Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs

Question 1231: A 28-year-old primigravida with 32 weeks of gestation presents with profuse vaginal discharge since yesterday. She was advised USG, which showed a single live intrauterine gestational sac with FL and AC corresponding to the weeks of gestation and AFI as adequate. What is the diagnosis?

A. Candidiasis
B. Trichomoniasis
C. Normal vaginal discharge (Correct Answer)
D. Preterm Premature Rupture of Membranes (PPROM)

Explanation: ***Normal vaginal discharge*** - Profuse vaginal discharge is a common and **physiological occurrence** in pregnancy due to increased estrogen levels and blood flow to the vagina. - The ultrasound findings of **adequate amniotic fluid index (AFI)** rule out rupture of membranes, and no other symptoms of infection are reported. *Preterm Premature Rupture of Membranes (PPROM)* - PPROM would present with a significant reduction in the **amniotic fluid index (AFI)** on ultrasound, which is noted as adequate in this case. - The discharge in PPROM is typically **amniotic fluid**, which is clear and watery, unlike mere profuse vaginal discharge. *Trichomoniasis* - This infection typically causes a **frothy, greenish-yellow discharge** with a foul odor, along with vulvar itching and irritation. - These characteristic symptoms are not mentioned in the patient's presentation. *Candidiasis* - Vaginal candidiasis usually presents with a **thick, white, cottage cheese-like discharge** accompanied by intense itching and burning. - The patient's description of discharge is simply "profuse," without these specific characteristics.

Question 1232: What size of Hegar's dilator, when passed through the internal os, indicates cervical incompetence?

A. 4
B. 6
C. 10
D. 8 or more (Correct Answer)

Explanation: ***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.

Question 1233: Number of stem villi at term in human placenta is?

A. 60
B. 240 (Correct Answer)
C. 120
D. 480

Explanation: ***240*** - At term, the **human placenta** contains numerous **stem villi** which branch extensively to form the villous tree. - The approximate number of **stem villi** at term is around **240**, contributing to the large surface area for maternal-fetal exchange. *60* - This number is significantly **lower** than the actual count of **stem villi** found in a mature, term placenta. - Such a low number would result in an **insufficient surface area** for effective nutrient and gas exchange. *120* - While higher than 60, this number is still **underestimated** for the quantity of **stem villi** present in a full-term human placenta. - A placenta with only 120 stem villi might not be able to adequately support a fetus at term. *480* - This number is an **overestimation** of the typical count of **stem villi** in a human placenta at term. - While villi are extensive, 480 stem villi represent a significantly higher number than usually observed.

Question 1234: What is the recommended management for a patient with complete placenta previa at 38 weeks gestation without any vaginal bleeding?

A. Elective caesarean section (Correct Answer)
B. Observation and monitoring until delivery
C. Conservative management with bed rest
D. Urgent caesarean section due to bleeding risk

Explanation: ***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 1235: Which of the following statements about abdominal pregnancy is true?

A. Primary abdominal pregnancy is a common condition.
B. Most fetuses in abdominal pregnancies survive to term.
C. Leaving the placenta behind can lead to infection. (Correct Answer)
D. Separation of the placenta is always necessary.

Explanation: ***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.

Question 1236: Which of the following conditions is ruled out in a twin pregnancy of the same age and sex?

A. Monozygotic twins
B. Superfetation (Correct Answer)
C. Superfecundation
D. None of the following

Explanation: ***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).

Question 1237: Common misdiagnosis of partial mole is

A. Choriocarcinoma
B. Complete mole
C. Ectopic pregnancy
D. Threatened abortion (Correct Answer)

Explanation: ***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.

Question 1238: A G2P1L1 female presents at 28 weeks of gestation with a 1:4 anti-D titre. What is the most appropriate management option?

A. MCA Doppler (Correct Answer)
B. Caesarean section
C. Induction of labour
D. Amniocentesis

Explanation: ***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.

Question 1239: In cervical incompetence, the diameter of the internal os of the cervix is typically greater than -

A. 1 cm
B. 1.5 cm
C. 2.5 cm (Correct Answer)
D. 2 cm

Explanation: ***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.

Question 1240: Uterine height is greater than gestational age of the patient in a case of all except -

A. Fibroid uterus
B. Wrong dates
C. Polyhydramnios
D. IUGR (Correct Answer)

Explanation: ***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.

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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