Maternal-Fetal Medicine — MCQs
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The incidence of congenital fetal anomalies is highest when a pregnancy is complicated by
In the rhesus-negative mothers, the factors which influence the development of rhesus incompatibility include all except
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?
A young female patient presents with a history of two months amenorrhoea and complaints of severe lower abdominal pain, syncopal attacks and minimal per vaginal bleeding. On examination, she has tachycardia and appears pale. The clinical diagnosis is
An elderly gravida with 36-weeks pregnancy presents with severe pregnancy induced hypertension (PIH), severe abdominal pain, per vaginal bleeding and loss of foetal movements. The diagnosis is
A 35-year-old woman presents with complaints of profuse vaginal bleeding. She also has a history of abortion 4 months ago. On examination, the uterus is soft and bulky, both ovaries are enlarged and cystic, and the pregnancy test is positive. The probable diagnosis is
A 30-year-old third gravida, who has a 3-year-old child and had undergone a MTP one year ago, has presented with 30-weeks pregnancy. She complains of having vaginal bleeding 2 hours ago. She has not received any antenatal care. Her pulse is 78 beats per minute, and the BP is 102/58 mmHg. The most appropriate management will include: 1. Ultrasonographic evaluation 2. Watch for labour 3. Hospitalisation and bed rest 4. Speculum examination of vagina and cervix 5. I.V. fluid drip Select the appropriate combination:
A multiparous patient has been diagnosed to have foetal demise on a sonographic examination at 16 weeks of pregnancy. The ideal method for termination is
Which one of the following statements is not correct regarding the haemodynamic changes occurring during a pregnancy?
Consider the following statements regarding HCG : 1. HCG is a glycoprotein with two subunits α and β. 2. HCG levels reach the maximum between the 60th and 70th day in a normal pregnancy. 3. HCG is secreted by the syncytiotrophoblast. Which of the statements given above is/are correct ?
Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs
Question 981: The incidence of congenital fetal anomalies is highest when a pregnancy is complicated by
- A. Hydramnios detectable on clinical examination
- B. Maternal diabetes (Correct Answer)
- C. Congenital heart disease of the mother
- D. Intrauterine growth retardation of the foetus
Explanation: ***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.
Question 982: In the rhesus-negative mothers, the factors which influence the development of rhesus incompatibility include all except
- A. Amniocentesis
- B. Incoordinate uterine action
- C. Placental abruption
- D. Maternal age >35 years (Correct Answer)
Explanation: ***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**.
Question 983: 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?
- A. Corticosteroids
- B. Aspirin
- C. Aspirin and Heparin (Correct Answer)
- D. Heparin
Explanation: ***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 984: A young female patient presents with a history of two months amenorrhoea and complaints of severe lower abdominal pain, syncopal attacks and minimal per vaginal bleeding. On examination, she has tachycardia and appears pale. The clinical diagnosis is
- A. Missed abortion
- B. Molar pregnancy
- C. Ectopic pregnancy (Correct Answer)
- D. Inevitable abortion
Explanation: ***Ectopic pregnancy*** - The combination of **amenorrhoea**, severe **lower abdominal pain**, **syncopal attacks**, and signs of **hypovolemic shock** (tachycardia, pallor) strongly indicates a ruptured ectopic pregnancy. - Minimal per vaginal bleeding is common, and the syncopal episodes are due to **hemoperitoneum** and resulting hypovolemia. *Missed abortion* - A missed abortion typically involves **no symptoms of acute distress** or shock. Patients often present with absent fetal heart tones on ultrasound, but without acute pain or significant bleeding initially. - There would be no signs of hypovolemia such as tachycardia or syncopal attacks, as the bleeding is usually contained within the uterus or minimal. *Molar pregnancy* - While a molar pregnancy can present with amenorrhoea and vaginal bleeding, it typically causes symptoms like **excessive nausea and vomiting**, and a **grape-like vesicular discharge**. - It does not usually cause acute, severe abdominal pain or hypovolemic shock unless there is a rare complication like uterine perforation, which is not the primary presentation. *Inevitable abortion* - An inevitable abortion presents with **vaginal bleeding** and **cervical dilatation**, often accompanied by abdominal cramping. - While there can be significant bleeding, it is usually not associated with acute, severe pain or rapid onset of **hypovolemic shock** and syncopal attacks as seen with a ruptured ectopic pregnancy.
Question 985: An elderly gravida with 36-weeks pregnancy presents with severe pregnancy induced hypertension (PIH), severe abdominal pain, per vaginal bleeding and loss of foetal movements. The diagnosis is
- A. Vasa praevia
- B. Abruptio placenta (Correct Answer)
- C. Rupture of uterus
- D. Placenta praevia
Explanation: ***Abruptio placenta*** - The combination of **severe abdominal pain**, **vaginal bleeding**, **loss of fetal movements**, and **severe pregnancy-induced hypertension (PIH)** in an elderly gravida at 36 weeks is a classic presentation of **abruptio placenta** (placental abruption). - Severe PIH is a significant **risk factor for placental abruption**, and the pain, bleeding, and fetal distress are due to premature separation of the placenta from the uterine wall. *Vasa praevia* - Characterized by **painless, bright red vaginal bleeding** of fetal origin that typically occurs when the membranes rupture, associated with **fetal distress** or bradycardia. - While there is bleeding and fetal distress mentioned in the question, the presence of **severe abdominal pain** and **PIH** is not typical of vasa praevia, which presents with painless bleeding. *Rupture of uterus* - Uterine rupture usually presents with sudden, **excruciating abdominal pain**, **loss of uterine contractions**, **cessation of labor progress**, and often a **palpable fetal part** outside the uterus if the rupture is complete. - While severe pain and loss of fetal movements are present, the absence of prior uterine surgery (like a C-section) or high parity as risk factors, and the specific association with **severe PIH** pointing strongly to abruption, makes this less likely. *Placenta praevia* - Typically presents with **painless, bright red vaginal bleeding** in the second or third trimester, without associated abdominal pain. - The presence of **severe abdominal pain** and **loss of fetal movements** rules out placenta previa, as these are not characteristic symptoms.
Question 986: A 35-year-old woman presents with complaints of profuse vaginal bleeding. She also has a history of abortion 4 months ago. On examination, the uterus is soft and bulky, both ovaries are enlarged and cystic, and the pregnancy test is positive. The probable diagnosis is
- A. Malignant ovarian tumour
- B. Incomplete abortion
- C. Dysfunctional uterine bleeding
- D. Persistent trophoblastic disease (Correct Answer)
Explanation: ***Persistent trophoblastic disease*** - The history of **abortion 4 months ago** followed by **profuse vaginal bleeding**, a **positive pregnancy test**, and a **bulky uterus** strongly suggests persistent trophoblastic disease (PTD). - The presence of **bilaterally enlarged cystic ovaries** (theca-lutein cysts) is also characteristic, resulting from ovarian stimulation by persistently high levels of hCG. *Malignant ovarian tumour* - While it can cause vaginal bleeding, a **positive pregnancy test** and the finding of a **bulky uterus** are generally not primary features of most ovarian malignancies. - Ovarian tumours are less likely to present with the rapid development of bilateral, **cystic enlargement** associated with a recent pregnancy and persistent hCG. *Incomplete abortion* - While it causes **vaginal bleeding** and a **bulky uterus**, it typically occurs much more acutely and closer to the time of the abortion itself, not four months later. - An incomplete abortion would usually result in a **negative or rapidly declining pregnancy test** due to the absence of viable trophoblastic tissue. *Dysfunctional uterine bleeding* - This diagnosis usually implies bleeding without a clear organic cause and would not be associated with a **positive pregnancy test** or **enlarged, cystic ovaries**. - DUB is a diagnosis of exclusion after other causes, including **gestational** trophoblastic disease, have been ruled out.
Question 987: A 30-year-old third gravida, who has a 3-year-old child and had undergone a MTP one year ago, has presented with 30-weeks pregnancy. She complains of having vaginal bleeding 2 hours ago. She has not received any antenatal care. Her pulse is 78 beats per minute, and the BP is 102/58 mmHg. The most appropriate management will include: 1. Ultrasonographic evaluation 2. Watch for labour 3. Hospitalisation and bed rest 4. Speculum examination of vagina and cervix 5. I.V. fluid drip Select the appropriate combination:
- A. 1, 3 and 5 (Correct Answer)
- B. 2, 3 and 4
- C. 1 and 2
- D. 1, 4 and 5
Explanation: ***1, 3 and 5*** - This patient presents with **third-trimester vaginal bleeding** without prior antenatal care, which is a significant red flag requiring immediate investigation and management. An **ultrasonographic evaluation** is crucial to determine the cause of bleeding, especially to rule out **placenta previa** or **abruptio placentae**, which dictate further management. - **Hospitalization and bed rest** are essential to stabilize the patient, monitor the bleeding, and prepare for potential complications. Initiating an **I.V. fluid drip** is critical for maintaining **hemodynamic stability**, especially given her low blood pressure of 102/58 mmHg, and for providing immediate venous access. *2, 3 and 4* - **Watching for labor** without first establishing the cause of bleeding is inappropriate and potentially dangerous, as active management might be needed. - A **speculum examination** should *not* be the initial step before an ultrasound, as a digital or speculum exam in cases of undiagnosed placenta previa can provoke severe hemorrhage. *1 and 2* - While an **ultrasound (1)** is necessary to diagnose the cause of bleeding, **watching for labor (2)** without further intervention or stabilization is insufficient for a woman with third-trimester bleeding, especially with no prior antenatal care. - This option misses crucial components like hospitalization, bed rest, and IV fluids, which are part of initial stabilization. *1, 4 and 5* - **Ultrasonographic evaluation (1)** and **I.V. fluid drip (5)** are appropriate, but **speculum examination of the vagina and cervix (4)** should be avoided until placenta previa is ruled out by ultrasound. - A digital or speculum exam could exacerbate bleeding if **placenta previa** is present, making this a potentially harmful step in the initial management.
Question 988: A multiparous patient has been diagnosed to have foetal demise on a sonographic examination at 16 weeks of pregnancy. The ideal method for termination is
- A. High vaginal insertion of dinoprostone gel (Correct Answer)
- B. Extra-amniotic ethacridine
- C. Dilation and evacuation (D&E)
- D. Hysterectomy with tubectomy
Explanation: ***High vaginal insertion of dinoprostone gel*** - **Dinoprostone gel** (PGE2) is a **prostaglandin** that softens the cervix and stimulates uterine contractions, making it an ideal agent for medical induction in cases of fetal demise, particularly in the second trimester. - Its **vaginal insertion** allows for controlled, localized delivery and absorption, promoting efficient uterine evacuation while minimizing systemic side effects. *Extra-amniotic ethacridine* - **Ethacridine lactate** is typically used for **mid-trimester abortion** by direct instillation into the extra-amniotic space. - While effective, it carries a higher risk of infection and uterine rupture compared to prostaglandin administration for fetal demise at 16 weeks. *Dilation and evacuation (D&E)* - **D&E** is a surgical procedure commonly used for **second-trimester abortions**, involving cervical dilation and surgical removal of uterine contents. - While an option, medical induction with prostaglandins is generally preferred for **fetal demise** at 16 weeks due to lower risks of uterine injury and adhesions, as well as providing a more natural expulsion process. *Hysterectomy with tubectomy* - **Hysterectomy with tubectomy** (removal of the uterus and fallopian tubes) is a major surgical procedure that is **not indicated** for termination of pregnancy due to fetal demise. - It is reserved for severe medical conditions or desires for permanent sterilization, given its irreversible nature and significant surgical risks.
Question 989: Which one of the following statements is not correct regarding the haemodynamic changes occurring during a pregnancy?
- A. The cardiac output is increased
- B. The serum colloid pressure is decreased
- C. The stroke volume is increased
- D. The systemic vascular resistance is increased (Correct Answer)
Explanation: ***The systemic vascular resistance is increased*** - During normal pregnancy, **systemic vascular resistance (SVR)** actually **decreases** due to vasodilation induced by factors like **prostaglandins** and **nitric oxide**. - A decrease in systemic vascular resistance helps accommodate the increased blood volume and cardiac output, ensuring adequate perfusion to the uteroplacental unit and other organs. *The cardiac output is increased* - **Cardiac output (CO)** progressively **increases** during pregnancy, peaking in the second and third trimesters. - This increase is primarily due to a rise in both **heart rate** and **stroke volume**. *The serum colloid pressure is decreased* - **Serum colloid osmotic pressure** (oncotic pressure) **decreases** in pregnancy due to a disproportionate increase in plasma volume relative to the increase in albumin production. - This leads to **dilutional hypoalbuminemia**, contributing to physiological edema. *The stroke volume is increased* - **Stroke volume (SV)** significantly **increases** during pregnancy, driven by increased end-diastolic volume and enhanced myocardial contractility. - This rise in stroke volume is a major contributor to the overall increase in cardiac output.
Question 990: Consider the following statements regarding HCG : 1. HCG is a glycoprotein with two subunits α and β. 2. HCG levels reach the maximum between the 60th and 70th day in a normal pregnancy. 3. HCG is secreted by the syncytiotrophoblast. Which of the statements given above is/are correct ?
- A. 2 and 3 only
- B. 1 and 2 only
- C. 1 and 3 only
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***Correct: 1, 2 and 3*** - **Human Chorionic Gonadotropin (HCG)** is a **glycoprotein hormone** composed of **alpha (α) and beta (β) subunits**, making statement 1 correct - HCG is primarily secreted by the **syncytiotrophoblast** cells of the placenta, confirming statement 3 - In a normal pregnancy, HCG levels typically **peak between 60-70 days (8-10 weeks)** after the last menstrual period, supporting statement 2 - All three statements are factually accurate regarding HCG structure, secretion, and physiological levels *Incorrect: 2 and 3 only* - This option incorrectly excludes statement 1 about HCG being a glycoprotein with α and β subunits - The structural composition of HCG as a heterodimeric glycoprotein is a fundamental characteristic *Incorrect: 1 and 2 only* - This option incorrectly excludes statement 3 about syncytiotrophoblast being the source of HCG - The syncytiotrophoblast is the outer layer of the trophoblast responsible for HCG secretion *Incorrect: 1 and 3 only* - This option incorrectly excludes statement 2 about HCG peak timing during pregnancy - Understanding that HCG peaks at 8-10 weeks (60-70 days) is crucial for monitoring early pregnancy
Practice by Chapter
Fetal Assessment Techniques
Practice Questions
Hypertensive Disorders in Pregnancy
Practice Questions
Intrauterine Growth Restriction
Practice Questions
Multiple Gestation
Practice Questions
Rh Isoimmunization and Other Blood Group Incompatibilities
Practice Questions
Intrauterine Fetal Therapy
Practice Questions
Prenatal Diagnosis and Genetic Counseling
Practice Questions
Placental Abnormalities
Practice Questions
Preterm Labor and Delivery
Practice Questions
Management of Medical Disorders in Pregnancy
Practice Questions
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