Maternal-Fetal Medicine — MCQs
On this page
Which of the following is NOT included in a modified Biophysical Profile (BPP)?
At which of the following gestational ages does a mother typically first perceive fetal movement?
A 32-year-old G2P1001 at 20 weeks gestational age presents to the emergency room complaining of constipation and abdominal pain for the past 24 hours. The patient also admits to bouts of nausea and emesis since eating a very spicy meal the evening before. She denies a history of any medical problems. During her last pregnancy, the patient underwent an elective cesarean section at term to deliver a fetus in the breech presentation. The emergency room doctor reports that the patient has a low-grade fever of 100°F, with a normal pulse and blood pressure. She is minimally tender to deep palpation with hypoactive bowel sounds and no rebound tenderness. Her WBC is 13,000, and electrolytes are normal. What is the appropriate next step in the management of this patient?
Which of the following is the earliest conclusive evidence of intrauterine death?
A pregnant woman presents with a blood pressure of 150/100 mmHg and proteinuria after 20 weeks of gestation. What is the most likely diagnosis?
"Twin peak" sign is seen in which type of twinning?
All of the following are included in the Manning score except?
A 20-year-old woman complains of sudden onset of right-sided lower abdominal pain and bleeding per vagina. Her last normal menstrual period was 35 days ago. Her blood pressure is 90/70 mmHg and the pulse rate is 100 bpm. There is tenderness and guarding in the right iliac fossa. She denies any sexual intercourse. What is the most appropriate next step in the management?
Alpha-feto-protein levels are typically lowered in which of the following conditions?
A 28 weeks pregnant primigravida presents with intermittent fever with chills, headache, and myalgia. Peripheral smear shows malarial parasites. Which of the following antimalarial medicines CANNOT be given to this patient?
Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs
Question 501: Which of the following is NOT included in a modified Biophysical Profile (BPP)?
- A. Oxytocin challenge test (Correct Answer)
- B. Non-stress test (NST)
- C. Amniotic fluid index (AFI)
- D. All of the above
Explanation: The **Modified Biophysical Profile (mBPP)** is a simplified, time-efficient method of fetal surveillance used to assess fetal well-being in high-risk pregnancies. It combines a short-term indicator of fetal acid-base status with a long-term indicator of placental function. ### Why "Oxytocin Challenge Test" is the Correct Answer: The **Oxytocin Challenge Test (OCT)**, also known as a Contraction Stress Test (CST), is a separate modality used to assess fetal heart rate response to uterine contractions. It is **not** a component of the modified BPP. While the full BPP includes five parameters (NST, fetal breathing, movements, tone, and liquor volume), the modified version specifically streamlines these into only two components. ### Explanation of Incorrect Options: * **Non-stress Test (NST):** This is a core component of the mBPP. It serves as an indicator of **acute fetal oxygenation**. A reactive NST suggests the absence of fetal acidemia at the time of testing. * **Amniotic Fluid Index (AFI):** This is the second core component of the mBPP. It serves as an indicator of **chronic placental function**. Decreased liquor (oligohydramnios) suggests chronic fetal hypoxia, which leads to shunting of blood away from the fetal kidneys. ### High-Yield Clinical Pearls for NEET-PG: * **Components of mBPP:** NST + AFI. * **Interpretation:** An mBPP is considered **normal** if the NST is reactive and the AFI is > 5 cm (or a single deepest pocket > 2 cm). * **Predictive Value:** The mBPP is as effective as the full BPP in predicting fetal acidemia but is much faster to perform. * **Abnormal Result:** If either the NST is non-reactive or the AFI is ≤ 5 cm, a full BPP or a Contraction Stress Test is typically indicated for further evaluation.
Question 502: At which of the following gestational ages does a mother typically first perceive fetal movement?
- A. 1 month
- B. 2 months (Correct Answer)
- C. 4 months
- D. 6 months
Explanation: **Explanation:** The perception of fetal movement by the mother is clinically termed **Quickening**. The timing of this milestone depends significantly on the mother’s parity: * **Primigravida (First-time mothers):** Typically perceive movement at **18–20 weeks** of gestation. * **Multigravida (Previous pregnancies):** Typically perceive movement earlier, at **16–18 weeks**, due to prior experience and abdominal muscle relaxation. In the context of this question, **4 months** (Option C) is the correct choice. At 16–20 weeks, the pregnancy is in its fourth to fifth lunar month. This is the period when the fetus has developed enough neuromuscular coordination and size for its movements to be felt through the uterine wall. **Analysis of Incorrect Options:** * **Option A (1 month) & B (2 months):** At 4–8 weeks, the embryo/fetus is too small, and movements are purely microscopic or detected only via high-resolution ultrasound. * **Option D (6 months):** By 24 weeks, fetal movements are vigorous and often visible externally. Waiting until 6 months to feel first movement would be a clinical delay (concerning for fetal well-being or incorrect dating). **NEET-PG High-Yield Pearls:** 1. **Quickening** is a subjective sign of pregnancy and is used to cross-check the Expected Date of Delivery (EDD). 2. **Rule of thumb:** Add 22 weeks to the date of quickening in a primigravida and 24 weeks in a multigravida to estimate the EDD. 3. **Ultrasound detection:** Fetal cardiac activity can be seen as early as 6 weeks via Transvaginal Sonography (TVS), long before the mother feels movement.
Question 503: A 32-year-old G2P1001 at 20 weeks gestational age presents to the emergency room complaining of constipation and abdominal pain for the past 24 hours. The patient also admits to bouts of nausea and emesis since eating a very spicy meal the evening before. She denies a history of any medical problems. During her last pregnancy, the patient underwent an elective cesarean section at term to deliver a fetus in the breech presentation. The emergency room doctor reports that the patient has a low-grade fever of 100°F, with a normal pulse and blood pressure. She is minimally tender to deep palpation with hypoactive bowel sounds and no rebound tenderness. Her WBC is 13,000, and electrolytes are normal. What is the appropriate next step in the management of this patient?
- A. The patient should be discharged with reassurance and instructions to give herself a soapsuds enema and follow a high-fiber diet with laxative use as needed.
- B. The patient should be prepped for the operating room immediately to have an emergent appendectomy.
- C. The patient should be reassured that her symptoms are due to the spicy meal consumed the evening before and should be given Pepto-Bismol to alleviate the symptoms.
- D. The patient should be sent to radiology for an upright abdominal x-ray. (Correct Answer)
Explanation: This patient presents with signs and symptoms suggestive of **Intestinal Obstruction**, a critical differential diagnosis in pregnancy. ### **Explanation of the Correct Answer** The patient has a history of a prior cesarean section, which is a significant risk factor for **postoperative adhesions**, the most common cause of intestinal obstruction in pregnancy. Her clinical presentation—constipation, abdominal pain, nausea, vomiting, and hypoactive bowel sounds—points toward an ileus or mechanical obstruction. An **upright abdominal X-ray** is the appropriate next step to look for dilated bowel loops and air-fluid levels. While ionizing radiation is generally avoided, a single abdominal film is safe in pregnancy (exposure <0.05 rad) and is necessary for a definitive diagnosis. ### **Analysis of Incorrect Options** * **Option A:** Discharging a patient with potential obstruction for an enema is dangerous, as it could delay diagnosis or exacerbate a mechanical blockage. * **Option B:** While appendicitis is the most common non-obstetric surgical emergency in pregnancy, this patient lacks localized right-sided pain (which shifts upward in pregnancy) and rebound tenderness. Surgery without imaging or a clear diagnosis is premature. * **Option C:** Pepto-Bismol (Bismuth subsalicylate) is generally avoided in pregnancy (especially in the third trimester) due to salicylate content. More importantly, dismissing these symptoms as simple indigestion ignores the surgical history and clinical signs of obstruction. ### **Clinical Pearls for NEET-PG** * **Most common cause of intestinal obstruction in pregnancy:** Adhesions from previous surgery (e.g., C-section or appendectomy). * **Most common non-obstetric surgical emergency in pregnancy:** Acute appendicitis. * **Imaging Safety:** A single X-ray or CT scan is not associated with measurable fetal risk; diagnostic necessity outweighs theoretical risks. * **Clinical Sign:** In pregnancy, the classic signs of peritonitis (guarding/rebound) are often absent because the enlarging uterus lifts the abdominal wall away from the inflamed viscera.
Question 504: Which of the following is the earliest conclusive evidence of intrauterine death?
- A. Shrinking of the body
- B. Intra-aortic gas (Correct Answer)
- C. Increased curvature of the spine
- D. Spalding sign
Explanation: **Explanation:** The diagnosis of intrauterine fetal death (IUFD) relies on specific radiological and clinical signs. The correct answer is **Intra-aortic gas (Robert’s Sign)**. **1. Why Intra-aortic gas is correct:** Robert’s Sign refers to the presence of gas (primarily nitrogen) in the fetal heart and large vessels (like the aorta). It is the **earliest radiological sign** of fetal death, appearing as early as **6 to 12 hours** after the event. It occurs due to the release of gases from decomposing fetal blood. **2. Why the other options are incorrect:** * **Spalding Sign (Option D):** This is the overlapping of fetal skull bones due to liquefaction of the brain and loss of intracranial pressure. While highly characteristic, it typically takes **4 to 7 days** to develop. * **Increased curvature of the spine (Option C):** Also known as **Hartley’s Sign**, this occurs due to the loss of fetal muscle tone, leading to an exaggerated flexion of the spine. It is a late sign and less specific than gas formation. * **Shrinking of the body (Option A):** This is a non-specific, late finding associated with maceration and absorption of amniotic fluid. **Clinical Pearls for NEET-PG:** * **Gold Standard:** Today, the definitive diagnosis of IUFD is the **demonstration of absent fetal cardiac activity on Ultrasound (USG)**. * **Spalding Sign:** Requires a living mother and a dead fetus; it is not valid if the labor has started (as molding can cause overlapping). * **Deuel’s Halo Sign:** Another radiological sign where a translucent halo appears around the fetal head due to edema of the scalp tissues. * **Rollover Test:** Used for predicting pre-eclampsia, not IUFD (common distractor).
Question 505: A pregnant woman presents with a blood pressure of 150/100 mmHg and proteinuria after 20 weeks of gestation. What is the most likely diagnosis?
- A. Pre-eclampsia (Correct Answer)
- B. Gestational hypertension
- C. Renal hypertension
- D. Eclampsia
Explanation: **Explanation:** The correct diagnosis is **Pre-eclampsia**. According to the standard diagnostic criteria, pre-eclampsia is defined as the new onset of hypertension (**BP ≥140/90 mmHg**) occurring **after 20 weeks of gestation** accompanied by significant **proteinuria** (≥300 mg/24h or ≥1+ on dipstick). In this case, the patient’s BP of 150/100 mmHg and the presence of proteinuria after the 20-week mark perfectly satisfy these criteria. **Analysis of Incorrect Options:** * **Gestational Hypertension:** This refers to hypertension (≥140/90) developing after 20 weeks of gestation **without** proteinuria or other systemic features of pre-eclampsia. * **Renal Hypertension:** This is typically a form of chronic hypertension that exists prior to pregnancy or is diagnosed before 20 weeks of gestation. While it causes proteinuria, the timing in this clinical vignette points toward a pregnancy-induced pathology. * **Eclampsia:** This is the occurrence of generalized tonic-clonic **seizures** in a woman with pre-eclampsia that cannot be attributed to other causes. Since no seizures were mentioned, this diagnosis is incorrect. **High-Yield Clinical Pearls for NEET-PG:** * **Timing is Key:** Hypertension before 20 weeks is "Chronic Hypertension"; after 20 weeks it is "Gestational Hypertension" or "Pre-eclampsia." * **New Criteria:** If proteinuria is absent, pre-eclampsia can still be diagnosed if there is new-onset hypertension plus evidence of end-organ dysfunction (thrombocytopenia, renal insufficiency, impaired liver function, or visual/cerebral symptoms). * **Drug of Choice:** Magnesium Sulfate ($MgSO_4$) is the drug of choice for seizure prophylaxis and control in eclampsia (Pritchard Regimen). * **Definitive Treatment:** Delivery of the fetus and placenta remains the only definitive cure.
Question 506: "Twin peak" sign is seen in which type of twinning?
- A. Dichorionic diamniotic twins (Correct Answer)
- B. Monochorionic monoamniotic twins
- C. Discordant twins
- D. Conjoined twins
Explanation: **Explanation:** The **"Twin Peak" sign** (also known as the **Lambda sign**) is a crucial ultrasonographic marker used to determine chorionicity in multiple pregnancies. **1. Why Dichorionic Diamniotic (DCDA) is correct:** In DCDA twins, each fetus has its own placenta. When these two placentas are adjacent or fused, a triangular wedge of placental tissue projects into the base of the inter-twin membrane. This creates a thick, "lambda-shaped" appearance at the junction. The presence of this sign confirms that there are two separate chorionic sacs, making it the hallmark of **Dichorionic** twinning. **2. Why the other options are incorrect:** * **Monochorionic (MC) twins:** These twins share a single placenta. The inter-twin membrane is very thin and meets the placenta at a perpendicular angle, forming a **"T-sign."** The absence of the twin peak sign indicates monochorionicity. * **Discordant twins:** This refers to a significant weight or size difference between twins (usually >20%) and is a clinical finding, not a marker of chorionicity. * **Conjoined twins:** These are always monochorionic monoamniotic (MCMA) and occur due to incomplete division of the embryonic disc after day 13. There is no inter-twin membrane, and thus no "peak" sign. **3. NEET-PG High-Yield Pearls:** * **Best time to determine chorionicity:** 10–14 weeks of gestation (first trimester). * **Lambda (λ) Sign:** DCDA twins (Thick membrane >2mm). * **T-Sign:** Monochorionic Diamniotic (MCDA) twins (Thin membrane <2mm). * **Chorionicity vs. Zygosity:** While all dizygotic twins are DCDA, monozygotic twins can be DCDA, MCDA, or MCMA depending on the day of division. * **Division Timeline:** * 0–3 days: DCDA * 4–8 days: MCDA * 8–13 days: MCMA * >13 days: Conjoined twins
Question 507: All of the following are included in the Manning score except?
- A. Breathing
- B. Non-stress test
- C. Movement
- D. Vibroacoustic stimulation (Correct Answer)
Explanation: The **Manning Score**, also known as the **Biophysical Profile (BPP)**, is a standardized ultrasound-based assessment used to evaluate fetal well-being and identify potential hypoxia. ### Why Vibroacoustic Stimulation is the Correct Answer **Vibroacoustic stimulation (VAS)** is a technique used during a Non-Stress Test (NST) to wake a sleeping fetus and elicit accelerations. While it is a tool used in fetal monitoring, it is **not** one of the five formal components of the Manning Score. ### Explanation of the Manning Score Components The Manning Score consists of five parameters, each scored as 2 (normal) or 0 (abnormal), for a maximum score of 10: 1. **Breathing (Option A):** At least one episode of rhythmic fetal breathing lasting $\geq$ 30 seconds within a 30-minute window. 2. **Movement (Option C):** At least three discrete body or limb movements in 30 minutes. 3. **Tone:** At least one episode of active extension with return to flexion (e.g., opening/closing a hand). 4. **Amniotic Fluid Volume (AFV):** At least one pocket of fluid measuring $\geq$ 2 cm in two perpendicular planes (Vertical pocket). 5. **Non-stress test (Option B):** A reactive NST (2 or more accelerations in 20 minutes). This is the only component that requires cardiotocography; the others are assessed via ultrasound. ### High-Yield Clinical Pearls for NEET-PG * **Modified BPP:** Consists of only two parameters: **NST** (indicator of acute oxygenation) and **Amniotic Fluid Index** (indicator of chronic placental perfusion). * **Sequence of Loss:** In fetal hypoxia, the first sign to disappear is the **NST (reactivity)** and **breathing**, while **fetal tone** is the last to disappear (as it is controlled by the most hypoxia-resistant part of the brain). * **Scoring:** A score of 8-10 is normal; 4-6 is equivocal (usually requires repeat or delivery depending on GA); 0-2 is strongly suggestive of fetal asphyxia and mandates immediate delivery.
Question 508: A 20-year-old woman complains of sudden onset of right-sided lower abdominal pain and bleeding per vagina. Her last normal menstrual period was 35 days ago. Her blood pressure is 90/70 mmHg and the pulse rate is 100 bpm. There is tenderness and guarding in the right iliac fossa. She denies any sexual intercourse. What is the most appropriate next step in the management?
- A. Estimate serum beta hCG levels
- B. Obtain a surgical opinion to exclude acute appendicitis
- C. Perform a laparoscopic examination
- D. Perform a transvaginal ultrasound scan (Correct Answer)
Explanation: ### Explanation This clinical scenario presents a classic diagnostic challenge: a young woman with acute abdominal pain, vaginal bleeding, and hemodynamic instability (hypotension and tachycardia). Despite the patient’s denial of sexual activity, the primary differential diagnosis remains a **ruptured ectopic pregnancy** until proven otherwise. **1. Why Option D is correct:** A **Transvaginal Ultrasound (TVS)** is the gold standard imaging modality for suspected ectopic pregnancy. In an emergency setting, TVS can rapidly identify an empty uterus, an adnexal mass, or free fluid (hemoperitoneum) in the Pouch of Douglas. Even in hemodynamically unstable patients, a "Point of Care Ultrasound" (POCUS) is prioritized to confirm the source of bleeding before proceeding to surgery. **2. Why the other options are incorrect:** * **Option A:** While a serum beta-hCG is essential for diagnosis, it is a laboratory test that takes time. In a patient showing signs of shock (BP 90/70 mmHg), immediate imaging is more critical to guide surgical intervention. * **Option B:** While acute appendicitis is a differential for right iliac fossa pain, the presence of vaginal bleeding and signs of shock strongly point toward a gynecological emergency. Surgical consultation should not delay primary obstetric evaluation. * **Option C:** Laparoscopy is the "gold standard" for *definitive* diagnosis and treatment, but it is an invasive procedure. Non-invasive imaging (TVS) must be performed first to justify surgical intervention. **3. Clinical Pearls for NEET-PG:** * **Rule of Thumb:** In any female of reproductive age presenting with abdominal pain, a pregnancy test is the first step, and an ectopic pregnancy must be excluded regardless of sexual history. * **Discriminatory Zone:** The level of beta-hCG at which an intrauterine gestational sac should be visible on TVS is **1500–2000 mIU/ml**. * **Classic Triad of Ectopic Pregnancy:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases). * **Management:** If the patient is hemodynamically unstable with a positive TVS for hemoperitoneum, the immediate treatment is **emergency laparotomy**.
Question 509: Alpha-feto-protein levels are typically lowered in which of the following conditions?
- A. Down's syndrome (Correct Answer)
- B. Renal anomalies
- C. Anterior abdominal wall defects
- D. Anencephaly
Explanation: **Explanation:** Alpha-fetoprotein (AFP) is a glycoprotein synthesized initially by the yolk sac and later by the fetal liver. It is the fetal equivalent of albumin. Monitoring Maternal Serum Alpha-Fetoprotein (MSAFP) levels is a crucial screening tool during the second trimester (15–20 weeks). **Why Down’s Syndrome is Correct:** In pregnancies affected by **Down’s syndrome (Trisomy 21)**, MSAFP levels are characteristically **decreased** (typically <0.5 MoM). While the exact pathophysiology is not fully understood, it is attributed to reduced synthesis by the fetal liver and a smaller-than-normal yolk sac. In a "Triple Test" for Down’s syndrome, you will typically see: * **Low AFP** * **Low Unconjugated Estriol (uE3)** * **High hCG** **Why the Other Options are Incorrect:** * **Anencephaly & Anterior Abdominal Wall Defects (e.g., Gastroschisis, Omphalocele):** These conditions involve "open" defects where fetal serum leaks directly into the amniotic fluid, leading to significantly **elevated** MSAFP levels. * **Renal Anomalies:** Conditions like congenital nephrosis or urinary tract obstructions lead to increased excretion of AFP into the amniotic fluid, resulting in **elevated** levels. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of increased MSAFP:** Incorrect gestational age (dating error). * **Elevated AFP (>2.5 MoM):** Neural tube defects (Anencephaly, Spina bifida), abdominal wall defects, multiple gestations, and fetal demise. * **Decreased AFP:** Down’s syndrome, Edward’s syndrome (Trisomy 18), gestational trophoblastic disease, and maternal obesity. * **Mnemonic for Down’s (Triple Test):** "HI" – **H**CG and **I**nhibin-A are **High**; the rest (AFP, uE3) are low.
Question 510: A 28 weeks pregnant primigravida presents with intermittent fever with chills, headache, and myalgia. Peripheral smear shows malarial parasites. Which of the following antimalarial medicines CANNOT be given to this patient?
- A. Chloroquine
- B. Primaquine (Correct Answer)
- C. Mefloquine
- D. Quinine
Explanation: **Explanation:** The correct answer is **Primaquine**. **1. Why Primaquine is Contraindicated:** Primaquine is strictly contraindicated throughout pregnancy. The primary concern is that the drug crosses the placenta and can cause **severe hemolysis and life-threatening hemolytic anemia** in the fetus, especially if the fetus has an unknown Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency. Since the G6PD status of a fetus cannot be determined in utero, the drug is avoided to prevent potential fetal demise. **2. Analysis of Other Options:** * **Chloroquine (Option A):** Considered the drug of choice for uncomplicated *P. vivax* malaria in pregnancy across all trimesters. It is safe and non-teratogenic. * **Mefloquine (Option B):** Safe for use in the second and third trimesters (and even the first trimester if the benefit outweighs the risk) for prophylaxis or treatment of chloroquine-resistant malaria. * **Quinine (Option D):** The traditional drug of choice for severe or chloroquine-resistant malaria in the first trimester. While it can cause hypoglycemia (hyperinsulinemia), it is not contraindicated. **3. High-Yield Clinical Pearls for NEET-PG:** * **Radical Cure:** In cases of *P. vivax* or *P. ovale*, Primaquine is used to kill hypnozoites (liver stage). In pregnant patients, this "radical cure" is **deferred until after delivery**. * **WHO Guidelines:** For uncomplicated *P. falciparum* in the 1st trimester, Quinine + Clindamycin is preferred. In the 2nd and 3rd trimesters, **Artemisinin-based Combination Therapy (ACT)** is the standard of care. * **Severe Malaria:** Intravenous **Artesunate** is the drug of choice for severe malaria in all trimesters of pregnancy.
Practice by Chapter
Fetal Assessment Techniques
Practice Questions
Hypertensive Disorders in Pregnancy
Practice Questions
Intrauterine Growth Restriction
Practice Questions
Multiple Gestation
Practice Questions
Rh Isoimmunization and Other Blood Group Incompatibilities
Practice Questions
Intrauterine Fetal Therapy
Practice Questions
Prenatal Diagnosis and Genetic Counseling
Practice Questions
Placental Abnormalities
Practice Questions
Preterm Labor and Delivery
Practice Questions
Management of Medical Disorders in Pregnancy
Practice Questions
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free