Maternal-Fetal Medicine Practice Questions

Q: In post-term pregnancy, what is the increased risk for the fetus, excluding one option?

Postpartum hemorrhage. **Explanation:** The question asks to identify the option that is **not** a direct fetal risk of post-term pregnancy (defined as ≥42 weeks of gestation). **1. Why Postpartum Hemorrhage (PPH) is the correct answer:** Postpartum hemorrhage is a **maternal complication**, not a fetal one. While post-term pregnancy increases the risk of PPH (often due to macrosomia causing uterine atony or extensive perineal tears), it does not represent a direct risk to the fetus itself. **2. Analysis of Fetal Risks (Incorrect Options):** * **Meconium Aspiration Syndrome (MAS):** As the fetus matures, motilin levels increase, leading to increased bowel peristalsis and passage of meconium. Combined with reduced amniotic fluid (oligohydramnios), the meconium becomes thick, significantly increasing the risk of aspiration. * **Intracranial Hemorrhage:** Post-term fetuses often have increased birth weight (macrosomia) and advanced bone ossification of the skull. This leads to reduced molding during labor, increasing the risk of birth trauma and intracranial hemorrhage during a difficult vaginal delivery. * **Placental Insufficiency:** The placenta has a finite lifespan. After 40-42 weeks, "placental senescence" occurs, characterized by infarctions and calcifications. This reduces oxygen and nutrient transfer, leading to fetal hypoxia and potentially stillbirth. **High-Yield Clinical Pearls for NEET-PG:** * **Post-term Definition:** Pregnancy extending to or beyond 42 weeks (294 days). * **Most Common Cause:** Incorrect dating (wrong LMP). * **Dysmaturity Syndrome (Post-maturity):** Seen in 20% of post-term neonates; characterized by loss of subcutaneous fat, wrinkled skin (parchment-like), and long nails. * **Management:** Induction of labor is generally recommended between 41 and 42 weeks to reduce perinatal morbidity.

Q: What is the earliest fetal anomaly detectable by ultrasound?

Anencephaly. **Explanation:** **Anencephaly** is the correct answer because it is the earliest fetal anomaly detectable by ultrasound, typically identifiable by the **10th to 12th week** of gestation (late first trimester). It is a lethal neural tube defect characterized by the absence of the cranial vault and cerebral hemispheres. On ultrasound, it presents with the classic **"Frog-eye appearance"** (Mickey Mouse sign) due to prominent orbits and the absence of the calvarium above the level of the orbits. **Analysis of Incorrect Options:** * **Hydrocephalus:** This involves the enlargement of cerebral ventricles. It is generally not diagnosed until the **second trimester** (usually after 18 weeks) because the choroid plexus normally fills the ventricles in the first trimester, making early detection difficult. * **Achondroplasia:** This is the most common form of skeletal dysplasia. It is typically diagnosed in the **third trimester** (after 26–28 weeks) when the characteristic rhizomelic (proximal) limb shortening becomes ultrasonographically evident. * **Spina Bifida:** While screening begins with the "Lemon" and "Banana" signs in the early second trimester (16–20 weeks), it is rarely diagnosed as early as anencephaly because the ossification of the spine is incomplete in the first trimester. **High-Yield Clinical Pearls for NEET-PG:** * **Folic Acid:** 400 mcg/day (standard) or 4 mg/day (previous history) prevents 70% of neural tube defects. * **AFP Levels:** Anencephaly is associated with significantly **elevated Maternal Serum Alpha-Fetoprotein (MSAFP)**. * **Polyhydramnios:** This is a common complication of anencephaly due to the failure of the fetus to swallow amniotic fluid.

Q: A 35-year-old lady, G4 P3, presents with amenorrhea of 12 weeks, excessive vomiting, and bleeding per vaginam. On examination, her pulse is 90/min, BP is 150/110 mm Hg, and the uterus is of 20 weeks size on palpation. What is your most probable diagnosis?

Molar pregnancy. **Explanation:** The clinical presentation is classic for a **Molar Pregnancy (Hydatidiform Mole)**. The diagnosis is based on the following triad: 1. **Size-Date Discrepancy:** The uterus (20 weeks) is significantly larger than the period of amenorrhea (12 weeks). 2. **Early-onset Preeclampsia:** Hypertension (150/110 mm Hg) occurring before 20 weeks of gestation is a hallmark sign of a molar pregnancy. 3. **Hyperemesis:** Excessive vomiting occurs due to abnormally high levels of hCG. **Analysis of Options:** * **Gestational Hypertension:** By definition, this occurs *after* 20 weeks of gestation. Hypertension in the first trimester strongly suggests a molar pregnancy or pre-existing chronic hypertension. * **Polyhydramnios:** While it causes a "size > dates" discrepancy, it typically manifests in the second or third trimester and is not associated with early-onset hypertension or excessive bleeding at 12 weeks. * **Antepartum Hemorrhage (APH):** This refers to bleeding from the genital tract after 28 weeks of gestation. At 12 weeks, bleeding is classified as an abortion or molar pregnancy. **NEET-PG High-Yield Pearls:** * **Gold Standard Investigation:** Pelvic Ultrasound showing a **"Snowstorm appearance"** (due to hydropic villi). * **hCG Levels:** Extremely high (often >100,000 mIU/mL). * **Associated Findings:** Theca lutein cysts (bilateral ovarian enlargement) and hyperthyroidism (hCG mimics TSH). * **Treatment of Choice:** Suction and Evacuation (S&E), regardless of uterine size. * **Follow-up:** Weekly serum hCG monitoring until three consecutive negative results to rule out Gestational Trophoblastic Neoplasia (GTN).

Q: A 28-week pregnant patient presents with abdominal pain and fever. Ultrasonography reveals the presence of a fibroid. What is the next line of management?

Conservative management. ### Explanation The correct management for a fibroid during pregnancy, even when symptomatic, is **Conservative Management**. **Why it is correct:** The clinical presentation of abdominal pain and fever in a pregnant patient with a known fibroid strongly suggests **Red Degeneration** (Necrobiosis). This occurs most commonly in the second or third trimester when the fibroid outgrows its blood supply, leading to ischemia and infarction. This is a self-limiting condition. Management focuses on hospitalization, bed rest, intravenous hydration, and analgesia (usually NSAIDs like Ibuprofen, though used with caution near term). Symptoms typically resolve within 4–7 days. **Why the other options are incorrect:** * **Hysterectomy:** This is contraindicated during pregnancy due to the extreme risk of life-threatening hemorrhage from the hypervascular gravid uterus. * **Termination:** Fibroids are not an indication for termination of pregnancy. Most pregnancies with fibroids proceed to a successful term delivery. * **Myomectomy:** Surgical removal of a fibroid is generally avoided during pregnancy due to the risk of uncontrollable bleeding and miscarriage/preterm labor. It is only considered in rare, extreme cases (e.g., a pedunculated fibroid with torsion). **High-Yield Clinical Pearls for NEET-PG:** * **Most common change** in a fibroid during pregnancy: **Asymptomatic** (though size may increase due to estrogen). * **Most common complication** of fibroid in pregnancy: **Red Degeneration**. * **Ultrasound finding:** A "flesh-colored" or "beefy red" appearance is seen pathologically; sonographically, it shows cystic changes or internal echoes. * **Delivery:** Fibroids are not an absolute indication for C-section unless they obstruct the birth canal (Previa fibroid).

Q: What happens to the S/D ratio in the umbilical artery during the progression of normal pregnancy?

Decreases. **Explanation:** The **S/D ratio** (Systolic/Diastolic ratio) in the umbilical artery is a measure of placental vascular resistance. In a normal pregnancy, as the fetus grows, the placenta undergoes significant physiological changes, including the proliferation of tertiary villi and the widening of the vascular bed. **Why the correct answer (A) is right:** As pregnancy progresses, the **placental resistance decreases** to accommodate the increased blood flow required for fetal growth. This drop in resistance leads to a significant increase in the **end-diastolic flow (EDF)**. Since the denominator (Diastole) increases more proportionately than the numerator (Systole), the overall S/D ratio **decreases**. By the third trimester, a normal S/D ratio is typically less than 3.0. **Why the incorrect options are wrong:** * **B & C:** An **increase** or **plateau** in the S/D ratio indicates high placental resistance. This is pathological and is commonly seen in conditions like Preeclampsia or Fetal Growth Restriction (FGR). * **D:** The ratio must change to reflect the dynamic maturation of the placental unit; a lack of change would suggest a failure of the low-resistance circuit to develop. **High-Yield Clinical Pearls for NEET-PG:** 1. **Absent End-Diastolic Velocity (AEDV):** An ominous sign indicating high resistance; it is associated with a high risk of perinatal mortality. 2. **Reversed End-Diastolic Velocity (REDV):** The most severe form of abnormal Doppler; it indicates imminent fetal compromise and usually necessitates urgent delivery. 3. **Normal Values:** The S/D ratio is usually >3.0 before 30 weeks and **<3.0 after 30 weeks** of gestation.

Question 1

In post-term pregnancy, what is the increased risk for the fetus, excluding one option?

Accepted Answer

Postpartum hemorrhage

Answer

Meconium aspiration syndrome

Answer

Intracranial hemorrhage

Answer

Placental insufficiency leading to fetal hypoxia

Question 2

What is the treatment of choice for intrahepatic cholestasis of pregnancy?

Accepted Answer

Ursodiol (Ursodeoxycholic acid)

Answer

Cholestyramine

Answer

Corticosteroids (Dexamethasone)

Answer

Antihistamines

Question 3

What is the earliest fetal anomaly detectable by ultrasound?

Accepted Answer

Anencephaly

Answer

Hydrocephalus

Answer

Achondroplasia

Answer

Spina bifida

Question 4

A 32-year-old primi gravida presents with deep vein thrombosis (DVT). There is a history of two episodes of DVT in the past and she was diagnosed to have antiphospholipid antibody syndrome. What is the next step in management?

Accepted Answer

Aspirin and heparin

Answer

Aspirin alone

Answer

Low molecular weight heparin (LMWH)

Answer

Warfarin for 6 months

Question 5

A 35-year-old lady, G4 P3, presents with amenorrhea of 12 weeks, excessive vomiting, and bleeding per vaginam. On examination, her pulse is 90/min, BP is 150/110 mm Hg, and the uterus is of 20 weeks size on palpation. What is your most probable diagnosis?

Accepted Answer

Molar pregnancy

Answer

Gestational hypertension

Answer

Polyhydramnios

Answer

Antepartum hemorrhage

Question 6

A 28-week pregnant patient presents with abdominal pain and fever. Ultrasonography reveals the presence of a fibroid. What is the next line of management?

Accepted Answer

Conservative management

Answer

Hysterectomy

Answer

Termination

Answer

Myomectomy

Question 7

Which of the following statements is NOT true regarding the amniotic fluid index (AFI)?

Accepted Answer

There is a steady increase in AFI after 36 weeks of gestation.

Answer

It is calculated by adding the vertical depths of the largest pocket in each of four equal uterine quadrants.

Answer

Fluid restriction may lead to a lower AFI.

Answer

Significant hydramnios is defined by an AFI greater than 24 cm.

Question 8

A G2P1 female at 35 weeks gestation presents with uterine contractions. Fetal distress is not observed, and her membranes are intact. What is the recommended course of action?

Accepted Answer

Obtain a vaginal swab for culture.

Answer

Administer 12 mg of betamethasone injection.

Answer

Initiate tocolytic therapy.

Answer

Perform cervical cerclage.

Question 9

Most deaths involving placenta previa result from:

Accepted Answer

Hemorrhage

Answer

Infection

Answer

Toxemia

Answer

Thrombophlebitis

Question 10

What happens to the S/D ratio in the umbilical artery during the progression of normal pregnancy?

Accepted Answer

Decreases

Answer

Increases

Answer

Plateaus

Answer

Shows no significant change

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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