Maternal-Fetal Medicine — MCQs
On this page
A patient with juvenile myoclonic epilepsy on valproate comes to you at 5 months of pregnancy with a normal level II scan. What will you advise?
A woman presents to you at 36 weeks of gestation with complaints of breathlessness and excessive abdominal distension. Fetal movements are normal. On examination, fetal parts are not easily felt and fetal heartbeat is heard but it is muffled. Her symphysis fundal height is 41 cm. Her abdomen is tense but not tender. What is the most likely diagnosis?
A 22-year-old primigravida visits ANC OPD with 20 weeks POG. On examination uterine height reveals a 16-week size. USG shows reduced liquor. What will be the diagnosis?
A patient with recurrent abortion is diagnosed to have antiphospholipid syndrome. What will be the treatment?
In a case of DCDA twins at 38 weeks, with the first twin in breech presentation, and the mother having a blood pressure of 140/96 and 1+ proteinuria, what is the preferred management?
Chromosome number of partial hydatidiform mole is-
What maternal condition is commonly associated with congenital heart defects in the fetus?
A 40 year old G2P1 woman with 18 weeks of amenorrhea comes with a dilated cervix. The cervical length is 15 mm. In spite of explaining the risks, she insisted on cerclage. Which of the following is a contraindication for cervical cerclage?
An intrauterine scan at the 13th week of pregnancy showed a fetus with multiple long bone fractures. What is commonly associated with this finding?
A primigravida at 22 weeks of gestation presents with profuse vaginal bleeding. Her blood pressure and glucose levels are normal. At which of the following sites can placental implantation lead to this condition?
Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs
Question 1211: A patient with juvenile myoclonic epilepsy on valproate comes to you at 5 months of pregnancy with a normal level II scan. What will you advise?
- A. Increase the dose of the drug
- B. Change the drug
- C. Decrease the dose of the drug
- D. Continue the drug in the same dose (Correct Answer)
Explanation: ***Continue the drug in the same dose*** - As the patient is already at **5 months of pregnancy** with a **normal level II scan**, the risk of major congenital malformations has largely passed. - **Maintaining seizure control** is crucial during pregnancy, as uncontrolled seizures pose significant risks to both the mother and fetus. *Change the drug* - Changing an antiepileptic drug during pregnancy, especially in the second trimester, can lead to a **loss of seizure control** and potentially expose the fetus to a new drug with unknown risks. - The period of highest risk for **major congenital malformations** from valproate exposure is during the first trimester. *Decrease the dose of the drug* - Decreasing the dose of valproate could lead to **breakthrough seizures**, which are dangerous for both the mother and the fetus. - **Plasma drug levels** often decrease in pregnancy due to increased volume of distribution and metabolism, potentially requiring a stable or even increased dose to maintain therapeutic levels. *Increase the dose of the drug* - Increasing the dose without clear clinical indication (e.g., breakthrough seizures or subtherapeutic levels) could increase the risk of **dose-dependent side effects** for both mother and fetus. - While therapeutic drug monitoring for valproate is often done in pregnancy, a **normal level II scan** does not automatically warrant a dose increase.
Question 1212: A woman presents to you at 36 weeks of gestation with complaints of breathlessness and excessive abdominal distension. Fetal movements are normal. On examination, fetal parts are not easily felt and fetal heartbeat is heard but it is muffled. Her symphysis fundal height is 41 cm. Her abdomen is tense but not tender. What is the most likely diagnosis?
- A. Abruptio placenta
- B. Hydrocephalus of fetus
- C. Polyhydramnios (Correct Answer)
- D. Oligohydramnios
Explanation: ***Polyhydramnios*** - The patient's symptoms of **breathlessness**, **excessive abdominal distension**, a **symphysis fundal height of 41 cm at 36 weeks** (indicating a significantly larger than expected uterus), and **muffled fetal heart tones** are classic signs of polyhydramnios. - **Difficulty feeling fetal parts** is also consistent with excess amniotic fluid, which cushions the fetus and makes palpation harder. *Abruptio placenta* - This condition typically presents with sudden onset of **painful vaginal bleeding**, uterine tenderness, and fetal distress, none of which are described here. - While the abdomen might be tense due to uterine contractions or concealed bleeding, the lack of pain and bleeding makes this diagnosis unlikely. *Hydrocephalus of fetus* - Fetal hydrocephalus would primarily manifest as an **abnormally large fetal head** upon ultrasound, potentially leading to a higher fundal height. - However, it wouldn't directly explain the generalized excessive abdominal distension or the difficulty in feeling fetal parts due to fluid, though it could be a cause of polyhydramnios itself, it is not the most likely primary diagnosis from the given options directly addressing the symptoms. *Oligohydramnios* - This condition is characterized by **too little amniotic fluid**, which would result in a **smaller than expected symphysis fundal height** and an easily palpable fetus. - The patient's symptoms, particularly the excessive distension and high fundal height, directly contradict the features of oligohydramnios.
Question 1213: A 22-year-old primigravida visits ANC OPD with 20 weeks POG. On examination uterine height reveals a 16-week size. USG shows reduced liquor. What will be the diagnosis?
- A. Bilateral renal agenesis (Correct Answer)
- B. Bartter’s syndrome
- C. Liddle syndrome
- D. Fetal anemia
Explanation: ***Renal agenesis*** - **Bilateral renal agenesis** leads to **oligohydramnios** because the fetal kidneys are the primary producers of amniotic fluid after 16 weeks of gestation. - The reduced amniotic fluid (liquor) is consistent with the decreased uterine size (16-week size at 20 weeks POG) and is a hallmark of this condition, often resulting in **Potter sequence**. *Bartter’s syndrome* - This is a rare, inherited renal tubulopathy characterized by significant electrolyte disturbances (hypokalemia, metabolic alkalosis, hypercalciuria) due to impaired ion transport. - While it affects kidney function, it does not typically cause severe **oligohydramnios** or **renal agenesis** and would not explain the small uterine size in this scenario. *Liddle syndrome* - This is a rare genetic disorder characterized by early-onset hypertension, hypokalemia, and metabolic alkalosis, due to constitutive activation of the epithelial sodium channel (ENaC) in the collecting ducts. - It does not involve structural kidney abnormalities or significantly impact amniotic fluid volume during pregnancy to cause the described findings. *Fetal anemia* - Fetal anemia can lead to complications such as **hydrops fetalis**, which would typically cause **polyhydramnios** or a uterine size larger than expected due to fluid accumulation, not oligohydramnios or a smaller uterine size. - Reduced liquor and a small uterine size are not characteristic presentations of fetal anemia.
Question 1214: A patient with recurrent abortion is diagnosed to have antiphospholipid syndrome. What will be the treatment?
- A. Aspirin alone
- B. Aspirin, Low molecular weight Heparin, and Prednisolone
- C. No treatment required
- D. Aspirin and Low molecular weight Heparin (Correct Answer)
Explanation: ***Aspirin and Low molecular weight Heparin*** - The combination of **low-dose aspirin (75-100 mg daily)** and **low molecular weight heparin (LMWH)** is the **standard of care** for pregnant women with antiphospholipid syndrome (APS) to prevent recurrent pregnancy loss. - **Aspirin** inhibits platelet aggregation and reduces thrombosis, while **LMWH** provides anticoagulation to prevent placental thrombosis and improve pregnancy outcomes. - This combination has been shown to **increase live birth rates** from approximately 40% (untreated) to **70-80%** in women with APS. *Aspirin alone* - While aspirin is part of the treatment regimen, **aspirin monotherapy is insufficient** for preventing recurrent pregnancy loss in patients with established APS. - Randomized controlled trials have demonstrated that adding heparin to aspirin **significantly improves live birth rates** compared to aspirin alone. *Aspirin, Low molecular weight Heparin, and Prednisolone* - **Corticosteroids (prednisolone)** are **not recommended** as routine treatment for recurrent pregnancy loss in APS patients due to potential maternal complications (gestational diabetes, hypertension, infection) and fetal risks. - Corticosteroids might be considered only in specific cases with coexisting autoimmune conditions (e.g., SLE), but they are **not first-line therapy** for APS-related pregnancy loss. *No treatment required* - **Antiphospholipid syndrome (APS)** is a significant cause of recurrent pregnancy loss due to placental thrombosis and impaired placental function. - **Untreated APS** carries a **high risk** (>70%) of pregnancy loss, along with increased risks of fetal growth restriction, preeclampsia, and preterm delivery, making treatment **essential** for a successful pregnancy outcome.
Question 1215: In a case of DCDA twins at 38 weeks, with the first twin in breech presentation, and the mother having a blood pressure of 140/96 and 1+ proteinuria, what is the preferred management?
- A. Plan induction of labor at 40 weeks
- B. Induce labor immediately and deliver if necessary
- C. Induce labor only if preeclampsia worsens
- D. Perform cesarean section (Correct Answer)
Explanation: ***Perform cesarean section*** - The combination of **DCDA twins** at **38 weeks**, the **first twin in breech presentation**, and maternal **preeclampsia** (BP 140/96, 1+ proteinuria) necessitates prompt delivery via cesarean section. - A **breech presentation** for the first twin significantly increases the risk of complications during vaginal delivery, making a **cesarean section** the safest and preferred route to prevent birth trauma, cord prolapse, and potential fetal distress. - At **38 weeks gestation** with **preeclampsia**, delivery is indicated as the definitive treatment, and cesarean section addresses both the obstetric indication (breech first twin) and maternal condition. *Plan induction of labor at 40 weeks* - This option is inappropriate due to the presence of **preeclampsia** and the **breech presentation** of the first twin, both of which indicate the need for earlier intervention. - Waiting until 40 weeks would expose the mother and fetuses to increased risks associated with prolonged preeclampsia and potential complications from breech vaginal delivery. *Induce labor immediately and deliver if necessary* - While prompt delivery is warranted due to preeclampsia at term, attempting **induction of labor** with a **breech presenting first twin** carries substantial risks for both twins. - **Vaginal delivery of a breech first twin** is generally discouraged in multiple gestations due to increased rates of fetal entrapment, cord prolapse, and other obstetrical emergencies, making cesarean section the safer choice. *Induce labor only if preeclampsia worsens* - This approach fails to address the immediate risks posed by the **breech presenting first twin** and the existing **preeclampsia** at term gestation. - Delaying intervention until the preeclampsia worsens could lead to severe maternal complications such as eclampsia, HELLP syndrome, or placental abruption, and increased fetal compromise.
Question 1216: Chromosome number of partial hydatidiform mole is-
- A. 46 XX
- B. 45 XO
- C. 69 chromosomes (Correct Answer)
- D. 47 chromosomes (XXY)
Explanation: ***69 chromosomes*** - A **partial hydatidiform mole** typically results from **dispermy** (fertilization of one ovum by two sperm), leading to a **triploid karyotype** (69 chromosomes). - This triploidy usually consists of **69, XXY** or **69, XXX**, with the paternal contribution being twice the maternal. *46 XX* - This is a normal diploid female karyotype and is the typical chromosome number for a **complete hydatidiform mole** if the maternal chromosomes are lost and the paternal chromosomes duplicate. - In a complete mole, there is **no fetal tissue**, unlike in a partial mole. *45 XO* - This karyotype, known as **Turner syndrome**, is characterized by the absence of one sex chromosome. - It does not represent a hydatidiform mole but is a chromosomal abnormality associated with developmental disorders. *47 chromosomes (XXY)* - This karyotype is characteristic of **Klinefelter syndrome**, a sex chromosome aneuploidy in males (47,XXY). - While it involves an extra sex chromosome, it is not associated with partial hydatidiform moles, which are triploid with 69 chromosomes.
Question 1217: What maternal condition is commonly associated with congenital heart defects in the fetus?
- A. Gestational Diabetes Mellitus (GDM)
- B. Pregestational Diabetes Mellitus (DM) (Correct Answer)
- C. Maternal use of Valproate
- D. Maternal use of ACE inhibitors
Explanation: ***Pregestational Diabetes Mellitus (DM)*** - **Pre-existing diabetes** in the mother is one of the **most significant** risk factors for various **congenital anomalies**, including **congenital heart defects** due to its teratogenic effects during critical periods of fetal development. - Poor glycemic control during the **first trimester** is particularly harmful, leading to increased rates of **septal defects (VSD, ASD)**, **transposition of the great arteries**, **coarctation of aorta**, and other cardiac malformations. - The risk increases with **HbA1c levels**, with poor control conferring up to a **3-5 fold increased risk** of congenital heart defects. *Gestational Diabetes Mellitus (GDM)* - While GDM can lead to fetal complications like **macrosomia** and an increased risk of childhood obesity, it is **not associated with major congenital malformations** compared to pregestational diabetes. - The onset of GDM typically occurs **after 20 weeks**, well after the primary period of **organogenesis** (weeks 3-8) when most cardiac defects are established. *Maternal use of Valproate* - **Valproate**, an antiepileptic drug, is a known teratogen associated with **multiple congenital anomalies** including **neural tube defects** (e.g., spina bifida), **facial dysmorphism**, and **congenital heart defects** (VSD, ASD, pulmonary stenosis). - However, while valproate does increase the risk of cardiac anomalies, **pregestational diabetes** is considered a **more common** and clinically significant association with congenital heart defects in routine obstetric practice. *Maternal use of ACE inhibitors* - **ACE inhibitors** are associated with issues such as **renal dysfunction**, **oligohydramnios**, **hypocalvaria**, and **fetal growth restriction** when used during the second and third trimesters. - Their primary teratogenic effects are on the **renal system** rather than cardiac development, making them less commonly associated with **congenital heart defects** compared to pregestational diabetes.
Question 1218: A 40 year old G2P1 woman with 18 weeks of amenorrhea comes with a dilated cervix. The cervical length is 15 mm. In spite of explaining the risks, she insisted on cerclage. Which of the following is a contraindication for cervical cerclage?
- A. Advanced maternal age
- B. Ruptured membranes (Correct Answer)
- C. Fetal fibronectin positive
- D. Prolapse of membranes into the vagina
Explanation: ***Ruptured membranes*** - **Ruptured membranes** are an **absolute contraindication** to cervical cerclage because the protective barrier against infection is lost. - Placing a cerclage after membrane rupture would trap bacteria within the uterus, leading to serious complications such as **chorioamnionitis** and **sepsis**. - Once membranes rupture, the focus shifts to prevention of infection and preparation for delivery rather than cervical reinforcement. *Prolapse of membranes into the vagina* - This represents a **relative contraindication** rather than an absolute one; cerclage can still be attempted in selected cases with appropriate technique. - While bulging or prolapsed membranes make the procedure more technically challenging and increase risks of membrane rupture, the membranes can sometimes be reduced back before cerclage placement. - This scenario requires careful patient counseling about increased risks, but is not an absolute contraindication if the patient insists and understands the complications. *Advanced maternal age* - **Advanced maternal age** (40 years in this case) is **not a contraindication** for cerclage at all. - The decision for cerclage is based on cervical findings and obstetric history showing cervical insufficiency, not on maternal age. - Age may be a risk factor for other pregnancy complications, but does not preclude cerclage if indicated. *Fetal fibronectin positive* - A **positive fetal fibronectin** test indicates increased risk of preterm labor but is **not a contraindication** to cerclage. - It may prompt closer monitoring or influence timing of intervention, but doesn't rule out cerclage if there's a strong indication based on cervical insufficiency. - Prophylactic or rescue cerclage can still be performed despite positive fetal fibronectin if clinically indicated.
Question 1219: An intrauterine scan at the 13th week of pregnancy showed a fetus with multiple long bone fractures. What is commonly associated with this finding?
- A. Osteogenesis imperfecta (Correct Answer)
- B. Marfan syndrome
- C. Achondroplasia
- D. Cretinism
Explanation: ***Osteogenesis imperfecta*** - **Multiple long bone fractures** detected early in pregnancy are a classic presentation of **osteogenesis imperfecta (OI)**, a genetic disorder characterized by **bone fragility**. - OI is primarily caused by mutations in genes encoding **type I collagen**, leading to defective bone formation. *Achondroplasia* - This condition is a form of **dwarfism** characterized by disproportionately short limbs and a normal-sized trunk, resulting from a mutation in the **FGFR3 gene**. - While it affects bone growth, it typically does not cause **multiple fractures** prenatally. *Marfan syndrome* - This is a connective tissue disorder affecting the skeletal, ocular, and cardiovascular systems, characterized by **tall stature**, **long limbs and fingers**, and **aortic root dilation**. - It results from a mutation in the **fibrillin-1 gene** and is not primarily associated with prenatal long bone fractures. *Cretinism* - This is a historical term for **congenital hypothyroidism**, which results from severely deficient thyroid hormone production in a newborn. - It leads to developmental delays, growth retardation, and intellectual disability, but not to **multiple bone fractures**.
Question 1220: A primigravida at 22 weeks of gestation presents with profuse vaginal bleeding. Her blood pressure and glucose levels are normal. At which of the following sites can placental implantation lead to this condition?
- A. Over the internal cervical os (Correct Answer)
- B. In the fallopian tube
- C. On the ovary
- D. In the abdominal cavity
Explanation: ***Over the internal cervical os*** - Implantation over the **internal cervical os** leads to **placenta previa**, which is a common cause of **painless, profuse vaginal bleeding** in the second and third trimesters. - The bleeding occurs as the cervix begins to efface and dilate, detaching the abnormally implanted placenta. *In the fallopian tube* - Implantation in the fallopian tube is known as an **ectopic pregnancy**, typically presenting with **abdominal pain** and bleeding in the **first trimester**, often requiring surgical intervention. - This condition is unlikely to result in profuse vaginal bleeding at 22 weeks of gestation with normal blood pressure. *On the ovary* - **Ovarian pregnancy** is a rare form of ectopic pregnancy that occurs when a fertilized egg implants on the surface of the ovary. - It usually presents with symptoms in the **first trimester**, such as abdominal pain and light spotting, not profuse hemorrhage in the second trimester. *In the abdominal cavity* - **Abdominal pregnancy** is another type of ectopic pregnancy where the fertilized egg implants in the abdominal cavity. - While it can lead to complications such as bleeding and abdominal pain, it is not typically associated with profuse vaginal bleeding as described for a 22-week gestation.
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