Maternal-Fetal Medicine — MCQs
On this page
In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?
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?
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?
A pregnant woman at 28 weeks gestation is diagnosed with late latent syphilis. Which of the following is the most appropriate treatment?
A pregnant woman is diagnosed with syphilis at 20 weeks gestation. Which of the following constitutes adequate treatment for prevention of congenital syphilis?
DOC of bacterial vaginosis in pregnancy is:
Which of the following drugs used for management of preterm labor also has neuroprotective role in fetus:
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?
Use of lithium during pregnancy increases the risk of development of which of the following malformations in the baby?
Placenta grade 3, 35+3 weeks pregnancy, and absent end diastolic flow Doppler; next management is:
Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs
Question 1101: In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?
- A. Biophysical profile
- B. Amniotic fluid spectrophotometry
- C. Middle cerebral artery Doppler wave forms (Correct Answer)
- D. Fetal blood sampling
Explanation: ***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.
Question 1102: 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?
- A. Cerebral hemorrhage and acute respiratory distress syndrome (Correct Answer)
- B. Cerebral edema and laryngeal edema
- C. Convulsions and renal tubular necrosis
- D. Hemolysis and hepatic infection
Explanation: ***Cerebral hemorrhage and acute respiratory distress syndrome*** - **Cerebral hemorrhage** is the leading cause of maternal death in preeclampsia/eclampsia, accounting for approximately 20-30% of maternal deaths, often resulting from uncontrolled severe hypertension leading to rupture of cerebral vessels. - **Acute Respiratory Distress Syndrome (ARDS)** is another major cause of maternal mortality in severe preeclampsia, developing due to endothelial dysfunction, capillary leak, and pulmonary edema leading to significant respiratory compromise. *Cerebral edema and laryngeal edema* - While **cerebral edema** can occur in severe preeclampsia and contribute to neurological complications, **cerebral hemorrhage** is the more direct and fatal cerebrovascular complication. - **Laryngeal edema** is rare in preeclampsia and not considered a primary cause of maternal death; it may occur with aggressive fluid resuscitation or as part of airway management complications. *Convulsions and renal tubular necrosis* - **Convulsions (eclampsia)** are a serious complication, but they are not the direct cause of death; rather, **cerebral hemorrhage** following eclamptic seizures or from uncontrolled hypertension is the actual fatal event. - **Acute tubular necrosis** can lead to acute kidney injury, but with modern dialysis and supportive care, renal failure is rarely a direct cause of maternal death compared to acute cerebrovascular or respiratory events. *Hemolysis and hepatic infection* - **Hemolysis** is a component of HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), a severe form of preeclampsia, but hemolysis itself is not typically the direct cause of death; associated complications like hepatic rupture or cerebral hemorrhage are the fatal events. - **Hepatic infection** is not a complication of preeclampsia; preeclampsia can lead to hepatic dysfunction, subcapsular hematoma, or hepatic rupture in HELLP syndrome, but not infection.
Question 1103: 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?
- A. Jaundice
- B. Fetal anemia
- C. Anencephaly
- D. Renal agenesis (Correct Answer)
Explanation: ***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.
Question 1104: A pregnant woman at 28 weeks gestation is diagnosed with late latent syphilis. Which of the following is the most appropriate treatment?
- A. Azithromycin 2g single dose
- B. Benzathine penicillin G 2.4 million units IM weekly for 3 weeks (Correct Answer)
- C. Doxycycline 100mg BD for 28 days
- D. Erythromycin 500mg QID for 14 days
Explanation: ***Benzathine penicillin G 2.4 million units IM weekly for 3 weeks*** - This regimen is the **standard treatment** for **late latent syphilis** (duration >1 year or unknown duration) in pregnant women. Treatment extends to three weekly doses to ensure complete eradication and prevent **congenital syphilis**. - **Penicillin** is the only antibiotic proven to effectively cross the placenta, treat both maternal and fetal infection, and prevent **congenital syphilis**. - For **primary, secondary, or early latent syphilis** (<1 year), a single dose would be sufficient, but late latent requires the extended 3-week regimen. *Azithromycin 2g single dose* - While used for some sexually transmitted infections, **azithromycin** is **not effective** for treating syphilis, particularly in pregnancy, due to documented treatment failures and associated resistance. - It does not achieve adequate **treponemicidal levels** to reliably prevent **congenital syphilis**. *Doxycycline 100mg BD for 28 days* - **Doxycycline** is an effective treatment for syphilis in non-pregnant adults, but it is **contraindicated in pregnancy** due to potential adverse effects on fetal bone and tooth development (dental discoloration, impaired bone growth). - This regimen is typically used for **late latent syphilis** in non-pregnant individuals who are penicillin-allergic. *Erythromycin 500mg QID for 14 days* - **Erythromycin** is no longer recommended as an alternative for syphilis due to **poor placental transfer** and inability to adequately treat **fetal infection**. - It is **not recommended** for treating syphilis in pregnant women due to its poor efficacy in preventing **congenital syphilis**. Penicillin-allergic pregnant women should undergo desensitization.
Question 1105: A pregnant woman is diagnosed with syphilis at 20 weeks gestation. Which of the following constitutes adequate treatment for prevention of congenital syphilis?
- A. Single-dose benzathine penicillin
- B. Delaying treatment until the third trimester
- C. Appropriately staged penicillin regimen (Correct Answer)
- D. Azithromycin monotherapy
Explanation: ***Appropriately staged penicillin regimen*** - Treatment for syphilis in pregnancy must match the **stage of infection** according to CDC guidelines to prevent **congenital syphilis**. - For **early syphilis** (primary, secondary, or early latent <1 year): single dose of benzathine penicillin G 2.4 million units IM is adequate. - For **late latent, latent of unknown duration, or tertiary syphilis**: three doses of benzathine penicillin G 2.4 million units IM at weekly intervals (staged regimen) is required. - Since the question doesn't specify the stage, the most complete answer is an **appropriately staged regimen** that matches the clinical scenario. *Single-dose benzathine penicillin* - A single dose of **benzathine penicillin G 2.4 million units IM** is appropriate for **early syphilis** (primary, secondary, or early latent <1 year) in pregnancy. - However, without knowing the stage of syphilis in this case, this may be **insufficient** if the patient has late latent or syphilis of unknown duration, which would require three weekly doses. - The question asks for "adequate treatment" without specifying the stage, making the staged approach more comprehensive. *Delaying treatment until the third trimester* - Delaying treatment significantly increases the risk of **fetal infection** and severity of **congenital syphilis**, as *Treponema pallidum* can cross the placenta at any stage of pregnancy. - **Immediate treatment upon diagnosis** is critical to prevent adverse pregnancy outcomes including stillbirth, neonatal death, and permanent sequelae. - Treatment efficacy is highest when given before the third trimester. *Azithromycin monotherapy* - **Azithromycin** is not recommended for treating syphilis in pregnancy due to increasing rates of **macrolide resistance** in *T. pallidum* and treatment failures documented in pregnancy. - **Penicillin** remains the only recommended antibiotic for treating syphilis in pregnancy as it effectively crosses the placenta and treats both mother and fetus. - Pregnant women with penicillin allergy should undergo **desensitization** followed by penicillin treatment.
Question 1106: DOC of bacterial vaginosis in pregnancy is:
- A. Metronidazole (Correct Answer)
- B. Erythromycin
- C. Clindamycin
- D. Rovamycin
Explanation: ***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.
Question 1107: Which of the following drugs used for management of preterm labor also has neuroprotective role in fetus:
- A. Ritodrine
- B. MgSO4 (Correct Answer)
- C. Nifedipine
- D. Isoxsuprine
Explanation: ***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.
Question 1108: 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?
- A. MRI brain
- B. Inj. Calcium gluconate
- C. Inj Phenytoin
- D. Inj. MgSO4 (Correct Answer)
Explanation: ***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.
Question 1109: Use of lithium during pregnancy increases the risk of development of which of the following malformations in the baby?
- A. Urogenital defects
- B. Neural tube defects
- C. Facial defects
- D. Cardiac defects (Correct Answer)
Explanation: ***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.
Question 1110: Placenta grade 3, 35+3 weeks pregnancy, and absent end diastolic flow Doppler; next management is:
- A. Monitor
- B. Terminate after 37 weeks
- C. Dexamethasone and terminate after 48 hours (Correct Answer)
- D. Consult pediatrician and plan immediate delivery
Explanation: ***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.
Practice by Chapter
Fetal Assessment Techniques
Practice Questions
Hypertensive Disorders in Pregnancy
Practice Questions
Intrauterine Growth Restriction
Practice Questions
Multiple Gestation
Practice Questions
Rh Isoimmunization and Other Blood Group Incompatibilities
Practice Questions
Intrauterine Fetal Therapy
Practice Questions
Prenatal Diagnosis and Genetic Counseling
Practice Questions
Placental Abnormalities
Practice Questions
Preterm Labor and Delivery
Practice Questions
Management of Medical Disorders in Pregnancy
Practice Questions
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free