Maternal-Fetal Medicine Practice Questions

Q: In a case of preterm labor, which steroid is used to enhance fetal lung maturity?

Dexamethasone. ***Dexamethasone*** - **Dexamethasone** is one of the two corticosteroids recommended for enhancing **fetal lung maturity** in preterm labor (the other being betamethasone). - It effectively crosses the placenta to stimulate **surfactant production** and lung structural maturation in the fetus. - Standard regimen: **6 mg IM every 12 hours for 4 doses** between 24-34 weeks of gestation. - Among the options provided, this is the **correct choice** for antenatal corticosteroid therapy. *Prednisolone* - **Prednisolone** is NOT used for fetal lung maturity as it is largely **inactivated by placental 11β-hydroxysteroid dehydrogenase**, limiting its transfer to the fetus. - Its efficacy in stimulating **fetal lung development** is significantly lower compared to dexamethasone or betamethasone. *Methylprednisolone* - Similar to prednisolone, **methylprednisolone** is also significantly **metabolized by the placenta**, reducing its availability to the fetus. - It is **not recommended** for **fetal lung maturity enhancement** in preterm labor. *Hydrocortisone* - **Hydrocortisone** has a shorter half-life and weaker potency compared to dexamethasone, making it ineffective for enhancing **fetal lung maturity**. - It does not achieve optimal fetal concentrations for the desired therapeutic effect in preterm labor.

Q: A pregnant woman presents with intrahepatic cholestasis. What is the first-line treatment?

Ursodeoxycholic acid. ***Ursodeoxycholic acid*** - **Ursodeoxycholic acid (UDCA)** is the **first-line treatment** for intrahepatic cholestasis of pregnancy (ICP) as it improves pruritus, liver function tests, and may reduce adverse fetal outcomes. - UDCA works by increasing the hydrophilicity of the bile acid pool, reducing serum bile acid levels, and protecting hepatocytes from toxic bile acids. *Silymarin* - **Silymarin** is a herbal derivative that has been studied for liver support, but it is **not considered first-line therapy** for ICP due to insufficient evidence of efficacy and safety in this condition. - It may have some hepatoprotective effects, but its role in managing the symptoms and potential fetal risks of ICP is not established. *Methotrexate* - **Methotrexate** is an **immunosuppressant** and antifolate agent primarily used in conditions like rheumatoid arthritis, psoriasis, and certain cancers. - It is **absolutely contraindicated in pregnancy** due to its severe teratogenic effects and is not used to treat liver conditions like ICP. *Prednisolone* - **Prednisolone** is a corticosteroid used to reduce inflammation and suppress the immune system, but it is **not a first-line treatment for ICP**. - While it has been investigated as an adjunctive therapy, its efficacy is inferior to UDCA, and it carries risks for both mother and fetus, especially with long-term use.

Q: Which ultrasound finding is associated with trisomy 21 in a fetus?

Nuchal edema. ***Nuchal edema*** - Increased nuchal translucency, or nuchal edema, is a classic and **strong marker for Trisomy 21** during the first-trimester ultrasound screening. - This finding reflects fetal lymphatic dysfunction and is a key indicator for further diagnostic testing. *Choroid plexus cysts* - While sometimes seen in Trisomy 18 (Edwards Syndrome), choroid plexus cysts are generally considered a **soft marker for aneuploidy** and are **rarely isolated findings** in Trisomy 21. - Many fetuses with choroid plexus cysts are chromosomally normal, especially if there are no other associated anomalies. *Echogenic foci in heart* - Intracardiac echogenic foci, often called a "golf ball sign," are a **minor or soft marker for aneuploidy**, including Trisomy 21, but their isolated finding has a **low predictive value**. - They represent mineralization within a papillary muscle and are often benign, especially in the absence of other risk factors or anomalies. *Hyperechogenic bowel* - Hyperechogenic bowel is a **non-specific finding** that can be associated with various conditions, including cystic fibrosis, intrauterine infection, or fetal growth restriction, as well as aneuploidy. - While it can be a soft marker for Trisomy 21, its presence alone is not a strong indicator without other associated anomalies.

Q: A 28-year-old primigravida at 32 weeks of gestation presents for a routine prenatal visit. She has no significant past medical history. During the ultrasound examination, various parameters are assessed to evaluate fetal growth and well-being. Which of the following is NOT a criterion used to diagnose Intrauterine Growth Restriction (IUGR)?

Uterine artery Pulsatility Index (PI) > 95th percentile. ***Uterine artery Pulsatility Index (PI) > 95th percentile*** - A **high uterine artery Pulsatility Index (PI)**, especially above the 95th percentile, is indicative of **increased vascular resistance** in the uteroplacental circulation. - While it suggests an **increased risk of IUGR** and other adverse pregnancy outcomes due to impaired placentation, it is a **risk predictor or screening tool, not a diagnostic criterion** for IUGR itself. - It helps identify high-risk pregnancies that require closer monitoring but does not diagnose IUGR. *Fetal weight less than the 3rd percentile* - This is a **direct diagnostic criterion** for severe IUGR, indicating significant growth restriction. - It signifies that the fetus is substantially smaller than expected for gestational age, reflecting a failure to meet its growth potential. *Abdominal circumference (AC) less than the 3rd percentile* - An **Abdominal Circumference (AC) below the 3rd percentile** is a **direct diagnostic criterion** for severe asymmetric IUGR. - The AC is a critical parameter as it reflects the fetal liver size and glycogen stores, which are reduced in growth restriction. - AC is often the first biometric parameter to show growth restriction in placental insufficiency. *Estimated fetal weight (EFW) below the 10th percentile for gestational age* - **EFW < 10th percentile** is the **most commonly used diagnostic criterion** for IUGR in clinical practice. - This threshold is widely accepted in international guidelines (ACOG, RCOG, ISUOG) for diagnosing IUGR. - Some centers use < 5th percentile or < 3rd percentile for severe IUGR, but the 10th percentile is the standard diagnostic cutoff.

Q: A 32-year-old female at 36 weeks of pregnancy presents with BP 170/100 mmHg, visual disturbances, headache, urine protein 3+. What will be the next step?

IV labetalol, magnesium sulfate (MgSO4), expedite delivery. ***IV labetalol, magnesium sulfate (MgSO4), expedite delivery*** - The patient presents with **severe preeclampsia** (BP > 160/110 mmHg, visual disturbances, headache, proteinuria) at 36 weeks, requiring **antihypertensive therapy** (labetalol) and seizure prophylaxis (**magnesium sulfate**). - Given the severe features and gestational age, **expedited delivery** is indicated to prevent maternal and fetal complications, as expectant management beyond severe preeclampsia at this stage offers minimal benefit and increased risk. *IV labetalol and delivery at 37 weeks* - While IV labetalol is appropriate for **blood pressure control**, delaying delivery to 37 weeks might not be optimal given the **severe features of preeclampsia** at 36 weeks, increasing risks for both mother and fetus. - The plan is incomplete without mentioning **seizure prophylaxis** with magnesium sulfate, which is crucial for severe preeclampsia. *IV labetalol, dexamethasone, and immediate termination of pregnancy* - **Dexamethasone** is used for **fetal lung maturity** in preterm deliveries and is not indicated for immediate termination unless the fetus is preterm and lung maturity is a concern. At 36 weeks, lung maturity is usually established. - While immediate termination might be considered, the phrase "immediate termination" implies C-section without considering vaginal delivery and overlooks the need for **seizure prophylaxis**. *IV labetalol, dexamethasone, and conservative management* - **Dexamethasone** is not a primary treatment for severe preeclampsia itself but rather for **fetal lung maturation** in preterm deliveries, which is less critical at 36 weeks. - **Conservative management** is generally inappropriate for **severe preeclampsia** at 36 weeks, as it increases maternal and fetal risk; delivery is the definitive treatment.

Q: A G2 P1 female with 6 weeks amenorrhea presents with bleeding PV, hypotension, and altered sensorium. She has pain in the abdomen and on per vaginal examination cervical movement tenderness is present. On USG, there is free fluid present in the right paracolic gutter. What is the most probable diagnosis?

Ruptured ectopic. ***Ruptured ectopic*** - The combination of **amenorrhea**, **vaginal bleeding**, **abdominal pain**, and signs of **hypovolemic shock** (hypotension, altered sensorium) is highly suggestive of a ruptured ectopic pregnancy. - The presence of **cervical motion tenderness** and **free fluid in the paracolic gutter** on ultrasound strongly indicates intra-abdominal hemorrhage. *Abruptio placenta* - This condition typically occurs in the **second or third trimester** of pregnancy, not at 6 weeks gestation. - While it causes vaginal bleeding and abdominal pain, the presentation of **profound shock** in early pregnancy with free fluid suggests an ectopic rupture rather than placental abruption. *Placenta previa* - **Painless vaginal bleeding** in the second or third trimester is characteristic of placenta previa. - It would not explain the severe abdominal pain, cervical motion tenderness, or signs of hypovolemic shock in a 6-week pregnancy. *Missed abortion* - A missed abortion involves the **death of the embryo/fetus** with retention of products of conception, often with minimal or no symptoms. - It would not typically present with **hypotension**, **altered sensorium**, **severe abdominal pain**, or **free fluid in the abdomen**.

Q: What is the correct dosing regimen of Dexamethasone for promoting fetal lung maturity in preterm infants?

Dexamethasone 6 mg - 4 doses every 12 hrly. **Dexamethasone 6 mg - 4 doses every 12 hrly** - The standard recommended dosing for **Dexamethasone** to promote fetal lung maturity is **6 mg intramuscularly every 12 hours for a total of four doses.** - This regimen ensures adequate **antenatal corticosteroid** exposure to enhance surfactant production and reduce the incidence and severity of **respiratory distress syndrome** in preterm infants. *Dexamethasone 6 mg - 2 doses every 12 hrly* - This regimen administers only **half the recommended total dose** of Dexamethasone. - It is **insufficient** to achieve the full benefits of antenatal corticosteroids for fetal lung maturity. *Betamethasone 12 mg - 2 doses every 24 hrly* - This is the correct dosing regimen for **Betamethasone**, not Dexamethasone. - While both are antenatal corticosteroids, their dosages and administration schedules differ. *Betamethasone 6 mg - 4 doses every 12 hrly* - This option uses an **incorrect total dose and frequency** for **Betamethasone**. - The standard Betamethasone regimen is 12 mg every 24 hours for two doses.

Q: A 35-year-old pregnant woman at 36 weeks of gestation presents with pruritus and jaundice. What is the most appropriate investigation?

Bile acids measurement. ***Bile acids measurement*** - Elevated **serum bile acids** are the hallmark of **intrahepatic cholestasis of pregnancy (ICP)**, which is strongly suggested by the patient's symptoms of pruritus and jaundice in late pregnancy. - This test directly measures the substance pathologically elevated in ICP, guiding diagnosis and management due to the associated risks to the fetus. *Liver function tests* - While **liver function tests (LFTs)** like **ALT** and **AST** are often abnormal in ICP (elevated), they are not as specific as bile acid levels for diagnosing ICP and can be elevated in various other liver conditions. - LFTs alone might not confirm the diagnosis of ICP, especially in cases where **pruritus** is the main symptom, and other liver enzymes are only mildly deranged. *Ultrasound of liver* - A **liver ultrasound** is useful for ruling out **extrahepatic cholestasis** (e.g., gallstones obstructing the bile duct) but will typically be normal in **intrahepatic cholestasis of pregnancy** itself. - It does not directly assess the biochemical markers indicative of ICP, which is primarily a functional disorder of bile acid transport. *Serum bilirubin* - While **elevated serum bilirubin** contributes to the **jaundice** observed in this patient, it is a non-specific finding that indicates impaired bile flow or liver dysfunction from various causes. - **Bilirubin** levels do not provide the specific diagnostic confirmation for **intrahepatic cholestasis of pregnancy** that **bile acid levels** do, nor do they reflect the severity or guide treatment for ICP as effectively.

Q: What is the most common complication of Zika virus infection in pregnant women?

Microcephaly in the newborn. ***Microcephaly in the newborn*** - **Microcephaly** is the most significant and characteristic neurological birth defect strongly linked to **Zika virus infection** during pregnancy. - The virus primarily targets developing brain cells, leading to severe brain underdevelopment and a smaller-than-normal head circumference in the fetus. - Microcephaly is the hallmark feature of **congenital Zika syndrome**, making it the most recognized complication. *Gestational diabetes* - **Gestational diabetes** is a metabolic disorder where pregnant women develop high blood sugar levels due to hormonal changes and insulin resistance. - It is not directly caused by viral infections like Zika virus. *Spontaneous abortion* - While Zika infection can increase the risk of pregnancy loss and adverse pregnancy outcomes, **spontaneous abortion** is not the most characteristic complication. - **Microcephaly** and other structural brain abnormalities are the defining features of congenital Zika syndrome and are more specifically documented. *Pre-eclampsia* - **Pre-eclampsia** is a hypertensive disorder of pregnancy characterized by high blood pressure and organ damage. - It has no direct causal link to **Zika virus infection**.

Question 1

In a case of preterm labor, which steroid is used to enhance fetal lung maturity?

Accepted Answer

Dexamethasone

Answer

Prednisolone

Answer

Methylprednisolone

Answer

Hydrocortisone

Question 2

A pregnant woman presents with intrahepatic cholestasis. What is the first-line treatment?

Accepted Answer

Ursodeoxycholic acid

Answer

Silymarin

Answer

Methotrexate

Answer

Prednisolone

Question 3

Which ultrasound finding is associated with trisomy 21 in a fetus?

Accepted Answer

Nuchal edema

Answer

Choroid plexus cysts

Answer

Echogenic foci in heart

Answer

Hyperechogenic bowel

Question 4

A 28-year-old primigravida at 32 weeks of gestation presents for a routine prenatal visit. She has no significant past medical history. During the ultrasound examination, various parameters are assessed to evaluate fetal growth and well-being. Which of the following is NOT a criterion used to diagnose Intrauterine Growth Restriction (IUGR)?

Accepted Answer

Uterine artery Pulsatility Index (PI) > 95th percentile

Answer

Fetal weight less than the 3rd percentile

Answer

Abdominal circumference (AC) less than the 3rd percentile

Answer

Estimated fetal weight (EFW) below the 10th percentile for gestational age

Question 5

A 32-year-old female at 36 weeks of pregnancy presents with BP 170/100 mmHg, visual disturbances, headache, urine protein 3+. What will be the next step?

Accepted Answer

IV labetalol, magnesium sulfate (MgSO4), expedite delivery

Answer

IV labetalol and delivery at 37 weeks

Answer

IV labetalol, dexamethasone, and immediate termination of pregnancy

Answer

IV labetalol, dexamethasone, and conservative management

Question 6

A G2 P1 female with 6 weeks amenorrhea presents with bleeding PV, hypotension, and altered sensorium. She has pain in the abdomen and on per vaginal examination cervical movement tenderness is present. On USG, there is free fluid present in the right paracolic gutter. What is the most probable diagnosis?

Accepted Answer

Ruptured ectopic

Answer

Abruptio placenta

Answer

Placenta previa

Answer

Missed abortion

Question 7

What is the correct dosing regimen of Dexamethasone for promoting fetal lung maturity in preterm infants?

Accepted Answer

Dexamethasone 6 mg - 4 doses every 12 hrly

Answer

Dexamethasone 6 mg - 2 doses every 12 hrly

Answer

Betamethasone 12 mg - 2 doses every 24 hrly

Answer

Betamethasone 6 mg - 4 doses every 12 hrly

Question 8

A 30-year-old woman presents with a history of recurrent pregnancy losses and a positive lupus anticoagulant test. What is the most appropriate treatment?

Accepted Answer

Heparin

Answer

Low-dose aspirin

Answer

Methotrexate

Answer

Corticosteroids

Question 9

A 35-year-old pregnant woman at 36 weeks of gestation presents with pruritus and jaundice. What is the most appropriate investigation?

Accepted Answer

Bile acids measurement

Answer

Liver function tests

Answer

Ultrasound of liver

Answer

Serum bilirubin

Question 10

What is the most common complication of Zika virus infection in pregnant women?

Accepted Answer

Microcephaly in the newborn

Answer

Gestational diabetes

Answer

Spontaneous abortion

Answer

Pre-eclampsia

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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