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: The 'T sign' is characteristic of which condition?

Membrane in twin pregnancy. The **'T sign'** is a classic ultrasonographic marker used to determine the chorionicity of a twin pregnancy. ### 1. Why Option B is Correct The 'T sign' is characteristic of **Monochorionic Diamniotic (MCDA)** twin pregnancies. It refers to the appearance of the inter-twin membrane as it meets the placenta. In MCDA twins, there is a single placenta and two amniotic sacs. Because there is no intervening chorionic tissue between the two layers of amnion, the membrane is very thin and joins the placenta at a sharp 90-degree angle, resembling the letter **'T'**. ### 2. Why Other Options are Incorrect * **Genital Tuberculosis:** This condition is associated with radiographic signs like the 'Beaded tube' or 'Lead pipe' appearance on HSG, but not the T sign. * **Molar Pregnancy:** Characterized by a 'Snowstorm' or 'Bunch of grapes' appearance on ultrasound due to hydropic villi. * **Choriocarcinoma:** Presents as a highly vascular, solid mass with areas of necrosis and hemorrhage, often showing high-velocity flow on Doppler. ### 3. Clinical Pearls for NEET-PG * **Lambda (λ) Sign / Twin Peak Sign:** This is the hallmark of **Dichorionic Diamniotic (DCDA)** twins. It occurs when a wedge of chorionic tissue grows into the base of the inter-twin membrane, creating a triangular shape. * **Timing of Cleavage:** * 0–3 days: DCDA (Lambda sign) * 4–8 days: MCDA (T sign) * 8–13 days: MCMA (No membrane) * >13 days: Conjoined twins * **Significance:** Determining chorionicity is most accurate in the **first trimester (10–14 weeks)**. It is crucial because monochorionic twins are at risk for Twin-to-Twin Transfusion Syndrome (TTTS).

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: 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: Implantation bleeding is called:

Haman's sign. **Explanation:** **Correct Answer: A. Hartman’s sign** *(Note: The question likely refers to **Hartman’s sign**, though it is occasionally misspelled as Haman’s in some question banks. Haman’s sign is traditionally a cardiac finding, but in the context of early pregnancy and implantation, Hartman’s sign is the standard term.)* **Hartman’s sign** refers to the slight spotting or bleeding that occurs during the process of implantation. This typically happens about 6–12 days after fertilization (around the time of the expected missed period). It occurs as the blastocyst burrows into the vascular endometrium (decidua), causing minor erosions of maternal capillaries. It is a physiological phenomenon and should not be confused with a threatened abortion. **Analysis of Incorrect Options:** * **B. Arias-Stella sign:** This refers to specific hypertrophic changes in the endometrial glandular epithelium (hyperchromatic nuclei and vacuolated cytoplasm). It is a histological finding associated with the presence of chorionic tissue, often seen in ectopic pregnancies, but it is not a clinical sign of bleeding. * **C. Hoffman’s sign:** In obstetrics, this refers to a technique used to evert flat or inverted nipples during pregnancy. In neurology, it is a reflex indicating upper motor neuron lesions. * **D. Reinz’s sign:** This is not a recognized clinical sign in standard Obstetrics and Gynecology. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** Implantation bleeding occurs roughly at the 4th week of gestation (calculated from LMP). * **Distinction:** Unlike menstruation, Hartman’s sign is usually brief (1–2 days), light in flow, and pinkish-brown in color. * **Decidualization:** The endometrium of pregnancy is called the **Decidua**. The part where the blastocyst implants is the **Decidua Basalis**.

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.

Question 1

All the following are true regarding HIV transmission from mother to infant, EXCEPT:

Accepted Answer

Emergency Cesarean section increases the chance of transmission.

Answer

Nevirapine prophylaxis is used for the prevention of vertical transmission.

Answer

Zidovudine should be given to both pregnant women and infants.

Answer

Avoid breastfeeding.

Question 2

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 3

The 'T sign' is characteristic of which condition?

Accepted Answer

Membrane in twin pregnancy

Answer

Genital Tuberculosis

Answer

Molar pregnancy

Answer

Choriocarcinoma

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

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 6

Which of the following cardiac diseases is associated with safe pregnancy?

Accepted Answer

Congenital acyanotic heart disease

Answer

Marfan's syndrome

Answer

Idiopathic pulmonary hypertension

Answer

Ebstein anomaly

Question 7

Implantation bleeding is called:

Accepted Answer

Haman's sign

Answer

Arias-Stella sign

Answer

Hoffman's sign

Answer

Reinz's sign

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 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)

Question 10

A 32-week pregnant woman presents with mild uterine contractions. On examination, her vital signs are stable, and placenta previa type III is present. What is the best management?

Accepted Answer

Bed rest + Nifedipine and Dexamethasone

Answer

Bed rest + Dexamethasone

Answer

Bed rest + Sedation

Answer

Immediate cesarean section

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?