Maternal-Fetal Medicine Practice Questions

Q: All of the following are increased in infants of mothers with heart disease, except:

Neural tube defect. **Explanation:** Maternal heart disease significantly impacts fetal outcomes primarily through two mechanisms: **chronic fetal hypoxia** and **genetic predisposition**. **Why Neural Tube Defects (NTD) is the correct answer:** Neural tube defects are primarily associated with folic acid deficiency, maternal diabetes, or exposure to teratogens (like valproate). There is no direct pathophysiological link between maternal cardiac disease and the failure of neural tube closure. Therefore, the incidence of NTDs remains the same as in the general population. **Analysis of Incorrect Options:** * **Prematurity:** Mothers with significant heart disease (especially those with cyanosis or congestive heart failure) have a higher incidence of preterm labor, often due to chronic hypoxia or iatrogenic delivery necessitated by deteriorating maternal health. * **Intrauterine Growth Restriction (IUGR):** Chronic maternal hypoxia and reduced cardiac output lead to placental insufficiency. This results in a suboptimal supply of oxygen and nutrients to the fetus, leading to symmetrical or asymmetrical growth restriction. * **Increased Incidence of Cardiac Disease:** Congenital heart disease (CHD) has a polygenic inheritance pattern. If a mother has CHD, the risk of the fetus having a cardiac defect increases from the baseline 0.8% to approximately 3–5% (depending on the specific lesion). **NEET-PG High-Yield Pearls:** * **Most common heart disease in pregnancy (India):** Rheumatic Heart Disease (Mitral Stenosis is the most common lesion). * **Most common heart disease in pregnancy (Developed countries):** Congenital Heart Disease. * **Highest risk period:** The immediate postpartum period (first 24–48 hours) due to the sudden "autotransfusion" of blood from the involuting uterus into the systemic circulation. * **Predictor of Fetal Risk:** Maternal cyanosis (Oxygen saturation <85%) is the strongest predictor of poor fetal outcome.

Q: All of the following diseases are transmitted vertically in the 3rd trimester of pregnancy except?

Congenital parvovirus B19. **Explanation:** The core concept tested here is the **timing of vertical transmission** and the resulting fetal pathology. While many infections can occur at any stage, their peak incidence of transmission often varies by trimester. **Why Parvovirus B19 is the correct answer:** Parvovirus B19 specifically targets **erythroid progenitor cells** in the fetal bone marrow and liver. The peak period of fetal vulnerability and vertical transmission is the **second trimester** (specifically 13–24 weeks), as this is the period of maximal hepatic hematopoiesis. Infection during this window leads to severe fetal anemia, high-output cardiac failure, and **Hydrops Fetalis**. While transmission can occur later, it is classically associated with second-trimester complications rather than third-trimester transmission. **Analysis of Incorrect Options:** * **Congenital Syphilis:** Transmission can occur at any stage, but the risk **increases with gestational age**, reaching its peak in the third trimester. * **Congenital Toxoplasmosis:** There is an inverse relationship between severity and transmission. While first-trimester infection is more severe, the **highest rate of transmission (up to 60-80%)** occurs in the third trimester. * **Congenital Hepatitis B:** Vertical transmission (primarily peripartum) is most common if the mother acquires the infection in the **third trimester** (up to 90% risk) compared to the first trimester (only 10%). **NEET-PG High-Yield Pearls:** * **Toxoplasmosis:** Transmission risk is highest in the 3rd trimester; Severity is highest in the 1st trimester. * **Parvovirus B19:** Most common cause of non-immune hydrops fetalis; diagnosed via MCA-PSV doppler (looking for fetal anemia). * **Syphilis:** Langhans layer of the placenta prevents transmission before 16 weeks; hence, treating the mother before 16 weeks prevents congenital syphilis.

Q: Which of the following signs is observed in intrauterine fetal demise?

Roberts sign. **Explanation:** **Robert’s Sign** is a classic radiological finding in **Intrauterine Fetal Demise (IUFD)**. It refers to the presence of gas (usually nitrogen) in the fetal heart and large blood vessels (like the aorta). This occurs due to the decomposition of fetal blood and is typically visible on an X-ray or ultrasound within 12 to 24 hours after fetal death. It is often the earliest radiological sign of IUFD. **Analysis of Incorrect Options:** * **Von Braun-Fernwald’s Sign:** This is a sign of **early pregnancy** (around 5–8 weeks) characterized by an irregular softening and enlargement of the uterine fundus at the site of implantation. * **Goodell’s Sign:** This refers to the **softening of the cervix**, a clinical sign of pregnancy usually detectable by the 6th week of gestation. * **Osiander’s Sign:** This is the feeling of **increased pulsations** in the lateral vaginal fornices due to increased vascularity of the uterus during early pregnancy (around 8 weeks). **High-Yield Clinical Pearls for NEET-PG:** * **Spalding’s Sign:** Another crucial sign of IUFD; it refers to the **overlapping of fetal skull bones** due to the liquefaction of the brain and loss of alignment. It usually appears 4–7 days after death. * **Deuel’s Halo Sign:** An X-ray finding in IUFD where an edematous scalp separates from the skull, creating a "halo" appearance. * **Confirmatory Test:** While these radiological signs are historically important, the **gold standard** for diagnosing IUFD today is the **absence of fetal cardiac activity on Real-Time Ultrasonography.**

Q: All the following are used in hypertensive emergencies in preeclampsia except?

Methyldopa. In a hypertensive emergency during pregnancy (defined as BP ≥160/110 mmHg), the goal is to rapidly lower blood pressure to prevent maternal stroke and encephalopathy. **Why Methyldopa is the correct answer (the "Except"):** Methyldopa is a centrally acting alpha-2 agonist. While it is the **drug of choice for chronic hypertension** in pregnancy, it is **not used in emergencies**. This is because it has a slow onset of action (4–6 hours) and a peak effect that takes up to 24 hours. In an acute crisis, drugs with a rapid onset (minutes) are required. **Explanation of incorrect options (Drugs used in emergencies):** * **Labetalol (IV):** A combined alpha and beta-blocker. It is often the first-line agent due to its rapid onset (5–10 mins) and favorable safety profile. * **Hydralazine (IV):** A direct vasodilator. It was traditionally the gold standard for acute hypertensive crisis in pregnancy. It is effective but may cause reflex tachycardia and headache. * **Nifedipine (Oral):** A calcium channel blocker (short-acting/immediate-release). It is highly effective, easy to administer orally, and has a rapid onset (10–20 mins). **High-Yield Clinical Pearls for NEET-PG:** 1. **Drug of Choice (DOC) for Chronic HTN in pregnancy:** Methyldopa. 2. **DOC for Hypertensive Emergency in pregnancy:** IV Labetalol (per ACOG/FOGSI). 3. **DOC for Eclampsia (Seizures):** Magnesium Sulfate ($MgSO_4$) – *Note: $MgSO_4$ is an anticonvulsant, not an antihypertensive.* 4. **Contraindicated Antihypertensives:** ACE inhibitors and ARBs (due to fetal renal dysgenesis and oligohydramnios) and Sodium Nitroprusside (risk of fetal cyanide poisoning, used only as a last resort).

Q: What is the best investigation to diagnose ectopic pregnancy?

Laparoscopy. **Explanation:** The diagnosis of ectopic pregnancy relies on a combination of clinical, biochemical, and radiological findings. However, **Laparoscopy** remains the **Gold Standard** and the best investigation for a definitive diagnosis. 1. **Why Laparoscopy is Correct:** Laparoscopy allows for direct visualization of the fallopian tubes, ovaries, and pelvic cavity. It provides a definitive diagnosis by confirming the presence of a gestational sac outside the uterine cavity and simultaneously offers the opportunity for immediate surgical management (e.g., salpingectomy or salpingostomy). 2. **Why other options are incorrect:** * **Urine Pregnancy Test:** This is a screening tool used to confirm pregnancy (by detecting hCG) but cannot differentiate between an intrauterine and an ectopic pregnancy. * **Ultrasound (USG):** Transvaginal Sonography (TVS) is the **investigation of choice** (first-line) and the most common way to diagnose ectopic pregnancy non-invasively. However, it may sometimes yield indeterminate results (e.g., Pregnancy of Unknown Location), making it less definitive than direct visualization via laparoscopy. * **Hysteroscopy:** This involves visualizing the *inside* of the uterine cavity. While it can confirm the absence of an intrauterine pregnancy, it cannot visualize the adnexa where most ectopic pregnancies occur. **Clinical Pearls for NEET-PG:** * **Gold Standard/Best Investigation:** Laparoscopy. * **Investigation of Choice (First-line):** Transvaginal Ultrasound (TVS). * **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases). * **Discriminatory Zone:** The level of serum β-hCG (usually 1500–2000 mIU/mL) at which a normal intrauterine pregnancy should be visible on TVS. If hCG is above this level and the uterus is empty, ectopic pregnancy is highly suspected. * **Most common site:** Ampulla of the Fallopian tube.

Q: What is the recommended treatment for an ovarian tumor diagnosed during the first trimester of pregnancy?

Ovarian cystectomy in the second trimester. **Explanation:** The management of an adnexal mass in pregnancy depends on the gestational age and the risk of malignancy or complications (torsion/rupture). **Why Option D is correct:** The **second trimester (specifically 14–20 weeks)** is the "golden window" for surgical intervention. By this time, the placenta has taken over progesterone production, so the removal of the corpus luteum (if necessary) will not cause a miscarriage. Additionally, the uterus is not yet large enough to obstruct the surgical field, and the risk of preterm labor is significantly lower than in the third trimester. **Why other options are incorrect:** * **Option A:** Surgery in the third trimester is technically difficult due to the large gravid uterus and carries a high risk of triggering preterm labor. * **Options B & C:** Ignoring the tumor is dangerous. Large or persistent tumors (>5–6 cm) carry a 10–15% risk of **ovarian torsion**, rupture, or labor dystocia. Furthermore, while most masses are benign (e.g., dermoid cysts), the risk of malignancy must be addressed. **NEET-PG High-Yield Pearls:** * **Most common ovarian tumor in pregnancy:** Mature cystic teratoma (Dermoid cyst). * **Most common complication:** Torsion (most frequent during the 1st trimester or early postpartum). * **Indications for surgery:** Mass >6 cm, solid components on USG, or symptoms of torsion/rupture. * **Laparoscopy vs. Laparotomy:** Laparoscopy is now considered safe in pregnancy when performed by experts, preferably in the second trimester.

Question 1

All of the following are increased in infants of mothers with heart disease, except:

Accepted Answer

Neural tube defect

Answer

Prematurity

Answer

Intrauterine growth restriction (IUGR)

Answer

Increased incidence of cardiac disease

Question 2

All of the following diseases are transmitted vertically in the 3rd trimester of pregnancy except?

Accepted Answer

Congenital parvovirus B19

Answer

Congenital syphilis

Answer

Congenital toxoplasmosis

Answer

Congenital hepatitis B

Question 3

What is the most common cause of epilepsy in pregnancy?

Accepted Answer

Idiopathic

Answer

Tuberculous meningitis

Answer

Cerebral malaria

Answer

Brain tumor

Question 4

Rh incompatibility does not produce serious complications in the first pregnancy. Which of the following explains this phenomenon?

Accepted Answer

Antibodies are not able to cross the placenta.

Answer

Antibody titer is very low during secondary immune response.

Answer

IgG generated is ineffective against fetal red cells.

Answer

Massive hemolysis is compensated by increased erythropoiesis.

Question 5

A 37-week pregnant woman presents with bleeding per vagina. Investigations reveal a severe degree of placenta previa. What is the appropriate management?

Accepted Answer

Immediate Cesarean section

Answer

Blood transfusion

Answer

Conservative management

Answer

Medical induction of labor

Question 6

Which of the following steps are useful in the perinatal prevention of mother-to-child transmission?

Accepted Answer

Antiretroviral prophylaxis

Answer

Cleaning the mother's vagina with antiseptic lotion

Answer

Elective Cesarean section

Answer

Avoiding breastfeeding

Question 7

Which of the following signs is observed in intrauterine fetal demise?

Accepted Answer

Roberts sign

Answer

Von Braun-Fernwalds sign

Answer

Goodell's sign

Answer

Osiander's sign

Question 8

All the following are used in hypertensive emergencies in preeclampsia except?

Accepted Answer

Methyldopa

Answer

Nifedipine

Answer

Labetalol

Answer

Hydralazine

Question 9

What is the best investigation to diagnose ectopic pregnancy?

Accepted Answer

Laparoscopy

Answer

Urine pregnancy test

Answer

Ultrasound (USG)

Answer

Hysteroscopy

Question 10

What is the recommended treatment for an ovarian tumor diagnosed during the first trimester of pregnancy?

Accepted Answer

Ovarian cystectomy in the second trimester

Answer

Surgery in the third trimester

Answer

No surgery is needed

Answer

Ignore the tumor

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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