Maternal-Fetal Medicine Practice Questions

Q: A 25-year-old lady had tubal rupture due to ectopic pregnancy at 6 weeks. The most common site of rupture of ectopic pregnancy amongst the following is:

2. ***Option 2 (Ampulla)*** - The image shows the **ampulla** of the fallopian tube labeled with '2'. This is the **most common site** for ectopic pregnancies, accounting for approximately **80-90%** of all tubal ectopic pregnancies. - The ampulla is the widest and longest part of the fallopian tube, making it a frequent location for implantation outside the uterus. Despite being wider, rupture is common here due to the thin wall and progressive distension from the growing pregnancy. *Option 1 (Interstitial/Cornual)* - The image points to the **interstitial** (or cornual) portion of the fallopian tube, labeled '1'. This is the **least common site** for ectopic pregnancy, accounting for only **2-4%** of cases. - While rare, rupture here can be **catastrophic** due to proximity to the uterine blood supply and rich vascular anastomoses, leading to severe hemorrhage. *Option 3 (Isthmus)* - The image highlights the **isthmus** of the fallopian tube with '3'. Ectopic pregnancies in the isthmus account for approximately **12%** of cases. - Rupture in the isthmus typically occurs **earlier** (around 6-8 weeks) than in the ampulla due to its narrower lumen and thicker muscular wall, which limits its ability to accommodate the growing pregnancy. *Option 4 (Infundibulum/Fimbriae)* - The image points to the **infundibulum** and **fimbriae**, labeled '4'. Fimbrial ectopic pregnancies are **extremely rare**, accounting for less than **5%** of cases. - The fimbriae are involved in capturing the ovum after ovulation. Implantation here is uncommon and may result in fimbrial abortion rather than rupture.

Q: A 25-year-old presents with amenorrhea of 8 weeks. What does the USG show?

Partial mole. ***Partial mole*** - The ultrasound image shows a **thickened placenta** with **multiple cystic spaces** (vesicles), often described as a "grape-like cluster" or "Swiss cheese" appearance, which is characteristic of a partial hydatidiform mole. - In a partial mole, there is often **fetal tissue present**, which may be seen as a small, abnormal fetus or amniotic sac, although sometimes it can be difficult to identify in early stages or if very rudimentary. *Complete mole* - A **complete mole** would typically show a **uterus filled with hydropic villi** and no evidence of fetal parts or an amniotic sac. - The "snowstorm" appearance due to diffuse hydropic villi is more characteristic of a complete mole, and while there are vesicles here, the presence of what appears to be some organized placental tissue with vesicles within it is more typical of a partial mole. *PCOS* - **Polycystic Ovary Syndrome (PCOS)** is characterized by **multiple small follicles (cysts)** arranged peripherally in the ovaries, and it would not present with this kind of uterine contents, which is clearly a product of conception. - PCOS is a hormonal disorder leading to chronic anovulation and hyperandrogenism, and its ultrasound findings are distinct from placental abnormalities. *Endometrioma* - An **endometrioma** is a type of **ovarian cyst** filled with old blood, presenting as a **homogenous, hypoechoic mass** with internal echoes, often described as a "ground glass" appearance. - This image clearly depicts contents within the uterine cavity related to a pregnancy, not an ovarian cyst.

Q: Between the three studies of fetal umbilical artery velocimetry by Doppler USG, which one will have the highest chances of fetal compromise?

B. ***B*** - Pattern B shows **reversed end-diastolic flow** in the umbilical artery. This indicates severe placental insufficiency and **fetal hypoxemia and acidosis**, signifying the highest risk of fetal compromise and poor perinatal outcomes. - Reversed end-diastolic flow suggests that the fetal heart is working against extremely high resistance in the placenta, leading to a backflow of blood during diastole, which drastically **reduces oxygen and nutrient delivery** to the fetus. *A* - Pattern A shows **absent end-diastolic flow**, meaning there is no forward blood flow through the umbilical artery during diastole. While concerning, it is generally considered less severe than reversed flow. - Absent end-diastolic flow indicates significantly increased placental resistance and is associated with increased fetal morbidity and mortality, but the fetus may still compensate for some time. *C* - Pattern C demonstrates **positive end-diastolic flow**, which is a normal finding in umbilical artery Doppler velocimetry. - The presence of continuous forward flow during diastole indicates normal placental resistance and **adequate blood perfusion** to the fetus. *All of the above equally* - This option is incorrect because the three patterns (A, B, and C) represent different degrees of compromise, with **reversed end-diastolic flow (B) being the most severe**. - A normal Doppler tracing (C) suggests a healthy fetus, while absent (A) and reversed (B) end-diastolic flows signify progressively worse fetal conditions due to placental insufficiency.

Q: A pregnant lady was admitted with diagnosis of PIH for monitoring and bed rest. When lying in supine position, which of the following complications is depicted in the image below?

Supine venocaval syndrome. ***Supine venocaval syndrome*** - The image depicts a pregnant woman lying in a **supine position**, where the **gravid uterus** compresses the **inferior vena cava (IVC)** and potentially the aorta against the vertebral column. - This compression of the IVC leads to reduced venous return to the heart, causing a drop in cardiac output and blood pressure, known as **supine venocaval syndrome** or **aortocaval compression syndrome**. *Abdominal aorta syndrome* - While the aorta can also be compressed in the supine position by the gravid uterus, symptoms primarily arise from **venous compression (IVC)** due to its lower pressure, which is more easily obstructed. - Significant symptoms solely from **aortic compression** are less common than those from IVC compression. *Ascending aorta syndrome* - The **ascending aorta** is located in the chest, not in the abdomen, and would not be compressed by the gravid uterus. - This condition generally refers to issues like ascending aortic aneurysm or dissection, unrelated to uterine compression. *Superior vena cava syndrome* - **Superior vena cava (SVC) syndrome** results from obstruction of the SVC, typically by **mediastinal tumors** or **thrombosis**. - The SVC is in the upper chest and is not affected by the gravid uterus in a supine position.

Q: What procedure is being demonstrated in the image?

Amniocentesis. ***Amniocentesis*** - The image clearly depicts a needle being inserted through the maternal abdomen into the **amniotic sac** to withdraw **amniotic fluid**, which is the procedure for amniocentesis. - This procedure is typically performed for prenatal diagnosis of genetic conditions, **fetal lung maturity assessment**, or to evaluate for uterine infections. *Artificial rupture of membranes* - This procedure involves using a specialized instrument (amniohook) to **break the amniotic sac** through the cervix during active labor to facilitate delivery, which is not what is shown. - The image shows an abdominal approach and aspiration of fluid, not membrane rupture through the vagina. *Fetal scalp pH monitoring* - Fetal scalp pH monitoring involves taking a small **blood sample from the fetal scalp** during labor to assess for fetal acidosis, typically done vaginally and not via abdominal puncture. - The instrument shown is a needle for fluid aspiration, not a blood sampling device or pH electrode. *Paracervical block* - A paracervical block is a regional anesthetic procedure involving injections into the **cervical tissue** to relieve pain during labor, which is not depicted in the image. - The image shows a procedure involving access to the amniotic fluid, not local anesthesia of the cervix.

Q: Increased nuchal translucency is a feature of:

Aneuploidy. ***Aneuploidy*** - Increased nuchal translucency (NT) is a well-established sonographic marker for fetal **aneuploidies**, particularly **Down syndrome (Trisomy 21)**. - The thickened NT reflects underlying fluid accumulation in the fetal neck due to various factors associated with aneuploidy, such as cardiac defects or altered lymphatic drainage. *Hyperploidy* - **Hyperploidy** refers to having more than the normal diploid number of chromosomes; it is a general term that includes aneuploidy. - While increased NT is a feature of conditions under the umbrella of hyperploidy, the term **aneuploidy** is more specific and commonly used in the context of NT screening for chromosomal abnormalities like trisomies. *Hypoploidy* - **Hypoploidy** refers to having fewer than the normal diploid number of chromosomes, such as **monosomy**. - While some hypoploid conditions (e.g., Turner syndrome, which is monosomy X) can be associated with increased NT, it is not the primary or most common genetic abnormality linked to significantly elevated NT measurements compared to aneuploidy in general. *Cystic fibrosis* - **Cystic fibrosis** is an autosomal recessive genetic disorder affecting exocrine glands, leading to mucus build-up in various organs. - It is **not directly associated with increased nuchal translucency** as a primary diagnostic marker; NT is a marker for chromosomal abnormalities and certain structural defects, not single-gene disorders like cystic fibrosis.

Q: A 21-year-old G2P1 presents to OPD at 20 weeks of gestation for a second opinion since her family physician had told her that the foetus had some problem. Her obstetric USG is given below. What is the diagnosis? (AIIMS May 2016)

Anencephaly. ***Anencephaly*** - The ultrasound images clearly show the **absence of the cranial vault** and the **cerebral hemispheres**, which is characteristic of anencephaly. The upper arrow in the right image points to the irregular brain tissue that is exposed, not covered by bone. - The "frog-like" appearance of the fetal head, with exposed brain tissue, is a classic sonographic finding for this neural tube defect. *Cystic hygroma* - A cystic hygroma would appear as a **multiloculated cystic mass**, typically in the posterior neck region, often associated with chromosomal abnormalities. - The image does not show such a cystic mass; instead, it shows a defect in the fetal skull. *Omphalocele* - An omphalocele involves the **protrusion of abdominal organs** into the umbilical cord base, covered by a membrane. - This condition affects the abdominal wall, not the fetal head or brain, and would appear as an abdominal mass rather than a cranial defect. *Encephalocele* - Encephalocele is characterized by the **protrusion of brain tissue and/or meninges** through a defect in the skull, typically covered by skin or a membrane. - In encephalocele, while some brain tissue might protrude, the **cranial vault is still visible**, unlike the complete absence seen in anencephaly.

Q: Which of the following maternal complications can be seen in hyperemesis gravidarum? I. Wernicke's encephalopathy II. Hepatic failure III. Hypoprothrombinemia IV. Convulsions Select the correct answer using the code given below :

I, III and IV only. ***Correct Option: I, III and IV only*** - **Hyperemesis gravidarum** can lead to severe metabolic derangements and nutrient deficiencies, resulting in multiple maternal complications. - **Wernicke's encephalopathy** occurs due to **thiamine (vitamin B1) deficiency** from prolonged vomiting and malnutrition, presenting with confusion, ataxia, and ophthalmoplegia. - **Hypoprothrombinemia** develops due to **vitamin K deficiency**, which can lead to coagulopathy and bleeding complications. - **Convulsions** can occur secondary to severe **electrolyte imbalances** (particularly hyponatremia, hypocalcemia) or metabolic derangements. *Incorrect Option: I, II, III and IV* - This option incorrectly includes **hepatic failure** as a complication of hyperemesis gravidarum. - While **mild transient elevation of liver enzymes** (transaminitis) can occur in hyperemesis gravidarum, **true hepatic failure does NOT occur**. - Hepatic failure in pregnancy is associated with other distinct conditions like **acute fatty liver of pregnancy (AFLP)** or **HELLP syndrome**, not hyperemesis gravidarum. *Incorrect Option: I, II and IV only* - This option incorrectly includes **hepatic failure**, which is not a recognized complication of hyperemesis gravidarum. - It also incorrectly excludes **hypoprothrombinemia**, which can occur due to vitamin K deficiency in severe cases. *Incorrect Option: II and III only* - This option is incorrect as it includes **hepatic failure** (which does not occur in hyperemesis gravidarum). - It also incorrectly excludes **Wernicke's encephalopathy** and **convulsions**, which are well-recognized severe complications of hyperemesis gravidarum.

Q: Twin pregnancy should have ultrasound at 10-13 weeks to confirm which of the following? I. Number of foetus II. Viability of foetus III. Chorionicity of twins IV. Malformation in either foetus Select the correct answer using the code given below :

I, II and III only. ***I, II and III only*** - A **first-trimester ultrasound** (10-13 weeks) in a twin pregnancy is essential for confirming the **number of fetuses**, assessing their **viability** (cardiac activity), and most importantly determining the **chorionicity of twins**. - **Chorionicity determination** is crucial at this stage as it guides the entire pregnancy management - monochorionic twins require more intensive surveillance due to higher risks. - While nuchal translucency screening for chromosomal abnormalities is performed at 11-13+6 weeks, **systematic structural malformation screening is NOT the primary objective** of the first-trimester scan and is typically performed at **18-22 weeks**. *I and III only* - While confirming the **number of fetuses** and **chorionicity** is essential, this option incorrectly omits the assessment of **fetal viability**. - Confirming cardiac activity and viability of both fetuses is a fundamental component of the first-trimester ultrasound examination. *II and IV only* - This option fails to include the most critical aspects of first-trimester twin ultrasound: confirming the **number of fetuses** and determining **chorionicity**. - Additionally, **malformation screening** is NOT a primary objective at 10-13 weeks; detailed anomaly scanning is performed in the second trimester (18-22 weeks). *I, II, III and IV* - While this option correctly includes fetal number, viability, and chorionicity determination, it incorrectly adds **malformation screening** as a primary objective. - **Structural anomaly scanning** is performed during the **mid-trimester ultrasound (18-22 weeks)**, not at 10-13 weeks, when organ development is more complete and detailed anatomical survey is possible.

Q: Which of the following is the primary surveillance tool in the growth-restricted fetus?

Umbilical artery Doppler. ***Umbilical artery Doppler*** - The **umbilical artery Doppler** is the primary tool for fetal surveillance in **growth-restricted fetuses** because it directly assesses **placental resistance** and **blood flow** to the fetus. - Abnormal findings, such as **increased resistance** or **absent/reversed end-diastolic flow**, indicate **placental insufficiency** and are key indicators for intervention. *Umbilical venous pulsation* - **Umbilical venous pulsation** can be a sign of **cardiac dysfunction** in the fetus but is considered a **late and severe sign** of fetal compromise, not a primary surveillance tool. - Its presence usually indicates significant **cardiac overload** or **venous congestion**, suggesting advanced stages of fetal distress. *Uterine artery Doppler* - **Uterine artery Doppler** is primarily used for **screening** for preeclampsia and fetal growth restriction in the **second trimester**, not as a primary surveillance tool once growth restriction is established. - It assesses **placental bed development** and **maternal uterine blood flow** but doesn't directly monitor the fetal response to placental insufficiency. *Middle cerebral artery Doppler* - **Middle cerebral artery (MCA) Doppler** is used to assess for **brain-sparing effect** in growth-restricted fetuses, indicating the fetus is shunting blood to the brain due to hypoxia. - While important for evaluating the severity of compromise, it is a **secondary surveillance tool** for brain perfusion, not the primary measure of placental function.

Question 1

A 25-year-old lady had tubal rupture due to ectopic pregnancy at 6 weeks. The most common site of rupture of ectopic pregnancy amongst the following is:

Accepted Answer

2

Answer

1

Answer

3

Answer

4

Question 2

A 25-year-old presents with amenorrhea of 8 weeks. What does the USG show?

Accepted Answer

Partial mole

Answer

Complete mole

Answer

Endometrioma

Answer

PCOS

Question 3

Between the three studies of fetal umbilical artery velocimetry by Doppler USG, which one will have the highest chances of fetal compromise?

Accepted Answer

B

Answer

A

Answer

C

Answer

All of the above equally

Question 4

A pregnant lady was admitted with diagnosis of PIH for monitoring and bed rest. When lying in supine position, which of the following complications is depicted in the image below?

Accepted Answer

Supine venocaval syndrome

Answer

Abdominal aorta syndrome

Answer

Ascending aorta syndrome

Answer

Superior vena cava syndrome

Question 5

What procedure is being demonstrated in the image?

Accepted Answer

Amniocentesis

Answer

Artificial rupture of membranes

Answer

Fetal scalp pH monitoring

Answer

Paracervical block

Question 6

Increased nuchal translucency is a feature of:

Accepted Answer

Aneuploidy

Answer

Hyperploidy

Answer

Hypoploidy

Answer

Cystic fibrosis

Question 7

A 21-year-old G2P1 presents to OPD at 20 weeks of gestation for a second opinion since her family physician had told her that the foetus had some problem. Her obstetric USG is given below. What is the diagnosis? (AIIMS May 2016)

Accepted Answer

Anencephaly

Answer

Cystic hygroma

Answer

Omphalocele

Answer

Encephalocele

Question 8

Which of the following maternal complications can be seen in hyperemesis gravidarum?
I. Wernicke's encephalopathy
II. Hepatic failure
III. Hypoprothrombinemia
IV. Convulsions

Select the correct answer using the code given below :

Accepted Answer

I, III and IV only

Answer

I, II, III and IV

Answer

I, II and IV only

Answer

II and III only

Question 9

Twin pregnancy should have ultrasound at 10-13 weeks to confirm which of the following?
I. Number of foetus
II. Viability of foetus
III. Chorionicity of twins
IV. Malformation in either foetus

Select the correct answer using the code given below :

Accepted Answer

I, II and III only

Answer

I and III only

Answer

II and IV only

Answer

I, II, III and IV

Question 10

Which of the following is the primary surveillance tool in the growth-restricted fetus?

Accepted Answer

Umbilical artery Doppler

Answer

Umbilical venous pulsation

Answer

Uterine artery Doppler

Answer

Middle cerebral artery Doppler

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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