Maternal-Fetal Medicine Practice Questions

Q: Which of the following represents fetal hypoxia, except:

Fetal scalp blood pH > 7.3. **Explanation:** Fetal hypoxia occurs when there is a deficiency in oxygen supply to the fetus, leading to anaerobic metabolism and metabolic acidosis. **Why Option C is the correct answer:** Fetal scalp blood sampling is the gold standard for assessing fetal acid-base status. A **pH > 7.25 is considered normal**. A pH between 7.20 and 7.25 is pre-pathological (borderline), and a **pH 7.3 represents a healthy, well-oxygenated fetus and is not a sign of hypoxia. **Analysis of Incorrect Options:** * **A. Excessive fetal movements:** Often referred to as "fetal alarm signals," a sudden burst of vigorous fetal activity followed by decreased movement can be an early clinical sign of acute hypoxia (the "struggle" phase). * **B. Meconium in vertex presentation:** Hypoxia causes increased intestinal peristalsis and relaxation of the anal sphincter, leading to the passage of meconium. While not always pathological, thick meconium in a vertex presentation is a classic warning sign of fetal distress. * **D. Heart rate < 100:** Persistent fetal bradycardia (FHR < 110 bpm) or late decelerations are hallmark electronic fetal monitoring (EFM) signs of hypoxia and impending fetal exhaustion. **NEET-PG High-Yield Pearls:** * **Normal Fetal pH:** 7.25 – 7.35. * **Critical pH for delivery:** If pH is < 7.20, immediate delivery is usually indicated. * **First sign of hypoxia on CTG:** Loss of variability (specifically short-term variability). * **Most specific sign of hypoxia:** Late decelerations. * **Modified Manning’s Criteria:** Combines Non-Stress Test (NST) and Amniotic Fluid Index (AFI).

Q: Which of the following sonographic findings suggests the development of preeclampsia?

Increased volume of chorionic villi.. **Explanation:** Preeclampsia is fundamentally a disease of **defective placentation**. In a normal pregnancy, extravillous trophoblasts invade the maternal spiral arterioles, converting them from high-resistance, narrow vessels into low-resistance, high-capacity channels. In preeclampsia, this process fails. **1. Why Option A is Correct:** In preeclampsia, the placenta undergoes compensatory changes due to chronic hypoxia and ischemia. Sonographically and histologically, there is an **increase in the volume and surface area of chorionic villi** (specifically terminal villi) as the placenta attempts to maximize nutrient and oxygen exchange despite poor maternal perfusion. This is often associated with "villous hypervascularity" or "chorangiosis" in response to the hypoxic environment. **2. Why the Other Options are Incorrect:** * **Option B:** Extensive remodeling of spiral arterioles is a feature of a **normal pregnancy**. In preeclampsia, remodeling is incomplete or absent, restricted only to the decidual segments rather than the deeper myometrial segments. * **Option C:** Increased invasion of extravillous trophoblasts is characteristic of a healthy placenta. In preeclampsia, there is **shallow/reduced invasion**, leading to high-resistance placental circulation. **Clinical Pearls for NEET-PG:** * **Uterine Artery Doppler:** The most reliable sonographic predictor of preeclampsia is an **increased Pulsatility Index (PI)** and the presence of **diastolic notches** (beyond 24 weeks). * **Placental Morphology:** Preeclamptic placentas are often smaller, but may show sonographic "lakes," infarcts, or retroplacental hematomas. * **Biomarkers:** A high **sFlt-1/PlGF ratio** is a strong biochemical predictor of preeclampsia development.

Q: Post term pregnancy is defined as a pregnancy that continues beyond how many days from the first day of the last menstrual period?

294 days. **Explanation:** **1. Understanding the Correct Answer (C):** According to the **International Federation of Gynecology and Obstetrics (FIGO)** and the **American College of Obstetricians and Gynecologists (ACOG)**, a **post-term pregnancy** is defined as one that extends to or beyond **42 completed weeks** (294 days) from the first day of the last menstrual period (LMP). * **Calculation:** 42 weeks × 7 days/week = **294 days**. It is crucial to distinguish this from "late-term" pregnancy, which is defined as 41 weeks to 41 weeks and 6 days. **2. Analysis of Incorrect Options:** * **Option A (274 days):** This represents approximately 39 weeks. This is considered "Full Term" (39 0/7 to 40 6/7 weeks), which is the ideal window for delivery to minimize neonatal morbidity. * **Option B (284 days):** This represents approximately 40 weeks and 4 days. While this is past the Estimated Date of Delivery (EDD), it is classified as "Full Term" and does not meet the criteria for post-term. * **Option D (304 days):** This represents approximately 43 weeks and 3 days. While this is technically post-term, the definition begins at the completion of the 42nd week (294 days). **3. High-Yield Clinical Pearls for NEET-PG:** * **Terminology:** * **Early Term:** 37 0/7 – 38 6/7 weeks. * **Full Term:** 39 0/7 – 40 6/7 weeks. * **Late Term:** 41 0/7 – 41 6/7 weeks. * **Post-term:** ≥ 42 0/7 weeks. * **Most Common Cause:** The most common cause of a post-term pregnancy diagnosis is **inaccurate dating** (wrong LMP). * **Etiology:** Associated with placental sulfatase deficiency, anencephaly, and fetal adrenal hypoplasia. * **Risks:** Increased risk of **Macrosomia**, **Meconium Aspiration Syndrome**, and **Dysmaturity Syndrome** (due to placental insufficiency). * **Management:** Induction of labor is generally recommended between 41 and 42 weeks to prevent stillbirth.

Q: Which of the following drugs should not be used in the conduct of labour in a woman with rheumatic heart disease?

Methylergometrine. **Explanation:** In patients with Rheumatic Heart Disease (RHD), particularly those with Mitral Stenosis, the management of the third stage of labor is critical. The primary goal is to prevent sudden changes in hemodynamics and fluid overload. **Why Methylergometrine is contraindicated:** Methylergometrine (Methergine) is a potent vasoconstrictor. It causes **systemic vasoconstriction** and a sudden shift of blood from the peripheral circulation to the central compartment (autotransfusion). In a woman with RHD, this sudden increase in venous return (preload) can lead to acute pulmonary edema and heart failure. Additionally, it can cause a sharp rise in blood pressure. **Evaluation of other options:** * **Oxytocin (Option C):** This is the drug of choice for preventing Postpartum Hemorrhage (PPH) in cardiac patients. However, it must be administered as a **slow intravenous infusion**, never as a bolus, to avoid sudden hypotension. * **Carboprost (Option B):** While it can increase pulmonary artery pressure, it is not absolutely contraindicated like Methylergometrine; however, it is used with caution. * **Misoprostol (Option D):** This prostaglandin E1 analogue is safe for use in cardiac patients as it does not have significant effects on the cardiovascular system or vascular tone. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice for PPH in RHD:** Oxytocin (slow IV drip). * **Drug of Choice for PPH in Asthma:** Oxytocin or Misoprostol (Avoid Carboprost/PGF2α). * **Drug of Choice for PPH in Hypertension/Preeclampsia:** Oxytocin (Avoid Methylergometrine). * **Management Tip:** In RHD patients, the second stage of labor is often shortened by using forceps or vacuum to prevent maternal exhaustion and tachycardia.

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.

Question 1

Which of the following represents fetal hypoxia, except:

Accepted Answer

Fetal scalp blood pH > 7.3

Answer

Excessive fetal movements

Answer

Meconium in vertex presentation

Answer

Heart rate < 100

Question 2

Which of the following sonographic findings suggests the development of preeclampsia?

Accepted Answer

Increased volume of chorionic villi.

Answer

Extensive remodelling of spiral arterioles.

Answer

Increased invasion of extravillous trophoblastic tissue.

Answer

None of the above.

Question 3

Post term pregnancy is defined as a pregnancy that continues beyond how many days from the first day of the last menstrual period?

Accepted Answer

294 days

Answer

274 days

Answer

284 days

Answer

304 days

Question 4

Which of the following drugs should not be used in the conduct of labour in a woman with rheumatic heart disease?

Accepted Answer

Methylergometrine

Answer

Carboprost

Answer

Oxytocin

Answer

Misoprostol

Question 5

Placenta accreta is associated with all except:

Accepted Answer

Uterine malformation

Answer

Placenta previa

Answer

Uterine scar

Answer

Multiparity

Question 6

Red degeneration most commonly occurs in which period?

Accepted Answer

2nd trimester

Answer

1st trimester

Answer

3rd trimester

Answer

Puerperium

Question 7

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 8

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 9

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 10

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

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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