causes of impaired fetal growth potential.

Q: Consider the following regarding the use of Magnesium Sulphate: 1. Used as tocolytic 2. As neuroprotective agent 3. Used in management of postpartum eclampsia Which of the statements given above are correct?

1, 2 and 3. ***1, 2 and 3*** - **Magnesium sulfate** is a well-established **tocolytic agent**, used to delay preterm labor by relaxing the uterine smooth muscle. - It is also utilized for its **neuroprotective effects** in preterm infants, reducing the risk of cerebral palsy and other neurological sequelae when administered to mothers at risk of preterm birth. - Furthermore, magnesium sulfate is the **drug of choice** for the prevention and management of **eclampsia and pre-eclampsia**, which can occur both during pregnancy and in the postpartum period. *1 and 3 only* - This option correctly identifies the use of **magnesium sulfate** as a **tocolytic** and for **postpartum eclampsia**, but incorrectly omits its significant role as a **neuroprotective agent**. - The neuroprotective effect, particularly in reducing the risk of cerebral palsy in preterm infants, is a crucial indication for magnesium sulfate use. *2 and 3 only* - This option correctly recognizes **magnesium sulfate's** application as a **neuroprotective agent** and in **postpartum eclampsia**, but overlooks its primary role as a **tocolytic** for preterm labor. - Its ability to relax uterine contractions makes it a vital medication in managing threatened preterm delivery. *1 and 2 only* - This option accurately states the use of **magnesium sulfate** as a **tocolytic** and a **neuroprotective agent**, but fails to include its critical role in the management of **postpartum eclampsia**. - Eclampsia, defined by seizures in a pre-eclamptic patient, is effectively prevented and treated with magnesium sulfate.

Q: A 25 year old G2P1L1, Rh –ve woman presented at 30 weeks gestation to the antenatal clinic, the indirect Coomb's test (ICT) was found to be positive. What would be the next line of management?

ICT titers to be closely monitored at weekly intervals. **ICT titers to be closely monitored at weekly intervals** - A **positive Indirect Coombs Test (ICT)** in an Rh-negative pregnant woman indicates the presence of maternal antibodies against fetal Rh antigens. The next step is to monitor the **titer** to assess the risk of **hemolytic disease of the fetus and newborn (HDFN)**. - Serial monitoring of ICT titers, typically every 2-4 weeks, helps to determine if the antibody levels are increasing, which would indicate a heightened risk to the fetus and necessitate further intervention. *Anti D to be given* - **Anti-D immunoglobulin** is administered to prevent **sensitization** in Rh-negative mothers who have not yet formed antibodies. - Since the ICT is already positive, the mother has already been **sensitized** and produced antibodies, making Anti-D administration ineffective at this stage. *Baby is to be delivered as soon as possible* - Premature delivery carries significant risks for the neonate due to **immaturity of organ systems**. - Delivery is usually reserved for cases of severe fetal compromise, not simply a positive ICT without further evidence of fetal anemia. *Amniocentesis for estimation of bilirubin by Liley's chart is to be done* - **Amniocentesis** for bilirubin estimation using **Liley's chart** is an invasive procedure that carries risks, including **infection** and **fetal loss**. - It is typically reserved for cases where **ICT titers are critically high** or there is evidence of fetal anemia on **Doppler ultrasound**, not as the initial management step for a positive ICT.

Q: Consider the following statements regarding pregnancy with Rh isoimmunization: 1. Indirect coombs test is performed in mother 2. Methergin is withheld at delivery of anterior shoulder 3. Middle cerebral artery peak systolic velocity is an accurate method to predict fetal anemia Which of the statements given above are correct?

1 and 3 only. ***1 and 3 only*** - The **indirect Coombs test (IAT)** is performed on the mother's serum to detect **Rh antibodies**, which is essential for diagnosing and monitoring Rh isoimmunization. - **Middle cerebral artery peak systolic velocity (MCA-PSV)** >1.5 MoM is a non-invasive and highly accurate ultrasound method to predict moderate to severe **fetal anemia** in Rh-isoimmunized pregnancies, guiding the need for intrauterine transfusion. - Statement 2 is **incorrect**: While minimizing fetomaternal hemorrhage is important in Rh isoimmunization, there is **no specific evidence-based guideline** that Methergine should be routinely withheld at delivery of the anterior shoulder in Rh-negative mothers. The focus is on **timely Anti-D administration** (within 72 hours postpartum) rather than avoiding specific uterotonics. *1 and 2 only* - Statement 1 is correct, but statement 2 is incorrect. - Methergine (methylergonovine) is not specifically contraindicated in Rh isoimmunization; its main contraindications include **hypertension and preeclampsia** due to vasoconstrictive effects. - Prevention of Rh sensitization focuses on **Anti-D immunoglobulin administration**, not withholding uterotonics. *2 and 3 only* - Statement 3 is correct regarding **MCA-PSV** accuracy for fetal anemia detection. - Statement 2 is incorrect: Methergine withholding is not a standard practice specifically for Rh isoimmunization management. *1, 2 and 3* - Statements 1 and 3 are correct. - Statement 2 is incorrect: There is no established protocol to withhold Methergine at delivery of the anterior shoulder specifically for Rh isoimmunization. Management focuses on **preventing sensitization through Anti-D prophylaxis**, **monitoring with antibody titers**, and **detecting fetal anemia via MCA-PSV**, not on avoiding specific uterotonics.

Q: Which of the following is NOT the hormonal basis for hyperemesis gravidarum?

Excess of Human Placental Lactogen. ***Excess of Human Placental Lactogen*** - **Human placental lactogen (hPL)** is primarily involved in **metabolic adaptation** during pregnancy, promoting insulin resistance and glucose availability for the fetus. - While essential for fetal growth, hPL has **no direct causal link** to the pathophysiology of nausea and vomiting in hyperemesis gravidarum. *High serum levels of Estrogen* - **Elevated estrogen levels** during pregnancy are believed to contribute to nausea and vomiting by affecting **gastrointestinal motility** and the central chemoreceptor trigger zone. - The rapid increase and high concentrations of estrogen correlate with the severity of symptoms in many pregnant women. *Excess of Progesterone* - **High progesterone levels** can cause **relaxation of smooth muscle**, including that of the gastrointestinal tract, leading to delayed gastric emptying and increased gastroesophageal reflux. - These effects can exacerbate nausea and vomiting, making it a contributing factor to hyperemesis gravidarum. *Excess of Chorionic Gonadotropin* - **High levels of human chorionic gonadotropin (hCG)** are strongly implicated in the etiology of hyperemesis gravidarum, with symptoms often correlating with peaks in hCG levels in early pregnancy. - hCG is thought to stimulate the **thyroid gland** (due to structural similarity to TSH) and directly affect the **chemoreceptor trigger zone** in the brain, inducing nausea and vomiting.

Q: The initial prevention strategy for antiphospholipid syndrome will be: 1. Steroids 2. Heparin 3. Low dose aspirin 4. Progesterone support Which of the above is/are correct?

2 and 3. ***2 and 3*** - For pregnant women with antiphospholipid syndrome (APS), a combination of **low-dose aspirin** and **low molecular weight heparin (LMWH)** or **unfractionated heparin (UFH)** is the most widely accepted and effective initial prevention strategy to prevent pregnancy complications. - **Low-dose aspirin** helps reduce platelet aggregation, while **heparin** inhibits coagulation, addressing both thrombotic tendencies associated with APS. *1 and 4* - **Steroids** are typically reserved for severe manifestations of APS, such as catastrophic APS or refractory cases, and are not part of the initial standard preventative regimen. - **Progesterone support** is indicated for threatened miscarriage or luteal phase defect but does not address the underlying thrombotic risk in APS for pregnancy prevention. *3 only* - While **low-dose aspirin** is an important component, it is insufficient on its own for preventing pregnancy complications in women with antiphospholipid syndrome due to the high thrombotic risk. - **Heparin**, either LMWH or UFH, is crucial to provide adequate anticoagulation and is always used in conjunction with aspirin for initial prevention. *3 and 4* - **Low-dose aspirin** is appropriate, but **progesterone support** (4) is not a primary measure for preventing thrombotic events or pregnancy complications specifically linked to antiphospholipid syndrome. - The critical missing component in this option is **heparin**, which is essential for anticoagulation in APS pregnancies.

Q: Common clinical presentations of moderate to severe abruption are all EXCEPT:

Prolonged labour. ***Prolonged labour*** - While **placental abruption** can sometimes lead to **uterine dysfunction** and difficulties in labor progression, **prolonged labor** is *not* a characteristic or common clinical presentation of an abruption itself. - The primary concerns with abruption are **hemorrhage**, **fetal compromise**, and rapid progression to delivery due to **uterine irritability**. *Uterine tenderness* - **Uterine tenderness** is a classic and common sign of **placental abruption**, resulting from the extravasation of blood into the myometrium. - This tenderness is often localized over the site of the abruption and can range from mild to severe depending on the extent of the blood collection. *Unexplained preterm labour* - **Placental abruption** is a known cause of **preterm labor**, often presenting as uterine contractions and pain. - The irritation of the uterus by blood and the presence of **prostaglandins** released during the abruption process can trigger premature contractions. *Fetal distress* - **Fetal distress**, indicated by **non-reassuring fetal heart rate patterns** like decelerations or bradycardia, is a common and serious consequence of **placental abruption**. - This occurs due to the reduction in **placental perfusion** and oxygen exchange between the mother and fetus.

Q: Which one of the following is NOT a risk factor for the development of placenta previa?

Maternal anaemia. ***Maternal anaemia*** - **Maternal anaemia** is generally considered a *consequence* of conditions like antenatal hemorrhage from placenta previa, rather than a direct risk factor for its development. - While anaemia is common in pregnancy and can exacerbate outcomes, it does not independently increase the likelihood of the placenta implanting abnormally close to or over the cervical os. *Maternal age* - **Advanced maternal age** (typically over 35 years) is a well-established risk factor for placenta previa. - This is thought to be due to an increased incidence of pre-existing uterine abnormalities and degenerative changes in the endometrium. *Previous caesarean section* - A **previous caesarean section** significantly increases the risk of placenta previa due to the presence of a uterine scar. - The placenta may preferentially implant over the scar tissue, which can be less vascular, leading to a lower implantation and potentially previa. *Smoking* - **Smoking** during pregnancy is a recognized risk factor for placenta previa, potentially due to hypoxic-ischemic effects on the endometrium. - It may contribute to abnormal placentation by inducing compensatory placental hypertrophy and extending the placental surface area, increasing the chance of covering the cervical os.

Q: As per ICMR guidelines, which one of the following statements is true regarding COVID-19 infection in pregnancy?

Pregnant women with heart disease are at higher risk. ***Pregnant women with heart disease are at higher risk*** - Pre-existing **heart disease** is a significant risk factor for severe COVID-19 outcomes in pregnant women due to the increased physiological cardiac demands of both pregnancy and infection. - According to ICMR guidelines and global data, comorbidities like **cardiovascular disease** place pregnant individuals in a higher-risk category for severe illness. *COVID-19 pneumonia in pregnancy is more severe with poor recovery* - While pregnant women *can* develop severe COVID-19 pneumonia, the general consensus, including ICMR guidelines, states that most pregnant women experience **mild to moderate illness** and have a **good recovery**. - Pooled data indicates that the majority of pregnant women with COVID-19 will not develop severe pneumonia or experience poorer recovery *solely* due to pregnancy. *COVID-19 virus is secreted in breast milk* - Current evidence suggests that the **COVID-19 virus is generally not detectable** in breast milk. - ICMR and other major health organizations recommend that **mothers with COVID-19 continue breastfeeding**, as the benefits outweigh potential risks, and antibodies may be transferred. *Vaginal secretions always test positive for COVID-19 in pregnancy* - The primary transmission route for COVID-19 is through **respiratory droplets**, not vaginal secretions. - While some studies have detected viral RNA in vaginal secretions in a small percentage of cases, it is **not always positive** and is not considered a primary source of transmission.

Question 1

Cause of Fetal growth restriction may be:

1. Chromosomal abnormality
2. Congenital abnormality
3. Abnormal cord insertion

Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

1 and 2 only

Answer

2 and 3 only

Question 2

Contraindications to Uterine Cerclage for Incompetent os are all EXCEPT:

Accepted Answer

Previous history suggestive of abortion due to incompetent os

Answer

Bulging membrane

Answer

History of vaginal bleeding

Answer

Ruptured membrane

Question 3

Consider the following regarding the use of Magnesium Sulphate:

1. Used as tocolytic
2. As neuroprotective agent
3. Used in management of postpartum eclampsia
Which of the statements given above are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Question 4

A 25 year old G2P1L1, Rh –ve woman presented at 30 weeks gestation to the antenatal clinic, the indirect Coomb's test (ICT) was found to be positive. What would be the next line of management?

Accepted Answer

ICT titers to be closely monitored at weekly intervals

Answer

Anti D to be given

Answer

Baby is to be delivered as soon as possible

Answer

Amniocentesis for estimation of bilirubin by Liley's chart is to be done

Question 5

Consider the following statements regarding pregnancy with Rh isoimmunization:

1. Indirect coombs test is performed in mother
2. Methergin is withheld at delivery of anterior shoulder
3. Middle cerebral artery peak systolic velocity is an accurate method to predict fetal anemia Which of the statements given above are correct?

Accepted Answer

1 and 3 only

Answer

1 and 2 only

Answer

2 and 3 only

Answer

1, 2 and 3

Question 6

Which of the following is NOT the hormonal basis for hyperemesis gravidarum?

Accepted Answer

Excess of Human Placental Lactogen

Answer

High serum levels of Estrogen

Answer

Excess of Progesterone

Answer

Excess of Chorionic Gonadotropin

Question 7

The initial prevention strategy for antiphospholipid syndrome will be:
1. Steroids
2. Heparin
3. Low dose aspirin
4. Progesterone support
Which of the above is/are correct?

Accepted Answer

2 and 3

Answer

1 and 4

Answer

3 only

Answer

3 and 4

Question 8

Common clinical presentations of moderate to severe abruption are all EXCEPT:

Accepted Answer

Prolonged labour

Answer

Uterine tenderness

Answer

Fetal distress

Answer

Unexplained preterm labour

Question 9

Which one of the following is NOT a risk factor for the development of placenta previa?

Accepted Answer

Maternal anaemia

Answer

Maternal age

Answer

Previous caesarean section

Answer

Smoking

Question 10

As per ICMR guidelines, which one of the following statements is true regarding COVID-19 infection in pregnancy?

Accepted Answer

Pregnant women with heart disease are at higher risk

Answer

COVID-19 pneumonia in pregnancy is more severe with poor recovery

Answer

COVID-19 virus is secreted in breast milk

Answer

Vaginal secretions always test positive for COVID-19 in pregnancy

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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