Maternal-Fetal Medicine — MCQs
On this page
What are the potential effects of amphetamine use during pregnancy?
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?
Which of the following is the MOST significant physiological change that occurs during pregnancy?
Which of the following statement is correct about acute fatty liver of pregnancy?
A baby born at 34 weeks gestation weighs 3kg. Which of the following conditions is this child most likely to develop in the immediate postnatal period?
A woman at 26 weeks of gestation presents for routine evaluation. On examination, fundal height corresponds to 24 weeks. Ultrasonography revealed decreased amniotic fluid. Which of the following conditions would have led to this presentation?
A patient with recurrent abortion is diagnosed to have antiphospholipid syndrome. What will be the treatment?
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 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?
Chromosome number of partial hydatidiform mole is-
Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs
Question 1211: What are the potential effects of amphetamine use during pregnancy?
- A. Intrauterine growth restriction (IUGR)
- B. Cardiac anomalies
- C. Cleft lip
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - Amphetamine use during pregnancy is associated with a wide range of adverse outcomes due to its **vasoconstrictive** and **teratogenic** effects. - This includes increased risks of **intrauterine growth restriction (IUGR)**, **cardiac anomalies**, and **cleft lip/palate**. *Intrauterine growth restriction (IUGR)* - Amphetamines cause **vasoconstriction**, which can reduce blood flow to the placenta and fetus, leading to **poor nutrient and oxygen delivery** and subsequent IUGR. - While IUGR is a significant risk, it is not the sole potential effect of amphetamine exposure. *Cardiac anomalies* - Amphetamines can disrupt early fetal development, specifically leading to an increased incidence of various **congenital heart defects**. - These cardiac malformations are just one component of the broader spectrum of anomalies associated with amphetamine exposure. *Cleft lip* - Maternal amphetamine use is linked to **craniofacial malformations**, including **cleft lip** and **cleft palate**, likely due to the drug's impact on neural crest cell migration and development. - This specific birth defect is among several potential structural abnormalities that can occur.
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: Which of the following is the MOST significant physiological change that occurs during pregnancy?
- A. Increase total protein
- B. Increase GFR
- C. Increase residual volume
- D. Increase cardiac output (Correct Answer)
Explanation: ***Increase cardiac output*** - **Cardiac output** significantly increases during pregnancy, starting in the first trimester and peaking in the third trimester. This is to meet the increased metabolic demands of the growing fetus, placenta, and maternal organs. - This increase is primarily due to an increase in **stroke volume** and **heart rate**, crucial for maintaining adequate uteroplacental perfusion. *Increase total protein* - While total blood volume increases during pregnancy, **plasma volume** increases disproportionately more than red blood cell mass, leading to hemodilution. - This hemodilution generally causes a *decrease* in total serum protein concentration and albumin levels, rather than an increase. *Increase residual volume* - **Residual volume** (the volume of air remaining in the lungs after maximal exhalation) actually *decreases* during pregnancy. - This decrease is due to the upward displacement of the diaphragm by the gravid uterus and an increase in inspiratory capacity, not an increase in residual volume. *Increase GFR* - **Glomerular filtration rate (GFR)** does significantly increase during pregnancy, often by 30-50% by the second trimester, in response to increased renal blood flow. - While important, the increase in GFR is a consequence of the systemic hemodynamic changes (including increased cardiac output) and is not as *overall* physiologically significant as the **fundamental increase in cardiac output** that drives many other physiological adaptations.
Question 1214: Which of the following statement is correct about acute fatty liver of pregnancy?
- A. Mostly seen in last trimester (Correct Answer)
- B. May be associated with decreased uric acid
- C. Occurs in 1 in 1000 pregnancies
- D. Not related to the gender of the fetus
Explanation: ***Mostly seen in last trimester*** - **Acute fatty liver of pregnancy (AFLP)** typically manifests in the **third trimester** (weeks 28-40) of gestation or in the immediate postpartum period. - This timing is due to the increased metabolic demands on the liver during late pregnancy, which can exacerbate underlying defects in mitochondrial fatty acid oxidation. *Occurs in 1 in 1000 pregnancies* - AFLP is a **rare** obstetric complication, occurring in approximately **1 in 7,000 to 1 in 16,000** pregnancies, not 1 in 1000. - The incidence of 1 in 1000 would make it far too common and is incorrect. *Not related to the gender of the fetus* - AFLP has been observed to have a higher incidence in pregnancies involving a **male fetus**. - This association is thought to be related to differences in fetal steroid metabolism or the demands placed on maternal liver function by the male fetus. *May be associated with decreased uric acid* - AFLP is typically associated with **elevated serum uric acid levels** (hyperuricemia), not decreased levels. - Other typical findings include elevated liver enzymes, bilirubin, and sometimes severe hypoglycemia.
Question 1215: A baby born at 34 weeks gestation weighs 3kg. Which of the following conditions is this child most likely to develop in the immediate postnatal period?
- A. APH
- B. Diabetes
- C. Anemia (Correct Answer)
- D. None of the options
Explanation: ***Anemia*** - A 3kg baby at 34 weeks is **large for gestational age (LGA)** and often associated with maternal diabetes, leading to initial **polycythemia** due to chronic intrauterine hypoxia and increased erythropoietin production. - After birth, the excess red blood cells undergo rapid **hemolysis**, resulting in **anemia** in the immediate postnatal period as a recognized complication of LGA babies. *APH* - **Antepartum hemorrhage (APH)** is a maternal obstetric complication involving bleeding before delivery, not a condition that develops in the newborn. - This is a **maternal complication** that occurs during pregnancy, not a neonatal condition that the baby would present with after birth. *Diabetes* - While **maternal diabetes** is often the cause of fetal macrosomia, the newborn does not develop diabetes itself in the immediate postnatal period. - These babies are instead at risk for **hypoglycemia**, **respiratory distress**, and **polycythemia** due to fetal hyperinsulinemia, but not diabetes as a presenting condition. *None of the options* - This is incorrect because **anemia** is indeed a valid condition that LGA babies can develop through the **polycythemia-hemolysis cycle**. - While other complications like **hypoglycemia** are more statistically common, anemia remains a recognized sequela among LGA babies in the immediate postnatal period.
Question 1216: A woman at 26 weeks of gestation presents for routine evaluation. On examination, fundal height corresponds to 24 weeks. Ultrasonography revealed decreased amniotic fluid. Which of the following conditions would have led to this presentation?
- A. Renal agenesis (Correct Answer)
- B. Tracheoesophageal fistula
- C. Cardiac abnormalities
- D. Ureteral stricture
Explanation: ***Renal agenesis*** - **Renal agenesis** directly leads to **oligohydramnios** (decreased amniotic fluid) because fetal urine is the primary contributor to amniotic fluid volume after 20 weeks of gestation. - This reduction in amniotic fluid subsequently causes a **smaller fundal height** than expected for gestational age. *Tracheoesophageal fistula* - A **tracheoesophageal fistula** is primarily associated with **polyhydramnios** (excessive amniotic fluid) due to the fetus's inability to properly swallow amniotic fluid. - It would not lead to decreased amniotic fluid or a reduced fundal height. *Cardiac abnormalities* - **Cardiac abnormalities** can cause various fetal complications but are not typically a direct cause of **oligohydramnios**. - While severe cardiac issues can indirectly impact fetal growth, they usually do not lead to a significant reduction in amniotic fluid volume. *Ureteral stricture* - A **ureteral stricture** would impair urine flow from the kidney to the bladder, causing **hydronephrosis** of the affected kidney. - While it affects the renal system, if the other kidney is functioning, it generally would not lead to widespread **oligohydramnios** or a significantly reduced fundal height.
Question 1217: 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 1218: 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 1219: 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 1220: 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.
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