Maternal-Fetal Medicine Practice Questions

Q: All are true about cancers during pregnancy, except:

Lymphoma is the most common cancer during pregnancy.. **Explanation** The incidence of cancer during pregnancy is relatively low, but it remains a significant clinical challenge. **1. Why Option D is the correct answer (The Exception):** While lymphoma (specifically Hodgkin’s lymphoma) is one of the most common malignancies in pregnancy, it is **not the most common**. Statistically, **Breast Cancer** is the most frequently diagnosed cancer during pregnancy, followed closely by cervical cancer. Therefore, the statement that lymphoma is the most common is incorrect. **2. Analysis of Incorrect Options:** * **Option A:** This is a statistically accurate statement. The incidence of malignancy complicating pregnancy is approximately **1 in 1,000 pregnancies**. * **Option B:** Because most cancers occur in older age groups, only a small fraction (**less than 1%**) of all female cancers are diagnosed during pregnancy. * **Option C:** This list correctly identifies the "Big Four" malignancies associated with pregnancy. **Breast cancer** (1 in 3,000) and **Cervical cancer** (1 in 2,500) are the most prevalent, followed by **Melanoma** and **Lymphoma**. **NEET-PG High-Yield Pearls:** * **Most common cancer in pregnancy:** Breast Cancer. * **Most common gynecological cancer in pregnancy:** Cervical Cancer. * **Diagnostic Caveat:** Pregnancy-associated breast cancer (PABC) is often diagnosed at a later stage due to physiological changes (engorgement/lactation) masking lumps. * **Management Rule:** Termination of pregnancy does not generally improve the prognosis of the maternal cancer. * **Chemotherapy:** Generally contraindicated in the 1st trimester (organogenesis) but can often be administered in the 2nd and 3rd trimesters. * **Radiotherapy:** Usually contraindicated throughout pregnancy due to fetal risks.

Q: A patient presents at 28 weeks gestation with severe abdominal pain, bleeding, and hypertension. What is the most likely diagnosis?

Abruptio placentae. **Explanation:** The clinical triad of **severe abdominal pain, vaginal bleeding, and hypertension** in the third trimester is a classic presentation of **Abruptio Placentae** (premature separation of a normally situated placenta). Hypertension (chronic or pregnancy-induced) is the most significant risk factor for placental abruption. The pain results from blood extravasating into the myometrium (Couvelaire uterus), causing uterine hypertonicity and tenderness. **Why the other options are incorrect:** * **Placenta Previa:** Characteristically presents as **painless**, bright red, causeless, and recurrent bleeding. The abdomen is typically soft and non-tender, and the fetal head is usually high or malpresented. * **Vasa Previa:** Presents with painless vaginal bleeding occurring immediately after the **rupture of membranes**. The bleeding is fetal in origin, leading to rapid fetal distress/demise while maternal vitals remain stable. * **Rupture of Ectopic Pregnancy:** While it causes pain and bleeding, it typically occurs in the **first trimester** (usually before 12 weeks). A patient at 28 weeks is in the third trimester. **NEET-PG High-Yield Pearls:** * **Most common cause of DIC in pregnancy:** Abruptio Placentae. * **Couvelaire Uterus:** A complication of abruption where blood seeps into the uterine musculature, giving it a port-wine appearance. * **Management:** If the patient is unstable or there is fetal distress, immediate delivery (usually via Cesarean section) is indicated regardless of gestational age. * **Diagnosis:** Primarily clinical; ultrasound has low sensitivity for detecting retroplacental clots.

Q: Obesity in pregnancy causes all of the following complications except?

Precipitate labor. **Explanation:** Obesity in pregnancy (BMI >30 kg/m²) is associated with significant maternal and fetal morbidity. The correct answer is **Precipitate labor** because obesity is actually associated with **prolonged labor**, not rapid delivery. **1. Why Precipitate Labor is the Correct Answer:** Precipitate labor is defined as labor lasting less than 3 hours. In obese women, labor is typically slower, particularly in the first stage. This is attributed to increased soft tissue resistance in the birth canal and a higher incidence of **abnormal uterine action** (inefficient contractions), leading to a higher rate of induction and cesarean sections. **2. Why the other options are complications of obesity:** * **Abnormal uterine action:** Excess adipose tissue is thought to alter myometrial function and hormonal signaling (e.g., leptin and cholesterol levels), leading to poor uterine contractility and dystocia. * **Fetal neural tube defects (NTDs):** Obesity is a known independent risk factor for NTDs. This may be due to metabolic disturbances, undiagnosed hyperglycemia, or difficulties in achieving adequate folate levels. * **Venous thrombosis:** Pregnancy is a hypercoagulable state; obesity further increases venous stasis and inflammation, significantly raising the risk of Deep Vein Thrombosis (DVT) and Pulmonary Embolism. **Clinical Pearls for NEET-PG:** * **Shoulder Dystocia:** Obese women have a higher risk due to fetal macrosomia. * **Anesthesia risks:** Increased difficulty with regional anesthesia and "failed intubation" in general anesthesia. * **Postpartum Hemorrhage (PPH):** Higher risk due to uterine atony and trauma. * **Dosing:** Obese patients often require higher doses of prophylactic anticoagulants and folic acid (5mg/day).

Q: Which of the following is NOT a cause of hydramnios?

Posterior urethral valve. **Explanation:** The volume of amniotic fluid is a dynamic balance between production (primarily fetal urine) and removal (primarily fetal swallowing). **Hydramnios (Polyhydramnios)** occurs when there is either excessive production of urine or an inability of the fetus to swallow and absorb fluid. **Why Posterior Urethral Valve (PUV) is the correct answer:** PUV is a condition found in male fetuses where an obstructing membrane in the urethra prevents the bladder from emptying. This leads to **reduced fetal urine output** (oliguria/anuria). Since fetal urine is the primary source of amniotic fluid in the second and third trimesters, PUV results in **Oligohydramnios**, not hydramnios. **Analysis of Incorrect Options:** * **Anencephaly:** Causes hydramnios due to two mechanisms: the absence of the swallowing reflex and the transudation of fluid from the exposed meninges (cerebrospinal fluid) into the amniotic sac. * **Esophageal Atresia:** This creates a mechanical GI tract obstruction. The fetus is unable to swallow amniotic fluid, preventing its absorption by the intestines, leading to fluid accumulation. * **Twins:** Multiple gestations (especially Monochorionic) are associated with hydramnios, often due to Twin-to-Twin Transfusion Syndrome (TTTS), where the recipient twin develops polyuria. **High-Yield Clinical Pearls for NEET-PG:** * **Definition:** Amniotic Fluid Index (AFI) > 25 cm or Single Deepest Pocket (SDP) > 8 cm. * **Most common cause:** Idiopathic (approx. 50-60%), followed by Maternal Diabetes. * **Mnemonic for Oligohydramnios (DRIPPC):** **D**eath of fetus, **R**enal agenesis (Potter’s), **I**UGR, **P**rom (Premature Rupture of Membranes), **P**ost-term pregnancy, **C**hromosomal anomalies.

Q: During ultrasonography, fetal abdominal circumference is measured at the level of which structures?

Stomach and umbilical vein, perpendicular to the spine. **Explanation:** The **Abdominal Circumference (AC)** is the most sensitive ultrasound parameter for assessing fetal growth and detecting Intrauterine Growth Restriction (IUGR) or macrosomia, as it reflects the size of the liver and subcutaneous fat stores. **Why Option A is Correct:** To ensure accuracy and reproducibility, the AC must be measured at a specific transverse plane. The anatomical landmarks required are: 1. **The Stomach bubble:** Representing the left side. 2. **The Umbilical Vein (specifically the "J-shape" junction with the left portal vein):** This ensures the slice is not too low in the abdomen. 3. **The Spine:** The cross-section must be **perpendicular** to the spine to ensure a circular, rather than elliptical, measurement. **Why Other Options are Incorrect:** * **Option B (Kidneys):** The kidneys are located retroperitoneally and inferior to the ideal AC plane. Including them indicates the slice is too low, which would underestimate the circumference. * **Option C (Parallel to the spine):** A parallel (longitudinal) orientation would measure the length of the abdomen, not the circumference. * **Option D (Liver and Spleen):** While the liver occupies most of the AC plane, the spleen is not a standardized landmark for this measurement. **High-Yield Clinical Pearls for NEET-PG:** * **Formula:** $AC = 2\pi r$ (if circular) or $1.57 \times (D1 + D2)$ using the Hadlock method. * **IUGR:** AC is the first parameter to lag in **Asymmetrical IUGR** (Head-sparing effect). * **Technical Tip:** The umbilical vein should be seen within the liver, but it should **not** meet the anterior abdominal wall in the measurement plane. * **Accuracy:** AC has the largest reporting error among all fetal biometry parameters but is the best predictor of birth weight.

Q: Which of the following conditions is NOT associated with decreased variability of fetal heart rate?

Fetal movement. **Explanation:** Fetal heart rate (FHR) variability represents the beat-to-beat fluctuations in the baseline heart rate, reflecting a healthy, mature interaction between the sympathetic and parasympathetic nervous systems. **Why Fetal Movement is the Correct Answer:** Fetal movement is associated with **increased** variability and accelerations. When a fetus moves, the sympathetic nervous system is activated, causing a transient rise in heart rate (acceleration). This is a hallmark of fetal well-being and forms the basis of a "Reactive" Non-Stress Test (NST). Therefore, it is not a cause of decreased variability. **Analysis of Incorrect Options:** * **Sleep (Fetal Sleep Cycles):** This is the most common physiological cause of decreased variability. Fetal quiet sleep cycles usually last 20–40 minutes; during this time, the autonomic nervous system is less active, leading to a "flat" or minimally variable tracing. * **Chronic Hypoxia & Acidemia:** These are pathological causes. As the fetus becomes hypoxic or acidotic, the central nervous system (CNS) becomes depressed. This depression impairs the autonomic regulatory centers in the brainstem, leading to a loss of variability. Persistent absent variability combined with late decelerations is a sign of impending fetal compromise. **High-Yield Clinical Pearls for NEET-PG:** * **Normal Variability:** 6 to 25 beats per minute (Moderate). * **Drugs causing decreased variability:** Magnesium sulfate, opioids (morphine, pethidine), diazepam, and atropine. * **Saltatory Pattern:** Variability >25 bpm; often seen during acute hypoxia or umbilical cord compression. * **Sinusoidal Pattern:** A smooth, undulating wave-like pattern (variability is technically absent); classically associated with **severe fetal anemia** (Rh isoimmunization) or fetal hemorrhage.

Q: What is the drug of choice for hypertensive emergencies in pregnancy?

Labetalol. **Explanation:** In the management of hypertensive emergencies in pregnancy (defined as BP ≥160/110 mmHg), the goal is to rapidly lower blood pressure to prevent maternal complications like intracranial hemorrhage without compromising uteroplacental blood flow. **1. Why Labetalol is the Correct Answer:** Labetalol is a non-selective beta-blocker with alpha-1 blocking activity (ratio of 1:7 for IV). It is considered the **first-line drug of choice** because of its rapid onset of action (5–10 minutes), excellent safety profile, and its ability to lower BP without causing significant reflex tachycardia. It maintains stable placental perfusion, making it ideal for acute management. **2. Analysis of Incorrect Options:** * **Methyldopa (A):** While it is the drug of choice for *chronic* hypertension in pregnancy, it is **not** used in emergencies due to its slow onset of action (4–6 hours) and sedative side effects. * **Nitroprusside (B):** It is generally avoided in pregnancy due to the risk of **fetal cyanide toxicity**. It is reserved only for refractory cases where all other agents fail. * **Nicardipine (D):** A calcium channel blocker that is effective, but it is typically considered a second-line or alternative agent to Labetalol and Hydralazine. **High-Yield Clinical Pearls for NEET-PG:** * **First-line agents for Acute Hypertensive Crisis:** IV Labetalol, IV Hydralazine, or Oral Nifedipine (immediate release). * **Contraindication for Labetalol:** Avoid in patients with asthma, heart failure, or bradycardia. * **Target BP:** Aim to lower the MAP by no more than 25% in the first hour, targeting a diastolic BP of 90–100 mmHg. * **ACE Inhibitors/ARBs:** Absolutely contraindicated in pregnancy (Teratogenic; cause fetal renal dysgenesis and oligohydramnios).

Q: Rubin's diagnostic criteria is used for which of the following conditions?

Cervical pregnancy.. **Explanation:** **Rubin’s Criteria** are the established diagnostic benchmarks used to confirm a **Cervical Pregnancy**, a rare but life-threatening form of ectopic pregnancy where the blastocyst implants in the endocervical canal. **Why Cervical Pregnancy is Correct:** According to Rubin (1948), for a diagnosis of cervical pregnancy, the following four histological/anatomical criteria must be met: 1. Cervical glands must be opposite the placental attachment site. 2. The attachment of the placenta to the cervix must be intimate (below the internal os). 3. The whole or a portion of the placenta must be situated below the level of the internal os. 4. Fetal elements must be absent from the uterine cavity. **Analysis of Incorrect Options:** * **Ovarian Pregnancy:** Diagnosed using **Spiegelberg’s Criteria** (e.g., the tube on the affected side must be intact, the gestational sac must occupy the position of the ovary). * **Abdominal Pregnancy:** Diagnosed using **Studdiford’s Criteria** (e.g., normal tubes and ovaries with no evidence of recent pregnancy, no evidence of uteroperitoneal fistula). * **Hydatidiform Mole:** This is a gestational trophoblastic disease diagnosed via ultrasound ("snowstorm appearance") and serum beta-hCG levels, not by Rubin’s criteria. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Characterized by painless vaginal bleeding and a soft, "hourglass" shaped uterus (distended cervix larger than the fundus). * **Management:** Historically required hysterectomy due to profuse bleeding; currently managed conservatively with **Methotrexate** or uterine artery embolization. * **Key Distinction:** Do not confuse Rubin’s Criteria (Cervical Pregnancy) with the **Rubin Test** (Insufflation of fallopian tubes with $CO_2$ to check patency).

Q: During an antenatal check-up, a primigravida is found to be positive for Treponema pallidum infection. She is worried about her child. At which week of gestation does Treponema pallidum infection typically transfer to the fetus?

20th week. **Explanation:** The transmission of *Treponema pallidum* (the causative agent of Syphilis) from the mother to the fetus occurs via the placenta. While the spirochetes can technically cross the placenta as early as the 9th week of gestation, the **pathological effects and established infection typically occur after the 16th to 20th week.** The correct answer is **20th week** because, prior to this period, the fetus is protected by the **Langhans layer** (cytotrophoblast) of the chorion. After the 16th week, this layer begins to atrophy, and by the 20th week, it disappears, making the placenta more permeable to the spirochetes. Furthermore, the fetal immune system only becomes capable of mounting an inflammatory response (which causes the characteristic tissue damage of congenital syphilis) after the 18th–20th week. **Analysis of Incorrect Options:** * **A & B (4th and 8th week):** During the first trimester, the Langhans layer is thick and well-developed, acting as a robust physical barrier against the transmission of large organisms like spirochetes. * **C (16th week):** While the Langhans layer begins to thin at this stage, the most significant risk and the standard teaching for established clinical infection is the 20th week. **Clinical Pearls for NEET-PG:** * **Treatment:** Penicillin G is the only effective treatment for preventing fetal infection and treating the fetus. If the mother is allergic, **desensitization** is mandatory. * **Jarisch-Herxheimer Reaction:** Pregnant women treated for syphilis must be monitored for this reaction, as it can trigger preterm labor or fetal distress. * **Screening:** All pregnant women should be screened at the first prenatal visit using non-treponemal tests (VDRL/RPR). * **Congenital Syphilis:** If untreated, it can lead to abortion, stillbirth, or neonatal features like snuffles, Hutchinson’s teeth, and Mulberry molars.

Question 1

All are true about cancers during pregnancy, except:

Accepted Answer

Lymphoma is the most common cancer during pregnancy.

Answer

Cancer develops during approximately 1 in every 1000 pregnancies.

Answer

Of all cancers that occur in women, less than 1% are seen in pregnant ladies.

Answer

The four cancers most commonly developing during pregnancy are cervical cancer, breast cancer, melanoma, and lymphoma (usually Hodgkin's lymphoma).

Question 2

A patient presents at 28 weeks gestation with severe abdominal pain, bleeding, and hypertension. What is the most likely diagnosis?

Accepted Answer

Abruptio placentae

Answer

Placenta previa

Answer

Vasa previa

Answer

Rupture of ectopic pregnancy

Question 3

Obesity in pregnancy causes all of the following complications except?

Accepted Answer

Precipitate labor

Answer

Abnormal uterine action

Answer

Fetal neural tube defect

Answer

Venous thrombosis

Question 4

Which of the following is NOT a cause of hydramnios?

Accepted Answer

Posterior urethral valve

Answer

Anencephaly

Answer

Esophageal atresia

Answer

Twins

Question 5

A 33-year-old patient has an infection during pregnancy. Which of the following infections is a reactivation and therefore not a risk to the fetus?

Accepted Answer

Shingles

Answer

Group B coxsackievirus

Answer

Rubella virus

Answer

Toxoplasmosis

Question 6

During ultrasonography, fetal abdominal circumference is measured at the level of which structures?

Accepted Answer

Stomach and umbilical vein, perpendicular to the spine

Answer

Kidneys

Answer

Stomach, parallel to the spine

Answer

Liver and spleen

Question 7

Which of the following conditions is NOT associated with decreased variability of fetal heart rate?

Accepted Answer

Fetal movement

Answer

Chronic hypoxia

Answer

Sleep

Answer

Acidemia

Question 8

What is the drug of choice for hypertensive emergencies in pregnancy?

Accepted Answer

Labetalol

Answer

Methyldopa

Answer

Nitroprusside

Answer

Nicardipine

Question 9

Rubin's diagnostic criteria is used for which of the following conditions?

Accepted Answer

Cervical pregnancy.

Answer

Ovarian pregnancy.

Answer

Hydatiform mole.

Answer

Abdominal pregnancy.

Question 10

During an antenatal check-up, a primigravida is found to be positive for Treponema pallidum infection. She is worried about her child. At which week of gestation does Treponema pallidum infection typically transfer to the fetus?

Accepted Answer

20th week

Answer

4th week

Answer

8th week

Answer

16th week

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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