Maternal-Fetal Medicine Practice Questions

Q: Which of the following conditions is considered least dangerous in pregnancy?

Ebstein's anomaly. **Explanation:** In maternal-fetal medicine, cardiac diseases are categorized by their risk of maternal mortality. **Ebstein’s anomaly** is generally well-tolerated during pregnancy, provided there is no significant right-to-left shunting or severe heart failure. In this condition, the tricuspid valve is displaced downward into the right ventricle; however, unless accompanied by severe cyanosis or arrhythmias (like WPW syndrome), most women have successful obstetric outcomes. **Why the other options are more dangerous:** * **Pulmonary Hypertension (Option B):** This is the most lethal condition in pregnancy (mortality rates of 30-50%). The inability of the right ventricle to increase cardiac output against fixed pulmonary resistance leads to sudden cardiovascular collapse, especially during labor or the immediate postpartum period. * **Cyanotic Heart Disease (Option C):** Conditions like Eisenmenger syndrome or uncorrected Tetralogy of Fallot carry a high risk (mortality >25%). Pregnancy-induced systemic vasodilation increases right-to-left shunting, worsening hypoxia for both mother and fetus. * **Marfan Syndrome (Option D):** Pregnancy increases the risk of life-threatening **aortic dissection** or rupture due to hypervolemia and hormonal changes (estrogen/progesterone) affecting the aortic wall integrity, especially if the aortic root diameter exceeds 4 cm. **High-Yield Clinical Pearls for NEET-PG:** * **WHO Class IV (Pregnancy Contraindicated):** Pulmonary hypertension, severe systemic ventricular dysfunction (EF 45mm. * **Most common heart disease in pregnancy:** Mitral Stenosis (Rheumatic). * **Most common congenital heart disease in pregnancy:** ASD (Atrial Septal Defect). * **Ebstein’s Anomaly** is uniquely associated with maternal **Lithium** intake during the first trimester.

Q: A 32-week pregnant woman presents with mild uterine contractions. On examination, her vital signs are stable, and placenta previa type III is present. What is the best management?

Bed rest, Nifedipine, and Dexamethasone. **Explanation:** The management of Placenta Previa depends on the gestational age, the severity of bleeding, and the maternal/fetal status. This patient is at **32 weeks (preterm)** with **mild contractions** and stable vitals, indicating a candidate for **Expectant Management (Macafee-Johnson Regime)**. 1. **Why Option B is Correct:** * **Bed Rest:** Essential to reduce pressure on the lower uterine segment and minimize bleeding. * **Nifedipine (Tocolysis):** The patient is experiencing contractions. Tocolytics are used to arrest preterm labor, providing a window (48 hours) for steroid action. * **Dexamethasone (Corticosteroids):** Crucial at 32 weeks to promote fetal lung maturity and reduce the risk of Respiratory Distress Syndrome (RDS), Intraventricular Hemorrhage, and Necrotizing Enterocolitis. 2. **Why Other Options are Incorrect:** * **Option A:** Lacks the tocolytic (Nifedipine) needed to stop the contractions that could lead to further placental separation. * **Option C:** Sedation may provide rest but does not address fetal lung maturity or the physiological process of preterm labor. * **Option D:** Immediate C-section is reserved for patients with heavy, life-threatening hemorrhage, fetal distress, or those who have reached 37 weeks. At 32 weeks with stable vitals, the goal is to prolong the pregnancy. **Clinical Pearls for NEET-PG:** * **Macafee-Johnson Regime:** Aimed at carrying the pregnancy to **37 weeks** to avoid prematurity. * **Contraindication:** Digital vaginal examination is strictly contraindicated in suspected placenta previa as it can provoke torrential hemorrhage. * **Type III/IV Previa:** Always requires a Cesarean Section for delivery. * **Tocolytic of Choice:** Nifedipine is preferred over Beta-mimetics (like Ritodrine) in previa because Beta-mimetics cause tachycardia, which can mask signs of hypovolemic shock.

Q: All are true about ectopic pregnancy EXCEPT:

A negative pregnancy test excludes the diagnosis.. **Explanation:** The correct answer is **C (A negative pregnancy test excludes the diagnosis)** because this statement is clinically inaccurate. While a urine pregnancy test (UPT) is highly sensitive, it has a threshold (usually 20–25 mIU/mL). In cases of chronic ectopic pregnancy or very early gestations, the hCG levels may fall below this threshold, leading to a "false negative" UPT. Therefore, a negative urine test cannot 100% exclude an ectopic pregnancy; a serum beta-hCG test is the gold standard for confirmation. **Analysis of other options:** * **Option A:** Pelvic Inflammatory Disease (PID), specifically caused by *Chlamydia trachomatis*, is the **most common risk factor** because it causes tubal scarring and cilia dysfunction. * **Option B:** Serial hCG levels are crucial for diagnosis. In a normal pregnancy, hCG doubles every 48 hours; a suboptimal rise (less than 35-53%) suggests an ectopic or failing intrauterine pregnancy. * **Option D:** Methotrexate (a folate antagonist) is the standard medical management for hemodynamically stable patients meeting specific criteria (e.g., hCG <5000 mIU/mL, no fetal heart tone, mass <4cm). **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ampulla of the Fallopian tube (70%). * **Most common site for rupture:** Isthmus (due to narrow lumen). * **Discriminatory Zone:** The serum hCG level (usually 1500–2000 mIU/mL) at which a gestational sac should be visible on Transvaginal Sonography (TVS). If hCG is above this and the uterus is empty, suspect ectopic pregnancy. * **Arias-Stella Reaction:** Hypersecretory endometrium seen on biopsy, which is suggestive of pregnancy but not specific to ectopic.

Q: What can Doppler ultrasound in pregnancy detect?

IUGR. **Explanation:** **Why IUGR is the correct answer:** Doppler ultrasound is a functional imaging modality used to assess feto-placental hemodynamics. In **Intrauterine Growth Restriction (IUGR)**, there is often placental insufficiency. Doppler allows for the evaluation of blood flow in the **Umbilical Artery (UA)**, **Middle Cerebral Artery (MCA)**, and **Ductus Venosus**. * **Key Finding:** A high-resistance pattern in the Umbilical Artery (decreased, absent, or reversed end-diastolic flow) indicates placental resistance. * **Brain Sparing Effect:** Increased flow in the MCA suggests the fetus is redirecting blood to the brain due to hypoxia. This makes Doppler the gold standard for monitoring the timing of delivery in growth-restricted fetuses. **Why the other options are incorrect:** * **A, B, & C (Cardiovascular malformations, Neural tube defects, Abdominal masses):** These are **structural/anatomical abnormalities**. They are primarily diagnosed using **Routine Morphological Ultrasound (Level II scan/Anomaly scan)** between 18–22 weeks, which uses 2D/3D B-mode grayscale imaging to visualize anatomy rather than blood flow velocity. **High-Yield Clinical Pearls for NEET-PG:** * **Umbilical Artery:** The most common vessel studied; **Absent End Diastolic Velocity (AEDV)** or **Reversed End Diastolic Velocity (REDV)** are critical indicators of fetal distress. * **Uterine Artery Doppler:** Used at 11–14 weeks to screen for the risk of developing **Pre-eclampsia**. * **Ductus Venosus:** Abnormal (reversed) 'a' wave is a late sign of fetal cardiac failure and an indication for immediate delivery. * **MCA Doppler:** The investigation of choice for detecting **Fetal Anemia** (e.g., in Rh isoimmunization) by measuring Peak Systolic Velocity (PSV).

Q: A pregnant woman is found to have excessive accumulation of amniotic fluid. Polyhydramnios is likely to be associated with all of the following conditions, except?

Bilateral renal agenesis. **Explanation:** The volume of amniotic fluid is a dynamic balance between production and removal. From the second trimester onwards, **fetal urine** is the primary source of amniotic fluid, while **fetal swallowing** is the primary route of removal. **Why Bilateral Renal Agenesis is the Correct Answer:** In bilateral renal agenesis (Potter’s sequence), the fetus lacks kidneys and cannot produce urine. Since urine is the major contributor to the amniotic pool, its absence leads to **Oligohydramnios** (decreased fluid), not polyhydramnios. This is a classic "must-know" distinction for NEET-PG. **Analysis of Other Options (Causes of Polyhydramnios):** * **Twinning:** Specifically in Monochorionic twins, Twin-to-Twin Transfusion Syndrome (TTTS) leads to polyhydramnios in the recipient twin due to volume overload and polyuria. * **Microanencephaly/Anencephaly:** Polyhydramnios occurs due to two reasons: 1) Failure of the swallowing reflex due to neurological deficit, and 2) Transudation of fluid from the exposed meninges/choroid plexus. * **Oesophageal Atresia:** This creates a mechanical obstruction in the gastrointestinal tract, preventing the fetus from swallowing and absorbing amniotic fluid, leading to its accumulation. **High-Yield Clinical Pearls for NEET-PG:** * **Definition:** Polyhydramnios is defined as an Amniotic Fluid Index (AFI) **>25 cm** or a Single Deepest Pocket (SDP) **>8 cm**. * **Maternal Cause:** The most common maternal cause of polyhydramnios is **Maternal Diabetes** (fetal hyperglycemia leads to osmotic diuresis/polyuria). * **Fetal Causes:** Any condition that impairs swallowing (CNS anomalies, GI atresias) or increases urine output (Hydrops fetalis, TTTS) results in polyhydramnios. * **Potter’s Sequence:** Bilateral renal agenesis → Oligohydramnios → Pulmonary hypoplasia and limb deformities.

Q: A primigravida at 36 weeks gestation has a USG revealing a complete placenta previa. The uterus is relaxed, but she starts to bleed heavily. All of the following are appropriate next steps, EXCEPT?

Administer intramuscular terbutaline. **Explanation:** In a case of **complete placenta previa** with **heavy bleeding**, the clinical priority is maternal stabilization and immediate delivery, regardless of gestational age. **1. Why Option A is the Correct Answer (The "Except"):** Terbutaline is a tocolytic agent used to suppress uterine contractions. In this scenario, the question states the **uterus is already relaxed**. More importantly, tocolytics are strictly **contraindicated** in cases of heavy antepartum hemorrhage (APH) with hemodynamic instability. Administering a beta-mimetic like terbutaline can cause maternal tachycardia and peripheral vasodilation, which would mask signs of hypovolemic shock and worsen the patient's cardiovascular status. **2. Why the other options are incorrect (Appropriate steps):** * **Option B & C:** Heavy bleeding in placenta previa is a life-threatening emergency. Immediate **resuscitation** with large-bore IV fluids and cross-matching **packed RBCs** (at least 4 units) is mandatory to maintain perfusion and prepare for an emergency Cesarean section. * **Option D:** **Urine output monitoring** (via Foley catheter) is the most sensitive non-invasive indicator of vital organ perfusion and renal function during obstetric hemorrhage. **Clinical Pearls for NEET-PG:** * **Management Gold Standard:** For complete placenta previa with active, heavy bleeding, the treatment of choice is **Immediate Cesarean Section**, irrespective of the period of gestation. * **Vaginal Examination:** Never perform a digital vaginal examination (PV) in a suspected case of APH until placenta previa is ruled out by USG, as it can provoke torrential hemorrhage (**"Stallworthy's sign"**). * **Expectant Management (Macafee & Johnson):** Only indicated if the bleeding is slight, the patient is stable, and the fetus is preterm (<37 weeks). It is NOT applicable in this scenario due to heavy bleeding.

Q: What is the most common abnormality found in first-trimester abortions?

Defective genes. **Explanation:** **1. Why "Defective Genes" is Correct:** The most common cause of spontaneous abortion in the first trimester (up to 80%) is **genetic factors**, specifically **chromosomal abnormalities**. Among these, **Autosomal Trisomies** are the most frequent (Trisomy 16 being the most common specific trisomy). These genetic defects lead to improper embryonic development, often resulting in a "blighted ovum" or early embryonic demise. This is nature’s way of screening out non-viable pregnancies. **2. Why Other Options are Incorrect:** * **Cervical Incompetence (B):** This is a classic cause of **second-trimester** (mid-trimester) habitual abortions, typically characterized by painless cervical dilatation and membrane prolapse. * **Placental and Membrane Abnormality (C):** While these can cause complications, they are rarely the primary cause of first-trimester loss. Placental issues usually manifest later in pregnancy (e.g., abruption or insufficiency). * **Uterine Retroversion (D):** A retroverted uterus is considered a normal anatomical variant in many women. It does not increase the risk of miscarriage unless it leads to "incarceration" of the gravid uterus, which is extremely rare. **Clinical Pearls for NEET-PG:** * **Most common chromosomal abnormality:** Autosomal Trisomy (50-60% of all cases). * **Most common single trisomy:** Trisomy 16. * **Most common single chromosomal anomaly:** Monosomy X (Turner Syndrome, 45,X). * **Triploidy** is the second most common numerical aberration. * **Timing:** 80% of spontaneous abortions occur within the first 12 weeks of pregnancy.

Q: Indications for termination of pregnancy include all of the following except:

Tricuspid stenosis. In maternal-fetal medicine, the decision to terminate a pregnancy is based on the risk of maternal mortality. Heart diseases are classified into risk groups, with certain conditions posing a prohibitively high risk (25–50% mortality). **Why Tricuspid Stenosis is the Correct Answer:** Tricuspid stenosis (TS) is generally well-tolerated during pregnancy. Unlike left-sided obstructive lesions, TS involves the low-pressure venous system. While it may cause peripheral edema and hepatic congestion, it rarely leads to life-threatening pulmonary edema or sudden cardiac death. Therefore, it is **not** an absolute indication for termination. **Analysis of Incorrect Options:** * **Eisenmenger Syndrome:** This carries the highest risk (up to 50% mortality). The drop in systemic vascular resistance during pregnancy worsens the right-to-left shunt, leading to severe hypoxemia and heart failure. Termination is strongly advised. * **Aortic Stenosis (Severe/Symptomatic):** This is a fixed-output state. The heart cannot increase cardiac output to meet pregnancy demands, leading to syncope, heart failure, or sudden death. * **NYHA Grade 4 Heart Disease:** Patients symptomatic at rest have minimal cardiac reserve. The physiological hemodilution and increased cardiac output of pregnancy often lead to decompensation and death. **Clinical Pearls for NEET-PG:** * **WHO Class IV Heart Diseases (Termination Recommended):** Eisenmenger syndrome, Pulmonary Arterial Hypertension (PAH), Severe Aortic Stenosis, Marfan Syndrome with aortic root >40mm, and previous Peripartum Cardiomyopathy with residual dysfunction. * **Mitral Stenosis:** The most common rheumatic valvular lesion in pregnancy; while dangerous, it is often managed medically or via valvuloplasty rather than mandatory termination unless refractory. * **Highest Risk Period:** The immediate postpartum period (first 24–48 hours) due to "autotransfusion" from the involuting uterus.

Q: What is the most common neurological disorder encountered in pregnancy?

Epilepsy. **Explanation:** **Epilepsy** is the most common major neurological disorder encountered in pregnancy, affecting approximately **0.5% to 1%** of all pregnant women. It is a high-yield topic for NEET-PG because it requires careful management of anti-epileptic drugs (AEDs) to balance maternal seizure control against the risk of fetal malformations. **Why the other options are incorrect:** * **Alzheimer’s Disease:** This is a neurodegenerative condition primarily affecting the elderly. It is extremely rare in the reproductive age group. * **Cerebrovascular Disorders:** While the risk of stroke and venous sinus thrombosis increases during pregnancy and the puerperium due to a hypercoagulable state, these events are statistically less frequent than pre-existing epilepsy. * **Multiple Sclerosis (MS):** MS is the second most common neurological disorder in pregnancy. While it frequently affects women of childbearing age, its prevalence in the pregnant population is lower than that of epilepsy. **High-Yield Clinical Pearls for NEET-PG:** 1. **Pre-conception:** Women should be started on **high-dose Folic Acid (5 mg/day)** to reduce the risk of neural tube defects associated with AEDs. 2. **Teratogenicity:** **Sodium Valproate** is the most teratogenic AED (associated with neural tube defects and lower IQ); **Lamotrigine and Levetiracetam** are generally considered the safest options. 3. **Seizure Frequency:** About 1/3 of patients experience increased seizure frequency, often due to physiological changes (increased volume of distribution) or non-compliance. 4. **Vitamin K:** Infants born to mothers on enzyme-inducing AEDs (e.g., Phenytoin, Phenobarbital) should receive Vitamin K at birth to prevent hemorrhagic disease of the newborn.

Question 1

Which of the following conditions is considered least dangerous in pregnancy?

Accepted Answer

Ebstein's anomaly

Answer

Pulmonary hypertension

Answer

Cyanotic heart disease

Answer

Marfan syndrome

Question 2

A 32-week pregnant woman presents with mild uterine contractions. On examination, her vital signs are stable, and placenta previa type III is present. What is the best management?

Accepted Answer

Bed rest, Nifedipine, and Dexamethasone

Answer

Bed rest and Dexamethasone

Answer

Bed rest and Sedation

Answer

Immediate caesarean section

Question 3

All are true about ectopic pregnancy EXCEPT:

Accepted Answer

A negative pregnancy test excludes the diagnosis.

Answer

The most common cause is pelvic inflammatory disease.

Answer

It can be diagnosed by human chorionic gonadotropin (hCG) levels.

Answer

Methotrexate is used as a part of medical management.

Question 4

What can Doppler ultrasound in pregnancy detect?

Accepted Answer

IUGR

Answer

Cardiovascular malformation

Answer

Neural tube defect

Answer

Abdominal masses

Question 5

A pregnant woman is found to have excessive accumulation of amniotic fluid. Polyhydramnios is likely to be associated with all of the following conditions, except?

Accepted Answer

Bilateral renal agenesis

Answer

Twinning

Answer

Microanencephaly

Answer

Oesophageal atresia

Question 6

A primigravida at 36 weeks gestation has a USG revealing a complete placenta previa. The uterus is relaxed, but she starts to bleed heavily. All of the following are appropriate next steps, EXCEPT?

Accepted Answer

Administer intramuscular terbutaline

Answer

Arrange for 4 units of packed red blood cells

Answer

Administer intravenous fluids

Answer

Monitor urine output strictly

Question 7

What is the most common abnormality found in first-trimester abortions?

Accepted Answer

Defective genes

Answer

Cervical incompetence

Answer

Placental and membrane abnormality

Answer

Uterine retroversion

Question 8

Indications for termination of pregnancy include all of the following except:

Accepted Answer

Tricuspid stenosis

Answer

Aortic stenosis

Answer

Eisenmenger syndrome

Answer

NYHA grade 4 heart disease

Question 9

A woman has a history of repeated first-trimester bleeding episodes. She is now 28 weeks of gestation. When discussing the prognosis for her pregnancy outcome, what increased risk should she be informed about?

Accepted Answer

All of the above

Answer

Preterm labor

Answer

Intrauterine growth restriction (IUGR)

Answer

Placental abruption

Question 10

What is the most common neurological disorder encountered in pregnancy?

Accepted Answer

Epilepsy

Answer

Alzheimer's disease

Answer

Cerebrovascular disorders

Answer

Multiple sclerosis

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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