Maternal-Fetal Medicine Practice Questions

Q: Which of the following is seen in intrauterine fetal demise?

Disseminated intravascular coagulation (DIC). **Explanation:** Intrauterine Fetal Demise (IUFD) refers to fetal death occurring after 20 weeks of gestation but before birth. **Why B is Correct:** The primary complication associated with a retained dead fetus is **Disseminated Intravascular Coagulation (DIC)**. When a fetus dies and is retained in the uterus for more than 3–4 weeks, thromboplastin-like substances are released from the degenerating fetal tissues and placenta into the maternal circulation. This triggers the extrinsic coagulation pathway, leading to the consumption of clotting factors (especially fibrinogen) and platelets, ultimately resulting in a consumptive coagulopathy. **Why Incorrect Options are Wrong:** * **A. Hypertension:** IUFD does not cause hypertension. While Preeclampsia is a common *cause* of IUFD, the death of the fetus itself often leads to a decrease in blood pressure as the placental hormonal influence diminishes. * **C. Increase in fundal height:** In IUFD, the fundal height **decreases** or remains stationary. This is due to the cessation of fetal growth, the absorption of amniotic fluid (liquor), and the collapse of the fetal skull bones (Spalding’s sign). * **D. Increased uterine tone:** IUFD is typically associated with a "silent" or flaccid uterus. Increased uterine tone (hypertonicity) is more characteristic of Abruptio Placentae. **High-Yield Clinical Pearls for NEET-PG:** * **Spalding’s Sign:** Overlapping of fetal skull bones (seen on X-ray/USG 4–7 days after death). * **Robert’s Sign:** Appearance of gas in the fetal large vessels or heart (earliest radiological sign, seen within 12 hours). * **Investigation of Choice:** Ultrasound (demonstrates absence of fetal heart activity). * **Management:** If fibrinogen levels drop below 150 mg/dL, it indicates impending DIC, and the uterus must be evacuated immediately after stabilizing the patient.

Q: What is the single most sensitive marker of intrauterine growth restriction on ultrasonography?

Abdominal Circumference (AC). **Explanation:** **Abdominal Circumference (AC)** is the single most sensitive ultrasound parameter for diagnosing Intrauterine Growth Restriction (IUGR). The physiological basis lies in the fact that the fetal liver is the first organ to be affected by chronic placental insufficiency. IUGR leads to a depletion of fetal glycogen stores in the liver and a reduction in subcutaneous fat. Since the AC measurement primarily reflects the size of the liver and the thickness of the abdominal wall fat, it decreases significantly before other skeletal parameters are affected. **Analysis of Options:** * **Amniotic Fluid Index (AFI):** While oligohydramnios (low AFI) is a common association and a sign of fetal distress in IUGR, it is a non-specific marker and can occur due to various other causes (e.g., PROM, renal anomalies). * **Femur Length (FL) & Biparietal Diameter (BPD):** These are markers of skeletal growth. In "Asymmetrical IUGR" (the most common type), the fetus exhibits "brain-sparing," meaning the head and long bones continue to grow while the body remains small. Therefore, BPD and FL remain relatively preserved until the late stages of growth restriction. **Clinical Pearls for NEET-PG:** * **Most sensitive single parameter:** Abdominal Circumference (AC). * **Most sensitive ratio:** HC/AC ratio (Head Circumference/Abdominal Circumference). This ratio is elevated in asymmetrical IUGR. * **Earliest sign of IUGR on Doppler:** Increased resistance/pulsatility index in the **Umbilical Artery**. * **Gold Standard for Monitoring:** Umbilical Artery Doppler is the best tool for managing IUGR and deciding the timing of delivery.

Q: What is the most common association of renal failure in obstetrics?

Pregnancy-induced hypertension (PIH). **Explanation:** Acute Kidney Injury (AKI) in pregnancy is a serious complication, and **Pregnancy-Induced Hypertension (PIH)**, specifically pre-eclampsia and eclampsia, remains the most common cause of renal failure in the obstetric population. **1. Why PIH is the Correct Answer:** The pathophysiology of PIH involves widespread endothelial dysfunction and vasospasm. In the kidneys, this manifests as **Glomerular Endotheliosis** (swelling of endothelial cells and loss of capillary lumen), which leads to a decreased Glomerular Filtration Rate (GFR), proteinuria, and eventually, acute renal failure. While modern management has reduced its incidence, it still accounts for the majority of obstetric AKI cases globally. **2. Analysis of Incorrect Options:** * **Sepsis:** A significant cause of AKI, particularly in the first trimester (due to septic abortion) or postpartum (puerperal sepsis). However, statistically, it follows PIH in overall frequency. * **Abruptio Placentae:** This is the most common cause of **Acute Tubular Necrosis (ATN)** and **Bilateral Renal Cortical Necrosis** in pregnancy due to severe hypovolemia and DIC. While it is a "classic" cause of severe AKI, it is less frequent than PIH. * **HELLP Syndrome:** While HELLP is a severe variant of PIH and frequently involves renal impairment, it is a subset of the broader category of hypertensive disorders of pregnancy. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of AKI in 1st trimester:** Septic abortion. * **Most common cause of AKI in 3rd trimester:** PIH (Pre-eclampsia/Eclampsia). * **Renal Cortical Necrosis:** Classically associated with Abruptio Placentae; it often leads to permanent renal failure. * **Glomerular Endotheliosis:** The pathognomonic renal lesion of pre-eclampsia.

Q: A pregnant woman is found to have excessive accumulation of amniotic fluid. Polyhydramnios is likely to be associated with all of the following conditions, except:

Bilateral renal agenesis. **Explanation:** The volume of amniotic fluid is a dynamic balance between production (primarily fetal urine) and clearance (primarily fetal swallowing). **Polyhydramnios** occurs when there is either excessive production or impaired clearance of fluid. **Why Bilateral Renal Agenesis is the Correct Answer:** In **Bilateral Renal Agenesis** (Potter’s Syndrome), the fetal kidneys fail to develop. Since fetal urine is the primary source of amniotic fluid from the second trimester onwards, its absence leads to **Oligohydramnios** (deficiency of fluid), not polyhydramnios. This is a classic "except" question where the condition leads to the exact opposite pathology. **Analysis of Incorrect Options:** * **Twin Pregnancy:** Polyhydramnios can occur due to increased fetal surface area or, more specifically, in **Twin-to-Twin Transfusion Syndrome (TTTS)**, where the recipient twin develops polyuria and subsequent polyhydramnios. * **Anencephaly:** This neural tube defect causes polyhydramnios via two mechanisms: (1) failure of the fetal swallowing reflex and (2) transudation of fluid from the exposed meninges into the amniotic sac. * **Esophageal Atresia:** This creates a mechanical obstruction in the fetal gastrointestinal tract, preventing the fetus from swallowing and absorbing amniotic fluid, leading to accumulation. **High-Yield Clinical Pearls for NEET-PG:** * **Definition:** Polyhydramnios is defined as an Amniotic Fluid Index (AFI) **> 25 cm** or a Single Deepest Pocket (SDP) **> 8 cm**. * **Maternal Cause:** The most common maternal cause of polyhydramnios is **Maternal Diabetes Mellitus** (due to fetal osmotic diuresis). * **Potter Sequence:** Bilateral renal agenesis → Oligohydramnios → Pulmonary hypoplasia, limb deformities, and flattened facies.

Q: Which of the following is the drug of choice in pregnancy-induced hypertension?

Methyldopa. **Explanation:** **Alpha-methyldopa** is considered the traditional drug of choice for the management of chronic hypertension and pregnancy-induced hypertension (PIH). It is a centrally acting alpha-2 adrenergic agonist that reduces sympathetic outflow. Its preference in pregnancy stems from its long-standing safety profile, lack of teratogenicity, and the fact that it does not compromise uteroplacental blood flow. **Analysis of Options:** * **B. Diltiazem:** This is a calcium channel blocker (CCB). While certain CCBs like Nifedipine are commonly used in pregnancy, Diltiazem is not a first-line agent for PIH due to less clinical data compared to Methyldopa or Labetalol. * **C. Metoprolol:** While beta-blockers can be used, Metoprolol is generally avoided in the first trimester due to risks of fetal bradycardia and potential growth restriction (IUGR). **Labetalol** (a combined alpha/beta-blocker) is the preferred beta-blocker in pregnancy. * **D. Enalapril:** ACE inhibitors and ARBs are **strictly contraindicated** in pregnancy (Category X). They are associated with fetal renal dysgenesis, oligohydramnios, and skull hypoplasia. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (Chronic/Long-term):** Methyldopa. * **Drug of Choice (Acute Hypertensive Crisis/Emergency):** Intravenous **Labetalol** (fastest acting) or Hydralazine. * **Oral Labetalol** is increasingly replacing Methyldopa in modern guidelines due to a faster onset and fewer side effects (like sedation/depression). * **Prophylaxis:** Low-dose Aspirin (75–150 mg) is started before 16 weeks for women at high risk of preeclampsia. * **Magnesium Sulfate ($MgSO_4$):** The drug of choice for seizure prophylaxis and control in Eclampsia.

Q: On TVS, which of the following shapes of the cervix indicates preterm labor?

U shape. **Explanation:** The assessment of cervical morphology via Transvaginal Sonography (TVS) is a critical predictor of preterm labor. The process of cervical effacement occurs through a predictable sequence of structural changes known by the mnemonic **"TRUST"** (T → Y → V → U). 1. **Correct Answer (C):** The **U shape** represents the final stage of cervical funneling. In this stage, the internal os has opened significantly, and the cervical canal has shortened drastically, leaving only a small portion of the distal cervix closed. This indicates advanced cervical ripening and carries the highest risk for imminent preterm delivery. 2. **Incorrect Options:** * **T shape (A):** This is the normal appearance of a closed, long cervix. The internal os is flat, indicating no funneling and a low risk of preterm labor. * **Y shape (B):** This represents the earliest stage of funneling, where the internal os begins to open slightly while the rest of the canal remains closed. * **V shape:** (Though not an option, it follows 'Y') This indicates deeper funneling toward the external os. * **O shape (D):** This is not a standard sonographic term used to describe the progression of cervical funneling in the context of preterm labor. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** TVS is superior to transabdominal ultrasound for measuring cervical length. * **Critical Cut-off:** A cervical length of ** 5 mm. * **Management:** If a short cervix is detected early, interventions include vaginal progesterone or cervical cerclage (e.g., McDonald or Shirodkar technique).

Q: Which of the following risk factors is most commonly associated with chorioamnionitis?

Prolonged rupture of membranes. **Explanation:** **Chorioamnionitis** (intra-amniotic infection) is an inflammation of the fetal membranes and amniotic fluid, typically caused by an ascending polymicrobial infection from the vaginal flora. **Why Option D is Correct:** **Prolonged rupture of membranes (PROM)** is the single most significant risk factor for chorioamnionitis. Once the protective physical barrier of the amniotic sac is breached, the sterile intrauterine environment is exposed to vaginal pathogens (e.g., *E. coli*, Group B Streptococcus). The risk increases linearly with the **duration of the latent period** (the time between rupture and delivery), especially if it exceeds 18–24 hours. Frequent digital vaginal examinations after ROM further exacerbate this risk by manually introducing bacteria into the cervical canal. **Why Other Options are Incorrect:** * **A & B (Maternal drug abuse/Poor hygiene):** While these may be associated with poor prenatal care or increased risk of STIs, they are not direct or primary independent risk factors for the development of chorioamnionitis. * **C (Prior cesarean delivery):** This is a risk factor for uterine rupture or placenta accreta spectrum in subsequent pregnancies, but it does not predispose a patient to intra-amniotic infection. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Diagnosis (Gibbs’ Criteria):** Maternal fever (>39.0°C or 102.2°F) PLUS at least two of: Maternal tachycardia, Fetal tachycardia (>160 bpm), Uterine tenderness, or Foul-smelling liquor. * **Management:** Prompt initiation of broad-spectrum IV antibiotics (Ampicillin + Gentamicin) and **expedited delivery** (regardless of gestational age). Chorioamnionitis is *not* a contraindication to vaginal delivery. * **Gold Standard Diagnosis:** Histopathological examination of the placenta and membranes after delivery.

Q: Which of the following is not a predisposing factor for Preeclampsia?

Smoking. **Explanation:** Preeclampsia is a multisystem disorder characterized by new-onset hypertension and proteinuria after 20 weeks of gestation. Understanding its risk factors is crucial for NEET-PG. **Why Smoking is the Correct Answer:** Counter-intuitively, **smoking is a protective factor** against preeclampsia (reducing risk by approximately 30-50%). The underlying medical concept involves the stimulation of placental growth factor (PlGF) and the inhibition of soluble fms-like tyrosine kinase-1 (sFlt-1) by carbon monoxide and nicotine. This helps maintain a pro-angiogenic balance, preventing the endothelial dysfunction typical of preeclampsia. **Analysis of Incorrect Options:** * **Anti-phospholipid antibody (APLA):** This is a major risk factor. APLA syndrome causes placental thrombosis and impaired trophoblastic invasion, leading to placental ischemia and early-onset preeclampsia. * **Gestational Diabetes (GDM):** Hyperinsulinemia and insulin resistance are associated with systemic inflammation and endothelial damage, significantly increasing the risk of hypertensive disorders. * **Molar Pregnancy:** This is a classic "high-yield" risk factor. The excessive trophoblastic proliferation leads to the release of anti-angiogenic factors. Notably, preeclampsia occurring **before 20 weeks** should always raise suspicion of a hydatidiform mole. **Clinical Pearls for NEET-PG:** * **Highest Risk Factor:** A prior history of preeclampsia is the strongest predictor. * **Nulliparity:** Often called the "disease of theories," it is most common in first pregnancies. * **Protective Factors:** Smoking and previous term delivery with a different partner (though the latter is debated). * **Prophylaxis:** Low-dose Aspirin (75–150 mg) started before 16 weeks is recommended for high-risk patients.

Question 1

Which of the following is seen in intrauterine fetal demise?

Accepted Answer

Disseminated intravascular coagulation (DIC)

Answer

Hypertension

Answer

Increase in fundal height of uterus

Answer

Increased uterine tone

Question 2

What is the single most sensitive marker of intrauterine growth restriction on ultrasonography?

Accepted Answer

Abdominal Circumference (AC)

Answer

Amniotic Fluid Index (AFI)

Answer

Femur Length (FL)

Answer

Biparietal Diameter (BPD)

Question 3

In multiple pregnancy, fetal reduction is typically performed using which of the following agents?

Accepted Answer

Potassium chloride (KCl)

Answer

Mifepristone

Answer

Prostaglandin F2-alpha (PGF2-alpha)

Answer

Methotrexate

Question 4

Which of the following Doppler findings in Intrauterine Growth Restriction (IUGR) is associated with the worst prognosis?

Accepted Answer

Reversal of diastolic flow

Answer

Dicrotic notch

Answer

Absence of diastolic flow

Answer

Absence of systolic flow

Question 5

What is the most common association of renal failure in obstetrics?

Accepted Answer

Pregnancy-induced hypertension (PIH)

Answer

Sepsis

Answer

Abruptio placentae

Answer

HELLP syndrome

Question 6

A pregnant woman is found to have excessive accumulation of amniotic fluid. Polyhydramnios is likely to be associated with all of the following conditions, except:

Accepted Answer

Bilateral renal agenesis

Answer

Twin pregnancy

Answer

Anencephaly

Answer

Esophageal atresia

Question 7

Which of the following is the drug of choice in pregnancy-induced hypertension?

Accepted Answer

Methyldopa

Answer

Diltiazem

Answer

Metoprolol

Answer

Enalapril

Question 8

On TVS, which of the following shapes of the cervix indicates preterm labor?

Accepted Answer

U shape

Answer

T shape

Answer

Y shape

Answer

O shape

Question 9

Which of the following risk factors is most commonly associated with chorioamnionitis?

Accepted Answer

Prolonged rupture of membranes

Answer

Maternal drug abuse

Answer

Poor maternal hygiene

Answer

Prior cesarean delivery

Question 10

Which of the following is not a predisposing factor for Preeclampsia?

Accepted Answer

Smoking

Answer

Anti-phospholipid antibody

Answer

Gestational diabetes

Answer

Molar pregnancy

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?