Maternal-Fetal Medicine Practice Questions

Q: Which of the following conditions typically improves during pregnancy?

Rheumatoid arthritis. **Explanation:** **Rheumatoid Arthritis (RA)** is the correct answer because approximately **75–90% of patients** experience significant clinical improvement or even complete remission during pregnancy. This improvement is primarily attributed to the **shift from a Th1 (pro-inflammatory) to a Th2 (anti-inflammatory) cytokine profile**, increased levels of circulating progesterone, and the presence of fetal-maternal HLA disparity, which induces a state of maternal immune tolerance. However, it is important to note that up to 90% of these patients will experience a **flare-up in the postpartum period**. **Analysis of Incorrect Options:** * **Multiple Sclerosis (MS):** While the relapse rate often decreases during the second and third trimesters, MS does not "typically improve" in the same predictable manner as RA. Furthermore, there is a significantly high risk of relapse in the first 3 months postpartum. * **Systemic Lupus Erythematosus (SLE):** Pregnancy is generally a period of **exacerbation** for SLE. It can trigger new flares (especially lupus nephritis) and is associated with increased risks of preeclampsia, fetal loss, and Neonatal Lupus (due to Anti-Ro/SSA and Anti-La/SSB antibodies). * **Myasthenia Gravis:** The course is highly unpredictable. One-third improve, one-third worsen, and one-third remain stable. It is not characterized by typical improvement. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice for RA in pregnancy:** Sulfasalazine and Hydroxychloroquine are considered safe. **Methotrexate and Leflunomide are strictly contraindicated** (teratogenic). * **Postpartum Flare:** RA is notorious for flaring up 6–12 weeks after delivery. * **SLE & Pregnancy:** Patients should ideally be in remission for at least 6 months before conceiving to ensure the best maternal and fetal outcomes.

Q: Congenital heart block develops in fetuses of women suffering from which of the following conditions?

Systemic Lupus Erythematosus (SLE). **Explanation:** **Correct Answer: A. Systemic Lupus Erythematosus (SLE)** The association between maternal SLE and **Congenital Complete Heart Block (CCHB)** is a classic high-yield topic in Maternal-Fetal Medicine. The underlying mechanism involves the transplacental passage of maternal IgG autoantibodies, specifically **Anti-Ro (SS-A)** and **Anti-La (SS-B)**. These antibodies cross the placenta (usually between 18–24 weeks of gestation) and cause an inflammatory reaction in the fetal heart, leading to fibrosis and permanent damage to the Atrioventricular (AV) node. Once complete heart block develops, it is typically irreversible and carries a high risk of fetal hydrops and neonatal mortality. **Why other options are incorrect:** * **B. Epilepsy:** Maternal epilepsy is primarily associated with risks related to **Anti-Epileptic Drugs (AEDs)**, such as Valproate, which can cause Neural Tube Defects (NTDs) or orofacial clefts, but not congenital heart block. * **C. Rheumatoid Arthritis (RA):** While RA is an autoimmune condition, it is rarely associated with Anti-Ro/La antibodies. It generally does not adversely affect the fetal heart. * **D. Ankylosing Spondylitis:** This is a seronegative spondyloarthropathy (HLA-B27 associated) and does not involve the autoantibodies responsible for fetal conduction defects. **NEET-PG High-Yield Pearls:** * **Neonatal Lupus Syndrome:** Characterized by CCHB, photosensitive skin rashes, and cytopenias. While the rash and cytopenia resolve as maternal antibodies wane, the **heart block is permanent**. * **Screening:** Pregnant women with known SLE/Anti-Ro antibodies should undergo weekly or bi-weekly **fetal echocardiography** from 18 to 26 weeks to monitor the PR interval. * **Treatment:** If early-stage (incomplete) block is detected, maternal **fluorinated corticosteroids** (Dexamethasone or Betamethasone) are used as they cross the placenta and reduce inflammation.

Q: As per WHO, anemia is considered to exist in pregnancy if the hemoglobin level is below what value?

11 gm%. **Explanation:** The correct answer is **11 gm%**. According to the **World Health Organization (WHO)**, anemia in pregnancy is defined as a hemoglobin (Hb) concentration of **< 11 g/dL** (or a hematocrit < 33%). This threshold is lower than that for non-pregnant women (12 g/dL) due to the physiological changes of pregnancy. During gestation, there is a disproportionate increase in plasma volume (approx. 50%) compared to red cell mass (approx. 20-30%), leading to **hemodilution**, often referred to as "physiological anemia of pregnancy." **Analysis of Options:** * **11 gm% (Correct):** The WHO standard for anemia throughout pregnancy. However, note that the CDC and some guidelines suggest < 10.5 g/dL specifically during the second trimester. * **12 gm% (Incorrect):** This is the WHO cutoff for anemia in **non-pregnant, non-lactating adult women**. * **13 gm% (Incorrect):** This is the WHO cutoff for anemia in **adult men**. * **14 gm% (Incorrect):** This represents a normal, healthy hemoglobin level and is never used as a diagnostic cutoff for anemia. **High-Yield Clinical Pearls for NEET-PG:** 1. **ICMR/Government of India Classification:** While WHO uses < 11 g/dL, the National Iron Plus Initiative (NIPI) in India classifies severity as: * **Mild:** 10 – 10.9 g/dL * **Moderate:** 7 – 9.9 g/dL * **Severe:** < 7 g/dL * **Very Severe:** < 4 g/dL 2. **Most Common Cause:** Iron deficiency anemia (IDA) is the most common cause of anemia in pregnancy worldwide. 3. **Prophylaxis:** Under the *Anemia Mukt Bharat* strategy, pregnant women should receive **60 mg elemental iron and 500 mcg folic acid** daily for 180 days, starting from the second trimester.

Q: In asymmetrical Intrauterine Growth Restriction (IUGR), which organ is typically spared from significant growth restriction?

Brain. **Explanation:** In **Asymmetrical Intrauterine Growth Restriction (IUGR)**, the correct answer is the **Brain**. This phenomenon is known as the **"Brain-Sparing Effect."** **1. Why the Brain is spared:** Asymmetrical IUGR typically occurs in the late second or third trimester, often due to placental insufficiency (e.g., maternal hypertension or pre-eclampsia). When the fetus faces a chronic shortage of nutrients and oxygen, it undergoes a hemodynamic redistribution. Blood flow is preferentially shunted toward vital organs—the **brain, heart, and adrenal glands**—at the expense of peripheral and abdominal organs. This ensures that neurological development is prioritized despite the growth restriction. **2. Why other options are incorrect:** * **Liver:** This is the most significantly affected organ. The liver size decreases due to depleted glycogen stores and reduced venous return from the umbilical vein. This leads to a reduced abdominal circumference (AC), which is the earliest sign of asymmetrical IUGR. * **Subcutaneous Fat and Muscle:** These are non-essential tissues during fetal stress. The body mobilizes these energy stores to support vital organ function, leading to the characteristic "scrawny" appearance of the newborn with wasted extremities. **High-Yield Clinical Pearls for NEET-PG:** * **Ponderal Index:** It is **low** in asymmetrical IUGR (the baby is "thin") but normal in symmetrical IUGR. * **HC/AC Ratio:** In asymmetrical IUGR, the Head Circumference (HC) to Abdominal Circumference (AC) ratio is **increased** (>1.0). * **Symmetrical IUGR:** Usually occurs early in pregnancy due to intrinsic factors (chromosomal anomalies, TORCH infections). Here, all organs, including the brain, are proportionately small. * **Diagnosis:** The single most sensitive parameter for diagnosing asymmetrical IUGR is a **lagging Abdominal Circumference (AC)** on ultrasound.

Q: The clinical diagnosis of threatened abortion is presumed when a bloody vaginal discharge appears through a closed cervical os during which period of pregnancy?

First half of pregnancy. **Explanation:** **1. Why Option A is Correct:** The definition of **Threatened Abortion** is clinically specific: it refers to vaginal bleeding occurring before the **20th week of gestation** (the first half of pregnancy) in the presence of a **closed cervical os**. At this stage, the fetus is still viable, and the pregnancy may continue. The "first half of pregnancy" is the standard medical threshold because, after 20 weeks (or 24 weeks in some jurisdictions), the fetus reaches the age of viability, and any bleeding or complications are categorized under different clinical entities like antepartum hemorrhage or preterm labor. **2. Why Other Options are Incorrect:** * **Option B & C:** Bleeding in the second half of pregnancy or the third trimester is classified as **Antepartum Hemorrhage (APH)**. Common causes include Abruptio Placentae or Placenta Previa. The term "abortion" is never used for complications occurring after the point of viability. * **Option D:** Since the terminology changes based on gestational age, "All" is incorrect. **3. NEET-PG High-Yield Pearls:** * **Cervical Os Status:** In Threatened Abortion, the internal os is always **closed**. If the os is open with bleeding, it is classified as an Inevitable or Incomplete abortion. * **Prognosis:** Approximately 50% of threatened abortions proceed to actual miscarriage. However, if fetal heart activity is documented on ultrasound, the chance of pregnancy continuation is >90%. * **Management:** The mainstay of treatment is **expectant management** and bed rest (though evidence for bed rest is limited). Progesterone supplementation is often used if a corpus luteum deficiency is suspected. * **Differential Diagnosis:** Always rule out ectopic pregnancy and molar pregnancy in any patient presenting with first-trimester bleeding.

Q: A primigravida at full term complains of faintness when lying supine, which resolves when she turns to her side or sits up. What is the most likely cause of this symptom?

Inferior vena cava (IVC) compression. **Explanation:** The clinical presentation described is a classic case of **Supine Hypotension Syndrome** (also known as Aortocaval Compression). **1. Why the correct answer is right:** In a term pregnancy, the gravid uterus is heavy and bulky. When the patient lies in the supine position, the uterus gravitates backward, compressing the **Inferior Vena Cava (IVC)** against the vertebral column. This leads to: * Decreased venous return to the heart (reduced preload). * A subsequent fall in cardiac output. * Systemic hypotension, leading to symptoms of faintness, dizziness, or nausea. Turning to the **left lateral position** relieves the compression, restores venous return, and resolves the symptoms. **2. Why the incorrect options are wrong:** * **A. Increased abdominal pressure:** While intra-abdominal pressure does increase in pregnancy, it causes symptoms like GERD or breathlessness, not acute postural syncope. * **C. Increased intracranial pressure:** This would typically present with headaches, projectile vomiting, or papilledema, and is not relieved by simple postural changes. * **D. Orthostatic hypotension after a meal:** Orthostatic hypotension occurs upon standing, not lying down. Post-prandial symptoms are unrelated to the mechanical compression seen in late pregnancy. **High-Yield Clinical Pearls for NEET-PG:** * **The "Poseiro Effect":** This refers to the compression of the abdominal aorta (rather than the IVC) by the uterus, which can lead to fetal distress without maternal hypotension. * **Management:** Always advise pregnant women in the third trimester to sleep in the **left lateral position** to maximize uterine blood flow. * **Clinical Significance:** During CPR in a pregnant woman, manual left uterine displacement (LUD) is a critical step to relieve IVC compression and improve the efficacy of chest compressions.

Q: Which of the following is NOT a risk factor for preeclampsia?

Diabetes in pregnancy. **Explanation:** The correct answer is **A. Diabetes in pregnancy**. In the context of NEET-PG, it is crucial to distinguish between **Pre-gestational Diabetes** (Type 1 or Type 2) and **Gestational Diabetes (GDM)**. While pre-gestational diabetes is a well-established major risk factor for preeclampsia due to underlying vasculopathy, simple "Diabetes in pregnancy" (often implying GDM) is generally considered a *consequence* of shared metabolic risk factors rather than a primary independent trigger, making it the "least" correct risk factor among the options provided in classic MCQ patterns. **Analysis of Options:** * **B. Hydatidiform Mole:** This is a high-yield risk factor. The hyperplacentosis (excessive trophoblastic tissue) leads to high levels of sFlt-1 and other anti-angiogenic factors. Preeclampsia occurring before 20 weeks is highly suggestive of a molar pregnancy. * **C. Primipara:** Nulliparity or being a primigravida is a classic risk factor. The "first exposure" to paternal antigens and the lack of previous uterine vascular remodeling increase the risk. * **D. Previous history of preeclampsia:** This is the strongest predictor for the development of preeclampsia in a subsequent pregnancy. **High-Yield Clinical Pearls for NEET-PG:** * **Major Risk Factors:** Previous preeclampsia, chronic hypertension, pre-gestational diabetes, multifetal gestation, and autoimmune diseases (SLE, APS). * **Moderate Risk Factors:** Nulliparity, obesity (BMI >30), family history, and advanced maternal age (≥35). * **Prophylaxis:** Low-dose Aspirin (75–150 mg) started before 16 weeks is recommended for women with high-risk factors. * **Protective Factor:** Interestingly, **smoking** is associated with a *decreased* risk of preeclampsia (though not recommended due to other fetal risks).

Q: Which of the following statements is NOT true regarding the use of Nifedipine in pregnant women with hypertension?

None of the above.. **Explanation:** The correct answer is **D (None of the above)** because all the statements (A, B, and C) are clinically accurate regarding the use of Nifedipine in pregnancy. * **Option A (True):** While Nifedipine is a first-line agent for managing severe hypertension in pregnancy, its rapid-acting oral formulation can occasionally cause a precipitous drop in blood pressure. This may lead to reflex tachycardia and decreased coronary perfusion, potentially triggering **myocardial infarction**. Additionally, excessive fluid resuscitation combined with peripheral vasodilation can lead to **pulmonary edema**. * **Option B (True):** Nifedipine is a Calcium Channel Blocker (CCB) that inhibits the influx of calcium into the myometrium, leading to smooth muscle relaxation. It is widely used as a **first-line tocolytic agent** for preterm labor due to its efficacy and favorable side-effect profile compared to beta-mimetics. * **Option C (True):** Both Nifedipine and Magnesium Sulfate ($MgSO_4$) inhibit calcium entry into cells. When used concurrently, Nifedipine can **potentiate the neuromuscular blocking effect** of $MgSO_4$, theoretically increasing the risk of muscular paralysis or respiratory depression, though this is rare in clinical practice. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Blocks L-type calcium channels. * **Dosage:** For acute hypertensive crisis, 10–20 mg orally (not sublingually, as sublingual use is associated with unpredictable absorption and sudden hypotension). * **Side Effects:** Headache, flushing, and peripheral edema are common. * **Contraindication:** Avoid in women with known hypersensitivity to CCBs or specific cardiac conditions like aortic stenosis.

Question 1

Which of the following conditions typically improves during pregnancy?

Accepted Answer

Rheumatoid arthritis

Answer

Multiple sclerosis

Answer

Systemic lupus erythematosus (SLE)

Answer

Myasthenia gravis

Question 2

Congenital heart block develops in fetuses of women suffering from which of the following conditions?

Accepted Answer

Systemic Lupus Erythematosus (SLE)

Answer

Epilepsy

Answer

Rheumatoid arthritis

Answer

Ankylosing spondylitis

Question 3

As per WHO, anemia is considered to exist in pregnancy if the hemoglobin level is below what value?

Accepted Answer

11 gm%

Answer

14 gm%

Answer

12 gm%

Answer

13 gm%

Question 4

In asymmetrical Intrauterine Growth Restriction (IUGR), which organ is typically spared from significant growth restriction?

Accepted Answer

Brain

Answer

Subcutaneous fat

Answer

Muscle

Answer

Liver

Question 5

The clinical diagnosis of threatened abortion is presumed when a bloody vaginal discharge appears through a closed cervical os during which period of pregnancy?

Accepted Answer

First half of pregnancy

Answer

Second half of pregnancy

Answer

Third trimester

Answer

All

Question 6

Which of the following statements regarding the transmission of HIV to an infant from an infected mother are true?

Accepted Answer

Start zidovudine during labor, 25% chance of vertical transmission, and avoid breastfeeding.

Answer

Start zidovudine during labor, 25% chance of vertical transmission, and vaccinate infant with OPV and MMR.

Answer

Start zidovudine during labor, avoid breastfeeding, and Cesarean section causes less transmission.

Answer

Start zidovudine during labor, vaccinate infant with OPV and MMR, and Cesarean section causes less transmission.

Question 7

A primigravida at full term complains of faintness when lying supine, which resolves when she turns to her side or sits up. What is the most likely cause of this symptom?

Accepted Answer

Inferior vena cava (IVC) compression

Answer

Increased abdominal pressure

Answer

Increased intracranial pressure

Answer

Orthostatic hypotension after a meal

Question 8

Which of the following is NOT a risk factor for preeclampsia?

Accepted Answer

Diabetes in pregnancy

Answer

Hydatidiform mole

Answer

Primipara

Answer

Previous history of preeclampsia

Question 9

A 19-year-old primigravida presents with vaginal bleeding, an enlarged-for-dates uterus, and absent fetal heart sounds. Ultrasound findings are consistent with this presentation. What is the most likely diagnosis?

Accepted Answer

Hydatidiform mole

Answer

Sarcoma botryoides

Answer

Tuberculous endometritis

Answer

Adenocarcinoma of the uterus

Question 10

Which of the following statements is NOT true regarding the use of Nifedipine in pregnant women with hypertension?

Accepted Answer

None of the above.

Answer

Can cause myocardial infarction and pulmonary edema in patients with severe gestational hypertension.

Answer

Also used for tocolysis in preterm labor.

Answer

Can potentiate the action of magnesium sulfate given for eclampsia neuroprophylaxis.

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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