Maternal-Fetal Medicine Practice Questions

Q: What is the definitive treatment for preeclampsia?

Delivery of the baby. ***Delivery of the baby*** - **Preeclampsia** is a multisystem disorder of pregnancy; its pathogenesis is directly linked to the **placenta**. - **Removal of the placenta** through delivery is the only definitive cure for preeclampsia, leading to the resolution of symptoms. *Use of antihypertensive medications* - Antihypertensive medications are used to **manage blood pressure** in preeclampsia, preventing complications like stroke. - They **do not address the underlying cause** of the disease and are not a curative treatment. *Dietary modifications* - While a healthy diet is important during pregnancy, **dietary modifications** alone cannot resolve the pathological processes of preeclampsia. - There is **no specific diet** proven to cure or prevent preeclampsia. *Increased rest and monitoring* - **Increased rest and close monitoring** are supportive measures that can help manage symptoms and detect complications. - These interventions **do not reverse the disease process** and are not a definitive treatment.

Q: Which of the following statements about cholestasis of pregnancy is false?

Most common cause of jaundice in pregnancy. ***Most common cause of jaundice in pregnancy*** - This statement is **FALSE** - while **intrahepatic cholestasis of pregnancy (ICP)** is the most common **pregnancy-specific** cause of jaundice, it is NOT the most common cause of jaundice overall in pregnancy. - **Viral hepatitis** (especially hepatitis A, B, and E) remains the **most common cause of jaundice in pregnancy** worldwide, accounting for approximately 40-50% of cases. - ICP accounts for about 20-25% of jaundice cases in pregnancy, making it the leading obstetric-specific cause but not the overall leading cause. *Bilirubin level >2mg%* - In ICP, **bilirubin levels** are typically **normal or only mildly elevated** (usually 10 μmol/L), not bilirubin. *Oestrogen is involved* - **TRUE** - Elevated **estrogen and progesterone levels** during pregnancy play a key role in ICP pathophysiology. - These hormones affect **hepatic bile salt transporters** (particularly BSEP and MDR3), leading to impaired bile secretion in genetically susceptible individuals. *Manifestations usually appear in last trimester* - **TRUE** - ICP typically presents in the **third trimester** (usually after 28 weeks), with **pruritus** as the predominant symptom. - Symptoms resolve within days to weeks after delivery, correlating with declining hormone levels.

Q: Which condition is associated with exclusively fetal blood loss?

Vasa previa. ***Vasa previa*** - Vasa previa occurs when **fetal blood vessels** from the umbilical cord traverse the membranes over the cervical os, underneath the fetal presenting part. - Rupture of these unprotected vessels, which can happen during labor or membrane rupture, leads to **exclusively fetal blood loss**, posing a high risk of fetal exsanguination and death. *Placenta praevia* - This condition involves the **placenta implanting low** in the uterus, potentially covering the internal cervical os. - Bleeding in placenta previa is typically **maternal** in origin, resulting from the detachment of the placenta from the uterine wall as the cervix dilates. *Polyhydramnios* - Polyhydramnios is characterized by an **excessive amount of amniotic fluid**. - It is not directly associated with antepartum or intrapartum bleeding, but rather with conditions that affect fetal swallowing or urination, such as **fetal gastrointestinal anomalies** or maternal diabetes. *Oligohydramnios* - Oligohydramnios refers to an **insufficient amount of amniotic fluid**. - While it can be associated with various fetal and maternal complications, such as **renal agenesis** or premature rupture of membranes, it does not typically cause blood loss.

Q: What is the best method to diagnose an unruptured ectopic pregnancy?

USG. ***Correct Answer: USG*** - **Transvaginal ultrasound (TVS)** is the most common and effective method for diagnosing an unruptured ectopic pregnancy. It allows for visualization of a gestational sac outside the uterus or an adnexal mass. - In conjunction with **serum beta-hCG levels**, TVS helps to differentiate between an intrauterine pregnancy and an ectopic pregnancy, especially when hCG levels are above the discriminatory zone (typically 1500-2000 mIU/mL). - TVS has high sensitivity and specificity for detecting ectopic pregnancy and is **non-invasive**. *Incorrect: Endoscopy* - **Endoscopy** (such as laparoscopy) is a surgical procedure, primarily used for direct visualization and treatment of ectopic pregnancies, not for initial diagnosis. - It is *too invasive* for routine diagnostic purposes in an unruptured ectopic pregnancy. *Incorrect: UPT* - A **urine pregnancy test (UPT)** confirms pregnancy but *cannot determine the location* of the pregnancy. - A positive UPT only indicates the presence of **hCG**, which is elevated in both intrauterine and ectopic pregnancies. *Incorrect: Culdocentesis* - **Culdocentesis** involves aspirating fluid from the cul-de-sac and is used to detect the presence of *free blood* in the peritoneal cavity, indicating a **ruptured** ectopic pregnancy. - It is not useful for diagnosing an **unruptured ectopic pregnancy** and is largely replaced by ultrasound in modern practice.

Q: Which drug is known to cause placental abruption?

Cocaine. **Cocaine** - **Cocaine** use during pregnancy is strongly associated with an increased risk of **placental abruption** due to its vasoconstrictive effects on uterine blood vessels. - Its potent **vasoconstrictive properties** lead to uterine ischemia and contractions, which can cause the placenta to detach prematurely from the uterine wall. *Methadone* - While methadone use during pregnancy is associated with risks such as **neonatal abstinence syndrome**, it is not a primary cause of **placental abruption**. - It is often used as a maintenance therapy for opioid-dependent pregnant women to avoid the fluctuating levels of illicit drug use, which can have more severe consequences. *Amphetamine* - Amphetamine use can lead to adverse pregnancy outcomes like **preterm birth** and **low birth weight** due to its stimulant effects. - Although it causes vasoconstriction, its association with **placental abruption** is less direct and less pronounced compared to cocaine. *Fluoxetine* - Fluoxetine, an **SSRI antidepressant**, generally has a relatively safe profile in pregnancy, although some studies suggest a small increased risk of persistent **pulmonary hypertension** in neonates. - It is not known to be a cause of **placental abruption**.

Q: What is the most common site for ectopic pregnancies?

Ampulla. ***Ampulla*** - The **ampulla** of the fallopian tube is the most common site for ectopic pregnancies, accounting for about **70-80% of all cases**. - Its **wider lumen** and **tortuous path** can delay the ovum's transit, increasing the likelihood of implantation there. *Isthmus* - The **isthmus** is the second most common site for ectopic pregnancies, accounting for about **12% of cases**. - Pregnancies in this narrow, muscular part of the tube are more prone to **early rupture** due to limited distensibility. *Fimbriae* - **Fimbrial** ectopic pregnancies are rare, accounting for approximately **5% of cases**. - These occur when the fertilized egg implants on the **finger-like projections** at the end of the fallopian tube. *Interstitial/Cornual* - **Interstitial** or **cornual** pregnancies are uncommon but serious, making up about **2-4% of ectopic pregnancies**. - They occur in the portion of the fallopian tube that passes through the **muscular wall of the uterus** and carry a higher risk of hemorrhage due to rich vascularity.

Q: Cardiac output increases maximum at which week?

30-32 wks. ***30-32 wks*** - **Cardiac output** in healthy pregnant women typically reaches its maximum increase of **30-50%** above pre-pregnancy levels between **28 and 32 weeks** of gestation. - This peak output is sustained until term, primarily driven by a significant increase in **stroke volume** and a moderate increase in **heart rate**. *26-28 wks* - While cardiac output steadily rises throughout pregnancy, the **peak increase** is generally not observed as early as **26-28 weeks**. - At this stage, the increase is substantial but is still progressing towards its **maximum point**. *32-34 wks* - The maximal cardiac output is usually achieved **before** this period, typically by **32 weeks**. - From **32 weeks** onwards, cardiac output tends to **plateau**, not increase further. *34-36 wks* - By **34-36 weeks**, cardiac output has generally already reached its peak and **stabilized**. - There is typically no further increase in cardiac output during this timeframe; rather, it is maintained at its maximal level.

Q: What is the most common cause of hydrops fetalis in current medical practice?

Cardiac malformations. ***Cardiac malformations*** - **Cardiovascular abnormalities** are the **most common cause** of **non-immune hydrops fetalis** in current medical practice, accounting for **20-40%** of cases - Includes **structural heart defects** (septal defects, valvular abnormalities) and **arrhythmias** (supraventricular tachycardia, complete heart block) - These conditions lead to **heart failure** and **increased hydrostatic pressure**, causing fluid accumulation in fetal tissues and body cavities - With the near-elimination of Rh disease through immunoprophylaxis, cardiac causes have emerged as the leading etiology *Chromosomal abnormalities* - Account for **10-20%** of non-immune hydrops cases - **Turner syndrome (45,X)** is the most common chromosomal cause, associated with **cystic hygroma** and **lymphatic dysgenesis** - Other chromosomal conditions include **trisomy 21, 18, and 13**, which can cause hydrops through associated cardiac defects or other mechanisms - While significant, chromosomal causes are less common than cardiovascular causes overall *Fetal infections (e.g., parvovirus B19)* - Infections account for **5-10%** of non-immune hydrops cases - **Parvovirus B19** is the most common infectious cause, leading to severe **fetal anemia** through bone marrow suppression - Other infectious agents include **CMV**, **toxoplasmosis**, and **syphilis** - The TORCH screening helps identify treatable infectious causes *Rh incompatibility (historically significant)* - Historically the **leading cause** before the 1970s, accounting for most hydrops cases - Now accounts for **<10%** of cases due to routine **Rho(D) immune globulin (RhoGAM)** administration at 28 weeks and postpartum - Causes **immune hydrops** through maternal antibodies crossing the placenta and destroying fetal red blood cells, leading to severe anemia and heart failure - Still important in under-immunized populations or cases of missed prophylaxis

Q: Which of the following is the MOST CRITICAL indication for Acyclovir use during pregnancy?

Treatment of disseminated herpes. ***Treatment of disseminated herpes*** - **Disseminated herpes** in pregnancy is a severe, life-threatening condition for both the mother and the fetus, making acyclovir use critically indicated. - This systemic infection can lead to **visceral organ involvement**, **encephalitis**, and significantly increased maternal and fetal morbidity and mortality. - Immediate treatment with intravenous acyclovir is essential to prevent **multi-organ failure** and death. *Treatment of chickenpox in the first trimester* - While chickenpox in the first trimester can be serious, leading to **congenital varicella syndrome**, acyclovir's role here is primarily to mitigate maternal illness, not as critical as disseminated herpes. - The risk of congenital varicella syndrome for the fetus is relatively low (around 0.4%) after maternal infection in the first trimester. *Prophylaxis for recurrent herpes during pregnancy* - **Prophylactic acyclovir** in the third trimester is commonly used to prevent recurrent genital herpes and reduce the risk of **neonatal herpes**, but it is not as acutely critical as treating disseminated disease. - This intervention aims to prevent transmission during delivery rather than managing an immediate, life-threatening maternal or fetal condition. *Prevention of cytomegalovirus infection in pregnancy* - Acyclovir has **minimal activity against CMV** and is not indicated for CMV prevention or treatment. - **Ganciclovir** or **valganciclovir** are the antivirals used for CMV, not acyclovir.

Q: A hypertensive pregnant woman at 34 weeks presents with a history of abdominal pain, bleeding per vaginum, and loss of fetal movements. On examination, the uterus is contracted with increased uterine tone, and fetal heart sounds are absent. Which of the following is the most likely diagnosis?

Abruptio placenta. ***Abruptio placenta*** - The classic presentation of **abruptio placenta** includes **abdominal pain**, **vaginal bleeding**, **increased uterine tone**, and **loss of fetal movements** in a patient with **hypertension**. - **Hypertension** is a significant risk factor for abruptio placenta, and the absence of fetal heart sounds suggests **fetal demise**, which can occur due to severe abruption. *Polyhydramnios* - Characterized by an **excessive accumulation of amniotic fluid**, which leads to an abnormally large uterus. - It usually presents with **uterine distension** and shortness of breath, not abdominal pain, vaginal bleeding, or increased uterine tone. *Placenta previa* - Typically presents with **painless vaginal bleeding** in the second or third trimester. - The uterus is usually **soft and non-tender**, unlike the increased uterine tone seen in abruptio placenta. *Premature labour* - Defined by **regular uterine contractions** causing cervical change before 37 weeks of gestation. - While contractions cause abdominal pain, it does not typically present with significant **vaginal bleeding** or sustained **increased uterine tone** as described.

Question 1

What is the definitive treatment for preeclampsia?

Accepted Answer

Delivery of the baby

Answer

Use of antihypertensive medications

Answer

Dietary modifications

Answer

Increased rest and monitoring

Question 2

Which of the following statements about cholestasis of pregnancy is false?

Accepted Answer

Most common cause of jaundice in pregnancy

Answer

Bilirubin level >2mg%

Answer

Oestrogen is involved

Answer

Manifestations usually appear in last trimester

Question 3

Which condition is associated with exclusively fetal blood loss?

Accepted Answer

Vasa previa

Answer

Placenta praevia

Answer

Polyhydramnios

Answer

Oligohydramnios

Question 4

What is the best method to diagnose an unruptured ectopic pregnancy?

Accepted Answer

USG

Answer

Endoscopy

Answer

UPT

Answer

Culdocentesis

Question 5

Which drug is known to cause placental abruption?

Accepted Answer

Cocaine

Answer

Amphetamine

Answer

Fluoxetine

Answer

Methadone

Question 6

What is the most common site for ectopic pregnancies?

Accepted Answer

Ampulla

Answer

Isthmus

Answer

Fimbriae

Answer

Interstitial/Cornual

Question 7

Cardiac output increases maximum at which week?

Accepted Answer

30-32 wks

Answer

26-28 wks

Answer

34-36 wks

Answer

32-34 wks

Question 8

What is the most common cause of hydrops fetalis in current medical practice?

Accepted Answer

Cardiac malformations

Answer

Fetal infections (e.g., parvovirus B19)

Answer

Chromosomal abnormalities

Answer

Rh incompatibility (historically significant)

Question 9

Which of the following is the MOST CRITICAL indication for Acyclovir use during pregnancy?

Accepted Answer

Treatment of disseminated herpes

Answer

Treatment of chickenpox in the first trimester

Answer

Prophylaxis for recurrent herpes during pregnancy

Answer

Prevention of cytomegalovirus infection in pregnancy

Question 10

A hypertensive pregnant woman at 34 weeks presents with a history of abdominal pain, bleeding per vaginum, and loss of fetal movements. On examination, the uterus is contracted with increased uterine tone, and fetal heart sounds are absent. Which of the following is the most likely diagnosis?

Accepted Answer

Abruptio placenta

Answer

Polyhydramnios

Answer

Premature labour

Answer

Placenta previa

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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