Maternal-Fetal Medicine Practice Questions

Q: Which of the following complications is NOT associated with an increased risk in multifetal pregnancy?

Post-term pregnancy. **Explanation:** In multifetal pregnancies, the primary physiological challenge is uterine overdistension and increased metabolic demand. **Post-term pregnancy** is not associated with multifetal gestations because these pregnancies are characterized by a significantly higher risk of **preterm labor and delivery**. The average duration of pregnancy decreases as the number of fetuses increases (approx. 37 weeks for twins, 33 weeks for triplets). Consequently, the clinical concern is prematurity rather than post-term complications. **Analysis of Incorrect Options:** * **Maternal Death:** Multifetal pregnancies carry a 2-to-3-fold higher maternal mortality rate compared to singletons, primarily due to complications like hemorrhage and embolism. * **Preeclampsia:** The increased placental mass in multifetal gestations leads to higher levels of anti-angiogenic factors (like sFlt-1), making hypertensive disorders 2–3 times more common and often more severe. * **Hysterectomy:** There is a significantly higher risk of peripartum hysterectomy due to **postpartum hemorrhage (PPH)** caused by uterine atony (from overdistension) or abnormal placentation (e.g., placenta previa). **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication:** Preterm labor/prematurity. * **Most common presentation:** Vertex-Vertex (approx. 40-50%). * **Weight Gain:** Recommended weight gain for a woman with a normal BMI carrying twins is **17–25 kg** (37–54 lbs). * **Iron Deficiency Anemia:** Risk is significantly higher due to increased fetal demand and expanded maternal plasma volume.

Q: What is the exclusive complication of monochorionic twins?

Twin-to-twin transfusion syndrome. **Explanation:** The defining feature of **monochorionic (MC) placentation** is the presence of **vascular anastomoses** (arterio-venous, arterio-arterial, or veno-venous) on the placental surface that connect the circulations of the two fetuses. **Twin-to-Twin Transfusion Syndrome (TTTS)** is the correct answer because it is caused specifically by an imbalance in these deep **arterio-venous (AV) anastomoses**. Blood is shunted from a "donor" twin to a "recipient" twin, leading to a sequence of polyhydramnios-oligohydramnios. This hemodynamic complication cannot occur in dichorionic twins because their placentas are separate and lack these shared vascular connections. **Analysis of Incorrect Options:** * **A. Cord entanglement:** This is an exclusive complication of **monoamniotic** twins (a subset of monochorionic twins where both fetuses share one amniotic sac). While all monoamniotic twins are monochorionic, not all monochorionic twins are monoamniotic. * **C. Discordant growth:** This refers to a significant weight difference between twins. It can occur in **both** monochorionic (due to TTTS or unequal placental sharing) and dichorionic twins (due to genetic factors or individual placental insufficiency). * **D. Abortion:** Spontaneous pregnancy loss can occur in any pregnancy, whether singleton, dichorionic, or monochorionic. **High-Yield Clinical Pearls for NEET-PG:** * **Quintero Staging** is used to classify the severity of TTTS (Stage I: Oligo/Polyhydramnios to Stage V: Death of one or both fetuses). * **TAPS (Twin Anemia Polycythemia Sequence):** Another MC-exclusive complication caused by slow transfusion through tiny diameter anastomoses. * **TRAP (Twin Reversed Arterial Perfusion) Sequence:** Also exclusive to MC twins, involving an "acardiac" twin. * **Lambda sign (T-sign):** On ultrasound, the absence of the Lambda sign (presence of **T-sign**) confirms monochorionicity.

Q: What are the effects of smoking during pregnancy?

Intrauterine Growth Restriction (IUGR). **Explanation:** Smoking during pregnancy is a high-yield topic in NEET-PG, primarily associated with adverse perinatal outcomes due to chronic placental insufficiency. **Why Option A is Correct:** The primary mechanism behind **Intrauterine Growth Restriction (IUGR)** in smokers is twofold: 1. **Carbon Monoxide (CO):** CO has a higher affinity for hemoglobin than oxygen, forming carboxyhemoglobin. This reduces the oxygen-carrying capacity of maternal blood, leading to fetal hypoxia. 2. **Nicotine:** Nicotine acts as a potent vasoconstrictor, reducing uterine blood flow and impairing the transfer of essential nutrients across the placenta. Collectively, these factors lead to a significant reduction in birth weight (on average 150–200g less) and increased risk of Small for Gestational Age (SGA) infants. **Why Other Options are Incorrect:** * **Option B (PIH):** Interestingly, smoking is statistically associated with a *decreased* risk of preeclampsia/PIH, likely due to the inhibition of certain inflammatory pathways, though this is not a reason to encourage smoking. * **Option C (Malpresentation):** This is typically associated with factors like placenta previa, uterine anomalies, or polyhydramnios, rather than smoking. * **Option D (PPH):** While smoking increases the risk of Abruptio Placentae and Placenta Previa (which can cause antepartum hemorrhage), it is not a direct primary cause of Postpartum Hemorrhage (PPH). **High-Yield Clinical Pearls for NEET-PG:** * **Placental Complications:** Smoking is a major risk factor for **Placenta Previa** and **Abruptio Placentae**. * **Membranes:** It is strongly linked to **Preterm Premature Rupture of Membranes (PPROM)** and preterm labor. * **Long-term:** Increased risk of **Sudden Infant Death Syndrome (SIDS)** and childhood respiratory infections. * **Congenital Anomalies:** Specifically associated with an increased risk of **Orofacial clefts**.

Q: What is the risk of mother-to-child HIV transmission in a pregnant woman at the time of delivery and after delivery in a non-breastfeeding woman?

15-30%. **Explanation:** The risk of Mother-to-Child Transmission (MTCT) of HIV occurs in three distinct phases: in-utero (antenatal), during labor and delivery (intranatal), and through breastfeeding (postnatal). **1. Why 15-30% is correct:** In the absence of any medical intervention (Antiretroviral Therapy - ART) and assuming the mother **does not breastfeed**, the cumulative risk of transmission is approximately **15-30%**. * **Antenatal risk:** ~5-10% * **Intranatal risk:** ~10-20% (The majority of transmission occurs during labor due to exposure to infected maternal blood and vaginal secretions). Combining these two phases results in the 15-30% range. If breastfeeding were included, the risk would increase to 30-45%. **2. Analysis of Incorrect Options:** * **Option A (5-10%):** This represents only the antenatal (in-utero) risk or the risk in a woman on highly effective ART with a suppressed viral load. * **Option B (10-15%):** This is too low for a woman not receiving any intervention; it underestimates the significant risk during the intrapartum period. * **Option D (>50%):** This is an overestimation. Even without treatment, the majority of infants born to HIV-positive mothers do not contract the virus. **3. NEET-PG High-Yield Pearls:** * **Most common timing of transmission:** Intrapartum (during labor/delivery). * **Effect of ART:** With effective ART and viral suppression ( 1000 copies/mL or unknown. * **Feeding:** In India, exclusive breastfeeding is recommended for the first 6 months if replacement feeding is not "Acceptable, Feasible, Affordable, Sustainable, and Safe" (AFASS). However, the question specifically specifies a **non-breastfeeding** woman.

Q: Which of the following has proven to be effective in the management of preeclampsia?

Calcium. **Explanation:** The correct answer is **Calcium**. The management of preeclampsia involves two distinct strategies: **prevention** (prophylaxis) and **treatment** of complications. 1. **Why Calcium is correct:** According to WHO and ACOG guidelines, calcium supplementation (1.5–2.0 g/day) is proven to **reduce the risk of developing preeclampsia**, particularly in populations with low dietary calcium intake. The underlying mechanism involves the suppression of parathyroid hormone release and intracellular calcium reduction, which decreases vascular smooth muscle reactivity and prevents hypertension. 2. **Why other options are incorrect:** * **Magnesium:** While **Magnesium Sulfate (MgSO₄)** is the drug of choice for the *prevention and treatment of seizures* (eclampsia), it does not prevent the onset of preeclampsia itself. The question asks for the management of the condition broadly; in the context of nutritional/preventative interventions, calcium has the strongest evidence base. * **Zinc:** Various studies have evaluated antioxidants and minerals like Zinc, Vitamin C, and Vitamin E. However, clinical trials have failed to show any significant benefit in the prevention or management of preeclampsia. **High-Yield Clinical Pearls for NEET-PG:** * **Low-dose Aspirin (75–150 mg):** The most effective pharmacological intervention for preventing preeclampsia in high-risk women, ideally started before 16 weeks of gestation. * **Definitive Treatment:** Delivery of the fetus and placenta remains the only definitive cure for preeclampsia. * **Antihypertensives of choice:** Labetalol (first line), Hydralazine, and Nifedipine. **ACE inhibitors and ARBs are contraindicated** due to teratogenicity.

Q: What is the effect of preeclampsia on the glomerular filtration rate?

Decreases. **Explanation:** In a normal pregnancy, the Glomerular Filtration Rate (GFR) typically increases by 40–50% due to increased plasma volume and renal blood flow. However, in **preeclampsia**, the underlying pathophysiology is systemic endothelial dysfunction and vasospasm. The characteristic renal lesion in preeclampsia is **Glomerular Endotheliosis**. This involves swelling of the glomerular endothelial cells and subendothelial deposits of fibrin-like material, which physically narrows the capillary lumens and reduces the surface area available for filtration. Consequently, renal plasma flow decreases and the **GFR decreases** (typically by 30–40% compared to normal pregnancy levels). This reduction in GFR leads to an increase in serum uric acid (an early marker) and, in severe cases, elevated serum creatinine. **Analysis of Options:** * **A. Increases:** This is incorrect. While GFR increases in a healthy pregnancy, the pathological changes of preeclampsia reverse this trend. * **C. Remains the same:** This is incorrect. The structural damage (endotheliosis) and vasospasm significantly alter renal hemodynamics. * **D. May increase or decrease:** This is incorrect. The physiological hallmark of preeclampsia is a consistent reduction in GFR compared to the expected hyperfiltration of pregnancy. **NEET-PG High-Yield Pearls:** * **Glomerular Endotheliosis** is the pathognomonic renal lesion of preeclampsia. * **Hyperuricemia** (due to decreased GFR and increased tubular reabsorption) is often the first biochemical sign and correlates with the severity of the disease. * Proteinuria in preeclampsia is primarily due to increased glomerular permeability to proteins. * Unlike most renal diseases, the filtration fraction in preeclampsia is often decreased because the reduction in GFR is more pronounced than the reduction in renal plasma flow.

Q: Which of the following side-effects is NOT associated with the use of magnesium sulfate in pregnancy?

Bradycardia. **Explanation:** Magnesium sulfate ($MgSO_4$) is the drug of choice for seizure prophylaxis in pre-eclampsia and management of eclampsia. It acts as a CNS depressant and a calcium antagonist at the neuromuscular junction. **Why Bradycardia is the correct answer:** While $MgSO_4$ has significant cardiovascular effects at toxic levels, it typically causes **tachycardia** (due to peripheral vasodilation and compensatory mechanisms) or hypotension. Bradycardia is not a characteristic side effect; instead, toxicity leads to **cardiac arrest** in asystole at very high serum concentrations (>25–30 mEq/L). **Analysis of incorrect options:** * **Muscular paralysis:** Magnesium inhibits the release of acetylcholine at the motor endplate. Toxicity manifests as a loss of deep tendon reflexes (7–10 mEq/L), progressing to generalized muscle paralysis. * **Cardiac arrhythmias:** At toxic levels (above 15 mEq/L), magnesium causes conduction delays, leading to EKG changes (prolonged PR/QRS intervals) and potentially fatal arrhythmias. * **Respiratory depression:** This is a critical sign of toxicity (12–15 mEq/L) occurring due to the paralysis of respiratory muscles. **High-Yield NEET-PG Pearls:** 1. **Therapeutic Range:** 4–7 mEq/L. 2. **Sequence of Toxicity:** Loss of Patellar Reflex (earliest sign) → Respiratory Depression → Cardiac Arrest. 3. **Monitoring:** Always check urine output (>30 ml/hr), respiratory rate (>12/min), and patellar reflexes before each dose. 4. **Antidote:** 10 ml of 10% **Calcium Gluconate** IV (administered over 10 minutes).

Q: A sinusoidal heart rate pattern is most commonly associated with which of the following conditions?

Vasa previa. **Explanation:** A **sinusoidal heart rate pattern** is a Category III fetal heart rate (FHR) tracing characterized by a smooth, sine-wave-like undulating pattern with a frequency of 3–5 cycles per minute and an amplitude of 5–15 bpm. It is a classic sign of **severe fetal anemia** or acute fetal hypoxia. **Why Vasa Previa is correct:** In vasa previa, fetal vessels run unprotected by Wharton's jelly across the internal os. When the membranes rupture (ROM), these vessels can lacerate, leading to immediate **fetal exsanguination**. Because the fetus has a small blood volume, rapid blood loss leads to severe anemia and hypoxia, manifesting on the CTG as a sinusoidal pattern. This is a surgical emergency. **Why the other options are incorrect:** * **Placenta Previa:** While it causes significant maternal bleeding, it rarely causes acute fetal blood loss unless there is placental abruption or trauma. The blood lost is primarily maternal. * **Battledore Placenta:** This refers to the insertion of the umbilical cord at the margin of the placenta. It is usually an incidental finding and does not typically cause acute fetal anemia or sinusoidal patterns. * **Succenturiate Placenta:** This is an accessory lobe of the placenta. While it increases the risk of vasa previa (if vessels run between lobes), the condition itself does not cause a sinusoidal pattern unless those vessels rupture. **High-Yield Clinical Pearls for NEET-PG:** * **Apt Test:** Used to differentiate fetal blood from maternal blood in cases of vaginal bleeding (positive in vasa previa). * **Causes of Sinusoidal Pattern:** Fetal anemia (Rh isoimmunization, Parvovirus B19, vasa previa), severe hypoxia, and certain drugs (e.g., narcotics like alphaprodine). * **Management:** A persistent sinusoidal pattern requires immediate Cesarean delivery.

Question 1

A 30-year-old G2P1L1 at 37 weeks gestational age presents for a routine visit. Her first delivery was a vaginal delivery of a 4.3 kg baby boy after 30 minutes of pushing. This fetus is breech. A vaginal examination shows that the cervix is 50% effaced and 1 to 2 cm dilated. The presenting breech is high out of the pelvis. The estimated fetal weight is approximately 3.2 kgs. A sonogram confirms a fetus with a frank breech presentation, normal amniotic fluid, and the head is well flexed. Which of the following is NOT a possible management plan?

Accepted Answer

Perform a cesarean section immediately.

Answer

Allow the patient to attempt a vaginal breech delivery when she goes into labor.

Answer

Pinard's maneuver can be utilized for the delivery of extended legs.

Answer

Schedule an external cephalic version in the next few days.

Question 2

Which of the following complications is NOT associated with an increased risk in multifetal pregnancy?

Accepted Answer

Post-term pregnancy

Answer

Maternal death

Answer

Preeclampsia

Answer

Hysterectomy

Question 3

What is the exclusive complication of monochorionic twins?

Accepted Answer

Twin-to-twin transfusion syndrome

Answer

Cord entanglement

Answer

Discordant growth

Answer

Abortion

Question 4

What are the effects of smoking during pregnancy?

Accepted Answer

Intrauterine Growth Restriction (IUGR)

Answer

Pregnancy-Induced Hypertension (PIH)

Answer

Malpresentation

Answer

Postpartum Hemorrhage (PPH)

Question 5

What is the risk of mother-to-child HIV transmission in a pregnant woman at the time of delivery and after delivery in a non-breastfeeding woman?

Accepted Answer

15-30%

Answer

5-10%

Answer

10-15%

Answer

More than 50%

Question 6

A pregnant mother presents with a history of delivering a previous child with Congenital Adrenal Hyperplasia (CAH). What is the best management protocol for the current pregnancy?

Accepted Answer

Start dexamethasone as soon as pregnancy is confirmed

Answer

Start prednisolone after establishing whether the fetus is affected by Chorionic Villous Sampling

Answer

Start dexamethasone after determining the sex of the fetus by Karyotyping

Answer

Start prednisolone after determining the sex of the fetus with USG

Question 7

Which of the following has proven to be effective in the management of preeclampsia?

Accepted Answer

Calcium

Answer

Zinc

Answer

Magnesium

Answer

None

Question 8

What is the effect of preeclampsia on the glomerular filtration rate?

Accepted Answer

Decreases

Answer

Increases

Answer

Remains the same

Answer

May increase or decrease

Question 9

Which of the following side-effects is NOT associated with the use of magnesium sulfate in pregnancy?

Accepted Answer

Bradycardia

Answer

Muscular paralysis

Answer

Cardiac arrhythmias

Answer

Respiratory depression

Question 10

A sinusoidal heart rate pattern is most commonly associated with which of the following conditions?

Accepted Answer

Vasa previa

Answer

Placenta previa

Answer

Battledore placenta

Answer

Succenturiate placenta

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?