Maternal-Fetal Medicine Practice Questions

Q: Which of the following is not a potentially teratogenic infection if contracted in pregnancy?

Influenza virus. ***Influenza virus*** - While influenza can cause severe illness in pregnant women, it is **not generally considered teratogenic**, meaning it does not typically cause birth defects like the other listed infections. - The primary risks of influenza in pregnancy are severe maternal complications, **preterm birth**, and **low birth weight**, rather than congenital anomalies. *Chicken pox* - Maternal infection with **varicella-zoster virus (chickenpox)** during the first 20 weeks of pregnancy can lead to **Congenital Varicella Syndrome**, characterized by skin scarring, limb hypoplasia, microphthalmia, and neurological deficits. - Infection late in pregnancy can cause **neonatal varicella**, which can be severe and life-threatening for the newborn. *Rubella* - Maternal infection with **rubella (German measles)**, especially during the first trimester, is a well-known cause of **Congenital Rubella Syndrome (CRS)**. - CRS can result in severe birth defects, including **cataracts**, **heart defects** (e.g., patent ductus arteriosus, pulmonary artery stenosis), and **sensorineural hearing loss**. *Cytomegalovirus* - **Congenital cytomegalovirus (CMV)** infection is a leading cause of **non-hereditary sensorineural hearing loss** and neurodevelopmental disabilities. - While many infected infants are asymptomatic at birth, some develop **microcephaly**, periventricular calcifications, hepatosplenomegaly, and **chorioretinitis**.

Q: Polyhydramnios at term is diagnosed when AFI is more than:

25 cm. ***25 cm*** - **Polyhydramnios** is diagnosed when the **Amniotic Fluid Index (AFI)** at term is greater than or equal to **25 cm**. - This indicates an excessive amount of **amniotic fluid**, which can be associated with various maternal or fetal complications. *15 cm* - An AFI of 15 cm is within the **normal range** for amniotic fluid volume. - It does not meet the criteria for either **polyhydramnios** or **oligohydramnios**. *20 cm* - An AFI of 20 cm is considered to be in the **upper normal limit** or **borderline high**, but it does not definitively meet the diagnostic criteria for **polyhydramnios**. - Close monitoring would be indicated, but it's not severe polyhydramnios. *10 cm* - An AFI of 10 cm is also within the **normal range** for amniotic fluid volume. - It is neither indicative of too much nor too little amniotic fluid.

Q: Amniocentesis is called for in all of the following circumstances EXCEPT:

A father aged 50 year or more. ***A father aged 50 year or more*** - Advanced paternal age (typically 40 years or more) may be associated with a slightly increased risk of certain **autosomal dominant disorders** (e.g., achondroplasia, Marfan syndrome) and **schizophrenia** due to an accumulation of de novo mutations in sperm. - However, it is not a direct indication for **amniocentesis** for chromosomal abnormalities in the same way advanced maternal age or a history of chromosomal issues is. *Parents who are known to have chromosomal translocation* - If either parent carries a **balanced chromosomal translocation**, there is a significant risk that the pregnancy could result in an **unbalanced translocation** in the fetus, leading to developmental abnormalities or miscarriage. - **Amniocentesis** is indicated to determine whether the fetus has inherited an unbalanced translocation. *Mother who had a child with Down's syndrome or other chromosomal anomalies* - A prior pregnancy affected by **Down syndrome (Trisomy 21)** or another **chromosomal anomaly** significantly increases the risk of recurrence in subsequent pregnancies. - **Amniocentesis** allows for prenatal diagnosis to detect if the current fetus is affected. *A mother aged 35 years or more* - Advanced maternal age, generally defined as 35 years or older at the time of delivery, is associated with an increased risk of **aneuploidies**, such as **Down syndrome**. - **Amniocentesis** is offered to these mothers for prenatal chromosomal analysis.

Q: Which one of the following regarding fetal growth restriction is NOT true?

Delivery always at 34 weeks. ***Delivery always at 34 weeks*** - The timing of delivery in **fetal growth restriction (FGR)** is highly **individualized** and depends on several factors, including the severity of FGR, gestational age, and results of fetal surveillance tests like Doppler studies and biophysical profiles. It is not an absolute rule to deliver all FGR fetuses at 34 weeks. - Early delivery, especially before term, carries risks of **prematurity**, and the decision is made when the risks of continuing the pregnancy outweigh the risks of early delivery. *Biophysical profile is done* - The **biophysical profile (BPP)** is a common method of fetal surveillance used in pregnancies complicated by FGR to assess fetal well-being, including **fetal movements, tone, breathing, amniotic fluid volume,** and **non-stress test results**. - It helps in making decisions about the timing of delivery and ongoing management. *Umbilical artery Doppler studies are done* - **Umbilical artery Doppler studies** are crucial for monitoring FGR, as they assess placental function and fetal compromise by measuring blood flow in the umbilical artery. - Abnormal Doppler findings, such as **absent** or **reversed end-diastolic flow**, indicate increased placental resistance and are important in guiding management and determining the optimal timing of delivery. *Daily fetal movement count is advised* - **Daily fetal movement counting**, or "kick counts," is an important and simple method of fetal surveillance that women can perform at home to monitor fetal well-being. - A significant decrease in fetal movements can signal **fetal compromise** and warrants further evaluation.

Q: Cause of Fetal growth restriction may be: 1. Chromosomal abnormality 2. Congenital abnormality 3. Abnormal cord insertion Which of the statements given above is/are correct?

1, 2 and 3. ***Correct: 1, 2 and 3*** All three statements represent established causes of **Fetal Growth Restriction (FGR)**: - **Chromosomal abnormalities** (trisomy 13, 18, 21, Turner syndrome) cause **intrinsic poor growth potential** of the fetus by disrupting normal cellular development and metabolism, directly leading to FGR. - **Congenital abnormalities** (cardiac defects, renal malformations, CNS anomalies) impair fetal development and nutrient utilization through structural and functional deficits, resulting in FGR. - **Abnormal cord insertion** (velamentous or marginal cord insertion) compromises the efficiency of **nutrient and oxygen transfer** from the placenta to the fetus by reducing vascular support, thus causing placental insufficiency and FGR. *Incorrect: 1 and 3 only* This incorrectly excludes **congenital abnormalities**, which are a well-established independent cause of FGR. Structural malformations directly impair fetal growth through metabolic and functional deficits. *Incorrect: 1 and 2 only* This incorrectly excludes **abnormal cord insertion**, which directly impacts placental function and nutrient supply—a key pathway for uteroplacental insufficiency leading to FGR. *Incorrect: 2 and 3 only* This incorrectly excludes **chromosomal abnormalities**, which are a major genetic cause of intrinsic FGR. Chromosomal defects (e.g., trisomies) are fundamental causes of impaired fetal growth potential.

Q: Consider the following regarding the use of Magnesium Sulphate: 1. Used as tocolytic 2. As neuroprotective agent 3. Used in management of postpartum eclampsia Which of the statements given above are correct?

1, 2 and 3. ***1, 2 and 3*** - **Magnesium sulfate** is a well-established **tocolytic agent**, used to delay preterm labor by relaxing the uterine smooth muscle. - It is also utilized for its **neuroprotective effects** in preterm infants, reducing the risk of cerebral palsy and other neurological sequelae when administered to mothers at risk of preterm birth. - Furthermore, magnesium sulfate is the **drug of choice** for the prevention and management of **eclampsia and pre-eclampsia**, which can occur both during pregnancy and in the postpartum period. *1 and 3 only* - This option correctly identifies the use of **magnesium sulfate** as a **tocolytic** and for **postpartum eclampsia**, but incorrectly omits its significant role as a **neuroprotective agent**. - The neuroprotective effect, particularly in reducing the risk of cerebral palsy in preterm infants, is a crucial indication for magnesium sulfate use. *2 and 3 only* - This option correctly recognizes **magnesium sulfate's** application as a **neuroprotective agent** and in **postpartum eclampsia**, but overlooks its primary role as a **tocolytic** for preterm labor. - Its ability to relax uterine contractions makes it a vital medication in managing threatened preterm delivery. *1 and 2 only* - This option accurately states the use of **magnesium sulfate** as a **tocolytic** and a **neuroprotective agent**, but fails to include its critical role in the management of **postpartum eclampsia**. - Eclampsia, defined by seizures in a pre-eclamptic patient, is effectively prevented and treated with magnesium sulfate.

Q: A 25 year old G2P1L1, Rh –ve woman presented at 30 weeks gestation to the antenatal clinic, the indirect Coomb's test (ICT) was found to be positive. What would be the next line of management?

ICT titers to be closely monitored at weekly intervals. **ICT titers to be closely monitored at weekly intervals** - A **positive Indirect Coombs Test (ICT)** in an Rh-negative pregnant woman indicates the presence of maternal antibodies against fetal Rh antigens. The next step is to monitor the **titer** to assess the risk of **hemolytic disease of the fetus and newborn (HDFN)**. - Serial monitoring of ICT titers, typically every 2-4 weeks, helps to determine if the antibody levels are increasing, which would indicate a heightened risk to the fetus and necessitate further intervention. *Anti D to be given* - **Anti-D immunoglobulin** is administered to prevent **sensitization** in Rh-negative mothers who have not yet formed antibodies. - Since the ICT is already positive, the mother has already been **sensitized** and produced antibodies, making Anti-D administration ineffective at this stage. *Baby is to be delivered as soon as possible* - Premature delivery carries significant risks for the neonate due to **immaturity of organ systems**. - Delivery is usually reserved for cases of severe fetal compromise, not simply a positive ICT without further evidence of fetal anemia. *Amniocentesis for estimation of bilirubin by Liley's chart is to be done* - **Amniocentesis** for bilirubin estimation using **Liley's chart** is an invasive procedure that carries risks, including **infection** and **fetal loss**. - It is typically reserved for cases where **ICT titers are critically high** or there is evidence of fetal anemia on **Doppler ultrasound**, not as the initial management step for a positive ICT.

Question 1

Regarding hypertensive disorders of pregnancy, the following are true except:

Accepted Answer

Urinary dipstick result of +1 is equivalent to urinary protein concentration of 300 mg/dl

Answer

Significant proteinuria is more than/equal to 0.3 g/24hr

Answer

Eclampsia may present in the absence of hypertension

Answer

A protein:creatinine ratio more than 30 mg/mmol is considered significant

Question 2

Which of the following is not a potentially teratogenic infection if contracted in pregnancy?

Accepted Answer

Influenza virus

Answer

Chicken pox

Answer

Rubella

Answer

Cytomegalovirus

Question 3

Polyhydramnios at term is diagnosed when AFI is more than:

Accepted Answer

25 cm

Answer

15 cm

Answer

20 cm

Answer

10 cm

Question 4

Amniocentesis is called for in all of the following circumstances EXCEPT:

Accepted Answer

A father aged 50 year or more

Answer

Parents who are known to have chromosomal translocation

Answer

Mother who had a child with Down's syndrome or other chromosomal anomalies

Answer

A mother aged 35 years or more

Question 5

A 29 year old woman presents in emergency ward with amenorrhea of 6 weeks and pain. Urine pregnancy test shows positive. Examination shows diffuse significant lower abdomen tenderness. The pelvic examination is difficult to accomplish due to guarding. Her Beta-hCG level is 4000 mIU/ml. Transvaginal ultrasound shows no pregnancy in the uterus and no adnexal mass but moderate fluid in abdomen. Which of the following is the next best step?

Accepted Answer

Emergency laparotomy

Answer

Repeat Beta-hCG level in 48 hours

Answer

Institution of methotrexate

Answer

Wait and watch

Question 6

Which one of the following regarding fetal growth restriction is NOT true?

Accepted Answer

Delivery always at 34 weeks

Answer

Biophysical profile is done

Answer

Umbilical artery Doppler studies are done

Answer

Daily fetal movement count is advised

Question 7

Cause of Fetal growth restriction may be:

1. Chromosomal abnormality
2. Congenital abnormality
3. Abnormal cord insertion

Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

1 and 2 only

Answer

2 and 3 only

Question 8

Contraindications to Uterine Cerclage for Incompetent os are all EXCEPT:

Accepted Answer

Previous history suggestive of abortion due to incompetent os

Answer

Bulging membrane

Answer

History of vaginal bleeding

Answer

Ruptured membrane

Question 9

Consider the following regarding the use of Magnesium Sulphate:

1. Used as tocolytic
2. As neuroprotective agent
3. Used in management of postpartum eclampsia
Which of the statements given above are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Question 10

A 25 year old G2P1L1, Rh –ve woman presented at 30 weeks gestation to the antenatal clinic, the indirect Coomb's test (ICT) was found to be positive. What would be the next line of management?

Accepted Answer

ICT titers to be closely monitored at weekly intervals

Answer

Anti D to be given

Answer

Baby is to be delivered as soon as possible

Answer

Amniocentesis for estimation of bilirubin by Liley's chart is to be done

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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