Maternal-Fetal Medicine Practice Questions

Q: Recurrent fetal loss is associated with which of the following conditions?

All of the above. **Explanation:** Recurrent fetal loss (RFL) is a significant clinical challenge often rooted in autoimmune and thrombophilic disorders. The correct answer is **All of the above** because these conditions are pathophysiologically linked through the mechanism of placental insufficiency. 1. **Antiphospholipid Antibody Syndrome (APLAS):** This is the most common acquired thrombophilia leading to RFL. It is characterized by the presence of antibodies (Lupus anticoagulant, Anticardiolipin, or Anti-β2 glycoprotein I) that induce a prothrombotic state. This leads to thrombosis of placental vessels, infarction, and subsequent fetal loss, typically after 10 weeks of gestation. 2. **Lupus Anticoagulant (LA):** This is one of the specific antibodies used to diagnose APLAS. Despite its name, it is a potent procoagulant *in vivo*. It has the strongest association with pregnancy complications and adverse outcomes among all antiphospholipid antibodies. 3. **Systemic Lupus Erythematosus (SLE):** Patients with SLE have a higher baseline risk of fetal loss due to active inflammation, vasculitis, and the frequent co-existence of secondary APLAS (found in approximately 30-40% of SLE patients). **High-Yield Clinical Pearls for NEET-PG:** * **APLAS Diagnostic Criteria (Sapporo):** Requires at least one clinical criterion (vascular thrombosis or pregnancy morbidity) and one laboratory criterion (positive LA, ACL, or Anti-β2 GPI on two occasions, 12 weeks apart). * **Pregnancy Morbidity in APLAS:** Defined as ≥3 unexplained consecutive spontaneous abortions before 10 weeks, OR ≥1 death of a morphologically normal fetus at ≥10 weeks, OR ≥1 preterm birth before 34 weeks due to severe pre-eclampsia or placental insufficiency. * **Management:** The standard treatment for APLAS in pregnancy is a combination of **Low-Dose Aspirin (LDA)** and **Low Molecular Weight Heparin (LMWH)**.

Q: When the death of one fetus in a multiple pregnancy occurs early in pregnancy, how may it manifest?

Vanishing twin. ### Explanation The correct answer is **B. Vanishing twin**. **1. Why "Vanishing Twin" is correct:** When a fetus dies **early in pregnancy** (typically during the first trimester), the gestational sac and fetal tissues are often completely reabsorbed by the mother or the surviving twin. On a follow-up ultrasound, the previously documented twin simply "disappears," leaving a single viable fetus. This phenomenon occurs in approximately 20–30% of pregnancies conceived via assisted reproductive techniques. **2. Why the other options are incorrect:** * **A. Fetus papyraceus:** This occurs when fetal death happens in the **second trimester** (usually after 14 weeks). The fetus is too large to be fully reabsorbed; instead, the amniotic fluid is absorbed, and the dead fetus becomes flattened, mummified, and parchment-like due to mechanical compression by the growing survivor. * **C. Fetus compressus:** This is a similar stage to fetus papyraceus. It refers to a fetus that has died and been compressed, but the term "papyraceus" is more specifically used when it is flattened to a paper-thin state. * **D. Fetus acardiacus (TRAP Sequence):** This is a rare complication of monochorionic twinning where one twin has a rudimentary or absent heart and is perfused by the "pump twin" through large artery-to-artery anastomoses. It is a developmental malformation, not a manifestation of early fetal death/reabsorption. **3. Clinical Pearls for NEET-PG:** * **Timing is Key:** Early 1st Trimester = Vanishing Twin; 2nd Trimester = Fetus Papyraceus. * **Prognosis:** If a twin "vanishes" in the 1st trimester, the prognosis for the surviving twin is usually excellent. * **Monochorionic Risk:** Death of a twin in the **2nd or 3rd trimester** in a monochorionic pregnancy carries a high risk of neurological damage (periventricular leukomalacia) or death for the survivor due to acute hemodynamic shifts.

Q: Which of the following is true about magnesium sulfate (MgSO4)?

Magnesium sulfate is used in the management of eclampsia.. **Explanation:** **Magnesium Sulfate (MgSO₄)** is the drug of choice for both the prophylaxis and treatment of seizures in eclampsia (Pritchard or Zuspan regimens). It acts primarily by blocking NMDA receptors, increasing the seizure threshold, and causing cerebral vasodilation. **Analysis of Options:** * **Option B (Correct):** MgSO₄ is the gold standard for managing eclamptic seizures and preventing progression from pre-eclampsia to eclampsia. * **Option A (Incorrect):** While not the *first-line* choice today (calcium channel blockers are preferred), MgSO₄ **is** a tocolytic. It acts as a calcium antagonist, relaxing uterine smooth muscle to delay preterm labor. * **Option C (Incorrect):** MgSO₄ crosses the placenta. In cases of maternal toxicity or prolonged high-dose infusion, it can cause **neonatal respiratory depression**, hypotonia ("floppy infant syndrome"), and suppressed reflexes. * **Option D (Incorrect):** MgSO₄ is **strictly contraindicated in Myasthenia Gravis**. It inhibits the release of acetylcholine at the neuromuscular junction, which can precipitate a life-threatening myasthenic crisis. **High-Yield Clinical Pearls for NEET-PG:** 1. **Therapeutic Range:** 4–7 mEq/L. 2. **Monitoring:** Always check for **Patellar reflex** (first to disappear at 8–10 mEq/L), **Respiratory rate** (>12/min), and **Urine output** (>30 ml/hr, as it is renally excreted). 3. **Antidote:** 10 ml of 10% **Calcium Gluconate** IV (administered slowly). 4. **Neuroprotection:** MgSO₄ is also used for fetal neuroprotection in imminent preterm births <32 weeks to reduce the risk of cerebral palsy.

Q: Grade 2 abruptio placenta is characterized by?

Fetal distress. **Explanation:** Abruptio placentae is the premature separation of a normally situated placenta. To standardize clinical management, the **Sher and Linthicum classification** is used to grade the severity based on clinical findings. **Why Fetal Distress is the Correct Answer:** In **Grade 2 (Moderate) Abruption**, the separation involves approximately 1/4th to 2/3rd of the placental surface. This significant loss of surface area leads to uteroplacental insufficiency. The classic presentation includes uterine tenderness, increased uterine tone, and most characteristically, **evidence of fetal distress** (abnormal heart rate patterns or fetal tachycardia). While the mother may show signs of tachycardia or orthostatic hypotension, she is not yet in profound shock. **Analysis of Incorrect Options:** * **A & B (Pronounced shock & Severe bleeding):** These are hallmarks of **Grade 3 (Severe) Abruption**. In Grade 2, bleeding is mild to moderate, and maternal hemodynamics are usually maintained despite compensated tachycardia. * **C (Coagulation defect):** Consumptive coagulopathy (DIC) is a severe complication typically reserved for **Grade 3** cases, often associated with intrauterine fetal death (IUFD). **NEET-PG High-Yield Pearls:** * **Grade 0:** Asymptomatic; diagnosed retrospectively by finding a retroplacental clot after delivery. * **Grade 1:** Mild; no fetal distress, no maternal shock. * **Grade 3:** Severe; characterized by **maternal shock, fetal death (IUFD), and often DIC.** * **Couvelaire Uterus:** A complication where blood extravasates into the myometrium (port-wine appearance); it is a clinical diagnosis made during laparotomy. * **Most common risk factor:** Maternal hypertension (Chronic or PIH).

Q: Funneling in cervicogram is seen in which of the following conditions?

Cervical incompetence. **Explanation:** **Cervical incompetence** (now often termed cervical insufficiency) is the correct answer. It is characterized by the painless dilation and effacement of the cervix, typically during the second trimester, leading to recurrent pregnancy loss or preterm birth. **Funneling** refers to the protrusion of the amniotic membranes into the internal os as it begins to open, while the external os remains closed. On ultrasound (cervicogram), this creates a characteristic "V" or "U" shaped appearance. **Analysis of Options:** * **A. During labor:** While the cervix dilates and effaces during labor, this is a physiological process driven by uterine contractions. The term "funneling" specifically describes the pre-labor pathological changes seen in an incompetent cervix. * **C. Cervical ectopic pregnancy:** This condition involves the implantation of the blastocyst within the cervical canal. It typically presents with a "hourglass" shaped uterus and a closed internal os, rather than the progressive funneling of membranes. * **D. During TVS:** Transvaginal sonography is the **modality** used to diagnose funneling, not a condition itself. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** TVS is the gold standard. A cervical length **<25 mm** before 24 weeks is a significant risk factor. * **The "Trust" Rule:** The sequence of cervical changes in funneling follows the mnemonic **T-Y-U-V** (T = normal, Y = early funneling, U = advanced funneling, V = imminent loss). * **Management:** The primary treatment is **Cervical Cerclage** (e.g., McDonald or Shirodkar techniques), usually performed between 12–14 weeks of gestation. * **Clinical Sign:** On physical exam, "bulging membranes" or "hourglass membranes" may be visible at the external os.

Q: Spalding's ring is seen in which of the following conditions?

Deadborn. **Explanation:** **Spalding’s Sign** is a classic radiological indicator of **intrauterine fetal death (IUFD)**. It refers to the **overlapping of the fetal skull bones** caused by the liquefaction of the brain matter and the loss of intracranial pressure following fetal demise. 1. **Why "Deadborn" is correct:** When a fetus dies in utero, the brain tissue undergoes autolysis and shrinks. This leads to a collapse of the cranial vault. The resulting loss of alignment causes the parietal bones to overlap at the sutures. This sign typically appears **4 to 7 days** after fetal death has occurred. 2. **Why other options are incorrect:** * **Liveborn/Premature:** In a living fetus (whether term or premature), intracranial pressure is maintained, and the brain provides a structural scaffold that keeps the skull bones aligned. While "molding" can occur during labor in a live birth, it is symmetrical and disappears shortly after delivery, unlike the pathological collapse seen in Spalding’s sign. * **Stillborn:** While "stillborn" and "deadborn" are often used interchangeably in general terms, in the context of this specific radiological sign, it specifically denotes a fetus that has been dead in the uterus for a sufficient period to allow for bone collapse. **High-Yield Clinical Pearls for NEET-PG:** * **Robert’s Sign:** The presence of gas in the fetal heart and great vessels (earliest radiological sign of IUFD, seen within 12 hours). * **Deuel’s Halo Sign:** Edema of the fetal scalp causing a "halo" appearance (indicates fetal death). * **Confirmatory Test:** Today, **Ultrasonography** is the gold standard for diagnosing IUFD, showing the absence of fetal heart activity (cardiac flicker). Spalding's sign is now primarily a historical radiological finding but remains a frequent "favorite" in exams.

Q: Which of the following statements is true?

All of the above.. **Explanation:** This question addresses the management of valvular heart disease in pregnancy, a high-yield topic for NEET-PG. * **Option A:** Mitral Stenosis (MS) is the most common valvular lesion in pregnancy. While medical management is preferred, if surgery is required (due to refractory NYHA Class III/IV symptoms), it is ideally performed **pre-conception**. During pregnancy, the physiological increase in blood volume and heart rate can lead to pulmonary edema. If intervention is unavoidable, Percutaneous Mitral Balloon Valvotomy (PMBV) is preferred over open-heart surgery, which carries a high fetal mortality rate (up to 30%). * **Option B:** While Mitral Regurgitation (MR) is generally well-tolerated in pregnancy due to decreased systemic vascular resistance, the development of **Pulmonary Hypertension (PH)** significantly increases maternal mortality (25-50%). Severe PH is a contraindication to pregnancy and a definite indication for early termination to save the mother's life. * **Option C:** In young patients, **Bicuspid Aortic Valve** is the most common congenital cause of Aortic Stenosis. In the context of pregnancy, it is particularly concerning as it is often associated with aortic root dilation and risk of dissection. **Clinical Pearls for NEET-PG:** 1. **Most common heart disease in pregnancy:** Rheumatic Heart Disease (Mitral Stenosis). 2. **Worst prognosis in pregnancy:** Pulmonary Hypertension (Eisenmenger syndrome). 3. **Anticoagulation:** Warfarin is teratogenic (6-12 weeks); switch to LMWH or Unfractionated Heparin during the first trimester and near term. 4. **Labor Management:** Shorten the second stage of labor (using forceps/ventouse) to avoid the Valsalva maneuver.

Q: Hemoconcentration is seen in which of the following conditions?

Preeclampsia. **Explanation:** In **Preeclampsia**, the fundamental pathophysiology involves widespread endothelial dysfunction. This leads to increased vascular permeability, causing fluid to leak from the intravascular compartment into the interstitial space (resulting in edema). Consequently, there is a **contraction of plasma volume**. While both plasma and red cell mass are affected, the reduction in plasma volume is disproportionately greater, leading to **hemoconcentration** (manifesting as an elevated hematocrit). This is a hallmark of the disease and distinguishes it from the physiological changes of a healthy pregnancy. **Analysis of Incorrect Options:** * **Normal Pregnancy:** This is characterized by **hemodilution**. While both plasma volume and red cell mass increase, the plasma volume increases by ~40–50% while red cell mass increases by only ~20–30%. This disproportion leads to "Physiological Anemia of Pregnancy." * **Ectopic Pregnancy:** If ruptured, this leads to hemorrhage and hypovolemia. Initially, the hematocrit may remain normal, but as compensatory mechanisms shift fluid into the vessels, it results in hemodilution (decreased hematocrit), not hemoconcentration. **High-Yield Clinical Pearls for NEET-PG:** * **Hematocrit Trend:** A rising hematocrit in a hypertensive pregnant woman is an ominous sign indicating worsening disease severity and significant plasma volume depletion. * **The "Gold Standard" Pathophysiology:** Preeclampsia is a disease of "theories," but **endothelial dysfunction** and **vasospasm** are the core mechanisms. * **Fluid Management:** Because patients with preeclampsia are hemoconcentrated but have leaky capillaries, they are at high risk for both pulmonary edema (if over-hydrated) and acute kidney injury (due to low intravascular volume).

Question 1

Recurrent fetal loss is associated with which of the following conditions?

Accepted Answer

All of the above

Answer

Systemic lupus erythematosus (SLE)

Answer

Lupus anticoagulant

Answer

Antiphospholipid antibody syndrome (APLAS)

Question 2

When the death of one fetus in a multiple pregnancy occurs early in pregnancy, how may it manifest?

Accepted Answer

Vanishing twin

Answer

Fetus papyraceus

Answer

Fetus compressus

Answer

Fetus acardiacus

Question 3

Post-term pregnancy is associated with which of the following conditions?

Accepted Answer

Anencephaly

Answer

Spina bifida

Answer

Congenital adrenal hyperplasia

Answer

Cerebral palsy

Question 4

Which of the following is true about magnesium sulfate (MgSO4)?

Accepted Answer

Magnesium sulfate is used in the management of eclampsia.

Answer

Magnesium sulfate is not a tocolytic.

Answer

Magnesium sulfate does not cause neonatal respiratory depression.

Answer

Magnesium sulfate can be given in myasthenia gravis.

Question 5

Grade 2 abruptio placenta is characterized by?

Accepted Answer

Fetal distress

Answer

Pronounced shock

Answer

Severe bleeding

Answer

Coagulation defect

Question 6

Funneling in cervicogram is seen in which of the following conditions?

Accepted Answer

Cervical incompetence

Answer

During labor

Answer

Cervical ectopic pregnancy

Answer

During transvaginal sonography (TVS)

Question 7

Spalding's ring is seen in which of the following conditions?

Accepted Answer

Deadborn

Answer

Stillborn

Answer

Liveborn

Answer

Premature

Question 8

A 38-year-old woman, gravida 3, para 2, at 32 weeks' gestation presents with vaginal bleeding. She reports passing two quarter-sized clots of blood this morning. She denies contractions, gushes of fluid, or fetal distress. Her obstetrical history includes two low-transverse cesarean deliveries due to non-reassuring fetal heart rate tracings. An ultrasound reveals a complete placenta previa. For which of the following conditions is this patient at highest risk?

Accepted Answer

Placenta accreta

Answer

Dystocia

Answer

Intrauterine fetal demise (IUFD)

Answer

Preeclampsia

Question 9

Which of the following statements is true?

Accepted Answer

All of the above.

Answer

Mitral stenosis surgery is better avoided in pregnancy.

Answer

Mitral regurgitation with pulmonary hypertension is a definite indication for termination of pregnancy.

Answer

Aortic stenosis in young age is usually due to a bicuspid valve.

Question 10

Hemoconcentration is seen in which of the following conditions?

Accepted Answer

Preeclampsia

Answer

Normal pregnancy

Answer

Ectopic pregnancy

Answer

All of the above

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?