Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs

Question 261: All are true about diabetes in pregnancy except?

A. Macrosomia
B. Intrauterine growth restriction (IUGR)
C. Congenital anomalies
D. Neonatal hyperglycemia (Correct Answer)

Explanation: In maternal diabetes, the pathophysiology is governed by the **Pedersen Hypothesis**: maternal hyperglycemia leads to fetal hyperglycemia, which triggers fetal pancreatic beta-cell hyperplasia and **hyperinsulinism**. **Explanation of the Correct Answer:** * **D. Neonatal Hyperglycemia:** This is the correct "except" choice because infants of diabetic mothers (IDMs) actually experience **Neonatal Hypoglycemia**. After birth, the high glucose supply from the mother is abruptly cut off, but the neonate’s hyperinsulinemic state persists, causing a rapid drop in blood glucose levels (usually within 1–3 hours of birth). **Explanation of Incorrect Options:** * **A. Macrosomia:** Fetal hyperinsulinism acts as a growth hormone, leading to excessive deposition of fat and glycogen (macrosomia), typically defined as a birth weight >4000g. * **B. IUGR:** While Gestational Diabetes (GDM) causes macrosomia, **Pre-gestational Diabetes** (Type 1 or 2) with long-standing vascular complications (vasculopathy) can lead to placental insufficiency, resulting in growth restriction. * **C. Congenital Anomalies:** These occur due to poor glycemic control during organogenesis (first trimester). The most specific anomaly is **Caudal Regression Syndrome**, though the most common are **Cardiac defects** (e.g., VSD, Transposition of Great Arteries). **NEET-PG High-Yield Pearls:** * **Most common metabolic abnormality in IDM:** Hypoglycemia. * **Other metabolic issues:** Hypocalcemia, Hypomagnesemia, and Hyperbilirubinemia. * **Hematologic:** Polycythemia (due to fetal hypoxia and increased erythropoietin). * **Respiratory:** Delayed pulmonary surfactant synthesis leading to **Respiratory Distress Syndrome (RDS)**. * **Cardiac:** Hypertrophic Cardiomyopathy (specifically asymmetric septal hypertrophy).

Question 262: In gestational hypertension, hypertension should resolve by how many weeks in the postpartum period?

A. 2 weeks
B. 6 weeks
C. 8 weeks
D. 12 weeks (Correct Answer)

Explanation: **Explanation:** **1. Why 12 Weeks is Correct:** Gestational hypertension is defined as the new onset of hypertension (Systolic BP ≥140 mmHg or Diastolic BP ≥90 mmHg) after 20 weeks of gestation in a previously normotensive woman, without proteinuria or features of end-organ dysfunction. By definition, this condition is **transient**. According to ACOG and NHBPEP guidelines, the blood pressure must return to normal by **12 weeks postpartum**. If hypertension persists beyond 12 weeks, the diagnosis is revised to **Chronic Hypertension**. **2. Why Other Options are Incorrect:** * **A (2 weeks) & B (6 weeks):** While many patients see a resolution of BP within the first few days or weeks after delivery, these timeframes are too short to be the diagnostic cutoff. Six weeks marks the end of the traditional puerperium, but the physiological changes of pregnancy can take longer to stabilize. * **C (8 weeks):** This is an arbitrary timeframe and does not align with the standardized diagnostic criteria used in international obstetric guidelines. **3. Clinical Pearls & High-Yield Facts for NEET-PG:** * **Transient Hypertension:** If BP resolves by 12 weeks postpartum, the retrospective diagnosis is "Transient Hypertension of Pregnancy." * **Chronic Hypertension:** Hypertension present *before* pregnancy or diagnosed *before* 20 weeks of gestation is termed Chronic Hypertension. * **Preeclampsia:** If gestational hypertension is accompanied by proteinuria (>300mg/24hrs) or signs of end-organ damage (e.g., thrombocytopenia, elevated liver enzymes), it is classified as Preeclampsia. * **Risk Factor:** Women with gestational hypertension have a higher risk of developing essential hypertension and cardiovascular disease later in life.

Question 263: What is the recommended treatment for cholera during pregnancy?

A. Furazolidone
B. Tetracycline
C. Doxycycline
D. Azithromycin (Correct Answer)

Explanation: **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.

Question 264: A patient presents with a history of recurrent early pregnancy loss. What investigations should be ordered?

A. VDRL
B. Toxoplasma serology
C. Hemogram and blood grouping (Correct Answer)
D. Rubella screening

Explanation: 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.

Question 265: What are the signs of heart disease in pregnancy?

A. Diastolic murmur
B. Systolic murmur
C. Tachycardia
D. All of the above (Correct Answer)

Explanation: In pregnancy, the cardiovascular system undergoes significant physiological changes, including a 40-50% increase in blood volume and cardiac output. Distinguishing between normal physiological adaptations and pathological heart disease is critical for NEET-PG. **Explanation of the Correct Answer:** The correct answer is **All of the above** because while pregnancy mimics certain cardiac symptoms, specific clinical findings strongly indicate underlying pathology: * **Diastolic Murmurs:** These are **never physiological** in pregnancy. While a soft systolic flow murmur (Grade I/II) is common due to increased blood flow across valves, any diastolic, presystolic, or continuous murmur suggests organic heart disease (e.g., Mitral Stenosis). * **Systolic Murmurs:** While mild systolic murmurs can be physiological, a **loud systolic murmur (Grade III or higher)** or one associated with a thrill is a definitive sign of heart disease. * **Tachycardia:** Persistent tachycardia or significant arrhythmias (like Atrial Fibrillation) are abnormal. While the resting heart rate increases by 10-15 bpm normally, sustained tachycardia often signals cardiac decompensation. **Why other options are considered part of the "Signs":** In the context of a multiple-choice question, "Signs of heart disease" refers to the clinical criteria used to diagnose cardiac issues in a pregnant patient. According to Burwell and Metcalfe’s criteria, the presence of any of these—especially diastolic murmurs and severe arrhythmias—necessitates further investigation. **High-Yield Clinical Pearls for NEET-PG:** * **Most common heart disease in pregnancy (India):** Rheumatic Heart Disease (Mitral Stenosis is the most common lesion). * **Most common heart disease (Global/Developed):** Congenital Heart Disease. * **Gold Standard Investigation:** Echocardiography. * **Critical Periods for Heart Failure:** 28–32 weeks (peak blood volume), during labor (second stage), and immediately postpartum (autotransfusion from the uterus). * **NYHA Classification:** Used to assess functional capacity; Class III and IV usually contraindicate pregnancy.

Question 266: Which lung head ratio is associated with a good prognosis?

A. Less than 1
B. Less than 1.4
C. Greater than 1
D. Greater than 1.4 (Correct Answer)

Explanation: **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 or < 1.4):** Lower values indicate significant pulmonary hypoplasia. An **LHR < 1.0** is associated with a **poor prognosis** and high mortality (survival rates often < 25-30%), often requiring Extracorporeal Membrane Oxygenation (ECMO). * **Option C (LHR > 1):** While better than < 1, this range is too broad. The specific threshold for a "good" prognosis in clinical guidelines and exam standards is specifically defined as > 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.

Question 267: What is the most common route of transmission of HIV from mother to baby?

A. During pregnancy (vertical transmission)
B. During vaginal delivery (Correct Answer)
C. Through breast milk
D. Through constant touch and handling

Explanation: **Explanation:** The transmission of HIV from mother to child is known as **Vertical Transmission** or **Parent-to-Child Transmission (PPTCT)**. While transmission can occur at various stages, the timing is distributed as follows: 1. **During Pregnancy (In-utero):** Approximately 20% of cases. 2. **During Labor and Delivery (Intrapartum):** Approximately **50–60% of cases**. 3. **Breastfeeding (Postpartum):** Approximately 20–25% of cases. **Why Option B is Correct:** The **intrapartum period (vaginal delivery)** is the most common route because the fetus is exposed to high concentrations of the virus in maternal blood and cervicovaginal secretions. The risk is further increased by the "micro-transfusions" that occur during uterine contractions and the potential for fetal scalp abrasions during the passage through the birth canal. **Analysis of Incorrect Options:** * **Option A:** While vertical transmission is the umbrella term, transmission *during* pregnancy (transplacental) is less common than during delivery because the placenta acts as a partial barrier. * **Option C:** Breast milk contains the virus, but the cumulative risk is lower than the acute exposure during birth. However, in untreated cases, prolonged breastfeeding can significantly increase the total transmission rate. * **Option D:** HIV is not transmitted through casual contact, touch, or respiratory droplets. **High-Yield Clinical Pearls for NEET-PG:** * **Most important determinant of transmission:** Maternal viral load. * **Gold Standard for Prevention:** Highly Active Antiretroviral Therapy (HAART) for the mother and Zidovudine prophylaxis for the neonate. * **Mode of Delivery:** Elective Cesarean Section (at 38 weeks) reduces risk if the viral load is >1000 copies/mL. * **Breastfeeding:** In India, the WHO/NACO guidelines recommend exclusive breastfeeding for 6 months if replacement feeding is not **AFASS** (Affordable, Feasible, Acceptable, Sustainable, and Safe). Mixed feeding is strictly contraindicated.

Question 268: Which type of hepatitis is prevalent in pregnancy?

A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis E (Correct Answer)

Explanation: **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).

Question 269: Which type of hepatitis causes more morbidity in pregnant females?

A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis E (Correct Answer)

Explanation: **Explanation:** **Hepatitis E Virus (HEV)** is the most significant cause of maternal morbidity and mortality among viral hepatitides. While HEV is generally self-limiting in the general population, it takes a fulminant course in pregnant women, particularly during the **second and third trimesters**. **Why Hepatitis E is the Correct Answer:** The mortality rate for HEV in pregnancy can reach as high as **15–25%**. The increased severity is attributed to a combination of factors: * **Hormonal changes:** High levels of estrogen and progesterone may enhance viral replication. * **Immunological shift:** A shift from Th1 to Th2 immune response in pregnancy leads to an altered cytokine profile, making the liver more susceptible to necrosis. * **Complications:** It frequently leads to Fulminant Hepatic Failure (FHF), Disseminated Intravascular Coagulation (DIC), and obstetric complications like Abruptio Placentae. **Why Other Options are Incorrect:** * **Hepatitis A:** While it can cause acute hepatitis, it rarely progresses to fulminant failure and does not show increased severity specifically due to pregnancy. * **Hepatitis B:** It is the most common cause of chronic hepatitis globally. While it poses a high risk of **vertical transmission** to the neonate, it does not typically cause increased maternal morbidity compared to non-pregnant states. * **Hepatitis C:** Primarily leads to chronic infection. Maternal morbidity is generally low; the main concern is the risk of vertical transmission (approx. 5%). **High-Yield Clinical Pearls for NEET-PG:** * **Route of Transmission:** HEV is transmitted via the **fecal-oral route** (water-borne). * **Genotype:** HEV Genotype 1 and 2 are most commonly associated with outbreaks in developing countries like India. * **Vertical Transmission:** HEV has a high rate of vertical transmission, often leading to neonatal hypoglycemia and hypoprothrombinemia. * **Management:** Treatment is primarily supportive; there is no specific antiviral therapy or immunoglobulin currently recommended for post-exposure prophylaxis in pregnancy.

Question 270: What is the common cause of spontaneous abortion in the first trimester?

A. Trisomy 21
B. Monosomy
C. Trauma
D. All of the above (Correct Answer)

Explanation: **Explanation:** Spontaneous abortion (miscarriage) occurs in approximately 10–15% of clinically recognized pregnancies, with the vast majority occurring in the first trimester. The etiology is multifactorial, involving genetic, environmental, and maternal factors. **Why "All of the above" is correct:** 1. **Chromosomal Abnormalities (Trisomy 21 & Monosomy):** Genetic defects are the single most common cause of first-trimester abortions, accounting for 50–60% of cases. * **Autosomal Trisomies** are the most frequent chromosomal finding (approx. 50% of all abnormal karyotypes). While Trisomy 16 is the most common specific trisomy found in abortuses, **Trisomy 21** is also a frequent contributor. * **Monosomy X (45,X - Turner Syndrome)** is the single most common specific chromosomal abnormality found in spontaneous abortions (approx. 20% of chromosomally abnormal cases). 2. **Trauma:** While less common than genetic factors, significant physical trauma or invasive procedures (like CVS) can trigger uterine contractions or placental abruption, leading to pregnancy loss. **High-Yield Clinical Pearls for NEET-PG:** * **Most common overall cause of 1st-trimester abortion:** Chromosomal abnormalities (Genetic factors). * **Most common chromosomal abnormality:** Autosomal Trisomy (specifically Trisomy 16). * **Single most common specific karyotype:** 45,X (Monosomy X). * **Second most common cause:** Endocrine factors (e.g., Luteal Phase Defect, uncontrolled Diabetes). * **Recurrent Pregnancy Loss (RPL):** Defined as $\geq$ 2 consecutive spontaneous abortions. The most common treatable cause is Antiphospholipid Antibody Syndrome (APS).

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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