Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs

Question 1221: 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 1222: 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 1223: 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.

Question 1224: The major contributor to amniotic fluid after 20 weeks of gestation is:

A. Fetal urine (Correct Answer)
B. Fetal skin
C. Ultrafiltrate of maternal plasma
D. Fluid from fetal lungs

Explanation: ***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.

Question 1225: 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 1226: Which of the following is not a high-risk pregnancy?

A. Age 25-30 years (Correct Answer)
B. Diabetes mellitus
C. Previous history of manual removal of placenta
D. Anemia

Explanation: ***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**.

Question 1227: Which of the following antihypertensive medications is not recommended for use in preeclampsia?

A. Labetalol
B. Hydralazine
C. Methyldopa
D. Atenolol (Correct Answer)

Explanation: ***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.

Question 1228: Which of the following is NOT a cause of oligohydramnios?

A. Renal agenesis
B. Amnion nodosum
C. Chorioangioma (Correct Answer)
D. IUGR

Explanation: ***Chorioangioma*** - A **chorioangioma** is a benign placental tumor that causes **polyhydramnios** (excess amniotic fluid), which is the **opposite** of oligohydramnios. - Large chorioangiomas lead to increased transudation from the tumor's vascular channels, fetal anemia, and high-output cardiac failure, resulting in increased fetal urine production. - This is clearly **NOT a cause** of oligohydramnios, making it the correct answer. *IUGR* - **Intrauterine growth restriction (IUGR)**, particularly with placental insufficiency, is a common cause of **oligohydramnios**. - Reduced placental perfusion leads to decreased **fetal renal blood flow** and diminished urine production. - Since fetal urine is the main source of amniotic fluid after 16 weeks, reduced output causes oligohydramnios. *Renal agenesis* - **Bilateral renal agenesis** (Potter syndrome) is a classic and severe cause of **oligohydramnios/anhydramnios**. - Complete absence of kidneys means **no fetal urine production**, eliminating the primary source of amniotic fluid in the second and third trimesters. - Results in severe oligohydramnios with associated pulmonary hypoplasia and Potter facies. *Amnion nodosum* - **Amnion nodosum** refers to small, grayish-yellow nodules on the fetal surface of the amnion, composed of aggregated fetal squamous epithelial cells and vernix. - These nodules are a **pathological finding** that occurs as a **consequence** of chronic oligohydramnios, not a cause. - They form due to prolonged contact between the fetal skin and amnion when amniotic fluid is severely reduced. - While technically "not a cause," it is strongly **associated with** oligohydramnios, whereas chorioangioma causes the opposite condition entirely.

Question 1229: All are true about uteroplacental circulation except:

A. The villi depend on the maternal blood for their nutrition
B. Blood in the intervillous space is completely replaced 3-4 times per minute
C. A mature placenta has 150 ml of blood in the villi system and 350 ml of blood in the intervillous space (Correct Answer)
D. Intervillous blood flow at term is 500-600 ml per minute

Explanation: ***A mature placenta has 150 ml of blood in the villi system and 350 ml of blood in the intervillous space*** - This statement is incorrect because a **mature placenta** typically holds approximately **350 ml of blood** in the **villi system** and **150 ml of blood** in the **intervillous space**, which is the reverse of what is stated. - The villi system contains the fetal blood, which has a larger volume within the placental unit. *Blood in the intervillous space is completely replaced 3-4 times per minute* - This is a correct statement regarding uteroplacental circulation, as the **high turnover rate** ensures efficient **nutrient and gas exchange** between mother and fetus. - The rapid replacement prevents stagnant blood and facilitates continuous delivery of essential substances. *The villi depend on the maternal blood for their nutrition* - This statement is true because the **chorionic villi**, which are the functional units of the placenta, are bathed in **maternal blood** within the intervillous space. - The placental tissue itself receives its **nutrients and oxygen** directly from this maternal blood supply. *Intervillous blood flow at term is 500-600 ml per minute* - This is an accurate physiological fact. At term, the **maternal blood flow** through the intervillous space is indeed substantial, typically ranging from **500 to 700 ml per minute**, ensuring adequate perfusion for the growing fetus. - This significant blood flow is crucial for meeting the high metabolic demands of the fetus.

Question 1230: What is the most common type of conjoint twin?

A. Thoracopagus (Correct Answer)
B. Omphalopagus
C. Craniopagus
D. Rachipagus

Explanation: ***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.

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

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