Maternal-Fetal Medicine Practice Questions

Q: Most sensitive diagnostic test for ectopic pregnancy is which one?

Transvaginal USG. ***Transvaginal USG*** - **Transvaginal ultrasonography (TVS)** is considered the most sensitive diagnostic test because it can directly visualize the presence or absence of an intrauterine pregnancy and detect an ectopic gestational sac or mass. - It allows for early detection of an ectopic pregnancy, often even before symptoms become severe, by identifying findings like an **adnexal mass**, **free fluid in the cul-de-sac**, or an **empty uterus** in the presence of positive hCG. *Serial monitoring of beta HCG* - While serial monitoring of **beta-hCG** levels is a crucial component in the diagnosis of ectopic pregnancy, particularly for early pregnancy of unknown location (PUL), it is not the most sensitive single diagnostic test. - It helps in discerning between a normal intrauterine pregnancy, an ectopic pregnancy, or a miscarriage based on the **rate of hCG rise**, but it does not directly localize the pregnancy. *Culdocentesis* - **Culdocentesis** involves aspirating fluid from the pouch of Douglas to detect non-clotting blood, which suggests a ruptured ectopic pregnancy. - It is an invasive procedure and has significantly decreased in use due to the availability of highly sensitive imaging techniques like TVS; it primarily identifies rupture rather than diagnosing the intact ectopic pregnancy itself. *MRI* - **Magnetic Resonance Imaging (MRI)** can be used to diagnose ectopic pregnancy, especially in complex or unusual locations, but it is typically reserved for cases where ultrasound is inconclusive or technically difficult. - It is **more expensive** and less readily available than TVS, and its sensitivity for routine ectopic pregnancy diagnosis does not surpass that of a high-quality TVS.

Q: On USG finding of cystic hygroma in a fetus is suggestive of:

Turner's syndrome. ***Turner's syndrome*** - **Cystic hygroma** is a significant fetal ultrasound marker most classically associated with **Turner's syndrome (45,X)**, due to lymphatic system abnormalities (failure of lymphatic channels to connect with the jugular vein). - Other findings in Turner's syndrome may include fetal hydrops, renal anomalies, and coarctation of the aorta. *Down's syndrome* - While **nuchal translucency** can be increased in Down's syndrome, a frank **cystic hygroma** is less specific and less commonly seen than in Turner's syndrome. - Other markers for Down's syndrome include **duodenal atresia**, **heart defects**, and **shortened long bones**. *Marfan's syndrome* - This is a **connective tissue disorder** not typically associated with cystic hygroma in utero. - Fetal manifestations are rare but can include significant **cardiac defects** like aortic root dilation. *Klinefelter's syndrome* - **Klinefelter's syndrome (47,XXY)** generally has subtle or no prenatal ultrasound findings. - **Cystic hygroma** is not a characteristic feature of this condition.

Q: All of the following are associated with breech presentation at normal full-term pregnancy, except:

Placenta accreta. ***Placenta accreta*** - **Placenta accreta** is a condition where the placenta abnormally adheres to the uterine wall, which is typically associated with previous uterine surgery (e.g., C-sections) and **placenta previa**, not breech presentation. - While both can increase risks in pregnancy, there is no direct causal link or strong association between **placenta accreta** and **breech presentation** in a full-term pregnancy. *Fetal malformation* - **Fetal malformations**, particularly those affecting neural tube development, neuromuscular control, or fetal head/neck flexibility, can lead to a reduced ability of the fetus to turn into a cephalic presentation. - Conditions like **hydrocephalus** or **anencephaly** can hinder the spontaneous version to a head-down position. *Uterine anomaly* - **Uterine anomalies** such as a **septate uterus**, **bicornuate uterus**, or **fibroids** can alter the shape of the uterine cavity, restricting fetal movement and preventing the fetus from assuming a cephalic presentation. - These structural abnormalities can physically limit the space available for the fetus to turn. *Cornual implantation of placenta* - **Cornual implantation** or **fundal implantation** of the placenta can reduce the available space in the lower uterine segment, making it difficult for the fetus to turn and maintain a cephalic presentation. - The placenta's position can exert pressure or create an unfavorable environment that encourages the fetus to remain in a breech position.

Q: Earliest detectable congenital malformation by ultrasound (USG) is

Anencephaly. ***Anencephaly*** - **Anencephaly** is a severe neural tube defect resulting in the absence of a major portion of the brain, skull, and scalp, which can be reliably visualized as early as **11-12 weeks of gestation** due to the absent cranial vault. - The lack of a normal fetal head pole and the presence of the **"frog-eye" appearance** on ultrasound are characteristic early findings. - It is considered the **earliest consistently detectable major congenital malformation** by ultrasound due to its obvious and unmistakable appearance. *Spina bifida* - **Spina bifida** (an open neural tube defect) is typically detectable later than anencephaly, often around **18-22 weeks of gestation**, as it involves a vertebral arch defect. - While it is a significant congenital malformation, its ultrasound signs, such as the **"lemon sign"** and **"banana sign"**, tend to become apparent as the fetal brain and spinal cord structures further develop. *Meningocoele* - A **meningocoele** is a less severe form of spina bifida where only the meninges protrude through an opening in the spine. - This malformation is generally detected in the **second trimester** (around 18-22 weeks) during detailed anomaly scans, as the sac might be small and difficult to visualize earlier. *Cystic hygroma* - A **cystic hygroma** is a lymphatic malformation, typically a multiloculated cystic mass, most commonly found in the neck region. - While it can be detected early in the **first trimester** (10-14 weeks) during nuchal translucency screening, it is not classified as a major structural malformation in the same category as neural tube defects. - **Anencephaly** is considered the earliest detectable **major congenital malformation** because it is more consistently and reliably visualized as an obvious structural defect compared to cystic hygroma, which may vary in size and detectability.

Q: Risk of recurrence of hydatidiform mole in future pregnancy is:

1-4%. ***1-4%*** - The risk of a **recurrent hydatidiform mole** in a subsequent pregnancy is generally cited to be between **1-2%**, with some sources extending it up to 4%. - This risk is significantly higher than that of the general population for a first mole (0.1%), but still relatively low. *8-10%* - This percentage represents a **significantly higher recurrence risk** than what is typically observed for hydatidiform moles. - Such a high risk would be more concerning for **persistent trophoblastic disease** or choriocarcinoma development after an initial mole, rather than for recurrence in a future pregnancy. *4-8%* - While higher than the typical 1-2%, a 4-8% recurrence risk is still considered **elevated** compared to the established data. - This range might be considered if there are **additional risk factors** or a history of multiple previous molar pregnancies, which are not specified in the question. *10-12%* - A 10-12% risk for recurrence of hydatidiform mole is **exceptionally high** and not consistent with current understanding. - Such a high figure would suggest almost certain recurrence, which is not the case for most patients.

Q: What is the rate of uterine blood flow at term?

350-400 ml/min. ***350-400 ml/min*** - At term, the **uterine blood flow** significantly increases to meet the metabolic demands of the growing fetus and placenta. - This flow rate ensures adequate **oxygen and nutrient delivery** and waste removal for the uteroplacental unit. *50-75 ml/min* - This rate is characteristic of a **non-gravid uterus**, which has significantly lower metabolic needs. - It does not reflect the dramatic increase in blood supply required to sustain a full-term pregnancy. *150-200 ml/min* - This rate represents an increase from the non-gravid state but is still **insufficient for a term pregnancy**. - Uterine blood flow typically continues to rise progressively throughout gestation. *>600 ml/min* - While uterine blood flow is very high at term, exceeding 600 ml/min is generally an **overestimation of the average rate**. - The typical range for a normal term pregnancy is closer to 350-400 ml/min.

Q: Anencephaly can be diagnosed by ultrasound (USG) at

14-18 weeks of gestation. ***14-18 weeks of gestation*** - **Anencephaly**, characterized by the absence of a major portion of the brain and skull, can be reliably diagnosed by **ultrasound (USG)** during this gestational period. - At this stage, the fetal head structures are sufficiently developed to clearly visualize the **absence of the cranium and cerebral hemispheres**. *10-12 weeks of gestation* - While some gross anomalies might be suspected, the developing fetal skull and brain are often **too small** for a definitive diagnosis of anencephaly. - The **ossification of the calvaria** (skull bones) is still incomplete, making it difficult to confidently identify its absence. *20-24 weeks of gestation* - Anencephaly would be clearly detectable by this stage, but it is **later than the optimal window** for early diagnosis and intervention, if desired. - Many screening programs aim for diagnosis before this period to allow for more options for parental decision-making. *24-28 weeks of gestation* - At this advanced stage, the diagnosis of anencephaly would be evident, but it represents a **significantly delayed diagnosis** given the availability of earlier screening methods. - The primary purpose of **antenatal screening** is to detect such severe congenital anomalies in the mid-trimester.

Q: HIV transmission to the newborn is most effectively prevented by which of the following methods?

Antiretroviral therapy (ART). ***Antiretroviral therapy (ART)*** - **Antiretroviral therapy (ART)** for pregnant women with HIV significantly reduces the viral load, which is the primary determinant of vertical transmission risk. - Maternal ART, especially when administered throughout pregnancy and to the newborn, has been shown to reduce the rate of mother-to-child transmission to less than 1%. *Vaginal delivery* - While vaginal delivery can be an option for women with **well-controlled HIV and low viral loads**, it is not the most effective preventive measure on its own. - **Caesarean section** might be recommended for women with high viral loads near term to further reduce the risk of transmission through exposure to maternal blood and secretions. *Zidovudine prophylaxis* - **Zidovudine (AZT) prophylaxis** was historically one of the first effective interventions to reduce vertical transmission. - However, it is now considered part of a broader **ART regimen** and not as effective as a comprehensive, multi-drug ART approach in achieving the lowest possible transmission rates. *Breast feeding* - **Breastfeeding** is a known risk factor for **postnatal HIV transmission** from mother to child. - In developed countries where safe alternatives are available, mothers with HIV are generally advised to **avoid breastfeeding** to prevent transmission.

Q: Which of the viruses listed below is not teratogenic?

Herpes simplex. ***Herpes simplex*** - HSV is **not considered a classic teratogen** and does not cause congenital malformations from intrauterine infection. - The primary risk is **neonatal HSV infection** acquired during vaginal delivery through an infected birth canal, not from transplacental transmission causing birth defects. - Neonatal HSV can cause serious disease (disseminated infection, encephalitis, skin/eye/mouth disease), but these are **postnatal infections**, not true teratogenic effects. *Rubella* - Rubella virus is a well-known **teratogen**, causing **congenital rubella syndrome (CRS)** if infection occurs early in pregnancy. - CRS can lead to severe birth defects including **cataracts**, **congenital heart defects**, and **sensorineural hearing loss** (classic triad). - Greatest risk when infection occurs in the **first trimester**. *Cytomegalovirus* - **Congenital CMV infection** is the most common congenital viral infection and a leading cause of birth defects. - Can cause **microcephaly**, **periventricular calcifications**, **sensorineural hearing loss**, **hepatosplenomegaly**, and **intellectual disability**. - Part of the **TORCH** screening panel for teratogenic infections. *Measles* - Measles (rubeola) during pregnancy can cause complications including **spontaneous abortion**, **premature delivery**, and **low birth weight**. - While less studied than rubella, measles has been associated with increased risk of pregnancy complications and adverse fetal outcomes. - Can cause maternal morbidity with increased risk of pneumonia and encephalitis during pregnancy.

Question 1

Most sensitive diagnostic test for ectopic pregnancy is which one?

Accepted Answer

Transvaginal USG

Answer

Serial monitoring of beta HCG

Answer

Culdocentesis

Answer

MRI

Question 2

On USG finding of cystic hygroma in a fetus is suggestive of:

Accepted Answer

Turner's syndrome

Answer

Down's syndrome

Answer

Marfan's syndrome

Answer

Klinefelter's syndrome

Question 3

All of the following are associated with breech presentation at normal full-term pregnancy, except:

Accepted Answer

Placenta accreta

Answer

Fetal malformation

Answer

Uterine anomaly

Answer

Cornual implantation of placenta

Question 4

Earliest detectable congenital malformation by ultrasound (USG) is

Accepted Answer

Anencephaly

Answer

Spina bifida

Answer

Meningocoele

Answer

Cystic hygroma

Question 5

Risk of recurrence of hydatidiform mole in future pregnancy is:

Accepted Answer

1-4%

Answer

8-10%

Answer

4-8%

Answer

10-12%

Question 6

What is the rate of uterine blood flow at term?

Accepted Answer

350-400 ml/min

Answer

>600 ml/min

Answer

50-75 ml/min

Answer

150-200 ml/min

Question 7

Anencephaly can be diagnosed by ultrasound (USG) at

Accepted Answer

14-18 weeks of gestation

Answer

20-24 weeks of gestation

Answer

24-28 weeks of gestation

Answer

10-12 weeks of gestation

Question 8

Anti-D prophylaxis is MOST critically indicated in which of the following situations?

Accepted Answer

Intra-uterine transfusion at 28 weeks

Answer

Amniocentesis at 16 weeks

Answer

Manual removal of placenta

Answer

MTP at 63 days

Question 9

HIV transmission to the newborn is most effectively prevented by which of the following methods?

Accepted Answer

Antiretroviral therapy (ART)

Answer

Breast feeding

Answer

Vaginal delivery

Answer

Zidovudine prophylaxis

Question 10

Which of the viruses listed below is not teratogenic?

Accepted Answer

Herpes simplex

Answer

Rubella

Answer

Cytomegalovirus

Answer

Measles

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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