Maternal-Fetal Medicine Practice Questions

Q: At what time frame does peripartum cardiomyopathy typically occur?

Within 5 months of delivery. ***Within 5 months of delivery*** - **Peripartum cardiomyopathy** is defined as the development of heart failure with **left ventricular systolic dysfunction** occurring during the **last month of pregnancy or within five months after delivery**. - The postpartum component extends up to **5 months (approximately 20 weeks)** after delivery, making this the most complete answer among the given options. - This timeframe is essential for differentiating **peripartum cardiomyopathy** from other forms of cardiomyopathy. *Within 6 weeks of delivery* - While this represents the traditional postpartum period and many cases do present within 6 weeks, the diagnostic definition of **peripartum cardiomyopathy** extends further to **5 months postpartum**. - This narrower timeframe would miss cases presenting between 6 weeks and 5 months, thus not encompassing the full diagnostic criteria. *Within 24 months of delivery* - This timeframe significantly exceeds the established diagnostic window for **peripartum cardiomyopathy**. - Heart failure presenting beyond 5 months postpartum would likely be classified as **dilated cardiomyopathy** or another form of cardiomyopathy with different underlying causes. *Within 7 days of delivery* - This is too narrow a window and represents only the immediate postpartum period. - While some cases can present acutely in the first week, the diagnostic definition allows for onset up to **5 months postpartum**, and limiting it to 7 days would miss the majority of cases.

Q: Earliest sign after IUFD is ?

Gas in great vessel. ***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.

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: A 28-year-old pregnant woman presents with severe hypertension and proteinuria. What is the most appropriate initial management?

Anticonvulsant and antihypertensive therapy. ***Anticonvulsant and antihypertensive therapy*** - The patient presents with **severe preeclampsia** (hypertension and proteinuria in pregnancy), which carries a risk of seizures (**eclampsia**). - **Magnesium sulfate** is the first-line anticonvulsant for the prevention and treatment of eclamptic seizures, and **antihypertensive agents** (e.g., labetalol, hydralazine) are necessary to control blood pressure and prevent maternal complications. *Emergency cesarean section* - An emergency cesarean section is indicated for **fetal distress**, **maternal instability** not responsive to conservative management, or **failed induction of labor**. - Without information about fetal compromise or maternal organ dysfunction, immediate surgical delivery is not the initial step. *Induction of labor if stable* - Induction of labor is a consideration for delivery in cases of **preeclampsia at term** or when expectant management is no longer safe. - However, the immediate priority in severe preeclampsia is to stabilize the mother with **anticonvulsant and antihypertensive therapy** first. *Observation and monitoring* - **Close monitoring** is essential in preeclampsia, but simply observing without active intervention in severe cases would be irresponsible. - Severe hypertension and proteinuria require **active management** to prevent progression to eclampsia or other severe maternal and fetal complications.

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: 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: 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: With reference to fetal heart rate, a nonstress test is considered reactive when?

Two fetal heart rate accelerations are noted in 20 minutes. **Two fetal heart rate accelerations are noted in 20 minutes** - A **nonstress test (NST)** is considered reactive when there are at least two accelerations of the fetal heart rate within a 20-minute period. - An **acceleration** is defined as an increase in fetal heart rate of at least 15 beats per minute above baseline, lasting for at least 15 seconds (for gestations ≥32 weeks). - This is the **standard definition** of a reactive NST and indicates adequate fetal well-being. *One fetal heart rate acceleration is noted in 20 minutes* - While an acceleration is a positive sign, a **reactive NST** specifically requires at least two accelerations within the 20-minute timeframe. - A single acceleration within 20 minutes would render the NST **non-reactive**, requiring further evaluation or extended monitoring up to 40 minutes. *Two fetal heart rate accelerations are noted in 10 minutes* - While two accelerations occurring in 10 minutes is clinically reassuring and technically occurs within 20 minutes, the **standard definition** for reporting NST reactivity specifically states "two or more accelerations **in** 20 minutes." - The 20-minute observation period is the established timeframe for NST assessment, not 10 minutes. - This option tests knowledge of the precise standard criteria rather than clinical interpretation. *Three fetal heart rate accelerations are noted in 30 minutes* - The standard definition for a **reactive NST** requires assessment within a **20-minute window**, not 30 minutes. - While three accelerations indicate fetal well-being, this exceeds the standard observation period and does not meet the formal definition of a reactive NST within the specified timeframe. - An NST is typically extended to 40 minutes if non-reactive at 20 minutes, but the definition of reactivity remains based on the 20-minute criterion.

Question 1

At what time frame does peripartum cardiomyopathy typically occur?

Accepted Answer

Within 5 months of delivery

Answer

Within 6 weeks of delivery

Answer

Within 24 months of delivery

Answer

Within 7 days of delivery

Question 2

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 3

Earliest sign after IUFD is ?

Accepted Answer

Gas in great vessel

Answer

Hyperflexion of spine

Answer

Overlapping of skull bones

Answer

Overcrowding of ribs

Question 4

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?

Accepted Answer

Laparotomy

Answer

Medical management

Answer

IV fluids and cross match

Answer

Laparoscopy

Question 5

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 6

A 28-year-old pregnant woman presents with severe hypertension and proteinuria. What is the most appropriate initial management?

Accepted Answer

Anticonvulsant and antihypertensive therapy

Answer

Emergency cesarean section

Answer

Induction of labor if stable

Answer

Observation and monitoring

Question 7

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 8

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 9

Modified biophysical profile is:

Accepted Answer

NST + AFI

Answer

NST + Fetal Tone

Answer

Fetal Tone + AFI

Answer

NST + Fetal Tone + AFI

Question 10

With reference to fetal heart rate, a nonstress test is considered reactive when?

Accepted Answer

Two fetal heart rate accelerations are noted in 20 minutes

Answer

One fetal heart rate acceleration is noted in 20 minutes

Answer

Two fetal heart rate accelerations are noted in 10 minutes

Answer

Three fetal heart rate accelerations are noted in 30 minutes

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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