Maternal-Fetal Medicine Practice Questions

Q: Most common cause of early abortion?

Genetic. ***Correct: Genetic*** - **Chromosomal abnormalities**, such as aneuploidy, are the most frequent cause of **spontaneous abortions**, especially early in pregnancy (accounting for **50-60% of first-trimester losses**). - These genetic errors often lead to **non-viable embryos**, resulting in early pregnancy loss. - Most common abnormalities include **trisomies** (especially trisomy 16), **monosomy X**, and **triploidy**. *Incorrect: Maternal* - While maternal factors like **diabetes** or **thyroid dysfunction** can contribute to abortion, they are less common causes of early abortion compared to genetic issues. - Systemic maternal health problems usually account for a smaller percentage of all miscarriages. *Incorrect: Immunologic* - **Autoimmune disorders** like **antiphospholipid syndrome** can cause recurrent pregnancy loss, but they are not the primary cause of the majority of early, sporadic abortions. - These are typically considered in cases of **recurrent miscarriages**, not usually the first or early spontaneous abortion. *Incorrect: Anatomic abnormalities* - **Uterine anomalies** (e.g., septate uterus) or **cervical incompetence** can lead to recurrent pregnancy loss, particularly in the later first or second trimester. - However, they are less frequently the cause of very early, isolated miscarriages compared to genetic factors.

Q: Couvelaire uterus is associated with which condition?

Abruptio placentae. ***Abruptio placentae*** - **Couvelaire uterus**, also known as uteroplacental apoplexy, is a complication of severe **abruptio placentae** where blood infiltrates the myometrium, giving the uterus a bruised, purplish appearance. - This condition occurs when the **retroplacental hemorrhage** is extensive enough to dissect into the uterine muscle fibers. *Placenta previa* - **Placenta previa** is characterized by the placenta covering the cervical os, leading to painless vaginal bleeding, and is not associated with myometrial hemorrhage or a Couvelaire uterus. - The bleeding in placenta previa is typically from the placental villi or exposed maternal vessels in the lower uterine segment, not internal uterine dissection. *Placenta accreta* - **Placenta accreta** involves abnormal adherence of the placenta to the uterine wall (into the myometrium), which causes difficulty with placental separation after birth and significant hemorrhage, but not the myometrial infiltration seen in Couvelaire uterus. - The primary issue is the **abnormal invasion** of placental villi into the uterine wall, not bleeding dissecting within the myometrium. *Velamentous placenta* - A **velamentous placenta** is a condition where the umbilical cord inserts into the fetal membranes then courses to the placenta, leaving fetal vessels exposed, which can rupture during labor causing fetal hemorrhage. - It does not involve abnormalities of the uterine wall or extensive myometrial bleeding found in a Couvelaire uterus.

Q: Which of the following statements is incorrect regarding complete hydatidiform mole?

Triploid. ***Triploid*** - A complete hydatidiform mole is typically **diploid** (with all chromosomes derived from the father), not triploid [1]. - Triploidy is associated with **partial moles**, where there is fetal tissue present, which is not the case in a complete mole [1]. *Beta HCG > 50,000* - It is common in complete hydatidiform moles to have **elevated beta HCG levels**, often greater than 50,000 [1]. - High levels of beta HCG are indicative of abnormal placental development, characteristic of a complete mole [1]. *Absence of fetal parts* - Complete hydatidiform moles typically show **no development of fetal tissue**, aligning with the absence of fetal parts [1]. - This is a defining feature that differentiates complete moles from partial moles, which may have some fetal development [1]. *Diffuse trophoblastic hyperplasia* - **Diffuse trophoblastic hyperplasia** is associated with complete moles, characterized by abnormal proliferation of trophoblasts [1]. - This hyperplasia leads to the distinctive hydropic changes seen in the placental tissue in a complete mole [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1042-1046.

Q: Monozygotic twin with one healthy baby born at term and one dead mummified fetus is suggestive of?

Fetus papyraceous. ***Fetus papyraceous*** - This term describes a **mummified fetus** that has been flattened and compressed due to the growth of a co-twin, often observed in **monochorionic twin pregnancies** where one twin dies in utero. - The presence of one healthy, term baby and one dead, mummified fetus is the classic presentation of **fetus papyraceous**. *Fetus acardiacus* - This is a rare anomaly where one twin, typically in a **monochorionic-monoamniotic pregnancy**, lacks a functional heart and other upper body structures, relying on the healthy twin's circulation. - An acardiac twin would present as an underdeveloped, often malformed structure, not a mummified, flattened fetus. *Hydatidiform mole* - A **hydatidiform mole** is an abnormal pregnancy characterized by the growth of many cysts (grape-like vesicles) within the uterus, resulting from an issue with fertilization, often leading to a non-viable pregnancy. - It does not involve the presence of a healthy twin alongside a dead mummified one. *Vanishing twin* - **Vanishing twin syndrome** occurs when one of two or more embryos or fetuses in a multiple pregnancy dies and is completely reabsorbed by the mother or the surviving twin. - While it involves the death of a twin, the reabsorption typically means there's no mummified fetus remaining by the time of birth; if a remnant is found, it's typically much smaller and not described as "papyraceous."

Q: Main factor responsible for increased perinatal mortality in twin pregnancy is?

Prematurity. ***Prematurity*** - **Premature birth** is the leading cause of perinatal mortality in twin pregnancies, as twins are significantly more likely to be born before term compared to singletons. - Complications associated with prematurity, such as **respiratory distress syndrome**, **intraventricular hemorrhage**, and **necrotizing enterocolitis**, are major contributors to infant death. *Intrauterine growth restriction (IUGR)* - While IUGR is common in twin pregnancies and can increase perinatal morbidity and mortality, it is a **secondary complication** often associated with prematurity or underlying placental issues rather than the primary cause of mortality itself. - IUGR might lead to other complications, but **prematurity** has a more direct and widespread impact on survival. *Excess amniotic fluid (Polyhydramnios)* - **Polyhydramnios** can occur in twin pregnancies, especially in twin-to-twin transfusion syndrome, and may predispose to preterm labor and delivery. - However, it is a **risk factor for prematurity** rather than the direct primary cause of mortality. *Rupture of the uterus* - **Uterine rupture** is a rare but catastrophic event, typically associated with prior uterine surgery or grand multiparity, and **less commonly linked to twin pregnancy alone**. - While extremely serious, its infrequency makes it a far less common cause of overall perinatal mortality in twin pregnancies than prematurity.

Q: Estimation of fetal hemoglobin is done by?

Kleihauer-Betke Acid Elution Test (KB Test). ***Kleihauer-Betke Acid Elution Test (KB Test)*** - The **Kleihauer-Betke test** is a widely used laboratory method to quantify the amount of **fetal hemoglobin** in a maternal blood sample. - This test is crucial in situations involving **fetomaternal hemorrhage** for calculating the dose of Rh immunoglobulin. *Apt test* - The Apt test is used to determine if blood in a **neonate's stool or vomitus** is of fetal or maternal origin. - It differentiates between **fetal hemoglobin (HbF)**, which is resistant to alkaline denaturation, and adult hemoglobin (HbA), which is not. *Flow cytometry* - **Flow cytometry** is a powerful technique used for sorting and counting cells, detecting **biomarkers**, and analyzing cell characteristics. - While it can be adapted to detect cells containing fetal hemoglobin (e.g., in research settings), it is not the primary or standard method for estimating the **total amount of fetal hemoglobin** in a sample for clinical purposes. *Spectrophotometry* - **Spectrophotometry** measures the absorption or transmission of light through a sample at different wavelengths. - It is used in many biochemical assays but is not the specific or sensitive method for **quantifying fetal hemoglobin** due to the similar absorption spectra of different hemoglobin types.

Q: Vasa previa is associated with which type of placental vessel insertion?

Velamentous. ***Velamentous*** - **Vasa previa** occurs when **fetal blood vessels** from a **velamentous cord insertion** cross the internal cervical os, unprotected by placental tissue or Wharton's jelly. - In a **velamentous insertion**, the umbilical cord inserts into the **chorioamniotic membranes** distant from the placental margin, with the vessels then coursing through the membranes to the placenta. *Central* - A **central placental vessel insertion** is the normal and healthy insertion point, typically near the center of the placenta. - This type of insertion is **not associated** with vasa previa, as the vessels are well-protected within the umbilical cord. *Peripheral* - A **peripheral placental vessel insertion** refers to the cord inserting at the margin of the placenta. - While considered marginal, it is **not directly associated** with vasa previa, which specifically involves vessels traversing unprotected membranes over the cervical os. *None of the options* - This option is incorrect because **velamentous cord insertion** is a direct and well-documented cause of vasa previa. - There is a specific and known association between velamentous insertion and vasa previa.

Q: What is the lower end of the estimated risk of recurrence of anencephaly in subsequent pregnancies?

2%. ***2%*** - The estimated risk of recurrence for anencephaly in subsequent pregnancies ranges from 2% to 5%. - This 2% represents the **lower end** of the typical recurrence risk for anencephaly, a severe **neural tube defect (NTD)**. *1%* - A 1% recurrence risk is generally considered too low for a previous NTD such as anencephaly. - While it's lower than the recurrence risk for the general population (0.1%), it's still below the consensus range for a subsequent pregnancy. *4%* - A 4% recurrence risk falls within the accepted range (2-5%) and represents a **higher end** estimate. - This value would be plausible for the recurrence risk, but the question specifically asks for the *lower end*. *3%* - A 3% recurrence risk falls within the accepted range (2-5%) but is not the **lower end** of that range. - While a clinically relevant risk, it is not the minimum value requested in the question.

Q: All of the following are causes of oligohydramnios except:

Labetalol. ***Labetalol*** - **Labetalol** is a beta-blocker commonly used to treat **hypertension in pregnancy** and is generally considered safe. - It does not cause oligohydramnios; in fact, there is some evidence that it may slightly increase **amniotic fluid volume** by improving placental perfusion. *IUGR* - **Intrauterine growth restriction (IUGR)** leads to shunting of blood flow away from the kidneys to vital organs, reducing **fetal urine production**, a major contributor to amniotic fluid. - Reduced fetal urine output directly results in decreased **amniotic fluid volume**, causing oligohydramnios. *Postmaturity* - In **post-term pregnancies** (gestation beyond 40 weeks), there is a physiological decline in **amniotic fluid volume** due to aging placenta and reduced fetal urine output. - This natural reduction in fluid production often leads to **oligohydramnios** in postmature fetuses. *Maternal dehydration* - **Maternal dehydration** can reduce **maternal blood volume** and placental perfusion, consequently affecting **fetal fluid balance** and urine production. - This reduced fluid availability can diminish the amount of **amniotic fluid**, contributing to oligohydramnios.

Question 1

Most common cause of early abortion?

Accepted Answer

Genetic

Answer

Maternal

Answer

Immunologic

Answer

Anatomic abnormalities

Question 2

Couvelaire uterus is associated with which condition?

Accepted Answer

Abruptio placentae

Answer

Placenta previa

Answer

Velamentous placenta

Answer

Placenta accreta

Question 3

Which of the following statements is incorrect regarding complete hydatidiform mole?

Accepted Answer

Triploid

Answer

Diffuse trophoblastic hyperplasia

Answer

Absence of fetal parts

Answer

Beta HCG > 50,000

Question 4

What is the recommended management for a fetus diagnosed with severe anemia in Liley's Zone 3 at 35 weeks of gestation?

Accepted Answer

Preterm delivery of the fetus

Answer

Intrauterine blood transfusion

Answer

Observation and follow-up

Answer

Cord blood sampling

Question 5

Monozygotic twin with one healthy baby born at term and one dead mummified fetus is suggestive of?

Accepted Answer

Fetus papyraceous

Answer

Fetus acardiacus

Answer

Hydatidiform mole

Answer

Vanishing twin

Question 6

Main factor responsible for increased perinatal mortality in twin pregnancy is?

Accepted Answer

Prematurity

Answer

Intrauterine growth restriction (IUGR)

Answer

Excess amniotic fluid (Polyhydramnios)

Answer

Rupture of the uterus

Question 7

Estimation of fetal hemoglobin is done by?

Accepted Answer

Kleihauer-Betke Acid Elution Test (KB Test)

Answer

Apt test

Answer

Flow cytometry

Answer

Spectrophotometry

Question 8

Vasa previa is associated with which type of placental vessel insertion?

Accepted Answer

Velamentous

Answer

Central

Answer

Peripheral

Answer

None of the options

Question 9

What is the lower end of the estimated risk of recurrence of anencephaly in subsequent pregnancies?

Accepted Answer

2%

Answer

4%

Answer

1%

Answer

3%

Question 10

All of the following are causes of oligohydramnios except:

Accepted Answer

Labetalol

Answer

Postmaturity

Answer

Maternal dehydration

Answer

IUGR

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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