Maternal-Fetal Medicine Practice Questions

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.

Q: Which of the following dietary supplements is recommended for a pregnant patient receiving Heparin therapy?

Calcium. **Explanation:** **Correct Option: B (Calcium)** The primary reason for recommending Calcium supplementation in pregnant patients on long-term Heparin therapy is to mitigate the risk of **Heparin-Induced Osteoporosis**. Heparin increases osteoclast activity and decreases osteoblast function, leading to a reduction in bone mineral density. Since pregnancy itself increases calcium demands for fetal skeletal development, the addition of Heparin significantly elevates the risk of maternal bone loss and vertebral fractures. Therefore, patients on Heparin (either Unfractionated Heparin or LMWH) should receive supplemental Calcium (1000–1500 mg/day) and Vitamin D. **Incorrect Options:** * **A. Folic acid:** While Folic acid is routinely supplemented in all pregnancies to prevent Neural Tube Defects (NTDs), its requirement is not specifically linked to Heparin therapy. * **C & D. Zinc and Copper:** These are trace elements. While they are present in standard prenatal multivitamins, there is no specific clinical indication or increased requirement for them necessitated by Heparin administration. **NEET-PG High-Yield Pearls:** * **Heparin vs. Warfarin:** Heparin is the anticoagulant of choice in pregnancy because it is a large molecule that **does not cross the placenta**, unlike Warfarin, which is teratogenic (causing Fetal Warfarin Syndrome). * **LMWH vs. UFH:** Low Molecular Weight Heparin (LMWH), such as Enoxaparin, is preferred over Unfractionated Heparin (UFH) due to a lower risk of osteoporosis and Heparin-Induced Thrombocytopenia (HIT). * **Monitoring:** UFH is monitored using **aPTT**, whereas LMWH usually does not require monitoring (though **Anti-Xa levels** are used if necessary).

Q: Which of the following is NOT a cause of antepartum hemorrhage?

Atonic uterus. **Explanation:** **Antepartum Hemorrhage (APH)** is defined as bleeding from or into the genital tract occurring from the 28th week of pregnancy until the birth of the baby. The core concept here is the timing of the bleeding relative to delivery. **Why Atonic Uterus is the correct answer:** Uterine atony (failure of the uterus to contract after delivery) is the most common cause of **Postpartum Hemorrhage (PPH)**, not antepartum hemorrhage. Since the bleeding occurs *after* the expulsion of the placenta, it does not fall under the definition of APH. **Analysis of Incorrect Options:** * **Placenta Previa:** This is a leading cause of APH. It occurs when the placenta is implanted in the lower uterine segment, leading to painless, causative, and recurrent bleeding as the lower segment stretches. * **Abruptio Placenta:** This refers to the premature separation of a normally situated placenta. It is a major cause of APH and typically presents with painful vaginal bleeding and uterine tenderness. * **Circumvallate Placenta:** This is a morphological variation where the chorionic plate is smaller than the basal plate. It is a known placental cause of APH, often leading to intermittent bleeding and hydrorrhea. **NEET-PG High-Yield Pearls:** * **Most common cause of APH:** Abruptio Placenta (though Placenta Previa is a close second). * **Most common cause of PPH:** Uterine Atony (accounts for ~80% of cases). * **Vasa Previa:** A rare but critical cause of APH where fetal vessels run over the internal os; it is associated with high fetal mortality. * **Warning Hemorrhage:** Specifically refers to the initial small bouts of painless bleeding seen in Placenta Previa.

Q: For antenatal fetal monitoring in a diabetic pregnancy, all of the following are useful except?

Doppler flow study. **Explanation:** The primary goal of antenatal fetal monitoring in diabetic pregnancies is to prevent stillbirth caused by **fetal acidemia and hyperglycemia-induced hypoxia**. **Why Doppler flow study is the correct answer:** Umbilical artery Doppler flow studies are primarily used to monitor pregnancies complicated by **Intrauterine Growth Restriction (IUGR)** and **Placental Insufficiency** (e.g., Preeclampsia). In a typical diabetic pregnancy (especially Gestational Diabetes or Type 2), the pathophysiology involves fetal hyperinsulinemia and increased metabolic demand rather than primary placental vascular resistance. Therefore, Doppler studies are **not** routinely recommended for monitoring fetal well-being in diabetic patients unless there is concurrent hypertension or suspected growth restriction. **Why the other options are used:** * **Fetal Kick Count (D):** A simple, cost-effective screening tool for all high-risk pregnancies to assess fetal alertness. * **Non-Stress Test (NST) (A):** The most common surveillance tool used (usually starting at 32–34 weeks) to assess fetal heart rate reactivity, which reflects an intact central nervous system. * **Biophysical Profile (BPP) (B):** Combines NST with ultrasound parameters (breathing, movements, tone, and liquor). It is highly sensitive for detecting acute and chronic fetal hypoxia in diabetic mothers. **High-Yield Clinical Pearls for NEET-PG:** * **Target:** The most common cause of fetal demise in poorly controlled diabetes is **fetal acidemia**. * **Polyhydramnios:** Common in diabetes; if present, BPP is often preferred over NST. * **Timing:** For well-controlled GDM, monitoring usually starts at **32–34 weeks**; if poorly controlled, it may start earlier. * **Doppler Exception:** Use Doppler in diabetics **only** if there is associated **Pre-eclampsia** or **Small for Gestational Age (SGA)** fetus.

Question 1

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 2

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 3

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 4

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 5

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 6

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.

Question 7

What are the most life-threatening complications of septic abortion?

Accepted Answer

Respiratory distress syndrome

Answer

Peritonitis

Answer

Renal failure

Answer

Septicemia

Question 8

Which of the following dietary supplements is recommended for a pregnant patient receiving Heparin therapy?

Accepted Answer

Calcium

Answer

Folic acid

Answer

Zinc

Answer

Copper

Question 9

Which of the following is NOT a cause of antepartum hemorrhage?

Accepted Answer

Atonic uterus

Answer

Placenta previa

Answer

Abruptio placenta

Answer

Circumvallate placenta

Question 10

For antenatal fetal monitoring in a diabetic pregnancy, all of the following are useful except?

Accepted Answer

Doppler flow study

Answer

Non-stress test

Answer

Biophysical profile

Answer

Fetal kick count

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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