Maternal-Fetal Medicine Practice Questions

Q: All of the following factors are used to assess intrauterine growth retardation, EXCEPT?

Fetal movements. **Explanation:** The diagnosis and assessment of **Intrauterine Growth Restriction (IUGR)** rely on objective measurements of fetal size and growth velocity. **Why Fetal Movements is the Correct Answer:** Fetal movements (Kick counts) are a subjective measure of **fetal well-being** and placental function, rather than a parameter for assessing growth. While a decrease in movements may indicate fetal distress in a growth-restricted fetus, it does not help in diagnosing or quantifying the degree of growth retardation itself. **Analysis of Incorrect Options:** * **Fundal Height:** This is the primary **clinical screening tool**. A symphysis-fundal height (SFH) lag of more than 3 cm compared to the gestational age suggests IUGR. * **Abdominal Circumference (AC):** This is the **most sensitive** sonographic parameter for diagnosing IUGR. Since the liver is the first organ to be affected by malnutrition (depletion of glycogen stores), the AC reduces significantly. * **Head Size (Biparietal Diameter/Head Circumference):** These are used to differentiate between **Symmetrical** (small head) and **Asymmetrical** (head-sparing) IUGR. The HC/AC ratio is a classic marker used in this assessment. **High-Yield Clinical Pearls for NEET-PG:** * **Best parameter for IUGR:** Abdominal Circumference (AC). * **Best parameter for Gestational Age:** Crown-Rump Length (CRL) in the 1st trimester. * **Ponderal Index:** Used to identify malnourished fetuses (Asymmetrical IUGR). * **Gold Standard for Monitoring:** Doppler Velocimetry (specifically the Umbilical Artery) is the best tool to manage IUGR and decide the timing of delivery.

Q: Which of the following maternal factors is most commonly associated with first-trimester pregnancy loss?

Advanced maternal age. **Explanation:** **1. Why Advanced Maternal Age (AMA) is the correct answer:** Advanced maternal age (typically defined as ≥35 years) is the most significant maternal risk factor for first-trimester pregnancy loss. The underlying medical concept is the **decline in oocyte quality and quantity**. As maternal age increases, there is a higher incidence of **meiotic non-disjunction**, leading to fetal chromosomal abnormalities (aneuploidies). Since approximately 50–70% of all first-trimester miscarriages are caused by chromosomal anomalies (most commonly autosomal trisomies), AMA directly correlates with the highest risk of loss. **2. Why the other options are incorrect:** * **Incompetent Cervix:** This is a classic cause of **second-trimester** (mid-trimester) pregnancy loss, characterized by painless cervical dilatation and membrane prolapse, rather than first-trimester loss. * **Intrauterine Infection:** While infections (like TORCH or bacterial vaginosis) can cause sporadic loss, they are much less common than chromosomal causes in the first trimester. * **Hyperemesis Gravidarum:** This condition involves severe nausea and vomiting. While it can lead to maternal dehydration and electrolyte imbalance, it is generally associated with *favorable* pregnancy outcomes and is not a cause of miscarriage. **3. NEET-PG High-Yield Pearls:** * **Most common cause of 1st-trimester miscarriage:** Fetal chromosomal anomalies (Aneuploidy). * **Most common specific chromosomal anomaly:** Autosomal Trisomy (Trisomy 16 is the most common specific trisomy found in abortuses). * **Most common single chromosomal anomaly:** Monosomy X (Turner Syndrome, 45,X). * **Risk of miscarriage:** At age 20-24, the risk is ~10%; by age 45, the risk exceeds 50-75%.

Q: A 32-year-old primigravida, at 35 weeks gestation, is admitted to the antenatal ward. Her blood pressure is found to be 160/110 mmHg, and her urine does not contain albumin. Which of the following drugs should not be used in her management?

Furosemide. ### Explanation **Correct Option: A (Furosemide)** The patient presents with **Severe Gestational Hypertension** (BP ≥160/110 mmHg without proteinuria). In hypertensive disorders of pregnancy (HDP), there is a paradoxical state of **pathological plasma volume contraction** despite systemic edema. **Furosemide (a loop diuretic)** is generally contraindicated because it further depletes intravascular volume, leading to decreased placental perfusion and potential fetal compromise. Diuretics are strictly reserved for specific complications like **acute pulmonary edema** or congestive heart failure in pregnancy. **Analysis of Incorrect Options:** * **B. Hydralazine:** A potent vasodilator used frequently in the acute management of severe hypertension in pregnancy (hypertensive crisis). It is a safe and effective second-line agent. * **C. Labetalol:** A combined alpha and beta-blocker. It is considered the **first-line intravenous drug** for the acute management of severe hypertension in pregnancy due to its rapid onset and favorable safety profile. * **D. Methyldopa:** A centrally acting alpha-2 agonist. It is the **drug of choice for chronic hypertension** in pregnancy due to its long-term safety record, though it is less effective for acute hypertensive emergencies due to its slow onset of action. **NEET-PG High-Yield Pearls:** * **Drug of Choice (DOC) for Chronic Hypertension in Pregnancy:** Methyldopa. * **DOC for Acute Hypertensive Crisis in Pregnancy:** IV Labetalol (Hydralazine is an alternative). * **DOC for Eclampsia Prophylaxis/Treatment:** Magnesium Sulfate ($MgSO_4$). * **ACE Inhibitors/ARBs:** Strictly contraindicated in pregnancy (cause fetal renal dysgenesis and skull defects). * **Target BP in Pregnancy:** Aim to maintain Systolic 140–150 mmHg and Diastolic 90–100 mmHg to prevent maternal cerebrovascular accidents without compromising placental blood flow.

Q: What is the preventive dose of anti-D gamma globulin given to a mother?

300 mcg. **Explanation:** The standard preventive dose of Anti-D gamma globulin (RhoGAM) for a non-sensitized Rh-negative mother is **300 mcg** (equivalent to 1500 IU). This dose is administered intramuscularly to prevent Rh isoimmunization by neutralizing fetal Rh-positive red blood cells that may enter the maternal circulation. **Why 300 mcg is correct:** A 300 mcg dose is specifically designed to neutralize up to **30 mL of fetal whole blood** (or 15 mL of fetal packed red cells). This volume is sufficient to cover the majority of feto-maternal hemorrhages (FMH) occurring during a standard delivery or third-trimester events. **Analysis of Incorrect Options:** * **A. 200 mcg:** This is an insufficient dose for standard third-trimester prophylaxis or delivery. However, a lower dose of **50 mcg** is often used for first-trimester events (e.g., abortion before 12 weeks), as the fetal blood volume is much smaller. * **C & D. 400 mcg / 500 mcg:** These doses exceed the standard prophylactic requirement. While higher doses are administered if a Kleihauer-Betke (KB) test confirms a massive FMH (>30 mL), they are not the "standard" preventive dose. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** Routine antenatal prophylaxis is given at **28 weeks** gestation. Postpartum, it must be given within **72 hours** of delivery if the neonate is Rh-positive. * **Kleihauer-Betke Test:** Used to quantify the volume of FMH to determine if additional doses of Anti-D are required. * **Route:** Intramuscular (IM) is standard. * **Indirect Coombs Test (ICT):** Must be negative in the mother before administration (indicating she is not yet sensitized).

Q: Which of the following methods does not improve fetoplacental function in women with IUGR?

Allyl estranol. **Explanation:** Intrauterine Growth Restriction (IUGR) is primarily managed by improving uteroplacental blood flow and optimizing maternal nutrition. **Why Allyl estranol is the correct answer:** Allyl estranol is a synthetic progestogen. While it was historically used to prevent miscarriage or preterm labor, large-scale clinical trials and Cochrane reviews have proven that it has **no role** in improving fetoplacental function or treating IUGR. It does not increase placental perfusion or fetal weight. In modern obstetrics, its use for growth restriction is considered obsolete and ineffective. **Why the other options are incorrect:** * **High protein diet:** Maternal malnutrition is a modifiable risk factor. Supplementing the mother with a balanced, high-protein diet ensures adequate amino acid transfer to the fetus, which is essential for cellular growth and improving fetal weight. * **Left lateral position:** This is a fundamental nursing intervention. It prevents **aortocaval compression** by the gravid uterus, thereby increasing venous return to the heart, improving cardiac output, and maximizing uterine artery blood flow to the placenta. * **Intermittent O2 therapy:** Administering oxygen to the mother increases the oxygen concentration gradient across the placenta. This can temporarily improve fetal oxygenation and is sometimes used in cases of suspected fetal distress or severe growth restriction. **Clinical Pearls for NEET-PG:** * **Bed Rest:** The most effective non-pharmacological "treatment" for IUGR is bed rest in the left lateral position. * **Low-dose Aspirin (75-150 mg):** If started before 16 weeks, it can help prevent IUGR in high-risk women by improving trophoblastic invasion. * **Definitive Management:** The only definitive "cure" for IUGR is delivery once the fetus has reached a viable age or if fetal surveillance (Doppler/NST) indicates compromise.

Q: All of the following are complications in a pregnant woman with systemic lupus erythematosus (SLE) disease except?

Post-term delivery. **Explanation:** Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disorder that significantly impacts pregnancy outcomes. The core pathophysiology involves immune complex deposition and vasculitis, which compromises placental function. **Why Post-term delivery is the correct answer:** In SLE, the primary concern is **placental insufficiency** caused by decidual vasculopathy. This leads to complications that necessitate early delivery, either due to spontaneous onset (preterm labor) or medical induction (fetal distress/preeclampsia). Therefore, SLE is associated with **preterm delivery**, not post-term delivery. **Analysis of Incorrect Options:** * **Preterm Labor:** This is a hallmark complication of SLE, occurring in up to 30-50% of cases due to premature rupture of membranes, placental abruption, or iatrogenic delivery for maternal/fetal indications. * **Thrombophilia:** SLE is frequently associated with **Antiphospholipid Syndrome (APS)**. The presence of Lupus Anticoagulant or Anticardiolipin antibodies creates a hypercoagulable state, leading to venous/arterial thrombosis and placental infarctions. * **Eclampsia:** SLE patients have a significantly higher risk of **Preeclampsia and Eclampsia**. Differentiating between a "Lupus Nephritis flare" and "Preeclampsia" is a common clinical challenge; however, both conditions predispose the patient to hypertensive crises and seizures. **High-Yield Clinical Pearls for NEET-PG:** * **Best time to conceive:** When SLE has been in remission for at least **6 months**. * **Neonatal Lupus:** Caused by transplacental passage of **Anti-Ro (SS-A)** and **Anti-La (SS-B)** antibodies. The most serious permanent complication is **Congenital Heart Block**. * **Drug of Choice:** **Hydroxychloroquine** is safe and should be continued throughout pregnancy to prevent flares. * **Flare Marker:** Low complement levels (**C3, C4**) usually indicate an SLE flare rather than preeclampsia.

Q: What is the most common presentation in twin pregnancies?

Both Vertex. **Explanation:** In twin pregnancies, the presentation of the fetuses is determined by the available intrauterine space and the tendency of the fetuses to accommodate the oval shape of the uterus. **1. Why "Both Vertex" is correct:** Cephalic (Vertex) presentation is the most common presentation for a single fetus (95%), and this trend continues in multifetal gestations. **Vertex-Vertex** is the most frequent combination, occurring in approximately **40–50%** of all twin pregnancies. This is the most favorable presentation for a planned vaginal delivery, provided there are no other contraindications. **2. Analysis of Incorrect Options:** * **Vertex + Breech (Option C):** This is the second most common presentation, occurring in about **30–35%** of cases. While common, it is statistically less frequent than both being vertex. * **Vertex + Transverse (Option A):** This occurs in approximately **10%** of cases. It is less common because the transverse lie is unstable and usually converts to longitudinal as the pregnancy progresses. * **Both Breech (Option D):** This is relatively rare, occurring in only about **10%** of twin pregnancies. **3. High-Yield Clinical Pearls for NEET-PG:** * **Management Rule:** If the first twin (Twin A) is non-vertex, a Cesarean Section is generally indicated regardless of the presentation of Twin B. * **Internal Podalic Version:** This is a classic obstetric maneuver that may be used for the delivery of a **second twin** (Twin B) if it is in a non-vertex presentation (like transverse) after the successful vaginal birth of Twin A. * **Locked Twins:** A rare but serious complication (1 in 1000 twin births) most commonly seen when **Twin A is Breech and Twin B is Vertex**. Their chins become interlocked, necessitating a C-section.

Q: What is the most common indirect cause of maternal mortality?

Anemia. **Explanation:** Maternal mortality causes are classified into two categories: **Direct** (obstetric complications) and **Indirect** (pre-existing or co-existing diseases aggravated by pregnancy). **Why Anemia is Correct:** In the context of **indirect causes**, **Anemia** is the leading cause of maternal mortality globally and in India. It contributes to death not only through direct cardiac failure but also by lowering the patient's threshold to tolerate blood loss, making even a minor postpartum hemorrhage (PPH) fatal. It also increases susceptibility to infections. **Analysis of Incorrect Options:** * **Hemorrhage (Option B):** This is the **most common direct cause** of maternal mortality (specifically Postpartum Hemorrhage). It is the leading cause of maternal death overall, but it is classified as a direct obstetric cause, not indirect. * **Sepsis (Option A):** This is a major **direct cause**, often resulting from poor hygiene during labor or unsafe abortions. * **Obstructed Labor (Option C):** This is a **direct cause** leading to complications like uterine rupture or maternal exhaustion. **NEET-PG High-Yield Pearls:** * **Most common cause of Maternal Mortality (Overall):** Hemorrhage (Direct). * **Most common Indirect cause:** Anemia (followed by Heart Disease). * **Most common cause of Anemia in pregnancy:** Iron Deficiency Anemia. * **Maternal Mortality Ratio (MMR):** Calculated as maternal deaths per 1,00,000 live births. * **Target:** Under the Sustainable Development Goals (SDG), the target is to reduce MMR to less than 70 per 1,00,000 live births by 2030.

Question 1

All of the following factors are used to assess intrauterine growth retardation, EXCEPT?

Accepted Answer

Fetal movements

Answer

Head size

Answer

Fundal height

Answer

Abdominal circumference

Question 2

Which of the following maternal factors is most commonly associated with first-trimester pregnancy loss?

Accepted Answer

Advanced maternal age

Answer

Incompetent cervix

Answer

Intrauterine infection

Answer

Hyperemesis gravidarum

Question 3

A 32-year-old primigravida, at 35 weeks gestation, is admitted to the antenatal ward. Her blood pressure is found to be 160/110 mmHg, and her urine does not contain albumin. Which of the following drugs should not be used in her management?

Accepted Answer

Furosemide

Answer

Hydralazine

Answer

Labetalol

Answer

Methyldopa

Question 4

What is the treatment of choice for an unruptured tubal pregnancy with a serum p-hCG titre of 2000 IU/mL?

Accepted Answer

Single dose of methotrexate

Answer

Variable dose of methotrexate

Answer

Expectant management

Answer

Laparoscopic salpingostomy

Question 5

What is the preventive dose of anti-D gamma globulin given to a mother?

Accepted Answer

300 mcg

Answer

200 mcg

Answer

400 mcg

Answer

500 mcg

Question 6

Which of the following methods does not improve fetoplacental function in women with IUGR?

Accepted Answer

Allyl estranol

Answer

High protein diet

Answer

Left lateral position

Answer

Intermittent O2 therapy

Question 7

All of the following are complications in a pregnant woman with systemic lupus erythematosus (SLE) disease except?

Accepted Answer

Post-term delivery

Answer

Preterm labor

Answer

Thrombophilia

Answer

Eclampsia

Question 8

What advice should be given to an HIV-positive primigravida near term regarding labor and delivery?

Accepted Answer

Cesarean section would decrease transmission of HIV to the baby.

Answer

Treatment should be started before labor.

Answer

Avoid mixing of blood intrapartum.

Answer

Vaginal delivery is preferred.

Question 9

What is the most common presentation in twin pregnancies?

Accepted Answer

Both Vertex

Answer

Vertex + Transverse

Answer

Vertex + Breech

Answer

Both Breech

Question 10

What is the most common indirect cause of maternal mortality?

Accepted Answer

Anemia

Answer

Sepsis

Answer

Hemorrhage

Answer

Obstructed labor

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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