Neonatology and Perinatology Practice Questions

Q: Least chances of perinatal transmission are seen in?

HSV. ***HSV*** - **Perinatal transmission of HSV** is rare, occurring in approximately 1 in 3,000 to 1 in 20,000 live births, primarily from contact with maternal genital lesions during vaginal delivery. - Transmission rates are lowest when the mother has **recurrent herpes lesions** due to the presence of maternal antibodies offering some fetal protection. *Rubella* - **Congenital rubella syndrome** carries a high risk of transmission (up to 90%) if the mother contracts rubella in the first trimester. - It can lead to severe birth defects such as **heart abnormalities**, **cataracts**, and **deafness**. *Hepatitis B* - The risk of **vertical transmission of Hepatitis B** is significant, especially if the mother is HBeAg-positive (up to 90%). - Without intervention, chronic infection develops in 70-90% of infected infants, often leading to **liver disease** later in life. *CMV* - **Congenital CMV infection** is the most common congenital viral infection, with a transmission rate of 30-40% in primary maternal infection. - It can cause severe neurological deficits, **sensorineural hearing loss**, and **developmental delays** in affected infants.

Q: A patient at 37 weeks' gestation came to the hospital without antenatal check-up and presented with onset of labor. On examination, the mother is Hep B positive. What management should be given to the neonate?

Hep B vaccine+ IG. ***Hep B vaccine + IG*** - Neonates born to mothers with **positive hepatitis B surface antigen (HBsAg)** should receive both the **hepatitis B vaccine** and **hepatitis B immune globulin (HBIG)** within **12 hours of birth**. - This combination provides both **passive immunity** (from HBIG) and **active immunity** (from the vaccine) to rapidly protect the newborn from perinatal hepatitis B transmission. *Hep B vaccine only* - Administering only the **hepatitis B vaccine** would provide active immunity, but the **onset of protection is slower**, leaving the neonate vulnerable during the immediate high-risk period of exposure. - While essential for long-term protection, the vaccine alone is **insufficient for immediate post-exposure prophylaxis** in a high-risk scenario. *Only IG* - Administering only **HBIG** provides immediate passive immunity, offering short-term protection, but it **does not confer long-lasting immunity**. - Without the vaccine, the infant would remain susceptible to future HBV infection once the passive antibodies wane, which typically occurs within a few months. *First IG then Hep B vaccine after 1 month* - Delaying the **hepatitis B vaccine** by a month would leave the neonate inadequately protected against subsequent exposure or potential continued viral replication after the HBIG's passive immunity declines. - The goal in this high-risk situation is to initiate **both passive and active immunity as quickly as possible** to maximize protection against perinatal transmission.

Q: Basanti, a 29-year-old female from Bihar, presents with drug-sensitive tuberculosis. She delivers a baby. All of the following are indicated except:

Withhold breast feeding. ***Withhold breast feeding*** - For mothers with **drug-sensitive tuberculosis**, breastfeeding is **strongly encouraged** by WHO and CDC guidelines as the benefits far outweigh any theoretical risks. - Tuberculosis is **not transmitted through breast milk**, and the nutritional and immunological benefits of breastfeeding are crucial for the newborn. - With appropriate maternal treatment and **INH prophylaxis** for the baby, breastfeeding poses no significant risk and should **never be withheld**. *Administer INH to the baby* - **Isoniazid (INH) prophylaxis** for 6 months is the standard of care for newborns exposed to maternal tuberculosis. - This protects the infant from potential infection via respiratory droplets while the mother is receiving treatment. - After completing prophylaxis, BCG vaccination is given if tuberculosis is excluded. *Separate the baby from mother immediately* - **Immediate routine separation** is generally not recommended for drug-sensitive TB if the mother has been on appropriate treatment for at least 2 weeks and is clinically improving. - **Rooming-in is encouraged** with respiratory hygiene measures (mask wearing, hand hygiene, covering mouth when coughing). - Separation may be considered only for untreated or inadequately treated mothers, or those with multi-drug resistant TB. *Ask mother to ensure proper disposal of sputum* - **Proper sputum disposal** and adherence to respiratory hygiene are essential infection control measures. - This reduces environmental contamination and protects healthcare workers, family members, and the newborn from infectious aerosols. - This is a standard precaution for all tuberculosis patients regardless of drug sensitivity.

Q: Which of the following is NOT an indication for the administration of Betamethasone to preterm patients?

Prevent postpartum hemorrhage (PPH). ***Prevent postpartum hemorrhage (PPH)*** - **Betamethasone** is a **corticosteroid** primarily used in preterm labor to accelerate fetal lung development and reduce the risk of neonatal complications, not to prevent **postpartum hemorrhage**. - **Postpartum hemorrhage (PPH)** is typically managed with uterine massage, oxytocics (e.g., oxytocin, methylergonovine), or other interventions aimed at uterine contraction and hemostasis. *Fetal lung maturity* - **Betamethasone** is widely administered to pregnant individuals at risk of preterm delivery to promote **fetal lung maturation** by stimulating surfactant production. - This reduces the incidence and severity of **respiratory distress syndrome (RDS)** in premature infants. *Prevents periventricular leukomalacia* - **Antenatal corticosteroids** like **betamethasone** have been shown to reduce the risk of **periventricular leukomalacia (PVL)**, a form of brain injury in preterm infants. - This protective effect is thought to be mediated by improving fetal cerebral vascular stability and reducing inflammation. *Decrease intraventricular hemorrhage* - Administration of **betamethasone** significantly reduces the risk and severity of **intraventricular hemorrhage (IVH)** in preterm neonates. - This benefit is primarily due to the stabilization of cerebral vasculature and reduced fluctuations in cerebral blood flow.

Q: Main factor responsible for increased perinatal mortality in twin pregnancy is?

Prematurity. ***Prematurity*** - **Premature birth** is the leading cause of perinatal mortality in twin pregnancies, as twins are significantly more likely to be born before term compared to singletons. - Complications associated with prematurity, such as **respiratory distress syndrome**, **intraventricular hemorrhage**, and **necrotizing enterocolitis**, are major contributors to infant death. *Intrauterine growth restriction (IUGR)* - While IUGR is common in twin pregnancies and can increase perinatal morbidity and mortality, it is a **secondary complication** often associated with prematurity or underlying placental issues rather than the primary cause of mortality itself. - IUGR might lead to other complications, but **prematurity** has a more direct and widespread impact on survival. *Excess amniotic fluid (Polyhydramnios)* - **Polyhydramnios** can occur in twin pregnancies, especially in twin-to-twin transfusion syndrome, and may predispose to preterm labor and delivery. - However, it is a **risk factor for prematurity** rather than the direct primary cause of mortality. *Rupture of the uterus* - **Uterine rupture** is a rare but catastrophic event, typically associated with prior uterine surgery or grand multiparity, and **less commonly linked to twin pregnancy alone**. - While extremely serious, its infrequency makes it a far less common cause of overall perinatal mortality in twin pregnancies than prematurity.

Q: Vertical transmission of HIV is highest with-

High viral RNA load. ***High viral RNA load*** - A **high maternal viral load** (HIV RNA copies per milliliter of blood) is the most significant risk factor for **mother-to-child transmission (MTCT)** of HIV. The higher the viral load, the greater the likelihood of the virus being transmitted to the infant. - This is because a higher viral load indicates more circulating virus that can cross the **placenta** during gestation, be exchanged during labor and delivery, or be transmitted through breast milk. *Elective caesarean section* - An **elective caesarean section (C-section)** is a method used to *reduce* the risk of vertical transmission of HIV, especially when the maternal viral load is high. It *does not increase* the risk. - By avoiding passage through the birth canal, C-section minimizes the infant's exposure to maternal blood and genital secretions. *Breast feeding* - **Breastfeeding** is a known route of vertical HIV transmission and significantly increases the risk compared to formula feeding in HIV-positive mothers who are not on antiretroviral therapy (ART). - However, the overall *highest risk* factor *before* deciding on infant feeding is the *maternal viral load*, which dictates the likelihood of transmission via any route (intrauterine, intrapartum, or postpartum). *Term delivery* - **Term delivery** (vaginal delivery at term) carries a higher risk of vertical HIV transmission compared to an elective C-section, especially in mothers with high viral loads. - However, the *primary determinant* of this risk, even during vaginal delivery, is the **maternal viral load**. A mother with a well-controlled, low viral load at term has a significantly reduced risk of transmission even during vaginal delivery.

Q: Where is the newborn care corner located?

Labour room. ***Labour room*** - A **newborn care corner** is an essential facility located in the **labour room** to provide immediate care, resuscitation, and stabilization for newborns right after birth. - This setup ensures that critical interventions like **drying**, **warming**, **suctioning**, and initiation of **ventilation** can be performed promptly, improving neonatal outcomes. *NICU* - The **NICU (Neonatal Intensive Care Unit)** is for sick or premature newborns requiring intensive medical care, not the initial care at birth for all newborns. - While newborns from the labour room may be transferred to the NICU if they require specialized care, the initial care corner is distinct. *OPD* - **OPD (Outpatient Department)** is for patients seeking consultation without admission, and is not equipped or intended for immediate newborn care. - Newborns are brought to OPD for follow-up visits or routine check-ups much later, not immediately after birth. *Wards side room* - A **ward side room** is part of a general hospital ward, usually for inpatient care, and is not specifically designed or staffed for the initial, immediate care of a newborn at the moment of delivery. - While mothers and newborns may be transferred to a ward side room after stabilization, it's not where delivery and immediate postnatal care occur.

Q: Which virus has the highest chance of transmission to the newborn during delivery?

HSV. ***HSV*** - **Herpes Simplex Virus (HSV)** has the **highest transmission rate during vaginal delivery** if the mother has active genital lesions, with transmission rates of **30-50% for recurrent infection** and up to **85-90% for primary infection**. - Neonatal herpes can lead to severe disseminated disease, central nervous system involvement, or mucocutaneous lesions with high morbidity and mortality. - **Cesarean section is indicated** if active lesions are present at the time of labor to prevent transmission. *CMV* - **Cytomegalovirus (CMV)** is primarily transmitted **congenitally (in utero)** rather than during delivery. - While perinatal transmission can occur through cervical secretions or blood during delivery, the rate is **much lower** than HSV and most postnatal transmission occurs through **breastfeeding**. - Intrapartum transmission, when it occurs, generally causes less severe disease compared to congenital infection. *VZV* - **Varicella-Zoster Virus (VZV)** transmission to the newborn occurs primarily when maternal infection develops **within 5 days before to 2 days after delivery**. - This can cause severe neonatal varicella, but the **overall intrapartum transmission rate is lower** than HSV. - Most severe fetal effects occur with **congenital varicella syndrome** (first or second trimester infection). *Rubella* - **Rubella** is almost exclusively transmitted **congenitally during early pregnancy**, leading to **congenital rubella syndrome**. - There is **no significant transmission during delivery** itself. - The critical period for fetal damage is during the first trimester, not at the time of birth.

Q: Following tests are done for assessing fetal lung maturity. Which of the following test results does not indicate adequate fetal lung maturity?

Lecithin/sphingomyelin ratio less than 2. ***Lecithin/sphingomyelin ratio less than 2*** - A **lecithin/sphingomyelin (L/S) ratio** of **less than 2:1** indicates a higher risk of respiratory distress syndrome (RDS) due to insufficient **surfactant** production. - Surfactant is crucial for reducing surface tension in the alveoli, preventing their collapse at the end of expiration. - An L/S ratio **≥2:1** is considered indicative of fetal lung maturity. *Foam stability index greater than 47* - A **foam stability index (FSI) greater than or equal to 47** indicates the presence of sufficient **surfactant** to create stable foam, suggesting **fetal lung maturity**. - This test is based on the ability of surfactant to reduce surface tension in amniotic fluid when mixed with ethanol. *Presence of phosphatidylglycerol* - The **presence of phosphatidylglycerol (PG)** in the amniotic fluid is a strong indicator of **fetal lung maturity**. - PG is a mature **surfactant** component that appears later in gestation and signifies a very low risk of respiratory distress syndrome (RDS). *Optical density at 650 nm less than 0.15* - An **optical density (OD) at 650 nm of less than 0.15** in the amniotic fluid indicates **fetal lung maturity**. - This test measures the turbidity of amniotic fluid, with lower values indicating the presence of mature surfactant and clear fluid.

Q: In a macerated baby, the ideal sample for genetic analysis is obtained from:

Placental Tissue. ***Placental Tissue*** - **Placental tissue** (chorionic villi) is preferred for genetic analysis in macerated fetuses because it is less susceptible to **autolysis** and **bacterial contamination** compared to fetal tissues. - The placenta often retains viable cells with intact DNA even when fetal tissues have significantly degraded, making it a more reliable source for **karyotyping** or **molecular genetic studies**. *Clotted fetal blood* - **Clotted fetal blood** from a macerated fetus is generally unsuitable due to significant **cellular degradation** and **DNA fragmentation** caused by autolysis. - The quality of DNA extracted from such a sample would likely be poor, leading to unreliable or unsuccessful genetic testing. *Fibroblast from skin* - While fibroblasts can be cultured from skin, obtaining a viable biopsy from a **macerated fetus** is challenging due to extensive **tissue degradation** and the high risk of **bacterial contamination**. - Successful culture and growth of fibroblasts would be unlikely given the compromised state of the fetal tissue. *Fibroblast from Achilles tendon* - Similar to skin, obtaining viable fibroblasts from the **Achilles tendon** of a macerated fetus is difficult due to widespread **autolysis** and **tissue degeneration**. - The degradation of cells in macerated fetuses significantly reduces the chances of culturing viable cells needed for genetic analysis from any fetal tissue, including tendons.

Question 1

Least chances of perinatal transmission are seen in?

Accepted Answer

HSV

Answer

Rubella

Answer

Hepatitis B

Answer

CMV

Question 2

A patient at 37 weeks' gestation came to the hospital without antenatal check-up and presented with onset of labor. On examination, the mother is Hep B positive. What management should be given to the neonate?

Accepted Answer

Hep B vaccine+ IG

Answer

Hep B vaccine only

Answer

Only IG

Answer

First IG then Hep B vaccine after 1 month

Question 3

Basanti, a 29-year-old female from Bihar, presents with drug-sensitive tuberculosis. She delivers a baby. All of the following are indicated except:

Accepted Answer

Withhold breast feeding

Answer

Administer INH to the baby

Answer

Separate the baby from mother immediately

Answer

Ask mother to ensure proper disposal of sputum

Question 4

Which of the following is NOT an indication for the administration of Betamethasone to preterm patients?

Accepted Answer

Prevent postpartum hemorrhage (PPH)

Answer

Prevents periventricular leukomalacia

Answer

Fetal lung maturity

Answer

Decrease intraventricular hemorrhage

Question 5

Main factor responsible for increased perinatal mortality in twin pregnancy is?

Accepted Answer

Prematurity

Answer

Intrauterine growth restriction (IUGR)

Answer

Excess amniotic fluid (Polyhydramnios)

Answer

Rupture of the uterus

Question 6

Vertical transmission of HIV is highest with-

Accepted Answer

High viral RNA load

Answer

Elective caesarean section

Answer

Breast feeding

Answer

Term delivery

Question 7

Where is the newborn care corner located?

Accepted Answer

Labour room

Answer

NICU

Answer

OPD

Answer

Wards side room

Question 8

Which virus has the highest chance of transmission to the newborn during delivery?

Accepted Answer

HSV

Answer

CMV

Answer

VZV

Answer

Rubella

Question 9

Following tests are done for assessing fetal lung maturity. Which of the following test results does not indicate adequate fetal lung maturity?

Accepted Answer

Lecithin/sphingomyelin ratio less than 2

Answer

Foam stability index greater than 47

Answer

Presence of phosphatidylglycerol

Answer

Optical density at 650 nm less than 0.15

Question 10

In a macerated baby, the ideal sample for genetic analysis is obtained from:

Accepted Answer

Placental Tissue

Answer

Clotted fetal blood

Answer

Fibroblast from skin

Answer

Fibroblast from Achilles tendon

Neonatology and Perinatology — MCQs

Neonatology and Perinatology — MCQs

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