Maternal-Fetal Medicine Practice Questions

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: 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.

Q: Which is not a risk factor for gestational hypertension

Smoking. ***Smoking*** - **Smoking** paradoxically shows a *protective effect* against gestational hypertension and preeclampsia, making it the correct answer as it is NOT a risk factor for gestational hypertension. - This well-documented phenomenon may be related to smoking's vasodilatory effects and reduced production of anti-angiogenic factors. - However, smoking carries numerous other serious risks including **intrauterine growth restriction (IUGR)**, **placental abruption**, **preterm birth**, and **perinatal mortality**. *Primigravida* - **Primigravida** (first pregnancy) is a well-established risk factor for gestational hypertension and preeclampsia. - First-time exposure to paternal antigens and incomplete immune tolerance may contribute to this increased risk. - The risk decreases in subsequent pregnancies with the same partner. *Factor V Leiden mutation* - The **Factor V Leiden mutation** is the most common inherited thrombophilia and significantly increases the risk of gestational hypertension and preeclampsia. - This mutation causes resistance to activated protein C, leading to a hypercoagulable state that can impair placental perfusion. - Associated with increased risk of venous thromboembolism during pregnancy. *Low maternal age* - **Low maternal age** (adolescent pregnancy, <20 years) is actually a recognized *risk factor* for gestational hypertension. - Young mothers may have incomplete physical and cardiovascular maturity to handle pregnancy-related physiological changes. - Adolescent pregnancies are associated with higher rates of hypertensive disorders of pregnancy.

Q: Which of the following is NOT a cause of oligohydramnios?

Chorioangioma. ***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.

Q: Most common antigen involved in erythroblastosis fetalis is:

D antigen in Rh group. ***D antigen in Rh group*** - The **D antigen** is the most immunogenic of the Rh antigens and is responsible for the vast majority of cases of **erythroblastosis fetalis** (hemolytic disease of the fetus and newborn). - When an **Rh-negative mother** is exposed to Rh-positive fetal blood (usually during previous pregnancies or transfusions), she can form antibodies against the D antigen, which can then cross the placenta in subsequent pregnancies and attack Rh-positive fetal red blood cells. *C antigen in Rh group* - While the **C antigen** is part of the Rh blood group system, antibodies to it are much less common and typically cause less severe hemolytic disease compared to anti-D antibodies. - The C antigen is less immunogenic than the D antigen, meaning it is less likely to provoke an immune response in an Rh-negative individual. *E antigen in Rh group* - Similar to the C antigen, the **E antigen** is another Rh antigen, but antibodies against it (anti-E) are also less frequently implicated in severe erythroblastosis fetalis than anti-D. - Antibodies to E can cause hemolytic disease, but their clinical significance is usually milder than that of anti-D. *Duffy antigen* - The **Duffy antigen system** is separate from the Rh system and is known for its role in resistance to certain malarial parasites (e.g., *Plasmodium vivax*). - Although antibodies to Duffy antigens (anti-Fya, anti-Fyb) can cause **hemolytic disease of the fetus/newborn**, they are a far less common cause of erythroblastosis fetalis than antibodies to the Rh D antigen.

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: What size of Hegar's dilator, when passed through the internal os, indicates cervical incompetence?

8 or more. ***8 or more*** - The passage of a **Hegar's dilator of size 8 mm or larger** through the internal os without resistance is a classic diagnostic criterion for **cervical incompetence** or insufficiency. - This finding suggests a **weakened cervix** that is unable to withstand the pressure of a growing pregnancy, leading to recurrent mid-trimester pregnancy losses or preterm births. *4* - A Hegar's dilator of size 4 mm is relatively small and can often pass through a normal, non-pregnant **cervical os** without indicating pathology. - This size would not be considered abnormal and does not signify **cervical incompetence**. *6* - While a Hegar's dilator of 6 mm is larger than 4 mm, it is still generally within the range that might pass through a normal cervix, especially in **multiparous women**, without definitively diagnosing incompetence. - The threshold for diagnosing **cervical incompetence** is typically set higher, at 8 mm or more. *10* - While the passage of a 10 mm Hegar's dilator would certainly indicate **cervical incompetence**, the diagnostic cutoff is typically considered to be **8 mm or more**. - Any dilator **equal to or greater than 8 mm** confirms the diagnosis, so 10 mm is not the *only* size indicating incompetence.

Q: In cervical incompetence, the diameter of the internal os of the cervix is typically greater than -

2.5 cm. ***2.5 cm*** * In **cervical incompetence**, the cervix prematurely dilates and effaces, often leading to second-trimester pregnancy loss or preterm birth. * A classic ultrasound finding suggestive of cervical incompetence is an internal os diameter greater than **2.5 cm** in the second trimester, in the absence of uterine contractions. *1 cm* * A normal internal os diameter is typically less than **1 cm**. A diameter of 1 cm would not be indicative of cervical incompetence without other clinical signs. * This measurement is within the **normal range** for a non-dilating cervix during pregnancy. *1.5 cm* * While 1.5 cm is larger than a typical closed os, it is generally not considered the definitive threshold for diagnosing **cervical incompetence** on its own. * The progression to a wider diameter, usually **2.5 cm or more**, is more clinically significant for diagnosis. *2 cm* * An internal os diameter of 2 cm may raise suspicion but is still often considered a **borderline finding**. * Many clinicians and guidelines use **2.5 cm as the more established cutoff** for identifying significant cervical incompetence.

Q: Which of the following is not associated with maternal age?

Post maturity. ***Post maturity*** - **Post-maturity** (post-term pregnancy, >42 weeks) does NOT have a consistent or strong association with maternal age in current obstetric literature. - While some older studies suggested associations, modern evidence shows **no significant independent effect of maternal age** on post-term pregnancy rates. - Post-term pregnancy is more related to factors like **first pregnancy**, **prior post-term delivery**, and **fetal sex** (males more common). *Preterm labour* - **Preterm birth is strongly associated with maternal age**, particularly at both extremes: - **Teenage mothers** (<20 years): Increased risk due to biological immaturity and socioeconomic factors - **Advanced maternal age** (≥35 years): Increased risk due to higher rates of maternal complications (hypertension, diabetes) and placental dysfunction - This is well-established in obstetric literature and clinical guidelines. *Aneuploidy* - The risk of **aneuploidy**, particularly **Down syndrome (Trisomy 21)**, **increases dramatically with advancing maternal age**. - At age 35: ~1/350 risk; at age 40: ~1/100 risk; at age 45: ~1/30 risk - Due to age-related decline in oocyte quality causing meiotic errors during egg formation. *Hydatidiform mole* - **Gestational trophoblastic disease** (hydatidiform mole) is strongly associated with **extremes of maternal age**: - **Women >40 years**: 5-10 fold increased risk - **Teenagers**: 1.5-2 fold increased risk - Related to abnormal fertilization events more common at age extremes.

Question 1

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 2

Funneling in cervicogram is seen in -

Accepted Answer

Weak cervical tissue leading to pregnancy complications

Answer

Cervical ectopic

Answer

During TVS

Answer

During labor

Question 3

What is the most appropriate management for a 28-year-old hemodynamically stable patient with mild abdominal pain and an unruptured tubal ectopic pregnancy measuring 2.5 x 3 cm, with β-hCG level of 8500 mIU/mL, visible fetal cardiac activity, and who desires future fertility?

Accepted Answer

Laparoscopic salpingostomy

Answer

Methotrexate therapy

Answer

Laparoscopic salpingectomy

Answer

Expectant management

Question 4

Which is not a risk factor for gestational hypertension

Accepted Answer

Smoking

Answer

Primigravida

Answer

Factor V Leiden mutation

Answer

Low maternal age

Question 5

Which of the following is NOT a cause of oligohydramnios?

Accepted Answer

Chorioangioma

Answer

Renal agenesis

Answer

Amnion nodosum

Answer

IUGR

Question 6

Most common antigen involved in erythroblastosis fetalis is:

Accepted Answer

D antigen in Rh group

Answer

C antigen in Rh group

Answer

E antigen in Rh group

Answer

Duffy antigen

Question 7

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 8

What size of Hegar's dilator, when passed through the internal os, indicates cervical incompetence?

Accepted Answer

8 or more

Answer

4

Answer

6

Answer

10

Question 9

In cervical incompetence, the diameter of the internal os of the cervix is typically greater than -

Accepted Answer

2.5 cm

Answer

1 cm

Answer

1.5 cm

Answer

2 cm

Question 10

Which of the following is not associated with maternal age?

Accepted Answer

Post maturity

Answer

Preterm labour

Answer

Aneuploidy

Answer

Hydatidiform mole

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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