Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs

Question 1341: When treating urinary tract infection (UTI) in the third trimester, what is the antibiotic of choice?

A. Tetracycline
B. Sulfonamide
C. Nitrofurantoin
D. Cephalosporin (Correct Answer)

Explanation: ***Cephalosporin*** - **Cephalosporins** are generally considered safe and effective for treating UTIs during all trimesters of pregnancy, including the third trimester. - They have **low teratogenic risk** and broad-spectrum activity against common UTI pathogens. *Tetracycline* - **Tetracyclines** are contraindicated in the third trimester due to the risk of permanent **discoloration of fetal teeth** and inhibition of bone growth. - They readily cross the **placenta** and accumulate in the fetal skeletal system. *Sulfonamide* - **Sulfonamides** like trimethoprim-sulfamethoxazole should be avoided in the third trimester, especially near term, due to the risk of **kernicterus** in the neonate. - Sulfonamides compete with **bilirubin** for binding sites on albumin, potentially leading to elevated unconjugated bilirubin. *Nitrofurantoin* - **Nitrofurantoin** should be avoided in the third trimester (after 36 weeks of gestation) in pregnant patients with G6PD deficiency due to the risk of **hemolytic anemia** in the neonate. - It's generally considered safe in the first and second trimesters, but caution is advised in the late third trimester.

Question 1342: Which of the following statements is true regarding twin-to-twin transfusion syndrome?

A. The donor twin is more likely to develop widespread thromboses
B. The donor twin usually suffers from anemia.
C. Gross differences may be observed between donor and recipient placentas
D. The recipient twin develops hydramnios more often than does the donor twin. (Correct Answer)

Explanation: **The recipient twin develops hydramnios more often than does the donor twin.** - In **twin-to-twin transfusion syndrome (TTTS)**, the **recipient twin** receives excess blood flow, leading to **polycythemia** and increased urine output, which causes **polyhydramnios/hydramnios** (excess amniotic fluid). - The donor twin, experiencing decreased blood volume and oliguria, typically has **oligohydramnios** (reduced amniotic fluid). - This is the **most characteristic finding** of TTTS, with the classic presentation being **polyhydramnios in one sac and oligohydramnios in the other**. *Gross differences may be observed between donor and recipient placentas* - TTTS occurs in **monochorionic pregnancies**, meaning there is a **single shared placenta** (not separate placentas) with vascular anastomoses connecting both twins. - While there may be size disparities in the umbilical cords or membrane thickness, there are **not separate donor and recipient placentas** to compare. *The donor twin usually suffers from anemia.* - The **donor twin** does lose blood chronically to the recipient twin and can develop **anemia, hypovolemia, and growth restriction**. - However, this statement is **less consistently true** than the polyhydramnios/oligohydramnios pattern, as the severity of anemia varies. - The donor twin's primary features are **oligohydramnios, growth restriction, and stuck twin phenomenon**. *The donor twin is more likely to develop widespread thromboses* - **Widespread thromboses** are more characteristic of the **recipient twin** due to **polycythemia** and hyperviscosity from the increased blood volume. - The donor twin is more likely to experience **growth restriction, hypovolemia, and complications related to reduced blood flow**.

Question 1343: Which antihypertensive is considered the first-line treatment in pregnancy?

A. Hydralazine
B. Propranolol
C. Alpha methyl dopa
D. Labetalol (Correct Answer)

Explanation: ***Labetalol*** - **Labetalol** is a **beta-blocker** with **alpha-blocking activity** and is widely considered a **first-line agent** for **hypertension in pregnancy** due to its established safety profile and effectiveness. - It effectively **lowers blood pressure** without significantly compromising **placental perfusion** or causing adverse fetal effects, making it a preferred choice for both **chronic and gestational hypertension**. - Along with **methyldopa**, labetalol is recommended as a first-line agent by major guidelines, with **labetalol increasingly preferred** in modern practice due to its more rapid onset and better tolerability. *Hydralazine* - **Hydralazine** is a **direct arterial vasodilator** typically used for **acute severe hypertension in pregnancy**, such as in **preeclampsia with severe features** or **eclampsia**. - While effective in emergent situations, it is generally **not favored as first-line treatment** for chronic management due to reflex tachycardia and the need for frequent dosing. *Propranolol* - **Propranolol** is a **non-selective beta-blocker** that is **less preferred** for chronic hypertension in pregnancy compared to other options like labetalol or methyldopa. - Its use has been associated with concerns regarding **fetal growth restriction** and **neonatal bradycardia**, especially with prolonged use. *Alpha methyl dopa* - **Alpha methyl dopa** is a **centrally acting alpha-2 adrenergic agonist** that has the **longest safety record** for **hypertension in pregnancy** and is considered a **first-line agent** by WHO and other international guidelines. - While it has extensive safety data spanning decades, **labetalol is often preferred in current practice** due to its more rapid onset of action, better maternal tolerability, and lower incidence of side effects like sedation.

Question 1344: Which of the following is not seen in hypertensive disorders of pregnancy?

A. HELLP syndrome
B. Proteinuria
C. Macrosomia (Correct Answer)
D. Eclampsia

Explanation: ***Macrosomia*** - **Macrosomia** (large-for-gestational-age infant) is typically associated with **gestational diabetes,** not hypertensive disorders of pregnancy. - Hypertensive disorders often lead to **fetal growth restriction** due to reduced placental blood flow. *Eclampsia* - **Eclampsia** is defined by **new-onset grand mal seizures** in a woman with preeclampsia, underscoring its direct link to hypertensive disorders. - It represents a severe manifestation of **preeclampsia**, a hypertensive disorder, and is therefore seen in these conditions. *HELLP syndrome* - **HELLP syndrome** (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe obstetric complication considered a variant of **preeclampsia**. - It is a life-threatening condition directly associated with **hypertensive disorders of pregnancy.** *Proteinuria* - **Proteinuria** is a hallmark diagnostic criterion for **preeclampsia**, indicating kidney involvement and endothelial dysfunction. - Its presence is crucial in defining and classifying **hypertensive disorders of pregnancy.**

Question 1345: A 27-year-old primigravida presents with pre-eclampsia, with a blood pressure of 150/100 mmHg at 32 weeks of gestation. If there are no complications, the pregnancy should be best terminated at:

A. 35 completed weeks.
B. 37 completed weeks. (Correct Answer)
C. 40 completed weeks.
D. 34 completed weeks.

Explanation: ***37 completed weeks.*** - For women with **pre-eclampsia without severe features** and **no complications**, delivery is typically recommended at **37 weeks of gestation**. - This timing balances the risks of prematurity with the potential for disease progression or complications if the pregnancy continues. *40 completed weeks.* - Continuing the pregnancy until 40 weeks in a pre-eclamptic patient, even without severe features, increases the risk of **maternal and fetal complications**. - There is a higher likelihood of disease progression, **placental insufficiency**, and adverse outcomes beyond 37 weeks in such cases. *35 completed weeks.* - Delivery at 35 completed weeks would be considered **late preterm** and is generally reserved for cases of **pre-eclampsia with severe features** or other complications. - While pre-eclampsia is present, the absence of complications or severe features indicates that the benefits of prolonging the pregnancy to improve fetal lung maturity outweigh the risks at this stage. *34 completed weeks.* - Delivery at 34 completed weeks is considered **moderately preterm** and is usually indicated for **severe pre-eclampsia** or other urgent medical conditions. - In a patient with mild pre-eclampsia and no complications, extending the pregnancy to at least 37 weeks allows for further optimal fetal development.

Question 1346: A 3rd gravida with normal previous two pregnancies. What is the best test to diagnose Rh sensitization in an Rh-negative mother?

A. Direct Coombs' test
B. Rh Antigen test
C. Indirect Coombs' test (Correct Answer)
D. Rh Sensitization test

Explanation: ***Indirect Coombs' test*** - The **indirect Coombs' test** (or **indirect antiglobulin test, IAT**) is the **gold standard** for detecting **Rh antibodies** in the **mother's serum**, indicating **Rh sensitization**. - This test detects **free antibodies** circulating in maternal blood that can cross the placenta and attack fetal Rh-positive red blood cells. - A positive result means the mother has developed **anti-D antibodies** against Rh-positive fetal RBCs, which can cause **hemolytic disease of the fetus and newborn (HDFN)**. - Performed at **first antenatal visit**, **28 weeks**, and **after delivery** in Rh-negative mothers to guide **RhoGAM administration**. *Direct Coombs' test* - The **direct Coombs' test** (or **direct antiglobulin test, DAT**) is performed on the **infant's red blood cells** after birth, not the mother's serum. - It detects antibodies **already bound** to neonatal RBCs, confirming if hemolysis is occurring in the newborn. - This does **not diagnose maternal sensitization** but rather assesses the **severity of HDFN** in the affected infant. *Rh Antigen test* - This test determines the **Rh status** (positive or negative) of an individual by detecting the presence of the **D antigen** on red blood cells. - It identifies **who is at risk** (Rh-negative mother with Rh-positive baby) but does **not detect antibodies** or confirm sensitization. - It is a prerequisite screening test, not a diagnostic test for sensitization. *Rh Sensitization test* - This is a **non-specific descriptive term**, not an actual standardized laboratory test. - While the clinical goal is to assess for "Rh sensitization," the **specific test** that accomplishes this is the **indirect Coombs' test**.

Question 1347: What examination will confirm premature rupture of membranes in a 34-week pregnant patient with complaints of leaking vaginal discharge?

A. Digital vaginal examination
B. Ultrasound examination
C. Speculum examination (Correct Answer)
D. Urine analysis

Explanation: ***Speculum examination*** - A **sterile speculum examination** allows direct visualization of the cervix and vaginal vault to identify **pooling of amniotic fluid** or fluid leaking from the cervical os. - It also enables collection of samples for **nitrazine testing** (to confirm alkaline pH) and **ferning test** (to observe characteristic fern-like crystallization of amniotic fluid). *Digital vaginal examination* - This is generally **avoided** in suspected premature rupture of membranes (PROM) due to the increased risk of **introducing infection** into the birth canal, especially if the patient is not in active labor. - It does not directly visualize the leakage of fluid and is less sensitive for diagnosing PROM than speculum examination. *Ultrasound examination* - While ultrasound can assess **amniotic fluid volume**, which might be reduced in PROM, it is not a direct diagnostic test for the rupture itself. - A normal fluid volume does not rule out a small leak, and a low volume can have other causes. *Urine analysis* - Urine analysis is used to detect conditions like **urinary tract infections** or **proteinuria**, but it does not provide information about the integrity of the amniotic sac. - It cannot differentiate amniotic fluid from urine or vaginal secretions.

Question 1348: What is the most important intervention following antenatal maternal HIV diagnosis?

A. To prevent vertical transmission (Correct Answer)
B. To discharge with routine follow-up
C. To terminate the pregnancy immediately
D. To isolate the patient from other pregnant women

Explanation: ***To prevent vertical transmission*** - The most critical intervention following an antenatal maternal **HIV diagnosis** is to initiate strategies to **prevent mother-to-child (vertical) transmission** of the virus. - This involves **antiretroviral therapy (ART)** for the mother, safe delivery practices, and interventions for the newborn, significantly reducing transmission risk. *To terminate the pregnancy immediately* - **Termination of pregnancy** is generally not recommended solely due to an HIV diagnosis, as effective interventions can prevent vertical transmission. - Abortion is a personal choice and not a standard medical intervention for managing maternal HIV. *To discharge with routine follow-up* - A diagnosis of **maternal HIV** requires immediate and specialized attention, not just routine follow-up, to implement preventative measures. - **Immediate intervention** is necessary to reduce the risk of vertical transmission and manage maternal health. *To isolate the patient from other pregnant women* - **HIV is not transmitted through casual contact**, so there is no medical reason to isolate an HIV-positive pregnant woman from others. - Such isolation would be discriminatory and medically unfounded, as the primary concern is vertical transmission, not horizontal transmission in a healthcare setting.

Question 1349: Which of the following is false about gestational hypertension?

A. There is a sustained rise of BP > 140/90 mmHg
B. Perinatal mortality remains unaffected (Correct Answer)
C. Blood pressure returns to normal within 12 weeks of delivery
D. It is associated with lower incidence of essential hypertension in the later life as compared to preeclampsia

Explanation: ***Perinatal mortality remains unaffected*** - This statement is false because **gestational hypertension** can significantly *increase* the risk of perinatal morbidity and mortality due to complications like **placental abruption** and **fetal growth restriction**. - While typically less severe than preeclampsia, gestational hypertension is still associated with adverse outcomes for both mother and fetus, including increased rates of **preterm birth** and **intrauterine growth restriction (IUGR)**. *There is a sustained rise of BP > 140/90 mmHg* - This is a diagnostic criterion for gestational hypertension: **systolic blood pressure ≥ 140 mmHg** or **diastolic blood pressure ≥ 90 mmHg** on two occasions at least four hours apart. - This **hypertension** typically appears after **20 weeks of gestation** in a previously normotensive woman, without proteinuria. *Blood pressure returns to normal within 12 weeks of delivery* - By definition, gestational hypertension resolves by **12 weeks postpartum**; if it persists beyond this period, the diagnosis is reclassified as **chronic hypertension**. - This transient nature of **elevated blood pressure** after delivery is a key differentiating feature from chronic hypertension. *It is associated with lower incidence of essential hypertension in the later life as compared to preeclampsia* - While both gestational hypertension and preeclampsia increase the risk of **future chronic hypertension**, the risk is *lower* for women with isolated gestational hypertension compared to those who experienced preeclampsia. - Both conditions are considered risk factors for **cardiovascular disease** later in life, but preeclampsia specifically signals a higher risk.

Question 1350: Hydrops fetalis in a fetus can be due to:

A. Human papilloma virus
B. Parvovirus B19 (Correct Answer)
C. Influenza Virus
D. Epstein-Barr virus

Explanation: ***Parvovirus B19*** - **Parvovirus B19** infection in a fetus can lead to severe **anemia** and **hydrops fetalis** because the virus targets **erythroid progenitor cells**, impairing red blood cell production. - The resulting severe anemia causes **high-output cardiac failure**, leading to widespread edema, ascites, pleural effusions, and pericardial effusions, which characterize hydrops fetalis. *Epstein-Barr virus* - While **Epstein-Barr virus (EBV)** can infect the fetus, it is more commonly associated with conditions like **lymphoproliferative disorders** or **hepatosplenomegaly**, not typically hydrops fetalis as a primary manifestation. - EBV infection in pregnancy is often asymptomatic or causes mild illness and is not a common cause of severe fetal anemia or hydrops. *Human papilloma virus* - **Human papilloma virus (HPV)** is known to cause **genital warts** and is associated with **cervical cancer**, but it does not cause hydrops fetalis. - Vertical transmission of HPV can occur, leading to conditions like **recurrent respiratory papillomatosis** in the infant, but it does not affect red blood cell production or fluid balance in the fetus in a way that would cause hydrops. *Influenza Virus* - **Influenza virus** infection during pregnancy can lead to complications such as **preterm delivery** or **low birth weight**, but it is not a direct cause of hydrops fetalis. - The influenza virus primarily affects the respiratory system and does not directly target fetal erythroid cells or cause the severe anemia necessary for hydrops.

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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