Maternal-Fetal Medicine Practice Questions

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.

Q: What is the most important feature for diagnosing fetal aneuploidy?

Nuchal translucency. **Explanation:** **Nuchal Translucency (NT)** is the most important and sensitive ultrasound marker for diagnosing fetal aneuploidy, particularly Trisomy 21 (Down Syndrome), during the first-trimester screening (11 to 13+6 weeks). It refers to the subcutaneous collection of fluid behind the fetal neck. An increased NT measurement is associated not only with chromosomal abnormalities but also with structural defects like congenital heart disease. **Analysis of Options:** * **B. Nuchal Translucency (Correct):** It is the primary screening tool. When combined with maternal age and serum markers (PAPP-A and β-hCG), it achieves a detection rate of approximately 90% for Down Syndrome. * **A. Absent Nasal Bone:** While a highly specific marker for Trisomy 21 (absent in ~60-70% of cases), it is considered a "secondary" or "soft" marker that improves the sensitivity of the NT scan rather than replacing it. * **C. Increased Frontomaxillary Angle:** This measures facial flatness. While often increased in Trisomy 21, it is technically difficult to measure and less standardized than NT. * **D. Reversal of Ductus Venosus (DV) Flow:** Abnormal DV flow (absent or reversed a-wave) is a marker of fetal cardiac dysfunction and is associated with aneuploidy, but it is used as a secondary adjunctive marker to refine the risk calculated by NT. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** NT must be measured when the Crown-Rump Length (CRL) is between **45 mm and 84 mm**. * **Cut-off:** An NT value **>3.5 mm** (or >95th percentile for CRL) is generally considered pathological. * **Combined Test:** The "First Trimester Combined Screening" includes NT + PAPP-A + free β-hCG. * **Next Step:** If NT is increased, the definitive diagnostic test is **Chorionic Villus Sampling (CVS)** in the first trimester or **Amniocentesis** after 15 weeks.

Q: All of the following are causes of Disseminated Intravascular Coagulation (DIC), except?

Multiple pregnancy. **Explanation:** Disseminated Intravascular Coagulation (DIC) in obstetrics is a secondary pathological process triggered by the entry of procoagulant substances (like thromboplastin) into the maternal circulation, leading to widespread activation of the clotting cascade and subsequent consumption of clotting factors. **Why Multiple Pregnancy is the correct answer:** Multiple pregnancy, by itself, is a physiological state and not a trigger for DIC. While it increases the risk for complications like Postpartum Hemorrhage (PPH) or Pre-eclampsia, it does not involve the release of thromboplastin into the circulation unless one of those secondary complications occurs. **Why the other options are causes of DIC:** * **Abruptio Placentae:** This is the **most common cause** of DIC in pregnancy. Retroplacental clots release massive amounts of tissue thromboplastin into the maternal venous sinuses. * **Intrauterine Death (IUD) & Missed Abortion:** If a dead fetus is retained for more than 3–4 weeks, the autolysis of fetal tissues and the placenta releases thromboplastin into the maternal circulation, leading to "Dead Fetus Syndrome" and consumption coagulopathy. **NEET-PG High-Yield Pearls:** 1. **Most common cause of DIC in pregnancy:** Abruptio Placentae. 2. **Most common cause of DIC in clinical practice (overall):** Sepsis. 3. **Amniotic Fluid Embolism:** A rare but catastrophic cause of sudden, severe DIC due to the high concentration of procoagulants in amniotic fluid. 4. **Diagnosis:** Look for decreased Fibrinogen (<150 mg/dL), increased D-dimer/FDPs, and prolonged PT/APTT. 5. **Management:** The definitive treatment is the delivery of the fetus and placenta to remove the source of thromboplastin. Blood products (FFP, Cryoprecipitate, Platelets) are used for stabilization.

Q: A G2P1 patient presents at 34 weeks of pregnancy in labor with cervical dilatation of 3 cm and minimal uterine contractions. After artificial rupture of membranes, fresh bleeding is observed along with late decelerations. An emergency cesarean section was performed, but the fetus could not be saved. No abruption or placenta previa was noted. What is the most likely diagnosis?

Vasa previa. **Explanation:** The clinical presentation of **Vasa Previa** is classic: painless vaginal bleeding (fetal blood) occurring immediately after the **rupture of membranes (ROM)**, followed by rapid fetal distress (late decelerations or bradycardia) and fetal demise. In vasa previa, fetal vessels run unprotected by Wharton’s jelly across the internal os. When the membranes rupture, these vessels tear, leading to rapid fetal exsanguination since the total fetal blood volume is very small (~80-100 mL/kg). **Why other options are incorrect:** * **Concealed Abruptio Placentae:** While it causes fetal distress, it is usually associated with severe abdominal pain, a "woody hard" uterus, and the absence of fresh vaginal bleeding. The question specifically ruled out abruption during the C-section. * **Battledore Placenta:** This refers to the insertion of the umbilical cord at the placental margin. While it can lead to vasa previa if vessels traverse the membranes, the term itself describes a placental morphology that does not inherently cause bleeding unless vessels are ruptured. * **Placenta Accreta:** This is a disorder of placental adhesion to the myometrium. It typically presents with a failure of placental separation and massive postpartum hemorrhage, not fetal bleeding during labor. **Clinical Pearls for NEET-PG:** * **Triad of Vasa Previa:** Rupture of membranes + Painless vaginal bleeding + Fetal distress (bradycardia/sinusoidal pattern). * **Apt Test / Kleihauer-Betke Test:** Used to differentiate fetal blood from maternal blood in vaginal discharge. * **Risk Factors:** Velamentous cord insertion, succenturiate placental lobes, and IVF pregnancies. * **Management:** If diagnosed prenatally via Doppler USG, elective C-section is planned at 34–35 weeks. If diagnosed during labor, immediate emergency C-section is mandatory.

Question 1

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 2

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 3

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 4

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 5

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 6

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

Question 7

A pregnant woman at 38 weeks gestation presents with painless vaginal bleeding. On examination, the head is engaged and the uterus is non-tender and relaxed. What is the next line of treatment?

Accepted Answer

Termination of pregnancy

Answer

Per speculum examination

Answer

Conservative management

Answer

Ultrasonography

Question 8

What is the most important feature for diagnosing fetal aneuploidy?

Accepted Answer

Nuchal translucency

Answer

Absent nasal bone

Answer

Increased frontomaxillary angle

Answer

Reversal of ductus venosus flow

Question 9

All of the following are causes of Disseminated Intravascular Coagulation (DIC), except?

Accepted Answer

Multiple pregnancy

Answer

Intrauterine death

Answer

Missed abortion

Answer

Abruptio placentae

Question 10

A G2P1 patient presents at 34 weeks of pregnancy in labor with cervical dilatation of 3 cm and minimal uterine contractions. After artificial rupture of membranes, fresh bleeding is observed along with late decelerations. An emergency cesarean section was performed, but the fetus could not be saved. No abruption or placenta previa was noted. What is the most likely diagnosis?

Accepted Answer

Vasa previa

Answer

Concealed abruptio placentae

Answer

Battledore placenta

Answer

Placenta accreta

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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