Maternal-Fetal Medicine Practice Questions

Q: During a routine prenatal visit, a 22-week gravid woman is found to be affected with ankle oedema and new onset hypertension. The urine analysis reveals marked proteinuria. Which of the following, if it were to occur, would substantiate the diagnosis of eclampsia?

Seizures. ***Seizures*** - The development of **new-onset generalized tonic-clonic seizures** in a patient with pre-existing pre-eclampsia (hypertension and proteinuria during pregnancy) is the defining criterion for **eclampsia**. - These seizures are not attributable to other causes and are a severe complication of pre-eclampsia, indicating central nervous system involvement. *Molar pregnancy* - While molar pregnancy can be associated with early-onset and more severe pre-eclampsia due to high hCG levels and abnormal placental development, it is not a direct diagnostic criterion for **eclampsia** itself. - Eclampsia specifically refers to the occurrence of seizures in the context of pre-eclampsia, regardless of the underlying cause of the pre-eclampsia. *Thrombocytopenia* - **Thrombocytopenia** (platelet count <100,000/µL) is a potential complication of severe pre-eclampsia and a component of **HELLP syndrome** (Hemolysis, Elevated Liver enzymes, Low Platelets). - While it indicates worsening disease, the presence of thrombocytopenia alone does not define eclampsia; eclampsia is characterized by the occurrence of **seizures**. *Hyperuricaemia* - **Hyperuricaemia** (elevated serum uric acid) is a common finding in pre-eclampsia and often correlates with the severity of the disease. - However, it is a biochemical marker of kidney dysfunction and increased oxidative stress, not a defining diagnostic feature of **eclampsia**, which is specifically marked by the onset of **seizures**.

Q: In a pregnancy complicated by heart disease, which of the following is/are contraindicated? 1. External cephalic version 2. LSCS 3. Corrective surgery of the heart lesion 4. Prophylactic intravenous meth-ergine at the birth of anterior shoulder Select the correct answer from the code given below :

1 and 4 only. ***1 and 4 only*** - **External cephalic version (ECV)** is generally contraindicated in pregnancy complicated by heart disease because the procedure can induce uterine contractions, maternal stress, and potential hemodynamic instability, which may precipitate cardiac decompensation in susceptible patients. - **Prophylactic intravenous methergine (methylergonovine)** is **absolutely contraindicated** in patients with heart disease due to its potent **vasoconstrictive effects** leading to increased systemic vascular resistance, hypertension, and elevated afterload, which can precipitate acute cardiac failure or pulmonary edema. *1 only* - This option incorrectly identifies only ECV as contraindicated while missing the important contraindication of **methergine**, which is strongly contraindicated due to its cardiovascular effects. - Methergine-induced vasoconstriction can cause dangerous hemodynamic changes in cardiac patients. *1 and 3 only* - While ECV is contraindicated, **corrective cardiac surgery** is NOT contraindicated during pregnancy when indicated for maternal survival or significant functional improvement. - Cardiac surgery can be safely performed during pregnancy (ideally in second trimester) with cardiopulmonary bypass when maternal benefit outweighs risks, making this a potential therapeutic intervention rather than a contraindication. *1, 2, 3 and 4* - **LSCS (Lower Segment Cesarean Section)** is NOT contraindicated in heart disease; in fact, it is often the **preferred mode of delivery** in severe cardiac conditions (NYHA Class III-IV) to avoid the hemodynamic stress of prolonged labor and bearing down efforts. - Similarly, corrective cardiac surgery is not contraindicated when medically necessary.

Q: A nulliparous woman presents with acute lower abdominal pain. She has a history of missed periods. The ultrasound examination shows an empty uterus. The cervical movements are very tender. The vital signs are stable. How will you manage her?

Admit her for observation. ***Admit her for observation*** - The patient presents with classic symptoms of a **potential ectopic pregnancy** (missed periods, lower abdominal pain, empty uterus on ultrasound, cervical motion tenderness). However, her **vital signs are stable**, indicating she is currently hemodynamically stable. - Admission for observation allows for close monitoring of vital signs, serial **beta-hCG measurements**, and repeat ultrasounds to confirm the diagnosis and assess for any signs of rupture, enabling timely intervention if needed. *Start a pitocin drip* - **Pitocin (oxytocin)** is used to induce labor or manage postpartum hemorrhage, as it contracts the uterus. - In a suspected ectopic pregnancy with an empty uterus, administering oxytocin would be ineffective and potentially harmful if a **tubal pregnancy** is present. *Treat her as a case of Pelvic Inflammatory Disease.* - While PID can cause lower abdominal pain and cervical motion tenderness, the history of **missed periods** and an **empty uterus on ultrasound** strongly suggest pregnancy complications rather than infection. - Treating for PID without ruling out ectopic pregnancy could lead to a catastrophic delay in managing a ruptured ectopic pregnancy. *Perform a laparotomy* - A laparotomy is an **invasive surgical procedure** typically reserved for confirmed or highly suspected cases of ruptured ectopic pregnancy or other acute abdominal emergencies. - Given the patient's **stable vital signs** and the possibility of a non-ruptured ectopic or even a miscarriage, immediate laparotomy is premature without further diagnostic assessment.

Q: Antimicrobial prophylaxis is essential for a woman in labour who has

Heart disease. ***Heart disease*** - Historically, women with certain types of heart disease, especially those with **valvular abnormalities** or a history of **infective endocarditis**, were considered to require antimicrobial prophylaxis during labor and delivery. - **Important Note**: Current guidelines (AHA 2007 onwards, ACOG) **no longer recommend routine antimicrobial prophylaxis** for prevention of infective endocarditis during uncomplicated vaginal delivery or cesarean section, even in women with valvular heart disease. - Prophylaxis may still be indicated if there are **infected tissues**, **chorioamnionitis**, or other **infectious complications** during delivery. - This question reflects **older clinical practice** when antimicrobial prophylaxis was more broadly recommended for cardiac patients during labor. *Hypertension* - **Hypertension** during labor, whether **chronic** or **gestational**, does not increase the risk of infectious complications requiring antimicrobial prophylaxis. - Management focuses on **blood pressure control** and monitoring for complications like pre-eclampsia or eclampsia. *Diabetes mellitus* - While women with **diabetes mellitus** may have slightly increased infection risk, it is **not an indication** for routine antimicrobial prophylaxis during labor for endocarditis prevention. - Prophylaxis during labor is indicated for **Group B Streptococcus (GBS) colonization** or specific obstetric indications, not diabetes itself. *Renal disease* - **Renal disease** itself is **not an indication** for antimicrobial prophylaxis during labor. - Management focuses on monitoring the renal condition and managing fluid and electrolyte balance during pregnancy and delivery.

Q: The perinatal complications of a diabetic pregnancy include : 1. Small for Gestational Age baby 2. Stillbirth 3. Hypoglycaemia 4. Respiratory distress syndrome Select the correct answer from the code given below :

2 and 3 only. ***2 and 3 only*** - **Stillbirth** is a major perinatal complication of diabetic pregnancy due to placental insufficiency, fetal hyperglycemia, and maternal ketoacidosis, occurring in up to 2-5% of poorly controlled cases. - **Neonatal hypoglycemia** occurs in 25-40% of infants of diabetic mothers due to fetal hyperinsulinemia. After delivery, the sudden withdrawal of maternal glucose supply while fetal insulin levels remain elevated leads to profound hypoglycemia within 1-2 hours of birth. - While **respiratory distress syndrome (RDS)** is also a recognized complication (due to delayed surfactant production from hyperinsulinemia), this question focuses on the most characteristic and immediate life-threatening perinatal complications requiring urgent monitoring and intervention. *1 and 2 only* - **Small for Gestational Age (SGA)** is NOT a typical complication of diabetic pregnancy. The classic presentation is **macrosomia** (Large for Gestational Age) due to fetal hyperinsulinemia driving increased glucose uptake and fat deposition. - SGA may occur in pre-gestational diabetes with severe vasculopathy, but this represents a minority of cases and is not the typical pattern. *1 and 4 only* - **Small for Gestational Age** is incorrect for the reasons stated above - diabetic pregnancies characteristically produce macrosomic infants, not growth-restricted ones. - **Respiratory distress syndrome** is indeed a complication, but the inclusion of the incorrect statement 1 makes this option wrong. *1 and 3 only* - **Small for Gestational Age** is fundamentally inconsistent with the pathophysiology of diabetic pregnancy, which involves fetal hyperglycemia and hyperinsulinemia leading to excessive growth. - **Hypoglycemia** is correct, but this option is invalidated by the inclusion of SGA.

Q: Abortions in the second trimester mainly occur due to

congenital anomalies of the foetus. ***congenital anomalies of the foetus*** - Among the given options, **fetal congenital anomalies** (chromosomal abnormalities and structural malformations) are a significant cause of second-trimester pregnancy loss. - These anomalies often become apparent during routine prenatal screenings or ultrasounds performed in the second trimester, leading to spontaneous loss or termination. - **Note:** In clinical practice, **cervical incompetence** is actually the most common cause of second-trimester abortion, but it is not listed among the options in this question. *congenital anomalies of the uterus* - **Uterine anomalies** like septate or bicornuate uterus are more commonly associated with **recurrent first-trimester miscarriages** or **preterm labor** in the third trimester. - While they can contribute to pregnancy loss, they are less frequently the primary cause of second-trimester abortions compared to fetal anomalies. *retroflected gravid uterus* - A **retroflected gravid uterus** typically resolves spontaneously as the uterus grows and rises out of the pelvis by 12-14 weeks. - If it remains retroverted and becomes incarcerated, it can cause **pelvic pain** and **urinary retention**, but this is a very rare cause of miscarriage, especially in the second trimester. *hormonal deficiencies* - **Hormonal deficiencies**, such as insufficient **progesterone** production by the corpus luteum, are a more common cause of **first-trimester miscarriages**. - By the second trimester, the placenta has taken over progesterone production (by 8-10 weeks), making hormonal deficiencies a much less common cause of abortion during this period.

Q: Which one of the following is diagnosed by Spiegelberg criteria?

Ovarian pregnancy. ***Ovarian pregnancy*** - Spiegelberg criteria are specifically used to diagnose an **ovarian ectopic pregnancy**, which is a rare form of ectopic pregnancy where the fertilized egg implants in the ovary. - The criteria include: the **fallopian tube and fimbria are intact** and separate from the ovary, the gestational sac is in the ovarian cortex, it is connected to the uterus by the **ovarian ligament**, and ovarian tissue can be histologically demonstrated in the sac wall. *Molar pregnancy* - This is a type of **gestational trophoblastic disease** characterized by abnormal growth of trophoblastic tissue, resulting in a non-viable pregnancy. - Diagnosis involves high levels of **hCG**, a "snowstorm" appearance on ultrasound, and histopathological examination, not Spiegelberg criteria. *Twin pregnancy* - This refers to the presence of **two fetuses** in a single pregnancy. - Diagnosis is primarily made via **ultrasound imaging** showing two distinct gestational sacs or two fetuses, and is unrelated to Spiegelberg criteria. *Uterine pregnancy* - This is a **normal intrauterine pregnancy** where the fertilized egg implants within the uterine cavity. - It is diagnosed by visualizing a gestational sac and eventually an embryo/fetus within the uterus by **ultrasound**, not by Spiegelberg criteria.

Q: The fetal well-being can be assessed by all of the following, except

Kleihauer-Betke test. ***Kleihauer-Betke test*** - The **Kleihauer-Betke test** is used to quantify the amount of **fetal hemoglobin** that has entered the maternal circulation, typically in cases of **fetomaternal hemorrhage**. - It does assess fetal red blood cells in maternal circulation but does not directly assess current fetal well-being in terms of **cardiac activity**, **movement**, or **oxygenation**. *non-stress test* - The **non-stress test (NST)** monitors **fetal heart rate (FHR)** accelerations in response to fetal movement as an indicator of adequate **fetal oxygenation** and **autonomic nervous system function**. - A **reactive NST** with appropriate accelerations is considered a sign of **fetal well-being**. *ultrasound* - **Ultrasound** is a versatile tool for assessing fetal well-being, providing information on **fetal growth**, **anatomy**, **amniotic fluid volume**, and **biophysical profile (BPP)**. - The BPP, which includes ultrasound observations of **fetal breathing**, **movement**, **muscle tone**, and **amniotic fluid volume**, along with an **NST**, offers a comprehensive assessment of fetal status. *contraction stress test* - The **contraction stress test (CST)** evaluates the response of the **fetal heart rate** to uterine contractions, which temporarily reduce placental blood flow. - A **negative CST** (no late decelerations) indicates good **fetal oxygen reserve** and is a reliable sign of **fetal well-being**.

Question 1

During a routine prenatal visit, a 22-week gravid woman is found to be affected with ankle oedema and new onset hypertension. The urine analysis reveals marked proteinuria. Which of the following, if it were to occur, would substantiate the diagnosis of eclampsia?

Accepted Answer

Seizures

Answer

Molar pregnancy

Answer

Thrombocytopenia

Answer

Hyperuricaemia

Question 2

In a pregnancy complicated by heart disease, which of the following is/are contraindicated?
1. External cephalic version
2. LSCS
3. Corrective surgery of the heart lesion
4. Prophylactic intravenous meth-ergine at the birth of anterior shoulder
Select the correct answer from the code given below :

Accepted Answer

1 and 4 only

Answer

1 only

Answer

1 and 3 only

Answer

1, 2, 3 and 4

Question 3

A nulliparous woman presents with acute lower abdominal pain. She has a history of missed periods. The ultrasound examination shows an empty uterus. The cervical movements are very tender. The vital signs are stable. How will you manage her?

Accepted Answer

Admit her for observation

Answer

Start a pitocin drip

Answer

Treat her as a case of Pelvic Inflammatory Disease.

Answer

Perform a laparotomy

Question 4

Antimicrobial prophylaxis is essential for a woman in labour who has

Accepted Answer

Heart disease

Answer

Hypertension

Answer

Diabetes mellitus

Answer

Renal disease

Question 5

The perinatal complications of a diabetic pregnancy include :

1. Small for Gestational Age baby
2. Stillbirth
3. Hypoglycaemia
4. Respiratory distress syndrome

Select the correct answer from the code given below :

Accepted Answer

2 and 3 only

Answer

1 and 2 only

Answer

1 and 4 only

Answer

1 and 3 only

Question 6

Abortions in the second trimester mainly occur due to

Accepted Answer

congenital anomalies of the foetus

Answer

congenital anomalies of the uterus

Answer

retroflected gravid uterus

Answer

hormonal deficiencies

Question 7

Which one of the following is diagnosed by Spiegelberg criteria?

Accepted Answer

Ovarian pregnancy

Answer

Molar pregnancy

Answer

Twin pregnancy

Answer

Uterine pregnancy

Question 8

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→3  B→4  C→1  D→2

Answer

A→1  B→4  C→3  D→2

Answer

A→2  B→4  C→1  D→3

Answer

A→4  B→1  C→3  D→2

Question 9

The fetal well-being can be assessed by all of the following, except

Accepted Answer

Kleihauer-Betke test

Answer

non-stress test

Answer

ultrasound

Answer

contraction stress test

Question 10

With reference to the transmission of HIV from mother to child, which one of the following statements is not correct?

Accepted Answer

Single dose of 200 mg nevirapine at the onset of labour eliminates the risk of HIV transmission to the newborn

Answer

The rate of transmission of HIV from mother to child is between 15-48%

Answer

HIV is transmitted through breast milk

Answer

In majority of cases, transmission of virus occurs during intrapartum period

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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