Maternal-Fetal Medicine Practice Questions

Q: Which of the following is NOT true regarding the management of suspected myocardial infarction in pregnancy?

Immediate delivery is indicated.. **Explanation:** The management of acute myocardial infarction (MI) in pregnancy follows the same life-saving principles as in non-pregnant adults, with the primary goal being maternal stabilization. **Why Option A is the correct answer (False statement):** Immediate delivery is **not** indicated in the management of acute MI. In fact, delivery (whether vaginal or cesarean) during the acute phase of an MI is associated with extremely high maternal mortality due to the massive hemodynamic shifts (increased cardiac output and stroke volume) that occur during labor and the immediate postpartum period. The goal is to stabilize the mother medically and delay delivery for at least **2–3 weeks** after the MI, if possible, to allow the myocardium to heal. **Analysis of other options:** * **Option B:** Beta-blockers (e.g., Metoprolol) are standard of care to reduce myocardial oxygen demand and are generally safe in pregnancy, though fetal growth should be monitored. * **Option C:** Low-dose aspirin is indicated for its antiplatelet effects and is considered safe throughout pregnancy. * **Option D:** Cardiac Troponins (I and T) are highly specific and are **not** elevated by normal pregnancy or labor. They remain the gold standard for diagnosing MI in pregnant patients. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause:** While atherosclerosis is common, **Spontaneous Coronary Artery Dissection (SCAD)** is a uniquely frequent cause of MI in the peripartum period. * **Positioning:** Always manage the patient in the **left lateral decubitus** position to prevent aortocaval compression. * **Thrombolysis:** If PCI (Percutaneous Coronary Intervention) is unavailable, thrombolytics can be used as they do not cross the placenta, though the risk of maternal hemorrhage (e.g., placental abruption) is increased.

Q: What is a true statement about symmetrical IUGR compared to asymmetrical IUGR?

Worse prognosis. **Explanation:** Intrauterine Growth Restriction (IUGR) is classified into two types based on the timing of the insult and the fetal growth pattern. **1. Why Option A is Correct:** **Symmetrical IUGR** (Type I) occurs due to an early insult during the **hyperplastic phase** of cellular growth (e.g., chromosomal anomalies, early TORCH infections). This results in a global reduction in the number of cells in all organs. Because the damage occurs early and affects the total cell count of the brain and body equally, the fetus has a limited capacity for catch-up growth, leading to a **worse prognosis** and higher risk of long-term neurodevelopmental deficits compared to asymmetrical IUGR. **2. Why Other Options are Incorrect:** * **B. Late onset:** Symmetrical IUGR is typically **early-onset** (before 32 weeks). Late-onset growth restriction is characteristic of asymmetrical IUGR, usually caused by placental insufficiency. * **C. Brain sparing effect:** This is a hallmark of **Asymmetrical IUGR**. In response to hypoxia, blood is shunted to the brain, heart, and adrenals at the expense of the liver and limbs. In symmetrical IUGR, the brain is not spared; the head circumference is reduced proportionately with the body. * **D. More common:** Asymmetrical IUGR is more common, accounting for approximately **70-80%** of all IUGR cases. Symmetrical IUGR accounts for only 20-30%. **High-Yield Clinical Pearls for NEET-PG:** * **Ponderal Index:** Low in asymmetrical IUGR; normal in symmetrical IUGR. * **HC/AC Ratio:** Elevated in asymmetrical IUGR (Head > Abdomen); normal in symmetrical IUGR. * **Most sensitive parameter for IUGR:** Abdominal Circumference (AC), as it reflects depleted glycogen stores in the fetal liver. * **Commonest cause of Asymmetrical IUGR:** Maternal hypertension/Placental insufficiency.

Q: Risk of damage to the fetus by maternal rubella is maximum if the mother gets infected in which period of pregnancy?

6-12 weeks of pregnancy. **Explanation:** The risk of congenital malformations following maternal rubella infection is inversely proportional to the gestational age at the time of infection. This is due to the concept of **organogenesis**, which occurs primarily during the first trimester. **Why Option A is Correct:** The period between **6-12 weeks** (early first trimester) is the most critical window for fetal development. During this time, the virus can cause chronic fetal infection, leading to cell death and inhibition of cell division. If infection occurs before 11 weeks, the risk of **Congenital Rubella Syndrome (CRS)** is as high as **90%**. The classic "Gregg’s Triad" (Cataracts, Sensorineural hearing loss, and Cardiac defects like PDA) is most likely to manifest when infection occurs during this specific window. **Why Options B, C, and D are Incorrect:** * **20-24 weeks (Option B):** By the second trimester, organogenesis is largely complete. The risk of major structural defects drops significantly after 16 weeks and is negligible after 20 weeks. * **24-36 weeks (Options C & D):** While the virus can still cross the placenta in the third trimester, it typically results in intrauterine growth restriction (IUGR) or a subclinical infection rather than the structural malformations characteristic of CRS. **Clinical Pearls for NEET-PG:** * **Maximum Risk:** 0-12 weeks (up to 90% risk of CRS). * **Safe Period:** Infection after **20 weeks** rarely results in congenital defects. * **Most Common Defect:** Sensorineural hearing loss (can occur up to 16 weeks). * **Most Common Cardiac Defect:** Patent Ductus Arteriosus (PDA). * **Diagnosis:** Presence of **Rubella-specific IgM** in fetal blood or neonatal cord blood is diagnostic of congenital infection. * **Prevention:** Rubella vaccine (RA 27/3) is a live attenuated vaccine and is **contraindicated in pregnancy**. Pregnancy should be avoided for 1 month after vaccination.

Q: All of the following are included in the expectant management of placenta previa, except:

Cervical cerclage. The expectant management of placenta previa, also known as the **MacAfee and Johnson regimen**, aims to prolong pregnancy until fetal maturity is reached without compromising maternal safety. ### **Why Cervical Cerclage is the Correct Answer** Cervical cerclage (Option A) is a surgical procedure used to treat cervical insufficiency. It is **not** a standard component of placenta previa management. In fact, any vaginal or cervical manipulation (including digital exams or invasive procedures) is strictly contraindicated in placenta previa as it can trigger massive, life-threatening hemorrhage by disturbing the placental site. ### **Explanation of Other Options** * **Anti-D administration (Option B):** Essential for Rh-negative unsensitized mothers who experience vaginal bleeding (antepartum hemorrhage) to prevent isoimmunization. * **Corticosteroids (Option C):** Administered between 24 and 34 weeks of gestation to accelerate fetal lung maturity, reducing the risk of Respiratory Distress Syndrome (RDS) in case of preterm delivery. * **Blood Transfusion (Option D):** The primary goal of expectant management is to maintain maternal hemoglobin levels (usually >10 g/dL) to ensure hemodynamic stability in the event of a sudden re-bleed. ### **NEET-PG High-Yield Pearls** * **Ideal Candidate:** Gestation <37 weeks, hemodynamically stable mother, and no active bleeding. * **The "Golden Rule":** Never perform a per-vaginal (PV) examination in a case of antepartum hemorrhage until placenta previa is ruled out by ultrasound. * **Stallworthy’s Sign:** A drop in fetal heart rate when the head is pushed into the pelvis, suggestive of posterior placenta previa. * **Termination:** Expectant management is typically discontinued at **37 weeks**, and delivery is planned. If the placenta is <2 cm from the internal os, Cesarean section is the mode of choice.

Q: Which of the following is NOT a feature of inevitable abortion?

Closed internal os. **Explanation:** In **Inevitable Abortion**, the clinical process has progressed to a state where the continuation of pregnancy is impossible. The hallmark diagnostic feature that differentiates it from a threatened abortion is the **dilatation of the internal os**. 1. **Why "Closed internal os" is the correct answer:** In inevitable abortion, the internal os is **open** (dilated). A closed internal os is characteristic of a *threatened abortion* (where the pregnancy may still continue) or a *missed abortion*. Therefore, a closed os is NOT a feature of an inevitable abortion. 2. **Analysis of incorrect options:** * **Bleeding per vaginam:** This is a cardinal feature. Bleeding is usually more profuse than in threatened abortion and may be associated with the rupture of membranes. * **Pain:** Significant lower abdominal pain (colicky in nature) is present due to uterine contractions attempting to expel the products of conception. This pain is typically more severe than that seen in threatened abortion. **High-Yield Clinical Pearls for NEET-PG:** * **Threatened Abortion:** Bleeding + **Closed Os** + Fetal heart present. * **Inevitable Abortion:** Bleeding + **Open Os** + Rupture of membranes/Pain. * **Incomplete Abortion:** Some products expelled + **Open Os**. * **Complete Abortion:** All products expelled + **Closed Os** + Empty uterus on USG. * **Missed Abortion:** Fetal demise + **Closed Os** + Regression of pregnancy symptoms. * **Management Tip:** For inevitable abortion, the management is usually **evacuation** (suction and evacuation) to prevent heavy bleeding or infection.

Question 1

In pregnancy, what is the drug of choice for initial treatment of immune thrombocytopenic purpura?

Accepted Answer

Systemic corticosteroids

Answer

Azathioprine

Answer

Intravenous immunoglobulins

Answer

Laparoscopic splenectomy

Question 2

Which of the following is NOT true regarding the management of suspected myocardial infarction in pregnancy?

Accepted Answer

Immediate delivery is indicated.

Answer

The patient should be started on a beta-blocker.

Answer

Daily low-dose aspirin should be given to the patient.

Answer

Troponin levels are helpful in the diagnosis of MI in pregnancy.

Question 3

Which of the following statements about acute fatty liver of pregnancy is true?

Accepted Answer

It is the most common cause of acute liver failure during pregnancy.

Answer

It typically manifests in the early weeks of pregnancy.

Answer

Hepatic dysfunction persists postpartum.

Answer

Some patients develop transient diabetes mellitus in the postpartum period.

Question 4

What is a true statement about symmetrical IUGR compared to asymmetrical IUGR?

Accepted Answer

Worse prognosis

Answer

Late onset

Answer

Brain sparing effect

Answer

More common

Question 5

Which of the following statements regarding vasa previa is NOT true?

Accepted Answer

The APT test is the investigation of choice for diagnosing vasa previa.

Answer

Vasa previa is often associated with velamentous cord insertion.

Answer

There is a very high perinatal mortality rate due to exclusive fetal blood loss.

Answer

An urgent cesarean delivery is usually the best option to save the fetus.

Question 6

Risk of damage to the fetus by maternal rubella is maximum if the mother gets infected in which period of pregnancy?

Accepted Answer

6-12 weeks of pregnancy

Answer

20-24 weeks of pregnancy

Answer

24-28 weeks of pregnancy

Answer

32-36 weeks of pregnancy

Question 7

Which of the following statements related to the therapy of iron deficiency anemia is incorrect?

Accepted Answer

Oral iron can be given at any stage of pregnancy if iron deficiency anemia is detected.

Answer

Parenteral iron therapy markedly increases the reticulocytic count within 7-14 days.

Answer

Parenteral iron therapy is ideal during 30-36 weeks of gestation.

Answer

Blood transfusion may be useful in severe anemia beyond 36 weeks of gestation.

Question 8

All of the following are included in the expectant management of placenta previa, except:

Accepted Answer

Cervical cerclage

Answer

Anti-D administration

Answer

Corticosteroids

Answer

Blood transfusion

Question 9

Which of the following is NOT a feature of inevitable abortion?

Accepted Answer

Closed internal os

Answer

Bleeding per vaginam

Answer

Pain

Answer

None of the above

Question 10

Which of the following statements is FALSE regarding pregnancy with epilepsy?

Accepted Answer

Seizure risk is decreased by 30% in most epileptic women during pregnancy.

Answer

Valproate is associated with adverse fetal outcomes.

Answer

Antiepileptic drugs (AEDs) can cause malformations in approximately 15% of cases.

Answer

Monotherapy with antiepileptic drugs is generally preferred during pregnancy.

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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