Maternal-Fetal Medicine Practice Questions

Q: Which of the following findings is considered a positive interpretation in a contraction stress test?

Persistent late deceleration. **Explanation:** The **Contraction Stress Test (CST)**, also known as the Oxytocin Challenge Test, evaluates the respiratory function of the placenta and the fetal ability to withstand the transient hypoxia induced by uterine contractions. **Why Persistent Late Deceleration is Correct:** A **Positive CST** is defined by the presence of **late decelerations** following 50% or more of the contractions (even if the frequency is less than 3 in 10 minutes). Late decelerations indicate **uteroplacental insufficiency**. During a contraction, intramyometrial pressure exceeds capillary perfusion pressure; a healthy fetus has enough oxygen reserve to tolerate this, but a compromised fetus develops hypoxia, leading to myocardial depression or chemoreceptor-mediated late decelerations. **Analysis of Incorrect Options:** * **Early Deceleration:** These are caused by fetal head compression and are considered physiological (benign). They do not indicate fetal distress or placental compromise. * **Early Acceleration:** Accelerations are a sign of fetal well-being and reactive sympathetic nervous system. They are the hallmark of a reassuring Non-Stress Test (NST). * **Variable Deceleration:** These are typically caused by umbilical cord compression. While they may occur during a CST, they do not constitute a "Positive" result; if significant, the test may be labeled as "Suspicious." **NEET-PG High-Yield Pearls:** * **Negative CST (Normal):** No late or significant variable decelerations with a minimum of 3 contractions in 10 minutes. This is highly reassuring (NPV for fetal demise >99%). * **Contraindications:** CST should be avoided in conditions where labor is contraindicated, such as **Placenta Previa, previous classical Cesarean section, or Preterm Rupture of Membranes (PROM).** * **Suspicious/Equivocal:** Intermittent late decelerations or significant variable decelerations.

Q: All of the following are true about placenta previa EXCEPT:

Increased uterine tone. **Explanation:** Placenta previa is characterized by the implantation of the placenta in the lower uterine segment. The hallmark clinical presentation is **painless, causeless, and recurrent bright red vaginal bleeding.** **Why "Increased uterine tone" is the correct answer (EXCEPT):** In placenta previa, the bleeding is **extra-vaginal** and does not involve the formation of a retroplacental clot. Consequently, the uterus remains **soft, relaxed, and non-tender** on palpation. Increased uterine tone (uterine hypertonicity or "woody hard" uterus) and abdominal pain are classic features of **Abruptio Placentae**, not placenta previa. **Analysis of Incorrect Options:** * **A & B (Bright red/Painless bleeding):** Since the bleeding occurs from the lower uterine segment (where there is less contractile tissue) and escapes directly through the cervix, it is typically bright red and occurs without the pain associated with uterine contractions or placental shearing. * **D (Malpresentations):** Because the placenta occupies the lower uterine segment, it prevents the fetal head from engaging. This leads to a high frequency of malpresentations (e.g., breech or transverse lie) and a high presenting part. **NEET-PG High-Yield Pearls:** * **Stallworthy’s Sign:** A drop in fetal heart rate when the head is pressed into the pelvis, which recovers when pressure is released; suggestive of posterior placenta previa. * **Investigation of Choice:** Transvaginal Ultrasound (TVS) is the gold standard (more accurate than transabdominal). * **Contraindication:** **Digital vaginal examination** is strictly contraindicated unless the patient is in the operation theater for a "Double Setup Examination," as it can provoke torrential hemorrhage.

Q: Saffron-colored meconium is typically seen in which of the following conditions?

Post-term gestation. **Explanation:** The color of the amniotic fluid (liquor) and meconium provides critical diagnostic clues regarding fetal well-being and gestational age. **Post-term gestation (Correct Answer):** In pregnancies exceeding 42 weeks, the meconium often takes on a characteristic **saffron or golden-yellow** hue. This occurs because the meconium becomes more concentrated and undergoes chemical changes over time. Additionally, in post-maturity syndrome (Ballantyne-Runge syndrome), the vernix caseosa disappears, allowing the yellow pigment to stain the fetal skin and nails. **Incorrect Options:** * **Tuberculosis:** This is associated with **"Rice water"** appearance of the amniotic fluid, not saffron-colored meconium. * **Breech presentation:** While meconium passage is common in breech presentation due to physical compression of the fetal abdomen during labor, the color remains typically **dark green/black** (fresh meconium) rather than saffron. * **Normal newborn appearance:** Normal liquor is clear or straw-colored. Fresh meconium passed by a healthy newborn is thick, tenacious, and dark green. **Clinical Pearls for NEET-PG:** * **Green (Dark Green):** Fresh meconium (suggests fetal distress or breech). * **Golden Yellow:** Rh-isoimmunization (due to bilirubin from hemolysis). * **Greenish-Yellow (Saffron):** Post-maturity. * **Dark Red (Meat washings):** Intrauterine Fetal Death (IUFD) due to blood-stained liquor. * **Rice Water:** Congenital Tuberculosis.

Q: Pregnancy should be strongly discouraged in women with which of the following conditions?

Eisenmenger's syndrome. **Explanation:** The correct answer is **Eisenmenger’s syndrome**. This condition represents the final stage of a long-standing left-to-right shunt (like ASD or VSD) that has resulted in irreversible pulmonary hypertension and a reversal of the shunt (right-to-left). **Why Eisenmenger’s Syndrome is the Correct Answer:** In pregnancy, systemic vascular resistance (SVR) normally decreases. In patients with Eisenmenger’s, this drop in SVR exacerbates the right-to-left shunt, leading to profound hypoxemia, cyanosis, and often sudden cardiovascular collapse. The maternal mortality rate is exceptionally high (30–50%), making it a **WHO Class IV** cardiac condition where pregnancy is strictly contraindicated and termination is advised. **Analysis of Incorrect Options:** * **Mitral Stenosis (A):** While it is the most common rheumatic heart lesion in pregnancy and carries risks (especially pulmonary edema due to tachycardia), it is generally manageable with beta-blockers and activity restriction. It is not an absolute contraindication unless extremely severe. * **Atrial Septal Defect (B) & Ventricular Septal Defect (C):** These are usually well-tolerated during pregnancy provided there is no associated pulmonary hypertension. Most women with isolated, uncomplicated shunts have successful pregnancies. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications to Pregnancy (WHO Class IV):** 1. Eisenmenger’s Syndrome. 2. Pulmonary Arterial Hypertension (PAH). 3. Severe Systemic Ventricular Dysfunction (LVEF 45mm. * **Management:** If a woman with Eisenmenger’s becomes pregnant, the gold standard recommendation is **early therapeutic abortion**. If she continues the pregnancy, strict bed rest and hospitalization are required.

Q: A 14-week pregnant woman presents with abdominal pain. Ultrasound reveals the fetus is located in a rudimentary uterine horn. What is the most appropriate management in this situation?

Surgical removal of the pregnant rudimentary uterine horn. **Explanation:** A **rudimentary horn pregnancy** is a rare but life-threatening form of ectopic pregnancy occurring in a non-communicating horn of a unicornuate uterus (Müllerian anomaly Class II). **1. Why the correct answer is right:** The myometrium of a rudimentary horn is typically underdeveloped and cannot accommodate a growing fetus. This leads to a high risk of **spontaneous rupture**, usually in the second trimester (10–20 weeks), resulting in massive hemoperitoneum. Once diagnosed, the standard of care is **surgical removal of the pregnant rudimentary horn (excision)** to prevent rupture and maternal mortality. The ipsilateral fallopian tube is also typically removed to prevent a future ectopic pregnancy in that remnant. **2. Why incorrect options are wrong:** * **Hysterectomy (A):** This is overly radical for a 14-week pregnancy in a young patient. The main unicornuate uterus is functional and should be preserved to allow for future pregnancies. * **Induction of labor (C):** Most rudimentary horns do not communicate with the cervix. Therefore, prostaglandins will cause uterine contractions against an obstructed outlet, inevitably leading to rupture rather than delivery. * **Conservative management (D):** This is contraindicated due to the near-certainty of rupture and life-threatening hemorrhage as the pregnancy advances. **Clinical Pearls for NEET-PG:** * **Classic Presentation:** Severe abdominal pain and collapse in the second trimester (unlike tubal ectopics which rupture in the first trimester). * **Baartman’s Sign:** A clinical finding where the pregnant horn is palpated as a mass separated from the uterus by a groove. * **Ultrasound Finding:** A "pseudo-asymmetrical" uterus with a gestational sac surrounded by myometrium, separate from the main uterine body. * **Risk:** 80-90% of these pregnancies end in rupture.

Q: What is true about heterotopic pregnancy?

It occurs following assisted reproductive techniques. **Explanation:** **Heterotopic pregnancy** is defined as the simultaneous occurrence of two or more implantation sites, where one is **intrauterine** and the other is **extrauterine** (most commonly in the fallopian tube). **1. Why Option B is Correct:** In the general population, the incidence of heterotopic pregnancy is rare (approx. 1 in 30,000). However, there is a significant rise in incidence (up to 1 in 100–500) following **Assisted Reproductive Techniques (ART)** like IVF. This is due to factors such as the transfer of multiple embryos, the high volume of transfer media which may carry embryos into the tubes, and underlying tubal pathology in subfertile women. **2. Why the other options are incorrect:** * **Option A:** The incidence is nowhere near 10%. Even in ART pregnancies, it remains below 1%. In natural conceptions, it is extremely rare (0.003%). * **Option C:** This describes a bilateral ectopic pregnancy, not heterotopic. Heterotopic pregnancy must involve at least one intrauterine sac. * **Option D:** While this describes the most common *type* of heterotopic pregnancy, it is not a "true" statement defining the condition as a whole. A heterotopic pregnancy can involve an intrauterine sac and an extrauterine sac in locations other than the tube (e.g., cervical, ovarian, or abdominal). Option B is the stronger clinical association tested in exams. **High-Yield Clinical Pearls for NEET-PG:** * **The "Double Sac" Sign:** On ultrasound, the presence of an intrauterine gestational sac does **not** rule out an ectopic pregnancy, especially if the patient underwent ART. * **Management:** The goal is to surgically remove the ectopic pregnancy (usually via laparoscopic salpingectomy) while preserving the viable intrauterine pregnancy. * **Clinical Triad:** Abdominal pain, adnexal mass, and an enlarged uterus (though symptoms are often masked by the intrauterine pregnancy).

Q: What is the most common feature of ectopic pregnancy?

Abdominal pain. **Explanation:** Ectopic pregnancy is a life-threatening condition where the blastocyst implants outside the uterine cavity, most commonly in the ampulla of the fallopian tube. **Why Abdominal Pain is the Correct Answer:** Abdominal pain is the **most common clinical feature**, present in approximately **95–100%** of cases. The pain is typically caused by tubal distension, peritoneal irritation by leaking blood, or tubal rupture. While the "classic triad" includes abdominal pain, amenorrhea, and vaginal bleeding, pain is the most consistent symptom across both ruptured and unruptured presentations. **Analysis of Incorrect Options:** * **B. Amenorrhea:** While a common sign (seen in ~75–90% of cases), it is not as universal as pain. Patients may sometimes mistake early vaginal bleeding for a normal period, leading to a reported absence of amenorrhea. * **C. Fainting attack:** This is a sign of **ruptured** ectopic pregnancy leading to hemoperitoneum and hypovolemic shock. While highly specific for a surgical emergency, it occurs in only about 30–50% of cases. * **D. Per vaginal bleeding:** This occurs in about 70–80% of cases due to the breakdown of the decidua (as hCG levels are insufficient to maintain it). It usually follows the onset of pain, making it less frequent and less early a sign than pain itself. **NEET-PG High-Yield Pearls:** * **Most common site:** Fallopian tube (97%), specifically the **Ampulla** (70%). * **Most common site for rupture:** Isthmus (due to its narrow lumen). * **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVS) + Serum Beta-hCG (Discriminatory zone: 1500–2000 mIU/ml). * **Arias-Stella Reaction:** Hypersecretory endometrium seen on curettage; it is suggestive but not diagnostic of ectopic pregnancy.

Q: In an unruptured ectopic pregnancy patient who underwent a salpingostomy procedure, what is the typical management of the tubal incision?

The tubal incision is left open for secondary healing.. ### Explanation In the surgical management of an unruptured ectopic pregnancy, **Salpingostomy** is the preferred fertility-preserving procedure. **1. Why Option A is Correct:** During a linear salpingostomy, a longitudinal incision is made on the antimesenteric border of the fallopian tube over the site of the ectopic gestation. After the products of conception are removed and hemostasis is achieved, the **incision is left open to heal by secondary intention**. Studies have shown that suturing the thin, delicate tubal wall (primary closure) does not improve future pregnancy rates and may actually increase the risk of tubal scarring, narrowing, and subsequent recurrent ectopic pregnancy. **2. Why Other Options are Incorrect:** * **Option B:** Closing the incision with sutures (Salpingotomy) is generally avoided as it increases operative time and the risk of tubal lumen stenosis without providing any clinical benefit over salpingostomy. * **Option C:** "Milking" or tubal expression involves pushing the pregnancy out through the fimbrial end. This is associated with a higher risk of persistent trophoblastic tissue and a higher recurrence rate compared to salpingostomy. * **Option D:** Partial excision (Salpingectomy) is the treatment of choice for a **ruptured** ectopic pregnancy or when the tube is severely damaged, but it is not the standard for a simple salpingostomy. ### High-Yield Clinical Pearls for NEET-PG: * **Gold Standard for Diagnosis:** Transvaginal Ultrasound (TVS) + Serum β-hCG. * **Surgical Approach:** Laparoscopy is the gold standard for hemodynamically stable patients. * **Persistent Trophoblast:** The most common complication of salpingostomy. Post-operative weekly β-hCG monitoring is mandatory until levels are <5 mIU/mL. * **Rh-Negative Mothers:** Always administer Anti-D immunoglobulin post-procedure to prevent isoimmunization.

Question 1

Which of the following findings is considered a positive interpretation in a contraction stress test?

Accepted Answer

Persistent late deceleration

Answer

Early deceleration

Answer

Early acceleration

Answer

Variable deceleration

Question 2

All of the following are true about placenta previa EXCEPT:

Accepted Answer

Increased uterine tone

Answer

Bright red blood loss

Answer

Painless vaginal bleeding

Answer

Malpresentations usually found

Question 3

Saffron-colored meconium is typically seen in which of the following conditions?

Accepted Answer

Post-term gestation

Answer

Tuberculosis

Answer

Breech presentation

Answer

Normal newborn appearance

Question 4

Pregnancy should be strongly discouraged in women with which of the following conditions?

Accepted Answer

Eisenmenger's syndrome

Answer

Mitral stenosis

Answer

Atrial septal defect (ASD)

Answer

Ventricular septal defect (VSD)

Question 5

A 14-week pregnant woman presents with abdominal pain. Ultrasound reveals the fetus is located in a rudimentary uterine horn. What is the most appropriate management in this situation?

Accepted Answer

Surgical removal of the pregnant rudimentary uterine horn

Answer

Hysterectomy

Answer

Induction of labor using prostaglandins

Answer

Conservative management with no active treatment

Question 6

What is true about heterotopic pregnancy?

Accepted Answer

It occurs following assisted reproductive techniques

Answer

Its incidence is 10%

Answer

It has two extrauterine gestational sacs

Answer

It has one gestational sac in the fallopian tube and another intrauterine

Question 7

A woman has experienced three consecutive second-trimester abortions. She is now presenting for a prenatal checkup. What is the most appropriate investigation among the following?

Accepted Answer

Hysterosalpingography

Answer

Hysteroscopy

Answer

Chromosomal analysis

Answer

Prenatal cerclage

Question 8

What is the most common feature of ectopic pregnancy?

Accepted Answer

Abdominal pain

Answer

Amenorrhea

Answer

Fainting attack

Answer

Per vaginal bleeding

Question 9

In an unruptured ectopic pregnancy patient who underwent a salpingostomy procedure, what is the typical management of the tubal incision?

Accepted Answer

The tubal incision is left open for secondary healing.

Answer

The tubal incision is closed with sutures.

Answer

Milking of the tube is performed.

Answer

Partial excision of the tube is done.

Question 10

In the second trimester of pregnancy, the diagnosis of IUGR can be best made by assessing which of the following parameters?

Accepted Answer

Biparietal Diameter (BPD)

Answer

Head Circumference (HC)

Answer

Abdominal Circumference (AC)

Answer

Crown-Rump Length (CRL)

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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