Maternal-Fetal Medicine Practice Questions

Q: Red degeneration most commonly occurs in which period?

2nd trimester. **Explanation:** **Red Degeneration (Carneous Degeneration)** is a form of aseptic necrosis of a uterine fibroid (leiomyoma). It occurs when a rapidly growing fibroid outstrips its blood supply, leading to venous thrombosis and interstitial hemorrhage within the tumor. **Why the 2nd Trimester is Correct:** Red degeneration is most frequently associated with pregnancy, specifically the **second trimester**. During this period, high levels of estrogen and progesterone cause rapid hypertrophy of the fibroid. The blood supply cannot keep pace with this growth, leading to infarction. The characteristic "red" color is due to the diffusion of hemoglobin into the necrotic tissue. **Analysis of Incorrect Options:** * **1st Trimester:** While fibroids can grow in the first trimester, they rarely reach the critical size or growth velocity required to trigger massive ischemic necrosis compared to the second trimester. * **3rd Trimester:** By the third trimester, the growth rate of fibroids typically plateaus or slows down, making acute degeneration less common than in mid-pregnancy. * **Puerperium:** Although red degeneration can occur in the puerperium due to sudden changes in uterine blood flow after delivery, it is statistically less common than the second-trimester occurrence. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Acute onset of localized abdominal pain, low-grade fever, and leukocytosis. * **Diagnosis:** Primarily clinical; Ultrasound may show a "cystic" appearance or a "whorled" pattern with internal echoes. MRI is the most sensitive imaging modality. * **Management:** Always **conservative**. Treatment involves bed rest, hydration, and analgesics (NSAIDs like Ibuprofen are the first line). Surgery (Myomectomy) is contraindicated during pregnancy due to the risk of massive hemorrhage. * **Key Association:** It is the most common complication of fibroids during pregnancy.

Q: Which of the following statements about multiple pregnancies is TRUE?

The Twin Peak Sign is seen in dichorionicity.. **Explanation:** In multiple pregnancies, determining **chorionicity** is the single most important factor for risk stratification and management. **1. Why Option B is Correct:** The **Twin Peak Sign** (also known as the **Lambda sign**) is the pathognomonic ultrasound feature of **dichorionic (DC)** twins. It occurs when the thick chorionic tissue projects into the base of the inter-twin membrane, creating a triangular appearance. This confirms that each fetus has its own placenta, even if they are fused. **2. Why the Other Options are Incorrect:** * **Option A:** Same-gender fetuses do **not** exclude dichorionicity. While all dizygotic twins are dichorionic, approximately 25-30% of monozygotic twins also result in dichorionicity (if cleavage occurs within 72 hours). Only different-gender twins *guarantee* dichorionicity. * **Option C:** A **thick separating membrane** (>2 mm) is a feature of **dichorionic** twins (consisting of 4 layers: 2 amnions and 2 chorions). Monochorionic twins have a thin membrane (<2 mm) consisting of only 2 layers of amnion (the **T-sign**). * **Option D:** Chorionicity is most reliably detected in the **first trimester** (10–14 weeks). As the pregnancy progresses beyond 16 weeks, the chorion laeve disappears, and the "Lambda sign" may regress into a "false T-sign," making late diagnosis difficult. **High-Yield Clinical Pearls for NEET-PG:** * **Lambda Sign (λ):** Dichorionic Diamniotic (DCDA). * **T-Sign:** Monochorionic Diamniotic (MCDA). * **Timing of Cleavage:** * 0–72 hours: DCDA * 4–8 days: MCDA (Most common monozygotic type) * 8–13 days: MCMA (Monochorionic Monoamniotic) * >13 days: Conjoined twins

Q: Which of the following is NOT true about red degeneration of myomas?

Immediate surgical intervention is needed. **Explanation:** Red degeneration (also known as **carneous degeneration**) is a specific type of aseptic necrosis of a uterine fibroid. It is most commonly seen during the **second trimester of pregnancy** or the puerperium. **1. Why Option B is the Correct Answer (The "False" Statement):** Red degeneration is a **self-limiting medical condition**, not a surgical emergency. Immediate surgical intervention (like myomectomy) is strictly contraindicated during pregnancy due to the high risk of uncontrollable hemorrhage and miscarriage. The management is always **conservative**, focusing on bed rest, intravenous fluids, and analgesia. **2. Analysis of Other Options:** * **Option A:** It occurs in approximately 5–10% of pregnancies. The rapid enlargement of the uterus causes the fibroid to grow quickly, outstripping its blood supply. * **Option C:** The underlying pathology is an **infarction**. Rapid growth leads to venous obstruction and thrombosis within the tumor, causing congestion, interstitial hemorrhage, and the characteristic "beefy red" appearance (due to hemolysis). * **Option D:** Since the primary symptom is acute, localized abdominal pain and low-grade fever, the mainstay of treatment is **analgesics** (usually NSAIDs or narcotics) to manage the pain until the episode resolves (typically within 4–7 days). **Clinical Pearls for NEET-PG:** * **Characteristic Smell:** On gross examination, the fibroid has a "stale fish" odor. * **Diagnosis:** Primarily clinical, but Ultrasound/MRI may show a cystic center or peripheral echoes. * **Differential Diagnosis:** Must be distinguished from acute appendicitis, abruptio placentae, or twisted ovarian cyst. * **Key Management Rule:** "Wait and watch" with medical management; surgery is reserved only for rare cases of failed conservative therapy or peritonitis.

Q: Which of the following is the investigation of choice in a pregnant lady at 18 weeks of gestation with a past history of delivering a baby with Down's syndrome?

Amniocentesis. **Explanation:** The core concept here is distinguishing between **screening** and **diagnostic** tests. A woman with a prior history of a child with Down syndrome is at a significantly higher risk for recurrence. Therefore, she requires a definitive diagnostic test rather than a screening test. **1. Why Amniocentesis is the Correct Answer:** Amniocentesis is the **investigation of choice** for chromosomal analysis (karyotyping) when the patient is in the second trimester (typically performed between 15–20 weeks). Since this patient is at **18 weeks**, amniocentesis is the most appropriate diagnostic procedure to confirm or rule out trisomy 21. **2. Why other options are incorrect:** * **Triple Screen Test (Option A):** This is a screening test (measuring AFP, hCG, and uE3). In a high-risk patient with a prior history, screening is bypassed in favor of definitive diagnosis. * **Chorionic Villus Sampling (Option C):** While CVS is a diagnostic test, it is ideally performed between **10–13 weeks** (first trimester). At 18 weeks, the placenta is more developed, and the risk-benefit ratio favors amniocentesis. * **Ultrasonography (Option D):** USG can identify "soft markers" (like nuchal fold thickness), but it is not a definitive diagnostic tool for Down syndrome. **Clinical Pearls for NEET-PG:** * **Timing is Key:** CVS (10–13 weeks), Amniocentesis (15–20 weeks), Cordocentesis (>20 weeks). * **Gold Standard:** Karyotyping via amniocentesis remains the gold standard for diagnosing chromosomal aneuploidies in the second trimester. * **Risk of Loss:** The procedure-related pregnancy loss for amniocentesis is approximately 0.5% (1 in 200). * **Recurrence Risk:** The risk of Down syndrome in a subsequent pregnancy after one affected child is approximately 1% or the age-related risk, whichever is higher.

Q: A multipara at 34 weeks of pregnancy presents with tachycardia, fever, hepatosplenomegaly, and pallor. What is the most likely diagnosis?

Malaria. **Explanation:** The clinical presentation of **tachycardia, fever, hepatosplenomegaly, and pallor** in a pregnant woman is a classic constellation of symptoms for **Malaria**. 1. **Why Malaria is correct:** Malaria in pregnancy is a medical emergency. The presence of **fever** indicates an infectious process, while **pallor** (anemia) results from the hemolysis of infected red blood cells. **Hepatosplenomegaly** is a hallmark sign caused by the sequestration of parasites and the resultant immune response in the reticuloendothelial system. In endemic areas, any pregnant woman presenting with fever and anemia should be screened for malaria. 2. **Why other options are incorrect:** * **Iron deficiency anemia & Megaloblastic anemia:** While both cause significant pallor and tachycardia (due to compensatory high-output states), they are **not** associated with fever or hepatosplenomegaly. * **Physiological anemia:** This is a normal adaptation due to plasma volume expansion exceeding red cell mass. It is usually mild (Hb >10 g/dL) and never presents with fever or organomegaly. **Clinical Pearls for NEET-PG:** * **Most common species in pregnancy:** *Plasmodium falciparum* is associated with more severe maternal and fetal complications (hypoglycemia, pulmonary edema, and placental sequestration). * **Drug of Choice:** According to the latest WHO/NVBDCP guidelines, **Artesunate-based Combination Therapy (ACT)** is now recommended for uncomplicated malaria in **all trimesters** (including the first). * **Complication:** Malaria in pregnancy is a leading cause of **Low Birth Weight (LBW)** due to placental insufficiency and IUGR.

Q: A 26-year-old G2P1L1 at 10 weeks complains of abdominal pain and bleeding per vaginum. On examination, products of conception are seen partially extruding through the cervix. What is your diagnosis?

Incomplete abortion. **Explanation:** The clinical presentation of a patient with abdominal pain, vaginal bleeding, and **products of conception partially extruding through the cervix** is the hallmark of an **Incomplete Abortion**. In this condition, the cervical os is open, but only a portion of the products of conception has been expelled, while some remain within the uterine cavity. **Analysis of Options:** * **Incomplete Abortion (Correct):** Defined by the partial expulsion of products. The cervical os is open, and tissue is often visible at the os or on ultrasound. * **Inevitable Abortion:** The cervical os is open and bleeding is present, but **no products of conception have been expelled yet**. The process is in progress but remains "internal." * **Threatened Abortion:** Characterized by vaginal bleeding with a **closed cervical os** and a viable fetus. The pregnancy may still continue. * **Complete Abortion:** All products of conception have been expelled. The cervical os typically closes afterward, and the uterus is firm and contracted. **High-Yield Clinical Pearls for NEET-PG:** * **Management:** Incomplete abortion requires evacuation of the remaining products via **Surgical Evacuation (D&C/MVA)** or medical management (Misoprostol) to prevent complications like hemorrhage or sepsis. * **Cervical Os Status:** This is the primary clinical differentiator. If the os is **closed**, it is either Threatened, Complete, or Missed abortion. If the os is **open**, it is either Inevitable or Incomplete abortion. * **Ultrasound Finding:** In an incomplete abortion, the endometrial stripe is typically thickened (>15 mm) or shows irregular echogenic masses.

Question 1

Placenta accreta is associated with all except:

Accepted Answer

Uterine malformation

Answer

Placenta previa

Answer

Uterine scar

Answer

Multiparity

Question 2

Red degeneration most commonly occurs in which period?

Accepted Answer

2nd trimester

Answer

1st trimester

Answer

3rd trimester

Answer

Puerperium

Question 3

Which of the following statements about multiple pregnancies is TRUE?

Accepted Answer

The Twin Peak Sign is seen in dichorionicity.

Answer

Fetuses of the same gender exclude dichorionicity.

Answer

A thick separating membrane is a feature of monochorionic twins.

Answer

Chorionicity can be reliably detected only after 16 weeks of gestation.

Question 4

A patient at 22 weeks gestation is diagnosed with intra-uterine fetal demise (IUFD) that occurred at 17 weeks. The patient is at increased risk of which of the following complications?

Accepted Answer

Consumptive coagulopathy with hypofibrinogenemia

Answer

Septic abortion

Answer

Future infertility

Answer

Ectopic pregnancy

Question 5

Which of the following is NOT true about red degeneration of myomas?

Accepted Answer

Immediate surgical intervention is needed

Answer

It occurs commonly during pregnancy

Answer

It is due to interference with blood supply

Answer

It is treated with analgesics

Question 6

A pregnant mother at 32 weeks gestation presents in preterm labor. Antenatal steroid to induce fetal lung maturity is indicated in all of the following conditions, EXCEPT:

Accepted Answer

Chorioamnionitis

Answer

Prolonged rupture of membranes for more than 24 hours

Answer

Pregnancy induced hypertension

Answer

Diabetes mellitus

Question 7

Which of the following is the investigation of choice in a pregnant lady at 18 weeks of gestation with a past history of delivering a baby with Down's syndrome?

Accepted Answer

Amniocentesis

Answer

Triple screen test

Answer

Chorionic villus sampling

Answer

Ultrasonography

Question 8

A multipara at 34 weeks of pregnancy presents with tachycardia, fever, hepatosplenomegaly, and pallor. What is the most likely diagnosis?

Accepted Answer

Malaria

Answer

Iron deficiency anemia

Answer

Physiological anemia

Answer

Megaloblastic anemia

Question 9

A 26-year-old G2P1L1 at 10 weeks complains of abdominal pain and bleeding per vaginum. On examination, products of conception are seen partially extruding through the cervix. What is your diagnosis?

Accepted Answer

Incomplete abortion

Answer

Inevitable abortion

Answer

Threatened abortion

Answer

Complete abortion

Question 10

Which of the following predisposes to placenta previa?

Accepted Answer

Past cesarean pregnancy

Answer

Primigravida

Answer

Singleton pregnancy

Answer

Diabetes mellitus

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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