Maternal-Fetal Medicine Practice Questions

Q: What is the most common complication due to expectant management of preeclampsia?

Placental abruption. **Explanation:** The goal of expectant management in preeclampsia (typically practiced between 24 and 34 weeks of gestation) is to improve neonatal outcomes by allowing for fetal growth and lung maturation. However, this prolongs exposure to a pathophysiological state characterized by systemic vasospasm and endothelial dysfunction. **Why Placental Abruption is the Correct Answer:** Placental abruption is the **most common maternal complication** associated with the expectant management of preeclampsia. The underlying mechanism involves chronic placental ischemia and high systemic vascular resistance, which leads to rupture of the maternal spiral arteries into the decidua basalis. Studies indicate that in patients undergoing expectant management for severe preeclampsia, the incidence of abruption is significantly higher compared to the general obstetric population. **Analysis of Incorrect Options:** * **A. Acute Renal Failure:** While preeclampsia causes glomerular endotheliosis and reduced GFR, frank acute renal failure is less common than abruption unless complicated by HELLP syndrome or massive hemorrhage. * **B. Pulmonary Edema:** This is a life-threatening complication usually triggered by iatrogenic fluid overload or left ventricular failure, but it occurs less frequently than abruption. * **C. Cardiac Arrest:** This is an extremely rare, terminal event and not a standard "common" complication of expectant management. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of death in Preeclampsia:** Cerebral Hemorrhage (Stroke). * **Most common maternal complication of expectant management:** Placental Abruption. * **Indication for immediate delivery:** Signs of maternal/fetal deterioration (e.g., eclampsia, persistent severe headache, pulmonary edema, or non-reassuring CTG) regardless of gestational age. * **Drug of choice for seizure prophylaxis:** Magnesium Sulfate ($MgSO_4$).

Q: A 23-year-old female presents with 42 days of amenorrhea and vaginal spotting. Which of the following is the most useful diagnostic test?

Transvaginal ultrasonography. **Explanation:** The clinical presentation of **amenorrhea (6 weeks) with vaginal spotting** is a classic triad for early pregnancy complications, most notably **ectopic pregnancy** or threatened abortion. **1. Why Transvaginal Ultrasonography (TVS) is the correct answer:** TVS is the gold standard and the most useful diagnostic tool in this scenario. At 6 weeks (42 days) of gestation, TVS can reliably identify an intrauterine gestational sac (visible at 4.5–5 weeks) or a yolk sac (visible at 5.5 weeks). Its primary utility is to **confirm the location of the pregnancy** (intrauterine vs. ectopic) and assess viability. In a patient with spotting, identifying the pregnancy's location is the immediate clinical priority. **2. Why the other options are incorrect:** * **Urine Pregnancy Test (UPT):** While it confirms pregnancy, it cannot differentiate between a healthy intrauterine pregnancy, a miscarriage, or a life-threatening ectopic pregnancy. * **Beta-hCG:** A single quantitative value is rarely diagnostic. It is most useful when used serially (to check doubling time) or in conjunction with TVS (the "Discriminatory Zone" concept). * **Serum Progesterone:** While low levels (<5 ng/mL) suggest a non-viable pregnancy, it cannot pinpoint the location or provide a definitive diagnosis. **Clinical Pearls for NEET-PG:** * **Discriminatory Zone:** The level of β-hCG at which an intrauterine sac should be visible on TVS is **1500–2000 mIU/mL**. If β-hCG is above this and the uterus is empty, suspect ectopic pregnancy. * **First Sign on TVS:** The "Intrachorionic sac" or "Double decidual sac sign" is the earliest sign of intrauterine pregnancy. * **Management Priority:** In any woman of reproductive age with amenorrhea and abdominal pain/spotting, **Ectopic Pregnancy** must be ruled out first using TVS.

Q: What is the most common cause of first-trimester abortion?

Chromosomal defect. **Explanation:** **1. Why Chromosomal Defect is Correct:** Chromosomal abnormalities are the single most common cause of spontaneous abortion in the first trimester, accounting for **50–70% of all cases**. These are usually sporadic (de novo) events resulting from errors in gametogenesis, such as non-disjunction. Among these, **Autosomal Trisomy** is the most frequent specific abnormality (Trisomy 16 being the most common), followed by Monosomy X (Turner Syndrome) and Triploidy. **2. Analysis of Incorrect Options:** * **Endocrine disturbances:** Conditions like Luteal Phase Defect (Progesterone deficiency), uncontrolled Diabetes Mellitus, and Thyroid disorders are significant causes but are statistically less frequent than genetic factors. * **Anatomic abnormality of the uterus:** Factors such as septate uterus, submucosal fibroids, or cervical incompetence more commonly lead to **second-trimester** losses rather than first-trimester abortions. * **Infections:** While TORCH infections, *Listeria*, and *Mycoplasma* can cause pregnancy loss, they are rare causes of early sporadic abortion in modern clinical practice. **3. NEET-PG High-Yield Pearls:** * **Most common Trisomy in abortus:** Trisomy 16 (Note: Trisomy 21 is the most common trisomy in live births). * **Most common single chromosomal anomaly:** Monosomy X (45,X). * **Second-trimester abortions:** Most commonly due to maternal factors (anatomic defects, systemic diseases) rather than fetal factors. * **Recurrent Pregnancy Loss (RPL):** Defined as ≥2 consecutive spontaneous abortions; the most common treatable cause is Antiphospholipid Antibody Syndrome (APS).

Q: A diabetic mother may have the following complications in the fetus EXCEPT:

Dimorphic anemia. **Explanation:** The correct answer is **Dimorphic anemia**. In diabetic pregnancies, the primary hematological complication in the fetus is **polycythemia** (not anemia). This occurs because fetal hyperglycemia leads to hyperinsulinemia, which increases the metabolic rate and oxygen consumption. The resulting fetal hypoxia stimulates erythropoietin production, leading to an excess of red blood cells. **Analysis of Options:** * **Hydramnios (Polyhydramnios):** This is a common complication. Fetal hyperglycemia causes osmotic diuresis, leading to **fetal polyuria**, which increases the volume of amniotic fluid. * **Macrosomia:** Maternal hyperglycemia results in fetal hyperinsulinemia. Since insulin is a potent growth-promoting hormone, it leads to excessive fat deposition and organomegaly, typically resulting in a birth weight >4000g. * **Cardiac Anomaly:** Pre-gestational diabetes is teratogenic. The most common cardiac defect is a **Ventricular Septal Defect (VSD)**, though **Transposition of the Great Arteries (TGA)** and Hypertrophic Cardiomyopathy (septal hypertrophy) are also highly associated. **NEET-PG High-Yield Pearls:** 1. **Most common malformation:** Cardiovascular anomalies. 2. **Most specific malformation:** **Caudal Regression Syndrome** (Sacral agenesis). 3. **Metabolic triad in neonate:** Hypoglycemia, Hypocalcemia, and Hypomagnesemia. 4. **Respiratory risk:** Delayed surfactant production leads to an increased risk of **Respiratory Distress Syndrome (RDS)**, even in near-term infants.

Question 1

Regarding HIV transmission to the fetus, all statements are true except?

Accepted Answer

Can present as failure to thrive

Answer

More than 50% risk of transmission to the fetus

Answer

Greatest risk of transmission is in the perinatal period

Answer

Cannot be diagnosed

Question 2

In a primigravida with mechanical heart valves, at which gestational week is intravenous heparin typically introduced?

Accepted Answer

36 weeks

Answer

32 weeks

Answer

40 weeks

Answer

At the time of labor

Question 3

What is the most common complication due to expectant management of preeclampsia?

Accepted Answer

Placental abruption

Answer

Acute renal failure

Answer

Pulmonary edema

Answer

Cardiac arrest

Question 4

Which of the following is NOT a cause of intrauterine fetal death?

Accepted Answer

Pregnancy-induced hypertension (PIH)

Answer

Disseminated intravascular coagulation (DIC)

Answer

Psychological upset

Answer

Infection

Question 5

A 23-year-old female presents with 42 days of amenorrhea and vaginal spotting. Which of the following is the most useful diagnostic test?

Accepted Answer

Transvaginal ultrasonography

Answer

Urine pregnancy test

Answer

Beta-hCG

Answer

Serum progesterone

Question 6

A 26-year-old woman, who underwent mitral valve replacement two years ago for severe mitral stenosis and is currently on therapeutic anticoagulation with 5mg of Warfarin daily, seeks preconception counseling. Which of the following statements is FALSE?

Accepted Answer

Warfarin should be stopped periconceptionally and switched to heparin.

Answer

The risk of warfarin embryopathy is approximately 6%.

Answer

Anticoagulation must continue throughout pregnancy.

Answer

The prognosis for her pregnancy is influenced by her NYHA functional class.

Question 7

What is the most common cause of first-trimester abortion?

Accepted Answer

Chromosomal defect

Answer

Endocrine disturbances

Answer

Anatomic abnormality of the uterus

Answer

Infections

Question 8

A diabetic mother may have the following complications in the fetus EXCEPT:

Accepted Answer

Dimorphic anemia

Answer

Hydramnios

Answer

Macrosomia

Answer

Cardiac anomaly

Question 9

Which type of delivery is safest in maternal heart disease?

Accepted Answer

Outlet forceps

Answer

Vaginal

Answer

Cesarean section

Answer

Mid-cavity forceps

Question 10

A 32-year-old female, unable to conceive for 6 years, presents with a missed period of three weeks, left-sided lower abdominal pain, and nausea. B subunit human chorionic gonadotropin (HCG) and pelvic ultrasound confirm an ectopic pregnancy. What is the appropriate management?

Accepted Answer

If unruptured, the fallopian tube should be spared

Answer

Immediate laparotomy and salpingectomy

Answer

Avoid incidental appendectomy

Answer

If the patient is hemodynamically stable, surgery should be avoided

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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