Maternal-Fetal Medicine Practice Questions

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: 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: 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: Uterine height is greater than gestational age of the patient in a case of all except -

IUGR. ***IUGR*** - In **Intrauterine Growth Restriction (IUGR)**, the fetus is smaller than expected for gestational age, leading to a **fundal height** that measures less than the actual gestational age. - This condition is characterized by a **restricted growth rate** of the fetus, causing the uterine size to be disproportionately small. *Fibroid uterus* - The presence of **uterine fibroids** (leiomyomas) can increase the overall size of the uterus beyond what would be expected for a given gestational age. - These benign tumors add bulk to the uterine wall, leading to a **larger-than-expected uterine height**. *Wrong dates* - Incorrect estimation of the **Last Menstrual Period (LMP)** or date of conception can lead to a miscalculation of gestational age. - If the gestational age is **underestimated**, the actual uterine height will appear greater than the calculated gestational age. *Polyhydramnios* - **Polyhydramnios** is a condition characterized by an **excessive accumulation of amniotic fluid**, which distends the uterus. - Increased amniotic fluid volume leads to a significantly **larger uterine size** and a fundal height greater than the gestational age.

Q: Which of the following conditions is ruled out in a twin pregnancy of the same age and sex?

Superfetation. ***Superfetation*** - **Superfetation** refers to the fertilization of an ovum when another pregnancy is already established in the uterus, resulting in two fetuses of **different gestational ages**. - As the question specifies a twin pregnancy of the **same age**, superfetation is ruled out. *Monozygotic twins* - **Monozygotic twins** originate from a single zygote that splits, resulting in genetically identical individuals of the **same sex** and age. - This condition is consistent with the given scenario of same-sex, same-aged twins. *Superfecundation* - **Superfecundation** is the fertilization of two or more ova from the same ovulatory cycle by sperm from **different acts of coitus** (which may involve different partners). - The twins are of the **same gestational age** (same cycle) but are **dizygotic**, and can be either the same sex or different sexes. - This condition is NOT ruled out by the criteria given in the question. *None of the following* - This option is incorrect because **superfetation** is definitively ruled out by the criteria of the question (twins of the same age).

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: A G2P1L1 female presents at 28 weeks of gestation with a 1:4 anti-D titre. What is the most appropriate management option?

MCA Doppler. ***MCA Doppler*** - The presence of anti-D antibodies in a pregnant woman indicates **Rh isoimmunization**, which can lead to **hemolytic disease of the fetus and newborn (HDFN)**. - Even though a titre of **1:4 is below the critical threshold** (usually 1:16 or 1:32), any detectable anti-D titre at 28 weeks warrants **fetal surveillance** to detect early signs of fetal anemia. - **Middle cerebral artery (MCA) Doppler** is the **non-invasive gold standard** for detecting fetal anemia by measuring peak systolic velocity (PSV), which increases in anemic fetuses due to hyperdynamic circulation. - Serial MCA Doppler monitoring allows timely intervention if fetal anemia develops, avoiding unnecessary invasive procedures. *Caesarean section* - This is a mode of delivery and would only be considered if there were severe **fetal compromise** or other obstetric indications after proper monitoring and management. - At 28 weeks gestation with a low anti-D titre, immediate delivery is **not indicated** and would result in significant prematurity risks. *Induction of labour* - Induction of labour is a delivery method that would only be planned at term or for specific indications like severe fetal compromise unresponsive to other interventions. - At **28 weeks gestation**, the focus should be on **monitoring and prolonging pregnancy** while ensuring fetal wellbeing, not on delivery. *Amniocentesis* - Historically used to assess **bilirubin levels (ΔOD450)** in amniotic fluid as an indirect measure of fetal hemolysis, but it is an **invasive procedure** with risks (miscarriage ~1%, infection, worsening sensitization). - **MCA Doppler has largely replaced amniocentesis** for initial and serial assessment of fetal anemia due to its non-invasive nature, high sensitivity, and ability to be repeated safely.

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.

Question 1

Which of the following is NOT a cause of oligohydramnios?

Accepted Answer

Chorioangioma

Answer

Renal agenesis

Answer

Amnion nodosum

Answer

IUGR

Question 2

Common misdiagnosis of partial mole is

Accepted Answer

Threatened abortion

Answer

Choriocarcinoma

Answer

Complete mole

Answer

Ectopic pregnancy

Question 3

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 4

Uterine height is greater than gestational age of the patient in a case of all except -

Accepted Answer

IUGR

Answer

Fibroid uterus

Answer

Wrong dates

Answer

Polyhydramnios

Question 5

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 6

Which of the following conditions is ruled out in a twin pregnancy of the same age and sex?

Accepted Answer

Superfetation

Answer

Monozygotic twins

Answer

Superfecundation

Answer

None of the following

Question 7

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 8

All are true about uteroplacental circulation except:

Accepted Answer

A mature placenta has 150 ml of blood in the villi system and 350 ml of blood in the intervillous space

Answer

The villi depend on the maternal blood for their nutrition

Answer

Blood in the intervillous space is completely replaced 3-4 times per minute

Answer

Intervillous blood flow at term is 500-600 ml per minute

Question 9

A G2P1L1 female presents at 28 weeks of gestation with a 1:4 anti-D titre. What is the most appropriate management option?

Accepted Answer

MCA Doppler

Answer

Caesarean section

Answer

Induction of labour

Answer

Amniocentesis

Question 10

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

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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