Maternal-Fetal Medicine Practice Questions

Q: All of the following is true about abruptio placentae except?

Bright red blood. **Explanation:** Abruptio placentae refers to the premature separation of a normally situated placenta from the uterine wall before the birth of the fetus. **Why Option B is the correct answer (False statement):** In abruptio placentae, the bleeding is typically **dark-colored (non-clotting)** because it is often retroplacental and undergoes changes before escaping through the cervix. In contrast, **bright red, painless bleeding** is the hallmark of **Placenta Previa**. Abruptio is usually associated with severe abdominal pain and uterine tenderness. **Analysis of other options:** * **Option A:** This is the standard definition of abruption. Unlike placenta previa (where the placenta is low-lying), abruption involves a placenta in the normal upper segment. * **Option C:** Recurrence is a significant risk factor. After one episode of abruption, the risk of recurrence in a subsequent pregnancy is approximately **5–15%**, and it rises to 25% after two episodes. * **Option D:** Abruption is statistically more common in **multigravida** women. Other major risk factors include pregnancy-induced hypertension (most common cause), trauma, smoking, and cocaine use. **NEET-PG High-Yield Pearls:** * **Couvelaire Uterus:** A complication of severe abruption where blood extravasates into the myometrium, giving it a port-wine/purplish appearance. * **Most common cause of DIC in pregnancy:** Abruptio placentae (due to release of thromboplastin). * **Clinical Triad:** Abdominal pain, vaginal bleeding (may be concealed), and uterine hypertonicity/tenderness. * **Management:** If the fetus is alive and at term, or if there is maternal instability, immediate delivery (usually via LSCS) is indicated.

Q: Which parameter on umbilical artery Doppler indicates imminent fetal demise?

Reversal of flow. **Explanation:** The umbilical artery Doppler is a critical tool for assessing placental vascular resistance and fetal well-being in cases of Fetal Growth Restriction (FGR). **1. Why "Reversal of Flow" is correct:** As placental insufficiency worsens, the resistance in the umbilical artery increases. Eventually, the pressure in the fetal systemic circulation becomes lower than the pressure in the placenta during diastole. This causes blood to flow backward toward the fetal heart (**Reversed End-Diastolic Velocity - REDV**). This represents extreme placental compromise (usually >70% of the placental bed is non-functional) and is a pre-terminal sign indicating **imminent fetal demise** or severe acidemia. Delivery is usually indicated urgently if the fetus is viable. **2. Analysis of Incorrect Options:** * **Increased S/D ratio:** This is the earliest sign of increased placental resistance. While it indicates placental insufficiency, it is not an immediate marker of fetal death. * **Absent diastolic flow (AEDV):** This occurs when resistance is high enough that flow stops during diastole. It is a serious sign and precedes reversal, but the risk of immediate demise is significantly higher once the flow reverses. * **Normal S/D ratio:** This indicates healthy placental perfusion and low resistance, which is the expected finding in a normal pregnancy. **3. High-Yield Clinical Pearls for NEET-PG:** * **Sequence of Deterioration:** Increased S/D ratio → Absent End Diastolic Velocity (AEDV) → Reversed End Diastolic Velocity (REDV). * **Ductus Venosus:** If REDV is noted in the umbilical artery, the next step is often checking the Ductus Venosus. **Reversal of the 'a' wave** in the Ductus Venosus is the most definitive predictor of imminent fetal heart failure. * **Management:** AEDV usually warrants delivery by 34 weeks; REDV usually warrants delivery by 32 weeks (after steroid cover).

Q: Betamethasone in pregnancy is given to prevent which of the following complications?

Respiratory distress syndrome. **Explanation:** **Betamethasone** is a corticosteroid administered to pregnant women at risk of preterm delivery (between 24 and 34 weeks of gestation) to accelerate fetal lung maturity. **Why Respiratory Distress Syndrome (RDS) is the correct answer:** The primary mechanism of Betamethasone is the induction of **Type II pneumocytes** in the fetal lungs. This stimulation increases the production and release of **surfactant**, which reduces alveolar surface tension. Adequate surfactant prevents alveolar collapse upon expiration, thereby significantly reducing the incidence and severity of RDS, intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). **Analysis of Incorrect Options:** * **A. Prematurity:** Betamethasone does not prevent preterm labor or birth; it only improves the neonatal outcomes associated with being born early. Tocolytics are used to delay prematurity. * **B. Neonatal convulsions:** These are typically caused by metabolic disturbances (hypoglycemia/hypocalcemia) or birth asphyxia, not steroid deficiency. * **C. Cerebral palsy:** While steroids reduce IVH (a risk factor for CP), they are not the primary preventive agent. **Magnesium sulfate** is the drug of choice for neuroprotection to reduce the risk of cerebral palsy in imminent preterm births. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Dose:** 12 mg intramuscularly, 2 doses, 24 hours apart. * **Drug of Choice:** Betamethasone is preferred over Dexamethasone because it has a longer half-life and is associated with a lower risk of periventricular leukomalacia. * **Time to Benefit:** Maximum benefit occurs 24 hours after the first dose and lasts for up to 7 days. * **Indication:** All women between **24–34 weeks** at risk of delivery within 7 days. (Recent guidelines extend this to 36 weeks 6 days in specific "late preterm" scenarios).

Q: A 30-year-old primigravida complains of vaginal bleeding, pain in the abdomen, and vomiting. The uterus is enlarged, soft, and non-tender. Based on the ultrasound findings, what is the most likely diagnosis?

Hydatidiform mole. ***Hydatidiform mole*** - Classic presentation of **vaginal bleeding**, **hyperemesis gravidarum** (severe vomiting), and **enlarged soft uterus** in a primigravida strongly suggests molar pregnancy. - Ultrasound shows characteristic **"snowstorm" appearance** with grape-like vesicular pattern and absence of fetal structures. *Missed abortion* - Features **retained dead fetus** with **closed cervix** and **absence of cardiac activity** on ultrasound, not the snowstorm pattern. - Typically presents with **minimal bleeding** and **cramping pain**, with uterus smaller than expected for gestational age. *Blighted ovum* - Shows **empty gestational sac** without embryonic structures on ultrasound, lacking the vesicular pattern of molar pregnancy. - Usually presents with **mild bleeding** and **cramping**, without the severe vomiting seen in this case. *Ectopic pregnancy* - Occurs when pregnancy implants **outside the uterine cavity**, most commonly in **fallopian tubes**. - Presents with **severe unilateral pain**, **amenorrhea**, and potential **hemodynamic instability**, not an enlarged soft uterus.

Q: Maximum cardiac output during pregnancy is typically observed at which gestational age?

34 weeks. **Explanation:** The correct answer is **34 weeks**. During pregnancy, the maternal cardiovascular system undergoes significant physiological adaptations to meet the metabolic demands of the fetus. Cardiac output (CO) begins to increase as early as 5 weeks gestation, primarily due to an increase in stroke volume and later, an increase in heart rate. **Why 34 weeks is correct:** Cardiac output increases progressively throughout the first and second trimesters, reaching its peak (approximately 30–50% above pre-pregnancy levels) between **32 and 34 weeks** of gestation. After this point, it typically plateaus until the onset of labor. **Analysis of Incorrect Options:** * **A (20 weeks):** While CO is significantly elevated by this stage, it has not yet reached its maximum plateau. * **B (30 weeks):** This is close to the peak, but the maximum physiological rise is traditionally cited at the 34-week mark. * **D (36 weeks):** By 36 weeks, the CO has usually plateaued or may even appear slightly decreased in the supine position due to **aortocaval compression** by the gravid uterus, which reduces venous return. **High-Yield Clinical Pearls for NEET-PG:** * **Maximum CO overall:** The absolute peak of cardiac output occurs **immediately postpartum** (up to 60–80% increase) due to the "autotransfusion" of blood from the involuting uterus and the relief of caval compression. * **Labor:** CO increases by an additional 15% in the first stage and 50% in the second stage of labor. * **Clinical Significance:** Patients with underlying heart disease (e.g., Mitral Stenosis) are at the highest risk of heart failure at **32–34 weeks** and during the **immediate postpartum period**.

Q: A woman presents with amenorrhea of 6 weeks duration and a lump in the right iliac fossa. What is the investigation of choice?

Ultrasound (USG) abdomen. **Explanation:** The clinical presentation of **amenorrhea** followed by a **palpable mass in the iliac fossa** is a classic "red flag" for an **Ectopic Pregnancy** until proven otherwise. Other differentials include a corpus luteum cyst or a tubo-ovarian mass. **1. Why Ultrasound (USG) is the Investigation of Choice:** USG (specifically Transvaginal Sonography/TVS) is the gold standard initial investigation for any woman of reproductive age presenting with early pregnancy complications. It is non-invasive, cost-effective, and highly sensitive in identifying an intrauterine vs. extrauterine gestational sac. In this case, USG can confirm the location of the pregnancy, assess the nature of the iliac mass, and check for free fluid (hemoperitoneum) in the Pouch of Douglas. **2. Why other options are incorrect:** * **Laparoscopy:** While it is the *gold standard for diagnosis* and allows for simultaneous treatment, it is an invasive surgical procedure. It is reserved for cases where USG is inconclusive or the patient is hemodynamically unstable. * **CT Scan:** CT is contraindicated in early pregnancy due to high ionizing radiation (teratogenic risk) and provides inferior soft-tissue detail of the pelvis compared to USG. * **Shielded X-ray:** X-rays have no role in diagnosing early pregnancy or adnexal masses and expose the fetus to unnecessary radiation. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad of Ectopic Pregnancy:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases). * **Discriminatory Zone:** The level of serum β-hCG (usually 1500–2000 mIU/ml) at which an intrauterine gestational sac should be visible on TVS. * **Arias-Stella Reaction:** Hypersecretory endometrium seen on biopsy in ectopic pregnancy (due to hormonal stimulation without an intrauterine sac).

Question 1

A 35-year-old G2P1L1 presents at 35 weeks of gestation with leakage per vagina. Examination of the pooled fluid shows it turns red litmus paper blue and exhibits ferning. The patient's temperature is 102
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Accepted Answer

Administer antibiotics

Answer

Administer betamethasone

Answer

Administer tocolytics

Answer

Place a cervical cerclage

Question 2

All of the following is true about abruptio placentae except?

Accepted Answer

Bright red blood

Answer

Premature separation of normally attached placenta

Answer

Risk of recurrence is about 15% with previous abruption

Answer

More common in multigravida

Question 3

Which parameter on umbilical artery Doppler indicates imminent fetal demise?

Accepted Answer

Reversal of flow

Answer

Increased S/D ratio

Answer

Absent diastolic flow

Answer

Normal S/D ratio

Question 4

A hypertensive primigravida with completely subsided pre-eclamptic features, up to what gestational age should the pregnancy be continued?

Accepted Answer

37 weeks

Answer

35 weeks

Answer

39 weeks

Answer

40 weeks

Question 5

Betamethasone in pregnancy is given to prevent which of the following complications?

Accepted Answer

Respiratory distress syndrome

Answer

Prematurity

Answer

Neonatal convulsions

Answer

Cerebral palsy

Question 6

A 30-year-old primigravida complains of vaginal bleeding, pain in the abdomen, and vomiting. The uterus is enlarged, soft, and non-tender. Based on the ultrasound findings, what is the most likely diagnosis?

Accepted Answer

Hydatidiform mole

Answer

Missed abortion

Answer

Blighted ovum

Answer

Ectopic pregnancy

Question 7

An 8th-month primigravida presented with severe pruritus and mild icterus. Her serum bilirubin was 3 mg/dL, with elevated AST, ALT, and alkaline phosphatase. Her renal function tests and coagulation profile were within normal limits. What is the most likely diagnosis?

Accepted Answer

Obstetric cholestasis

Answer

HELLP syndrome

Answer

Hepatorenal syndrome

Answer

Viral hepatitis

Question 8

Maximum cardiac output during pregnancy is typically observed at which gestational age?

Accepted Answer

34 weeks

Answer

20 weeks

Answer

30 weeks

Answer

36 weeks

Question 9

All of the following statements about prenatal steroids are true except?

Accepted Answer

These can be given even in the presence of chorioamnionitis.

Answer

They cause a 50% reduction in respiratory distress syndrome and intraventricular hemorrhage.

Answer

These are advocated for mothers at risk of preterm delivery between 24-34 weeks of gestation.

Answer

These can be safely administered to mothers with hypertension or diabetes.

Question 10

A woman presents with amenorrhea of 6 weeks duration and a lump in the right iliac fossa. What is the investigation of choice?

Accepted Answer

Ultrasound (USG) abdomen

Answer

Laparoscopy

Answer

CT scan

Answer

Shielded X-ray

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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