Maternal-Fetal Medicine Practice Questions

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

Speculum examination. ***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.

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

To prevent vertical transmission. ***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.

Q: Which of the following is false about gestational hypertension?

Perinatal mortality remains unaffected. ***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.

Q: Placenta previa risk increases with the following except:

Contraceptive use. ***Contraceptive use*** - There is currently **no scientific evidence** to suggest that contraceptive use increases the risk of **placenta previa**. - Contraceptive use is not associated with placental implantation abnormalities in subsequent pregnancies. *Maternal age >35 yrs* - **Advanced maternal age** is a well-established risk factor for placenta previa, as the uterine lining may be less favorable for normal implantation in older women. - The risk of placental abnormalities, including **placenta previa**, increases with each decade of maternal age beyond 35 years. *Multiparity* - **Multiparity**, or having had multiple previous pregnancies, increases the risk of placenta previa. - This is thought to be due to **scarring or changes in the uterine lining** from previous pregnancies and deliveries, leading to preferential implantation in the lower uterine segment. *Previous cesarean section* - **Prior cesarean delivery** is one of the **most significant risk factors** for placenta previa. - Uterine scarring from cesarean section damages the endometrium, leading to abnormal placental implantation. - The risk increases with the **number of previous cesarean sections** and may lead to placenta previa with accreta spectrum disorders.

Q: Fetal lung maturity assessed by all except -

Measurement of alpha-fetoprotein. ***Measurement of alpha-fetoprotein*** - **Alpha-fetoprotein (AFP)** is a marker for **neural tube defects** and **chromosomal abnormalities**, not fetal lung maturity. - While AFP is found in amniotic fluid, its levels do not correlate with the production of **surfactant** or the development of mature lung function. *Lecithin: sphingomyelin ratio* - The **lecithin: sphingomyelin (L:S) ratio** is a classic and reliable indicator of fetal lung maturity. - A ratio of **2:1 or higher** generally suggests sufficient **pulmonary surfactant** production, reducing the risk of **respiratory distress syndrome (RDS)**. *Phosphatidyl choline concentration in amniotic fluid* - **Phosphatidylcholine**, also known as **lecithin**, is a primary component of **surfactant**, which prevents alveolar collapse. - Measuring its concentration, specifically the **disaturated phosphatidylcholine (DSPC)**, directly assesses the lung's ability to produce adequate surfactant. *Lamellar body count* - **Lamellar bodies** are surfactant storage organelles secreted by type II pneumocytes into the amniotic fluid. - A count of **≥50,000/μL** indicates fetal lung maturity, and this test correlates well with the L:S ratio while being faster and more cost-effective.

Q: All of the following are the most commonly used ultrasonographic fetal growth parameters for estimating gestational age of the fetus, except:

Transcerebellar diameter. ***Transcerebellar diameter*** - While it can be used for gestational age estimation, especially in cases of **intrauterine growth restriction (IUGR)** or during the third trimester, it is **not one of the most commonly used** or primary parameters for routine gestational age assessment in early pregnancy. - The transcerebellar diameter is less affected by **growth disturbances** compared to other parameters but is not part of the standard set of measurements. *Biparietal diameter* - This is a **primary and highly reliable parameter** for estimating gestational age, particularly in the **second trimester**. - It measures the distance between the two parietal bones of the fetal skull. *Head circumference* - **Head circumference** is another **standard and essential parameter** for estimating gestational age and assessing fetal growth. - It provides a comprehensive measurement of the fetal head. *Femur length* - **Femur length** is a **routinely used parameter** for estimating gestational age, especially from the end of the first trimester through the third trimester. - It measures the longest bone in the fetal body, the femur.

Q: The immediate complication of vesicular mole evacuation is:

Hemorrhage. **Hemorrhage** - **Excessive bleeding** is the most common and immediate complication following the evacuation of a **vesicular mole**, due to the highly vascularized nature of the molar pregnancy tissue and the dilated uterine vessels. - The risk of hemorrhage is increased with larger uterine size or more aggressive suction curettage, necessitating careful monitoring and prompt intervention. *Post-operative infection* - While a potential complication, **infection** typically manifests with a slight delay (hours to days post-procedure) rather than being an immediate concern. - Prophylactic antibiotics are often given to mitigate this risk. *Residual tissue* - The presence of **residual molar tissue** is a common and important long-term complication leading to persistent trophoblastic disease, but it is usually not an immediate event that poses a direct threat to the patient's immediate stability upon evacuation. - It requires subsequent monitoring of hCG levels and potentially further intervention. *Septic shock* - **Septic shock** is a severe, life-threatening condition resulting from an uncontrolled infection, which is a rare and delayed complication of molar evacuation, not an immediate one. - It would typically be preceded by signs of infection and severe systemic inflammation.

Q: Fetal immune response to Treponema pallidum becomes detectable at which week of pregnancy?

18th week. ***Correct: 18th week*** - The **fetal immune system** is sufficiently developed by the **18th week of gestation** to mount a detectable immune response to *Treponema pallidum* - This marks the earliest point during pregnancy when **fetal IgM antibodies** specific to syphilis can be produced - Maternal treatment before 18 weeks can prevent fetal infection because the fetus cannot yet respond immunologically *Incorrect: 4th week* - At the **4th week of gestation**, the fetus is still in the **early embryonic stage**, and its immune system is not yet formed - No detectable **immune response** to any pathogen can be mounted at this very early stage *Incorrect: 8th week* - By the **8th week**, organogenesis is largely complete, but the **immune system is still immature** and not capable of a significant immune response - **Fetal antibody production** is extremely limited, if present at all, at this stage *Incorrect: 28th week* - While the fetal immune system is more robust by the **28th week**, the *Treponema pallidum* immune response is **detectable much earlier** (by 18 weeks) - A response by 28 weeks would indicate a **delayed diagnosis**, as the infection could have been identified sooner if screening occurred around 18 weeks

Q: A 37-week G2P1L1 is admitted with abdominal pain for 2 hours. On examination, the patient has a hemoglobin level of 9 g%, blood pressure of 150/90 mmHg, and urine albumin positivity. Palpation reveals a 36-week fetus with good fetal heart rate and regular uterine contractions with uterine tenderness on palpation. Per vaginal examination shows 6 cm dilation. Artificial rupture of membranes (ARM) reveals blood-stained amniotic fluid. What is the next line of management?

Immediate cesarean section. ***Immediate cesarean section*** - The presence of **uterine tenderness**, **blood-stained amniotic fluid** following rupture of membranes, and **abdominal pain** in a patient with **hypertension and proteinuria (preeclampsia)** strongly suggests **placental abruption**. - Given the maternal and fetal instability (potential for further bleeding, risk of fetal hypoxia), **expeditious delivery** via cesarean section is indicated to prevent severe complications for both mother and fetus. - Although the patient is 6 cm dilated, the signs of abruption with preeclampsia warrant immediate operative delivery rather than awaiting vaginal delivery. *Observation and monitoring* - This approach is inappropriate and potentially dangerous given the clinical signs suggestive of **placental abruption**, which can rapidly escalate to severe hemorrhage and fetal distress. - Close monitoring alone would delay definitive intervention and increase risks. *Blood transfusion if necessary* - While a **blood transfusion** may be necessary due to the low hemoglobin level and potential for further blood loss, it is a supportive measure, not the primary management for **placental abruption**. - Addressing the cause of bleeding (delivery) is paramount, after which transfusion can be given as needed. *Oxytocin administration* - **Oxytocin** is used to augment labor or prevent postpartum hemorrhage but is **contraindicated** in cases of suspected **placental abruption** with unconfirmed fetal well-being or significant maternal bleeding. - It would increase uterine contractions which could worsen the abruption and fetal distress.

Question 1

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

Accepted Answer

Speculum examination

Answer

Digital vaginal examination

Answer

Ultrasound examination

Answer

Urine analysis

Question 2

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

Accepted Answer

To prevent vertical transmission

Answer

To discharge with routine follow-up

Answer

To terminate the pregnancy immediately

Answer

To isolate the patient from other pregnant women

Question 3

Which of the following is false about gestational hypertension?

Accepted Answer

Perinatal mortality remains unaffected

Answer

There is a sustained rise of BP > 140/90 mmHg

Answer

Blood pressure returns to normal within 12 weeks of delivery

Answer

It is associated with lower incidence of essential hypertension in the later life as compared to preeclampsia

Question 4

Placenta previa risk increases with the following except:

Accepted Answer

Contraceptive use

Answer

Maternal age >35 yrs

Answer

Multiparity

Answer

Previous cesarean section

Question 5

Fetal lung maturity assessed by all except -

Accepted Answer

Measurement of alpha-fetoprotein

Answer

Phosphatidyl choline concentration in amniotic fluid

Answer

Lecithin: sphingomyelin ratio

Answer

Lamellar body count

Question 6

All of the following are the most commonly used ultrasonographic fetal growth parameters for estimating gestational age of the fetus, except:

Accepted Answer

Transcerebellar diameter

Answer

Biparietal diameter

Answer

Head circumference

Answer

Femur length

Question 7

A female of 36 weeks' gestation presents with severe hypertension, blurring of vision, and headache. Her blood pressure readings are 180/120 mmHg and 174/110 mmHg after 20 minutes. What is the most appropriate management for this patient?

Accepted Answer

Admit the patient, start antihypertensives, administer MgSO4, and plan for delivery.

Answer

Admit the patient and monitor her condition.

Answer

Discharge the patient with oral antihypertensives and schedule a follow-up.

Answer

Admit the patient, initiate antihypertensive therapy, and continue the pregnancy until term.

Question 8

The immediate complication of vesicular mole evacuation is:

Accepted Answer

Hemorrhage

Answer

Post-operative infection

Answer

Residual tissue

Answer

Septic shock

Question 9

Fetal immune response to Treponema pallidum becomes detectable at which week of pregnancy?

Accepted Answer

18th week

Answer

4th week

Answer

8th week

Answer

28th week

Question 10

A 37-week G2P1L1 is admitted with abdominal pain for 2 hours. On examination, the patient has a hemoglobin level of 9 g%, blood pressure of 150/90 mmHg, and urine albumin positivity. Palpation reveals a 36-week fetus with good fetal heart rate and regular uterine contractions with uterine tenderness on palpation. Per vaginal examination shows 6 cm dilation. Artificial rupture of membranes (ARM) reveals blood-stained amniotic fluid. What is the next line of management?

Accepted Answer

Immediate cesarean section

Answer

Observation and monitoring

Answer

Blood transfusion if necessary

Answer

Oxytocin administration

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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