Maternal-Fetal Medicine Practice Questions

Q: In Peripartum cardiomyopathy, cardiac failure occurs at:-

Within 5 months after delivery.. ***Within 5 months after delivery.*** - Peripartum cardiomyopathy (PPCM) is defined as the development of **cardiac failure** in the **last month of pregnancy** or within **5 months after delivery**, in the absence of any other identifiable cause. - Among the given options, "within 5 months after delivery" represents the **postpartum component** of the diagnostic timeframe and is the most complete answer. - This time frame is a key diagnostic criterion recognized by major cardiology societies (some recent guidelines extend this to 6 months postpartum). - **Note:** The complete definition includes both antepartum (last month of pregnancy) and postpartum (up to 5 months) periods. *Within 24 months after delivery.* - This timeframe is **too broad** and does not align with the standard diagnostic criteria for PPCM. - While some women may experience ongoing cardiac dysfunction or relapse, the initial diagnosis of PPCM is restricted to within 5 months postpartum. - Extended cardiac issues beyond 5 months may represent persistent PPCM or dilated cardiomyopathy rather than new-onset PPCM. *Within 6 weeks after delivery.* - While many cases of PPCM manifest within **6 weeks postpartum** (the traditional puerperium), this definition is **too restrictive**. - Symptoms can appear up to **5 months after delivery**, and using only 6 weeks would miss a significant proportion of cases. - This period captures the most acute presentations but doesn't encompass the entire recognized diagnostic window. *Within 7 days after delivery.* - The onset within **7 days after delivery** represents only the **immediate postpartum period** and is an overly narrow definition. - PPCM can develop much later in the postpartum period (up to 5 months), making this timeframe inadequate for diagnosis. - Using this restrictive criterion would result in many missed diagnoses.

Q: A woman with 18 weeks gestation presented to the OPD. On abdominal examination, the uterine size was 16 weeks. On USG, oligohydramnios was found, which of the following is suspected?

Renal agenesis. ***Renal agenesis*** - **Oligohydramnios** (low amniotic fluid) and a **smaller-than-expected uterine size** at 18 weeks gestation are strong indicators of fetal renal agenesis. - Fetal kidneys are crucial for producing amniotic fluid through urine excretion, so their absence or severe malfunction leads to insufficient fluid. *Jaundice* - Not directly associated with **oligohydramnios** or a smaller uterine size. - While it can occur in utero, it doesn't cause a reduction in amniotic fluid volume. *Fetal anemia* - Often associated with **hydrops fetalis** and **polyhydramnios** (excess amniotic fluid), due to increased cardiac output and fluid retention, rather than oligohydramnios. - Doesn't typically present with a uterus smaller than expected for gestational age. *Anencephaly* - A neural tube defect characterized by the absence of a major portion of the brain and skull. - It is usually associated with **polyhydramnios** (excess amniotic fluid) due to impaired fetal swallowing, making it inconsistent with the given findings.

Q: Which of the following drugs used for management of preterm labor also has neuroprotective role in fetus:

MgSO4. ***MgSO4*** - **Magnesium sulfate (MgSO4)** is a commonly used tocolytic for preterm labor that also offers significant **neuroprotective benefits** for the fetus. - It reduces the risk and severity of **cerebral palsy** and other neurological morbidities in preterm infants. *Ritodrine* - **Ritodrine** is a **beta-2 adrenergic agonist** that relaxes uterine smooth muscle, thereby inhibiting contractions. - It has no known neuroprotective effects on the fetus; its primary role is solely to **delay preterm labor**. *Nifedipine* - **Nifedipine** is a **calcium channel blocker** that inhibits the entry of calcium into uterine smooth muscle cells, reducing contractions. - While effective as a tocolytic, it does not confer specific neuroprotective benefits to the fetus. *Isoxsuprine* - **Isoxsuprine** is a **beta-adrenergic agonist** that, similar to ritodrine, acts by relaxing uterine musculature. - It is used for tocolysis but lacks any documented neuroprotective properties for the developing fetus.

Q: Loading dose of MgSO4 (IV) for severe preeclampsia/eclampsia should be prepared as:

8 ml 50% w/v plus 12 ml NS. **Correct: 8 ml 50% w/v plus 12 ml NS** - A common regimen for a magnesium sulfate loading dose for severe preeclampsia/eclampsia is **4-6 grams IV over 15-20 minutes**. - To achieve **4 grams** with a 50% w/v MgSO4 solution (meaning **50 grams per 100 mL** or **500 mg per mL**), you would need **8 mL** (4000 mg / 500 mg/mL = 8 mL), which is then diluted with **12 mL of normal saline** to create a 20 mL solution that can be infused. - This is the **standard loading dose** recommended by WHO and most international guidelines. *Incorrect: 12 ml 50% w/v plus 8 ml NS* - This combination would deliver **6 grams of MgSO4** (12 mL x 500 mg/mL). While 6 grams can be used as a loading dose in some protocols, the most common and widely taught initial recommendation for severe preeclampsia is **4 grams**. - A higher dose without specific clinical indication could increase the risk of **magnesium toxicity**. *Incorrect: 4 ml 50% w/v plus 16 ml NS* - This combination would deliver only **2 grams of MgSO4** (4 mL x 500 mg/mL). - A 2-gram loading dose is generally **insufficient** for preventing or treating eclamptic seizures in severe preeclampsia, as it may not achieve therapeutic magnesium levels quickly enough. *Incorrect: 16 ml 50% w/v plus 4 ml NS* - This combination would deliver **8 grams of MgSO4** (16 mL x 500 mg/mL). - An 8-gram loading dose is **excessively high** and carries a significant risk of **magnesium toxicity**, including respiratory depression and cardiac arrest.

Q: A 36 week primigravida was admitted in view of a single seizure episode. On examination her BP is 170/100, PR is 90/min, fetal heart rate is present. Immediate next step in management is?

Inj. MgSO4. ***Inj. MgSO4*** - The patient presents with **seizure** and **hypertension** (BP 170/100) at 36 weeks gestation, which are classic signs of **eclampsia**. - **Magnesium sulfate** is the drug of choice for the prevention and treatment of eclamptic seizures due to its potent anticonvulsant and neuroprotective effects. *MRI brain* - While an **MRI brain** can be useful in evaluating neurological symptoms, it is not the immediate first step in the presence of an acute eclamptic seizure. - The priority is to control life-threatening seizures and hypertension, not to perform diagnostic imaging. *Inj. Calcium gluconate* - **Calcium gluconate** is primarily used as an antidote for **magnesium sulfate toxicity**. - It does not have anticonvulsant properties and would not be given as an initial treatment for eclamptic seizures. *Inj Phenytoin* - **Phenytoin** is an anticonvulsant used for various seizure disorders, but it is **less effective and has more side effects** compared to magnesium sulfate for eclamptic seizures. - While it can be considered in cases where magnesium sulfate is contraindicated or ineffective, it is not the first-line immediate management.

Q: Placenta grade 3, 35+3 weeks pregnancy, and absent end diastolic flow Doppler; next management is:

Dexamethasone and terminate after 48 hours. ***Dexamethasone and terminate after 48 hours*** - Absent end diastolic flow (AEDF) at 35+3 weeks indicates **severe uteroplacental insufficiency** and significant fetal compromise, requiring intervention. - Administering **dexamethasone** (corticosteroids) for 48 hours helps to accelerate **fetal lung maturity** before delivery, reducing the risk of respiratory distress syndrome. *Monitor* - Simply monitoring is an inappropriate and potentially harmful management strategy given the presence of **absent end diastolic flow**, which reflects **critical fetal hypoxia**. - Delaying intervention in cases of AEDF significantly increases the risk of **fetal demise** and severe morbidity. *Terminate after 37 weeks* - Waiting until 37 weeks is too long. **Absent end diastolic flow** at 35+3 weeks significantly increases the risk of **fetal compromise** and death if delivery is delayed. - The goal is to balance the risks of prematurity with the risks of continued intrauterine compromise. *Consult pediatrician and plan immediate delivery* - While immediate delivery might be considered in some scenarios of fetal distress, delivering without prior **corticosteroid administration** (dexamethasone) at 35+3 weeks would increase the risk of **neonatal respiratory distress syndrome**. - The 48-hour window allows for **fetal lung maturation** while still addressing the urgent need for delivery due to AEDF.

Q: A 30-year-old female with 8 weeks of amenorrhea presents with sudden onset lower abdominal pain and vaginal bleeding. She is hypotensive with a positive pregnancy test. Ultrasound shows no intrauterine pregnancy. What is the most likely diagnosis?

Ectopic pregnancy. ***Correct: Ectopic pregnancy*** - The combination of **amenorrhea**, **positive pregnancy test**, **abdominal pain**, **vaginal bleeding**, and **hypotension** with no intrauterine pregnancy on ultrasound is highly indicative of a **ruptured ectopic pregnancy**. - **Hypotension** suggests significant blood loss into the abdominal cavity (hemoperitoneum), a common and dangerous complication of a ruptured ectopic pregnancy. - This is a medical emergency requiring immediate surgical intervention. *Incorrect: Threatened abortion* - This is characterized by vaginal bleeding with a **closed cervix** and an **intrauterine pregnancy** seen on ultrasound, which is not the case here. - While bleeding is present, the **hypotension** and **empty uterus** on ultrasound rule out threatened abortion. *Incorrect: Molar pregnancy* - A molar pregnancy would present with a positive pregnancy test and vaginal bleeding, but typically features an **abnormally large uterus** for gestational age and characteristic **"snowstorm" appearance** on ultrasound, not an empty uterus. - **Hypotension** in this context is not a typical initial presentation of molar pregnancy; rather, it's suggestive of acute blood loss, more consistent with rupture. *Incorrect: Ovarian torsion* - Ovarian torsion causes **sudden, severe unilateral pelvic pain** and may be associated with nausea and vomiting but typically does not involve **vaginal bleeding** or a **positive pregnancy test**. - While pain can be severe, **hypotension** due to acute blood loss is not characteristic of ovarian torsion itself, differentiating it from a ruptured ectopic pregnancy.

Question 1

In Peripartum cardiomyopathy, cardiac failure occurs at:-

Accepted Answer

Within 5 months after delivery.

Answer

Within 24 months after delivery.

Answer

Within 6 weeks after delivery.

Answer

Within 7 days after delivery.

Question 2

A 25-year-old lady, Neethu, in her 22nd week of pregnancy develops hypertension and mild proteinuria. Due to the baby's gestational age, her obstetrician chooses to carefully monitor the mother for any sign of developing complications rather than to immediately deliver the baby. Which of the following complications account for the most maternal deaths in preeclampsia?

Accepted Answer

Cerebral hemorrhage and acute respiratory distress syndrome

Answer

Cerebral edema and laryngeal edema

Answer

Convulsions and renal tubular necrosis

Answer

Hemolysis and hepatic infection

Question 3

A woman with 18 weeks gestation presented to the OPD. On abdominal examination, the uterine size was 16 weeks. On USG, oligohydramnios was found, which of the following is suspected?

Accepted Answer

Renal agenesis

Answer

Jaundice

Answer

Fetal anemia

Answer

Anencephaly

Question 4

A pregnant woman at 28 weeks gestation is diagnosed with late latent syphilis. Which of the following is the most appropriate treatment?

Accepted Answer

Benzathine penicillin G 2.4 million units IM weekly for 3 weeks

Answer

Azithromycin 2g single dose

Answer

Doxycycline 100mg BD for 28 days

Answer

Erythromycin 500mg QID for 14 days

Question 5

A pregnant woman is diagnosed with syphilis at 20 weeks gestation. Which of the following constitutes adequate treatment for prevention of congenital syphilis?

Accepted Answer

Appropriately staged penicillin regimen

Answer

Single-dose benzathine penicillin

Answer

Delaying treatment until the third trimester

Answer

Azithromycin monotherapy

Question 6

Which of the following drugs used for management of preterm labor also has neuroprotective role in fetus:

Accepted Answer

MgSO4

Answer

Ritodrine

Answer

Nifedipine

Answer

Isoxsuprine

Question 7

Loading dose of MgSO4 (IV) for severe preeclampsia/eclampsia should be prepared as:

Accepted Answer

8 ml 50% w/v plus 12 ml NS

Answer

12 ml 50% w/v plus 8 ml NS

Answer

4 ml 50% w/v plus 16 ml NS

Answer

16 ml 50% w/v plus 4 ml NS

Question 8

A 36 week primigravida was admitted in view of a single seizure episode. On examination her BP is 170/100, PR is 90/min, fetal heart rate is present. Immediate next step in management is?

Accepted Answer

Inj. MgSO4

Answer

MRI brain

Answer

Inj. Calcium gluconate

Answer

Inj Phenytoin

Question 9

Placenta grade 3, 35+3 weeks pregnancy, and absent end diastolic flow Doppler; next management is:

Accepted Answer

Dexamethasone and terminate after 48 hours

Answer

Monitor

Answer

Terminate after 37 weeks

Answer

Consult pediatrician and plan immediate delivery

Question 10

A 30-year-old female with 8 weeks of amenorrhea presents with sudden onset lower abdominal pain and vaginal bleeding. She is hypotensive with a positive pregnancy test. Ultrasound shows no intrauterine pregnancy. What is the most likely diagnosis?

Accepted Answer

Ectopic pregnancy

Answer

Threatened abortion

Answer

Molar pregnancy

Answer

Ovarian torsion

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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