Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs

Question 1161: Which drug is commonly used to promote fetal lung maturity?

A. Betamethasone (Correct Answer)
B. Hydrocortisone
C. Dexamethasone
D. Prednisolone

Explanation: ***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.

Question 1162: A 21-year-old female presents to the emergency ward with 2 months of amenorrhea, abdominal pain, and shock. Her blood pressure is 90/60 mmHg and hemoglobin is 6 gm%. A urine pregnancy test is positive. What is the next immediate line of treatment?

A. Medical management
B. IV fluids and cross match
C. Laparoscopy
D. Laparotomy (Correct Answer)

Explanation: ***Laparotomy*** - The patient presents with **amenorrhea**, **positive urine pregnancy test**, **abdominal pain**, and **shock** with significant **anemia** (hemoglobin 6 gm%), highly suggestive of a **ruptured ectopic pregnancy** - **Laparotomy** offers immediate surgical access to control hemorrhage, which is critical in an unstable patient, and is the definitive treatment for a ruptured ectopic pregnancy in this setting - In a hemodynamically unstable patient with signs of significant intra-abdominal hemorrhage, **emergency laparotomy** is the gold standard for rapid control of bleeding *Medical management* - **Medical management**, typically with **methotrexate**, is only suitable for **stable patients** with **unruptured ectopic pregnancies** and specific criteria (e.g., small gestational sac size, no fetal cardiac activity, low hCG levels) - This patient's signs of shock and severe anemia contraindicate medical management, as it would not address the acute hemorrhage - Medical management requires hemodynamic stability and absence of rupture *IV fluids and cross match* - While essential for **resuscitation** and preparing for potential **blood transfusions**, these are supportive measures and not the definitive treatment for a ruptured ectopic pregnancy - These measures should be initiated **simultaneously** with surgical preparation, but delaying definitive surgical intervention to solely focus on these steps could worsen the patient's condition due to ongoing internal bleeding - Resuscitation should proceed in parallel with emergency surgery, not as a sequential step *Laparoscopy* - **Laparoscopy** can be used to treat ectopic pregnancies, but it is generally reserved for **hemodynamically stable patients** - In a patient presenting with **shock** and significant **hemorrhage**, **laparotomy** is preferred due to the urgency required for rapid control of bleeding and its potentially faster approach compared to laparoscopy - Laparoscopy may be technically challenging in the presence of significant hemoperitoneum and requires more time for setup

Question 1163: At what day after fertilization is the utero-placental circulation typically established?

A. 5
B. 20
C. 10
D. 15 (Correct Answer)

Explanation: ***Day 15 (Correct Answer)*** - **Utero-placental circulation** is established around day 15 after fertilization, coinciding with the development of the **chorionic villi** and their vascularization. - At this stage, the **trophoblast** has invaded the maternal decidua, allowing for the formation of lacunae filled with maternal blood, facilitating early nutrient and waste exchange. - The **primary chorionic villi become vascularized**, creating the functional connection between maternal and fetal circulations. *Day 5 (Incorrect)* - By day 5, the embryo is typically at the **blastocyst stage** and is undergoing **hatching** from the zona pellucida before implantation. - There is no significant utero-placental circulation established at this very early stage; the embryo relies on diffusion for nourishment. *Day 10 (Incorrect)* - Around day 10, the **blastocyst is actively implanting** into the uterine wall, and the trophoblast differentiates into **cytotrophoblast** and **syncytiotrophoblast**. - While lacunae are forming within the syncytiotrophoblast and beginning to fill with maternal blood, a fully established circulatory system with functional villi is not yet present. *Day 20 (Incorrect)* - By day 20, the **utero-placental circulation** is already well-established and functional, having begun several days prior. - This later stage marks a more mature state of placental development, where the villi are more complex and efficient for exchange.

Question 1164: Up to what gestational age is the corpus luteum essential for pregnancy maintenance, such that its surgical excision would result in miscarriage?

A. Before 6 weeks
B. 8-10 weeks (Correct Answer)
C. 6-8 weeks
D. 10-12 weeks

Explanation: ***8-10 weeks*** - The corpus luteum produces **progesterone** that is essential for maintaining early pregnancy until the **luteal-placental shift** occurs. - This shift, where the **placenta takes over progesterone production**, typically completes between **7-9 weeks** of gestation. - However, to ensure safety and account for individual variation, the corpus luteum should be considered essential **up to 10 weeks**. - Surgical excision of the corpus luteum **before 10 weeks** carries significant risk of miscarriage, while removal **after 10 weeks** is generally safe as the placenta has established autonomous progesterone production. *Before 6 weeks* - While removal before 6 weeks would certainly cause miscarriage, this is not the **maximum gestational age** at which the corpus luteum remains essential. - The critical dependency extends well beyond 6 weeks. *6-8 weeks* - During this period, the corpus luteum is still **absolutely essential** for progesterone production. - The luteal-placental shift is typically **incomplete** during this timeframe. - Removal would result in miscarriage, but this is still not the maximum safe window. *10-12 weeks* - By 10-12 weeks, the **placenta has fully taken over** progesterone production. - At this stage, the corpus luteum is no longer functionally necessary, and its removal does **not increase miscarriage risk**.

Question 1165: What is the term used to describe the phenomenon of a fetus making a sound in utero?

A. Vagitus uterinus (Correct Answer)
B. Neonatal cry
C. Fetal vocalization
D. Intrauterine sound

Explanation: ***Vagitus uterinus*** - This term specifically refers to the phenomenon of a fetus crying or making a sound while still inside the intact **uterus** or during a **breech delivery** before the head is delivered. - It is a rare event, often occurring when air enters the uterus during delivery or a procedure, allowing the vocal cords to vibrate. *Neonatal cry* - This term describes the cry of a **newborn baby** after birth, once completely exposed to the external environment and able to take its first breath of air. - It does not specifically refer to sounds made while still within the uterus. *Fetal vocalization* - This is a more general term that could imply any sound made by a fetus, but it is not the specific medical term for a cry within the uterus. - It lacks the precise historical and medical connotation of sound made from a fetus still in the womb. *Intrauterine sound* - This is a broad term that encompasses any sound originating from within the uterus, such as **fetal heart sounds**, maternal bowel sounds, or blood flow, but not necessarily a vocal cry by the fetus. - It does not specifically refer to the act of crying by the fetus.

Question 1166: Which of the following statements about cardiovascular changes during pregnancy is true?

A. Increase in left ventricular end diastolic diameter (Correct Answer)
B. None of the options are true
C. Cardiac output decreases during pregnancy
D. Pregnancy causes right axis deviation

Explanation: ***Increase in left ventricular end diastolic diameter*** - Pregnancy leads to a significant increase in **blood volume** (up to 50% by the third trimester), which directly increases **venous return** to the heart. - This increased preload stretches the left ventricle, causing an increase in its **end-diastolic dimension** and volume to accommodate the larger blood volume. *Cardiac output decreases during pregnancy* - **Cardiac output actually increases** significantly during pregnancy, by 30-50%, reaching its peak in the second trimester and remaining high until delivery. - This increase is necessary to meet the metabolic demands of the growing fetus and uteroplacental unit, and is primarily driven by an increase in **stroke volume** and **heart rate**. *Pregnancy causes right axis deviation* - Pregnancy typically causes a **leftward shift of the cardiac axis**, leading to **left axis deviation** (or a more horizontal axis) on an electrocardiogram. - This is due to the elevation of the diaphragm by the gravid uterus, which pushes the heart superiorly and to the left. *None of the options are true* - This statement is incorrect because the increase in **left ventricular end-diastolic diameter** during pregnancy is a well-established physiological change. - The other two options are false, but there is a correct statement among the choices.

Question 1167: After IUFD, when does the mother develop DIC?

A. 48 hours
B. 1-2 weeks
C. 3-4 weeks (Correct Answer)
D. 6 weeks

Explanation: ***3-4 weeks*** - Following intrauterine fetal demise (IUFD), **Disseminated Intravascular Coagulation (DIC)** can develop due to the continuous release of thromboplastin from the degenerating fetal tissue into the maternal circulation. - While the risk is present earlier, significant changes leading to symptomatic DIC typically manifest around **3-4 weeks** after the demise if the fetus is retained. *48 hours* - The development of DIC within **48 hours** of IUFD is less common. - This time frame is generally too short for enough thromboplastin to accumulate and trigger a full DIC syndrome in most cases. *1-2 weeks* - While some changes in coagulation parameters might begin within **1-2 weeks**, overt clinical DIC is usually not observed during this period. - The placental and fetal tissue breakdown products require more time to induce a profound coagulopathy. *6 weeks* - By **6 weeks** after IUFD, if the fetus is still retained, the risk of DIC becomes very high, and the process is usually already well underway or has been identified earlier. - Early management, such as evacuating the uterus, is crucial to prevent DIC from reaching this advanced stage.

Question 1168: Which of the following procedures is associated with the least risk of feto-maternal hemorrhage?

A. Amniocentesis (Correct Answer)
B. Chorionic villus sampling
C. External cephalic version
D. Cordocentesis

Explanation: ***Amniocentesis*** - This procedure involves sampling **amniotic fluid**, which is primarily fetal urine and cells, not directly blood. - The needle typically avoids the placenta and fetal vessels, making **feto-maternal hemorrhage less likely** compared to procedures directly accessing fetal blood or placental tissue. - Risk of FMH is approximately **1-2%**, the lowest among invasive prenatal procedures. *Cordocentesis* - This procedure involves direct **percutaneous umbilical blood sampling** from the umbilical cord. - Due to direct needle puncture of fetal blood vessels, the potential for **feto-maternal hemorrhage is 40-50%**. - Highest risk among diagnostic procedures listed. *Chorionic villus sampling* - This procedure involves taking a sample of the **placenta** (chorionic villi), which contains fetal cells and is rich in blood vessels. - Disrupting the placental-uterine interface can lead to **feto-maternal hemorrhage in 10-15%** of cases. - Higher risk than amniocentesis due to placental manipulation. *External cephalic version* - This procedure involves **manual manipulation** of the fetus through the maternal abdomen to convert breech to cephalic presentation. - The mechanical pressure and manipulation can cause **placental separation or disruption**, leading to FMH in approximately **2-6%** of cases. - Risk is higher than amniocentesis due to physical manipulation of the gravid uterus.

Question 1169: Which of the following is a complication of pre-eclampsia?

A. Eclampsia (Correct Answer)
B. HELLP syndrome
C. Postdatism
D. Disseminated Intravascular Coagulation (DIC)

Explanation: ***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

Question 1170: Which of the following is the BEST management principle regarding abdominal pregnancy?

A. Fetal survival rate approaches 80% with modern care.
B. The placenta should always be removed to prevent infection.
C. The placenta can be left in situ at the time of surgery. (Correct Answer)
D. Gastrointestinal symptoms are typically mild and resolve spontaneously.

Explanation: ***The placenta can be left in situ at the time of surgery.*** - This is the **key management principle** for abdominal pregnancy due to the **highly vascularized nature** of the placenta. - Leaving the **placenta in situ** is often the safest approach, allowing for gradual resorption and minimizing the risk of **life-threatening hemorrhage**. - This is considered **standard practice** when the placenta is adherent to vital structures or highly vascularized peritoneal surfaces. - The cord should be ligated close to the placental insertion, and the placenta left to undergo spontaneous resorption, with serial hCG monitoring. *Fetal survival rate approaches 80% with modern care.* - This is **incorrect**. The reported survival rate for fetuses in abdominal pregnancies remains very low, ranging from **1% to 10%**. - Low survival is due to **fetal deformities**, **prematurity**, and **placental insufficiency** that often lead to intrauterine fetal death. - Even with advances in modern obstetric care, the prognosis remains poor. *The placenta should always be removed to prevent infection.* - This is **incorrect** and potentially dangerous. Aggressive attempts at complete placental removal can lead to **massive hemorrhage**. - The placenta in abdominal pregnancy often attaches to various **peritoneal structures** (bowel, bladder, major vessels), making complete removal hazardous. - Leaving the placenta in situ is preferred, with the risk of infection managed through monitoring and antibiotics if needed. *Gastrointestinal symptoms are typically mild and resolve spontaneously.* - This is **incorrect**. **Gastrointestinal symptoms** are typically **significant and severe** in abdominal pregnancies. - Symptoms include **nausea, vomiting, severe abdominal pain, and potential bowel obstruction** due to the fetus and placenta growing within the peritoneal cavity. - These symptoms often warrant urgent investigation and intervention.

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

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