Maternal-Fetal Medicine Practice Questions

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: 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%).

Q: Smoking in pregnancy causes all of the following except:

Postpartum Hemorrhage (PPH). **Explanation:** Smoking during pregnancy is a significant risk factor for various adverse obstetric outcomes, primarily due to the effects of **nicotine** (a potent vasoconstrictor) and **carbon monoxide** (which increases carboxyhemoglobin levels, leading to fetal hypoxia). **Why Postpartum Hemorrhage (PPH) is the correct answer:** While smoking is associated with numerous placental and fetal complications, it is **not** a direct cause of Postpartum Hemorrhage. PPH is primarily caused by the "4 Ts": Tone (Atony), Tissue (Retained products), Trauma, and Thrombin (Coagulopathy). Interestingly, some epidemiological studies have even suggested a slightly lower risk of PPH in smokers, though it is not considered a protective factor. **Analysis of Incorrect Options:** * **IUGR (Option A):** Nicotine causes vasoconstriction of uteroplacental vessels, while carbon monoxide reduces oxygen delivery to the fetus. This leads to chronic fetal hypoxia and is a classic cause of **asymmetrical IUGR**. * **PIH (Option B):** This is a controversial but high-yield point. While some studies suggest smoking might paradoxically lower the risk of preeclampsia, standard medical teaching and exams often link smoking to **Pregnancy-Induced Hypertension** and vascular damage due to oxidative stress and endothelial dysfunction. * **APH (Option C):** Smoking is a major risk factor for **Abruptio Placentae** and **Placenta Previa**. Decidual necrosis and vascular changes in the placenta increase the risk of premature separation and abnormal implantation. **Clinical Pearls for NEET-PG:** * **Sudden Infant Death Syndrome (SIDS):** Maternal smoking is the most important modifiable risk factor for SIDS. * **Congenital Anomalies:** Smoking is specifically linked to an increased risk of **Orofacial clefts** (Cleft lip/palate). * **Spontaneous Abortion:** Smoking increases the risk of miscarriage by approximately 25%.

Q: What is the rate of transmission of HIV from an infected mother to her infant?

30%. **Explanation:** The transmission of HIV from an mother to her infant is known as **Vertical Transmission** or Mother-to-Child Transmission (MTCT). In the absence of any medical intervention (antiretroviral therapy, elective cesarean section, or avoidance of breastfeeding), the overall risk of transmission is approximately **25–30%**. **Breakdown of Transmission Timing:** * **In-utero (Antenatal):** ~5–10% * **During Labor/Delivery (Intrapartum):** ~15% (This is the period of highest risk due to exposure to infected maternal blood and vaginal secretions). * **Breastfeeding (Postpartum):** ~5–10% **Analysis of Options:** * **Option A (100%) & B (66%):** These are incorrectly high. HIV is not transmitted to every fetus because the placenta acts as a partial barrier and viral load varies. * **Option C (30%):** **Correct.** This represents the global average risk in a non-intervention scenario. * **Option D (5–10%):** This represents the risk if only one phase (like breastfeeding or antenatal) is considered, or the risk achieved with partial medical intervention. **High-Yield Clinical Pearls for NEET-PG:** 1. **With Intervention:** With modern HAART (Highly Active Antiretroviral Therapy), elective LSCS, and formula feeding, the transmission risk can be reduced to **<2%**. 2. **Most Common Route:** Intrapartum (during labor) is the most common time for transmission. 3. **Zidovudine:** Historically the drug of choice for prophylaxis; however, current WHO/National guidelines (NACO) recommend **Tenofovir + Lamivudine + Efavirenz (TLE)** or Dolutegravir-based regimens for all pregnant women regardless of CD4 count. 4. **Breastfeeding:** In India, exclusive breastfeeding is recommended for the first 6 months if replacement feeding is not "Acceptable, Feasible, Affordable, Sustainable, and Safe" (AFASS).

Q: A small-sized placenta is typically seen in which of the following conditions?

Pre-eclampsia. **Explanation:** The size and weight of the placenta are directly related to the surface area available for nutrient and oxygen exchange. A **small-sized placenta** (placental hypoplasia) occurs when there is impaired trophoblastic invasion or chronic uteroplacental insufficiency. **Why Pre-eclampsia is correct:** In pre-eclampsia, there is a failure of the secondary wave of trophoblastic invasion (at 16–20 weeks). This results in the spiral arteries remaining narrow and high-resistance, leading to reduced blood flow to the placental bed. The chronic ischemia causes placental infarcts, cytotrophoblastic proliferation, and villous hypoplasia, ultimately resulting in a small, underweight placenta. This is a classic cause of Fetal Growth Restriction (FGR). **Analysis of Incorrect Options:** * **Peripheral vascular disease:** While systemic, it does not specifically target the uterine spiral arteries like the localized pathology of pre-eclampsia. * **Maternal weight < 50 kg:** While maternal nutrition affects birth weight, a low BMI alone does not pathologically restrict placental growth unless associated with severe malnutrition or anemia. * **Multiple pregnancy:** This is a cause of a **large/heavy placenta** (or multiple placentas), as the increased fetal demand requires a larger surface area for exchange. **High-Yield Clinical Pearls for NEET-PG:** * **Large Placenta (Placentomegaly):** Seen in Diabetes Mellitus, Rh-isoimmunization, Syphilis, and Multiple pregnancy. * **Placental Weight:** The average weight at term is ~500g (Ratio of placental weight to fetal weight is 1:6). * **Microscopic hallmark of Pre-eclampsia:** Tenney-Parker changes (increased syncytial knots).

Question 1

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 2

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 3

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 4

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 5

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

Question 6

Which of the following cardiac lesions is associated with the least maternal mortality?

Accepted Answer

Patent ductus arteriosus

Answer

Previous myocardial infarction

Answer

Aortic stenosis

Answer

Pulmonary hypertension

Question 7

In a case of intrauterine growth retardation, what is the most dependable method for determining fetal well-being?

Accepted Answer

Contraction stress test (oxytocin challenge test)

Answer

Ultrasonic fetal cephalometry

Answer

Amniotic fluid triglyceride

Answer

Uteroplacental blood flow

Question 8

Smoking in pregnancy causes all of the following except:

Accepted Answer

Postpartum Hemorrhage (PPH)

Answer

Intrauterine Growth Restriction (IUGR)

Answer

Pregnancy-Induced Hypertension (PIH)

Answer

Antepartum Hemorrhage (APH)

Question 9

What is the rate of transmission of HIV from an infected mother to her infant?

Accepted Answer

30%

Answer

100%

Answer

66%

Answer

5-10%

Question 10

A small-sized placenta is typically seen in which of the following conditions?

Accepted Answer

Pre-eclampsia

Answer

Peripheral vascular disease in the mother

Answer

Maternal weight less than 50 kg

Answer

Multiple pregnancy

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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