Maternal-Fetal Medicine Practice Questions

Q: The image shows the X-ray abdomen of a 30-yearold SLE patient, who cannot feel her baby moving for the past 7 days. All are correct about the condition shown except:

Elevated fibrinogen. ***Elevated fibrinogen*** - This is the **INCORRECT** statement (answer to this EXCEPT question). - In fetal demise with retained dead fetus, fibrinogen levels typically **DECREASE, not increase**. - **Hypofibrinogenemia** occurs due to **consumption coagulopathy** from the release of thromboplastic substances from dead fetal tissue into maternal circulation. - If the dead fetus is retained for prolonged periods (>4-5 weeks), there is risk of **DIC (Disseminated Intravascular Coagulation)** with depletion of clotting factors including fibrinogen. - While SLE itself may have inflammatory markers, the statement "elevated fibrinogen" does not apply to the fetal demise scenario shown. *Hyperflexion of spine* - **CORRECT** finding in fetal demise with Spalding's sign. - The X-ray shows **overlapping of fetal skull bones** (Spalding's sign) indicating fetal death. - Loss of **fetal muscle tone** after death causes the spine to become **hyperflexed and curled**, visible on imaging. - This is a characteristic radiological finding of retained dead fetus. *Single fetus* - **CORRECT** observation from the X-ray. - The image clearly shows skeletal structures of **one fetus only**. - The fetal skull and spine outline confirm a single intrauterine fetal demise. *Anti-Beta 2 glycoprotein antibody* - **CORRECT** association in this clinical scenario. - Patient has **SLE** with fetal demise, strongly suggesting **Antiphospholipid Syndrome (APS)**. - **Anti-β2-glycoprotein I antibodies** are one of the diagnostic criteria for APS. - APS causes **recurrent pregnancy loss** and **fetal death after 10 weeks** due to **placental thrombosis**. - This antibody should be tested in SLE patients with adverse pregnancy outcomes.

Q: A gynecologist noted that fetal head is difficult to push down into the pelvis at 36 weeks of gestation. Antenatal USG done shows presence of:

Congenital hydrocephalus. ***Congenital hydrocephalus*** - The ultrasound image shows significantly **enlarged ventricles (V)** indicated by the arrows, which is characteristic of **hydrocephalus**. - **Fetal head pushing down into the pelvis** in late pregnancy can be difficult if the head is abnormally large due to hydrocephalus, making it a plausible finding. *Snowstorm appearance of antenatal USG* - A **snowstorm appearance** on antenatal ultrasound is pathognomonic for **complete hydatidiform mole**, which is a placental abnormality, not a fetal head anomaly. - This finding would not explain difficulty pushing the fetal head into the pelvis. *Spinal dysraphism* - **Spinal dysraphism** involves malformations of the spinal cord and its coverings (e.g., spina bifida), and while it can be associated with hydrocephalus (e.g., Arnold-Chiari malformation), the primary USG finding for dysraphism itself is a defect in the spine. - The image provided specifically highlights **enlarged cerebral ventricles**, not a spinal defect. *Increased nuchal translucency* - **Increased nuchal translucency** refers to an abnormal accumulation of fluid behind the fetal neck in the first trimester, typically associated with chromosomal abnormalities like **Down syndrome** or cardiac defects. - While an important early marker, it is not directly related to difficulty descending the fetal head or the ventricular enlargement seen in the image.

Q: The following diagram shows:

Concealed abruptio. ***Concealed abruptio*** - The image shows **blood pooling behind the placenta** with no visible external bleeding. This is the hallmark of a **concealed placental abruption** (abruptio placentae). - In this type, blood collects between the placenta and uterine wall (retroplacental hematoma), with no passage through the cervix, increasing intramyometrial pressure and risk of severe maternal-fetal complications. - Accounts for approximately **20% of placental abruptions** and is associated with more severe outcomes due to lack of external warning signs. *Revealed abruptio* - In a revealed abruption (external hemorrhage), the **blood escapes through the cervix** and is visible externally as vaginal bleeding. - This is the most common presentation (~80% of cases), where the hemorrhage tracks downward between the membranes and uterine wall. - While still serious, external bleeding allows for earlier clinical recognition compared to concealed abruption. *Subchorionic abruptio* - This is **not standard medical terminology**. The correct term is either "subchorionic hematoma" (bleeding between chorion and decidua) or "retroplacental hematoma." - Subchorionic hematomas are typically seen in early pregnancy and represent a different entity from acute placental abruption. - The image shows classic concealed abruption with retroplacental blood collection, not a subchorionic collection. *Subamniotic abruptio* - This is **not a recognized classification** of placental abruption in standard obstetric terminology. - Placental abruption is classified as concealed (no external bleeding), revealed (external bleeding), or mixed based on the pathway of blood. - "Subamniotic" would theoretically mean beneath the amnion, which does not describe the pathophysiology of placental separation from the decidua basalis.

Q: The optical density of amniotic fluid at 450 nm peak was plotted on Liley's chart and falls in zone marked as C. Which of the following statements is correct?

Fetus is severely affected. ***Fetus is severely affected*** - A reading falling in **Zone C** on **Liley's chart** indicates a significantly increased concentration of bilirubin in the amniotic fluid. - This high bilirubin level is a direct marker of **severe hemolytic disease in the fetus**, requiring immediate intervention. *Fetus is unlikely to be affected* - This statement is incorrect because Zone A indicates mild or no hemolysis, and Zone B indicates moderate disease. **Zone C** explicitly signifies **severe fetal affection**. - A finding in Zone C rules out the possibility of the fetus being unaffected or only mildly affected by hemolytic disease. *Repeat amniocentesis after 2 weeks* - Given the severity indicated by Zone C, waiting two weeks for a repeat amniocentesis would be too long and could delay critical interventions. - Immediate action, such as **frequent monitoring**, **intrauterine transfusion**, or **early delivery**, is typically required when findings are in Zone C. *Recalibrate the colorimeter used for measuring optical density* - While proper calibration is crucial for accurate results, assuming a calibration error is the cause without further evidence is inappropriate, especially with a critical finding. - The primary interpretation of a Zone C result is severe fetal compromise, not simply a measurement error; thus, immediate clinical response is warranted rather than re-calibration.

Q: The following curve is used in evaluation of:

Rh incompatibility. ***Rh incompatibility*** - The curve shown represents **spectrophotometric analysis of amniotic fluid at 450 nm (ΔOD450)**, known as the **Liley curve** or **Queenan curve**. - This measures **bilirubin concentration** in amniotic fluid to assess the **severity of fetal hemolytic anemia** in **Rh isoimmunization**. - The ΔOD450 value is plotted against gestational age to categorize disease severity into zones (Liley zones 1, 2, and 3) and guide management decisions regarding timing of delivery or intrauterine transfusion. - This is the **gold standard** for monitoring fetuses at risk of hemolytic disease of the newborn. *Fetal maturity* - Fetal lung maturity is assessed using different amniotic fluid tests: **lecithin/sphingomyelin (L/S) ratio**, **phosphatidylglycerol (PG)**, **foam stability index**, or **lamellar body count**. - These tests measure surfactant components, not bilirubin, and do NOT use ΔOD450 spectrophotometry. - While both involve amniotic fluid analysis, the techniques and purposes are completely different. *Nonprogression of labor* - Labor progression is monitored using a **partogram** (cervicograph), which plots cervical dilation and fetal descent against time. - This has no relation to amniotic fluid spectrophotometry. *Fetal distress* - Fetal distress is evaluated using **continuous fetal heart rate monitoring (cardiotocography)**, **biophysical profile**, and **umbilical artery Doppler**. - While severe fetal anemia from Rh disease can cause distress, the ΔOD450 curve specifically assesses the underlying hemolytic process, not acute distress.

Q: For the formation of the shown monozygotic twins, division should take place by

>14 days. ***>14 days*** - The image shows **conjoined twins**, which results from an incomplete separation of a single zygote. - This very late and incomplete division occurs when the zygote splits after **more than 14 days** post-fertilization, after the formation of the embryonic disc. *<3 days* - Division within the first three days results in **dichorionic-diamniotic twins**, meaning each twin has its own chorion and amnion. - This scenario would show **two separate placentas** and two distinct amniotic sacs. *4-8 days* - Division between 4 and 8 days typically leads to **monochorionic-diamniotic twins**, where twins share a placenta but have separate amniotic sacs. - The image depicts a shared sac and an incomplete division of the embryo itself. *8-14 days* - Division between 8 and 14 days results in **monochorionic-monoamniotic twins**, where twins share both a placenta and an amniotic sac. - While sharing a sac, this period usually leads to two distinct, non-conjoined fetuses within that single sac.

Q: What is the type of placenta previa shown below?

Type 4. ***Type 4*** - Type 4 placenta previa, also known as **complete or central placenta previa**, occurs when the **placenta completely covers the internal cervical os**. - This type necessitates a **cesarean section** delivery due to the complete obstruction of the birth canal. *Type 1* - Type 1 placenta previa, or **low-lying placenta**, means the placenta is in the lower uterine segment but **does not reach the cervical os**. - It often resolves by term as the uterus grows, potentially allowing a **vaginal delivery**. *Type 2* - Type 2 placenta previa, or **marginal placenta previa**, indicates the placental edge **reaches the internal cervical os** but does not cover it. - While a vaginal delivery might be possible, there's an increased risk of **hemorrhage**. *Type 3* - Type 3 placenta previa, or **partial placenta previa**, is where the placenta **partially covers the internal cervical os** but not completely. - This type also typically requires a **cesarean section** due to the obstruction.

Q: Vasa previa is a complication of which of the following types of placenta?

All of these. ***All of these*** - **Vasa previa** is a condition where fetal blood vessels run through the membranes covering the internal cervical os, unprotected by placental tissue or umbilical cord. - It is associated with **velamentous cord insertion** (most common), where the umbilical cord inserts into the fetal membranes rather than directly into the placental mass, leaving vessels exposed. - **Succenturiate (accessory) lobe** can also lead to vasa previa when connecting vessels between the main placenta and accessory lobe cross over the cervical os. - **Bilobed placenta** may have communicating vessels between the two lobes that traverse the lower uterine segment. - All these placental abnormalities increase the risk of vasa previa, which can cause catastrophic fetal hemorrhage if the vessels rupture during labor or membrane rupture. *Note: The images demonstrate these placental variations associated with vasa previa.*

Q: Which of the following is correct about the placenta shown below? (Recent NEET Pattern 2016-17)

Battledore placenta. ***Battledore placenta*** - This image depicts a **marginal insertion of the umbilical cord** into the placenta, where the cord attaches to the edge rather than the center or a more central part of the placental disc. This is characteristic of a battledore placenta. - The name "battledore" refers to the resemblance of the placenta and cord to a **tennis racket (battledore)**, where the cord is the handle and the placenta is the head. *Velamentous cord insertion* - In velamentous insertion, the **umbilical vessels diverge in the membranes before reaching the placental disc**, making them unprotected. - In this image, the cord clearly inserts into the edge of the placenta, rather than having vessels spread out in the membranes. *Placental chorioangioma* - A placental chorioangioma is a **benign tumor of the placenta**, characterized by an abnormal proliferation of fetal vessels within the chorionic villi. - This condition is a **mass within the placenta** itself and is not depicted by an anomalous cord insertion pattern. *Circumvallate placenta* - A circumvallate placenta has a **thickened, rolled amnion and chorion** due to a fold of the fetal membranes on the fetal side limiting the expansion of the placenta. - This describes a **membrane abnormality** affecting the shape of the placenta, not directly related to the cord insertion site shown.

Q: What is the type of placenta shown below?

Battledore placenta. ***Battledore placenta*** - The image clearly displays the **umbilical cord inserted into the margin** of the placenta, which is the defining characteristic of a battledore placenta (also known as a marginal cord insertion). - This type of insertion is generally benign but can be associated with some complications, such as **intrauterine growth restriction (IUGR)** or **preterm birth**. *Velamentous placenta* - In a **velamentous insertion**, the umbilical cord inserts into the **chorioamniotic membranes** some distance from the placental margin. - The umbilical vessels then travel unprotected within the membranes before reaching the placental disc, increasing the risk of **vasa previa** and fetal hemorrhage. *Placental chorioangioma* - A **chorioangioma** is a benign vascular tumor of the placenta that appears as a well-defined mass of varying size. - It is not a type of placental insertion and typically presents as a **focal lesion** within the placental tissue, which is not depicted in the image. *Circumvallate placenta* - A **circumvallate placenta** is characterized by a double fold of amnion and chorion around the fetal surface of the placenta, causing a thick, raised ring at the margin where the chorionic plate ends. - This morphology is distinctly different from the marginal cord insertion shown in the image.

Question 1

The image shows the X-ray abdomen of a 30-yearold SLE patient, who cannot feel her baby moving for the past 7 days. All are correct about the condition shown except:

Accepted Answer

Elevated fibrinogen

Answer

Hyperflexion of spine

Answer

Single fetus

Answer

Anti-Beta 2 glycoprotein antibody

Question 2

A gynecologist noted that fetal head is difficult to push down into the pelvis at 36 weeks of gestation. Antenatal USG done shows presence of:

Accepted Answer

Congenital hydrocephalus

Answer

Snowstorm appearance of antenatal USG

Answer

Spinal dysraphism

Answer

Increased nuchal translucency

Question 3

The following diagram shows:

Accepted Answer

Concealed abruptio

Answer

Revealed abruptio

Answer

Subchorionic abruptio

Answer

Subamniotic abruptio

Question 4

The optical density of amniotic fluid at 450 nm peak was plotted on Liley's chart and falls in zone marked as C. Which of the following statements is correct?

Accepted Answer

Fetus is severely affected

Answer

Fetus is unlikely to be affected

Answer

Repeat amniocentesis after 2 weeks

Answer

Recalibrate the colorimeter used for measuring optical density

Question 5

The following curve is used in evaluation of:

Accepted Answer

Rh incompatibility

Answer

Nonprogression of labor

Answer

Fetal distress

Answer

Fetal maturity

Question 6

For the formation of the shown monozygotic twins, division should take place by

Accepted Answer

>14 days

Answer

<3 days

Answer

4-8 days

Answer

8-14 days

Question 7

What is the type of placenta previa shown below?

Accepted Answer

Type 4

Answer

Type 1

Answer

Type 2

Answer

Type 3

Question 8

Vasa previa is a complication of which of the following types of placenta?

Accepted Answer

All of these

Answer

Velamentous insertion of cord

Answer

Succenturiate lobe

Answer

Bilobed placenta

Question 9

Which of the following is correct about the placenta shown below? (Recent NEET Pattern 2016-17)

Accepted Answer

Battledore placenta

Answer

Velamentous cord insertion

Answer

Placental chorioangioma

Answer

Circumvallate placenta

Question 10

What is the type of placenta shown below?

Accepted Answer

Battledore placenta

Answer

Velamentous placenta

Answer

Placental chorioangioma

Answer

Circumvallate placenta

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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