Maternal-Fetal Medicine Practice Questions

Q: Patients with organic heart disease in pregnancy most commonly die during which period?

Soon following delivery. **Explanation:** The correct answer is **Soon following delivery** (Option C). The period immediately following the delivery of the placenta is the most critical for a woman with organic heart disease. This is due to a phenomenon known as **"Autotransfusion."** When the placenta is delivered, the compression of the inferior vena cava is relieved, and the blood previously circulating in the uteroplacental unit (approx. 500-800 mL) is shifted back into the maternal systemic circulation. This sudden increase in venous return leads to a massive surge in cardiac output (up to 60-80% above baseline), which can overwhelm a compromised heart, leading to acute pulmonary edema and heart failure. **Analysis of Incorrect Options:** * **A. 20-24 weeks:** While cardiac output begins to rise significantly during the second trimester, it reaches its peak plateau between **28-32 weeks**. This is a period of high risk, but not the most common time for mortality compared to the immediate postpartum surge. * **B. First stage of labor:** Cardiac output increases during labor due to pain, anxiety, and uterine contractions (each contraction pushes ~300-500 mL of blood into circulation), but the peak hemodynamic stress occurs after the fetus is expelled. * **D. Two weeks postpartum:** By this time, hemodynamic stability is usually restored as the excess fluid has been diuresed. **High-Yield Clinical Pearls for NEET-PG:** * **Maximum Risk Periods:** 1. Immediately postpartum (highest risk), 2. During labor, 3. 28-32 weeks of gestation. * **Management:** To prevent heart failure during the third stage, avoid ergometrine (causes vasoconstriction) and use slow IV infusion of oxytocin. * **Positioning:** Encourage the left lateral position to minimize caval compression. * **Vaginal vs. C-Section:** Vaginal delivery with an assisted second stage (forceps/ventouse) to cut short maternal bearing down is preferred over elective Cesarean section.

Q: An ultrasound shows a twin pregnancy. Which of the following is a feature of dizygotic twins?

Separate chorion and amnion. **Explanation:** **1. Why Option B is Correct:** Dizygotic (fraternal) twins result from the fertilization of **two separate ova by two separate sperm**. Because each zygote undergoes its own independent process of implantation and development, each fetus develops its own placenta, its own outer membrane (chorion), and its own inner sac (amnion). Therefore, dizygotic twins are **always Dichorionic-Diamniotic (DCDA)**. **2. Why the Other Options are Incorrect:** * **Option A (Separate amnion and same chorion):** This describes Monochorionic-Diamniotic (MCDA) twins. This configuration is unique to **monozygotic** (identical) twins where the zygote splits between days 4 and 8 post-fertilization. Dizygotic twins can never share a chorion. * **Option C (Always different sex):** This is a common misconception. Since two separate sperm are involved, the sex of each twin is independent. They can be the same sex (approx. 50% of the time) or different sexes. Only "different sex" twins are guaranteed to be dizygotic, but dizygotic twins are not "always" different sex. **3. NEET-PG High-Yield Pearls:** * **Zygosity vs. Chorionicity:** All dizygotic twins are DCDA. Monozygotic twins can be DCDA, MCDA, or MCMA depending on the timing of the split. * **The "Lambda" vs. "T" Sign:** On ultrasound, a thick membrane with the **Lambda (λ) sign** (or twin-peak sign) indicates DCDA (Dizygotic or early-split Monozygotic). A thin membrane with a **T-sign** indicates MCDA. * **Incidence:** The rate of monozygotic twins is constant worldwide (~1 in 250), whereas the rate of dizygotic twins varies by race (highest in Nigerians, lowest in Japanese), maternal age, and use of assisted reproductive technology (ART).

Q: Which of the following is NOT a complication of Rh incompatibility?

Oligohydramnios. **Explanation:** Rh isoimmunization occurs when a Rh-negative mother carries a Rh-positive fetus, leading to the production of maternal antibodies that cross the placenta and cause fetal hemolysis. **Why Oligohydramnios is the correct answer:** In Rh incompatibility, fetal hemolysis leads to **anemia**. To compensate, the fetus increases cardiac output, leading to hyperdynamic circulation and eventual heart failure (Hydrops fetalis). A key physiological response to fetal anemia is increased hepatic and splenic erythropoiesis, which causes organomegaly and portal hypertension. Crucially, fetal anemia leads to **Polyhydramnios**, not oligohydramnios. This occurs due to increased fetal cardiac output resulting in increased renal perfusion and fetal urine production, as well as placental edema interfering with fluid exchange. **Analysis of other options:** * **APH & PPH:** Rh isoimmunization is associated with a **large, boggy, and edematous placenta** (Placentomegaly). This increases the risk of placental abruption (leading to APH) and uterine atony after delivery due to overdistension (leading to PPH). * **Pregnancy-induced hypertension (PIH):** The enlarged, "hyperplacentosis" state seen in severe Rh isoimmunization is a known risk factor for the early onset of preeclampsia (Mirror Syndrome). **NEET-PG High-Yield Pearls:** * **Mirror Syndrome (Ballantyne’s Syndrome):** A rare condition where maternal edema "mirrors" fetal and placental hydrops; it is often associated with severe Rh isoimmunization. * **First sign of Hydrops on USG:** Increased thickness of the placenta (>4 cm). * **Most sensitive non-invasive test for fetal anemia:** Peak Systolic Velocity of the Middle Cerebral Artery (MCA-PSV) via Doppler.

Q: According to Browne's classification of placenta previa, which type describes the placenta covering the internal os when closed but not when fully dilated?

Type 3. ### Explanation **Browne’s Classification** (also known as the Traditional or Stallworthy classification) is a clinical grading system for placenta previa based on the relationship between the placental edge and the internal os. **Why Type 3 is Correct:** In **Type 3 (Incomplete or Partial Central)** placenta previa, the placenta completely covers the internal os when it is closed. However, as labor progresses and the cervix undergoes effacement and dilatation, the placenta only partially covers the opening. This is a critical distinction for NEET-PG, as it differentiates Type 3 from Type 4. **Analysis of Incorrect Options:** * **Type 1 (Low-lying):** The placenta is implanted in the lower uterine segment, but the lower edge does not reach the internal os (it is usually within 2–5 cm of the os). * **Type 2 (Marginal):** The placental edge reaches the margin of the internal os but does not cover it. It is further divided into 2a (Anterior) and 2b (Posterior). * **Type 4 (Total/Complete Central):** The placenta completely covers the internal os even when the cervix is fully dilated. This always necessitates a Cesarean section. **High-Yield Clinical Pearls for NEET-PG:** * **Type 2b (Posterior Marginal)** is known as the **"Dangerous Placenta Previa"** because the placenta can be compressed between the fetal head and the sacral promontory, leading to fetal distress and interfering with head engagement (Stallworthy’s sign). * **Diagnosis:** Transvaginal Ultrasound (TVS) is the gold standard for locating the placenta. * **Management:** For Types 1 and 2a (Anterior), a trial of vaginal delivery may be attempted. For Types 2b, 3, and 4, Cesarean section is the mandatory mode of delivery. * **Mnemonic:** Remember the "Rule of Os"—Type 3 covers the os *only* when closed; Type 4 covers it *always*.

Q: Administration of betamethasone during pregnancy causes which of the following effects, EXCEPT:

Decrease in the incidence of hyperbilirubinemia. **Explanation:** Antenatal corticosteroids (ANS), such as **Betamethasone** or Dexamethasone, are administered to women at risk of preterm delivery (24–34 weeks) to accelerate fetal organ maturation. **Why Option D is the Correct Answer:** Betamethasone does **not** decrease the incidence of hyperbilirubinemia. In fact, some studies suggest that steroids may slightly increase the risk of neonatal jaundice or have a neutral effect. Hyperbilirubinemia in preterm infants is primarily a result of hepatic immaturity and increased red cell breakdown, which are not significantly mitigated by corticosteroid therapy. **Analysis of Incorrect Options:** * **Option A (Neonatal Mortality):** ANS significantly reduces overall neonatal mortality by improving multi-organ stability, particularly in the lungs and brain. * **Option B (ARDS/RDS):** This is the primary indication. Steroids induce the maturation of Type II pneumocytes, leading to increased production of **surfactant**, which prevents Alveolar Respiratory Distress Syndrome (RDS). * **Option C (Intraventricular Hemorrhage):** ANS stabilizes fetal germinal matrix blood vessels and improves circulatory stability, significantly reducing the incidence and severity of IVH and Necrotizing Enterocolitis (NEC). **NEET-PG High-Yield Pearls:** * **Standard Dose:** Betamethasone (12 mg IM, 2 doses, 24 hours apart) is preferred over Dexamethasone due to better neuroprotection and decreased risk of periventricular leukomalacia. * **Window of Efficacy:** Maximum benefit occurs if delivery happens **24 hours to 7 days** after the first dose. * **Key Reductions:** Remember the "Big Three" reductions: **RDS, IVH, and NEC.** * **Contraindications:** Systemic fungal infections or active maternal tuberculosis.

Question 1

Patients with organic heart disease in pregnancy most commonly die during which period?

Accepted Answer

Soon following delivery

Answer

20-24 weeks of pregnancy

Answer

First stage of labor

Answer

Two weeks postpartum

Question 2

An ultrasound shows a twin pregnancy. Which of the following is a feature of dizygotic twins?

Accepted Answer

Separate chorion and amnion

Answer

Separate amnion and same chorion

Answer

Always different sex

Answer

None of the above

Question 3

Which of the following complications is seen in pregnancy?

Accepted Answer

Hypertension complicating pregnancy

Answer

Diabetes complicating pregnancy

Answer

Placenta previa complicating pregnancy

Answer

Preterm delivery

Question 4

A 32-year-old primigravida woman at 20 weeks gestation has blood group O positive. Her husband has blood group AB positive. Which of the following is the most appropriate response to the patient's query, given that she and her husband have different blood groups and have already experienced a pregnancy?

Accepted Answer

Newborns affected by ABO incompatibility will have only mild hemolytic disease.

Answer

ABO antigens elicit only an IgM response, which does not cross the placenta.

Answer

Antibodies to ABO antigens are not hemolytic.

Answer

She is not at risk as the immune response is depressed during pregnancy.

Question 5

A 21-week pregnant patient presents with fever and chills, and a diagnosis of Malaria is made. What is the next line of management?

Accepted Answer

Start antimalarial treatment immediately and continue the pregnancy.

Answer

Wait until term and start treatment for malaria.

Answer

Terminate the pregnancy and treat the patient for malaria.

Answer

Treat only if it is falciparum malaria; otherwise, wait until term.

Question 6

In a non-pregnant uterus, which of the following is the treatment for cervical incompetence?

Accepted Answer

Counselling

Answer

Shirodkar cerclage suture

Answer

McDonald cerclage suture

Answer

Abdominal cerclage

Question 7

Which of the following is NOT a complication of Rh incompatibility?

Accepted Answer

Oligohydramnios

Answer

Antepartum hemorrhage (APH)

Answer

Postpartum hemorrhage (PPH)

Answer

Pregnancy-induced hypertension

Question 8

According to Browne's classification of placenta previa, which type describes the placenta covering the internal os when closed but not when fully dilated?

Accepted Answer

Type 3

Answer

Type 1

Answer

Type 2

Answer

Type 4

Question 9

Administration of betamethasone during pregnancy causes which of the following effects, EXCEPT:

Accepted Answer

Decrease in the incidence of hyperbilirubinemia

Answer

Decrease in neonatal mortality

Answer

Decrease in the incidence of ARDS

Answer

Decrease in the incidence of intraventricular hemorrhage

Question 10

Which mode of delivery is associated with the least rate of HIV transmission?

Accepted Answer

Cesarean section

Answer

Forceps delivery

Answer

Normal delivery

Answer

Breast feeding

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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