Maternal-Fetal Medicine Practice Questions

Q: The image shows different types of placenta in relation to the internal cervical os. Identify the type of placenta previa shown in the highlighted/marked image.

Type II (marginal).. ***Type II (marginal)*** - In **marginal placenta previa**, the placenta reaches the **edge of the internal cervical os** but does not cover it. - This is classified as a minor placenta previa, as depicted in the provided image. *Type I (low-lying)* - A **low-lying placenta** is when the placental edge is within **2 cm of the internal cervical os** but does not reach it. - The image for low-lying placenta shows the edge 1-20 mm from the os, not directly at the edge as in marginal. *Type III (partial)* - **Partial placenta previa** occurs when the placenta **partially covers the internal cervical os**. - The image labeled "Partial placenta previa" illustrates the placenta covering only a portion of the os, which is a major previa. *Type IV (complete)* - **Complete placenta previa** involves the placenta **completely covering the internal cervical os**. - The image labeled "Complete placenta previa" clearly shows the placenta entirely obstructing the os, which is a major previa.

Q: Which drug is commonly used to promote fetal lung maturity?

Betamethasone. ***Betamethasone*** - **Betamethasone** is the preferred corticosteroid for promoting **fetal lung maturity** in women at risk of preterm delivery (24-34 weeks gestation). - It stimulates **surfactant production** in fetal lungs, reducing the risk of **respiratory distress syndrome (RDS)** and neonatal mortality. - Recommended regimen: **12 mg IM, two doses 24 hours apart**. - Evidence suggests betamethasone may have advantages over dexamethasone, including **reduced risk of intraventricular hemorrhage** and possibly better neurodevelopmental outcomes. *Dexamethasone* - **Dexamethasone** is also an effective corticosteroid for fetal lung maturation and is commonly used in many settings. - While both drugs are acceptable, **betamethasone** is generally preferred based on meta-analyses showing slightly better outcomes. - Dexamethasone regimen: 6 mg IM every 12 hours for 4 doses. *Hydrocortisone* - **Hydrocortisone** has poor placental transfer due to metabolism by placental 11β-hydroxysteroid dehydrogenase. - Its shorter half-life and lower potency make it unsuitable for antenatal corticosteroid therapy. - Not used for fetal lung maturation. *Prednisolone* - **Prednisolone** is also extensively metabolized by the placenta and has poor fetal exposure. - Not effective for promoting fetal lung maturity. - Used for maternal conditions but not for fetal indication.

Q: Which drug regimen is given to a pregnant woman with HIV infection?

All of the options. ***All of the options*** - All listed regimens—**Tenofovir disoproxil fumarate (TDF) with emtricitabine (FTC)**, **TDF with lamivudine (3TC)**, and **Abacavir (ABC) with lamivudine (3TC)**—are commonly used and generally safe combinations of **nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)** in pregnant women with HIV. - The choice of regimen depends on factors such as individual patient characteristics, viral resistance patterns, and potential side effects, but all mentioned regimens are considered **first-line options** in various guidelines for preventing mother-to-child transmission (PMTCT). *Tenofovir disoproxil fumarate with emtricitabine* - This combination is a common and effective **NRTI backbone** for HIV treatment, including in pregnancy, offering good efficacy and a generally favorable safety profile. - It is frequently paired with a third agent (e.g., a **non-nucleoside reverse transcriptase inhibitor (NNRTI)** or an **integrase strand transfer inhibitor (INSTI)**) as part of a highly active antiretroviral therapy (HAART) regimen. *Tenofovir disoproxil fumarate with lamivudine* - This is another widely used and effective **NRTI combination** and is also a recommended backbone for pregnant women with HIV. - While similar to TDF/FTC, some guidelines might prefer one over the other based on specific regional recommendations or drug availability. *Abacavir with lamivudine* - **Abacavir/lamivudine** is a well-established NRTI combination that is safe and effective in pregnancy, provided the mother is **HLA-B*5701 negative** to avoid hypersensitivity reactions. - It is considered a suitable alternative to TDF-containing regimens, especially when there are contraindications or intolerances to TDF.

Q: A primigravida with 36 weeks of pregnancy is in labor with 3 cm dilatation and minimal uterine contraction. On rupture of membranes, fresh bleeding is noted with late fetal deceleration up to 50 beats/min. The patient was taken for LSCS but fetus could not be saved. No abruptio or placenta previa was seen. The likely diagnosis is ?

Vasa previa. ***Vasa previa*** - The sudden onset of **painless vaginal bleeding** upon membrane rupture, combined with **fetal heart rate deceleration** (bradycardia), is highly suggestive of **vasa previa**. This condition involves fetal vessels coursing within the membranes over the cervical os, unprotected by placental tissue or Wharton's jelly, making them prone to rupture. - The **fetal origin of the bleeding** (leading to fetal hypovolemia and distress) and the absence of placental complications like abruptio or previa further support this diagnosis. *Placenta previa* - This condition involves the **placenta covering the cervical os**, leading to painless bright red bleeding, especially in the third trimester. - However, the question explicitly states "No abruptio or placenta previa was seen," directly ruling out this diagnosis. *Revealed abruptio* - **Placental abruption** is the premature detachment of the placenta, typically causing **painful vaginal bleeding**, uterine tenderness, and often hypertonic contractions. - The scenario describes **minimal uterine contraction** and a lack of overt abdominal pain, and explicitly states "No abruptio or placenta previa was seen," making abruptio unlikely. *Circumvallate placenta* - A **circumvallate placenta** has a folded double layer of amnion and chorion at its margin, which can cause bleeding in pregnancy due to detachment of the rolled margin. - While it can cause bleeding, it typically doesn't present with the acute, severe fetal distress (late decelerations with bradycardia) immediately following membrane rupture that indicates direct fetal blood loss, unlike vasa previa.

Q: What is the most common heart disease in pregnancy?

Mitral Stenosis (MS). **Mitral Stenosis (MS)** - **Mitral stenosis** is the most common form of **rheumatic heart disease**, which is the leading cause of heart disease in pregnant women. - Pregnancy exacerbates MS symptoms due to **increased blood volume** and **cardiac output**, leading to increased left atrial pressure and pulmonary congestion. *Aortic Stenosis (AS)* - While **aortic stenosis** can occur during pregnancy, it is less common than mitral stenosis as a primary cause of symptomatic heart disease. - The fixed outflow obstruction in AS can lead to complications, but its prevalence is lower compared to rheumatic MS. *Mitral Regurgitation (MR)* - **Mitral regurgitation** is generally better tolerated in pregnancy than stenotic lesions due to reduced afterload during gestation. - Although it can cause symptoms, it is not the most common heart disease encountered. *Wolff-Parkinson-White (WPW) syndrome* - **WPW syndrome** is an electrical conduction disorder, not a structural heart disease. - While it can manifest with arrhythmias exacerbated by pregnancy, it is not considered the most common structural heart disease in this population.

Q: A lady with 35 weeks of pregnancy is admitted in view of first episode of painless bout of bleeding yesterday. On examination Hb 10g%, BP 120/70 mmHg, uterus relaxed, and cephalic floating. FHS regular. Next line of management is ?

Wait and watch. ***Correct: Wait and watch*** - The patient presented with **first episode of painless bleeding yesterday** which has now **stopped**, with stable vitals (BP 120/70 mmHg) and regular FHS, suggesting **placenta previa**. - At **35 weeks gestation**, with bleeding resolved and hemodynamic stability, **expectant management** is the appropriate next step to allow fetal maturity to 37-38 weeks. - The goal is to **avoid preterm delivery** complications while monitoring closely for recurrent bleeding. Patient should be kept in hospital with cross-matched blood ready. - **Ultrasound** should be performed to confirm placenta location, and delivery planned at 37-38 weeks if patient remains stable. *Incorrect: Cesarean section* - While Cesarean section is the **definitive mode of delivery** for placenta previa, it is not indicated immediately in this stable patient at 35 weeks. - Indications for emergency Cesarean would include: **active ongoing bleeding**, maternal or fetal compromise, or reaching 37-38 weeks gestation. - Performing Cesarean at 35 weeks would result in unnecessary **preterm delivery complications** when expectant management is safe. *Incorrect: Induction of labor* - **Absolutely contraindicated** in suspected placenta previa due to high risk of torrential hemorrhage as cervix dilates. - Vaginal delivery is not attempted when placenta previa is suspected. *Incorrect: Blood transfusion* - Hemoglobin of **10g%** indicates mild anemia but does not require immediate transfusion in a stable patient. - Blood should be **cross-matched and kept ready** for emergency use, but transfusion is indicated only if bleeding recurs with significant drop in hemoglobin or hemodynamic instability.

Q: Which of the following is a complication of pre-eclampsia?

Eclampsia. ***Eclampsia*** - **Eclampsia** is defined as the occurrence of **generalized tonic-clonic seizures** in a woman with pre-eclampsia that cannot be attributed to other causes - It represents the **direct neurological progression** of pre-eclampsia and is the **most characteristic complication** - Eclampsia occurs in approximately **1-2%** of women with pre-eclampsia and is a **life-threatening emergency** - The seizures result from cerebral vasospasm, edema, and ischemia associated with the hypertensive disorder *HELLP syndrome* - **HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets)** is indeed a **recognized complication** of pre-eclampsia, occurring in **10-20% of severe cases** - However, HELLP represents a **specific multiorgan manifestation** involving hepatic dysfunction and hematological abnormalities, rather than the classic progression pathway - While both are serious complications, **eclampsia** is considered the **prototypical complication** that defines disease progression from pre-eclampsia - HELLP can occur with or without the full clinical picture of severe pre-eclampsia *Postdatism* - **Postdatism** (post-term pregnancy) refers to pregnancy extending beyond **42 weeks of gestation** - This is **completely unrelated** to pre-eclampsia, which is a hypertensive disorder of pregnancy - Pre-eclampsia typically occurs in the **third trimester** and is actually an indication for **delivery**, not prolonged pregnancy *Disseminated Intravascular Coagulation (DIC)* - **DIC** is a severe coagulopathy involving widespread activation of clotting cascades - While DIC can complicate severe pre-eclampsia, it is **not a primary or direct complication** - DIC more commonly develops as a consequence of **eclampsia, HELLP syndrome, placental abruption**, or other severe obstetric emergencies - It represents a **secondary complication** rather than a direct progression of pre-eclampsia itself

Q: A 30-year-old woman is 14 weeks pregnant and has a history of two painless deliveries at 16 weeks. What is the next line of management?

Cervical length assessment. ***Cervical length assessment*** - With a history of **two painless preterm deliveries at 16 weeks**, the patient is at high risk for **cervical insufficiency** (incompetent cervix). - While this history may warrant **history-indicated cerclage**, many current protocols recommend **cervical length assessment** via transvaginal ultrasound as the next step to objectively evaluate cervical status and guide management decisions. - An **ultrasound-indicated approach** allows for selective cerclage placement if cervical shortening is documented, avoiding unnecessary procedures in some cases. - Cervical length <25 mm before 24 weeks indicates need for intervention. *Cervical encerclage* - **Prophylactic cerclage** (history-indicated) is an evidence-based option for women with ≥2 prior spontaneous second-trimester losses, and can be placed at 12-14 weeks. - However, the **ultrasound-indicated approach** (assess first, then place cerclage if indicated) is also widely accepted and may prevent unnecessary cerclage in patients with adequate cervical length. - Both approaches are supported by evidence; the question favors assessment first. *Evaluation for diabetes mellitus and thyroid disorders* - While **diabetes mellitus** and **thyroid disorders** can contribute to pregnancy complications, they are not the primary cause of recurrent **painless mid-trimester losses**. - The clinical presentation strongly suggests **cervical insufficiency**, which requires specific cervical evaluation and management. - Medical screening is not the most immediate priority in this scenario. *Tocolytics* - **Tocolytics** are used to suppress **preterm labor contractions**. - This patient's history of **painless deliveries** indicates cervical insufficiency rather than preterm labor with contractions, making tocolytics inappropriate for prevention.

Question 1

A 22-year-old primigravida visits ANC OPD with 20 weeks POG. On examination uterine height reveals a 16-week size. USG shows reduced liquor. What will be the diagnosis?

Accepted Answer

Intrauterine growth restriction (IUGR)

Answer

Premature rupture of membranes (PROM)

Answer

Congenital absence of one or both kidneys

Answer

Polycystic kidney disease

Question 2

The image shows different types of placenta in relation to the internal cervical os. Identify the type of placenta previa shown in the highlighted/marked image.

Accepted Answer

Type II (marginal).

Answer

Type I (low-lying).

Answer

Type III (partial).

Answer

Type IV (complete).

Question 3

Which drug is commonly used to promote fetal lung maturity?

Accepted Answer

Betamethasone

Answer

Hydrocortisone

Answer

Dexamethasone

Answer

Prednisolone

Question 4

Which of the following conditions is least likely to be classified as a high-risk pregnancy?

Accepted Answer

History of manual removal of placenta

Answer

Severe anemia

Answer

Gestational diabetes

Answer

Obesity in pregnancy

Question 5

Which drug regimen is given to a pregnant woman with HIV infection?

Accepted Answer

All of the options

Answer

Tenofovir disoproxil fumarate with emtricitabine

Answer

Tenofovir disoproxil fumarate with lamivudine

Answer

Abacavir with lamivudine

Question 6

A primigravida with 36 weeks of pregnancy is in labor with 3 cm dilatation and minimal uterine contraction. On rupture of membranes, fresh bleeding is noted with late fetal deceleration up to 50 beats/min. The patient was taken for LSCS but fetus could not be saved. No abruptio or placenta previa was seen. The likely diagnosis is ?

Accepted Answer

Vasa previa

Answer

Placenta previa

Answer

Revealed abruptio

Answer

Circumvallate placenta

Question 7

What is the most common heart disease in pregnancy?

Accepted Answer

Mitral Stenosis (MS)

Answer

Aortic Stenosis (AS)

Answer

Mitral Regurgitation (MR)

Answer

Wolff-Parkinson-White (WPW) syndrome

Question 8

A lady with 35 weeks of pregnancy is admitted in view of first episode of painless bout of bleeding yesterday. On examination Hb 10g%, BP 120/70 mmHg, uterus relaxed, and cephalic floating. FHS regular. Next line of management is ?

Accepted Answer

Wait and watch

Answer

Induction of labor

Answer

Blood transfusion

Answer

Cesarean section

Question 9

Which of the following is a complication of pre-eclampsia?

Accepted Answer

Eclampsia

Answer

HELLP syndrome

Answer

Postdatism

Answer

Disseminated Intravascular Coagulation (DIC)

Question 10

A 30-year-old woman is 14 weeks pregnant and has a history of two painless deliveries at 16 weeks. What is the next line of management?

Accepted Answer

Cervical length assessment

Answer

Cervical encerclage

Answer

Evaluation for diabetes mellitus and thyroid disorders

Answer

Tocolytics

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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