Maternal-Fetal Medicine Practice Questions

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.

Q: A pregnant lady at 32 weeks' gestation presents with a BP of 160/110 mm Hg, proteinuria, and retinal hemorrhage. What is the definitive management of choice in this case?

Termination of pregnancy. **Explanation:** The patient presents with a blood pressure of 160/110 mm Hg and proteinuria, which confirms a diagnosis of **Preeclampsia**. The presence of **retinal hemorrhage** is a "severity marker" indicating end-organ damage (Grade IV hypertensive retinopathy). This classifies the condition as **Preeclampsia with Severe Features**. **1. Why "Termination of Pregnancy" is correct:** In cases of severe preeclampsia, the definitive treatment is the delivery of the fetus and placenta, regardless of gestational age. Once end-organ damage (like retinal hemorrhage, renal failure, or HELLP syndrome) occurs, the risk of maternal complications (stroke, retinal detachment, or eclampsia) outweighs the benefits of prolonging the pregnancy. At 32 weeks, the goal is maternal safety via termination. **2. Why other options are incorrect:** * **Ritodrine (A):** This is a tocolytic used to *stop* preterm labor. It is contraindicated here because we want to deliver the patient, not prolong the pregnancy. * **Nifedipine (B):** While used to control acute BP, it is a symptomatic treatment, not a definitive cure. * **Magnesium Sulfate (C):** This is the drug of choice for seizure prophylaxis (preventing eclampsia), but it does not treat the underlying pathology. It is an *adjunct* to management, not the definitive treatment. **High-Yield Clinical Pearls for NEET-PG:** * **Definitive treatment for Preeclampsia/Eclampsia:** Delivery (Termination of pregnancy). * **Indications for immediate delivery in Preeclampsia:** BP >160/110 despite meds, platelet count <1 lakh, deteriorating renal/liver function, placental abruption, or visual disturbances/retinal changes. * **Target BP in Severe Preeclampsia:** Maintain between 140/90 and 150/100 mm Hg to prevent hemorrhagic stroke.

Q: In a lady at 32 weeks gestation, an injection of dexamethasone is given to prevent which of the following in the newborn?

Respiratory Distress Syndrome. ### Explanation **Correct Option: A. Respiratory Distress Syndrome (RDS)** The primary goal of administering antenatal corticosteroids (like Dexamethasone or Betamethasone) between 24 and 34 weeks of gestation is to accelerate **fetal lung maturity**. Dexamethasone induces the maturation of **Type II pneumocytes**, which increases the production and release of **surfactant**. Surfactant reduces alveolar surface tension, preventing lung collapse upon expiration. This significantly reduces the incidence and severity of Respiratory Distress Syndrome (RDS), Intraventricular Hemorrhage (IVH), and Necrotizing Enterocolitis (NEC) in preterm neonates. **Why other options are incorrect:** * **B. Neonatal convulsion:** These are typically caused by metabolic disturbances (hypoglycemia, hypocalcemia), birth asphyxia, or infections, rather than a lack of steroids. * **C. Neonatal jaundice:** Steroids do not influence bilirubin metabolism or conjugation in the liver. Jaundice in preterm infants is usually due to hepatic immaturity or hemolysis. * **D. Cerebral palsy:** While steroids reduce IVH (a risk factor for brain injury), they are not primarily given to prevent cerebral palsy. Magnesium sulfate is the drug of choice for neuroprotection in pregnancies <32 weeks. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Dose:** Dexamethasone **6 mg IM every 12 hours (4 doses)** OR Betamethasone **12 mg IM every 24 hours (2 doses)**. * **Window of Efficacy:** Maximum benefit is seen if delivery occurs **after 24 hours** but **within 7 days** of the first dose. * **Rescue Dose:** A single "rescue course" can be given if the initial course was >7 days ago and the patient is still <34 weeks with an imminent risk of delivery. * **Contraindication:** Systemic maternal infection (e.g., Chorioamnionitis).

Q: Regarding autoimmune hemolytic anemia in pregnancy, all are true except?

Usually does not respond to steroids.. ### Explanation **Autoimmune Hemolytic Anemia (AIHA)** in pregnancy is a rare but serious condition characterized by the production of autoantibodies against red blood cell (RBC) antigens. **Why Option C is the Correct Answer (The "Except" Statement):** Contrary to the statement, **steroids (Corticosteroids) are the first-line treatment** for AIHA in pregnancy. Most cases are of the "warm-antibody" type (IgG), which typically shows a dramatic response to prednisone. Steroids work by decreasing antibody production and reducing the clearance of antibody-coated RBCs by the splenic macrophages. **Analysis of Other Options:** * **Option A (Direct Coombs Test):** This is the gold standard for diagnosis. A positive Direct Antiglobulin Test (DAT) confirms the presence of antibodies or complement attached to the patient's RBCs. * **Option B (Pregnancy accelerates hemolysis):** Pregnancy is known to exacerbate AIHA. The physiological changes and altered immune state can lead to increased hemolysis, often requiring higher doses of steroids or even blood transfusions. * **Option C (Fetal Microchimerism):** This is a recognized pathogenic theory. The trafficking of fetal cells into the maternal circulation (microchimerism) can trigger an immune dysregulation, leading to the production of aberrant autoantibodies against maternal RBCs. **High-Yield Clinical Pearls for NEET-PG:** * **Warm AIHA:** Most common type in pregnancy; mediated by **IgG**; responds well to steroids. * **Cold AIHA:** Mediated by **IgM**; usually does not respond to steroids; managed by avoiding cold exposure. * **Fetal Risk:** While maternal IgG can cross the placenta, significant fetal hemolysis is rare. However, there is an increased risk of preterm labor and fetal growth restriction (FGR). * **Second-line therapy:** If steroids fail, intravenous immunoglobulin (IVIG) or splenectomy (preferably in the second trimester) may be considered.

Q: Which of the following is NOT a contraindication for a cervical cerclage operation?

Pregnancy beyond 14 weeks. **Explanation:** Cervical cerclage is a surgical procedure used to treat cervical insufficiency by placing a non-absorbable suture around the cervix. The goal is to provide mechanical support and maintain the structural integrity of the cervical canal. **Why Option D is the Correct Answer:** Pregnancy beyond 14 weeks is **not** a contraindication; in fact, it is the standard timing for the procedure. An **Elective (Prophylactic) Cerclage** is typically performed between **12 and 14 weeks** of gestation, after confirming fetal viability and screening for chromosomal abnormalities (NT scan). Cerclage can also be performed as an "Urgent" or "Emergency" procedure up to 24 weeks if cervical shortening or dilation is noted. **Analysis of Incorrect Options (Contraindications):** * **Ruptured Membranes (A):** If the membranes have ruptured, the risk of ascending infection is extremely high, and the procedure will not prevent preterm birth. * **Chorioamnionitis (B):** Intrauterine infection is an absolute contraindication. Placing a stitch in an infected environment can lead to maternal sepsis. * **Vaginal Bleeding (C):** Active bleeding suggests placental abruption or labor. Cerclage in the presence of uterine activity or abruption can lead to cervical laceration or severe hemorrhage. **High-Yield Clinical Pearls for NEET-PG:** * **McDonald’s Operation:** The most common technique; a purse-string suture is placed at the cervicovaginal junction. * **Shirodkar’s Operation:** A submucosal stitch placed higher up at the level of the internal os. * **Indication:** History of ≥3 unexplained second-trimester losses or preterm births. * **Suture Removal:** Usually performed at **36–37 weeks** or immediately if labor begins, to prevent cervical rupture. * **Most common complication:** Preterm Prelabor Rupture of Membranes (PPROM).

Question 1

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 2

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 3

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 4

Which of the following predisposes to placenta previa?

Accepted Answer

Past cesarean pregnancy

Answer

Primigravida

Answer

Singleton pregnancy

Answer

Diabetes mellitus

Question 5

Which of the following is NOT a complication of placenta previa?

Accepted Answer

Rapid dilation of the cervix

Answer

Malpresentation

Answer

Premature labor

Answer

Retained placenta

Question 6

A pregnant lady at 32 weeks' gestation presents with a BP of 160/110 mm Hg, proteinuria, and retinal hemorrhage. What is the definitive management of choice in this case?

Accepted Answer

Termination of pregnancy

Answer

Ritodrine

Answer

Nifedipine

Answer

Magnesium sulfate

Question 7

In a lady at 32 weeks gestation, an injection of dexamethasone is given to prevent which of the following in the newborn?

Accepted Answer

Respiratory Distress Syndrome

Answer

Neonatal convulsion

Answer

Neonatal jaundice

Answer

Cerebral palsy

Question 8

Regarding autoimmune hemolytic anemia in pregnancy, all are true except?

Accepted Answer

Usually does not respond to steroids.

Answer

Direct Coombs test is usually positive.

Answer

Pregnancy accelerates hemolysis.

Answer

Fetal microchimerism results in aberrant antibody production.

Question 9

A 32-week pregnant patient presents with antepartum hemorrhage and unstable vitals (BP 80/60). What is the next step in management?

Accepted Answer

Blood transfusion

Answer

Careful observation

Answer

Medical induction of labor

Answer

Immediate cesarean section

Question 10

Which of the following is NOT a contraindication for a cervical cerclage operation?

Accepted Answer

Pregnancy beyond 14 weeks

Answer

Ruptured membranes

Answer

Signs of chorioamnionitis

Answer

History of vaginal bleeding

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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