Maternal-Fetal Medicine — MCQs

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 ?

Q1170

Modified biophysical profile is:

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

A. 10-12 weeks
B. 16-20 weeks
C. 8-11 weeks
D. 12-15 weeks (Correct Answer)

Explanation: ***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)**.

Question 1163: Earliest sign after IUFD is ?

A. Hyperflexion of spine
B. Overlapping of skull bones
C. Overcrowding of ribs
D. Gas in great vessel (Correct Answer)

Explanation: ***Gas in great vessel*** - The presence of **intravascular gas** (often in the heart or great vessels) is considered the **earliest reliable sonographic sign of fetal death**, appearing within 1-2 hours after demise. - This gas is thought to result from post-mortem **autolysis** and bacterial activity. *Overlapping of skull bones* - Known as **Spalding's sign**, this indicates skull bone collapse due to liquefaction of brain tissue and typically appears **several days (3-7 days)** after fetal demise. - It reflects a more advanced stage of fetal decomposition rather than an immediate post-mortem change. *Hyperflexion of spine* - This sign, along with abnormal fetal posture, can be seen with fetal demise but is generally evident **later than intravascular gas**, as fetal muscle tone diminishes. - It is a less specific and later indicator compared to intravascular gas. *Overcrowding of ribs* - This is an inconsistent and non-specific finding that may be observed in IUFD but does not serve as an **early diagnostic marker**. - It generally reflects changes in fetal soft tissue and skeletal structures due to maceration, occurring much later.

Question 1164: 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 1165: Which of the following parameters is most critical to monitor in a patient with pre-eclampsia?

A. Proteinuria
B. Blood pressure (Correct Answer)
C. Platelet count
D. Liver function tests (LFTs)

Explanation: ***Blood pressure*** - **Hypertension** is the hallmark of pre-eclampsia and directly correlates with the severity of the disease and the risk of complications such as **eclampsia** and **HELLP syndrome**. - Precise and frequent monitoring of blood pressure guides treatment decisions, including the initiation or adjustment of **antihypertensive medications**. *Proteinuria* - While **proteinuria** is a diagnostic criterion for pre-eclampsia, it is not the most critical parameter for ongoing management and predicting immediate adverse outcomes. - The quantity of proteinuria does not reliably predict the severity of maternal or fetal complications. *Platelet count* - **Thrombocytopenia** can occur in severe pre-eclampsia and **HELLP syndrome**, indicating disease progression. - While important for assessing coagulation status, it is a secondary monitoring parameter compared to blood pressure, which is central to diagnosis and acute management. *Liver function tests (LFTs)* - Elevated **LFTs** signify liver involvement, particularly in severe pre-eclampsia and **HELLP syndrome**. - Monitoring LFTs helps in assessing organ damage but is less immediate for day-to-day management decisions than blood pressure, which is the primary driver of intervention.

Question 1166: 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.

Question 1167: 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 1168: 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 ?

A. Induction of labor
B. Wait and watch (Correct Answer)
C. Blood transfusion
D. Cesarean section

Explanation: ***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.

Question 1169: 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 ?

A. Placenta previa
B. Revealed abruptio
C. Circumvallate placenta
D. Vasa previa (Correct Answer)

Explanation: ***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.

Question 1170: Modified biophysical profile is:

A. NST + Fetal Tone
B. Fetal Tone + AFI
C. NST + AFI (Correct Answer)
D. NST + Fetal Tone + AFI

Explanation: ***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**.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free