Maternal-Fetal Medicine Practice Questions

Q: Which of the following is NOT a characteristic of the recipient twin in a monochorionic twin gestation affected by twin-twin transfusion syndrome?

Hypovolemia. ***Hypovolemia*** - The recipient twin in twin-twin transfusion syndrome (TTTS) experiences **hypervolemia** due to excessive blood flow from the donor twin, not hypovolemia. - This increased blood volume leads to **polycythemia** and volume overload. - Hypovolemia is actually a characteristic of the **donor twin**, not the recipient. *Thrombosis* - The recipient twin has **polycythemia** and increased blood viscosity due to hypervolemia, which increases the risk of **thrombosis**. - This hyperviscosity can lead to **vascular occlusions** in various organs. *Polyhydramnios* - The recipient twin characteristically develops **polyhydramnios** (excessive amniotic fluid) due to increased urine output from hypervolemia. - This is one of the **classic ultrasound findings** in TTTS, with the recipient showing a large fluid-filled sac. *Heart failure* - The recipient twin's heart has to pump an increased volume of blood, leading to **cardiac overload** and hypertrophy. - This chronic workload can eventually result in **congestive heart failure** and hydrops fetalis.

Q: A 30-year-old primigravida at 36 weeks of pregnancy presents with a blood pressure of 160/110 mmHg, 3+ urinary albumin, and a platelet count of 80,000/mm3. What is the most appropriate management option?

Magnesium sulfate for seizure prophylaxis. ***Magnesium sulfate for seizure prophylaxis*** - This patient has **severe preeclampsia** (BP ≥160/110 mmHg, significant proteinuria, thrombocytopenia), making her at **high risk for eclamptic seizures**. - **Magnesium sulfate** is the **first-line treatment** and must be initiated immediately for **seizure prophylaxis** in severe preeclampsia. - According to **ACOG and RCOG guidelines**, magnesium sulfate should be started **before delivery** and is the most critical immediate intervention to prevent maternal mortality and morbidity. - While delivery is the definitive treatment for preeclampsia, magnesium sulfate must be administered first to stabilize the patient. *Urgent LSCS* - At **36 weeks with severe preeclampsia**, delivery is indicated within 24-48 hours, but **cesarean section is not automatically required**. - The **mode of delivery** depends on **obstetric factors** (cervical favorability, fetal presentation, previous cesarean, etc.), not the preeclampsia diagnosis itself. - With a platelet count of **80,000/mm³**, vaginal delivery is generally safe (platelets >50,000/mm³ are adequate for labor). - **Labor induction** would be appropriate first-line unless there are specific obstetric contraindications to vaginal delivery. *Labetalol for hypertension* - **Antihypertensive therapy** is important to prevent maternal stroke when BP is ≥160/110 mmHg. - However, **magnesium sulfate takes priority** as the immediate life-saving intervention for seizure prevention. - Labetalol would be administered concurrently but is not the single most appropriate answer. *Labour induction* - Labor induction is an appropriate method of delivery for severe preeclampsia at ≥34 weeks gestation. - However, **before proceeding with delivery**, the patient must be **stabilized with magnesium sulfate** and antihypertensives. - Induction would follow after initial stabilization with magnesium sulfate.

Q: A female with 6 weeks of amenorrhea presents with an ovarian cyst that requires surgical intervention. The optimal timing for surgery is:

Ovariotomy at second trimester. ***Ovariotomy at second trimester*** - The **second trimester (14-28 weeks)** is the optimal time for surgical management of ovarian cysts in pregnancy requiring intervention. - During this period, the risk of **miscarriage** is significantly reduced compared to the first trimester, as the placenta has taken over progesterone production. - Fetal organogenesis is complete, and the uterus size allows for adequate surgical access with minimal risk of injury. - Most functional cysts (corpus luteum) have resolved spontaneously by this time, so persistent cysts are more likely to be true neoplasms requiring removal. *Immediate ovariotomy* - Performing **immediate surgery** at 6 weeks of amenorrhea carries a high risk of **miscarriage** due to surgical stress and anesthesia effects. - At this early stage of pregnancy, the corpus luteum is essential for progesterone production, and its disruption could threaten pregnancy viability. - Surgery in the first trimester should be reserved only for acute complications like **torsion** or **rupture**. *Ovariotomy 24 hours after delivery* - Waiting until 24 hours after delivery would delay treatment unnecessarily for a cyst requiring intervention, potentially leading to complications like **torsion**, **rupture**, or **hemorrhage** during pregnancy. - If the cyst is large or suspicious, allowing it to persist throughout pregnancy increases maternal morbidity risk. - However, expectant management throughout pregnancy is appropriate for simple, asymptomatic cysts. *Ovariotomy with cesarean* - Performing **ovariotomy concurrently with Cesarean section** significantly increases operative time, blood loss, and risk of postpartum complications. - This approach is only justified if the cyst is causing obstruction of labor or has highly suspicious features for malignancy. - Routine combination of these procedures is not recommended for benign ovarian pathology.

Q: What is the most serious complication of maternal varicella infection during late pregnancy?

Severe neonatal varicella in the newborn.. ***Severe neonatal varicella in the newborn.*** - If a pregnant mother contracts **varicella** in the last 5 days before delivery or up to 2 days postpartum, the newborn is at risk for **severe, disseminated neonatal varicella**, which can be fatal. - This is because the mother does not have enough time to produce and transfer protective **antibodies** to the fetus before birth. - Mortality rates can reach 20-30% without treatment, making this the most serious complication of late pregnancy maternal varicella infection. *Affects the limbs more than the trunk.* - This statement refers to **congenital varicella syndrome**, which occurs with maternal infection in the first 20 weeks of pregnancy, not late pregnancy. - Congenital varicella syndrome characteristically presents with **skin scarring** in a dermatomal distribution, **limb hypoplasia**, and neurologic and ocular defects. *May cause pneumonitis.* - While **varicella pneumonitis** is a serious complication for the **mother** if infected during pregnancy, it is not a complication affecting the **newborn** due to late pregnancy maternal infection. - The question asks about complications of maternal infection during late pregnancy, and the most serious outcome for the **fetus/newborn** is severe neonatal varicella, not maternal pneumonitis. *Is commonly seen in a congenital form.* - **Congenital varicella syndrome** (the "congenital form") is rare and results from maternal infection during the **first 20 weeks of gestation**, not late pregnancy. - Late pregnancy infection leads to **neonatal varicella**, which is a distinct and often more severe acute entity compared to the chronic congenital syndrome.

Q: Consider the following: 1. Reactive non-stress test, 2. Absence of deceleration, and 3. Sinusoidal pattern. Which of the above findings in an antepartum cardiotocogram indicate fetal well-being?

1 and 2 only. ***1 and 2 only*** - A **reactive non-stress test (NST)** indicates adequate fetal oxygenation and an intact autonomic nervous system, characterized by accelerations in fetal heart rate. - The **absence of decelerations**, particularly late or variable decelerations, suggests that the fetus is not experiencing significant uteroplacental insufficiency or cord compression. *2 and 3 only* - While the **absence of decelerations** is a positive sign, a **sinusoidal pattern** is a sign of severe fetal compromise. - Therefore, combining the absence of deceleration with a sinusoidal pattern does not indicate fetal well-being. *1 and 3 only* - A **reactive non-stress test** is a good indicator of fetal well-being. - However, the presence of a **sinusoidal pattern** is a concerning sign and indicates severe fetal anemia or hypoxia, not well-being. *1, 2, 3* - A **reactive non-stress test** and the **absence of decelerations** both indicate fetal well-being. - A **sinusoidal pattern**, however, is a non-reassuring finding, often associated with severe fetal anemia, hypoxia, or severe neurological compromise, and therefore does not indicate well-being.

Q: A lady with 38 weeks of pregnancy is admitted due to a first episode of painless bleeding yesterday. On examination, her hemoglobin level is 10.5 g%, blood pressure is 124/78 mmHg, the uterus is relaxed, the head is unengaged and floating, and the fetal heart sounds are regular. Ultrasound confirms placenta previa. The next line of management is:

Caesarean section. ***Caesarean section*** - The combination of **painless vaginal bleeding** and an **unengaged, floating fetal head** in a 38-week pregnancy strongly suggests **placenta previa**. - **Placenta previa** is an absolute contraindication to vaginal delivery, necessitating a **Cesarean section** to prevent catastrophic hemorrhage. *Induction of labor* - **Vaginal examination** and, consequently, **induction of labor** are contraindicated in suspected or confirmed placenta previa due to the risk of severe hemorrhage. - Applying pressure to the cervix or performing an artificial rupture of membranes could directly traumatize the placental blood vessels. *Wait and watch* - While initial bleeding might temporarily stop, the risk of a more severe and sudden hemorrhage remains high with **placenta previa**, especially as labor progresses. - At 38 weeks, the fetus is term, and waiting carries unnecessary risks for both mother and fetus without clear benefit. *Blood transfusion* - Although the patient's hemoglobin is slightly low at 10.5 g%, the primary issue is the potential for acute, severe hemorrhage, not chronic anemia requiring immediate transfusion as the definitive management. - A **blood transfusion** might be indicated as supportive care if significant blood loss occurs, but it is not the primary management for placenta previa.

Q: Which of the following measures is NOT effective in reducing perinatal HIV transmission?

Breastfeeding. ***Breastfeeding*** - Breastfeeding is **NOT effective in reducing perinatal HIV transmission** - in fact, it is a route of HIV transmission from mother to child. - In resource-rich settings, HIV-positive mothers are advised against breastfeeding because breast milk can transmit HIV, with transmission risk of 5-20% through prolonged breastfeeding. - While breastfeeding offers nutritional and immunological benefits, the risk of HIV transmission outweighs these benefits when safe alternatives (formula feeding) are available. - **This is the correct answer** to the question asking what is "NOT effective" in reducing transmission. *Delivery by elective cesarean section* - An **elective cesarean section** before the onset of labor or rupture of membranes significantly reduces the risk of vertical HIV transmission. - This method avoids the neonate's exposure to maternal blood and genital secretions during vaginal delivery. - Reduces transmission risk by approximately 50% when used alone, and even more when combined with ART. *Antiretroviral therapy to the neonate* - Administering **antiretroviral therapy (ART)** to the neonate, typically within hours of birth and continuing for 4-6 weeks, is crucial in preventing HIV infection. - This post-exposure prophylaxis can prevent establishment of HIV infection that may have been acquired during delivery or in utero. - Reduces transmission risk significantly, especially when maternal viral load is high. *Intrapartum antiretroviral therapy* - **Intrapartum antiretroviral therapy** involves administering ART to the mother during labor and delivery. - This helps reduce the maternal viral load at the time of birth, thereby minimizing the risk of HIV transmission to the neonate. - Part of the comprehensive approach to prevent mother-to-child transmission (PMTCT).

Q: A 20-year-old woman has been brought to the casualty with a blood pressure of 70/40 mmHg, a pulse rate of 120/min, and a positive urine pregnancy test. She should be managed by:

Immediate laparotomy for ruptured ectopic pregnancy. ***Immediate laparotomy for ruptured ectopic pregnancy*** - The patient presents with classic signs of **hypovolemic shock (BP 70/40 mmHg, pulse 120/min)** in the setting of a positive pregnancy test, strongly indicating a **ruptured ectopic pregnancy**. - This is a **life-threatening emergency** requiring immediate surgical intervention to control bleeding and stabilize the patient. *Laparoscopy for diagnosis* - While laparoscopy can be used for diagnosis and treatment of ectopic pregnancy, it is **contraindicated in unstable patients** due to the increased risk associated with pneumoperitoneum and a longer operative time compared to laparotomy for an actively bleeding rupture. - In a hemodynamically unstable patient, the priority is rapid control of hemorrhage, which is often best achieved via **laparotomy**. *Resuscitation without surgical intervention* - Resuscitation is crucial, but it must be performed **concurrently with preparations for immediate surgical intervention**. - Resuscitation alone will not address the source of internal bleeding, which can lead to further deterioration and death. *Culdocentesis for fluid analysis* - **Culdocentesis** involves aspirating fluid from the pouch of Douglas to check for hemoperitoneum, but it is an **invasive procedure with limited diagnostic utility** in the age of ultrasound. - More importantly, it **delays definitive management** and offers no therapeutic benefit in an unstable patient with suspected ruptured ectopic pregnancy.

Q: Which of the following is not a feature of HELLP syndrome?

Eosinophilia. ***Eosinophilia*** - **Eosinophilia** (an increase in eosinophils) is not a characteristic feature of **HELLP syndrome**. - HELLP syndrome is defined by specific hematologic and liver abnormalities, not changes in eosinophil count. *Thrombocytopenia* - **Thrombocytopenia** (platelet count < 100,000/µL) is a defining feature of **HELLP syndrome**. - It results from increased platelet consumption due to microangiopathic hemolysis. *Raised liver enzyme* - **Raised liver enzymes** (AST or ALT ≥ 70 IU/L) are a crucial diagnostic criterion for **HELLP syndrome**, indicating hepatocellular injury. - This elevation reflects liver damage and is often associated with epigastric or right upper quadrant pain. *Hemolytic anemia* - **Hemolytic anemia** (evidenced by an abnormal peripheral blood smear, elevated bilirubin, or low haptoglobin) is another key component of **HELLP syndrome**. - This involves the destruction of red blood cells, leading to anemia and often contributing to the elevated liver enzymes and thrombocytopenia.

Q: Which of the following congenital conditions is most commonly associated with preterm delivery?

Anencephaly. ***Anencephaly*** - This condition is most commonly associated with **polyhydramnios**, an excess of **amniotic fluid**, which can lead to **premature rupture of membranes** and **preterm delivery** - The polyhydramnios occurs due to **impaired fetal swallowing** resulting from the absent brain structures - Due to the **absence of a significant portion of the brain and skull**, fetuses with anencephaly are considered incompatible with life and approximately **50% of pregnancies with anencephaly result in preterm delivery** *Spina bifida* - While it is a **neural tube defect**, it typically does not directly cause **preterm labor or delivery** in the same manner as anencephaly - Most pregnancies with spina bifida proceed to term unless there are associated complications like **polyhydramnios** (which is less common than with anencephaly) - The primary concern with spina bifida is typically its neurological impact, not its direct link to **preterm birth** *Gastroschisis* - This is an **abdominal wall defect** where bowel herniates through a defect lateral to the umbilicus - While **over 50% of gastroschisis cases deliver preterm**, the association is **not as strong or consistent as with anencephaly** - Preterm delivery in gastroschisis may be due to **polyhydramnios, bowel complications**, or **elective early delivery** rather than spontaneous preterm labor *Congenital adrenal hyperplasia* - This is an **endocrine disorder** affecting the **adrenal glands' ability to produce certain hormones** - It does not typically lead to complications such as **polyhydramnios** or directly cause **preterm labor and delivery** - Pregnancies with CAH usually proceed to term without increased risk of preterm delivery

Question 1

Which of the following is NOT a characteristic of the recipient twin in a monochorionic twin gestation affected by twin-twin transfusion syndrome?

Accepted Answer

Hypovolemia

Answer

Heart failure

Answer

Thrombosis

Answer

Polyhydramnios

Question 2

A 30-year-old primigravida at 36 weeks of pregnancy presents with a blood pressure of 160/110 mmHg, 3+ urinary albumin, and a platelet count of 80,000/mm3. What is the most appropriate management option?

Accepted Answer

Magnesium sulfate for seizure prophylaxis

Answer

Labetalol for hypertension

Answer

Labour induction

Answer

Urgent LSCS

Question 3

A female with 6 weeks of amenorrhea presents with an ovarian cyst that requires surgical intervention. The optimal timing for surgery is:

Accepted Answer

Ovariotomy at second trimester

Answer

Ovariotomy with cesarean

Answer

Ovariotomy 24 hours after delivery

Answer

Immediate ovariotomy

Question 4

What is the most serious complication of maternal varicella infection during late pregnancy?

Accepted Answer

Severe neonatal varicella in the newborn.

Answer

Affects the limbs more than the trunk.

Answer

May cause pneumonitis.

Answer

Is commonly seen in a congenital form.

Question 5

Consider the following: 1. Reactive non-stress test, 2. Absence of deceleration, and 3. Sinusoidal pattern. Which of the above findings in an antepartum cardiotocogram indicate fetal well-being?

Accepted Answer

1 and 2 only

Answer

2 and 3 only

Answer

1 and 3 only

Answer

1, 2, 3

Question 6

A lady with 38 weeks of pregnancy is admitted due to a first episode of painless bleeding yesterday. On examination, her hemoglobin level is 10.5 g%, blood pressure is 124/78 mmHg, the uterus is relaxed, the head is unengaged and floating, and the fetal heart sounds are regular. Ultrasound confirms placenta previa. The next line of management is:

Accepted Answer

Caesarean section

Answer

Induction of labor

Answer

Wait and watch

Answer

Blood transfusion

Question 7

Which of the following measures is NOT effective in reducing perinatal HIV transmission?

Accepted Answer

Breastfeeding

Answer

Delivery by elective cesarean section

Answer

Antiretroviral therapy to the neonate

Answer

Intrapartum antiretroviral therapy

Question 8

A 20-year-old woman has been brought to the casualty with a blood pressure of 70/40 mmHg, a pulse rate of 120/min, and a positive urine pregnancy test. She should be managed by:

Accepted Answer

Immediate laparotomy for ruptured ectopic pregnancy

Answer

Laparoscopy for diagnosis

Answer

Resuscitation without surgical intervention

Answer

Culdocentesis for fluid analysis

Question 9

Which of the following is not a feature of HELLP syndrome?

Accepted Answer

Eosinophilia

Answer

Raised liver enzyme

Answer

Hemolytic anemia

Answer

Thrombocytopenia

Question 10

Which of the following congenital conditions is most commonly associated with preterm delivery?

Accepted Answer

Anencephaly

Answer

Spina bifida

Answer

Congenital adrenal hyperplasia

Answer

Gastroschisis

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?