Maternal-Fetal Medicine Practice Questions

Q: 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?

Perform cesarean section. ***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.

Q: 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?

Over the internal cervical os. ***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.

Q: A female patient collapses soon after delivery. There is profuse bleeding and features of disseminated intravascular coagulation. Which of the following is the most likely etiology?

Amniotic fluid embolism. ***Amniotic fluid embolism as a complication of pregnancy*** - **Amniotic fluid embolism** is a rare but catastrophic complication where amniotic fluid enters the maternal circulation, leading to sudden **cardiovascular collapse**, **respiratory distress**, and **disseminated intravascular coagulation (DIC)**. - The rapid onset of symptoms after delivery, along with profuse bleeding and features of DIC, is highly characteristic of this condition. *Uterine atony* - **Uterine atony** is the most common cause of **postpartum hemorrhage**, typically leading to profuse bleeding due to the uterus's inability to contract. - While it causes significant bleeding, it does not typically cause the triad of sudden cardiovascular collapse, respiratory distress, and DIC seen in amniotic fluid embolism. *Peripartum cardiomyopathy as a cause of collapse* - **Peripartum cardiomyopathy** can lead to heart failure and cardiovascular collapse, but it typically develops **gradually** in the peripartum period. - It does not directly cause profuse bleeding or DIC; rather, its complications might include thromboembolic events, which are distinct from the primary events described. *Rupture of the uterus during delivery* - **Uterine rupture** causes significant hemorrhage and can lead to maternal collapse. - However, it primarily results in **external or internal bleeding** from the rupture site and does not typically trigger the widespread systemic inflammatory response and DIC as rapidly or profoundly as an amniotic fluid embolism.

Q: Chromosome number of partial hydatidiform mole is-

69 chromosomes. ***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.

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: What is the most common type of conjoint twin?

Thoracopagus. ***Thoracopagus*** - This type of conjoint twin, fused at the **thorax** and often sharing a heart and liver, is the **most common** variety, accounting for approximately **40%** of all cases. - The shared organs and complex anatomy often pose significant challenges for separation and survival. *Omphalopagus* - These twins are joined at the **abdomen** and typically share a liver, gastrointestinal tract, or other abdominal organs. - This is the second most common type, representing approximately **30-35%** of conjoint twins. *Craniopagus* - This rare form involves fusion at the **head**, often sharing parts of the skull, dura mater, or even brain tissue. - Due to the intricate neurological connections, craniopagus twins present exceptionally complex medical and ethical challenges, accounting for only **2-6%** of cases. *Rachipagus* - These twins are fused dorsally along the **spine** and typically share portions of the vertebral column and spinal cord. - This is an extremely rare type of conjoint twinning, representing less than **2%** of cases.

Q: Which of the following statements about abdominal pregnancy is true?

Leaving the placenta behind can lead to infection.. ***f6629bc8-61b2-4393-bb4c-9c32cd943e34*** - **Placenta acreta-like implantation** of the placenta into intra-abdominal organs or the abdominal wall makes removal dangerous due to potential damage and massive hemorrhage. - While leaving it in place can lead to serious complications like **infection**, **abscess formation**, or **secondary hemorrhage** as it degenerates, the risks of immediate removal often outweigh these, necessitating careful observation and management. *020c0067-d7b2-4fc2-85ae-2d6ba40ab437* - **Primary abdominal pregnancy** is extremely rare, accounting for less than 1% of all extrauterine pregnancies. - Abdominal pregnancies are generally **secondary** due to tubal abortion or rupture with subsequent reimplantation. *3560b92d-a63d-4966-8872-e4f56a82882f* - **Fetal survival rates** in abdominal pregnancies are very low, with a high incidence of **fetal anomalies** and **perinatal mortality**. - The abnormal placental implantation and lack of amniotic fluid protection lead to significant **growth restriction** and compression deformities. *5ab987e0-68ca-43f2-a8f2-238a5eb0c4f8* - The decision to remove the **placenta** in an abdominal pregnancy is complex and depends on its implantation site; often, it is left in situ due to the high risk of **hemorrhage** from attempting removal. - Removing the placenta can cause **uncontrollable bleeding**, especially if it is attached to vital organs or large blood vessels.

Q: What is the recommended management for a patient with complete placenta previa at 38 weeks gestation without any vaginal bleeding?

Elective caesarean section. ***Elective caesarean section*** - For women with **complete placenta previa** at term (38 weeks), an **elective caesarean section** is the recommended mode of delivery to avoid significant hemorrhage. - Even in the absence of bleeding, the risk of massive hemorrhage during labor with a complete previa is high, necessitating planned surgical delivery. *Observation and monitoring until delivery* - This approach is not safe for complete placenta previa at term due to the high risk of **unpredictable, severe hemorrhage** once labor begins or the cervix dilates. - Active monitoring without planned intervention carries significant maternal and fetal risk. *Conservative management with bed rest* - While bed rest may be used in cases of **placenta previa with bleeding** earlier in gestation to prolong pregnancy, it does not address the fundamental risk of hemorrhage from a complete previa at 38 weeks. - It would not prevent the need for an eventual caesarean section and prolongs potential risks. *Urgent caesarean section due to bleeding risk* - While there is a bleeding risk, this scenario describes a patient at 38 weeks gestation **without any vaginal bleeding**, making it an elective, rather than urgent, situation. - An **urgent caesarean section** is typically reserved for cases where active bleeding or other obstetric emergencies are present.

Q: Funneling in cervicogram is seen in -

Weak cervical tissue leading to pregnancy complications. ***Weak cervical tissue leading to pregnancy complications*** - **Funneling** in a cervicogram (or during transvaginal ultrasound) indicates the shortening and dilation of the internal cervical os, forming a funnel shape. - This finding is a key indicator of **cervical insufficiency** or **weak cervical tissue**, which significantly increases the risk of preterm birth and other pregnancy complications due to the inability of the cervix to retain the pregnancy. *During labor* - While the cervix dilates and effaces during labor, the term "funneling" specifically refers to the premature opening of the internal os seen *before* active labor, often indicative of **cervical insufficiency**. - During active labor, the entire cervix generally dilates progressively, rather than forming a distinct funnel shape. *Cervical ectopic* - A **cervical ectopic pregnancy** involves the implantation of a fertilized egg within the cervical canal. - While it affects the cervix, the defining characteristic is the presence of an implanted gestational sac, not specifically cervical funneling. *During TVS* - **Transvaginal ultrasound (TVS)** is the primary method used to assess cervical length and detect funneling. - Funneling itself is a sign of cervical changes, observed *via* TVS, rather than TVS *causing* or *being* the funneling.

Question 1

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?

Accepted Answer

Perform cesarean section

Answer

Plan induction of labor at 40 weeks

Answer

Induce labor immediately and deliver if necessary

Answer

Induce labor only if preeclampsia worsens

Question 2

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?

Accepted Answer

Over the internal cervical os

Answer

In the fallopian tube

Answer

On the ovary

Answer

In the abdominal cavity

Question 3

A female patient collapses soon after delivery. There is profuse bleeding and features of    disseminated intravascular coagulation. Which of the following is the most likely etiology?

Accepted Answer

Amniotic fluid embolism

Answer

Uterine atony

Answer

Peripartum cardiomyopathy

Answer

Rupture of the uterus during delivery

Question 4

Chromosome number of partial hydatidiform mole is-

Accepted Answer

69 chromosomes

Answer

46 XX

Answer

45 XO

Answer

47 chromosomes (XXY)

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 most common type of conjoint twin?

Accepted Answer

Thoracopagus

Answer

Omphalopagus

Answer

Craniopagus

Answer

Rachipagus

Question 8

Which of the following statements about abdominal pregnancy is true?

Accepted Answer

Leaving the placenta behind can lead to infection.

Answer

Primary abdominal pregnancy is a common condition.

Answer

Most fetuses in abdominal pregnancies survive to term.

Answer

Separation of the placenta is always necessary.

Question 9

What is the recommended management for a patient with complete placenta previa at 38 weeks gestation without any vaginal bleeding?

Accepted Answer

Elective caesarean section

Answer

Observation and monitoring until delivery

Answer

Conservative management with bed rest

Answer

Urgent caesarean section due to bleeding risk

Question 10

Funneling in cervicogram is seen in -

Accepted Answer

Weak cervical tissue leading to pregnancy complications

Answer

Cervical ectopic

Answer

During TVS

Answer

During labor

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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