Maternal-Fetal Medicine Practice Questions

Q: Placenta increta means:

Villi invade myometrium. ***Villi invade myometrium*** - **Placenta increta** is a condition where the **chorionic villi** invade into the **myometrium** (the muscular layer of the uterus) but do not penetrate through it. - This deep invasion prevents the normal separation of the placenta after birth, leading to significant complications like **hemorrhage**. *Villi are attached to lower uterine segment* - This describes **placenta previa**, where the placenta implants in the lower uterine segment, covering or nearly covering the cervical os. - While it can cause bleeding, it does not involve abnormal placental adherence to the uterine wall. *Villi are attached to myometrium* - This description is too general and most closely aligns with **placenta accreta**, where the villi attach to the myometrium without invading or penetrating it. - **Placenta accreta** is the least severe form of abnormally invasive placenta. *Villi penetrate through myometrium* - This describes **placenta percreta**, the most severe form of abnormally invasive placenta. - In **placenta percreta**, the chorionic villi penetrate **through the entire myometrium** and may invade adjacent organs like the bladder or rectum.

Q: Which of the following STDs causes fetal abnormality?

Syphilis. ***Syphilis*** - **Congenital syphilis**, resulting from maternal infection, can lead to severe fetal abnormalities such as **bone deformities**, **saddle nose**, **Hutchinson's teeth**, and **neurological problems**. - It can also cause stillbirth, prematurity, or hydrops fetalis, emphasizing the importance of early detection and treatment during pregnancy. *Herpes* - While **neonatal herpes** can be life-threatening and cause neurological damage, it is typically acquired during passage through the birth canal and does not cause **fetal abnormalities** during gestation. - Herpes simplex virus primarily causes localized lesions and systemic infection in the neonate, not developmental defects. *Gonorrhea* - Gonorrhea primarily causes **ophthalmia neonatorum** (conjunctivitis) in newborns through exposure during birth, which can lead to blindness if untreated. - It does not typically cause **fetal abnormalities** or congenital defects through transplacental transmission. *Hepatitis B* - Hepatitis B can be transmitted to the fetus during birth, leading to **chronic hepatitis B infection** in the infant. - Although it causes a chronic disease, it does not typically result in **fetal abnormalities** or congenital malformations.

Q: A young pregnant woman presents with fulminant hepatic failure. The most likely aetiological agent is -

Hepatitis E virus. ***Hepatitis E virus*** - **Hepatitis E virus (HEV)** infection is known to cause **fulminant hepatic failure** in pregnant women, leading to high maternal and fetal mortality rates. - The severity of HEV infection is significantly increased during pregnancy, particularly in the third trimester. *Hepatitis A virus* - **Hepatitis A virus (HAV)** typically causes an acute, self-limiting hepatitis and rarely leads to fulminant hepatic failure, even in pregnant women. - While HAV can impact pregnancy outcomes, the incidence of fulminant failure is much lower compared to HEV. *Hepatitis B virus* - **Hepatitis B virus (HBV)** infection can cause chronic hepatitis and cirrhosis, but acute HBV infection rarely results in fulminant hepatic failure during pregnancy. - The primary concern with HBV in pregnancy is vertical transmission to the neonate. *Hepatitis C virus* - **Hepatitis C virus (HCV)** infection often leads to chronic hepatitis and can progress to cirrhosis and hepatocellular carcinoma over decades. - Acute HCV infection rarely causes fulminant hepatic failure, and its impact on pregnancy is usually less severe in terms of acute liver failure compared to HEV.

Q: Most common karyotype of partial mole?

69 XXY. ***69 XXY*** - A **partial mole** is characterized by **triploidy**, meaning it has three sets of chromosomes (69 total). - **69 XXY** is the **most common karyotype** in partial moles, accounting for approximately **60% of cases**. - This typically results from the fertilization of a single egg (23 X) by **two sperm** (23 X and 23 Y), leading to one maternal and two paternal sets of chromosomes. *46 XX* - This is the normal diploid karyotype for a **female** and is associated with a **normal pregnancy**, not a partial molar pregnancy. - A **complete hydatidiform mole** can have a 46 XX karyotype, but this arises from fertilization of an "empty" egg by a single sperm that then duplicates its chromosomes (androgenetic origin). *69 XXX* - While **69 XXX** is also a triploid karyotype seen in partial moles (approximately **37% of cases**), it is **less common** than 69 XXY. - This results from fertilization of a single egg (23 X) by two sperm (both 23 X), or by a diploid sperm (46 XX). - The question asks for the **most common** karyotype, which is 69 XXY. *46 XY* - This is the normal diploid karyotype for a **male** and is associated with a **normal pregnancy**, not a molar pregnancy. - Like 46 XX, it represents a healthy, non-molar chromosomal constitution with the normal 46 chromosomes.

Q: A pregnant lady had no complaints but mild cervical lymphadenopathy in first trimester. She was prescribed spiramycin but she was noncompliant. Baby was born with hydrocephalus and intracerebral calcification. Which of these is likely cause ?

Toxoplasmosis. ***Toxoplasmosis*** - The combination of **hydrocephalus** and **intracerebral calcifications** in a newborn is highly characteristic of **congenital toxoplasmosis**. The mother's mild cervical lymphadenopathy in the first trimester, coupled with non-compliance to spiramycin (an agent used to limit vertical transmission), further supports this diagnosis. - While many maternal infections are asymptomatic, fetal infection can lead to severe consequences. **Spiramycin** is used to reduce the risk of transplacental transmission, but does not treat established fetal infection. *CMV* - **Congenital cytomegalovirus (CMV)** can also cause **intracerebral calcifications**, but these are typically **periventricular**, unlike the diffuse calcifications seen in toxoplasmosis. - CMV often presents with **microcephaly** rather than hydrocephalus, and can also involve symptoms like **sensorineural hearing loss** and hepatosplenomegaly. *Rubella* - **Congenital rubella syndrome** is characterized by the classic triad of **cataracts**, **sensorineural hearing loss**, and **congenital heart defects** (e.g., patent ductus arteriosus). - While it can cause some central nervous system abnormalities, **hydrocephalus** and **intracerebral calcifications** are not its primary or characteristic presentation. *Herpes* - **Congenital herpes simplex virus (HSV) infection** typically presents with skin vesicles, keratitis, and encephalitis. - While it can cause neurological complications, **hydrocephalus** and prominent **intracerebral calcifications** similar to those described are not the hallmark features.

Q: Fetus starts hearing by what time in intrauterine life:

20 weeks. ***20 weeks*** - The **cochlea** and auditory structures of the inner ear reach **structural maturity** around **20 weeks of gestation**, marking the anatomical basis for hearing capability. - At this gestational age, the **cochlear hair cells** and **spiral ganglion** are sufficiently developed to transmit auditory signals. - This is the **conventional answer** in medical education, representing when the anatomical structures necessary for hearing are first functional. - While more consistent behavioral responses occur later (24-26 weeks), the initial capacity for sound perception begins around 20 weeks. *14 weeks* - At 14 weeks, the **basic structures** of the ear are forming but remain immature. - The cochlea is still undergoing development, and the auditory pathway is not yet functional. - Sound perception capability is not present at this early stage. *32 weeks* - By 32 weeks, the auditory system is **highly mature** and well-developed. - The fetus demonstrates robust responses to various sounds and can distinguish between different voices. - However, this represents advanced auditory function, not the **onset** of hearing, which occurs much earlier at 20 weeks. *33 weeks* - At 33 weeks, the fetal brain shows **significant activity** in response to auditory stimuli with well-established neural pathways. - This is a stage of **refined hearing**, not the initial development of hearing capability. - The ability to hear has already been established weeks earlier.

Q: Snow storm appearance on an ultrasound is seen in:

Vesicular mole. ***Vesicular mole*** - The classic ultrasound finding in a **complete hydatidiform mole** is a **"snowstorm" appearance**, characterized by a uterine cavity filled with echogenic, vesicular tissue and no fetal parts. - This appearance is due to the **swollen chorionic villi** and **trophoblastic proliferation**. *Chronic ectopic pregnancy* - While an ectopic pregnancy involves an implantation outside the uterus, it typically presents with an **adnexal mass**, sometimes with a **"ring of fire" sign** on Doppler, but not a snowstorm pattern within the uterine cavity. - Chronic ectopic pregnancies may show a more complex adnexal mass with varying echogenicity due to hemorrhage and organization, but this is distinct from the diffuse uterine changes in a hydatidiform mole. *Hydatid cyst* - A **hydatid cyst**, caused by *Echinococcus granulosus*, is typically found in the liver or lungs and appears as a **well-defined, anechoic lesion** with possible internal septations or daughter cysts (often called a "water lily" sign if ruptured) but not a diffuse snowstorm pattern within the uterus. - This condition is a parasitic infection, entirely unrelated to pregnancy. *Dermoid cyst* - A **dermoid cyst** (mature cystic teratoma) is an ovarian tumor that typically appears as a **complex adnexal mass** with characteristic features like a **"Rokitansky nodule"**, fat-fluid levels, and highly echogenic components (e.g., hair, teeth). - Its appearance is localized to the ovary and does not mimic the widespread uterine findings of a vesicular mole.

Q: In pregnancies complicated by intrauterine growth restriction (IUGR) with otherwise reassuring fetal surveillance, what is the recommended gestational age for planned delivery to optimize neonatal outcomes?

38 weeks. ***38 weeks*** - For pregnancies complicated by **IUGR (Intrauterine Growth Restriction)** with reassuring fetal surveillance, planned delivery at **38-39 weeks** is recommended by **ACOG guidelines** to optimize neonatal outcomes. - Among the given options, **38 weeks** represents the earliest point in this recommended range, balancing the risks of continued intrauterine compromise with the risks of **prematurity** such as **respiratory distress syndrome**. - This timing is appropriate for **mild to moderate IUGR** without concerning Doppler findings or other complications. *39 weeks* - **39 weeks** is actually within the acceptable range (38-39 weeks) for IUGR delivery per current guidelines. - However, many obstetricians prefer **38 weeks** to minimize the risk of continued **fetal compromise** from **placental insufficiency**, making 38 weeks the more commonly cited benchmark. - The distinction between 38 and 39 weeks is nuanced and depends on individual case factors and surveillance findings. *37 weeks* - Delivery at **37 weeks** is considered **early term** and carries higher risk of **neonatal morbidities**, particularly **respiratory complications** and **hypoglycemia**. - This timing may be appropriate for **severe IUGR** with abnormal **umbilical artery Doppler** findings, **absent or reversed end-diastolic flow**, or other concerning features, but not for routine IUGR with reassuring surveillance. - It is not the standard recommendation for uncomplicated IUGR to optimize outcomes. *40 weeks* - Delivering at **40 weeks** in an IUGR pregnancy is **not recommended** due to increased risk of **stillbirth** and complications from ongoing **placental insufficiency**. - The risks of adverse outcomes escalate with expectant management beyond 38-39 weeks in IUGR pregnancies. - Minimal additional fetal growth occurs beyond this point while risks continue to increase.

Q: A patient at 8 weeks of pregnancy is diagnosed to have a dermoid cyst. It should be removed at:

At 14-16 weeks. ***At 14-16 weeks*** - This period, the **second trimester**, is generally considered the safest time for **non-emergent surgery** during pregnancy. - Waiting until 14-16 weeks allows for the completion of **organogenesis**, reducing the risk of teratogenicity, and the risk of **spontaneous abortion** is lower compared to the first trimester. *Only when it undergoes torsion* - While **torsion** is a significant complication requiring immediate surgical intervention, waiting for it to occur would expose the patient to unnecessary pain, **ischemia**, and potential loss of the **ovary**. - Elective removal at a safer time is preferred to prevent emergencies. *At term along with LSCS* - Removing the cyst at term during a **cesarean section (LSCS)** is not ideal if the cyst is larger than 6 cm due to the increased risk of **torsion, rupture**, or **obstruction of labor** earlier in pregnancy. - If the cyst is small and uncomplicated, some obstetricians may consider this, but it is not the standard approach for a newly diagnosed cyst at 8 weeks. *Immediately* - Performing surgery at **8 weeks of gestation (first trimester)** carries a higher risk of **spontaneous abortion** due to surgical stress, anesthesia, and potentially interfering with critical stages of **embryonic development**. - Unless there is an emergency (like rupture or acute torsion), elective surgery is typically postponed.

Question 1

Placenta increta means:

Accepted Answer

Villi invade myometrium

Answer

Villi are attached to lower uterine segment

Answer

Villi are attached to myometrium

Answer

Villi penetrate through myometrium

Question 2

Which of the following STDs causes fetal abnormality?

Accepted Answer

Syphilis

Answer

Herpes

Answer

Gonorrhea

Answer

Hepatitis B

Question 3

A young pregnant woman presents with fulminant hepatic failure. The most likely aetiological agent is -

Accepted Answer

Hepatitis E virus

Answer

Hepatitis A virus

Answer

Hepatitis B virus

Answer

Hepatitis C virus

Question 4

Most common karyotype of partial mole?

Accepted Answer

69 XXY

Answer

46 XX

Answer

69 XXX

Answer

46 XY

Question 5

A pregnant lady had no complaints but mild cervical lymphadenopathy in first trimester. She was prescribed spiramycin but she was noncompliant. Baby was born with hydrocephalus and intracerebral calcification. Which of these is likely cause ?

Accepted Answer

Toxoplasmosis

Answer

CMV

Answer

Rubella

Answer

Herpes

Question 6

Fetus starts hearing by what time in intrauterine life:

Accepted Answer

20 weeks

Answer

14 weeks

Answer

32 weeks

Answer

33 weeks

Question 7

Snow storm appearance on an ultrasound is seen in:

Accepted Answer

Vesicular mole

Answer

Chronic ectopic pregnancy

Answer

Hydatid cyst

Answer

Dermoid cyst

Question 8

In pregnancies complicated by intrauterine growth restriction (IUGR) with otherwise reassuring fetal surveillance, what is the recommended gestational age for planned delivery to optimize neonatal outcomes?

Accepted Answer

38 weeks

Answer

39 weeks

Answer

37 weeks

Answer

40 weeks

Question 9

What is the WHO definition of abortion?

Accepted Answer

Pregnancy termination or loss occurring before 22 weeks of gestation.

Answer

Pregnancy termination or loss occurring before 24 weeks of gestation.

Answer

Pregnancy termination or loss occurring before 12 weeks of gestation.

Answer

Pregnancy termination or loss occurring before 20 weeks of gestation.

Question 10

A patient at 8 weeks of pregnancy is diagnosed to have a dermoid cyst. It should be removed at:

Accepted Answer

At 14-16 weeks

Answer

Only when it undergoes torsion

Answer

At term along with LSCS

Answer

Immediately

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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