Maternal-Fetal Medicine Practice Questions

Q: A patient at 28 weeks gestation presents with low-grade fever, malaise, and vomiting for one week. On examination, she is icteric. Her Hb is 10 gm%, bilirubin is 5 mg/dL, SGOT and SGPT are 630 and 600 respectively, with a normal platelet count. What is the most probable cause of her jaundice?

Viral hepatitis. ### Explanation The clinical presentation of low-grade fever, malaise, and vomiting followed by jaundice (bilirubin 5 mg/dL) and significantly elevated transaminases (SGOT/SGPT > 500 IU/L) is classic for **Viral Hepatitis**. In pregnancy, viral hepatitis is the most common cause of jaundice worldwide. **Why Viral Hepatitis is correct:** * **Transaminase levels:** SGOT and SGPT levels in the 600s indicate acute hepatocellular injury. In most pregnancy-specific conditions, these levels rarely exceed 300–500 IU/L. * **Prodromal symptoms:** Fever, malaise, and vomiting are typical of a viral prodrome. * **Bilirubin:** A level of 5 mg/dL is consistent with hepatic parenchymal inflammation. **Why the other options are incorrect:** * **Intrahepatic Cholestasis of Pregnancy (IHCP):** Characterized primarily by intense pruritus (palms and soles) and elevated bile acids. Transaminases are only mildly elevated, and jaundice is usually mild or absent. * **Hyperemesis Gravidarum:** This occurs in the *first trimester* (usually <16 weeks). While it can cause mild transaminase elevation, it would not present at 28 weeks with fever and significant jaundice. * **HELLP Syndrome:** This is a triad of Hemolysis (low Hb, high LDH), Elevated Liver enzymes, and **Low Platelets**. The patient has a normal platelet count and no evidence of hemolysis, making this diagnosis unlikely. **NEET-PG High-Yield Pearls:** * **Most common cause of jaundice in pregnancy:** Viral Hepatitis (Hepatitis E is particularly associated with high mortality in pregnancy). * **AFLP vs. HELLP:** Acute Fatty Liver of Pregnancy (AFLP) presents with hypoglycemia and deranged coagulation (high PT/INR), which helps differentiate it from HELLP. * **Rule of Thumb:** If SGOT/SGPT are >1000 IU/L in pregnancy, always suspect Viral Hepatitis or drug-induced injury first.

Q: A 22-year-old primigravida at 11 weeks of gestational age has a blood pressure reading of 150/100 mm Hg obtained during a routine visit. The patient denies any headache, visual changes, nausea, vomiting, or abdominal pain. Her repeat BP is 160/90 mm Hg, and urinalysis is negative for protein. Which of the following is the most likely diagnosis?

Chronic hypertension. ### Explanation **1. Why Chronic Hypertension is Correct:** The diagnosis of hypertensive disorders in pregnancy is primarily based on the **gestational age** at onset. Chronic hypertension is defined as high blood pressure (≥140/90 mm Hg) that is present **before pregnancy** or diagnosed **before 20 weeks of gestation**. In this case, the patient is at 11 weeks (first trimester) with a BP of 150/100 mm Hg. Since the hypertension manifested before the 20-week cutoff, it is classified as chronic hypertension. **2. Why Other Options are Incorrect:** * **Preeclampsia:** This is a multi-system disorder characterized by hypertension arising **after 20 weeks** of gestation, typically accompanied by proteinuria or end-organ dysfunction. Since this patient is only at 11 weeks and has no proteinuria, preeclampsia is excluded. * **Gestational Hypertension:** This refers to new-onset hypertension (without proteinuria) occurring **after 20 weeks** of gestation in a previously normotensive woman. * **Eclampsia:** This is the onset of generalized tonic-clonic seizures in a woman with preeclampsia. This patient is asymptomatic (no seizures, no headache) and does not meet the criteria for preeclampsia. **3. NEET-PG High-Yield Pearls:** * **The 20-Week Rule:** This is the "Golden Rule" for PG exams. Hypertension 20 weeks = Gestational HTN or Preeclampsia. * **Exception to the Rule:** If hypertension and proteinuria appear before 20 weeks, consider **Hydatidiform Mole** or multiple pregnancy. * **Superimposed Preeclampsia:** This occurs when a patient with known chronic hypertension develops new-onset proteinuria or sudden worsening of BP/symptoms after 20 weeks. * **White Coat Hypertension:** Defined as elevated BP in the clinic but normal readings at home; it affects up to 15% of pregnant women.

Q: All of the following can be administered in acute hypertension during labor EXCEPT?

IV Nitroprusside. **Explanation:** The management of acute severe hypertension in labor (Systolic BP ≥160 mmHg or Diastolic BP ≥110 mmHg) aims to prevent maternal cerebrovascular accidents while maintaining placental perfusion. **Why IV Nitroprusside is the Correct Answer:** IV Nitroprusside is generally **avoided** in labor and pregnancy. Its metabolism involves the release of cyanide; while the mother can detoxify small amounts, the fetus lacks the necessary enzymes, leading to potential **fetal cyanide poisoning**. Additionally, it can cause a sudden, drastic drop in blood pressure, potentially compromising uteroplacental blood flow. It is reserved only as a last resort for refractory hypertension when all other agents have failed. **Analysis of Other Options:** * **IV Labetalol (Option A):** A combined alpha and beta-blocker. It is considered a **first-line agent** for acute hypertensive emergencies in pregnancy due to its rapid onset and favorable safety profile. * **IV Esmolol (Option B):** An ultra-short-acting beta-blocker. While not first-line like Labetalol, it can be used in specific acute settings (e.g., during intubation or aortic dissection in pregnancy) under close monitoring. * **IV Hydralazine (Option C):** A direct vasodilator. It is a traditional **first-line drug** for acute hypertensive crisis in pregnancy, though it carries a slightly higher risk of maternal hypotension compared to Labetalol. **High-Yield Clinical Pearls for NEET-PG:** * **First-line drugs for Acute HTN in Pregnancy:** IV Labetalol, IV Hydralazine, and Oral Nifedipine (Immediate Release). * **Drug of Choice for Eclampsia Prophylaxis:** Magnesium Sulfate ($MgSO_4$). * **Contraindicated Antihypertensives in Pregnancy:** ACE Inhibitors and ARBs (due to teratogenicity/renal agenesis) and Sodium Nitroprusside (due to cyanide toxicity). * **Target BP:** Aim to lower BP to 140–150/90–100 mmHg; avoid normalization to prevent placental hypoperfusion.

Q: Angular pregnancy refers to:

Intrauterine pregnancy. ### Explanation **Angular pregnancy** is defined as the implantation of the embryo in the lateral angle of the uterine cavity, specifically medial to the uterotubal junction and the round ligament. **1. Why the correct answer is right:** The key distinction is that an angular pregnancy is an **intrauterine pregnancy**. Although the embryo implants in a corner (angle) of the uterus, it remains within the endometrial cavity. While it carries a higher risk of spontaneous abortion or uterine rupture compared to a normal mid-cavity pregnancy, it is potentially viable and can sometimes progress to a full-term delivery. **2. Why the incorrect options are wrong:** * **Option A (Interstitial Pregnancy):** This is a type of **ectopic pregnancy**. The embryo implants within the intramural portion of the fallopian tube, which is lateral to the round ligament. Unlike angular pregnancy, interstitial pregnancy is life-threatening and cannot result in a viable birth. * **Option C (Heterotopic Pregnancy):** This refers to the simultaneous occurrence of an intrauterine and an extrauterine (ectopic) pregnancy. * **Option D (Broad Ligament Pregnancy):** This is a rare form of abdominal (ectopic) pregnancy where the fetus develops between the leaves of the broad ligament. **3. Clinical Pearls for NEET-PG:** * **The "Round Ligament Sign":** This is the gold standard for differentiation. In **Angular pregnancy**, the bulge is **medial** to the round ligament. In **Interstitial pregnancy**, the bulge is **lateral** to the round ligament. * **Wassermann’s Sign:** Clinical presentation of angular pregnancy often includes severe pain and asymmetric uterine enlargement. * **Management:** Unlike ectopic pregnancies which require termination (medical/surgical), angular pregnancies are managed expectantly with close ultrasound monitoring, as they may shift toward the center of the uterus as the pregnancy progresses.

Q: Intrauterine growth retardation can be caused by all of the following except:

Phenothiazine. **Explanation:** Intrauterine Growth Restriction (IUGR) occurs when a fetus does not reach its biological growth potential due to maternal, placental, or fetal factors. The correct answer is **Phenothiazine**, as it is not typically associated with fetal growth restriction. **1. Why Phenothiazine is the correct answer:** Phenothiazines (antipsychotics like chlorpromazine) are generally considered safe regarding fetal growth. While some studies suggest a potential risk of neonatal withdrawal or extrapyramidal symptoms if used near term, they are **not** known to cause IUGR. **2. Why the other options are incorrect:** * **Nicotine:** Smoking/Nicotine causes vasoconstriction of utero-placental vessels and increases carboxyhemoglobin levels, leading to fetal hypoxia and significant IUGR. * **Alcohol:** Chronic alcohol consumption leads to Fetal Alcohol Syndrome (FAS). Ethanol and its metabolite, acetaldehyde, interfere with cell division and nutrient transport, making IUGR a hallmark feature. * **Propranolol:** Beta-blockers, particularly Propranolol and Atenolol, are well-documented causes of IUGR. They can cause bradycardia and increase uterine activity, leading to decreased placental perfusion. **Clinical Pearls for NEET-PG:** * **Most common cause of IUGR:** Maternal vascular disease (e.g., Preeclampsia, Chronic Hypertension). * **Symmetric vs. Asymmetric IUGR:** Symmetric IUGR (early onset) is often due to chromosomal anomalies or TORCH infections; Asymmetric IUGR (late onset) is usually due to placental insufficiency. * **Drug-induced IUGR:** Other high-yield drugs include Antimetabolites (Methotrexate), Anticonvulsants (Phenytoin), and Warfarin. * **Ponderal Index:** Used to identify the severity of asymmetric IUGR (Formula: $[Weight (g) \times 100] / [Length (cm)]^3$).

Q: Singer's alkali denaturation test is performed for?

Vasa previa. **Explanation:** The **Singer’s alkali denaturation test** (also known as the Apt test) is used to differentiate between **fetal hemoglobin (HbF)** and **adult hemoglobin (HbA)**. The test relies on the principle that fetal hemoglobin is resistant to denaturation by strong alkalis (like Potassium Hydroxide), whereas adult hemoglobin is not. 1. **Why Vasa Previa is Correct:** In vasa previa, the bleeding originates from the fetal vessels crossing the internal os. When vaginal bleeding occurs, it is critical to determine if the blood is maternal or fetal. In the Singer test, the blood is mixed with 1% KOH; if the solution remains **pink**, it indicates the presence of HbF (fetal blood), confirming the diagnosis of vasa previa. If it turns yellow-brown, it is maternal blood. 2. **Why Incorrect Options are Wrong:** * **Rh Incompatibility:** This is managed by Kleihauer-Betke (KB) test (to quantify feto-maternal hemorrhage) or Indirect Coombs Test, not Singer’s test. * **Abruptio Placenta:** The bleeding here is primarily maternal in origin (retroplacental hemorrhage). * **Preterm Labor:** This is a clinical diagnosis based on uterine contractions and cervical changes; biochemical tests like Fetal Fibronectin (fFN) are used, not hemoglobin denaturation tests. **High-Yield Clinical Pearls for NEET-PG:** * **Apt Test vs. Kleihauer-Betke (KB) Test:** Apt test is a qualitative bedside test for vaginal blood; KB test is a quantitative acid-elution test used on maternal peripheral blood to calculate the dose of Anti-D. * **Vasa Previa Triad:** Rupture of membranes + Painless vaginal bleeding + Fetal bradycardia/distress. * **HbF Resistance:** HbF is resistant to both **alkali** (Singer/Apt test) and **acid** (KB test).

Q: The above shown device is used for:

Non-stress test. ***Non-stress test*** - The **cardiotocograph (CTG)** monitors **fetal heart rate** and **uterine contractions** simultaneously to assess fetal well-being without inducing stress. - **Non-stress test (NST)** evaluates fetal heart rate **accelerations** in response to fetal movements, indicating adequate fetal oxygenation and neurological function. *Gestational age assessment* - Gestational age is determined using **ultrasound biometry** measuring **biparietal diameter**, **head circumference**, and **femur length**. - **CTG** does not provide anatomical measurements required for gestational age calculation. *Fetal arterial Doppler* - **Doppler ultrasound** is used to assess **umbilical artery**, **middle cerebral artery**, and **uterine artery** blood flow patterns. - **CTG** monitors heart rate patterns but does not evaluate **vascular resistance** or blood flow velocities. *Detecting progression of labor* - Labor progression is assessed through **cervical dilation** and **fetal station** via **vaginal examination** and **partograph**. - While **CTG** monitors contractions, it does not measure **cervical changes** or **fetal descent** necessary for labor progression assessment.

Question 1

A patient at 28 weeks gestation presents with low-grade fever, malaise, and vomiting for one week. On examination, she is icteric. Her Hb is 10 gm%, bilirubin is 5 mg/dL, SGOT and SGPT are 630 and 600 respectively, with a normal platelet count. What is the most probable cause of her jaundice?

Accepted Answer

Viral hepatitis

Answer

Intrahepatic cholestasis of pregnancy (IHCP)

Answer

Hyperemesis gravidarum

Answer

HELLP syndrome

Question 2

A 22-year-old primigravida at 11 weeks of gestational age has a blood pressure reading of 150/100 mm Hg obtained during a routine visit. The patient denies any headache, visual changes, nausea, vomiting, or abdominal pain. Her repeat BP is 160/90 mm Hg, and urinalysis is negative for protein. Which of the following is the most likely diagnosis?

Accepted Answer

Chronic hypertension

Answer

Preeclampsia

Answer

Eclampsia

Answer

Gestational hypertension

Question 3

All of the following can be administered in acute hypertension during labor EXCEPT?

Accepted Answer

IV Nitroprusside

Answer

IV Labetalol

Answer

IV Esmolol

Answer

IV Hydralazine

Question 4

Angular pregnancy refers to:

Accepted Answer

Intrauterine pregnancy

Answer

Ectopic pregnancy of the interstitial part of the fallopian tube

Answer

Heterotopic pregnancy

Answer

Ectopic pregnancy of the broad ligament

Question 5

Intrauterine growth retardation can be caused by all of the following except:

Accepted Answer

Phenothiazine

Answer

Nicotine

Answer

Alcohol

Answer

Propranolol

Question 6

Which of the following is NOT true about premature rupture of membranes (PROM)?

Accepted Answer

Amnioinfusion is indicated.

Answer

Amoxiclav antibiotic prophylaxis should be administered.

Answer

Cervical examination should be performed aseptically.

Answer

Steroids are used for fetal lung maturation.

Question 7

A 30-year-old G1P1001 patient presents at 37 weeks gestational age with a breech presentation. The cervix is 50% effaced and 1-2 cm dilated. The estimated fetal weight is 7 lbs. The patient is offered all the following management plans EXCEPT:

Accepted Answer

Send the patient to labor and delivery immediately for an emergency Cesarean section.

Answer

Allow the patient to undergo a vaginal breech delivery when she goes into labor.

Answer

Schedule a Cesarean section at or after 39 weeks gestation.

Answer

Schedule an external cephalic version in the next few days.

Question 8

A pregnant woman at 39 weeks gestation with a singleton fetus in cephalic presentation develops chickenpox. She has no other pregnancy complications. What is the best method to prevent neonatal infection?

Accepted Answer

Continue the pregnancy for at least one week.

Answer

Administer varicella zoster immune globulin (VZIG) to the neonate soon after birth.

Answer

Administer varicella zoster vaccine to the neonate soon after birth.

Answer

Induce labor immediately.

Question 9

Singer's alkali denaturation test is performed for?

Accepted Answer

Vasa previa

Answer

Rh incompatibility

Answer

Abruptio placenta

Answer

Preterm labor

Question 10

The above shown device is used for:

Accepted Answer

Non-stress test

Answer

Gestational age assessment

Answer

Fetal arterial Doppler

Answer

Detecting progression of labor

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?