Maternal-Fetal Medicine Practice Questions

Q: Which drug is given to prevent vertical transmission of HIV from mother to child?

Nevirapine. **Explanation:** The prevention of mother-to-child transmission (PMTCT) of HIV is a high-yield topic for NEET-PG. **Nevirapine**, a Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI), is the drug of choice for prophylaxis in newborns. **Why Nevirapine is correct:** Nevirapine is highly effective because it has a long half-life and rapidly crosses the placenta. In the standard WHO/NACO protocol, a single dose of Nevirapine is administered to the infant immediately after birth (within 72 hours) to prevent vertical transmission during the intrapartum and early postpartum period. For the mother, the current "Option B+" strategy involves a lifelong Triple ART regimen (Tenofovir + Lamivudine + Efavirenz), but Nevirapine remains the classic answer for infant prophylaxis. **Why other options are incorrect:** * **Lamivudine (3TC):** While used as part of the mother’s triple-drug ART regimen, it is not typically used as a standalone prophylactic agent for the neonate unless in specific dual-therapy scenarios. * **Stavudine (d4T):** This drug is largely phased out of modern protocols due to significant mitochondrial toxicity and lipodystrophy. * **Abacavir (ABC):** Used in pediatric HIV treatment, but not used for immediate post-exposure prophylaxis in newborns due to the risk of hypersensitivity reactions (linked to HLA-B*5701). **Clinical Pearls for NEET-PG:** * **Most common route of transmission:** Intrapartum (during labor/delivery). * **Best method to reduce transmission:** Elective Cesarean Section (if viral load >1000 copies/mL) and avoiding breastfeeding. * **Infant Prophylaxis duration:** Usually 6 weeks of daily Nevirapine. * **Diagnosis in infants:** DNA-PCR is the gold standard (Antibody tests like ELISA are unreliable until 18 months due to maternal antibodies).

Q: What is the typical appearance of amniotic fluid in post-maturity?

Saffron colored. **Explanation:** The correct answer is **Saffron colored (A)**. In post-maturity (pregnancy extending beyond 42 weeks), the amniotic fluid often takes on a characteristic saffron or greenish-yellow hue. This occurs due to the presence of **vernix caseosa** and the passage of **meconium** (fetal stool) into the amniotic sac. As the placenta ages (placental insufficiency), the fetus may experience mild hypoxia, which stimulates bowel peristalsis and relaxation of the anal sphincter, leading to meconium staining. The "saffron" tint specifically refers to the staining of the fetal membranes and vernix by the bile pigments in the meconium over a prolonged period. **Analysis of Incorrect Options:** * **B. Tuberculosis:** This is a systemic infection and does not have a specific, diagnostic association with amniotic fluid color changes. * **C. Breech presentation:** While meconium passage is common in breech presentation due to physical compression of the fetal abdomen during labor, it is an acute event and does not typically result in the "saffron" staining seen in chronic post-maturity. * **D. Normal appearance:** Normal amniotic fluid is clear or straw-colored. In post-maturity, the fluid volume typically decreases (oligohydramnios) and its appearance changes due to meconium. **High-Yield Clinical Pearls for NEET-PG:** * **Golden Yellow:** Rh-isoimmunization (due to bilirubin from fetal hemolysis). * **Green (Dark):** Acute fetal distress (fresh meconium). * **Dark Red/Meat washings:** Intrauterine Fetal Death (IUFD). * **Dark Brown (Tobacco juice):** Also associated with IUFD (older hemorrhage/maceration). * **Post-maturity Syndrome:** Also known as Clifford’s syndrome; characterized by loss of subcutaneous fat, wrinkled skin, and long nails.

Q: Hypertension, proteinuria, and pitting edema are noted in the second month of the first pregnancy in a 25-year-old woman. The pathogenesis of her presenting complaints is most closely associated with which of the following?

A benign tumor of the chorionic villi. **Explanation:** The clinical triad of **hypertension, proteinuria, and edema** (Preeclampsia) occurring in the **first half of pregnancy** (before 20 weeks) is a classic diagnostic hallmark for a **Hydatidiform Mole** (molar pregnancy). **1. Why Option A is Correct:** A hydatidiform mole is a **benign tumor of the chorionic villi** characterized by trophoblastic proliferation and hydropic degeneration of the villi. While preeclampsia typically occurs after 20 weeks of gestation, its appearance in the first or early second trimester (as seen in this 25-year-old patient at two months) strongly suggests gestational trophoblastic disease (GTD). The pathogenesis involves abnormal placental development and excessively high levels of hCG, which are thought to trigger early-onset preeclamptic features. **2. Why the other options are incorrect:** * **Option B (Gestational Diabetes):** While GDM increases the risk of preeclampsia later in pregnancy, it does not cause early-onset hypertension in the second month. * **Options C & D (Primary Endometrial Cancer):** Endometrial cancer is rare in a 25-year-old and typically presents with abnormal uterine bleeding, not the systemic signs of preeclampsia or a positive pregnancy state. **High-Yield Clinical Pearls for NEET-PG:** * **Rule of Thumb:** Preeclampsia before 20 weeks = **Think Hydatidiform Mole** until proven otherwise. * **Diagnostic Investigation:** The gold standard is an **Ultrasound**, which reveals a characteristic **"Snowstorm appearance"** and absence of a fetus (in complete mole). * **Biochemical Marker:** Markedly elevated **serum β-hCG** levels (often >100,000 mIU/mL) are characteristic. * **Other Early-Onset Preeclampsia Causes:** Apart from molar pregnancy, consider Systemic Lupus Erythematosus (SLE) or Antiphospholipid Syndrome (APLS).

Q: What is a known consequence of maternal cocaine use during pregnancy?

Cerebral infarction. **Explanation:** The correct answer is **C. Cerebral infarction**. **Mechanism of Action:** Cocaine is a potent sympathomimetic agent that acts by inhibiting the reuptake of norepinephrine, epinephrine, and dopamine. In pregnancy, this leads to profound maternal and fetal vasoconstriction, tachycardia, and acute hypertension. These vascular disruptions cause "vascular accidents" in the developing fetus. **Cerebral infarction** (stroke) and intracranial hemorrhage occur due to sudden fluctuations in fetal blood pressure and reduced cerebral blood flow. Other related complications include placental abruption (due to uterine artery vasoconstriction) and limb reduction defects. **Analysis of Incorrect Options:** * **A. Hydrops fetalis:** This is typically caused by severe fetal anemia (Rh isoimmunization, Parvovirus B19) or cardiac failure, not the acute vasoconstrictive mechanism of cocaine. * **B. Sacral agenesis:** This is a highly specific pathognomonic finding associated with **maternal diabetes mellitus** (caudal regression syndrome), not drug abuse. * **D. Hypertrichosis:** Excessive hair growth is associated with fetal alcohol syndrome (hirsutism) or certain maternal endocrine disorders, but it is not a feature of cocaine embryopathy. **High-Yield NEET-PG Pearls:** * **Cocaine & Placenta:** Cocaine is a leading risk factor for **Abruptio Placentae**. * **Vascular Disruptions:** Besides cerebral infarcts, cocaine is associated with **Necrotizing Enterocolitis (NEC)** in neonates and **jejunal atresia** (Apple-peel atresia) due to mesenteric ischemia. * **Growth:** Cocaine use is strongly linked to **IUGR** (Intrauterine Growth Restriction) and microcephaly. * **Teratogen vs. Disruptor:** Cocaine is often viewed as a "vascular disruptor" rather than a classic malformative teratogen.

Q: What neurological defect is seen in the fetus of a diabetic mother?

All of the above. **Explanation:** In pregnancies complicated by pre-gestational diabetes mellitus, maternal hyperglycemia during the period of organogenesis (first 8 weeks) is highly teratogenic. High glucose levels lead to the production of reactive oxygen species (ROS), which disrupt gene expression and induce apoptosis in developing embryonic tissues. **Why "All of the above" is correct:** * **Neural Tube Defects (NTDs):** These are the **most common** CNS malformations in infants of diabetic mothers (IDM). The risk is increased 10-fold compared to the general population. * **Anencephaly:** This is a specific, severe type of open neural tube defect characterized by the absence of a major portion of the brain and skull. It falls under the spectrum of NTDs commonly seen in diabetic embryopathy. * **Caudal Regression Syndrome (Sacral Agenesis):** While rare, this is the **most characteristic/specific** malformation associated with maternal diabetes. It involves the underdevelopment of the distal spine and lower extremities. **Clinical Pearls for NEET-PG:** * **Most Common Cardiac Defect:** Ventricular Septal Defect (VSD). However, **Transposition of the Great Arteries (TGA)** is also highly associated. * **Most Specific Defect:** Caudal Regression Syndrome. * **HbA1c Correlation:** The risk of congenital anomalies increases significantly if the periconceptional HbA1c is >8.5%. * **Screening:** Fetal echocardiography and a detailed Level II ultrasound (at 18–20 weeks) are mandatory for diabetic mothers to screen for these defects. * **Prevention:** Strict glycemic control before conception and throughout the first trimester reduces the risk to near-baseline levels.

Q: In hydrops foetalis, what is the earliest sonographic sign observed?

Skin edema. **Explanation:** **Hydrops Foetalis** is defined as the abnormal accumulation of fluid in two or more fetal compartments (e.g., ascites, pleural effusion, pericardial effusion, or skin edema). It is often associated with polyhydramnios and placental thickening. **Why Skin Edema is the Correct Answer:** Among the sonographic markers of hydrops, **skin edema (anasarca)** is traditionally considered the **earliest sign**. It is defined as a skin thickness of **>5 mm**. The physiological basis lies in the initial increase in hydrostatic pressure or decrease in oncotic pressure within the fetal subcutaneous tissues, which manifests before significant fluid collection occurs in the serous cavities. **Analysis of Incorrect Options:** * **Ascites (B):** While ascites is often the most *easily* recognized sign and frequently the first sign of fluid in the *serous cavities*, it typically appears after the initial subcutaneous changes. * **Pericardial Effusion (A):** This is often a later finding. A small amount of fluid in the pericardium (up to 2 mm) can be physiological in a normal fetus; therefore, it is not a reliable early marker. * **Pleural Effusion (C):** This usually develops after ascites and skin edema as the hydrostatic pressure continues to rise or lymphatic drainage fails. **NEET-PG High-Yield Pearls:** * **Definition:** Fluid in $\geq$ 2 fetal compartments. * **Most common cause (Worldwide):** Non-immune hydrops (e.g., chromosomal anomalies like Turner syndrome, cardiovascular defects). * **Immune Hydrops:** Most commonly due to Rh isoimmunization. * **Mirror Syndrome:** A rare condition where the mother "mirrors" the fetal hydrops, developing edema and preeclampsia-like symptoms. * **Diagnostic Threshold:** Skin thickness >5 mm and placental thickness >4 cm are key sonographic criteria.

Question 1

All of the following are true of placenta previa EXCEPT:

Accepted Answer

Postpartum hemorrhage is infrequent

Answer

First-trimester bleeding is not uncommon

Answer

Premature labor is common

Answer

Malposition and malpresentation are common

Question 2

Which drug is given to prevent vertical transmission of HIV from mother to child?

Accepted Answer

Nevirapine

Answer

Lamivudine

Answer

Stavudine

Answer

Abacavir

Question 3

What is the typical appearance of amniotic fluid in post-maturity?

Accepted Answer

Saffron colored

Answer

Tuberculosis

Answer

Breech presentation

Answer

Normal appearance

Question 4

Ventricular function improves with pregnancy in which of the following conditions?

Accepted Answer

Mitral insufficiency

Answer

Mitral stenosis

Answer

Aortic stenosis

Answer

Pulmonary stenosis

Question 5

Hypertension, proteinuria, and pitting edema are noted in the second month of the first pregnancy in a 25-year-old woman. The pathogenesis of her presenting complaints is most closely associated with which of the following?

Accepted Answer

A benign tumor of the chorionic villi

Answer

Gestational diabetes mellitus

Answer

Primary endometrial cancer

Answer

Primary endometrial cancer

Question 6

Which of the following describes a dangerous placenta?

Accepted Answer

Type II posterior

Answer

Type I

Answer

Type II anterior

Answer

Type III

Question 7

What is a known consequence of maternal cocaine use during pregnancy?

Accepted Answer

Cerebral infarction

Answer

Hydrops fetalis

Answer

Sacral agenesis

Answer

Hypertrichosis

Question 8

What neurological defect is seen in the fetus of a diabetic mother?

Accepted Answer

All of the above

Answer

Caudal regression

Answer

Neural tube defect

Answer

Anencephaly

Question 9

Which of the following statements about the placenta is NOT true?

Accepted Answer

At term, approximately four-fifths of the placenta is of maternal origin.

Answer

The number of cotyledons increases with gestational age.

Answer

The weight of the fetus and placenta are approximately equal at 4 months of gestation.

Answer

After delivery, the weight of the placenta is typically around 500 gm.

Question 10

In hydrops foetalis, what is the earliest sonographic sign observed?

Accepted Answer

Skin edema

Answer

Pericardial effusion

Answer

Ascites

Answer

Pleural effusion

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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