Maternal-Fetal Medicine Practice Questions

Q: A 15 cm x 15 cm ovarian cyst has been diagnosed in an 8-week pregnant lady. Further management includes:

Laparotomy at 14-16 weeks. ### Explanation The management of an adnexal mass in pregnancy depends on the size of the cyst, its sonographic features, and the gestational age. **Why Option B is Correct:** A 15 cm ovarian cyst is considered large (typically >6–10 cm) and carries a high risk of **torsion, rupture, or labor obstruction**. The ideal time for surgical intervention is the **early second trimester (14–16 weeks)**. * By this time, the **luteo-placental shift** is complete (the placenta has taken over progesterone production from the corpus luteum), significantly reducing the risk of miscarriage. * The uterus is not yet large enough to technically obstruct the surgical field, making the procedure safer than in the third trimester. **Why Other Options are Incorrect:** * **Option A:** Observation is reserved for simple cysts <6 cm, which often resolve spontaneously. A 15 cm cyst is unlikely to resolve and poses an immediate risk of torsion. * **Option C & D:** Delaying surgery until term or postpartum increases the risk of emergency complications (torsion/rupture) throughout the pregnancy and may necessitate an emergency laparotomy, which carries higher maternal and fetal morbidity than an elective mid-trimester procedure. **High-Yield Clinical Pearls for NEET-PG:** * **Most common ovarian cyst in pregnancy:** Corpus luteum cyst (usually regresses by 12–14 weeks). * **Most common benign neoplasm in pregnancy:** Mature cystic teratoma (Dermoid). * **Indications for surgery:** Size >10 cm, solid components/papillary projections on ultrasound (suspicion of malignancy), or acute complications (torsion). * **Laparoscopy vs. Laparotomy:** While laparotomy is the traditional answer, laparoscopy is now considered safe in the second trimester if performed by an expert.

Q: Which of the following is NOT a cause of Disseminated Intravascular Coagulation (DIC)?

Fat emboli. **Explanation:** Disseminated Intravascular Coagulation (DIC) in obstetrics is primarily triggered by the release of **thromboplastin** (tissue factor) into the maternal circulation, leading to widespread activation of the coagulation cascade and subsequent consumption of clotting factors. **Why Fat Emboli is the Correct Answer:** While **Fat Embolism Syndrome (FES)** is a life-threatening condition typically associated with long bone fractures or orthopedic trauma, it is **not** a recognized cause of DIC in the obstetric context. FES primarily causes respiratory distress, petechial rashes, and neurological symptoms due to mechanical obstruction of capillaries and free fatty acid toxicity, rather than a systemic consumptive coagulopathy. **Analysis of Incorrect Options:** * **Abruption Placentae:** This is the **most common** cause of DIC in pregnancy. The retroplacental clot releases massive amounts of tissue thromboplastin into the maternal bloodstream. * **Amniotic Fluid Embolism (AFE):** This is the **most severe** cause. Amniotic fluid contains high concentrations of procoagulant factors and tissue factor, triggering an "anaphylactoid syndrome" and sudden, profound DIC. * **Intrauterine Fetal Demise (IUD):** If a dead fetus is retained for more than 3–4 weeks ("Dead Fetus Syndrome"), the gradual release of degenerating fetal tissue products into the maternal circulation leads to chronic DIC. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of DIC in pregnancy:** Abruptio Placentae. * **Earliest lab finding in DIC:** Decreased platelet count and presence of Schistocytes (fragmented RBCs) on peripheral smear. * **Best screening test:** FDPs (Fibrin Degradation Products) or D-dimer (elevated). * **Confirmatory/Most specific finding:** Low Fibrinogen levels (<150 mg/dL). * **Management:** Always treat the underlying cause (e.g., delivery) and replace blood products (FFP, Cryoprecipitate).

Q: Which among the following is decreased in twin pregnancy compared to singleton pregnancy?

Systemic vascular resistance. In a twin pregnancy, the maternal body undergoes exaggerated physiological adaptations compared to a singleton pregnancy to meet the increased metabolic demands of two fetuses. **Explanation of the Correct Answer:** **Systemic Vascular Resistance (SVR)** is significantly **decreased** in twin pregnancies. This is due to the high-flow, low-resistance circuit of the dual placentae and the profound vasodilatory effects of increased progesterone and nitric oxide. While SVR drops in all pregnancies, the decline is more pronounced in multifetal gestations to accommodate a much higher cardiac output (which increases by an additional 20% over singleton levels). **Why the other options are incorrect:** * **Blood loss at delivery:** This is **increased**. The larger placental site and the risk of uterine atony due to overdistension of the uterus make postpartum hemorrhage (PPH) much more common in twins. * **Blood pressure at term:** This is typically **increased** or remains similar. Twin pregnancies carry a significantly higher risk (3–4 times) of developing gestational hypertension and preeclampsia compared to singletons. * **Blood volume expansion:** This is **increased**. While singleton pregnancies see a 40–50% increase, twin pregnancies experience a 50–60% increase in plasma volume to support dual uteroplacental perfusion. **High-Yield Clinical Pearls for NEET-PG:** * **Anemia:** Because plasma volume expansion exceeds the rise in red cell mass more severely in twins, **physiologic anemia** is more profound. * **Cardiac Output:** Reaches its peak earlier and is higher in twins. * **Uterine Volume:** Can reach up to 10 liters or more, leading to increased diaphragmatic splinting and respiratory discomfort.

Q: All of the following are true about anencephaly except?

Preterm delivery is a norm. **Explanation:** Anencephaly is a lethal neural tube defect characterized by the absence of the cranial vault and cerebral hemispheres. **Why Option C is the correct answer (The False Statement):** Contrary to common belief, **post-term pregnancy (prolonged pregnancy)** is more common in anencephaly than preterm delivery. This occurs because the fetal pituitary-adrenal axis is defective or absent. The lack of fetal cortisol and precursors for estrogen synthesis leads to a failure in the initiation of labor, often resulting in a pregnancy that continues beyond 42 weeks unless medical intervention occurs. **Analysis of Incorrect Options:** * **A. Face presentation:** Due to the absence of the vertex (calvarium), the head cannot engage normally. The face becomes the leading part, making face presentation a common clinical finding. * **B. Increased alpha-fetoprotein (AFP):** Anencephaly is an open neural tube defect. This allows AFP to leak from the fetal circulation into the amniotic fluid and maternal serum, leading to significantly elevated levels. * **D. Polyhydramnios:** This occurs due to two reasons: (1) the fetus lacks the swallowing reflex due to neurological deficit, and (2) transudation of fluid from the exposed meninges (cerebrospinal fluid) into the amniotic sac. **High-Yield Clinical Pearls for NEET-PG:** * **Screening:** Elevated Maternal Serum AFP (MSAFP) at 15–20 weeks. * **Diagnosis:** Ultrasound is the gold standard (shows "Frog-eye appearance" or "Mickey Mouse sign" in early scans). * **Prevention:** 4 mg of Folic acid daily (pre-conceptionally) for women with a previous history; 400 mcg for low-risk pregnancies. * **Associated finding:** "Shoulder dystocia" can occur because these fetuses often have large trunks despite the absent cranial vault.

Q: What is the clinical diagnosis when a pregnant woman presents with bloody vaginal discharge through a closed cervical os during the first 20 weeks?

Threatened abortion. ### Explanation **Correct Answer: A. Threatened Abortion** **Medical Concept:** Threatened abortion is defined as vaginal bleeding occurring before the 20th week of gestation where the **cervical os remains closed**. It is a clinical diagnosis indicating that the pregnancy is at risk, but the products of conception have not been expelled. The hallmark features are painless or mildly painful bleeding with a closed internal os and a viable fetus on ultrasound. **Why the other options are incorrect:** * **B. Complete Abortion:** In this case, all products of conception have been expelled. The cervix has usually closed *after* the event, the uterus is smaller than the period of gestation, and ultrasound shows an empty cavity. * **C. Incomplete Abortion:** This involves the partial expulsion of products. Crucially, the **cervical os is open**, and some tissue remains within the uterus, often leading to heavy bleeding and crampy pain. * **D. Preterm Labor:** This refers to the onset of labor (regular contractions and cervical changes) occurring after the age of viability (typically >20–24 weeks) but before 37 weeks. The question specifies the first 20 weeks. **NEET-PG High-Yield Pearls:** * **Management:** The mainstay of treatment for threatened abortion is **expectant management** and bed rest (though evidence for bed rest is limited). Progesterone supplementation is often used if a deficiency is suspected. * **Prognosis:** Approximately 50% of threatened abortions progress to actual loss; however, if fetal heart activity is seen on USG, there is a >90% chance of the pregnancy continuing. * **Cervical Os Status:** This is the "deciding factor" in abortion questions. * **Closed Os:** Threatened or Missed abortion. * **Open Os:** Inevitable or Incomplete abortion.

Q: Which of the following is NOT a feature of postdated pregnancy?

Polyhydramnios. **Explanation:** Postdated pregnancy (defined as a pregnancy extending beyond 42 weeks) is characterized by a progressive decline in placental function. The correct answer is **Polyhydramnios** because postdated pregnancies are actually associated with **Oligohydramnios** (decreased amniotic fluid). **Why Polyhydramnios is the correct choice (the "NOT" feature):** As the placenta ages (placental insufficiency), fetal perfusion decreases. This leads to reduced fetal renal blood flow, resulting in decreased fetal urine output—the primary source of amniotic fluid in late pregnancy. Therefore, oligohydramnios is a hallmark of postterm pregnancy, not polyhydramnios. **Analysis of incorrect options:** * **Cord compression:** Due to the reduction in amniotic fluid (oligohydramnios), the umbilical cord is no longer cushioned, making it highly susceptible to compression during contractions or fetal movement. * **Fetal distress:** Placental insufficiency leads to chronic hypoxia. This, combined with cord compression, significantly increases the risk of non-reassuring fetal heart rate patterns and fetal distress. * **Intrauterine growth restriction (IUGR):** While many postterm fetuses are macrosomic, a subset experiences "Dysmaturity Syndrome" (Clifford’s Syndrome) due to placental failure, leading to loss of subcutaneous fat and growth restriction. **High-Yield Clinical Pearls for NEET-PG:** * **Definition:** Postterm is ≥42 weeks; Late-term is 41 weeks to 41 weeks 6 days. * **Most common cause:** Inaccurate dating (wrong dates). * **Amniotic Fluid Index (AFI):** An AFI <5 cm or a single deepest pocket <2 cm is a critical indicator for induction in postterm cases. * **Meconium Aspiration Syndrome (MAS):** Risk increases significantly post-42 weeks due to increased meconium passage in utero (triggered by vagal stimulation from cord compression).

Q: All of the following are to be monitored during Magnesium sulfate prophylaxis in impending eclampsia, EXCEPT:

Serum magnesium level. **Explanation:** Magnesium sulfate ($MgSO_4$) is the drug of choice for seizure prophylaxis in pre-eclampsia and control in eclampsia. It is primarily excreted by the kidneys and has a narrow therapeutic index. Therefore, monitoring for **magnesium toxicity** is mandatory. **Why Serum Magnesium Level is the Correct Answer:** Routine monitoring of serum magnesium levels is **not required** during prophylaxis. Clinical monitoring of bedside parameters is sufficient and more practical. Serum levels are only indicated if the patient has renal impairment (Serum Creatinine >1.0 mg/dL), if clinical signs of toxicity appear, or if seizures recur despite treatment. The therapeutic range is 4–7 mEq/L, while toxicity begins when levels exceed 7–10 mEq/L. **Why the other options are monitored (Clinical Monitoring):** Clinical signs of toxicity follow a predictable sequence, which must be monitored every 2–4 hours: * **Patellar reflex (A):** Loss of deep tendon reflexes (knee jerk) is the **earliest sign** of toxicity (occurs at 7–10 mEq/L). $MgSO_4$ must be stopped if the reflex is absent. * **Respiratory Rate (B):** Magnesium causes neuromuscular blockade. Respiratory depression (RR 30 ml/hr or 100 ml/4 hours) ensures the drug does not accumulate to toxic levels. **High-Yield Clinical Pearls for NEET-PG:** * **Antidote:** 10 ml of 10% **Calcium Gluconate** IV (administered slowly over 10 minutes). * **Pritchard Regimen:** 4g IV + 10g IM (loading), followed by 5g IM every 4 hours (maintenance). * **Zuspan Regimen:** 4g IV (loading), followed by 1-2g/hr IV infusion (maintenance). * **Therapeutic Range:** 4–7 mEq/L (or 4.8–8.4 mg/dL). * **Cardiac Arrest:** Occurs at levels >25 mEq/L.

Q: A 28-year-old female with a history of 8 weeks of amenorrhea complains of vaginal bleeding and lower abdominal pain. On USG examination, there is a gestational sac with absent fetal parts. What is the diagnosis?

Incomplete abortion. **Explanation:** The clinical presentation of vaginal bleeding and abdominal pain following amenorrhea, combined with the ultrasound finding of a gestational sac with absent fetal parts, points toward an **Incomplete Abortion**. **1. Why Incomplete Abortion is correct:** In an incomplete abortion, the products of conception (POC) have partially expelled from the uterus. On ultrasound, this typically manifests as an irregular gestational sac, a collapsed sac, or heterogeneous echogenic material (retained products) within the uterine cavity. The absence of fetal parts in a sac that previously contained them, or a disorganized sac at 8 weeks, confirms that the pregnancy is no longer viable and is in the process of expulsion. **2. Why other options are incorrect:** * **Ectopic Pregnancy:** While it presents with pain and bleeding, the ultrasound would typically show an empty uterus and an adnexal mass. A gestational sac *inside* the uterus (as stated in the question) makes this less likely. * **Threatened Abortion:** In this condition, bleeding occurs but the pregnancy remains viable. Ultrasound would show a well-formed gestational sac with a visible fetal pole and cardiac activity (at 8 weeks). * **Corpus Luteum Cyst:** This is a functional physiological cyst of pregnancy. While it may cause mild pain, it does not cause vaginal bleeding or the presence of a non-viable gestational sac. **High-Yield Clinical Pearls for NEET-PG:** * **Cervical Os Status:** In Incomplete and Inevitable abortions, the internal os is **open**. In Threatened and Missed abortions, the os is **closed**. * **Management:** Incomplete abortion is managed by medical evacuation (Misoprostol) or surgical evacuation (D&E/MVA). * **USG Hallmark:** The "Snowstorm appearance" is specific to Molar pregnancy, while an "Empty sac" >25mm MSD (Mean Sac Diameter) defines a Blighted Ovum (Anembryonic pregnancy).

Question 1

What is the highest risk factor for ectopic pregnancy?

Accepted Answer

Previous surgery for ectopic pregnancy

Answer

Intrauterine device

Answer

Salpingitis

Answer

Salpingitis isthmica nodosa

Question 2

A 28-week pregnant woman (G2P1) detected with major placenta previa on ultrasound (transvaginal scan) should have a confirmatory scan performed at which gestational age?

Accepted Answer

32 weeks

Answer

34 weeks

Answer

36 weeks

Answer

Onset of labor

Question 3

A 15 cm x 15 cm ovarian cyst has been diagnosed in an 8-week pregnant lady. Further management includes:

Accepted Answer

Laparotomy at 14-16 weeks

Answer

Only follow-up without surgical intervention

Answer

Cesarean delivery and ovariotomy at term

Answer

Surgery after delivery

Question 4

Which of the following is NOT a cause of Disseminated Intravascular Coagulation (DIC)?

Accepted Answer

Fat emboli

Answer

Abruption placentae

Answer

Amniotic fluid embolism

Answer

Intrauterine fetal demise (IUD)

Question 5

Which among the following is decreased in twin pregnancy compared to singleton pregnancy?

Accepted Answer

Systemic vascular resistance

Answer

Blood loss at delivery

Answer

Blood pressure at term

Answer

Blood volume expansion

Question 6

All of the following are true about anencephaly except?

Accepted Answer

Preterm delivery is a norm

Answer

Face presentation

Answer

Increased alpha-fetoprotein

Answer

Polyhydramnios

Question 7

What is the clinical diagnosis when a pregnant woman presents with bloody vaginal discharge through a closed cervical os during the first 20 weeks?

Accepted Answer

Threatened abortion

Answer

Complete abortion

Answer

Incomplete abortion

Answer

Preterm labor

Question 8

Which of the following is NOT a feature of postdated pregnancy?

Accepted Answer

Polyhydramnios

Answer

Cord compression

Answer

Fetal distress

Answer

Intrauterine growth restriction (IUGR)

Question 9

All of the following are to be monitored during Magnesium sulfate prophylaxis in impending eclampsia, EXCEPT:

Accepted Answer

Serum magnesium level

Answer

Patellar reflex

Answer

Respiratory Rate

Answer

Urine output

Question 10

A 28-year-old female with a history of 8 weeks of amenorrhea complains of vaginal bleeding and lower abdominal pain. On USG examination, there is a gestational sac with absent fetal parts. What is the diagnosis?

Accepted Answer

Incomplete abortion

Answer

Ectopic pregnancy

Answer

Threatened abortion

Answer

Corpus luteum cyst

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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