Maternal-Fetal Medicine Practice Questions

Q: Which of the following is NOT a component of the biophysical profile?

Placental grading. ***Placental grading*** - **Placental grading** (e.g., Grannum classification) is an ultrasound assessment of placental maturity based on its appearance, but it is **NOT** one of the five standard components of the biophysical profile. - While useful for assessing placental health and maturity, it does not directly reflect **acute fetal well-being** in the same way as the BPP parameters. *Fetal tone* - This **is** one of the five components assessed in a **biophysical profile (BPP)**, specifically looking for at least one episode of active extension with return to flexion. - A normal score for fetal tone indicates **fetal neurological integrity** and adequate oxygenation. *Nonstress test (Fetal heart rate)* - The **nonstress test (NST)** evaluating fetal heart rate accelerations in response to fetal movement **is** one of the five components of the biophysical profile. - It assesses fetal heart rate reactivity as an indicator of **fetal well-being** and adequate oxygenation. *Fetal breathing movements* - **Fetal breathing movements** **are** a component of the biophysical profile, requiring at least one episode of 30 seconds of sustained fetal breathing over 30 minutes. - This parameter assesses neurological function and helps confirm the maturity of the **fetal respiratory system**.

Q: Which of the following surgical procedures is most appropriate for a hemodynamically stable patient with a ruptured ectopic pregnancy?

Salpingectomy. ***Salpinectomy*** - For a **hemodynamically stable** patient with a **ruptured ectopic pregnancy**, **salpingectomy** (removal of the affected fallopian tube) is often the most appropriate surgical intervention. This approach definitively addresses the rupture and prevents further hemorrhage. - While other options might be considered for unruptured ectopic pregnancies or specific patient conditions, a ruptured ectopic pregnancy, even in a stable patient, necessitates surgical removal of the compromised tube to ensure patient safety and prevent significant blood loss. *Methotrexate* - **Methotrexate** is a medical management option typically reserved for **unruptured, hemodynamically stable ectopic pregnancies** with specific criteria (e.g., small gestational sac, low hCG levels). - It is contraindicated in cases of **ruptured ectopic pregnancy** due to the immediate risk of hemorrhage, which requires surgical intervention. *Laparotomy* - **Laparotomy** (open abdominal surgery) is an appropriate surgical approach for a ruptured ectopic pregnancy, especially in **hemodynamically unstable patients** or when minimally invasive techniques are not feasible. - However, for a **hemodynamically stable patient**, a **laparoscopic salpingectomy** is generally preferred due to its less invasive nature, quicker recovery, and reduced morbidity compared to open laparotomy. *Expectant management* - **Expectant management** involves close observation without immediate intervention and is only considered for **unruptured ectopic pregnancies** that are spontaneously resolving, with very low and declining hCG levels, and where the patient is asymptomatic and hemodynamically stable. - It is **contraindicated** in cases of **ruptured ectopic pregnancy** as it carries a significant risk of severe hemorrhage, maternal morbidity, and mortality, necessitating active intervention.

Q: A 28-year-old woman in labor with a history of preeclampsia presents with severe hypertension. What is the appropriate treatment?

Labetalol. ***Labetalol*** - **Labetalol IV** is a **first-line agent** for acute treatment of **severe hypertension in preeclampsia** with rapid onset (5-10 minutes) and predictable dose-response. - It works by blocking both **alpha- and beta-adrenergic receptors**, reducing blood pressure without significantly compromising **uteroplacental blood flow**. - **Advantages**: IV route allows titration, widely available, favorable maternal-fetal safety profile. *Hydralazine* - **Hydralazine IV** is **also a first-line agent** (not second-line) for severe hypertension in preeclampsia, with equal efficacy to labetalol. - **Disadvantages**: Can cause **reflex tachycardia** and **maternal headache/palpitations**, making it harder to distinguish from worsening preeclampsia symptoms. - Onset of action can be **less predictable** with more frequent maternal side effects compared to labetalol. *Nifedipine* - **Nifedipine (immediate-release oral)** is **also a first-line agent** for severe hypertension in pregnancy, with efficacy comparable to IV agents. - **Disadvantages**: Oral route may be less ideal during active labor; can cause **maternal flushing and headache**. - Risk of **hypotension** if combined with magnesium sulfate (commonly used in preeclampsia). *Methyldopa* - **Methyldopa** is used for **chronic hypertension in pregnancy**, NOT for acute severe hypertension. - Its **slow onset of action** (4-6 hours) makes it completely unsuitable for emergency blood pressure control in labor.

Q: A pregnant woman presents with symptoms consistent with Zika virus infection, and ultrasound reveals fetal abnormalities. What is the most appropriate course of action?

Perform amniocentesis to test for Zika virus RNA. ***Perform amniocentesis to test for Zika virus RNA*** - Amniocentesis is recommended to confirm the presence of **Zika virus RNA in amniotic fluid** when fetal abnormalities are detected and Zika infection is suspected. - This diagnostic step provides definitive evidence of **fetal infection**, which is crucial for counseling and management. *Terminate the pregnancy* - **Termination of pregnancy** is a significant decision that requires confirmed diagnosis and thorough counseling, and it is not the immediate first step. - While it may be considered later depending on the severity of fetal abnormalities and parental wishes, diagnostic confirmation is paramount. *Initiate antiviral therapy immediately* - Currently, there is **no specific antiviral therapy** approved or proven effective for treating Zika virus infection in pregnant women or fetuses. - Management is primarily supportive, focusing on monitoring and symptom relief. *Wait for further development and re-evaluate* - Given the presence of **fetal abnormalities** and symptoms consistent with Zika, **waiting for further development** without diagnostic intervention is inappropriate. - Prompt diagnosis is essential to understand the full extent of the infection and prognosticate fetal outcomes.

Q: Identify the most common risk factor for ectopic pregnancy.

History of pelvic inflammatory disease. ***History of pelvic inflammatory disease*** - **Pelvic inflammatory disease (PID)** is the *most common risk factor* for ectopic pregnancy as it can cause *inflammation* and *scarring* of the fallopian tubes, impairing ovum transport. - The resulting tubal damage, such as *adhesions* and *strictures*, creates a hostile environment for the fertilized egg, making it more likely to implant outside the uterus. *Previous ectopic pregnancy* - While a *significant risk factor*, a history of **ectopic pregnancy** is not the most common risk factor overall, as its prevalence is lower than that of PID. - Women who have had one ectopic pregnancy have a *10-15% chance* of having another, but this is a *recurrent risk* rather than a primary cause in the general population. *Use of intrauterine devices* - **Intrauterine devices (IUDs)**, particularly *progestin-releasing IUDs*, do not cause ectopic pregnancies but instead prevent intrauterine pregnancies. - If a pregnancy does occur with an IUD in place, there is a *higher chance* that it will be ectopic due to the successful prevention of uterine implantation. *Advanced maternal age* - Although **advanced maternal age** (typically defined as over 35 years) is associated with an *increased risk of infertility* and other pregnancy complications, it is not the leading risk factor for ectopic pregnancy. - The association is often due to the *cumulative exposure to other risk factors* over time, such as PID, rather than age itself directly causing ectopic implantation.

Q: A 35-year-old woman with a history of preterm labor at 32 weeks presents at 24 weeks with signs of preterm labor. Which treatment is recommended to prevent recurrence?

Progesterone supplementation. ***Correct: Progesterone supplementation*** - **Progesterone** helps maintain uterine quiescence and prevents cervical shortening, which is beneficial for women with a history of spontaneous preterm birth. - For women with a history of **preterm labor**, progesterone supplementation (either vaginal or intramuscular 17-alpha-hydroxyprogesterone caproate) is recommended to reduce the risk of recurrence. - This is supported by **ACOG guidelines** and multiple randomized controlled trials showing reduced risk of recurrent preterm birth. *Incorrect: Corticosteroids* - **Corticosteroids** (e.g., betamethasone or dexamethasone) are administered to women at risk of imminent preterm delivery to accelerate fetal lung maturity. - They are **not used for preventing recurrence** of preterm labor but rather for mitigating complications if preterm birth is unavoidable. - Typically given between 24-34 weeks when delivery is anticipated within 7 days. *Incorrect: Magnesium sulfate* - **Magnesium sulfate** is primarily used as a **neuroprotective agent** for the fetus in cases of anticipated preterm birth before 32 weeks, and for tocolysis to temporarily delay delivery. - It is **not a treatment for preventing recurrent preterm labor** or for long-term maintenance of pregnancy. - Used acutely, not for prophylaxis. *Incorrect: Cerclage* - **Cervical cerclage** is a surgical procedure to reinforce the cervix, typically performed in women with **cervical insufficiency** (a weakened cervix that opens prematurely). - It is indicated if the patient has a history of second-trimester losses due to cervical incompetence or if significant cervical shortening (<25mm) is observed in the current pregnancy. - Not the primary treatment for preventing recurrent preterm labor in the absence of documented cervical insufficiency.

Q: A 28-year-old woman at 32 weeks of gestation presents with vaginal bleeding and no pain. Ultrasound shows placenta previa. What is the initial management?

Expectant management. ***Expectant management*** - In a stable patient with **placenta previa** at 32 weeks and no signs of fetal distress or severe hemorrhage, the correct management **strategy** is expectant management (watchful waiting) rather than immediate delivery. - This involves **hospitalization** with close monitoring including **maternal vital signs**, amount of bleeding, and fetal well-being (e.g., nonstress tests). - **Corticosteroids should be administered immediately** as part of expectant management to promote fetal lung maturity, given the risk of preterm delivery. - The goal is to reach 36-37 weeks gestation when elective cesarean delivery can be performed safely. *Immediate delivery* - **Immediate delivery** is only indicated in cases of **severe hemorrhage**, maternal hemodynamic instability, or fetal distress. - At 32 weeks, delivering without urgent indication significantly increases neonatal morbidity and mortality. *Magnesium sulfate* - **Magnesium sulfate** may be used for **tocolysis** if uterine contractions are present or for **neuroprotection** before anticipated preterm delivery (to reduce risk of cerebral palsy). - However, it is not the primary initial management strategy compared to expectant management with monitoring. *Corticosteroids* - **Corticosteroids** (betamethasone or dexamethasone) are indeed administered immediately to promote **fetal lung maturity**. - However, this option alone is incomplete as an answer because it doesn't encompass the **overall management approach** (expectant vs immediate delivery), which is the key decision point. - Corticosteroids are an essential **component** of expectant management, not a separate strategy.

Q: What is the most appropriate management for a fetus diagnosed with non-immune hydrops due to fetal anemia?

Intrauterine transfusion. ***Intrauterine transfusion*** - Non-immune hydrops due to **fetal anemia** requires **intrauterine transfusion** as the most effective treatment. - This procedure directly addresses the underlying cause by providing healthy red blood cells, which can reverse heart failure and hydrops. - Common causes of anemia-induced hydrops include **parvovirus B19 infection**, **α-thalassemia**, and **fetomaternal hemorrhage**. *Immediate delivery* - While delivery might be considered in some severe cases close to term, it is generally not the initial management for hydrops, especially in **preterm fetuses**, as it introduces risks associated with prematurity. - The focus is often on treating the underlying *fetal condition* in utero to improve outcomes before delivery. *Corticosteroid administration* - Corticosteroids are primarily used to **accelerate fetal lung maturity** in anticipation of preterm delivery. - They do not address the *underlying cause* of anemia-induced hydrops and therefore are not the primary, most appropriate management. *Observation and serial ultrasounds* - This approach is generally insufficient for anemia-induced hydrops, which indicates **fetal compromise** and has a high mortality rate if left untreated. - While monitoring is part of management, active intervention with **intrauterine transfusion** to treat the **underlying anemia** is crucial for improving fetal outcomes.

Q: A 28-year-old primigravida at 38 weeks of gestation presents with intense itching, particularly on the palms and soles, without a rash. Liver function tests reveal abnormalities. What is the most likely diagnosis?

Intrahepatic cholestasis of pregnancy. ***Intrahepatic cholestasis of pregnancy*** - This condition typically presents in the **late second or third trimester** with generalized pruritus, predominantly on the **palms and soles**, without a primary rash. - **Elevated liver function tests** (LFTs), particularly bile acids, are characteristic, confirming the diagnosis. *Pruritic urticarial papules and plaques of pregnancy (PUPPP)* - PUPPP presents with **urticarial papules and plaques** that start in the striae of the abdomen and spread, which is different from the rash-less itching on palms/soles in this case. - Liver function tests are typically **normal** in PUPPP, distinguishing it from conditions with hepatic involvement. *Pemphigoid gestationis* - This is an **autoimmune blistering disease** of pregnancy, characterized by intensely pruritic urticarial lesions and blisters, usually starting around the periumbilical region. - While it causes severe itching, the key feature of **blisters** is absent in the patient's presentation, and liver involvement is not a primary feature. *Acute fatty liver of pregnancy* - This is a severe, life-threatening condition presenting with nausea, vomiting, abdominal pain, jaundice, and often **hypoglycemia** and **hepatic encephalopathy**. - While LFTs are abnormal and jaundice may cause itching, the primary symptom is not isolated pruritus without a rash, and the overall clinical picture is much more severe.

Q: A 25-year-old woman presents with a history of recurrent miscarriages. Blood tests reveal elevated anticardiolipin antibodies. What is the best treatment approach to prevent further pregnancy complications?

Daily aspirin and low-molecular-weight heparin. ***Daily aspirin and low-molecular-weight heparin*** - **Anticardiolipin antibodies** are associated with **antiphospholipid syndrome (APS)**, which causes recurrent miscarriages due to thrombosis in the placental circulation. - The combination of **low-dose aspirin** and **low-molecular-weight heparin (LMWH)** is the standard of care for pregnant women with APS to prevent thrombotic events and improve live birth rates. *Methotrexate therapy* - **Methotrexate** is an immunosuppressant and anti-proliferative agent, primarily used in conditions like **rheumatoid arthritis** or certain cancers. - It is **contraindicated in pregnancy** due to its teratogenic effects and would not prevent miscarriages in APS; instead, it would cause fetal harm. *Intravenous immunoglobulin* - **Intravenous immunoglobulin (IVIG)** is a therapy used for certain autoimmune conditions or immunodeficiencies. - While it has been explored for recurrent pregnancy loss in some autoimmune contexts, it is **not the first-line or standard treatment** for APS-related recurrent miscarriages, which primarily benefit from antithrombotic therapy. *Steroid pulse therapy* - **Steroid pulse therapy** involves high doses of corticosteroids over a short period and is typically used for severe flares of autoimmune diseases. - There is **no evidence** to support its effectiveness as a primary treatment for preventing recurrent miscarriages in **antiphospholipid syndrome**, and it carries significant side effects.

Question 1

Which of the following is NOT a component of the biophysical profile?

Accepted Answer

Placental grading

Answer

Fetal tone

Answer

Fetal heart rate

Answer

Breathing movements

Question 2

Which of the following surgical procedures is most appropriate for a hemodynamically stable patient with a ruptured ectopic pregnancy?

Accepted Answer

Salpingectomy

Answer

Laparotomy

Answer

Expectant management

Answer

Methotrexate

Question 3

A 28-year-old woman in labor with a history of preeclampsia presents with severe hypertension. What is the appropriate treatment?

Accepted Answer

Labetalol

Answer

Methyldopa

Answer

Nifedipine

Answer

Hydralazine

Question 4

A pregnant woman presents with symptoms consistent with Zika virus infection, and ultrasound reveals fetal abnormalities. What is the most appropriate course of action?

Accepted Answer

Perform amniocentesis to test for Zika virus RNA

Answer

Terminate the pregnancy

Answer

Initiate antiviral therapy immediately

Answer

Wait for further development and re-evaluate

Question 5

Identify the most common risk factor for ectopic pregnancy.

Accepted Answer

History of pelvic inflammatory disease

Answer

Previous ectopic pregnancy

Answer

Use of intrauterine devices

Answer

Advanced maternal age

Question 6

A 35-year-old woman with a history of preterm labor at 32 weeks presents at 24 weeks with signs of preterm labor. Which treatment is recommended to prevent recurrence?

Accepted Answer

Progesterone supplementation

Answer

Corticosteroids

Answer

Magnesium sulfate

Answer

Cerclage

Question 7

A 28-year-old woman at 32 weeks of gestation presents with vaginal bleeding and no pain. Ultrasound shows placenta previa. What is the initial management?

Accepted Answer

Expectant management

Answer

Immediate delivery

Answer

Magnesium sulfate

Answer

Corticosteroids

Question 8

What is the most appropriate management for a fetus diagnosed with non-immune hydrops due to fetal anemia?

Accepted Answer

Intrauterine transfusion

Answer

Immediate delivery

Answer

Corticosteroid administration

Answer

Observation and serial ultrasounds

Question 9

A 28-year-old primigravida at 38 weeks of gestation presents with intense itching, particularly on the palms and soles, without a rash. Liver function tests reveal abnormalities. What is the most likely diagnosis?

Accepted Answer

Intrahepatic cholestasis of pregnancy

Answer

Pruritic urticarial papules and plaques of pregnancy (PUPPP)

Answer

Pemphigoid gestationis

Answer

Acute fatty liver of pregnancy

Question 10

A 25-year-old woman presents with a history of recurrent miscarriages. Blood tests reveal elevated anticardiolipin antibodies. What is the best treatment approach to prevent further pregnancy complications?

Accepted Answer

Daily aspirin and low-molecular-weight heparin

Answer

Methotrexate therapy

Answer

Intravenous immunoglobulin

Answer

Steroid pulse therapy

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?