Maternal-Fetal Medicine Practice Questions

Q: As per ICMR guidelines, which one of the following statements is true regarding effects of COVID-19 on fetus according to current evidence?

COVID-19 virus is not teratogenic. ***COVID-19 virus is not teratogenic*** - Current evidence, including ICMR guidelines, indicates that the COVID-19 virus itself does not cause **congenital malformations** or developmental abnormalities in the fetus, distinguishing it from truly **teratogenic agents**. - While maternal infection can have adverse outcomes, these are generally not due to direct fetal malformation from the virus. *COVID-19 virus infection is an indication of MTP* - **MTP (Medical Termination of Pregnancy)** is not indicated solely based on maternal COVID-19 infection, as the virus is not considered teratogenic and typically does not cause severe direct fetal harm requiring termination. - Ethical and medical guidelines do not support routine termination for uncomplicated maternal COVID-19. *There is increased risk of fetal growth restriction* - While severe maternal COVID-19 can rarely be associated with *some* adverse pregnancy outcomes, a consistently and significantly increased risk of **fetal growth restriction (FGR)** is not definitively established as a direct effect of the virus itself, especially in mild to moderate cases. - Other factors, such as severe maternal illness, hypoxia, or comorbidities, are more strongly linked to FGR. *There is increased risk of early pregnancy loss* - Data from various studies has not consistently shown a significant or direct increase in the risk of **early pregnancy loss** (miscarriage) specifically due to COVID-19 infection in early pregnancy. - While any maternal infection can theoretically increase risk, COVID-19 is not classified as a primary cause of increased early pregnancy loss based on current evidence.

Q: Consider the following statements regarding Non Stress Test (NST): 1. Reactive NST indicates a healthy fetus 2. NST is an observed association of fetal breathing with fetal movements 3. NST has a low false negative rate ( 50%) 4. Testing should be started at 20 weeks Which of the statement(s) given above is/are correct?

1 and 3. ***1 and 3*** - A **reactive NST** indicates adequate fetal oxygenation and an intact autonomic nervous system, strongly suggesting a **healthy fetus**. - NST has excellent **sensitivity** for detecting fetal well-being, leading to a very **low false-negative rate** (less than 1%), but its relatively high rate of non-reactive results in healthy fetuses contributes to a **high false-positive rate** (over 50%). *1 and 4* - While statement 1 is correct, statement 4 is incorrect because NST testing is typically initiated at **28-32 weeks of gestation**, not 20 weeks, as fetal autonomic nervous system maturation is required. - At 20 weeks, the fetus often lacks the mature neurological responses necessary for a reliable NST. *2 only* - Statement 2 incorrectly describes NST; the NST observes the association of **fetal heart rate accelerations** with **fetal movements**, not fetal breathing. - Fetal breathing movements are typically assessed during a **biophysical profile**, not solely by NST. *3 only* - While statement 3 correctly describes the false negative and positive rates of NST, statement 1 is also correct, as a reactive NST is indeed a strong indicator of a healthy fetus. - This option is incomplete as it misses another correct statement.

Q: A G2P1L1 woman with a history of previous cesarean section presents with complications related to the placenta. The image below shows the gross appearance of the uterus. What is the most likely diagnosis?

Placenta accreta. ***Placenta accreta*** - A previous **cesarean section** is a strong risk factor for placenta accreta, as it can lead to scarring and defects in the uterine wall, allowing the placenta to implant too deeply. - The image suggests a placenta that is **firmly adhered and possibly invasive** into the uterine wall, making separation difficult, which is characteristic of accreta due to the absence of a proper decidual layer. *Uterine inversion* - This condition involves the **fundus of the uterus collapsing inward** or turning inside out, which is a clinical event during postpartum and not a morphological feature visible in a resected specimen like this. - The image shows an attached placenta within a uterine specimen, not an inverted uterus. *Placental abruption* - Placental abruption is the **premature separation of the placenta** from the uterine wall before delivery, often leading to retroplacental hemorrhage. - While it's a serious complication, the image does not show evidence of a separated placenta or a large retroplacental clot; instead, it depicts an abnormally adherent placenta. *Placenta previa* - Placenta previa occurs when the **placenta implants over the cervical os**, which would be diagnosed prenatally based on its location in the uterus. - The image does not provide information about the placental location relative to the cervix, but rather illustrates the manner of placental attachment.

Q: Which factor most strongly influences vertical transmission risk of hepatitis B from mother to infant?

Maternal HBeAg status. ***Maternal HBeAg status*** - A mother who is **HBeAg-positive** indicates high levels of ongoing **HBV replication** and viral load, leading to a significantly higher risk of vertical transmission (up to 90%) [1]. - The presence of **HBeAg** means the hepatitis B virus is actively replicating, making transmission readily possible during pregnancy and delivery [1]. *Breastfeeding* - **Breastfeeding** alone does not significantly increase the risk of hepatitis B transmission when the infant receives appropriate **immunoprophylaxis** at birth. - While HBV can be detected in breast milk, the risk of transmission through this route is considered **negligible** compared to in-utero or perinatal exposure. *Mode of delivery* - While there is some risk associated with both **vaginal** and **cesarean deliveries** due to exposure to maternal blood, the mode of delivery is not the strongest predictor of transmission. - The primary risk factor remains the mother's **viral load**, which is best indicated by HBeAg status, rather than how the baby is born [1]. *Gestational age at delivery* - **Prematurity** can potentially increase susceptibility to infection, but **gestational age** is not the primary determinant of hepatitis B vertical transmission risk. - The infectiousness of the mother (viral load and HBeAg status) is far more important than the infant's gestational age at delivery [1].

Q: A 24-year-old woman with bacterial vaginosis is admitted to the hospital in preterm labor at 30 weeks. What is the most appropriate antibiotic regimen?

Metronidazole 500mg orally twice daily for 7 days. ***Metronidazole 500mg orally twice daily for 7 days*** - This regimen is an appropriate and effective treatment for **bacterial vaginosis**, with **oral metronidazole** being a first-line therapy. - Treating **bacterial vaginosis** in a pregnant woman with **preterm labor** is crucial as untreated BV is a known risk factor for preterm birth and other obstetric complications. *Metronidazole 2g orally single dose* - While a **single-dose 2g metronidazole** regimen is an alternative for non-pregnant patients, it is generally **less effective** and not typically recommended for pregnant women, especially those in preterm labor, where complete eradication is critical. - **Higher recurrence rates** have been reported with single-dose regimens compared to multi-day treatments. *Clindamycin 300mg orally twice daily for 7 days* - **Oral clindamycin** is an alternative treatment for bacterial vaginosis, but **metronidazole** is often preferred as a first-line option due to its efficacy and safety profile in pregnancy. - The patient's condition of **preterm labor** would generally favor the most established and safest first-line treatment. *Clindamycin 5g vaginal cream for 7 days* - **Vaginal clindamycin cream** is an effective treatment for bacterial vaginosis, but in a patient with **preterm labor**, an **oral systemic antibiotic** is often preferred to ensure adequate tissue penetration and reduce the risk of ascending infection affecting the uterus. - Vaginal creams might be less effective in preventing obstetric complications associated with BV compared to oral therapy in high-risk pregnancies.

Q: A pregnant woman at 34 weeks is diagnosed with trichomoniasis. What is the most appropriate treatment?

Metronidazole 500mg orally twice daily for 7 days. ***Metronidazole 500mg orally twice daily for 7 days*** - For pregnant women with trichomoniasis, **metronidazole** is the treatment of choice and is safe in all trimesters. - Both the **7-day course (500mg BID)** and **single 2g dose** are considered **equally effective first-line treatments** per CDC and ACOG guidelines. - The 7-day regimen may be preferred in cases of **treatment failure**, **recurrent infection**, or when **better tissue penetration** is desired. - It ensures adequate eradication and provides sustained therapeutic levels throughout the treatment period. *Clindamycin cream vaginally for 7 days* - **Clindamycin** is effective for bacterial vaginosis but **not effective against Trichomonas vaginalis**, which is a protozoan parasite. - Topical treatments do not achieve sufficient systemic levels to adequately treat trichomoniasis. *Defer treatment until after delivery* - Untreated trichomoniasis in pregnancy is associated with significant risks including **preterm birth**, **premature rupture of membranes**, **low birth weight**, and **increased HIV transmission risk**. - Treatment during pregnancy is strongly recommended to mitigate these complications. - Metronidazole is safe in all trimesters of pregnancy. *Metronidazole 2g orally as single dose* - The **single 2g dose** is an equally effective first-line treatment option and is often preferred for **better patient compliance**. - Both this regimen and the 7-day course have **equivalent cure rates** (approximately 90-95%). - In this question context, while both are acceptable, the 7-day regimen is considered the correct answer.

Q: A pregnant female at 37 weeks of gestation with a history of prosthetic heart valves is currently taking warfarin. She comes for a routine antenatal check-up. What is the appropriate management advice?

Switch to low molecular weight heparin. ***Switch to low molecular weight heparin*** - **Warfarin** is **teratogenic** and carries a significant risk of **fetal bleeding** and **malformations**, especially close to term. Switching to **low molecular weight heparin (LMWH)** is crucial at 37 weeks. - **LMWH** does not cross the placenta, making it a safer alternative for anticoagulation in late pregnancy for women with prosthetic heart valves. *Immediate induction of labor* - While delivery is approaching, immediate induction of labor without addressing the **warfarin** use directly puts the fetus at high risk of **bleeding complications** during delivery. - This option does not specify concurrent management of the anticoagulation, which is the primary concern. *Perform LSCS (Lower Segment Cesarean Section)* - Similar to induction of labor, performing a C-section while the mother is on **warfarin** significantly increases the risk of **maternal and fetal hemorrhage**. - A C-section is an invasive procedure, and the immediate priority is to switch the anticoagulant rather than select the mode of delivery without addressing the current medication. *Continue the same medication* - Continuing **warfarin** at 37 weeks is highly dangerous due to the increased risk of **fetal intracranial hemorrhage** during labor and delivery. - This approach disregards the well-established **teratogenic effects** and **bleeding risks** associated with warfarin in late pregnancy.

Q: A patient with eclampsia is being treated with magnesium sulfate. Which of the following is an indication to stop the drug?

Urine output less than 100 ml in 4 hours. ***Urine output less than 100 ml in 4 hours*** - A **decreased urine output of less than 100 mL in 4 hours (< 25-30 mL/hour)** suggests **renal impairment**, which can lead to magnesium accumulation and toxicity. - **Magnesium is primarily excreted by the kidneys**, so reduced renal function necessitates discontinuation to prevent toxicity. - This is one of the **critical monitoring parameters** before each dose of magnesium sulfate. *Respiratory rate more than 18 per minute* - A **respiratory rate of 18 breaths per minute or more** is considered normal and does not indicate magnesium toxicity. - **Respiratory depression**, characterized by a rate of **less than 12 breaths per minute**, is a sign of toxicity and an indication to stop magnesium sulfate. *Exaggerated deep tendon reflexes* - **Exaggerated deep tendon reflexes** are typically associated with conditions like **pre-eclampsia**, not magnesium toxicity. - **Loss or absence of deep tendon reflexes** is a key indicator of magnesium toxicity due to its neuromuscular blocking effects and is an indication to stop the drug. *Presence of visual disturbances* - **Visual disturbances** such as blurred vision, scotomas, or flashing lights are common symptoms of **severe pre-eclampsia and eclampsia** itself. - These visual changes are part of the disease process, not a direct sign of magnesium toxicity or an indication to stop the infusion.

Question 1

As per ICMR guidelines, which one of the following statements is true regarding effects of COVID-19 on fetus according to current evidence?

Accepted Answer

COVID-19 virus is not teratogenic

Answer

COVID-19 virus infection is an indication of MTP

Answer

There is increased risk of fetal growth restriction

Answer

There is increased risk of early pregnancy loss

Question 2

Consider the following statements regarding Non Stress Test (NST):

1. Reactive NST indicates a healthy fetus
2. NST is an observed association of fetal breathing with fetal movements
3. NST has a low false negative rate (< 1%) but high false positive rate (>50%)
4. Testing should be started at 20 weeks Which of the statement(s) given above is/are correct?

Accepted Answer

1 and 3

Answer

1 and 4

Answer

2 only

Answer

3 only

Question 3

A G2P1L1 woman with a history of previous cesarean section presents with complications related to the placenta. The image below shows the gross appearance of the uterus. What is the most likely diagnosis?

Accepted Answer

Placenta accreta

Answer

Uterine inversion

Answer

Placental abruption

Answer

Placenta previa

Question 4

Which factor most strongly influences vertical transmission risk of hepatitis B from mother to infant?

Accepted Answer

Maternal HBeAg status

Answer

Breastfeeding

Answer

Mode of delivery

Answer

Gestational age at delivery

Question 5

Which of the following is TRUE regarding herpes simplex virus (HSV) in pregnancy?

Accepted Answer

Transmission risk is highest with first-episode primary infection near delivery

Answer

Neonatal transmission risk is similar for HSV-1 and HSV-2

Answer

Cesarean delivery is recommended for all HSV-positive women

Answer

Suppressive therapy is contraindicated during pregnancy

Question 6

A 24-year-old woman with bacterial vaginosis is admitted to the hospital in preterm labor at 30 weeks. What is the most appropriate antibiotic regimen?

Accepted Answer

Metronidazole 500mg orally twice daily for 7 days

Answer

Metronidazole 2g orally single dose

Answer

Clindamycin 300mg orally twice daily for 7 days

Answer

Clindamycin 5g vaginal cream for 7 days

Question 7

A pregnant woman at 34 weeks is diagnosed with trichomoniasis. What is the most appropriate treatment?

Accepted Answer

Metronidazole 500mg orally twice daily for 7 days

Answer

Clindamycin cream vaginally for 7 days

Answer

Defer treatment until after delivery

Answer

Metronidazole 2g orally as single dose

Question 8

A 28-year-old woman in her first trimester of pregnancy is diagnosed with syphilis (VDRL 1:32, TPHA positive). She reports penicillin allergy with previous anaphylaxis. What is the most appropriate management?

Accepted Answer

Penicillin desensitization followed by benzathine penicillin

Answer

Doxycycline for 14 days

Answer

Erythromycin for 14 days

Answer

Azithromycin single dose

Question 9

A pregnant female at 37 weeks of gestation with a history of prosthetic heart valves is currently taking warfarin. She comes for a routine antenatal check-up. What is the appropriate management advice?

Accepted Answer

Switch to low molecular weight heparin

Answer

Immediate induction of labor

Answer

Perform LSCS (Lower Segment Cesarean Section)

Answer

Continue the same medication

Question 10

A patient with eclampsia is being treated with magnesium sulfate. Which of the following is an indication to stop the drug?

Accepted Answer

Urine output less than 100 ml in 4 hours

Answer

Respiratory rate more than 18 per minute

Answer

Exaggerated deep tendon reflexes

Answer

Presence of visual disturbances

Maternal-Fetal Medicine — MCQs

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