Maternal-Fetal Medicine Practice Questions

Q: What is the most common presenting feature of a complete mole?

Bleeding per vaginum. ***Bleeding per vaginum (Correct)*** - **Vaginal bleeding** in the first or early second trimester is the **most common presenting symptom** of a complete hydatidiform mole, occurring in approximately 80-90% of cases - This bleeding can vary in amount and color, often described as **prune juice-like** discharge with passage of grape-like vesicles in some cases - Typically presents between **6-16 weeks of gestation** as the most frequent initial clinical sign *Vomiting (Incorrect)* - While nausea and vomiting are common in normal pregnancies, this is **not the most common presenting feature** of a complete mole - Vomiting may occur but is less specific and typically occurs after or in conjunction with vaginal bleeding - When severe, it manifests as hyperemesis gravidarum (a separate entity) *Hyperemesis gravidarum (Incorrect)* - This condition, characterized by **severe, persistent nausea and vomiting**, is more prevalent in molar pregnancies due to **excessively high hCG levels** - Occurs in approximately **25-30% of complete moles**, making it a significant but not the most common presentation - It is a **consequence** of the molar pregnancy, often presenting **after** initial bleeding, and is not the most frequent first clinical sign *Amenorrhoea (Incorrect)* - **Amenorrhoea** (absence of menstruation) is a **universal symptom** of any pregnancy, including a molar pregnancy - While it indicates conception, it does **not differentiate** a molar pregnancy from a normal pregnancy or other causes of amenorrhoea - Therefore, it is not the most specific or common **presenting feature** that would lead to diagnosis of a molar pregnancy

Q: Which condition is characterized by androgenesis (purely paternal genetic origin)?

Androgenic complete mole. ***Androgenic complete mole*** - A **complete hydatidiform mole** is characterized by the absence of maternal genetic material and a **purely paternal genetic origin** (androgenesis). - This typically results from the **fertilization of an 'empty' egg** by either two haploid sperm or one diploid sperm. *Turner's syndrome* - This condition is a **chromosomal disorder** in females where one of the two X chromosomes is missing or incomplete (45, X0). - It is not associated with androgenesis but rather with the **absence of a functionally complete X chromosome**. *Polycystic ovary syndrome (PCOS)* - PCOS is an **endocrine disorder** characterized by **hormonal imbalance** (high androgens), ovulatory dysfunction, and polycystic ovaries. - It involves maternal and paternal genetic contributions in a normal diploid set and is not related to androgenesis. *Androgenic partial mole* - A **partial hydatidiform mole** typically involves **triploidy**, where there are two sets of paternal chromosomes and one set of maternal chromosomes (e.g., 69, XXX or 69, XXY). - While it involves extra paternal genetic material, it is not purely paternal in origin, as a **maternal haploid set is also present**.

Q: What is the expected rate of turnover of amniotic fluid in a pregnant woman?

500 cc/h. ***500 cc/h*** - The **amniotic fluid** undergoes a rapid and continuous turnover, with approximately **500 cc/h** being exchanged through multiple pathways. - This dynamic process ensures the constant renewal of the fluid, maintaining its critical functions for fetal development and protection. *1L/hr* - A turnover rate of 1 liter per hour is **higher than the physiological range** for normal amniotic fluid dynamics. - Such a high rate would imply an **abnormal fluid exchange**, potentially leading to imbalances. *1500 cc/h* - This rate represents an **extremely high turnover**, significantly exceeding the typical physiological exchange. - Sustained rates this high are **not consistent with normal amniotic fluid physiology** and could indicate underlying pathology. *2L/h* - A turnover rate of 2 liters per hour is **dangerously high** and far beyond the normal capacity for amniotic fluid exchange. - Such a rapid turnover would be **detrimental to fetal well-being** and is not observed in healthy pregnancies.

Q: Red degeneration of fibroid is seen in which of the following?

Mid pregnancy. ***Mid pregnancy*** - **Red degeneration**, or **carneous degeneration**, is most common during the **second and third trimesters of pregnancy** due to increased metabolic demands of the growing fibroid outstripping its blood supply. - The rapid growth leads to **ischemia**, hemorrhage, and necrosis within the fibroid, causing acute abdominal pain. *Early pregnancy* - While fibroids can grow in early pregnancy, **red degeneration** is less common as the uterine blood supply is generally still adequate to meet the fibroid's metabolic needs. - Other forms of degeneration, like **hyaline degeneration**, are more frequently observed in non-pregnant or early pregnant states. *Puerperium* - In the puerperium, fibroids typically undergo **regression** rather than degeneration, as the hormonal stimulation (estrogen and progesterone) that promoted their growth significantly decreases. - The uterus involutes rapidly, and fibroids often shrink. *Nulliparous women* - Nulliparous women can have fibroids and experience various forms of degeneration, but **red degeneration** specifically is rare outside of pregnancy. - Degeneration in nulliparous women is more commonly **hyaline** or **cystic** degeneration.

Q: What is the recommended management for jaundice due to obstetric cholestasis in the third trimester?

Induction of labour at 38 weeks. ***Induction of labour at 38 weeks*** - **Obstetric cholestasis (Intrahepatic Cholestasis of Pregnancy)** is associated with increased risk of **stillbirth**, particularly beyond 37-38 weeks gestation. - Induction at **37-38 weeks** is recommended to balance reducing stillbirth risk while minimizing prematurity complications. - **Current practice**: Timing depends on **bile acid levels** - delivery at 37-38 weeks for bile acids >40 μmol/L, or 38-39 weeks for milder cases (19-39 μmol/L). - This option represents the standard management approach for most cases of obstetric cholestasis. *Induction of labour at 37 weeks* - Delivery at 37 weeks is also acceptable and increasingly preferred, particularly for **severe disease** (bile acids >40 μmol/L) or when there are additional risk factors. - Both 37 and 38 weeks are within the recommended window; the choice depends on **disease severity** and individual risk assessment. - This is not incorrect, but 38 weeks represents a slightly more conservative approach balancing risks. *Induction of labour at 42 weeks* - Waiting until 42 weeks significantly increases the risk of **intrauterine fetal death (IUFD)** in pregnancies complicated by obstetric cholestasis. - Prolonged exposure to **elevated bile acids** is toxic to the fetus and increases stillbirth risk, especially after 37-38 weeks. - This approach is **contraindicated** in obstetric cholestasis. *Wait for spontaneous labour* - Expectant management beyond 38 weeks is considered **unsafe** due to the unpredictable and progressive risk of **sudden intrauterine death**. - Active management with planned delivery at 37-38 weeks is the standard of care to prevent stillbirth. - Waiting for spontaneous labor exposes the fetus to unacceptable risks.

Q: The 'T' sign is associated with which condition?

Monochorionic twin pregnancy. ***Monochorionic twin pregnancy*** - The **'T' sign** on ultrasound is highly suggestive of a **monochorionic twin pregnancy**, indicating shared placenta and a thin inter-twin membrane that meets the chorion at a sharp, T-shaped angle. - This sign identifies the absence of a chorionic plate extending into the inter-twin membrane, distinguishing it from thick-membraned dichorionic pregnancies. *Dichorionic twin pregnancy* - Dichorionic pregnancies typically exhibit the **'lambda' or 'twin peak' sign**, where the chorion extends into the inter-twin membrane, creating a triangular projection, not a 'T' shape. - This sign indicates two separate placentas (or fused but distinct placentas) and two chorions, leading to a thicker inter-twin membrane. *Normal singleton pregnancy* - A normal singleton pregnancy involves only one fetus, and therefore no inter-twin membrane or associated signs like the 'T' or 'lambda' sign are present. - The concept of chorionicity and amnionicity is specific to multiple gestations, particularly twin pregnancies. *Multiple gestation* - While a monochorionic twin pregnancy is a type of multiple gestation, the term "multiple gestation" is too broad and does not specifically identify the **'T' sign**. - Multiple gestation can be either monochorionic or dichorionic, and only monochorionic pregnancies are associated with the 'T' sign.

Q: USG of 28 weeks gestation showing oligohydramnios is likely to be due to?

Renal pathway obstruction. ***Renal pathway obstruction*** - **Oligohydramnios** (low amniotic fluid) in the late second or third trimester is often caused by conditions that impair fetal urine production or outflow. - **Renal pathway obstruction** (e.g., posterior urethral valves, bilateral renal agenesis) prevents the fetus from producing or excreting sufficient urine, a primary source of amniotic fluid. *Gastrointestinal obstruction* - **Gastrointestinal obstruction** is more commonly associated with **polyhydramnios** because it impairs the fetal swallowing of amniotic fluid. - Inability to swallow leads to an *accumulation* of amniotic fluid, not a reduction. *Anencephaly* - **Anencephaly** is typically associated with **polyhydramnios** due to impaired swallowing of amniotic fluid. - The exposed brain tissue can also lead to increased fluid transudation. *Neuromuscular disorder* - **Neuromuscular disorders** can cause **polyhydramnios** if they lead to impaired fetal swallowing due to muscle weakness. - If a neuromuscular disorder affects the renal system, it could potentially cause oligohydramnios, but it is not the primary cause of oligohydramnios itself.

Q: In which part of the fallopian tube is there a high chance of rupture in a tubal pregnancy?

Isthmus. ***Isthmus*** - The **isthmus** is the narrowest and most muscular part of the fallopian tube. Due to its limited ability to stretch, an ectopic pregnancy here is highly prone to rupture **earlier** than in other segments (typically 6-8 weeks). - The **isthmic portion's** small lumen and thick muscular wall make rupture a rapid and common complication, often before significant fetal growth, giving it the **highest chance of rupture** when an ectopic pregnancy implants there. *Ampulla* - The **ampulla** is the most common site for ectopic pregnancies (approximately 70%) due to its wider lumen and being the usual site of fertilization. - However, rupture in the ampulla tends to occur **later** than in the isthmus (8-12 weeks) as it can accommodate the growing embryo for a longer period due to its greater distensibility. - While more ectopic pregnancies occur here in absolute numbers, each individual ampullary pregnancy has a **lower chance of rupture** compared to isthmic pregnancies. *Interstitial* - The **interstitial** (or cornual) part is the segment within the uterine wall, making it a rare site for ectopic pregnancies (2-4%). - Ruptures in the interstitial portion occur **latest** (12-16 weeks) but are often the most dangerous, leading to severe hemorrhage due to the surrounding vascularity of the uterus and proximity to uterine and ovarian arteries. *Fimbrial* - The **fimbrial** end is the portion closest to the ovary and is exceedingly rare for ectopic implantation. - Implantation near the fimbriae usually leads to an **"abdominal pregnancy"** if the embryo is extruded, or could result in early "tubal abortion" rather than a true rupture.

Question 1

What is the most common presenting feature of a complete mole?

Accepted Answer

Bleeding per vaginum

Answer

Vomiting

Answer

Hyperemesis gravidarum

Answer

Amenorrhoea

Question 2

What is the most common fetal complication associated with gestational diabetes?

Accepted Answer

There is a risk of macrosomia in babies born to mothers with gestational diabetes.

Answer

Only a small percentage of women with gestational diabetes develop overt diabetes.

Answer

Gestational diabetes is usually diagnosed in the second or third trimester.

Answer

Gestational diabetes can increase the risk of congenital malformations.

Question 3

Which condition is characterized by androgenesis (purely paternal genetic origin)?

Accepted Answer

Androgenic complete mole

Answer

Turner's syndrome

Answer

Polycystic ovary syndrome (PCOS)

Answer

Androgenic partial mole

Question 4

What is the expected rate of turnover of amniotic fluid in a pregnant woman?

Accepted Answer

500 cc/h

Answer

1 L/h

Answer

1500 cc/h

Answer

2L/h

Question 5

Red degeneration of fibroid is seen in which of the following?

Accepted Answer

Mid pregnancy

Answer

Early pregnancy

Answer

Nulliparous women

Answer

Puerperium

Question 6

What is the recommended management for jaundice due to obstetric cholestasis in the third trimester?

Accepted Answer

Induction of labour at 38 weeks

Answer

Induction of labour at 37 weeks

Answer

Induction of labour at 42 weeks

Answer

Wait for spontaneous labour

Question 7

The 'T' sign is associated with which condition?

Accepted Answer

Monochorionic twin pregnancy

Answer

Dichorionic twin pregnancy

Answer

Normal singleton pregnancy

Answer

Multiple gestation

Question 8

USG of 28 weeks gestation showing oligohydramnios is likely to be due to?

Accepted Answer

Renal pathway obstruction

Answer

Neuromuscular disorder

Answer

Gastrointestinal obstruction

Answer

Anencephaly

Question 9

In which part of the fallopian tube is there a high chance of rupture in a tubal pregnancy?

Accepted Answer

Isthmus

Answer

Interstitial

Answer

Fimbrial

Answer

Ampulla

Question 10

34 week primigravida punjabi khatri comes with history of consanguineous marriage, with history of repeated blood transfusion to her sibling since 8 months of age. The first diagnostic test is -

Accepted Answer

Hb electrophoresis

Answer

HPLC

Answer

Bone marrow

Answer

Blood smear

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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