Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs

Question 1191: According to limited observational studies, in cases where fetal movement has significantly decreased, approximately how long may elapse before fetal heart rate cessation occurs?

A. 1 hr
B. 2 hrs
C. 6 hrs
D. 12 hrs (Correct Answer)

Explanation: ***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 1192: What is the most common cancer in pregnancy?

A. Melanoma
B. Breast carcinoma (Correct Answer)
C. Gastric carcinoma
D. Thyroid carcinoma

Explanation: ***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

Question 1193: Spiegelberg criteria is used for?

A. Ovarian pregnancy (Correct Answer)
B. Ovarian malignancy
C. Cervical pregnancy
D. Cervical malignancy

Explanation: ***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.

Question 1194: All of the following are causes of oligohydramnios except:

A. Postmaturity
B. Maternal dehydration
C. IUGR
D. Labetalol (Correct Answer)

Explanation: ***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 1195: Which of the following statements is false regarding the management of intrauterine fetal death?

A. In 50% of cases spontaneous expulsion occurs in 2 weeks
B. Fibrinogen levels should be checked weekly (Correct Answer)
C. Delivery by medical induction is preferred if spontaneous expulsion does not occur
D. Caesarian section has limited place in management of intrauterine fetal death

Explanation: ***Fibrinogen levels should be checked weekly*** - This statement is considered **false** or **questionable** in the context of routine IUFD management. - While coagulation monitoring is important, **routine weekly fibrinogen checks** are not universally recommended for all cases of IUFD. - The risk of **consumptive coagulopathy (DIC)** becomes significant only after **3-4 weeks** of retaining a dead fetus. - Most guidelines recommend coagulation screening at diagnosis and then **periodic monitoring** if conservative management extends beyond 2-3 weeks, rather than mandatory weekly checks from the outset. - The frequency depends on clinical circumstances, gestational age, and institutional protocols. *In 50% of cases spontaneous expulsion occurs in 2 weeks* - This statement is **true**. Approximately **50-80%** of women will spontaneously go into labor within **2-3 weeks** after IUFD. - Most women prefer to await spontaneous labor initially, but medical induction is offered if this does not occur within a reasonable timeframe. *Delivery by medical induction is preferred if spontaneous expulsion does not occur* - This statement is **true**. **Medical induction of labor** is the preferred management when spontaneous expulsion does not occur. - Common induction agents include **misoprostol**, **mifepristone + misoprostol**, or **prostaglandin E2**. - Early delivery (within 1-2 weeks) minimizes maternal psychological distress and reduces the risk of coagulopathy. *Caesarian section has limited place in management of intrauterine fetal death* - This statement is **true**. **Cesarean delivery** is generally **avoided** in IUFD management because it carries maternal surgical risks without fetal benefit. - Vaginal delivery is preferred whenever possible. - C-section is reserved only for specific **obstetric indications** such as **placenta previa**, **previous classical cesarean scar**, or other contraindications to labor that exist regardless of fetal status.

Question 1196: What is the lower end of the estimated risk of recurrence of anencephaly in subsequent pregnancies?

A. 2% (Correct Answer)
B. 4%
C. 1%
D. 3%

Explanation: ***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.

Question 1197: Vasa previa is associated with which type of placental vessel insertion?

A. Central
B. Peripheral
C. Velamentous (Correct Answer)
D. None of the options

Explanation: ***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.

Question 1198: How many days does it take for a zygote with zona pellucida to reach the uterine cavity after fertilization?

A. 2 days
B. 4 days (Correct Answer)
C. 5 days
D. 6 days

Explanation: ***4 days*** - Following fertilization in the **ampulla** of the fallopian tube, the zygote undergoes cleavage divisions as it travels towards the uterus. - The **zona pellucida** remains intact during this journey, and the embryo (typically at the **morula** or early blastocyst stage) enters the uterine cavity around **Day 3-4** post-fertilization. - **Day 4** is the most commonly cited timeframe for entry into the uterine cavity with zona pellucida intact. *2 days* - At 2 days post-fertilization, the embryo is usually in the **2- to 4-cell stage** and is still located within the fallopian tube. - It has not yet completed its journey through the fallopian tube to reach the uterine cavity. *5 days* - By Day 5, the embryo has typically developed into a **blastocyst** and has already been in the uterine cavity for approximately 1-2 days. - This represents a later stage of development after the embryo has already reached the uterine cavity, not the initial arrival time. *6 days* - On Day 6, the blastocyst is typically **hatching out of the zona pellucida** and beginning implantation into the endometrium. - The zona pellucida is no longer intact at this stage, and the embryo has already been in the uterine cavity for approximately 2 days.

Question 1199: Estimation of fetal hemoglobin is done by?

A. Kleihauer-Betke Acid Elution Test (KB Test) (Correct Answer)
B. Apt test
C. Flow cytometry
D. Spectrophotometry

Explanation: ***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.

Question 1200: Which of the following statements is incorrect regarding complete hydatidiform mole?

A. Diffuse trophoblastic hyperplasia
B. Triploid (Correct Answer)
C. Absence of fetal parts
D. Beta HCG > 50,000

Explanation: ***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.

Practice by Chapter

Fetal Assessment Techniques

Practice Questions

Hypertensive Disorders in Pregnancy

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Intrauterine Growth Restriction

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Multiple Gestation

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Rh Isoimmunization and Other Blood Group Incompatibilities

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Intrauterine Fetal Therapy

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Prenatal Diagnosis and Genetic Counseling

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Placental Abnormalities

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Preterm Labor and Delivery

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Management of Medical Disorders in Pregnancy

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