Maternal-Fetal Medicine Practice Questions

Q: In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?

Middle cerebral artery Doppler wave forms. ***Middle cerebral artery Doppler wave forms*** - This is currently the most widely accepted and **non-invasive** method for monitoring **fetal anemia** in Rh-sensitized pregnancies. - An increase in the **peak systolic velocity (PSV)** in the middle cerebral artery indicates that the fetus is increasing cardiac output to compensate for a reduced oxygen-carrying capacity due to anemia. *Biophysical profile* - The biophysical profile assesses various fetal parameters like **movement**, **tone**, **breathing**, and **amniotic fluid volume**, which are often altered late in the course of severe fetal anemia. - It is a **less sensitive** indicator of early or moderate fetal anemia compared to MCA Doppler. *Amniotic fluid spectrophotometry* - This method measures the **bilirubin levels** in amniotic fluid, which correlates with the severity of hemolysis. - It is an **invasive procedure** (amniocentesis) and has largely been replaced by non-invasive MCA Doppler due to associated risks and better predictive value of Doppler. *Fetal blood sampling* - Fetal blood sampling (cordocentesis) provides a direct measurement of **fetal hemoglobin** and other blood parameters. - While definitive, it is a **highly invasive procedure** with significant risks, reserved primarily for confirmation of severe anemia or for direct transfusion, not for routine monitoring.

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: DOC of bacterial vaginosis in pregnancy is:

Metronidazole. ***Metronidazole*** - **Metronidazole** is the drug of choice for treating bacterial vaginosis in pregnancy and is effective against the anaerobic bacteria responsible for the condition. - It is considered safe throughout pregnancy, including the first trimester. - Recommended dose: 500 mg orally twice daily for 7 days OR 250 mg orally three times daily for 7 days. *Erythromycin* - **Erythromycin** is a macrolide antibiotic primarily used for respiratory tract infections and is not effective against bacterial vaginosis. - It does not have adequate activity against the anaerobic bacteria (Gardnerella vaginalis, Mobiluncus species) that cause bacterial vaginosis. *Clindamycin* - **Clindamycin** is an effective alternative treatment for bacterial vaginosis in pregnancy and can be used orally or topically. - While equally effective, **metronidazole** is traditionally preferred as the first-line drug of choice in most guidelines and medical education curricula. - Clindamycin is reserved as an alternative for patients who cannot tolerate or have contraindications to metronidazole. *Rovamycin* - **Rovamycin** (spiramycin) is a macrolide antibiotic used primarily for toxoplasmosis in pregnancy. - It has no role in the treatment of bacterial vaginosis and lacks efficacy against the causative anaerobic organisms.

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: 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: Use of lithium during pregnancy increases the risk of development of which of the following malformations in the baby?

Cardiac defects. ***Cardiac defects*** - Exposure to **lithium during pregnancy**, particularly in the first trimester, is associated with an increased risk of **cardiac malformations** in the fetus. - The most commonly associated cardiac defect is **Ebstein anomaly**, a rare congenital heart defect. *Urogenital defects* - While various medications can cause urogenital defects, **lithium is not specifically identified** as a primary teratogen for these types of malformations. - **ACE inhibitors**, for example, are known to cause renal dysfunction and urogenital anomalies. *Neural tube defects* - **Folic acid deficiency** and certain **antiepileptic drugs** (e.g., valproate) are well-known causes of neural tube defects. - **Lithium is not a primary risk factor** for neural tube defects. *Facial defects* - **Fetal alcohol syndrome** and certain anticonvulsants (e.g., phenytoin causing **fetal hydantoin syndrome**) are associated with facial dysmorphism. - **Lithium is not strongly linked** to specific facial defects.

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.

Question 1

In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?

Accepted Answer

Middle cerebral artery Doppler wave forms

Answer

Biophysical profile

Answer

Amniotic fluid spectrophotometry

Answer

Fetal blood sampling

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

DOC of bacterial vaginosis in pregnancy is:

Accepted Answer

Metronidazole

Answer

Erythromycin

Answer

Clindamycin

Answer

Rovamycin

Question 7

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 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

Use of lithium during pregnancy increases the risk of development of which of the following malformations in the baby?

Accepted Answer

Cardiac defects

Answer

Urogenital defects

Answer

Neural tube defects

Answer

Facial defects

Question 10

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

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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