Maternal-Fetal Medicine Practice Questions

Q: Which of the following is true about the amnion, except:

It has a rich blood supply.. The amnion is the innermost fetal membrane, characterized by its tough, thin, and transparent nature. Understanding its histology and function is high-yield for NEET-PG. ### **Explanation of the Correct Answer** **Option B (It has a rich blood supply)** is the correct answer because it is a **false statement**. The amnion is entirely **avascular**. It contains no blood vessels, lymphatics, or nerves. It derives its nutrition and oxygen primarily via diffusion from the amniotic fluid and the underlying vascularized decidua/chorion. ### **Analysis of Other Options** * **Option A (No lymph supply):** This is a true statement. As an avascular structure, it lacks a lymphatic drainage system. * **Option C (No nerve supply):** This is a true statement. The lack of nerve supply explains why procedures like amniocentesis do not cause pain when the needle pierces the amniotic sac (the pain felt is from the maternal abdominal wall and uterus). * **Option D (Dilates the cervix):** This is a true statement. During the first stage of labor, the intact "bag of waters" (amnion and chorion) acts as a hydrostatic wedge. According to **Pascal’s Law**, it transmits intrauterine pressure evenly to the cervix, aiding in effacement and dilatation. ### **High-Yield Clinical Pearls for NEET-PG** * **Structure:** The amnion consists of five layers, the innermost being a single layer of cuboidal/columnar epithelium. * **Tensile Strength:** The amnion provides the majority of the tensile strength of the fetal membranes, largely due to its **Type IV and V collagen** content. * **Amniotic Fluid Production:** Early in pregnancy, the amnion contributes to amniotic fluid production via active transport of solutes. * **Clinical Correlation:** Rupture of membranes (ROM) leads to the loss of the hydrostatic wedge, often resulting in a change in the mechanics of labor.

Q: Which of the following antibodies is NOT typically involved in Rh isoimmunization?

Anti-Lewis. **Explanation:** Rh isoimmunization occurs when maternal antibodies cross the placenta and target fetal red blood cell antigens, leading to Hemolytic Disease of the Fetus and Newborn (HDFN). **Why Anti-Lewis is the correct answer:** The Lewis antigens (Le^a and Le^b) are not integral to the red cell membrane; they are plasma glycosphingolipids adsorbed onto the RBC surface. Most importantly, **Anti-Lewis antibodies are typically IgM.** Since IgM antibodies are large pentamers, they **cannot cross the placenta**. Furthermore, Lewis antigens are poorly expressed on fetal erythrocytes. Consequently, Anti-Lewis antibodies do not cause HDFN and are clinically insignificant in Rh isoimmunization. **Analysis of incorrect options:** * **Anti-D (Option D):** This is the most common and clinically significant antibody involved in Rh isoimmunization, occurring in Rh-negative mothers carrying Rh-positive fetuses. * **Anti-C and Anti-E (Options A & B):** These belong to the Rh blood group system (C, c, E, e). While less common than Anti-D, these are **IgG antibodies** that can cross the placenta and cause significant fetal hemolysis. **Clinical Pearls for NEET-PG:** * **"Lewis Lives" (mnemonic):** Lewis antibodies do not "kill" the fetus because they don't cross the placenta. * **Kell Antibodies:** "Kell Kills." Anti-Kell is the second most common cause of severe HDFN; it causes hemolysis AND suppresses fetal erythropoiesis. * **Antibody Titers:** For Anti-D, a critical titer (usually 1:16) indicates a high risk for fetal hydrops and necessitates further fetal surveillance (e.g., MCA-PSV doppler).

Q: What is the drug of choice for the prevention of seizures in a patient with severe pre-eclampsia?

Magnesium sulphate. **Explanation:** **Magnesium Sulphate (MgSO₄)** is the gold standard and drug of choice for both the **prevention (prophylaxis)** of seizures in severe pre-eclampsia and the **control** of seizures in eclampsia. Its superiority was established by the landmark **MAGPIE trial**, which demonstrated that MgSO₄ reduces the risk of eclampsia by more than 50% compared to placebo. It acts primarily by decreasing acetylcholine release at the neuromuscular junction and causing cerebral vasodilation, thereby lowering cerebral ischemia. **Analysis of Incorrect Options:** * **A. Phenytoin:** While an effective antiepileptic, it is less effective than MgSO₄ in preventing eclamptic seizures and carries a higher risk of maternal toxicity and fetal side effects. * **C. Diazepam:** Formerly used for seizure control, the **Collaborative Eclampsia Trial** proved it is inferior to MgSO₄, as it is associated with higher rates of recurrent seizures and maternal respiratory depression. * **D. Nifedipine:** This is a Calcium Channel Blocker used as an **antihypertensive** to manage blood pressure in pre-eclampsia, but it has no intrinsic anticonvulsant properties. **High-Yield Clinical Pearls for NEET-PG:** * **Regimen:** The **Pritchard Regimen** (IM) and **Zuspan Regimen** (IV) are the standard protocols. * **Therapeutic Window:** 4–7 mEq/L. * **Toxicity Monitoring:** Always check for the presence of **Knee jerk** (lost at 8-10 mEq/L), **Respiratory rate** (>12/min), and **Urine output** (>30ml/hr). * **Antidote:** 10 ml of 10% **Calcium Gluconate** IV (administered over 10 minutes).

Q: Which of the following drugs is effective in preventing the vertical transmission of HIV from an infected pregnant mother to her child?

Zidovudine. **Explanation:** The prevention of parent-to-child transmission (PPTCT) of HIV is a critical aspect of maternal-fetal medicine. **Why Zidovudine (AZT) is the correct answer:** Zidovudine, a Nucleoside Reverse Transcriptase Inhibitor (NRTI), was the first drug proven to significantly reduce vertical transmission. According to the landmark **PACTG 076 trial**, a regimen of oral zidovudine during pregnancy, intravenous zidovudine during labor, and oral syrup for the newborn reduced transmission risk by nearly 70%. It remains the "gold standard" component for prophylaxis because it crosses the placenta efficiently and provides pre-exposure prophylaxis to the fetus. **Analysis of other options:** * **Lamivudine (3TC) and Didanosine (ddI):** While these are also NRTIs used in Highly Active Antiretroviral Therapy (HAART) to treat the mother’s infection, they are not typically used as *monotherapy* for the specific purpose of preventing vertical transmission. In modern protocols, they are used in combination with other drugs (like Tenofovir and Efavirenz) to achieve viral suppression, but Zidovudine is the classic answer for the specific drug historically validated for transmission prevention. **High-Yield Clinical Pearls for NEET-PG:** * **WHO/NACO Guidelines:** The current recommendation for all pregnant women with HIV is **Lifelong ART** (Triple drug regimen), regardless of CD4 count. The preferred regimen is **TLE** (Tenofovir + Lamivudine + Efavirenz) or **TLD** (Tenofovir + Lamivudine + Dolutegravir). * **Mode of Delivery:** Elective Cesarean Section (at 38 weeks) is recommended if the viral load is >1000 copies/mL near term. * **Infant Prophylaxis:** Infants born to HIV-positive mothers should receive **Nevirapine** (or Zidovudine) syrup for 6–12 weeks. * **Breastfeeding:** In India, exclusive breastfeeding for 6 months is recommended unless replacement feeding is AFASS (Affordable, Feasible, Acceptable, Sustainable, and Safe).

Q: Modified Biophysical Profile (BPP) consists of which of the following components?

Non-stress test (NST) with amniotic fluid index (AFI). The **Modified Biophysical Profile (mBPP)** is a simplified, efficient method of fetal surveillance used to assess fetal well-being in high-risk pregnancies. It combines two specific parameters that reflect both acute and chronic fetal oxygenation. ### **Explanation of the Correct Answer** * **Non-stress Test (NST):** This serves as an indicator of **acute fetal acid-base status**. A reactive NST suggests a functioning fetal central nervous system and the absence of immediate hypoxia. * **Amniotic Fluid Index (AFI):** This serves as an indicator of **chronic placental function**. Since fetal urine output is the primary source of amniotic fluid, a normal AFI (typically >5 cm) suggests adequate long-term placental perfusion. The mBPP is considered "normal" if the NST is reactive and the AFI is >5 cm. It is preferred in busy clinical settings because it is less time-consuming than a full BPP while maintaining a high negative predictive value. ### **Why Other Options are Incorrect** * **Options B, C, and D:** Fetal breathing movements, fetal movements, and fetal tone are components of the **Manning’s Full Biophysical Profile (BPP)**, which includes five parameters (NST + 4 ultrasound components). In a **Modified** BPP, these specific ultrasound markers are bypassed in favor of the AFI alone to represent long-term status. ### **NEET-PG High-Yield Pearls** * **Full BPP Components:** Tone, Movement, Breathing, NST, and Amniotic Fluid (Mnemonic: **"BATMAN"** - Breathing, Amniotic fluid, Tone, Movement, And Nst). * **First sign lost in hypoxia:** Fetal breathing movements (most sensitive). * **Last sign lost in hypoxia:** Fetal tone (indicates severe acidosis). * **AFI vs. SDP:** In a full BPP, the Single Deepest Pocket (SDP) >2 cm is often used; in mBPP, the AFI is the standard measurement.

Q: What is the most common cause of fetal ventriculomegaly?

Aqueductal stenosis. **Explanation:** **Ventriculomegaly** is defined as an atrial width of the lateral ventricles ≥10 mm. It is a common prenatal ultrasound finding that necessitates a thorough evaluation of the fetal neuroanatomy. **Why Aqueductal Stenosis is the Correct Answer:** **Aqueductal stenosis** is the most common cause of congenital obstructive (non-communicating) hydrocephalus, accounting for approximately **33–43% of cases**. It involves a narrowing or obstruction of the Aqueduct of Sylvius, which connects the third and fourth ventricles. This leads to a characteristic "upstream" dilation of the lateral and third ventricles, while the fourth ventricle remains normal in size. **Analysis of Incorrect Options:** * **Arnold-Chiari Malformation II:** This is a common cause of ventriculomegaly, but it is almost always associated with **neural tube defects** (specifically myelomeningocele). While high-yield, it is statistically less frequent as a primary cause compared to isolated aqueductal stenosis. * **Arnold-Chiari Malformation I:** This involves downward displacement of the cerebellar tonsils. It is rarely diagnosed prenatally and is generally not a common cause of fetal ventriculomegaly. * **Dandy-Walker Malformation:** This involves agenesis/hypoplasia of the cerebellar vermis and cystic dilation of the **fourth ventricle**. While it causes hydrocephalus, it is less common than aqueductal stenosis. **NEET-PG High-Yield Pearls:** * **Normal Atrial Width:** 15 mm is severe/frank hydrocephalus). * **The "Dangling Choroid" Sign:** A classic sonographic feature where the choroid plexus falls toward the dependent wall of the dilated lateral ventricle. * **X-linked Hydrocephalus:** The most common heritable form of aqueductal stenosis (HSAS), associated with the *L1CAM* gene mutation and characterized by "thumb adduction."

Q: Which of the following is classified as a high-risk pregnancy?

All the above. **Explanation:** A high-risk pregnancy is one where the mother, the fetus, or the newborn is at an increased risk of adverse health outcomes due to pre-existing conditions or complications arising during pregnancy. **Why "All the above" is correct:** 1. **Elderly Primigravida (Option A):** Defined as a woman over **35 years** of age pregnant for the first time. These pregnancies are high-risk due to an increased incidence of chromosomal abnormalities (e.g., Down Syndrome), gestational diabetes, pre-eclampsia, and a higher likelihood of operative interventions (Cesarean section). 2. **History of Eclampsia (Option B):** A previous history of eclampsia or severe pre-eclampsia significantly increases the risk of recurrence in subsequent pregnancies. It necessitates close monitoring for hypertension, proteinuria, and placental insufficiency (IUGR). 3. **Molar Pregnancy (Option C):** Gestational Trophoblastic Disease (GTD) is inherently high-risk. It carries risks of severe hemorrhage, hyperemesis gravidarum, early-onset pre-eclampsia, and the potential for malignant transformation into choriocarcinoma. **Clinical Pearls for NEET-PG:** * **Definition of Elderly Primigravida:** Age >35 years. Conversely, a **"Teenage Pregnancy"** (<19 years) is also classified as high-risk due to risks of anemia, CPD, and pre-eclampsia. * **Grand Multipara:** A woman who has had 5 or more previous deliveries is high-risk due to risks of malpresentation, postpartum hemorrhage (PPH), and placenta previa. * **Short Stature:** A primigravida with a height **<140-145 cm** is at high risk for Cephalopelvic Disproportion (CPD). * **Medical Comorbidities:** Any pregnancy complicated by Heart Disease (the most common non-obstetric cause of maternal death), Diabetes, or Anemia (Hb <7g/dL) is automatically high-risk.

Question 1

Which of the following is true about the amnion, except:

Accepted Answer

It has a rich blood supply.

Answer

It has no lymph supply.

Answer

It has no nerve supply.

Answer

It dilates the cervix during labor.

Question 2

In a case of antepartum hemorrhage with BP = 80/60 mmHg, what is the treatment of choice?

Accepted Answer

Blood transfusion

Answer

Morphine

Answer

Placentography

Answer

Panhysterectomy

Question 3

Which of the following antibodies is NOT typically involved in Rh isoimmunization?

Accepted Answer

Anti-Lewis

Answer

Anti C

Answer

Anti E

Answer

Anti D

Question 4

What is the drug of choice for the prevention of seizures in a patient with severe pre-eclampsia?

Accepted Answer

Magnesium sulphate

Answer

Phenytoin

Answer

Diazepam

Answer

Nifedipine

Question 5

Which of the following drugs is effective in preventing the vertical transmission of HIV from an infected pregnant mother to her child?

Accepted Answer

Zidovudine

Answer

Lamivudine

Answer

Didanosine

Answer

All of the above

Question 6

Which of the following types of hepatitis carries the worst prognosis in pregnancy?

Accepted Answer

Hepatitis E

Answer

Hepatitis A

Answer

Hepatitis B

Answer

Hepatitis C

Question 7

Modified Biophysical Profile (BPP) consists of which of the following components?

Accepted Answer

Non-stress test (NST) with amniotic fluid index (AFI)

Answer

Non-stress test (NST) with fetal breathing movements

Answer

Non-stress test (NST) with fetal movements

Answer

Non-stress test (NST) with fetal tone

Question 8

What is the most common cause of fetal ventriculomegaly?

Accepted Answer

Aqueductal stenosis

Answer

Arnold Chiari malformation I

Answer

Arnold Chiari malformation II

Answer

Dandy-Walker malformation

Question 9

Which is the most sensitive screening test for congenital malformations in diabetic mothers?

Accepted Answer

Glycosylated hemoglobin (HbA1C)

Answer

Maternal serum alpha-fetoprotein (MS AFP)

Answer

Blood glucose

Answer

Amniotic fluid alpha-fetoprotein (AFP)

Question 10

Which of the following is classified as a high-risk pregnancy?

Accepted Answer

All the above

Answer

Elderly primigravida

Answer

History of eclampsia

Answer

Molar pregnancy

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?