Maternal-Fetal Medicine Practice Questions

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.

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: Lowest frequency of twin pregnancy is seen in:

Japan. ***Japan*** - **Japan** has one of the **lowest rates of twin pregnancies globally**, characterized by a low incidence of both **monozygotic** and **dizygotic twins**. This is attributed to genetic predisposition and potentially lower use of assisted reproductive technologies. - The population's genetic background and reproductive practices contribute to the observed lower twinning rates compared to other regions. *Nigeria* - **Nigeria** has the **highest frequency of twin pregnancies in the world**, with birth rates significantly higher than the global average, particularly in certain ethnic groups like the **Yoruba**. - This high rate is primarily due to a genetic predisposition to **dizygotic twinning**, linked to specific dietary and genetic factors. *Philippines* - The **Philippines** has a relatively **moderate to high frequency of twin pregnancies** compared to some other Asian countries, though not as high as countries in Africa. - Genetic and possibly some socio-economic factors contribute to its twinning rate, which is higher than the lowest observed rates. *India* - **India** generally exhibits a **lower to moderate frequency of twin pregnancies** compared to African nations, but often higher than some East Asian countries. - While regional variations exist, the overall rate is influenced by a mix of genetic factors and the increasing, but still relatively limited, use of **assisted reproductive technologies (ART)**.

Q: What is the most specific use of Doppler ultrasound in twin pregnancies?

Assessing twin-to-twin transfusion syndrome. ***Assessing twin-to-twin transfusion syndrome (TTTS)*** - Doppler ultrasound is crucial for diagnosing and monitoring **TTTS** by evaluating blood flow in the umbilical arteries and veins, and assessing fetal cardiac output and venous flow patterns. - It helps detect the characteristic signs of **TTTS**, such as unequal blood flow between twins and abnormal Doppler indices in the umbilical and middle cerebral arteries, guiding timely intervention. *Evaluating conjoined twins* - While ultrasound identifies **conjoined twins** and their anatomical connections, Doppler primarily assesses blood flow, not the structural fusion itself. - 2D and 3D ultrasound are more directly used for the anatomical evaluation of the degree and type of organ sharing in **conjoined twins**. *Monitoring fetal well-being in twins* - Though Doppler can contribute to **fetal well-being assessment** through blood flow analysis, its primary and most specific role in twin pregnancies is the diagnosis and management of **TTTS**. - Other parameters like **biophysical profile** and growth scans are also vital for general fetal well-being in twins. *All of the options* - This option is incorrect because while Doppler ultrasound might be part of a broader assessment in some scenarios, its most significant and specific application in twin pregnancies is for **TTTS**. - Its role in the direct evaluation of conjoined twin anatomy or general fetal well-being is secondary to specialized applications like **TTTS** diagnosis.

Q: Which type of eclampsia has the worst prognosis?

Late postpartum. ***Late postpartum*** - **Late postpartum eclampsia**, occurring more than 48 hours after delivery, often presents with a poorer prognosis due to delayed diagnosis and potential for more severe complications, such as **cerebral hemorrhage** or **status epilepticus**, as patients may no longer be under close medical supervision. - The delayed onset can lead to misinterpretation of symptoms, making treatment less timely and effective, thus contributing to higher rates of morbidity and mortality. *Antepartum* - **Antepartum eclampsia** occurs before labor and while serious, is often detected when the patient is under medical care for preeclampsia, allowing for earlier intervention and management. - Although it can lead to complications such as **placental abruption** and **fetal distress**, the mother is typically in a healthcare setting, which facilitates immediate care. *Early postpartum* - **Early postpartum eclampsia** occurs within 48 hours after delivery, and while still critical, is usually managed in the hospital setting where medical attention is readily available, allowing for prompt treatment of seizures and associated complications. - The patient remains under close observation during this period, enabling quick response to emergent conditions. *Intrapartum* - **Intrapartum eclampsia** occurs during labor and delivery, and like early postpartum eclampsia, benefits from the patient being in a hospital environment with immediate access to medical personnel and emergency interventions. - The prompt recognition and management of seizures during childbirth can help mitigate severe outcomes for both mother and baby.

Q: Which of the following is NOT a finding in a dead-born fetus?

Caput succedaneum. ***Caput succedaneum*** - **Caput succedaneum** is a swelling on the baby's scalp that is present at birth, caused by pressure during a vaginal delivery. It is a sign of a **live birth** and indicates that the birth canal compressed the baby's head, leading to localized edema. - Since it is a result of forces experienced during the process of a live delivery, its presence would indicate that the fetus was **alive at the time of delivery**, not dead-born. *Spalding's sign* - **Spalding's sign** refers to the overlapping of the fetal skull bones (sutures) visualized on ultrasound or X-ray, which occurs due to **liquefaction of the brain** after fetal death and subsequent collapse of the skull. - This sign is a reliable indicator of **intrauterine fetal demise** and often appears within a week of death. *Robe's sign* - **Robe's sign** (also known as Robert's sign) describes the presence of **gas in the fetal circulatory system** or abdominal cavity, visible on X-ray or ultrasound. - This gas is produced by **bacterial decomposition** of the fetal tissues after death, making it a definitive sign of fetal demise, usually seen several days after death. *Maceration* - **Maceration** is the softening, discoloration (reddish-brown to black), and eventual aseptic autolysis of fetal tissues, especially the skin, that occurs when a fetus dies in utero and remains there. - The degree of maceration is directly related to the **duration of fetal death**, with more severe changes indicating a longer time since death.

Q: What is the critical value of the shock index that is considered abnormal in pregnancy?

0.9-1.1. ***0.9-1.1*** - A **shock index (heart rate/systolic blood pressure) of 0.9 or greater** is considered abnormal and a critical value in pregnant patients. - This elevated threshold indicates a significant risk of **hypovolemia and hemodynamic compromise**, which might be masked by the physiological changes of pregnancy. - Values ≥0.9 suggest that compensatory mechanisms are failing and require **immediate clinical intervention**. *0.5-0.7* - This range represents a **normal shock index for non-pregnant adults**. - Due to the **physiological hypervolemia and cardiovascular adaptations** of pregnancy, vital signs can remain deceptively stable even with significant blood loss, making this range inappropriately low for identifying shock in pregnant patients. *0.3-0.5* - A shock index within this range is considered **low** and generally indicative of a well-perfused state in non-pregnant individuals. - It does not reflect the **baseline physiological changes** seen in pregnancy and would miss critical hemodynamic compromise in obstetric emergencies. *0.7-0.9* - While this range may indicate mild elevation approaching abnormal values, it falls **below the established critical threshold of 0.9** for pregnancy. - The critical cutoff is specifically set at **≥0.9** to ensure **early detection and intervention** for maternal hemodynamic compromise before decompensation occurs.

Q: At what gestational age is transabdominal color Doppler sonography optimally performed to assess fetal well-being?

18-20 weeks. ***18-20 weeks*** - This gestational age is ideal for a **detailed anatomical survey** and assessing fetal well-being using **transabdominal color Doppler sonography**. - At this stage, fetal structures are well-developed, and the **fetus is large enough** for accurate assessment of blood flow in various vessels. *11-13 weeks* - This period is primarily for **nuchal translucency** screening and early structural assessment, but fetal vessels are generally too small for optimal Doppler flow studies. - While some early Doppler studies can be done, a comprehensive assessment of fetal well-being is usually not achieved. *Done before 10 weeks* - Before 10 weeks, the embryo/fetus is **too small** for a detailed anatomical survey or meaningful Doppler assessment of most vessels. - Doppler studies at this stage are usually limited to confirming viability via **heartbeat.** *5-7 weeks* - This is a very early stage of pregnancy where the primary goal of sonography is to confirm **intrauterine pregnancy**, **fetal viability**, and estimate gestational age. - **Fetal anatomical structures** are not yet sufficiently developed for detailed assessment or Doppler studies of most circulatory components.

Q: A pregnant patient with a prosthetic valve on warfarin should be switched to heparin at

36 weeks. ***36 weeks*** - At **36 weeks of gestation**, a pregnant patient on **warfarin** (due to a prosthetic valve) should be switched to **unfractionated heparin (UFH)** or **low molecular weight heparin (LMWH)**. - This timing is crucial to mitigate the risk of fetal coagulopathy from warfarin exposure during delivery and to allow for safer management of anticoagulation during labor and delivery. *30 weeks* - Switching to heparin at 30 weeks is generally too early and unnecessarily prolongs the period of subcutaneous injections, which can be burdensome for patients. - The primary concern of fetal coagulopathy with warfarin is highest closer to term, making a switch at 36 weeks more appropriate for balancing maternal and fetal risks. *38 weeks* - Switching at 38 weeks significantly increases the risk that labor might occur while the patient is still on warfarin, exposing the fetus to the drug and increasing the risk of maternal bleeding complications during delivery. - It leaves little buffer time for the warfarin's effects to wear off before spontaneous labor might begin. *Onset of labour* - Waiting until the onset of labor to switch from warfarin to heparin is dangerous and inappropriate. - Warfarin has a long half-life, and its anticoagulant effects would still be present during labor and delivery, posing a high risk of fetal hemorrhage (especially intracranial hemorrhage) and significant maternal bleeding.

Question 1

Which of the viruses listed below is not teratogenic?

Accepted Answer

Herpes simplex

Answer

Rubella

Answer

Cytomegalovirus

Answer

Measles

Question 2

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 3

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 4

Lowest frequency of twin pregnancy is seen in:

Accepted Answer

Japan

Answer

Philippines

Answer

India

Answer

Nigeria

Question 5

What is the most specific use of Doppler ultrasound in twin pregnancies?

Accepted Answer

Assessing twin-to-twin transfusion syndrome

Answer

Evaluating conjoined twins

Answer

Monitoring fetal well-being in twins

Answer

All of the options

Question 6

Which type of eclampsia has the worst prognosis?

Accepted Answer

Late postpartum

Answer

Early postpartum

Answer

Intrapartum

Answer

Antepartum

Question 7

Which of the following is NOT a finding in a dead-born fetus?

Accepted Answer

Caput succedaneum

Answer

Spalding's sign

Answer

Robe's sign

Answer

Maceration

Question 8

What is the critical value of the shock index that is considered abnormal in pregnancy?

Accepted Answer

0.9-1.1

Answer

0.3-0.5

Answer

0.7-0.9

Answer

0.5-0.7

Question 9

At what gestational age is transabdominal color Doppler sonography optimally performed to assess fetal well-being?

Accepted Answer

18-20 weeks

Answer

Done before 10 weeks

Answer

11-13 weeks

Answer

5-7 weeks

Question 10

A pregnant patient with a prosthetic valve on warfarin should be switched to heparin at

Accepted Answer

36 weeks

Answer

Onset of labour

Answer

30 weeks

Answer

38 weeks

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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