Maternal-Fetal Medicine Practice Questions

Q: What does a Cardiotocography (CTG) typically depict?

Fetal heart rate monitoring. **Explanation:** **Cardiotocography (CTG)** is a technical means of recording the **fetal heart rate (FHR)** and the **uterine contractions** during pregnancy. The term is derived from Greek: *Kardio* (heart), *Toco* (labor/contraction), and *Graph* (writing). It is the primary tool used in the third trimester and during labor to assess fetal well-being and identify signs of fetal distress (hypoxia). **Why Option A is Correct:** CTG uses two transducers placed on the maternal abdomen: an ultrasound transducer to monitor the fetal heart rate and a pressure-sensitive tocodynamometer to record the frequency and duration of uterine contractions. The resulting trace allows clinicians to analyze the baseline heart rate, variability, accelerations, and decelerations. **Why Other Options are Incorrect:** * **B & C (Fetal Growth/Size):** These are assessed via **Symphysio-fundal height (SFH)** measurement clinically or through **Obstetric Ultrasonography (USG)** using parameters like Biparietal Diameter (BPD), Abdominal Circumference (AC), and Femur Length (FL). * **D (Amniotic Fluid Index):** AFI is calculated using **Ultrasonography** by measuring the deepest vertical pockets in four quadrants of the uterus. **High-Yield Clinical Pearls for NEET-PG:** * **Normal Baseline FHR:** 110–160 bpm. * **Reassuring Feature:** Presence of **accelerations** (increase of >15 bpm for >15 seconds) and **good variability** (5–25 bpm). * **Early Decelerations:** Usually benign; caused by fetal head compression. * **Late Decelerations:** Pathological; indicates **uteroplacental insufficiency**. * **Variable Decelerations:** Most common; indicates **cord compression**.

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.

Q: Treatment of cholestasis during pregnancy is all except-

Oral contraceptive pills. **Explanation:** Intrahepatic Cholestasis of Pregnancy (ICP) is a reversible type of hormone-induced cholestasis occurring in the third trimester, characterized by intense pruritus and elevated serum bile acids. **Why Oral Contraceptive Pills (OCPs) are the correct answer:** OCPs are **contraindicated** in patients with a history of ICP. The pathogenesis of cholestasis is linked to high levels of estrogen and progesterone, which interfere with bile acid transport. Since OCPs contain synthetic estrogens and progestogens, they can trigger or worsen cholestasis. In fact, a history of ICP is a relative contraindication for combined hormonal contraception postpartum. **Analysis of other options:** * **Ursodeoxycholic acid (UDCA):** This is the **drug of choice** for ICP. It improves bile flow, reduces pruritus, and lowers serum bile acid levels, potentially improving fetal outcomes. * **Vitamin K:** Cholestasis leads to malabsorption of fat-soluble vitamins (A, D, E, K) due to decreased bile salts in the gut. Supplementation of Vitamin K is essential to prevent maternal postpartum hemorrhage and fetal intracranial hemorrhage. * **Cholestyramine:** This is a bile acid sequestrant used as a second-line agent to relieve itching. However, it can further deplete Vitamin K levels, so it must be used cautiously. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Symptom:** Pruritus, typically starting on the palms and soles, worsening at night. There is **no primary rash** (only excoriations). * **Diagnostic Gold Standard:** Elevated Total Serum Bile Acids (TSBA) >10 µmol/L. * **Fetal Risks:** Increased risk of meconium-stained amniotic fluid, preterm labor, and **sudden intrauterine fetal death (IUFD)**, especially if bile acids exceed 40–100 µmol/L. * **Management:** Delivery is usually recommended between 36 0/7 and 39 0/7 weeks, depending on bile acid levels.

Q: What is the best prenatal treatment for Congenital Adrenal Hyperplasia (CAH)?

Dexamethasone. **Explanation:** The primary goal of prenatal treatment for **Congenital Adrenal Hyperplasia (CAH)**, specifically the 21-hydroxylase deficiency variant, is to prevent the **virilization (masculinization)** of a female fetus by suppressing the fetal pituitary-adrenal axis. **Why Dexamethasone is the Correct Answer:** Dexamethasone is a potent glucocorticoid that **crosses the placenta** without being inactivated by the placental enzyme **11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2)**. By reaching the fetal circulation, it suppresses fetal ACTH secretion, thereby reducing the production of adrenal androgens that cause ambiguous genitalia in female fetuses. Treatment must be started early (before the 9th week of gestation) to be effective. **Why Other Options are Incorrect:** * **Prednisolone & Hydrocortisone:** These steroids are largely **inactivated** by the placental enzyme 11β-HSD2. Consequently, they do not reach the fetus in therapeutic concentrations and are ineffective for prenatal fetal treatment (though they are used to treat the mother). * **Betamethasone:** While betamethasone also crosses the placenta, it is primarily used for **fetal lung maturity** in cases of preterm labor. Clinical protocols for CAH specifically standardize the use of Dexamethasone (0.02 mg/kg/day). **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** Treatment must begin **empirically** as soon as pregnancy is confirmed (ideally by 6–7 weeks), before the sex of the fetus or the genetic status is known. * **Target:** Treatment is only necessary for **female fetuses** affected by CAH. If the fetus is male or an unaffected female (determined via CVS or NIPT), Dexamethasone is discontinued. * **Mechanism:** It works by providing negative feedback to the fetal hypothalamus/pituitary, preventing the "androgen shower" that occurs during the critical period of genital differentiation.

Q: Highest rate of transmission of toxoplasmosis to the fetus during pregnancy is seen in which trimester?

Third trimester. **Explanation:** The risk of vertical transmission of *Toxoplasma gondii* is directly proportional to the gestational age at the time of maternal infection. **1. Why the Third Trimester is Correct:** The rate of transmission is highest in the **third trimester (60–80%)**. This is primarily due to the increased permeability and surface area of the placenta, along with enhanced uterine blood flow as pregnancy progresses, which facilitates the passage of tachyzoites from the mother to the fetus. **2. Why Other Options are Incorrect:** * **First Trimester:** While the risk of transmission is lowest here (approx. 10–15%), the **severity** of fetal damage is highest (e.g., miscarriage, severe neurological deficits). * **Second Trimester:** The transmission rate is intermediate (approx. 25–30%). * **Puerperium:** This refers to the period after delivery. Congenital toxoplasmosis occurs due to *in utero* infection, not during the postpartum period. **3. High-Yield Clinical Pearls for NEET-PG:** * **Inverse Relationship:** Remember the "Rule of Inverses"—as gestational age increases, the **risk of transmission increases**, but the **severity of fetal disease decreases**. * **Classic Triad (Sabin’s Triad):** Chorioretinitis, Hydrocephalus, and Intracranial calcifications (usually diffuse). * **Diagnosis:** Maternal screening is done via IgM/IgG titers. Fetal diagnosis is best confirmed via **PCR of Amniotic fluid** (Gold Standard). * **Treatment:** * If maternal infection is suspected but fetal infection is not confirmed: **Spiramycin** (to prevent transmission). * If fetal infection is confirmed: **Pyrimethamine, Sulfadiazine, and Folinic acid**.

Question 1

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 2

What does a Cardiotocography (CTG) typically depict?

Accepted Answer

Fetal heart rate monitoring

Answer

Fetal growth monitoring

Answer

Fetal size monitoring

Answer

Amniotic fluid index monitoring

Question 3

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 4

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

Accepted Answer

Dimorphic anemia

Answer

Hydramnios

Answer

Macrosomia

Answer

Cardiac anomaly

Question 5

In which of the following conditions can normal pregnancy be continued?

Accepted Answer

Wolf-Parkinson-White syndrome

Answer

Primary pulmonary hypertension

Answer

Eisenmenger syndrome

Answer

Marfan syndrome with dilated aortic root

Question 6

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

Question 7

Treatment of cholestasis during pregnancy is all except-

Accepted Answer

Oral contraceptive pills

Answer

Vitamin K

Answer

Ursodeoxycholic acid

Answer

Cholestyramine

Question 8

Highest maternal mortality is seen in which congenital heart disease?

Accepted Answer

Eisenmenger's syndrome

Answer

Pulmonary stenosis

Answer

Coarctation of aorta

Answer

Ventricular septal defect (VSD)

Question 9

What is the best prenatal treatment for Congenital Adrenal Hyperplasia (CAH)?

Accepted Answer

Dexamethasone

Answer

Betamethasone

Answer

Prednisolone

Answer

Hydrocortisone

Question 10

Highest rate of transmission of toxoplasmosis to the fetus during pregnancy is seen in which trimester?

Accepted Answer

Third trimester

Answer

First trimester

Answer

Second trimester

Answer

Puerperium

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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