Maternal-Fetal Medicine Practice Questions

Q: The maximum chances of HIV infection being transmitted to the fetus/infant in an HIV infected mother are during

During labour. ***During labour*** - The **highest risk** of mother-to-child HIV transmission occurs during labor and delivery due to the infant's exposure to maternal blood and genital secretions. - The process of passing through the **birth canal** can lead to inoculation with HIV-infected cells and viral particles. *Third trimester* - While some transmission can occur in the third trimester, the risk is significantly **lower** than during labor. - The placenta generally provides a barrier, though there's a risk of **transplacental passage** if the placental integrity is compromised. *First trimester* - The **lowest risk** of HIV transmission occurs during the first trimester. - The developing fetus is relatively protected by the placenta, and the viral load in maternal blood might be lower compared to later stages without intervention. *During breast feeding* - **Breastfeeding** is a known route of HIV transmission, but its risk is generally **lower per exposure** compared to labor and delivery, especially if the mother is on antiretroviral therapy. - The risk is **cumulative** over the duration of breastfeeding.

Q: Which of the following statements is true for maternal rubella infection?

The primary infection is responsible for birth defects. ***The primary infection is responsible for birth defects*** - **Primary maternal rubella infection** during pregnancy is the primary cause of congenital rubella syndrome, as the virus can cross the placenta and infect the developing fetus. - The risk and severity of **birth defects** are highest when the mother is infected during the first trimester. *24% incidence of congenital infection if acquired during the last month of pregnancy* - While rubella infection late in pregnancy can still lead to fetal infection, the incidence of **congenital rubella syndrome** is significantly lower in the last trimester (typically less than 1%) compared to the first trimester. - The reported incidence of 24% is excessively high for an infection acquired in the **last month of pregnancy**. *It leads to abortions before 16 weeks of gestation* - While **rubella infection** can increase the risk of spontaneous abortion, especially if acquired early in pregnancy, it is not the *only* or *guaranteed* outcome. Many infected pregnancies continue to term with varying degrees of fetal compromise. - The statement suggests a direct and absolute causal link to abortion before 16 weeks, which is too definitive. *It causes blindness with recurrent infection* - **Congenital rubella syndrome** can cause ocular defects such as **cataracts**, **glaucoma**, and **retinopathy**, which can lead to blindness. - However, rubella infection typically confers **lifelong immunity**, making **recurrent infection** extremely rare and thus not a common mechanism for causing blindness.

Q: What is the commonest cause of retention of urine at 12-14 weeks of pregnancy ?

Retroverted gravid uterus. ***Retroverted gravid uterus*** - A **retroverted uterus** can become "trapped" in the pelvis as it enlarges during pregnancy, causing the **cervix to push against the urethra, leading to outflow obstruction**. - This typically occurs between **12-14 weeks of gestation** before the uterus ascents out of the pelvis. *Diminished bladder tone* - While bladder tone can be affected in pregnancy, it's not the primary or most common cause of **acute urinary retention** at this specific gestational age. - **Decreased bladder sensation** and volume capacity changes are more gradual and less likely to cause acute retention until later stages. *Prolapse of uterus* - **Uterine prolapse** is more common in **multiparous women** and tends to cause symptoms like pressure, discomfort, and potentially urinary incontinence, rather than acute retention, particularly in early pregnancy. - A prolapsed uterus is usually located **lower in the pelvic cavity**, which would not typically obstruct the urethra in the manner of a retroverted uterus. *Impacted pelvic tumour* - An **impacted pelvic tumour** could cause urinary retention, but it is a **less common cause** than a retroverted gravid uterus in the context of a healthy 12-14 week pregnancy. - This would be a more serious and typically pre-existing condition, often with other associated symptoms, and not a physiological consequence of pregnancy.

Q: The following conditions are associated with molar pregnancy except:

Gestational diabetes. **Gestational diabetes** - Gestational diabetes is not directly associated with a **molar pregnancy**. Its pathogenesis is related to **insulin resistance** and pancreatic beta-cell dysfunction during pregnancy. - While both conditions can occur during pregnancy, there is no increased risk of gestational diabetes in the presence of a molar pregnancy. *Thyrotoxicosis* - **Molar pregnancies** produce very high levels of **human chorionic gonadotropin (hCG)**, which has a structural similarity to thyroid-stimulating hormone (TSH). - This high hCG can stimulate the thyroid gland, leading to **hyperthyroidism** or thyrotoxicosis in some patients. *Hyperemesis gravidarum* - The extremely high levels of **hCG** produced in a **molar pregnancy** are strongly linked to the severity of nausea and vomiting experienced during pregnancy. - This often manifests as **hyperemesis gravidarum**, which is more common and severe in molar pregnancies due to the exaggerated hormonal response. *Pregnancy induced hypertension* - Patients with **molar pregnancies** are at an increased risk of developing **pregnancy-induced hypertension (PIH)**, often presenting earlier in gestation than typical pre-eclampsia. - The precise mechanism is thought to involve the abnormal placental development and exaggerated maternal inflammatory response associated with molar tissue.

Q: A pregnant woman in third trimester has normal blood pressure in the arms when standing and sitting but drops to 90/50 when lying down. What is the likely cause?

Compression of inferior vena cava. ***Compression of inferior vena cava*** - In the third trimester, the **gravid uterus** can compress the **inferior vena cava (IVC)** when the woman lies supine, reducing **venous return** to the heart. - This decreased preload leads to a drop in **cardiac output** and consequently a fall in **blood pressure** (supine hypotensive syndrome). *Compression of uterine artery* - Compression of the uterine artery would primarily affect **placental blood flow** and fetal well-being, but it is not the direct cause of the mother's systemic hypotension. - **Uterine artery compression** does not significantly impact overall systemic blood pressure in the mother. *Compression of aorta* - While the gravid uterus can compress the **aorta** (aortocaval compression), this typically leads to reduced blood flow to the lower extremities and uterus, not a generalized drop in systemic blood pressure, as collateral circulation usually compensates. - **Aortic compression** can cause a difference in blood pressure between the upper and lower extremities, but the scenario describes a drop in overall systemic pressure when recumbent. *Compression of internal iliac artery* - Compression of the internal iliac artery would mainly affect blood supply to the **pelvic organs** and gluteal region, but it does not account for the significant drop in systemic blood pressure observed in the supine position. - This compression would not cause a generalized reduction in **venous return** to the heart, which is the primary mechanism for supine hypotension.

Q: A 30-year-old woman presents with three-month amenorrhoea, pain abdomen for the last two days and fainting attacks for the last eight hours. On examination, her pulse rate is 102/min, and she has (1+) pallor. On abdominal palpation, she has tenderness. She is provisionally diagnosed with ectopic pregnancy. The most likely site of implantation within the fallopian tube is in the

Ampullary region of the tube. ***Ampullary region of the tube*** - The **ampulla** is the **widest and most tortuous part** of the fallopian tube, making it the most common site for egg fertilization and subsequent **ectopic implantation** (around 70-80% of cases). - Its larger lumen initially accommodates the growing embryo, but eventually, rupture and symptoms like **abdominal pain, amenorrhea**, and **fainting** (due to hemorrhage) occur. *Interstitial region of the tube* - Implantation in the **interstitial portion** (within the uterine wall) is less common but carries the highest risk of **massive hemorrhage** as it is surrounded by a rich vascular supply from the uterus. - Rupture usually occurs later, and symptoms can be more catastrophic due to its proximity to the uterine vessels. *Isthmic region of the tube* - The **isthmus** is the **narrowest part** of the fallopian tube. Ectopic pregnancies here are less common than in the ampulla but tend to rupture earlier due to the limited space. - Symptoms often present acutely and earlier in gestation compared to ampullary pregnancies due to the confined space. *Infundibular region of the tube* - Implantation in the **infundibulum** (fimbrial end) is the rarest site of tubal ectopic pregnancy, often described as an **abdominal pregnancy** if the ovum expels from the tube and implants elsewhere in the abdomen. - This location presents unique diagnostic and management challenges, often leading to later diagnosis and atypical symptoms.

Q: The incidence of congenital fetal anomalies is highest when a pregnancy is complicated by

Maternal diabetes. ***Maternal diabetes*** - **Poorly controlled maternal diabetes** significantly increases the risk of various congenital anomalies due to the teratogenic effects of hyperglycemia. - This includes defects like **sacral agenesis**, cardiovascular malformations, neural tube defects, and renal anomalies. *Hydramnios detectable on clinical examination* - **Hydramnios (polyhydramnios)**, an excess of amniotic fluid, is often associated with fetal anomalies, particularly those affecting swallowing (e.g., esophageal atresia) or urination. - However, it is a *marker* or *consequence* of a potential anomaly, rather than the primary cause of the highest incidence of anomalies. *Congenital heart disease of the mother* - While maternal congenital heart disease can influence pregnancy outcomes and may have a genetic component, it does not, by itself, lead to the highest overall incidence of *fetal congenital anomalies* compared to uncontrolled diabetes. - The risk of congenital heart disease in the fetus of a mother with congenital heart disease is increased, but this is a specific risk, not a broad increase in all anomalies. *Intrauterine growth retardation of the foetus* - **Intrauterine growth restriction (IUGR)** is a condition where the fetus is smaller than expected for its gestational age and is a common complication in pregnancies with underlying issues. - IUGR can be *caused* by placental insufficiency, genetic disorders, or infections, some of which may also cause congenital anomalies, but IUGR itself is not the condition that directly leads to the highest incidence of congenital anomalies.

Q: In the rhesus-negative mothers, the factors which influence the development of rhesus incompatibility include all except

Maternal age >35 years. ***Maternal age >35 years*** - **Maternal age** is not a direct factor influencing the development or severity of Rh incompatibility. The immune response to fetal Rh antigens is independent of the mother's age. - Rh sensitization occurs due to fetal-maternal hemorrhage, causing the mother's immune system to produce **antibodies** against Rh-positive red blood cells, which is not age-dependent. *Amniocentesis* - **Amniocentesis** can lead to **fetal-maternal hemorrhage** by puncturing the placental or fetal vessels, introducing fetal red blood cells into the maternal circulation. - This exposure can trigger the formation of **anti-D antibodies** in an Rh-negative mother if the fetus is Rh-positive, thereby increasing the risk of sensitization. *Incoordinate uterine action* - **Incoordinate uterine action**, especially during labor, can increase the risk of **fetal-maternal hemorrhage** due to increased uterine manipulation, trauma, or prolonged labor, leading to greater placental surface disruption. - Greater exposure to fetal red blood cells then enhances the likelihood of **Rh sensitization** in an Rh-negative mother carrying an Rh-positive fetus. *Placental abruption* - **Placental abruption**, the premature separation of the placenta from the uterine wall, significantly increases the risk of **fetal-maternal hemorrhage**. - A larger volume of fetal blood entering the maternal circulation substantially elevates the chances of an Rh-negative mother becoming **sensitized** and developing **anti-D antibodies**.

Q: A 30-year-old woman with history of previous three abortions, has been found to have antiphospholipid antibodies. What will be the treatment of choice in the subsequent pregnancy?

Aspirin and Heparin. ***Aspirin and Heparin*** - A history of recurrent abortions with positive **anti-phospholipid antibodies** indicates **antiphospholipid syndrome (APS)**. The combination of **aspirin** and **heparin (low molecular weight heparin is preferred)** is the treatment of choice to prevent further thrombotic events, including miscarriage, in pregnant women with APS. - Aspirin helps **reduce platelet aggregation**, while heparin **anticoagulates** by inhibiting clotting factors, thereby improving pregnancy outcomes. *Corticosteroids* - Corticosteroids like **prednisone** may be used in specific autoimmune conditions where inflammation is a primary concern, but they are not the primary treatment for preventing thrombotic events in APS and can have significant side effects in pregnancy. - They are generally reserved for cases with refractory symptoms or other autoimmune comorbidities. *Aspirin* - While **low-dose aspirin** is part of the treatment regimen for APS in pregnancy, it is **insufficient on its own** to prevent recurrent pregnancy losses associated with the thrombotic complications of the syndrome. - Aspirin primarily inhibits **platelet aggregation**, but **heparin** is crucial for its additional anticoagulation effects to address the hypercoagulable state. *Heparin* - **Heparin (low molecular weight)** is a critical component of treatment for APS in pregnancy to prevent thrombosis. However, it is optimally used in combination with **low-dose aspirin**. - Using heparin alone might not fully address all aspects of the prothrombotic state in APS, especially those related to platelet activation.

Question 1

Which one of the following statements is not correct about obstetric cholestasis ?

Accepted Answer

Associated with markedly high bilirubin and raised liver enzymes

Answer

It results in pruritus without rash

Answer

It is an indication of termination of pregnancy at 37 weeks

Answer

Risk of recurrence is high in future pregnancies

Question 2

The maximum chances of HIV infection being transmitted to the fetus/infant in an HIV infected mother are during

Accepted Answer

During labour

Answer

Third trimester

Answer

First trimester

Answer

During breast feeding

Question 3

Which of the following statements is true for maternal rubella infection?

Accepted Answer

The primary infection is responsible for birth defects

Answer

24% incidence of congenital infection if acquired during the last month of pregnancy

Answer

It leads to abortions before 16 weeks of gestation

Answer

It causes blindness with recurrent infection

Question 4

What is the commonest cause of retention of urine at 12-14 weeks of pregnancy ?

Accepted Answer

Retroverted gravid uterus

Answer

Diminished bladder tone

Answer

Prolapse of uterus

Answer

Impacted pelvic tumour

Question 5

The following conditions are associated with molar pregnancy except:

Accepted Answer

Gestational diabetes

Answer

Thyrotoxicosis

Answer

Hyperemesis gravidarum

Answer

Pregnancy induced hypertension

Question 6

A pregnant woman in third trimester has normal blood pressure in the arms when standing and sitting but drops to 90/50 when lying down. What is the likely cause?

Accepted Answer

Compression of inferior vena cava

Answer

Compression of uterine artery

Answer

Compression of aorta

Answer

Compression of internal iliac artery

Question 7

A 30-year-old woman presents with three-month amenorrhoea, pain abdomen for the last two days and fainting attacks for the last eight hours. On examination, her pulse rate is 102/min, and she has (1+) pallor. On abdominal palpation, she has tenderness. She is provisionally diagnosed with ectopic pregnancy. The most likely site of implantation within the fallopian tube is in the

Accepted Answer

Ampullary region of the tube

Answer

Interstitial region of the tube

Answer

Isthmic region of the tube

Answer

Infundibular region of the tube

Question 8

The incidence of congenital fetal anomalies is highest when a pregnancy is complicated by

Accepted Answer

Maternal diabetes

Answer

Hydramnios detectable on clinical examination

Answer

Congenital heart disease of the mother

Answer

Intrauterine growth retardation of the foetus

Question 9

In the rhesus-negative mothers, the factors which influence the development of rhesus incompatibility include all except

Accepted Answer

Maternal age >35 years

Answer

Amniocentesis

Answer

Incoordinate uterine action

Answer

Placental abruption

Question 10

A 30-year-old woman with history of previous three abortions, has been found to have antiphospholipid antibodies. What will be the treatment of choice in the subsequent pregnancy?

Accepted Answer

Aspirin and Heparin

Answer

Corticosteroids

Answer

Aspirin

Answer

Heparin

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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