Maternal-Fetal Medicine Practice Questions

Q: Golden coloured amniotic fluid is typically seen in which of the following conditions?

Rh incompatibility. **Explanation:** The color of amniotic fluid is a significant clinical indicator of fetal well-being. **Golden-colored amniotic fluid** is a classic diagnostic sign of **Rh isoimmunization (Rh incompatibility)**. **1. Why Rh Incompatibility is correct:** In Rh isoimmunization, maternal antibodies cross the placenta and cause hemolysis of fetal red blood cells. This massive breakdown of hemoglobin leads to the production of **unconjugated bilirubin**. This bilirubin is excreted into the fetal urine and subsequently into the amniotic fluid, imparting a characteristic golden-yellow hue. **2. Why other options are incorrect:** * **Fetal death (Option B):** In cases of Intrauterine Fetal Death (IUFD), the amniotic fluid typically appears **dark brown or "tobacco juice"** colored due to the presence of decomposed blood and macerated fetal tissues. * **Intrauterine Growth Restriction (Option C):** Simple IUGR does not typically change the color of the fluid unless accompanied by distress. * **Fetal distress with IUGR (Option D):** Fetal distress leads to the passage of meconium. This results in **greenish** amniotic fluid (meconium-stained). If the meconium is old, it may appear greenish-yellow (saffron). **Clinical Pearls for NEET-PG:** * **Normal:** Colorless or pale straw-colored (near term). * **Green (Meconium):** Fetal distress (acute). * **Golden:** Rh incompatibility (due to bilirubin). * **Greenish-Yellow (Saffron):** Post-maturity. * **Dark Red/Port Wine:** Abruptio placentae (due to concealed hemorrhage). * **Dark Brown (Tobacco juice):** I.U.F.D.

Q: What is the commonest chromosomal abnormality in early spontaneous abortions?

Autosomal trisomy. **Explanation:** Chromosomal abnormalities are responsible for approximately 50–60% of first-trimester spontaneous abortions. Among these, numerical aberrations are the most frequent cause. **1. Why Autosomal Trisomy is Correct:** Autosomal trisomy is the **single most common** chromosomal abnormality found in early miscarriages, accounting for about **50%** of all chromosomally abnormal abortuses. It occurs due to non-disjunction during meiosis (usually maternal). * **Trisomy 16** is the most common specific trisomy identified in these cases (though it is never seen in live births). * **Trisomy 21, 18, and 13** are also frequent but have higher rates of survival to term compared to Trisomy 16. **2. Analysis of Incorrect Options:** * **Monosomy (Option A):** Specifically, **45,X (Turner Syndrome)** is the **single most common specific chromosomal pattern** (karyotype) found in spontaneous abortions (approx. 20%). However, as a *group*, autosomal trisomies are more common than monosomies. * **Triploidy (Option C):** This involves 69 chromosomes (often due to dispermy). It accounts for about 15% of cases and is frequently associated with hydatidiform changes (Partial Mole). * **Tetraploidy (Option D):** This involves 92 chromosomes. It is rare (approx. 5%) and usually results in very early pregnancy loss (blighted ovum). **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of 1st-trimester abortion:** Chromosomal abnormalities. * **Most common group of abnormalities:** Autosomal Trisomy. * **Most common specific Trisomy:** Trisomy 16. * **Most common specific Karyotype:** 45,X (Turner Syndrome). * **Most common cause of 2nd-trimester abortion:** Maternal factors (e.g., Cervical incompetence, uterine anomalies).

Q: Elevated acetylcholinesterase levels in amniotic fluid most likely indicate which of the following conditions?

Open neural tube defects. **Explanation:** The correct answer is **Open neural tube defects (ONTDs)**. **1. Why it is correct:** Acetylcholinesterase (AChE) is an enzyme primarily found in nervous tissue. In cases of open neural tube defects (such as anencephaly or open spina bifida), the fetal neural tissue is directly exposed to the amniotic fluid. This allows AChE to leak from the exposed cerebrospinal fluid and neural membranes into the amniotic sac. While Alpha-fetoprotein (AFP) is used as a screening tool, it can be elevated in various other conditions (e.g., abdominal wall defects). **Amniotic fluid AChE is highly specific** and serves as the confirmatory biochemical test for ONTDs following an elevated AFP. **2. Why other options are incorrect:** * **Oesophageal atresia:** This condition is associated with polyhydramnios (due to inability to swallow) and may show elevated AFP, but it does not involve exposed neural tissue; therefore, AChE levels remain normal. * **Down syndrome (Trisomy 21):** This is characterized by **decreased** maternal serum AFP and specific ultrasound markers (increased nuchal translucency). AChE is not a marker for chromosomal aneuploidies. * **Edward syndrome (Trisomy 18):** Similar to Down syndrome, this is associated with low maternal serum AFP and HCG levels. It does not typically cause elevated amniotic AChE. **Clinical Pearls for NEET-PG:** * **Sequence of Testing:** Maternal Serum AFP (Screening) → Ultrasound → Amniotic Fluid AFP → **Amniotic Fluid AChE (Confirmatory)**. * **False Positives:** If the amniotic fluid sample is contaminated with fetal blood, AChE can be falsely elevated (pseudocholinesterase). * **Closed NTDs:** Conditions like *spina bifida occulta* do not typically show elevated AFP or AChE because the defect is covered by skin.

Q: A pregnant woman is found to be HIV positive in her first trimester. What is the next line of management?

Start ART now, continue throughout pregnancy and lifelong.. **Explanation:** The management of HIV in pregnancy is governed by the **WHO "Option B+" strategy**, which has been adopted by NACO (National AIDS Control Organisation) in India. **1. Why Option B is correct:** The current standard of care dictates that all pregnant women testing HIV positive should be started on **Triple Antiretroviral Therapy (ART)** immediately, regardless of their CD4 count or clinical stage. The primary goals are to achieve an undetectable viral load to prevent Mother-to-Child Transmission (MTCT) and to maintain the mother's health. Once started, ART is continued **lifelong** to prevent rebound viremia and improve long-term maternal outcomes. **2. Analysis of Incorrect Options:** * **Options A & C:** These suggest stopping ART 6 weeks after delivery. This reflects the outdated "Option B" strategy. Current guidelines emphasize lifelong treatment to prevent transmission in future pregnancies and to partners. * **Options C & D:** These suggest delaying ART until after the first trimester. Modern guidelines recommend starting ART **immediately upon diagnosis**, even in the first trimester. The benefits of early viral suppression far outweigh the theoretical risks of teratogenicity (including with drugs like Efavirenz or Dolutegravir). **High-Yield Clinical Pearls for NEET-PG:** * **Preferred Regimen (NACO):** TLD regimen (Tenofovir + Lamivudine + Dolutegravir). * **Most common timing of MTCT:** During labor and delivery (Intrapartum). * **Breastfeeding:** In India, exclusive breastfeeding for the first 6 months is recommended even for HIV-positive mothers, provided they are adherent to ART. * **Infant Prophylaxis:** Nevirapine or Zidovudine is typically given to the infant for 6 weeks.

Q: A primigravida presents at 32 weeks gestation with acute abdominal pain for 2 hours, vaginal bleeding, and decreased fetal movements. How should she be managed?

Immediate induction of labor. **Explanation:** The clinical presentation of acute abdominal pain, vaginal bleeding, and decreased fetal movements in a third-trimester pregnancy is a classic triad for **Abruptio Placentae**. In this scenario, the priority is to stabilize the mother and proceed with delivery, as placental abruption is a life-threatening obstetric emergency. **Why Option B is Correct:** In cases of placental abruption, **vaginal delivery is the preferred route** if the fetus is dead or if the mother is stable and labor is progressing. Even at 32 weeks (preterm), once a significant abruption occurs, the pregnancy must be terminated to prevent complications like DIC, Couvelaire uterus, or maternal shock. Induction of labor (usually with oxytocin or ARM) is initiated to expedite delivery. **Why Other Options are Incorrect:** * **Option A:** Cesarean section is indicated only if there is fetal distress (live fetus), maternal instability, or obstetric contraindications to vaginal delivery. It is not the "immediate" first choice for all cases. * **Option C:** Tocolytics are strictly **contraindicated** in placental abruption, as they can mask symptoms, worsen hemorrhage, and delay necessary delivery. * **Option D:** While MgSO4 is used for neuroprotection in preterm labor or for eclampsia, it is not the definitive management for the primary pathology (abruption) here. **NEET-PG High-Yield Pearls:** * **Most common cause of DIC in pregnancy:** Placental Abruption. * **Couvelaire Uterus:** Extravasation of blood into the myometrium, seen in severe abruption; managed with oxytocics (rarely requires hysterectomy). * **Key Distinction:** Unlike Placenta Previa (painless bleeding), Abruption presents with **painful** bleeding and a **rigid/tender uterus**.

Q: Which of the following statements is NOT true about antenatal Doppler analysis?

In normal gestation, placental resistance is high.. ### Explanation **Core Concept: The Low-Resistance Placental Bed** In a normal pregnancy, the physiological remodeling of maternal spiral arteries by trophoblastic invasion transforms them into high-capacitance, **low-resistance** vessels. This ensures continuous, high-volume blood flow to the fetus even during diastole. Therefore, the statement that placental resistance is high in normal gestation is **incorrect**. **Analysis of Options:** * **Option C (Correct Answer):** In normal pregnancy, placental resistance is **low**. High resistance is a pathological state often seen in pre-eclampsia or placental insufficiency. * **Option A & B:** As placental resistance increases (due to placental dysfunction), the diastolic flow in the Umbilical Artery decreases. A **reduction in end-diastolic flow (REDF)** or **absent/reversed end-diastolic flow (AREDF/REDF)** is a hallmark of **Intrauterine Growth Restriction (IUGR)** and is strongly associated with poor perinatal outcomes, including fetal hypoxia and acidosis. * **Option D:** The **S/D Ratio** (Systolic/Diastolic) measures the relationship between peak systole and end-diastole. In IUGR, the denominator (diastole) decreases due to high resistance, causing the overall **S/D ratio to increase**. **High-Yield Clinical Pearls for NEET-PG:** * **Umbilical Artery Doppler:** Primarily reflects **placental** health. Normal flow is forward throughout the cardiac cycle. * **Middle Cerebral Artery (MCA) Doppler:** Used to detect the **"Brain Sparing Effect."** In fetal hypoxia, resistance in the MCA decreases (vasodilation) to protect the brain. * **Ductus Venosus:** The most critical indicator of fetal cardiac failure; an "a-wave" reversal is a late sign of fetal distress. * **Uterine Artery Doppler:** High resistance with "diastolic NOTCHING" after 24 weeks is a predictor for the development of Pre-eclampsia.

Question 1

Golden coloured amniotic fluid is typically seen in which of the following conditions?

Accepted Answer

Rh incompatibility

Answer

Fetal death

Answer

Intrauterine Growth Restriction (IUGR)

Answer

Fetal distress with IUGR

Question 2

Placenta previa is characterized by all of the following except?

Accepted Answer

Presents after the first trimester

Answer

Painless bleeding

Answer

Causeless bleeding

Answer

Recurrent bleeding

Question 3

What is the commonest chromosomal abnormality in early spontaneous abortions?

Accepted Answer

Autosomal trisomy

Answer

Monosomy

Answer

Triploidy

Answer

Tetraploidy

Question 4

Elevated acetylcholinesterase levels in amniotic fluid most likely indicate which of the following conditions?

Accepted Answer

Open neural tube defects

Answer

Oesophageal atresia

Answer

Down syndrome

Answer

Edward syndrome

Question 5

Kamla Rani, a 20-year-old female with mitral stenosis class II and rheumatic heart disease, becomes pregnant. Which intervention is NOT indicated in her management during labor?

Accepted Answer

Give Methergin at delivery of the anterior shoulder.

Answer

Give prophylactic antibiotics.

Answer

Apply outlet forceps in the second stage of labor.

Answer

Give iv furosemide at delivery of the placenta.

Question 6

Which of the following is NOT true regarding lupus and pregnancy?

Accepted Answer

Antibodies to ss-A and ss-B antigens can result in ventricular apical fibrosis in the neonate.

Answer

Lupus in pregnancy can result in renal failure.

Answer

Women with cutaneous lupus usually have no adverse pregnancy outcomes.

Answer

Lupus in pregnancy can result in preterm labor.

Question 7

A woman at 8 months of pregnancy complains of abdominal pain and slight vaginal bleeding. On examination, the uterine size is larger than expected for gestational age, and fetal heart sounds are absent. What is the most likely diagnosis?

Accepted Answer

Concealed hemorrhage

Answer

Hydramnios

Answer

Active labor

Answer

Uterine rupture

Question 8

A pregnant woman is found to be HIV positive in her first trimester. What is the next line of management?

Accepted Answer

Start ART now, continue throughout pregnancy and lifelong.

Answer

Start antiretroviral therapy (ART) now, continue throughout pregnancy and for 6 weeks after delivery.

Answer

Start ART after the first trimester, continue throughout pregnancy and for 6 weeks after delivery.

Answer

Start ART after the first trimester, continue throughout pregnancy and lifelong.

Question 9

A primigravida presents at 32 weeks gestation with acute abdominal pain for 2 hours, vaginal bleeding, and decreased fetal movements. How should she be managed?

Accepted Answer

Immediate induction of labor

Answer

Immediate cesarean section

Answer

Tocolytic therapy

Answer

Magnesium sulfate therapy

Question 10

Which of the following statements is NOT true about antenatal Doppler analysis?

Accepted Answer

In normal gestation, placental resistance is high.

Answer

Reduction in end diastolic flow is associated with poor outcome.

Answer

Reduction in end diastolic flow is associated with IUGR.

Answer

S/D ratio is high in IUGR.

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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