Maternal-Fetal Medicine Practice Questions

Q: All of the following drugs can be given to a mother with lupus after 35th week of gestation, except?

Methotrexate. **Explanation:** The correct answer is **Methotrexate (Option B)**. Methotrexate is a potent folic acid antagonist and is strictly **contraindicated** throughout pregnancy (FDA Category X). While its teratogenic effects (fetal hydantoin-like syndrome, cranial anomalies) are most concerning in the first trimester, it remains contraindicated in the third trimester due to its potential for neonatal myelosuppression and hepatotoxicity. **Analysis of Options:** * **Chloroquine (Option A):** Antimalarials (Hydroxychloroquine/Chloroquine) are considered the cornerstone of SLE management in pregnancy. They are safe and essential to prevent lupus flares and reduce the risk of neonatal heart block. * **Sulphadiazine / Sulphasalazine (Option C):** These are considered safe in pregnancy. While sulfonamides are generally avoided near term due to the theoretical risk of neonatal kernicterus (by displacing bilirubin from albumin), Sulphasalazine is frequently used in stable autoimmune patients and is not strictly contraindicated like Methotrexate. * **Prednisolone (Option D):** This is the steroid of choice for maternal indications (like SLE flares). It is metabolized by the placental enzyme **11-beta-hydroxysteroid dehydrogenase**, ensuring that less than 10% of the drug reaches the fetus, thus minimizing fetal side effects. **NEET-PG High-Yield Pearls:** * **Drug of Choice for SLE in Pregnancy:** Hydroxychloroquine (reduces flares). * **Steroids in Pregnancy:** Prednisolone is used for maternal SLE; **Betamethasone/Dexamethasone** are used for fetal lung maturity (as they cross the placenta). * **Lupus & Neonatal Heart Block:** Associated with Anti-Ro (SSA) and Anti-La (SSB) antibodies. * **Safe Immunosuppressants in Pregnancy:** Azathioprine, Cyclosporine, and Tacrolimus. * **Contraindicated in SLE Pregnancy:** Methotrexate, Mycophenolate Mofetil (MMF), and Cyclophosphamide.

Q: Which drug is used for the management of ectopic pregnancy?

Methotrexate. **Explanation:** **Methotrexate (Option A)** is the drug of choice for the medical management of unruptured ectopic pregnancy. It is a folic acid antagonist that inhibits the enzyme **dihydrofolate reductase**, thereby preventing the synthesis of DNA, RNA, and proteins. Since trophoblastic tissue is rapidly dividing, it is highly sensitive to methotrexate, which effectively halts the growth of the ectopic pregnancy and allows for gradual resorption. **Why other options are incorrect:** * **Mifepristone (Option B):** While it is an anti-progestogen used for medical abortion (in combination with Misoprostol), it is not the primary treatment for ectopic pregnancy. It acts on the decidua but is insufficient to reliably terminate a tubal pregnancy. * **Procarbazine (Option C):** This is an alkylating agent primarily used in the treatment of Hodgkin’s lymphoma, not in obstetric practice. * **Cytosine arabinoside (Option D):** Also known as Cytarabine, this is a chemotherapy agent used for leukemias and has no role in managing ectopic pregnancies. **High-Yield Clinical Pearls for NEET-PG:** * **Indications for Methotrexate:** Hemodynamically stable patient, unruptured mass <3.5–4 cm, no fetal cardiac activity, and baseline serum β-hCG <5000 mIU/mL. * **Contraindications:** Breastfeeding, immunodeficiency, ruptured ectopic pregnancy, or hepatic/renal dysfunction. * **Dosing:** Most commonly administered as a single intramuscular dose (50 mg/m²). * **Monitoring:** Success is defined by a ≥15% drop in β-hCG levels between Day 4 and Day 7 after administration.

Q: Intrauterine growth restriction (IUGR) is caused by all of the following except?

Diabetes. **Explanation:** The correct answer is **Diabetes (Option A)**. In the context of pregnancy, maternal diabetes (specifically pre-gestational or gestational diabetes) is classically associated with **fetal macrosomia** (birth weight >4000g or >90th percentile) rather than growth restriction. This occurs because maternal hyperglycemia leads to fetal hyperglycemia, which stimulates the fetal pancreas to secrete excess insulin. Since insulin is a potent anabolic growth factor, it results in excessive fetal growth and fat deposition. *Note: The only exception is long-standing diabetes with advanced vascular complications (White’s Class F or R), which can cause placental insufficiency and lead to IUGR. However, as a general rule for NEET-PG, diabetes is the "odd one out" as it primarily causes large-for-gestational-age (LGA) babies.* **Why other options are incorrect:** * **Alcohol (Option B):** Alcohol is a known teratogen and a leading cause of symmetric IUGR. It interferes with cell division and protein synthesis. * **Smoking (Option C):** Nicotine and carbon monoxide cause vasoconstriction and reduce the oxygen-carrying capacity of fetal blood, leading to placental insufficiency and asymmetric IUGR. * **Chronic Renal Failure (Option D):** Maternal chronic disease leads to systemic hypertension and impaired uteroplacental blood flow, which are major risk factors for growth restriction. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of IUGR:** Placental insufficiency (often due to maternal hypertension). * **Symmetric IUGR:** Occurs early in pregnancy (e.g., chromosomal anomalies, TORCH infections). * **Asymmetric IUGR:** Occurs later in pregnancy; "Head sparing" effect is seen (e.g., Preeclampsia, Smoking). * **Ponderal Index:** Used to differentiate between symmetric and asymmetric IUGR.

Q: What is the primary benefit of using steroids in the treatment of HELLP syndrome?

Increase platelet count in severe thrombocytopenia.. **Explanation:** The primary clinical benefit of administering corticosteroids (such as Dexamethasone) in HELLP syndrome is the **transient increase in maternal platelet count**. While steroids do not cure the underlying pathophysiology of HELLP, they stabilize endothelial membranes and reduce the inflammatory response, which helps in elevating the platelet count. This is particularly crucial for patients with severe thrombocytopenia (<50,000/µL) to facilitate safer anesthesia (e.g., regional anesthesia) and reduce the risk of surgical site bleeding during delivery. **Analysis of Options:** * **Option A & B:** Large-scale randomized controlled trials (such as the COPE trial) and Cochrane reviews have demonstrated that steroids **do not** significantly reduce maternal mortality, the incidence of acute renal failure, or the need for blood transfusions. * **Option D:** While some studies show a slight improvement in laboratory parameters, the effect on liver enzyme recovery is inconsistent and not considered the "primary" clinical benefit compared to the stabilization of platelets for delivery management. **High-Yield NEET-PG Pearls:** * **Drug of Choice:** Dexamethasone (10 mg IV every 12 hours) is preferred over Betamethasone because it has a more potent effect on increasing platelet counts. * **Definitive Treatment:** The only definitive treatment for HELLP syndrome is **delivery** (usually after 34 weeks or if maternal/fetal condition deteriorates). * **Mississippi Classification:** Class 1 HELLP (Platelets ≤ 50,000/µL) is the most severe form and the primary indication for considering steroid therapy to "buy time" for delivery preparation. * **Postpartum:** Steroids may also be used postpartum to accelerate the recovery of platelet counts in refractory cases.

Q: A 24-week pregnant female has developed gestational diabetes. Which of the following congenital anomalies is MOST characteristic of diabetic pregnancy?

Caudal regression syndrome. **Explanation:** **Why Caudal Regression Syndrome is the Correct Answer:** While the most common congenital malformations in infants of diabetic mothers (IDM) are **cardiac defects** (specifically Ventricular Septal Defects), **Caudal Regression Syndrome** (Sacral Agenesis) is the **most characteristic** or specific anomaly. This condition involves the incomplete development of the lower spine and sacrum, often associated with lower limb deformities and bowel/bladder dysfunction. Its incidence is nearly 200 times higher in diabetic pregnancies compared to the general population, making it a pathognomonic marker for pre-gestational diabetes. **Analysis of Incorrect Options:** * **A. Multicystic kidneys:** While renal anomalies (like renal agenesis or hydronephrosis) can occur in IDM, they are not as specific or characteristic as caudal regression. * **B. Esophageal atresia:** Gastrointestinal anomalies are increased in diabetic pregnancies, but esophageal atresia is less frequently associated with diabetes than cardiac or skeletal defects. * **D. Duodenal atresia:** This is most classically associated with **Down Syndrome (Trisomy 21)**, not maternal diabetes. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Anomaly:** Cardiac defects (VSD is #1; Transposition of Great Arteries is also highly associated). * **Most Specific Anomaly:** Caudal Regression Syndrome. * **Critical Period:** These anomalies occur during **organogenesis** (first 8 weeks), meaning they are associated with pre-gestational diabetes or poorly controlled blood sugar at conception, rather than gestational diabetes developing in the second trimester. * **Neural Tube Defects:** There is a 10-fold increased risk of NTDs in diabetic pregnancies.

Question 1

All of the following drugs can be given to a mother with lupus after 35th week of gestation, except?

Accepted Answer

Methotrexate

Answer

Chloroquine

Answer

Sulphadiazine / Sulphasalazine

Answer

Prednisolone

Question 2

The oxytocin challenge test for assessing fetal well-being is contraindicated in all except which of the following conditions?

Accepted Answer

Breech presentation

Answer

Placenta previa

Answer

Previous two lower segment caesarean sections

Answer

Premature labor

Question 3

What is considered a dangerously low-lying placenta?

Accepted Answer

Type II posterior placenta

Answer

Type I anterior placenta

Answer

Type II anterior placenta

Answer

Type I posterior placenta

Question 4

Which drug is used for the management of ectopic pregnancy?

Accepted Answer

Methotrexate

Answer

Mifepristone

Answer

Procarbazine

Answer

Cytosine arabinoside

Question 5

Intrauterine growth restriction (IUGR) is caused by all of the following except?

Accepted Answer

Diabetes

Answer

Alcohol

Answer

Smoking

Answer

Chronic renal failure

Question 6

Cholestasis of pregnancy is characterized by:

Accepted Answer

Increased perinatal mortality and recurrence in subsequent pregnancies

Answer

Commonly occurs in the 1st trimester of pregnancy, increased perinatal mortality, and recurrence in subsequent pregnancies

Answer

Increased maternal mortality, increased perinatal mortality, and recurrence in subsequent pregnancies

Answer

Commonly occurs in the 1st trimester of pregnancy and recurrence in subsequent pregnancies

Question 7

What is the primary benefit of using steroids in the treatment of HELLP syndrome?

Accepted Answer

Increase platelet count in severe thrombocytopenia.

Answer

Decrease maternal mortality rate.

Answer

Decrease rate of acute renal failure.

Answer

Increase rate of recovery of liver enzymes.

Question 8

A 24-week pregnant female has developed gestational diabetes. Which of the following congenital anomalies is MOST characteristic of diabetic pregnancy?

Accepted Answer

Caudal regression syndrome

Answer

Multicystic kidneys

Answer

Esophageal atresia

Answer

Duodenal atresia

Question 9

A 30-year-old woman with gestational diabetes presents with true labor pains at 30 weeks of gestation. The woman is given glucocorticoid therapy. What is the purpose of prenatal steroid therapy?

Accepted Answer

To increase the lecithin/sphingomyelin ratio in the amniotic fluid

Answer

To increase blood flow to the fetal lungs

Answer

To increase fetal PO2

Answer

To shift the fetal oxyhemoglobin dissociation curve to the right

Question 10

A full-term primipara presents with antepartum hemorrhage. What is the next line of management?

Accepted Answer

Examination in the operating room followed by amniotomy

Answer

Pelvic examination

Answer

Conservative management until the onset of labor

Answer

Lower segment cesarean section

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?