Maternal-Fetal Medicine Practice Questions

Q: What is the recommended treatment for cholera during pregnancy?

Azithromycin. **Explanation:** The primary goal in treating cholera during pregnancy is aggressive rehydration and appropriate antibiotic therapy to reduce the duration of diarrhea and the volume of stool loss. **1. Why Azithromycin is the correct answer:** According to current WHO and CDC guidelines, **Azithromycin** is the drug of choice for treating cholera in pregnant women and children. It is a Macrolide (Category B) that is safe during pregnancy, effective against *Vibrio cholerae*, and has shown lower rates of treatment failure compared to other agents in regions with emerging resistance. **2. Why the other options are incorrect:** * **Tetracycline and Doxycycline:** These are traditionally the drugs of choice for non-pregnant adults. However, they are generally **avoided in pregnancy** (Category D) because they cross the placenta and can cause permanent tooth discoloration and enamel hypoplasia in the fetus, as well as affect fetal bone growth. * **Furazolidone:** While previously used in pregnancy, it is less effective than Azithromycin and is associated with higher rates of nausea and potential hemolytic anemia in G6PD-deficient individuals. It is no longer considered first-line. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (General Population):** Doxycycline (Single 300mg dose). * **Drug of Choice (Pregnancy/Children):** Azithromycin (Single 1g dose for adults). * **Most Important Step:** Rehydration (ORS for mild/moderate; IV Ringer’s Lactate for severe dehydration) is more critical than antibiotics for survival. * **Cholera in Pregnancy:** Increases the risk of miscarriage, preterm labor, and stillbirth due to severe maternal dehydration and electrolyte imbalance.

Q: A patient presents with a history of recurrent early pregnancy loss. What investigations should be ordered?

Hemogram and blood grouping. In the evaluation of **Recurrent Pregnancy Loss (RPL)**—defined as two or more consecutive clinical pregnancy losses—the goal is to identify treatable systemic or anatomical causes. **Why "Hemogram and blood grouping" is the correct answer:** While not a direct "cause" of recurrent loss in the same way as APS or uterine anomalies, a **Hemogram and Blood Grouping** are fundamental baseline investigations in any pregnancy-related workup. 1. **Hemogram:** Identifies chronic maternal anemia or systemic illness that may complicate pregnancy. 2. **Blood Grouping:** Essential to identify **Rh-negative** status. Rh isoimmunization can lead to hydrops fetalis and late-term losses, though its role in "early" recurrent loss is limited. However, in the context of standard NEET-PG protocols, baseline maternal health assessment always precedes specialized serology. **Why the other options are incorrect:** * **B & D (Toxoplasma and Rubella):** These are part of the **TORCH** panel. It is a high-yield fact that TORCH infections cause *sporadic* pregnancy loss, not *recurrent* loss. Once a mother develops antibodies, she is generally immune, preventing subsequent losses from the same pathogen. * **A (VDRL):** While Syphilis can cause mid-trimester fetal loss or stillbirth, it is rarely a cause of recurrent early (first trimester) loss. **NEET-PG High-Yield Pearls for RPL:** * **Most common cause of sporadic loss:** Fetal chromosomal anomalies (Trisomies). * **Most common treatable cause of RPL:** Antiphospholipid Syndrome (APS). * **Standard RPL Workup includes:** Parental karyotyping, Lupus anticoagulant/Anticardiolipin antibodies, Pelvic Ultrasound (for septate uterus), and TSH/HbA1c. * **Progesterone:** Only indicated if there is proven luteal phase defect or bleeding in the current pregnancy.

Q: Which lung head ratio is associated with a good prognosis?

Greater than 1.4. **Explanation:** The **Lung-to-Head Ratio (LHR)** is a critical sonographic marker used primarily to predict the prognosis and severity of pulmonary hypoplasia in fetuses with **Congenital Diaphragmatic Hernia (CDH)**. It is calculated by measuring the area of the contralateral lung (the lung not compressed by herniated organs) at the level of the four-chamber view of the heart and dividing it by the fetal head circumference. **Why Option D is Correct:** The LHR serves as a proxy for remaining lung volume. A higher ratio indicates more lung tissue and better development. * **LHR > 1.4:** Associated with a **good prognosis**, with survival rates approaching 100%. These neonates typically have manageable pulmonary hypertension and require less aggressive ventilatory support. **Analysis of Incorrect Options:** * **Options A & B (LHR 1):** While better than 1.4. **High-Yield Clinical Pearls for NEET-PG:** * **Observed/Expected LHR (O/E LHR):** To account for gestational age, clinicians now often use the O/E LHR. An **O/E LHR < 25%** signifies severe CDH. * **Liver Position:** The presence of the liver in the thorax ("Liver-up") is the single most important additional predictor of a poor outcome in CDH. * **Timing:** LHR is most predictive when measured between **22 and 26 weeks** of gestation.

Q: Which type of hepatitis is prevalent in pregnancy?

Hepatitis E. **Explanation:** **Hepatitis E Virus (HEV)** is the correct answer because it is the most common cause of acute viral hepatitis during pregnancy in developing countries, including India. While other hepatitis viruses occur in pregnant women, Hepatitis E is uniquely "prevalent" in terms of its clinical significance and the severity of outbreaks linked to contaminated water. * **Why Hepatitis E is the correct answer:** HEV is a feco-oral RNA virus. In the general population, it is usually self-limiting. However, in pregnant women (especially during the 2nd and 3rd trimesters), it carries a disproportionately high morbidity and mortality rate (up to 20–25%). This is attributed to high viral loads, altered immune responses (Th2 shift), and a high incidence of Fulminant Hepatic Failure (FHF). * **Why other options are incorrect:** * **Hepatitis A:** Also feco-oral, but rarely causes fulminant failure or significant outbreaks specifically targeting the pregnant population. * **Hepatitis B:** While it is the most common cause of *chronic* hepatitis and carries a high risk of vertical transmission, it does not typically cause the acute, epidemic-style prevalence or high maternal mortality associated with HEV in endemic zones. * **Hepatitis C:** Primarily transmitted parenterally; it rarely causes acute hepatitis during pregnancy and is not considered "prevalent" in the context of pregnancy-specific complications. **High-Yield Clinical Pearls for NEET-PG:** 1. **Mortality:** HEV has the highest maternal mortality rate among all viral hepatitides (20%). 2. **Transmission:** Vertical transmission of HEV is high (up to 100%), often leading to neonatal hypoglycemia and hypothermia. 3. **Diagnosis:** Detection of IgM anti-HEV is the gold standard for acute infection. 4. **Complications:** HEV in pregnancy is strongly associated with Disseminated Intravascular Coagulation (DIC) and Postpartum Hemorrhage (PPH).

Q: A patient with heart disease delivers. What should be given postpartum?

Furosemide. **Explanation:** The immediate postpartum period is the most critical time for a patient with heart disease. Following the delivery of the placenta, there is a massive "autotransfusion" of approximately 500–800 mL of blood from the uteroplacental circulation back into the systemic circulation. Additionally, the relief of inferior vena cava compression by the gravid uterus further increases venous return. **Why Furosemide is the Correct Answer:** This sudden increase in preload (volume overload) can lead to acute heart failure and pulmonary edema in a compromised heart. **Furosemide (Lasix)**, a potent loop diuretic, is administered to rapidly decrease this intravascular volume and prevent cardiac decompensation. **Analysis of Incorrect Options:** * **Methergine (Methylergonovine):** This is strictly **contraindicated** in cardiac patients. It causes peripheral vasoconstriction and can lead to sudden hypertension, coronary artery vasospasm, and acute heart failure. * **IVF fluids (1000 ml):** Rapid fluid administration is dangerous as it exacerbates the volume overload already occurring due to autotransfusion, increasing the risk of pulmonary edema. * **ACE Inhibitors:** While used in chronic heart failure management, they are not the immediate priority in the acute postpartum transition to prevent volume overload. **Clinical Pearls for NEET-PG:** * **Most dangerous time:** The first **24–48 hours postpartum** is the period of highest risk for cardiac failure. * **Uterotonic of choice:** **Oxytocin** (in dilute infusion) is the safest uterotonic for cardiac patients. Avoid bolus doses as they cause hypotension. * **Antibiotic Prophylaxis:** No longer routinely recommended for most cardiac lesions during delivery unless there is an active infection (as per recent AHA/ACOG guidelines), except for high-risk conditions like prosthetic valves.

Q: Abruptio placentae can be classified on the basis of which of the following?

Clinical findings. Abruptio placentae is primarily a **clinical diagnosis**. The most widely accepted classification system used in clinical practice is the **Sher’s Classification**, which categorizes the severity of placental abruption based on **clinical findings** such as vaginal bleeding, uterine tenderness, fetal distress, and maternal hemodynamic stability. ### Why "Clinical Findings" is Correct: The management of abruption depends on the degree of clinical compromise. Sher’s Classification grades abruption as: * **Grade 0:** Asymptomatic (diagnosed retrospectively by finding a retroplacental clot). * **Grade 1:** Mild (slight bleeding, no fetal distress). * **Grade 2:** Moderate (tense/tender uterus, fetal distress present). * **Grade 3:** Severe (maternal shock, fetal death, often associated with coagulopathy). ### Why Other Options are Incorrect: * **A. Anatomic locations:** This refers to the classification of *Placenta Previa* (e.g., Type I-IV), not abruption. * **B. Pathological features:** While coagulopathy (DIC) is a complication of Grade 3 abruption, it is a consequence rather than the primary basis for classification. * **D. Investigations (Ultrasound):** Ultrasound has low sensitivity (~25-50%) for detecting abruption. A negative ultrasound does **not** rule out abruption; therefore, it is not used as the basis for classification. ### High-Yield Clinical Pearls: * **Classic Triad:** Painful vaginal bleeding, uterine tenderness/hypertonicity, and fetal distress. * **Couvelaire Uterus:** A pathological finding where blood extravasates into the myometrium (port-wine appearance); it is not a reason for hysterectomy unless the uterus is atonic. * **Most common cause of DIC in pregnancy:** Abruptio placentae. * **Risk Factor:** Hypertension (most common), trauma, and cocaine use.

Q: What is the most common explanation for fetal tachycardia?

Maternal fever from amnionitis. **Explanation:** Fetal tachycardia is defined as a baseline fetal heart rate (FHR) greater than **160 beats per minute (bpm)** for at least 10 minutes. **Why Option B is Correct:** The most common cause of fetal tachycardia is **maternal fever**, often resulting from **chorioamnionitis (amnionitis)**. As maternal body temperature rises, the heat is transferred to the fetus. This increases the fetal metabolic rate and oxygen demand, leading to a compensatory increase in heart rate. In the context of labor, a rising FHR baseline is frequently the earliest clinical sign of intrauterine infection, often appearing before maternal pyrexia is fully manifest. **Analysis of Incorrect Options:** * **Option A:** While sympathomimetic drugs (e.g., Terbutaline, Ritodrine) cause tachycardia, and parasympatholytic drugs (e.g., Atropine) can increase FHR by blocking vagal tone, these are pharmacological interventions and not the most common clinical explanation encountered in labor wards. * **Option C & D:** Fetal cardiac defects and arrhythmias (like supraventricular tachycardia) are significant causes of persistent, extreme tachycardia (>200 bpm), but they are statistically rare compared to maternal infectious processes. **High-Yield Clinical Pearls for NEET-PG:** * **Definition:** Normal FHR is 110–160 bpm. * **Early Sign:** Fetal tachycardia is often the first sign of **fetal hypoxia** (due to sympathetic stimulation) before it progresses to bradycardia. * **Other Causes:** Maternal hyperthyroidism, fetal anemia, and fetal prematurity (due to an immature parasympathetic system). * **Management:** If tachycardia is due to amnionitis, management involves hydration, antipyretics, and broad-spectrum antibiotics.

Q: Which one of the following medical disorders leads to delayed fetal lung maturity?

Diabetes. **Explanation:** The correct answer is **Diabetes**. Fetal lung maturity is primarily determined by the production of pulmonary surfactant (phospholipids like lecithin). In pregnancies complicated by maternal diabetes, maternal hyperglycemia leads to **fetal hyperinsulinemia**. High levels of fetal insulin act as a potent antagonist to the action of cortisol on the type II pneumocytes. This inhibits the synthesis of surfactant proteins and phospholipids, specifically delaying the appearance of **Phosphatidylglycerol (PG)**. Consequently, infants of diabetic mothers are at a higher risk of Respiratory Distress Syndrome (RDS) even at relatively mature gestational ages. **Analysis of Incorrect Options:** * **Heart Disease:** Chronic maternal hypoxia or circulatory compromise (as seen in heart disease) acts as a form of chronic fetal stress. Stress triggers the premature release of endogenous fetal glucocorticoids, which actually **accelerates** lung maturity. * **Thalassemia Minor:** This is generally an asymptomatic carrier state and does not significantly alter the intrauterine environment or fetal hormonal milieu to delay lung maturation. * **Epilepsy:** While the medications used (anti-epileptics) may have teratogenic risks, the disorder itself does not interfere with the biochemical pathways of surfactant production. **High-Yield Clinical Pearls for NEET-PG:** * **Accelerated Lung Maturity:** Seen in conditions causing **chronic placental insufficiency** or fetal stress (e.g., Preeclampsia, Chronic Hypertension, IUGR, Premature Rupture of Membranes, and Maternal Smoking). * **Delayed Lung Maturity:** Primarily associated with **Diabetes Mellitus** and **Rh Isoimmunization**. * **Gold Standard:** The presence of **Phosphatidylglycerol (PG)** in amniotic fluid is the most reliable indicator of lung maturity in diabetic pregnancies, as the L/S ratio can sometimes be falsely reassuring.

Question 1

What is the recommended treatment for cholera during pregnancy?

Accepted Answer

Azithromycin

Answer

Furazolidone

Answer

Tetracycline

Answer

Doxycycline

Question 2

A patient presents with a history of recurrent early pregnancy loss. What investigations should be ordered?

Accepted Answer

Hemogram and blood grouping

Answer

VDRL

Answer

Toxoplasma serology

Answer

Rubella screening

Question 3

Which lung head ratio is associated with a good prognosis?

Accepted Answer

Greater than 1.4

Answer

Less than 1

Answer

Less than 1.4

Answer

Greater than 1

Question 4

What is the most common route of transmission of HIV from mother to baby?

Accepted Answer

During vaginal delivery

Answer

During pregnancy (vertical transmission)

Answer

Through breast milk

Answer

Through constant touch and handling

Question 5

Which type of hepatitis is prevalent in pregnancy?

Accepted Answer

Hepatitis E

Answer

Hepatitis A

Answer

Hepatitis B

Answer

Hepatitis C

Question 6

A patient with heart disease delivers. What should be given postpartum?

Accepted Answer

Furosemide

Answer

Ace inhibitors

Answer

Methergine

Answer

IVF fluids 1000 ml over the next 4 hours

Question 7

Abruptio placentae can be classified on the basis of which of the following?

Accepted Answer

Clinical findings

Answer

Anatomic locations of placenta

Answer

Pathological features including blood coagulation profile

Answer

Investigations using ultrasound

Question 8

Which type of hepatitis causes more morbidity in pregnant females?

Accepted Answer

Hepatitis E

Answer

Hepatitis A

Answer

Hepatitis B

Answer

Hepatitis C

Question 9

What is the most common explanation for fetal tachycardia?

Accepted Answer

Maternal fever from amnionitis

Answer

Maternal administration of parasympathetic or sympathomimetic drugs

Answer

Fetal cardiac defects

Answer

Cardiac arrhythmias

Question 10

Which one of the following medical disorders leads to delayed fetal lung maturity?

Accepted Answer

Diabetes

Answer

Heart disease

Answer

Thalassemia minor

Answer

Epilepsy

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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