Maternal-Fetal Medicine Practice Questions

Q: Modified biophysical profile is:

NST + AFI. ***Correct Answer: NST + AFI*** - The **modified biophysical profile (mBPP)** consists of a **nonstress test (NST)** and an **amniotic fluid index (AFI)**. - This combination is used to evaluate fetal well-being, with the NST assessing **acute hypoxia** and the AFI reflecting **chronic placental function**. - The mBPP is a **simplified version** of the full biophysical profile, designed for efficient antepartum fetal surveillance. *Incorrect: NST + Fetal Tone* - While both are components of the **full biophysical profile (BPP)**, this specific combination does not define the modified biophysical profile. - **Fetal tone** (flexion/extension of extremities) is a component of the full BPP but is omitted in the modified version to streamline the assessment. *Incorrect: Fetal Tone + AFI* - This combination is not a recognized standard for evaluating fetal well-being. - A **nonstress test (NST)** is a crucial component for assessing **acute fetal oxygenation** and is always included in the modified biophysical profile. *Incorrect: NST + Fetal Tone + AFI* - This combination represents three of the five components of the **full biophysical profile**, which also includes **fetal breathing** and **gross body movements**. - The **modified biophysical profile** specifically simplifies this by including only the **NST** and **AFI**.

Q: Which of the following is NOT a feature of mild or non-severe pre-eclampsia?

Premonitory symptoms present. ***Premonitory symptoms present*** - The **presence of premonitory symptoms** (such as **severe headache**, **visual disturbances**, **epigastric pain**, or **altered mental status**) is a defining feature of **severe pre-eclampsia**, NOT mild or non-severe pre-eclampsia. - These symptoms indicate impending eclampsia or serious end-organ involvement, which classifies the condition as severe. - This is the correct answer as it is NOT a feature of mild pre-eclampsia. *Diastolic BP <100 mm Hg* - In mild pre-eclampsia, the **diastolic blood pressure** is typically **elevated** (≥90 mmHg) but remains **below 110 mmHg**. - This is a defining characteristic of mild pre-eclampsia, differentiating it from severe pre-eclampsia where diastolic BP is ≥110 mmHg. - This IS a feature of mild pre-eclampsia. *Systolic BP <160 mm Hg* - A **systolic blood pressure** below **160 mmHg** (but ≥140 mmHg) is consistent with mild or non-severe pre-eclampsia. - Severe pre-eclampsia is characterized by a systolic BP of ≥160 mmHg, making this range indicative of milder disease. - This IS a feature of mild pre-eclampsia. *Mild IUGR* - **Mild intrauterine growth restriction (IUGR)** can occur in mild pre-eclampsia due to **placental insufficiency**. - While more severe IUGR is associated with severe pre-eclampsia, mild IUGR can be seen in non-severe cases. - This IS a feature that can occur in mild pre-eclampsia.

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: At what weeks of gestation does the second wave of trophoblastic invasion occur?

12-15 weeks. ***12-15 weeks*** - The **second wave of trophoblastic invasion** is a crucial event for proper placental development, occurring between **12 and 15 weeks of gestation**. - During this phase, **cytotrophoblast cells** invade the **spiral arteries** in the decidua and inner myometrium, replacing the smooth muscle and elastic tissue with fibrinoid material. *8-11 weeks* - This period primarily encompasses the **first wave of trophoblastic invasion**, where **cytotrophoblast cells** invade the decidual segments of the spiral arteries. - Inadequate first-wave invasion is associated with early pregnancy complications, but the full second wave has not yet occurred. *10-12 weeks* - While this period overlaps with the later part of the first wave and the very beginning of the second, it is not the primary window for the **complete second wave of trophoblastic invasion**. - The most significant remodelling of the deeper spiral arteries occurs slightly later in gestation. *16-20 weeks* - By this gestational stage, the **second wave of trophoblastic invasion** should have largely been completed, and the placental circulation is well-established. - Inadequate remodelling of the spiral arteries by this point is strongly associated with later pregnancy complications like **preeclampsia** and **intrauterine growth restriction (IUGR)**.

Q: Which of the following is NOT an indication for the administration of Betamethasone to preterm patients?

Prevent postpartum hemorrhage (PPH). ***Prevent postpartum hemorrhage (PPH)*** - **Betamethasone** is a **corticosteroid** primarily used in preterm labor to accelerate fetal lung development and reduce the risk of neonatal complications, not to prevent **postpartum hemorrhage**. - **Postpartum hemorrhage (PPH)** is typically managed with uterine massage, oxytocics (e.g., oxytocin, methylergonovine), or other interventions aimed at uterine contraction and hemostasis. *Fetal lung maturity* - **Betamethasone** is widely administered to pregnant individuals at risk of preterm delivery to promote **fetal lung maturation** by stimulating surfactant production. - This reduces the incidence and severity of **respiratory distress syndrome (RDS)** in premature infants. *Prevents periventricular leukomalacia* - **Antenatal corticosteroids** like **betamethasone** have been shown to reduce the risk of **periventricular leukomalacia (PVL)**, a form of brain injury in preterm infants. - This protective effect is thought to be mediated by improving fetal cerebral vascular stability and reducing inflammation. *Decrease intraventricular hemorrhage* - Administration of **betamethasone** significantly reduces the risk and severity of **intraventricular hemorrhage (IVH)** in preterm neonates. - This benefit is primarily due to the stabilization of cerebral vasculature and reduced fluctuations in cerebral blood flow.

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: HCG levels at which Expectant management of Ectopic pregnancy can be done :

1000 IU/L. ***1000 IU/L*** - Expectant management for ectopic pregnancy is most appropriate when **hCG levels are < 1000-1500 IU/L and declining**. - This approach is suitable for **hemodynamically stable** patients with no signs of rupture, minimal symptoms, and a small ectopic pregnancy on ultrasound. - The key requirement is that **hCG levels must be declining**, indicating spontaneous resolution. - **1000 IU/L** represents the safest and most widely accepted threshold for expectant management. *2500 IU/L* - An hCG level of **2500 IU/L** is generally **too high** for expectant management of ectopic pregnancy. - Most guidelines recommend expectant management only when hCG is **< 1000-1500 IU/L** (some extend to < 2000 IU/L). - At 2500 IU/L, the risk of **rupture** is significantly higher, and active intervention (medical or surgical) is typically indicated. *10000 IU/L* - An hCG level of **10,000 IU/L** is far too high for expectant management. - Such elevated levels indicate a **larger, active ectopic pregnancy** with high rupture risk. - This level typically requires **immediate medical (methotrexate) or surgical intervention**. *5000 IU/L* - An hCG level of **5000 IU/L** is well above the threshold for expectant management. - At this level, **medical treatment with methotrexate or surgical management** is indicated. - The risk of rupture and treatment failure with conservative approaches is too high for expectant management.

Q: What is the earliest sign of fetal death?

Absence of fetal heart sounds. ***Absence of fetal heart sounds*** - **Absence of fetal heart sounds** detected by **Doppler ultrasound** or **real-time ultrasound** is the **earliest and most definitive sign** of fetal death. - Cardiac activity ceases **immediately at the moment of fetal demise**, making this the **primary diagnostic criterion** for intrauterine fetal death. - **Ultrasound showing absent cardiac activity** is the gold standard for confirming fetal death and can detect it within minutes to hours. *Absence of fetal movements* - Absence of fetal movements is often the **first maternal perception** of potential fetal demise, typically noticed within hours to days. - However, it is **subjective and non-specific**, as fetal movements can naturally decrease during sleep cycles or may be less perceptible in some pregnancies. - While important for prompting further evaluation, it is not as definitive as absent cardiac activity on ultrasound. *Spalding sign* - The **Spalding sign** (overlapping of fetal skull bones) is a **late radiological sign** of fetal death that appears **1-2 weeks post-mortem**. - It occurs due to **brain liquefaction and decomposition**, causing collapse of the cranial vault and overlapping of skull sutures. - This is a **confirmatory sign of prolonged fetal demise**, not an early indicator. *Adipocere formation* - **Adipocere formation** (saponification of soft tissues) is a **very late post-mortem change** occurring **weeks to months** after death. - It represents advanced decomposition in a moist environment and is rarely seen in modern obstetric practice due to early detection and intervention. - This is the latest sign among all the options listed.

Q: According to limited observational studies, in cases where fetal movement has significantly decreased, approximately how long may elapse before fetal heart rate cessation occurs?

12 hrs. ***Correct: 12 hrs*** - Limited observational studies suggest that in cases of significantly decreased fetal movement, **fetal heart rate cessation** may occur approximately **12 hours** later. - This timeframe highlights the urgency of investigating decreased fetal movement to prevent **fetal demise**. - This observation forms the basis for clinical recommendations to evaluate decreased fetal movement **urgently within 12-24 hours**. *Incorrect: 1 hr* - This is generally too short a period; **fetal heart rate cessation** typically does not occur within 1 hour of decreased fetal movement. - While immediate evaluation is crucial for decreased fetal movement, **perinatal outcomes** are rarely impacted this quickly unless direct acute events occur (e.g., placental abruption, cord accident). *Incorrect: 2 hrs* - While **fetal compromise** can occur rapidly, 2 hours is often too short for complete **fetal heart rate cessation** after only decreased movement. - This timeframe still allows for potential **intervention** if the cause of decreased movement is identified quickly. *Incorrect: 6 hrs* - Although more plausible than 1 or 2 hours, 6 hours is still generally considered too short for **fetal cardiac arrest** after significantly decreased movement based on observational data. - Urgent evaluation is still recommended within this window to avoid **adverse fetal outcomes**.

Question 1

Modified biophysical profile is:

Accepted Answer

NST + AFI

Answer

NST + Fetal Tone

Answer

Fetal Tone + AFI

Answer

NST + Fetal Tone + AFI

Question 2

Which of the following is NOT a feature of mild or non-severe pre-eclampsia?

Accepted Answer

Premonitory symptoms present

Answer

Diastolic BP <100 mm Hg

Answer

Systolic BP< 160 mm Hg

Answer

Mild IUGR

Question 3

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

Accepted Answer

Eclampsia

Answer

HELLP syndrome

Answer

Postdatism

Answer

Disseminated Intravascular Coagulation (DIC)

Question 4

At what weeks of gestation does the second wave of trophoblastic invasion occur?

Accepted Answer

12-15 weeks

Answer

10-12 weeks

Answer

16-20 weeks

Answer

8-11 weeks

Question 5

Which of the following is NOT an indication for the administration of Betamethasone to preterm patients?

Accepted Answer

Prevent postpartum hemorrhage (PPH)

Answer

Prevents periventricular leukomalacia

Answer

Fetal lung maturity

Answer

Decrease intraventricular hemorrhage

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

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

Accepted Answer

The placenta can be left in situ at the time of surgery.

Answer

Fetal survival rate approaches 80% with modern care.

Answer

The placenta should always be removed to prevent infection.

Answer

Gastrointestinal symptoms are typically mild and resolve spontaneously.

Question 8

HCG levels at which Expectant management of Ectopic pregnancy can be done :

Accepted Answer

1000 IU/L

Answer

10000 IU/L

Answer

5000 IU/L

Answer

2500 IU/L

Question 9

What is the earliest sign of fetal death?

Accepted Answer

Absence of fetal heart sounds

Answer

Adipocere formation

Answer

Absence of fetal movements

Answer

Spalding sign

Question 10

According to limited observational studies, in cases where fetal movement has significantly decreased, approximately how long may elapse before fetal heart rate cessation occurs?

Accepted Answer

12 hrs

Answer

1 hr

Answer

2 hrs

Answer

6 hrs

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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