Maternal-Fetal Medicine Practice Questions

Q: What is the most common cancer in pregnancy?

Breast carcinoma. ***Breast carcinoma*** - **Breast cancer** is the most frequently diagnosed cancer during pregnancy, affecting approximately 1 in 3,000 pregnant women - Its high prevalence is due to the rising maternal age and the general incidence of breast cancer in women of reproductive age - Pregnancy-associated breast cancer (PABC) often presents at more advanced stages due to delayed diagnosis *Melanoma* - While **melanoma** is a significant concern during pregnancy due to hormonal influences on tumor growth, it is not the most common cancer overall - It ranks among the top three most common malignancies but is less frequent than breast cancer *Gastric carcinoma* - **Gastric carcinoma** is rare in young women and thus has a very low incidence during pregnancy - Its presence usually indicates a more aggressive form of the disease *Thyroid carcinoma* - **Thyroid cancer** is one of the more common cancers diagnosed during pregnancy, often due to increased thyroid nodule detection, but it is less common than breast cancer - Most cases are **papillary thyroid carcinomas**, which often have a good prognosis despite pregnancy

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: 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: Following are the ultrasound parameters used in the diagnosis of intrauterine growth restriction except?

Ponderal index. ***Ponderal index*** - The **ponderal index** is a measure of proportionality (weight/length³) used to assess fetal body proportions and nutritional status, but it is calculated **after birth** using the newborn's weight and length. - It is **not an ultrasound parameter** used during prenatal diagnosis of intrauterine growth restriction (IUGR). - While it can identify asymmetric growth patterns postnatally, it has no role in prenatal IUGR assessment. *Abdominal circumference* - **Fetal abdominal circumference (AC)** is a key **biometric ultrasound parameter** that is essential in diagnosing IUGR. - It reflects fetal liver size and subcutaneous fat stores, making it the **most sensitive single parameter** for detecting IUGR. - Serial AC measurements below the 10th percentile or showing poor growth velocity are diagnostic criteria for IUGR. *Doppler velocimetry* - **Doppler velocimetry**, particularly of the **umbilical artery**, is crucial for assessing placental vascular resistance and diagnosing IUGR. - Abnormal findings include **increased pulsatility index (PI)**, **absent end-diastolic flow (AEDF)**, or **reversed end-diastolic flow (REDF)**. - These findings indicate placental insufficiency and help classify IUGR severity. *Increased diastolic velocity in middle cerebral artery* - **Increased diastolic velocity** in the middle cerebral artery (leading to **decreased PI/RI**) indicates the **brain-sparing effect** (cerebrovasodilation). - This is a fetal compensatory response to chronic hypoxemia in IUGR. - The **cerebroplacental ratio (CPR)** (umbilical artery PI / MCA PI) is a sensitive marker for adverse perinatal outcomes in IUGR.

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: 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**.

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: Spiegelberg criteria is used for?

Ovarian pregnancy. ***Ovarian pregnancy*** - **Spiegelberg criteria** are a set of diagnostic criteria specifically used to confirm a rare form of **ectopic pregnancy** localized to the ovary. - These criteria include the **fallopian tube and fimbriae being intact**, the **gestational sac being located in the ovary**, the **ovarian tissue forming part of the sac wall**, and the **sac being connected to the uterus by the utero-ovarian ligament**. *Ovarian malignancy* - Diagnosis of **ovarian malignancy** primarily relies on imaging studies (e.g., ultrasound, CT), tumor markers (e.g., CA-125), and histological examination of biopsy samples. - The Spiegelberg criteria are not relevant for distinguishing between benign and malignant ovarian tumors as they are diagnostic for a specific type of ectopic pregnancy. *Cervical pregnancy* - **Cervical pregnancy** is diagnosed by findings such as a **barrel-shaped cervix**, internal os opening into a distended cervical canal, and a gestational sac located below the level of the internal os within the cervix. - While also an ectopic pregnancy, its diagnostic criteria are distinct from those for ovarian pregnancy and do not involve the Spiegelberg criteria. *Cervical malignancy* - Diagnosis of **cervical malignancy** involves **Pap smears**, **HPV testing**, **colposcopy with directed biopsies**, and histological confirmation. - The Spiegelberg criteria have no application in the diagnosis or staging of cervical cancer.

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

What is the most common cancer in pregnancy?

Accepted Answer

Breast carcinoma

Answer

Melanoma

Answer

Gastric carcinoma

Answer

Thyroid carcinoma

Question 2

Most common cause of early abortion?

Accepted Answer

Genetic

Answer

Maternal

Answer

Immunologic

Answer

Anatomic abnormalities

Question 3

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 4

Following are the ultrasound parameters used in the diagnosis of intrauterine growth restriction except?

Accepted Answer

Ponderal index

Answer

Doppler velocimetry

Answer

Increased diastolic velocity in middle cerebral artery

Answer

Abdominal circumference

Question 5

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 6

Which of the following statements is false regarding the management of intrauterine fetal death?

Accepted Answer

Fibrinogen levels should be checked weekly

Answer

In 50% of cases spontaneous expulsion occurs in 2 weeks

Answer

Delivery by medical induction is preferred if spontaneous expulsion does not occur

Answer

Caesarian section has limited place in management of intrauterine fetal death

Question 7

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

Question 8

Couvelaire uterus is associated with which condition?

Accepted Answer

Abruptio placentae

Answer

Placenta previa

Answer

Velamentous placenta

Answer

Placenta accreta

Question 9

Spiegelberg criteria is used for?

Accepted Answer

Ovarian pregnancy

Answer

Ovarian malignancy

Answer

Cervical pregnancy

Answer

Cervical malignancy

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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