Maternal-Fetal Medicine Practice Questions

Q: What is the characteristic finding of ectopic pregnancy on ultrasonography?

Absence of the gestational sac within the uterus. ### Explanation The diagnosis of ectopic pregnancy relies on the correlation of clinical findings, quantitative β-hCG levels, and ultrasonography (USG). **1. Why Option A is Correct:** The **absence of an intrauterine gestational sac** in a patient with a positive pregnancy test (especially when β-hCG is above the **discriminatory zone**, typically 1,500–2,000 mIU/mL for transvaginal sonography) is the most fundamental finding. While seeing an extrauterine embryo with a heartbeat is 100% specific, it is only seen in a minority of cases. Therefore, the "empty uterus" sign is the primary red flag that necessitates a thorough search for an ectopic gestation. **2. Analysis of Incorrect Options:** * **Option B:** While a **complex adnexal mass** (the "blob sign") is the most common USG finding in ectopic pregnancy (present in ~60-80% of cases), it is not as definitive as the absence of an intrauterine sac, as it can be confused with a corpus luteum or inflammatory mass. * **Option C:** Ectopic pregnancies typically show **low resistance flow** (high diastolic flow) on color Doppler, often referred to as the **"Ring of Fire"** sign. Increased resistance is incorrect. * **Option D:** **Free fluid** (hemoperitoneum) in the Pouch of Douglas is a common finding, especially in ruptured ectopics, but it is non-specific and can occur with ruptured hemorrhagic cysts or ovulation. **Clinical Pearls for NEET-PG:** * **Pseudogestational Sac:** A midline fluid collection in the uterus (without a yolk sac or double decidual sign) seen in 10% of ectopics. Do not mistake this for a normal pregnancy. * **Double Decidual Sac Sign:** A feature of a true intrauterine pregnancy; its absence helps confirm an ectopic. * **Gold Standard:** Laparoscopy remains the gold standard for diagnosis, though USG + β-hCG is the standard initial approach. * **Most Common Site:** The **Ampulla** of the Fallopian tube.

Q: A woman undergoes chorionic villous sampling at 11 weeks gestation. The result shows two cell lines: 46, XY and 47, XY, +21. What is your next step?

Perform amniocentesis for further confirmation. **Explanation:** The presence of two different cell lines (one normal and one aneuploid) in a Chorionic Villus Sampling (CVS) specimen is known as **Confined Placental Mosaicism (CPM)**. This occurs in approximately 1–2% of CVS procedures. Because CVS samples the trophoblastic tissue (placenta) rather than the fetus itself, the mosaicism may be restricted to the placenta while the fetus remains euploid. **Why Option C is Correct:** To differentiate between CPM and true fetal mosaicism, a definitive test that samples fetal cells is required. **Amniocentesis** (typically performed after 15 weeks) is the gold standard in this scenario. Amniocytes are derived from the fetus (skin, respiratory, and urinary tracts), providing a more accurate representation of the fetal karyotype than placental villi. **Why Other Options are Incorrect:** * **Option A:** Repeating CVS would likely yield the same placental results and does not resolve the diagnostic dilemma of whether the fetus is affected. * **Option B:** Ignoring the result is negligent, as there is still a significant risk that the fetus carries the trisomy 21 cell line. * **Option D:** Diagnosing Down syndrome based solely on a mosaic CVS result may lead to the termination of a genetically normal fetus. A definitive diagnosis requires amniocentesis. **Clinical Pearls for NEET-PG:** * **CVS Timing:** 10–13 weeks. It cannot detect Neural Tube Defects (NTDs) as it doesn't measure AFP. * **Amniocentesis Timing:** 15–20 weeks. * **Confined Placental Mosaicism (CPM):** Always consider this when CVS shows mosaicism but the ultrasound is normal. * **Risk of miscarriage:** CVS (~0.5–1%) is slightly higher than or equal to mid-trimester amniocentesis (~0.1–0.5%).

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

Multigravida. ### Explanation **Correct Answer: D. Multigravida** **1. Why Multigravida is the Correct Answer:** Preeclampsia is classically a disease of **primigravidae** (first-time mothers). The underlying pathophysiology involves an immune maladaptation to paternal antigens during the first exposure. Being a **multigravida** (especially with the same partner) is actually a **protective factor**, as the maternal immune system has been previously "sensitized" to fetal/placental antigens, reducing the risk of placental dysfunction. **2. Why the Other Options are Wrong (Risk Factors):** * **A. Antiphospholipid Syndrome (APS):** This is one of the strongest high-risk factors. It causes a prothrombotic state and defective trophoblastic invasion, leading to placental ischemia. * **B. Obesity:** A BMI >30 kg/m² is a significant risk factor. Obesity is associated with chronic inflammation and insulin resistance, which trigger endothelial dysfunction—the hallmark of preeclampsia. * **C. Previous History of Preeclampsia:** This is the single most important predictor. A woman with a history of preeclampsia has a 7-10x higher risk of recurrence in subsequent pregnancies. **3. High-Yield Clinical Pearls for NEET-PG:** * **The "New Partner" Rule:** If a multigravida has a child with a **new partner**, her risk resets to that of a primigravida (due to new paternal antigens). * **High-Risk Factors (Aspirin Indicated):** History of preeclampsia, Chronic Hypertension, Type 1 or 2 Diabetes, Renal disease, and Autoimmune diseases (SLE/APS). * **Moderate Risk Factors:** Nulliparity, Obesity, Family history (mother/sister), Age ≥35, and Multifetal gestation. * **Prophylaxis:** Low-dose Aspirin (75–150 mg) started before 16 weeks of gestation is recommended for women with high-risk factors.

Q: Abortion in the second trimester is mostly due to:

Incompetent cervix. **Explanation:** The majority of spontaneous abortions (miscarriages) occur in the first trimester, primarily due to chromosomal abnormalities. However, once a pregnancy reaches the **second trimester (13–28 weeks)**, the etiology shifts from genetic factors to anatomical and maternal factors. **1. Why "Incompetent Cervix" is correct:** Cervical insufficiency (incompetent cervix) is the most common cause of mid-trimester pregnancy loss. It is characterized by the painless dilation of the cervix, leading to the prolapse of membranes and subsequent expulsion of a premature but often morphologically normal fetus. This occurs because the cervix fails to remain closed against the increasing intrauterine pressure as the fetus grows. **2. Analysis of Incorrect Options:** * **Defective Genes (Chromosomal Abnormalities):** This is the leading cause of **first-trimester** abortions (approx. 50–60%). While they can cause second-trimester loss, their frequency decreases significantly as the pregnancy advances. * **Tuberculosis:** While genital TB is a major cause of primary and secondary infertility (due to tubal blockage or endometrial scarring), it is a rare cause of spontaneous abortion compared to anatomical defects. * **Trauma:** Though a common concern for patients, physical trauma is rarely the cause of abortion unless it is severe enough to cause placental abruption or direct uterine injury. **NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVS) showing a cervical length **<25 mm** or "funneling" of the internal os before 24 weeks. * **Treatment:** Cervical Cerclage (e.g., **McDonald’s or Shirodkar’s procedure**), typically performed between 14–18 weeks of gestation. * **Classic History:** Repeated, painless, mid-trimester abortions preceded by spontaneous rupture of membranes.

Q: Intrahepatic cholestasis of pregnancy typically occurs in which trimester?

Third trimester. **Explanation:** **Intrahepatic Cholestasis of Pregnancy (ICP)** is a reversible type of hormone-influenced cholestasis. The correct answer is the **Third Trimester** because this is when serum estrogen and progesterone levels reach their peak. High levels of estrogen (specifically estriol) and progesterone metabolites interfere with the transport of bile acids across the canalicular membrane, leading to their accumulation in the systemic circulation. * **Why Third Trimester is Correct:** Approximately 80% of cases occur after 30 weeks of gestation. The increasing hormonal load and the stretching of the gallbladder lead to decreased bile flow (cholestasis). * **Why other options are incorrect:** * **First Trimester:** Hormonal levels are not yet high enough to cause significant cholestasis. * **Second Trimester:** While possible in late second trimester, it is statistically much less common than the third. * **Postpartum:** ICP is characterized by the **rapid resolution** of symptoms (usually within 48 hours) after delivery as hormone levels plummet. **Clinical Pearls for NEET-PG:** 1. **Hallmark Symptom:** Pruritus, which is typically worse at night and characteristically involves the **palms and soles**. There is **no primary rash**. 2. **Diagnostic Gold Standard:** Elevated **Total Serum Bile Acids (TSBA)** >10 µmol/L. 3. **Fetal Risk:** Increased risk of sudden intrauterine fetal death (IUFD), meconium-stained liquor, and preterm labor. 4. **Management:** **Ursodeoxycholic Acid (UDCA)** is the drug of choice to reduce pruritus and improve biochemical parameters. Delivery is usually recommended by 37–38 weeks to prevent stillbirth.

Q: A 30-year-old primigravida presents with a blood pressure of 160/96 mm Hg. Her BUN is 14 mg/dL and creatinine is 1.0 mg/dL. Urinalysis shows no proteinuria. Complete blood count and liver function tests are within normal limits. What is the first best drug to be given to this patient?

Labetalol. ### Explanation **Diagnosis:** The patient is a primigravida with a blood pressure of 160/96 mm Hg, normal renal/liver function, and no proteinuria. This presentation is consistent with **Gestational Hypertension** (if >20 weeks) or **Chronic Hypertension** (if <20 weeks). Regardless of the specific classification, the immediate clinical goal is the safe management of hypertension in pregnancy. **Why Labetalol is Correct:** Labetalol is a combined alpha- and beta-adrenergic blocker and is considered a **first-line antihypertensive agent** in pregnancy. It is preferred due to its rapid onset of action, excellent safety profile, and lack of significant teratogenic effects. It effectively lowers blood pressure without causing significant reflex tachycardia or compromising uteroplacental blood flow. **Analysis of Incorrect Options:** * **Furosemide (A):** Diuretics are generally avoided in pregnancy as they can cause volume depletion and potentially decrease placental perfusion. They are only used in specific cases like pulmonary edema. * **Lisinopril (C) & Losartan (D):** ACE inhibitors and ARBs are **absolutely contraindicated** in pregnancy (Category D/X). They are associated with fetal renal dysgenesis, oligohydramnios, skull hypoplasia, and intrauterine growth restriction (IUGR). **Clinical Pearls for NEET-PG:** * **First-line drugs for Hypertension in Pregnancy:** Oral Labetalol, Methyldopa (safest long-term), and Nifedipine (long-acting). * **Management of Hypertensive Crisis (BP ≥160/110):** IV Labetalol, IV Hydralazine, or Oral Nifedipine. * **Drugs to Avoid:** ACE inhibitors, ARBs, Sodium Nitroprusside (cyanide toxicity), and Spironolactone. * **Target BP:** Aim to maintain systolic between 140–150 mmHg and diastolic between 90–100 mmHg to prevent maternal cerebrovascular accidents without compromising fetal circulation.

Q: Which of the following medications does NOT affect the fetus?

Magnesium sulfate. **Explanation:** The correct answer is **Magnesium Sulfate (MgSO₄)**. In the context of obstetric pharmacology, MgSO₄ is the drug of choice for seizure prophylaxis in pre-eclampsia and management of eclampsia. It is considered safe for the fetus because it does not have teratogenic effects. While it crosses the placenta, it typically only causes minor, transient neonatal effects (such as decreased heart rate variability or mild hypotonia) at therapeutic levels. It is also used for **fetal neuroprotection** in preterm births <32 weeks. **Why the other options are incorrect:** * **Lytic Cocktail (Pethidine, Chlorpromazine, Promethazine):** Historically used for eclampsia, these drugs cross the placenta and cause significant **neonatal respiratory depression** and sedation. * **Warfarin:** A potent teratogen. Exposure during the first trimester (6–9 weeks) leads to **Fetal Warfarin Syndrome** (stippled epiphyses, nasal hypoplasia). In later trimesters, it can cause fetal intracranial hemorrhage. * **Phenytoin:** An anticonvulsant associated with **Fetal Hydantoin Syndrome**, characterized by craniofacial anomalies (cleft lip/palate), phalangeal hypoplasia, and growth retardation. **High-Yield Clinical Pearls for NEET-PG:** * **Therapeutic range of MgSO₄:** 4–7 mEq/L. * **First sign of toxicity:** Loss of patellar reflex (8–10 mEq/L). * **Antidote:** 10% Calcium Gluconate (10 mL IV over 10 minutes). * **Safe Antihypertensives in Pregnancy:** Labetalol (1st line), Methyldopa, Nifedipine, and Hydralazine. * **Contraindicated Antihypertensives:** ACE inhibitors and ARBs (cause fetal renal dysgenesis and oligohydramnios).

Q: What is the easiest method for determining zygosity?

Placental examination. **Explanation:** Determining zygosity in multiple gestations is crucial for risk stratification. **Placental examination** is considered the **easiest and most practical method** for determining zygosity, particularly in the clinical setting immediately following delivery. 1. **Why Placental Examination is Correct:** By examining the placenta and the intervening membranes, clinicians can determine chorionicity. If the twins are **Monochorionic**, they are definitively **Monozygotic** (identical). If they are **Dichorionic**, they can be either dizygotic or monozygotic (if cleavage occurred early). While DNA fingerprinting is the "gold standard" for accuracy, placental examination provides an immediate, non-invasive, and highly reliable clinical assessment of zygosity in most cases. 2. **Analysis of Incorrect Options:** * **Sex of Fetus (B):** While different-sex twins are always dizygotic, same-sex twins can be either monozygotic or dizygotic. Therefore, sex alone is insufficient for a definitive diagnosis. * **Blood Grouping (A):** Different blood groups confirm dizygosity, but identical blood groups do not guarantee monozygosity, as dizygotic twins can share the same blood type by chance. * **Amniotic Fluid Examination (D):** This is primarily used for genetic testing or lung maturity and does not provide a direct structural assessment of zygosity. **NEET-PG High-Yield Pearls:** * **Gold Standard:** DNA Fingerprinting (most accurate). * **Best Ultrasound Sign:** The **"Twin Peak" or "Lambda" (λ) sign** indicates Dichorionic twins; the **"T-sign"** indicates Monochorionic twins. * **Timing of Cleavage:** * 0–72 hours: Dichorionic Diamniotic (DCDA) * 4–8 days: Monochorionic Diamniotic (MCDA) — *Most common type of MZ twins.* * 8–13 days: Monochorionic Monoamniotic (MCMA) * >13 days: Conjoined twins

Question 1

What is the characteristic finding of ectopic pregnancy on ultrasonography?

Accepted Answer

Absence of the gestational sac within the uterus

Answer

A complex adnexal mass

Answer

Increased resistance on color Doppler imaging

Answer

Free fluid in the peritoneal cavity

Question 2

A woman undergoes chorionic villous sampling at 11 weeks gestation. The result shows two cell lines: 46, XY and 47, XY, +21. What is your next step?

Accepted Answer

Perform amniocentesis for further confirmation

Answer

Repeat CVS at 13 weeks gestation

Answer

No further evaluation needed

Answer

Diagnose Down syndrome and counsel the couple

Question 3

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

Accepted Answer

Multigravida

Answer

Antiphospholipid syndrome

Answer

Obesity

Answer

Previous history of preeclampsia

Question 4

All of the following are obstetric clinical criteria for the diagnosis of Antiphospholipid Antibody Syndrome except:

Accepted Answer

One or more episodes of arterial, venous, or small vessel thrombosis in any tissue or organ.

Answer

One or more unexplained deaths of a morphologically normal fetus at or beyond 10 weeks gestation.

Answer

Severe preeclampsia or placental insufficiency necessitating delivery before 34 weeks.

Answer

Three or more unexplained consecutive abortions before 10 weeks gestation.

Question 5

Abortion in the second trimester is mostly due to:

Accepted Answer

Incompetent cervix

Answer

Defective genes

Answer

Tuberculosis

Answer

Trauma

Question 6

Intrahepatic cholestasis of pregnancy typically occurs in which trimester?

Accepted Answer

Third trimester

Answer

First trimester

Answer

Second trimester

Answer

Postpartum period

Question 7

IUGR is defined when:

Accepted Answer

Birth weight is below the tenth percentile for the gestational age

Answer

Birth weight is below the 20th percentile for the gestational age

Answer

Birth weight is below the 30th percentile for the gestational age

Answer

Weight of baby is less than 1000 gm

Question 8

A 30-year-old primigravida presents with a blood pressure of 160/96 mm Hg. Her BUN is 14 mg/dL and creatinine is 1.0 mg/dL. Urinalysis shows no proteinuria. Complete blood count and liver function tests are within normal limits. What is the first best drug to be given to this patient?

Accepted Answer

Labetalol

Answer

Furosemide

Answer

Lisinopril

Answer

Losartan

Question 9

Which of the following medications does NOT affect the fetus?

Accepted Answer

Magnesium sulfate

Answer

Lytic cocktail

Answer

Warfarin

Answer

Phenytoin

Question 10

What is the easiest method for determining zygosity?

Accepted Answer

Placental examination

Answer

Blood grouping

Answer

Sex of fetus

Answer

Amniotic fluid examination

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?