Maternal-Fetal Medicine Practice Questions

Q: Vertical transmission of HIV is highest with-

High viral RNA load. ***High viral RNA load*** - A **high maternal viral load** (HIV RNA copies per milliliter of blood) is the most significant risk factor for **mother-to-child transmission (MTCT)** of HIV. The higher the viral load, the greater the likelihood of the virus being transmitted to the infant. - This is because a higher viral load indicates more circulating virus that can cross the **placenta** during gestation, be exchanged during labor and delivery, or be transmitted through breast milk. *Elective caesarean section* - An **elective caesarean section (C-section)** is a method used to *reduce* the risk of vertical transmission of HIV, especially when the maternal viral load is high. It *does not increase* the risk. - By avoiding passage through the birth canal, C-section minimizes the infant's exposure to maternal blood and genital secretions. *Breast feeding* - **Breastfeeding** is a known route of vertical HIV transmission and significantly increases the risk compared to formula feeding in HIV-positive mothers who are not on antiretroviral therapy (ART). - However, the overall *highest risk* factor *before* deciding on infant feeding is the *maternal viral load*, which dictates the likelihood of transmission via any route (intrauterine, intrapartum, or postpartum). *Term delivery* - **Term delivery** (vaginal delivery at term) carries a higher risk of vertical HIV transmission compared to an elective C-section, especially in mothers with high viral loads. - However, the *primary determinant* of this risk, even during vaginal delivery, is the **maternal viral load**. A mother with a well-controlled, low viral load at term has a significantly reduced risk of transmission even during vaginal delivery.

Q: 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?

Ruptured membranes. ***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.

Q: The major contributor to amniotic fluid after 20 weeks of gestation is:

Fetal urine. ***Fetal urine*** - After **20 weeks of gestation**, the **fetal kidneys** are fully functional, and fetal urination becomes the primary source of amniotic fluid. - This contribution is crucial for the **volume of amniotic fluid** and plays a vital role in **fetal lung development** by allowing the fetus to "breathe" the fluid. *Ultrafiltrate of maternal plasma* - While an ultrafiltrate of maternal plasma contributes to the early amniotic fluid volume, its significance diminishes as the **fetal kidneys mature** past 20 weeks. - This source primarily provides water and dissolved solutes, but not a substantial volume. *Fluid from fetal lungs* - Fluid produced by the fetal lungs also contributes to amniotic fluid, but its volume is considerably smaller than that from **fetal urine**, especially after 20 weeks. - It mainly includes pulmonary surfactants and other specific proteins important for lung maturation. *Fetal skin* - Before **keratinization** of the fetal skin (around 20-22 weeks), the skin is permeable and allows for transepidermal fluid transport, contributing to amniotic fluid. - However, once **keratinization** is complete, the skin becomes impermeable, and its contribution to amniotic fluid becomes negligible.

Q: Which of the following antihypertensive medications is not recommended for use in preeclampsia?

Atenolol. ***Atenolol*** - **Atenolol** is a **beta-blocker** that can cause **fetal growth restriction**, **bradycardia**, and **neonatal hypoglycemia**. - Its use during pregnancy, especially in preeclampsia, is generally **contraindicated** due to these adverse fetal effects. *Methyldopa* - **Methyldopa** is a **centrally acting alpha-2 adrenergic agonist** and is considered a **first-line agent** for chronic hypertension in pregnancy and preeclampsia. - It has a **proven safety record** for both mother and fetus, with few adverse effects. *Labetalol* - **Labetalol** is an **alpha and beta-blocker** commonly used in pregnancy for both chronic hypertension and acute severe hypertension in preeclampsia. - It is considered **safe and effective** for immediate blood pressure control without significant harm to the fetus. *Hydralazine* - **Hydralazine** is a **direct arterial vasodilator** frequently used for **acute severe hypertension** in preeclampsia and eclampsia. - It provides rapid blood pressure reduction and is considered a **safe option** for managing hypertensive emergencies in pregnancy.

Q: Which of the following is not a high-risk pregnancy?

Age 25-30 years. ***Age 25-30 years*** - An age of **25-30 years** is generally considered the optimal reproductive age range, and pregnancies within this bracket are typically classified as low-risk based on age alone. - This age range carries the lowest statistical risk for both maternal and fetal complications, assuming no other co-morbidities. *Previous history of manual removal of placenta* - A previous history of manual removal of the placenta indicates a risk factor for **recurrent placental retention** or **morbidly adherent placenta** in future pregnancies, making it a high-risk factor. - This history suggests an increased likelihood of complications such as **postpartum hemorrhage** and can influence the management of subsequent deliveries. *Anemia* - **Anemia** in pregnancy, especially severe iron deficiency anemia, is considered a high-risk factor due to increased maternal and fetal morbidity. - It can lead to complications such as **preterm delivery**, **low birth weight**, and difficulties tolerating blood loss during delivery. *Diabetes mellitus* - **Diabetes mellitus**, whether pre-existing or gestational, makes a pregnancy high-risk due to potential adverse effects on both the mother and the fetus. - Risks include **preeclampsia**, **macrosomia**, **neonatal hypoglycemia**, and **congenital anomalies**.

Q: Common misdiagnosis of partial mole is

Threatened abortion. ***Threatened abortion*** - Partial moles often present with **vaginal bleeding** and a uterus size appropriate for gestational age, mimicking the symptoms of a **threatened abortion**. - **Fetal heartbeat** may be detectable in a partial mole, further complicating differentiation from a threatened abortion without detailed ultrasound or histological examination. *Choriocarcinoma* - **Choriocarcinoma** is a malignant tumor and a complication of molar pregnancy, not a common misdiagnosis of an early partial mole. - While both involve abnormal trophoblastic tissue, **choriocarcinoma** follows a molar pregnancy (or other gestations) and presents with systemic symptoms and very high hCG levels, distinct from the initial presentation of a partial mole. *Complete mole* - **Complete moles** are distinct from partial moles both genetically (46,XX or 46,XY with paternal origin only) and pathologically (no fetal tissue, generalized hydropic villi). - While both are types of molar pregnancy, they have different management and prognostic implications, and are distinct entities rather than a misdiagnosis of one for the other's initial presentation. *Ectopic pregnancy* - An **ectopic pregnancy** typically presents with pain and vaginal bleeding, along with an empty uterus on ultrasound. - While both involve abnormal pregnancy presentations, a **partial mole** usually shows some fetal tissue or identifiable placental tissue within the uterine cavity, distinguishing it from an ectopic pregnancy.

Q: Which of the following ovarian tumors is most prone to undergo torsion during pregnancy?

Dermoid cyst. ***Dermoid cyst*** - **Dermoid cysts**, or mature cystic teratomas, are the **most common ovarian tumors** to undergo torsion, especially during pregnancy due to their mobility and moderate size. - They are often **unilateral** and benign, containing various mature tissues such as hair, teeth, and sebaceous material. *Serous cystadenoma* - While common, **serous cystadenomas** are generally **less mobile** than dermoid cysts and thus have a lower propensity for torsion. - They are typically filled with **clear, watery fluid** and can grow to be quite large. *Mucinous cystadenoma* - **Mucinous cystadenomas** tend to be **larger** than dermoid cysts and are less prone to torsion due to their size and often fixed position within the pelvis. - They are filled with **thick, gelatinous mucin** and can reach massive sizes, sometimes filling the entire abdominal cavity. *Theca lutein cyst* - **Theca lutein cysts** are usually **bilateral** and occur with conditions like **gestational trophoblastic disease** or **ovarian hyperstimulation**. - While they can be large, their often bilateral nature and underlying pathological conditions make them **less likely to independently twist** as a primary event compared to a freely mobile dermoid cyst.

Q: Which of the following statements about chorionic villus sampling is false?

Is performed only in second trimester of pregnancy. ***Is performed only in second trimester of pregnancy*** - This statement is false because **chorionic villus sampling (CVS)** is typically performed earlier in pregnancy, specifically during the **first trimester**, usually between 10 and 13 weeks of gestation. - Performing CVS only in the second trimester would negate one of its main advantages: providing earlier genetic diagnostic information than **amniocentesis**. *Is used for prenatal genetic diagnosis* - **CVS** is a primary method for **prenatal genetic diagnosis**, allowing for the detection of chromosomal abnormalities and genetic disorders. - It involves analyzing fetal cells obtained from the **chorionic villi**. *Villi are collected from chorion frondosum* - The sample for **CVS** is indeed collected from the **chorion frondosum**, which is the fetal part of the placenta containing numerous chorionic villi. - These villi are genetically identical to the fetus, making them suitable for **genetic analysis**. *Can cause limb deformities* - There is a recognized, albeit small, risk of **limb reduction defects** associated with CVS, particularly if performed very early in gestation (before 9-10 weeks). - This risk is part of the counseling provided to prospective parents considering the procedure.

Question 1

Vertical transmission of HIV is highest with-

Accepted Answer

High viral RNA load

Answer

Elective caesarean section

Answer

Breast feeding

Answer

Term delivery

Question 2

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?

Accepted Answer

Ruptured membranes

Answer

Advanced maternal age

Answer

Fetal fibronectin positive

Answer

Prolapse of membranes into the vagina

Question 3

What maternal condition is commonly associated with congenital heart defects in the fetus?

Accepted Answer

Pregestational Diabetes Mellitus (DM)

Answer

Gestational Diabetes Mellitus (GDM)

Answer

Maternal use of Valproate

Answer

Maternal use of ACE inhibitors

Question 4

The major contributor to amniotic fluid after 20 weeks of gestation is:

Accepted Answer

Fetal urine

Answer

Fetal skin

Answer

Ultrafiltrate of maternal plasma

Answer

Fluid from fetal lungs

Question 5

Which of the following antihypertensive medications is not recommended for use in preeclampsia?

Accepted Answer

Atenolol

Answer

Labetalol

Answer

Hydralazine

Answer

Methyldopa

Question 6

Which of the following is not a high-risk pregnancy?

Accepted Answer

Age 25-30 years

Answer

Diabetes mellitus

Answer

Previous history of manual removal of placenta

Answer

Anemia

Question 7

What is the best initial management option for ovarian ectopic pregnancy?

Accepted Answer

Surgical management (laparoscopy if stable, laparotomy if unstable)

Answer

Expectant management with serial monitoring

Answer

Emergency laparotomy in all cases

Answer

Medical management with methotrexate

Question 8

Common misdiagnosis of partial mole is

Accepted Answer

Threatened abortion

Answer

Choriocarcinoma

Answer

Complete mole

Answer

Ectopic pregnancy

Question 9

Which of the following ovarian tumors is most prone to undergo torsion during pregnancy?

Accepted Answer

Dermoid cyst

Answer

Serous cystadenoma

Answer

Mucinous cystadenoma

Answer

Theca lutein cyst

Question 10

Which of the following statements about chorionic villus sampling is false?

Accepted Answer

Is performed only in second trimester of pregnancy

Answer

Can cause limb deformities

Answer

Is used for prenatal genetic diagnosis

Answer

Villi are collected from chorion frondosum

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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