Maternal-Fetal Medicine Practice Questions

Q: What is the management of choice for placenta previa at 32 weeks gestation?

Conservative treatment. **Explanation:** The primary goal in managing placenta previa before term (less than 37 weeks) is to prolong the pregnancy to allow for fetal lung maturity, provided there is no active, life-threatening hemorrhage. This approach is known as **MacAfee’s Conservative Management**. **Why Conservative Treatment is Correct:** At 32 weeks, the fetus is preterm. If the maternal and fetal conditions are stable (bleeding is not profuse), the patient is managed with bed rest, corticosteroids (for lung maturity), and close monitoring. This reduces the risks associated with prematurity while keeping the patient in a facility equipped for an emergency Cesarean section if bleeding recurs. **Why Other Options are Incorrect:** * **Oxytocin & Ergometrine:** These are uterotonic agents. Oxytocin is used for induction of labor or postpartum hemorrhage (PPH) management, and Ergometrine is strictly for PPH. Using them in placenta previa before delivery is contraindicated as they cause uterine contractions, which can lead to massive placental separation and fatal hemorrhage. * **Per Vaginal (PV) Examination:** This is **strictly contraindicated** in suspected placenta previa. A digital exam can dislodge a clot or tear the placenta, leading to torrential, life-threatening bleeding. PV exams should only be performed in a "Double Setup" (in an OT ready for immediate surgery). **High-Yield Clinical Pearls for NEET-PG:** * **MacAfee’s Criteria:** Pregnancy <37 weeks, bleeding is not active/profuse, and the mother/fetus are stable. * **Investigation of Choice:** Transvaginal Ultrasound (TVS) is the gold standard (safe and more accurate than transabdominal). * **Delivery Timing:** In stable cases of placenta previa, elective delivery is usually planned at **36–37 weeks**. * **Stallworthy’s Sign:** A drop in fetal heart rate when the head is pressed into the pelvis (seen in posterior placenta previa).

Q: Karyotyping of the fetus can be done through all of the following invasive methods except?

Fetal skin biopsy. **Explanation:** The core objective of prenatal karyotyping is to obtain viable fetal cells that can be cultured to visualize chromosomes. While several invasive procedures yield these cells, the choice of method depends on the gestational age and the specific diagnostic requirement. **Why Fetal Skin Biopsy is the Correct Answer:** Fetal skin biopsy is a highly specialized, invasive procedure used primarily for diagnosing **severe genodermatoses** (e.g., Epidermolysis bullosa or Ichthyosis) when DNA-based testing is unavailable. While skin cells contain the fetal genome, it is **not** a standard or routine method for karyotyping because it carries a significantly higher risk of fetal injury and pregnancy loss compared to other methods. It is considered a "last resort" for structural skin defects, not chromosomal analysis. **Analysis of Other Options:** * **Chorionic Villus Sampling (CVS):** Performed at **10–13 weeks**. It involves sampling trophoblastic tissue. It is the earliest invasive method for karyotyping. * **Amniocentesis:** The "gold standard" for prenatal diagnosis, typically performed at **15–20 weeks**. It collects fetal thyrocytes, skin cells, and gastrointestinal cells shed into the amniotic fluid. * **Cordocentesis (Percutaneous Umbilical Blood Sampling):** Performed after **18 weeks**. It provides rapid karyotyping (within 48–72 hours) by culturing fetal lymphocytes. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Karyotyping:** CVS (10 weeks). * **Most Common Method:** Amniocentesis. * **Rapid Karyotyping:** Cordocentesis (useful for late presenters or mosaicism confirmation). * **Risk of Procedure-Related Loss:** CVS (~0.5–1%) > Amniocentesis (~0.1–0.5%). * **Pre-procedure Requirement:** Always check maternal Rh status; administer Anti-D immunoglobulin if the mother is Rh-negative.

Q: Regarding Listeriosis in pregnancy, which of the following statements is false?

Symptoms typically occur within 3 days of exposure.. **Explanation:** Listeriosis, caused by the Gram-positive motile bacillus *Listeria monocytogenes*, is a significant foodborne illness in pregnancy due to the pathogen’s predilection for the placenta. **Why Option C is False (The Correct Answer):** The incubation period for *Listeria* is notably long and variable, typically ranging from **1 to 4 weeks** (average ~3 weeks), though it can extend up to 70 days. The statement that symptoms occur within 3 days is incorrect, as this is much shorter than the typical clinical course for listeriosis. **Analysis of Other Options:** * **Option A:** Listeriosis is a known cause of adverse pregnancy outcomes, including **second-trimester spontaneous abortion**, preterm labor, and stillbirth. * **Option B:** Infection is primarily foodborne. High-risk sources include **unpasteurized (raw) milk**, soft cheeses (feta, brie), deli meats, and contaminated sprouts. * **Option D:** **Granulomatosis infantiseptica** is the classic, severe neonatal manifestation of *in utero* infection. It is characterized by disseminated abscesses and granulomas in multiple organs (liver, spleen, lungs) and carries a high mortality rate. **Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Often presents as a non-specific **flu-like illness** (fever, myalgia, arthralgia) in the mother. * **Diagnosis:** The gold standard is a **blood culture**. * **Treatment of Choice:** **IV Ampicillin** (or Penicillin G). For penicillin-allergic patients, Trimethoprim-Sulfamethoxazole (TMP-SMX) is used. * **Microscopy:** Look for "tumbling motility" on wet mount at 25°C.

Q: A pregnant female at 35 weeks of gestation is diagnosed with SLE. Which of the following drugs can be used to treat SLE during pregnancy, EXCEPT:

Methotrexate. **Explanation:** The management of Systemic Lupus Erythematosus (SLE) during pregnancy requires balancing maternal disease control with fetal safety. The correct answer is **Methotrexate**, as it is strictly contraindicated in pregnancy. **1. Why Methotrexate is the Correct Answer:** Methotrexate is a folic acid antagonist that inhibits dihydrofolate reductase. It is a potent **teratogen** (FDA Category X). Exposure during the first trimester leads to "Methotrexate-induced fetopathy," characterized by cranial anomalies (craniosynostosis), limb defects, and growth restriction. It is also used as a medical management for ectopic pregnancy due to its ability to inhibit rapidly dividing trophoblastic cells. **2. Why the other options are incorrect:** * **Corticosteroids:** Prednisolone and Methylprednisolone are the mainstays for SLE flares. They are metabolized by placental 11β-hydroxysteroid dehydrogenase, meaning very little active drug reaches the fetus. (Note: Dexamethasone/Betamethasone *do* cross the placenta and are used for fetal lung maturity). * **Azathioprine:** Considered the steroid-sparing agent of choice in pregnancy. The fetal liver lacks the enzyme (thiopurine methyltransferase) to convert it into its active toxic metabolites, protecting the fetus. * **Hydroxychloroquine (HCQ):** Highly recommended to continue throughout pregnancy. It prevents lupus flares and reduces the risk of neonatal congenital heart block. **High-Yield Clinical Pearls for NEET-PG:** * **Safe in Pregnancy:** HCQ, Steroids, Azathioprine, Cyclosporine. * **Teratogenic (Avoid):** Methotrexate, Mycophenolate Mofetil (causes "faciodigital" malformations), Cyclophosphamide (except in life-threatening scenarios in 2nd/3rd trimester). * **Neonatal Lupus:** Associated with maternal **Anti-Ro (SSA)** and **Anti-La (SSB)** antibodies; the most serious complication is permanent congenital third-degree heart block.

Q: Placenta accreta is associated with which of the following conditions?

Uterine scar. **Explanation:** **Placenta Accreta** refers to an abnormal adherence of the placenta to the uterine wall due to the partial or total absence of the **Nitabuch’s layer** (decidua basalis). 1. **Why Uterine Scar is Correct:** The single most significant risk factor for placenta accreta is a previous **uterine scar**, most commonly from a prior Cesarean section. A scar creates a defect in the endometrial-myometrial junction, allowing chorionic villi to invade directly into or through the myometrium. The risk increases proportionally with the number of previous C-sections. 2. **Why Other Options are Incorrect:** * **Placenta Previa:** While placenta previa is strongly *associated* with accreta (especially when overlying a scar), the primary pathological trigger is the underlying damaged decidua (the scar itself). In the absence of a scar, previa alone has a much lower incidence of accreta. * **Multiple Pregnancy & Multiparity:** These are minor risk factors associated with placental site issues but do not inherently cause the defective decidualization required for accreta. **High-Yield Clinical Pearls for NEET-PG:** * **The "Incidence Rule":** If a patient has 1 prior C-section and a current placenta previa, the risk of accreta is ~11%. With 4 or more C-sections and previa, the risk jumps to **>60%**. * **Classification:** * **Accreta:** Villi attached to myometrium (80%). * **Increta:** Villi invade into myometrium (15%). * **Percreta:** Villi penetrate through the serosa/into bladder (5%). * **Diagnosis:** Antenatal diagnosis is via **Color Doppler Ultrasound** (showing "moth-eaten" placental lacunae and loss of the retroplacental hypoechoic zone). * **Management:** The standard treatment for confirmed placenta accreta is a planned **Cesarean Hysterectomy**.

Q: What is a complication specific to monoamniotic twins?

Cord entanglement. **Explanation:** Monoamniotic-monochorionic (MoMo) twins occur when the zygote divides between days 8 and 13 post-fertilization. Because these twins share a single amniotic sac without an intervening membrane, **cord entanglement** is a unique and life-threatening complication specific to this subtype. As the fetuses move within the same cavity, their umbilical cords frequently twist around each other, leading to occlusion of blood flow and sudden fetal demise. This necessitates intensive monitoring and elective delivery, typically between 32 and 34 weeks. **Analysis of Incorrect Options:** * **Twin-to-twin transfusion syndrome (TTTS):** While TTTS occurs in monochorionic twins, it requires two separate amniotic sacs (Diamniotic) to manifest clinically (e.g., polyhydramnios/oligohydramnios sequence). It is not *specific* to monoamniotic twins. * **Twin reversed arterial perfusion (TRAP) sequence / Acardiac twin:** These are the same clinical entity. While they occur in monochorionic pregnancies due to large artery-to-artery anastomoses, they can occur in both diamniotic and monoamniotic gestations; they are not unique to the monoamniotic state. **High-Yield Facts for NEET-PG:** * **Timing of Division:** * 0–72 hours: Dichorionic Diamniotic (Didi) * 4–8 days: Monochorionic Diamniotic (Modi) * **8–13 days: Monochorionic Monoamniotic (Momo)** * >13 days: Conjoined twins * **Management:** MoMo twins are often managed with inpatient surveillance starting at 24–28 weeks and mandatory Cesarean section to avoid cord accidents during labor. * **Most common type of MZ twins:** Monochorionic Diamniotic (~75%).

Question 1

What is the management of choice for placenta previa at 32 weeks gestation?

Accepted Answer

Conservative treatment

Answer

Oxytocin infusion

Answer

Ergometrine intravenous

Answer

Per vaginal examination and artificial rupture of membranes (ARM)

Question 2

A young lady with 6 weeks amenorrhea presents with nausea, vomiting, and severe abdominal pain. Her BP is 100/80 mm Hg. Examination reveals a 5 x 5 cm adnexal mass. What is the plan of management?

Accepted Answer

Plan for immediate laparoscopic surgery

Answer

beta-hCG

Answer

Methotrexate

Answer

Give IV fluids, keep NPO and observe for 4-5 days

Question 3

Karyotyping of the fetus can be done through all of the following invasive methods except?

Accepted Answer

Fetal skin biopsy

Answer

Chorionic villus sampling

Answer

Cordocentesis

Answer

Amniocentesis

Question 4

Antiphospholipid antibody detection is indicated in all of the following conditions except:

Accepted Answer

Gestational Diabetes

Answer

Three or more consecutive first trimester pregnancy losses

Answer

Unexplained cerebrovascular accidents

Answer

Early onset severe pre-eclampsia

Question 5

Regarding Listeriosis in pregnancy, which of the following statements is false?

Accepted Answer

Symptoms typically occur within 3 days of exposure.

Answer

It can cause second-trimester loss.

Answer

It is often acquired by drinking raw milk.

Answer

It can lead to granulomatosis infantiseptica.

Question 6

An ectopic pregnancy implanted in the ovary clinically may most closely mimic which of the following conditions?

Accepted Answer

Corpus luteum cyst rupture

Answer

Ovarian torsion

Answer

Uterine horn pregnancy rupture

Answer

Interstitial ectopic pregnancy rupture

Question 7

A pregnant female at 35 weeks of gestation is diagnosed with SLE. Which of the following drugs can be used to treat SLE during pregnancy, EXCEPT:

Accepted Answer

Methotrexate

Answer

Corticosteroids

Answer

Azathioprine

Answer

Hydroxychloroquine

Question 8

Placenta accreta is associated with which of the following conditions?

Accepted Answer

Uterine scar

Answer

Placenta previa

Answer

Multiple pregnancy

Answer

Multiparity

Question 9

What is a complication specific to monoamniotic twins?

Accepted Answer

Cord entanglement

Answer

Twin-to-twin transfusion syndrome (TTTS)

Answer

Twin reversed arterial perfusion (TRAP) sequence

Answer

Acardiac twin

Question 10

Which of the following is NOT a fetal affection caused by Rh antibodies?

Accepted Answer

Nonimmune hydrops fetalis

Answer

Icterus gravis neonatorum

Answer

Congenital anemia of the newborn

Answer

Fetal death

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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