Maternal-Fetal Medicine Practice Questions

Q: Ring of fire on USG signifies-

Ectopic pregnancy. ***Ectopic pregnancy*** - The \"ring of fire\" sign on ultrasound indicates increased vascularity around an **extrauterine gestational sac** or mass due to the surrounding trophoblastic tissue. - This Doppler finding is characteristic of an **ectopic pregnancy**, where a fertilized egg implants outside the uterus. *H. mole* - A **hydatidiform mole** (H. mole) typically presents with a \"snowstorm\" or \"grape-like cluster\" appearance on ultrasound, representing swollen chorionic villi. - While it involves abnormal trophoblastic proliferation, the classic **ring of fire** is not its defining ultrasound feature. *Aneuploidy* - **Aneuploidy** refers to an abnormal number of chromosomes and is detected through genetic testing or indicated by specific fetal anomalies on ultrasound. - It does not directly manifest as a \"ring of fire\" on ultrasound; this is a sign of abnormal gestational tissue vascularity. *PCOD* - **Polycystic Ovary Disease (PCOD)** is characterized by numerous small cysts in the ovaries (\"string of pearls\" appearance) and hormonal imbalances. - The \"ring of fire\" sign is not associated with PCOD; it is an indicator of vascular flow in a gestational sac.

Q: A 30-year-old lady develops retention of urine in the 2nd trimester. The most probable cause is:

Retroverted uterus. ***Retroverted uterus*** - A **retroverted uterus** in the second trimester can become entrapped in the sacral hollow, obstructing the bladder neck as the uterus enlarges. - This anatomical position prevents the uterus from rising into the abdomen, leading to **urinary retention**. *Bladder neck obstruction due to ovarian cyst* - While an **ovarian cyst** *could* potentially cause bladder neck obstruction, it is a less common cause of urinary retention in the second trimester compared to an entrapped retroverted uterus. - The presence of an ovarian cyst specifically causing significant obstruction would usually present with additional symptoms related to the cyst itself. *Fibroid uterus* - **Uterine fibroids** can cause various obstetric complications, but significant urinary retention due to bladder neck obstruction in the second trimester is not a typical presentation. - Large fibroids may put pressure on the bladder, but direct obstruction leading to retention is less common than with an entrapped retroverted uterus. *Neurogenic bladder* - A **neurogenic bladder** is a disorder of bladder function due to neurological damage, and its onset would likely predate or not specifically coincide with the second trimester of pregnancy. - This condition involves issues with nerve signals to the bladder, which would not typically manifest acutely as urinary retention solely due to pregnancy unless there was an underlying neurological condition.

Q: Termination of pregnancy in placenta previa is indicated in: a) Active bleeding b) Active labour c) Gestational age > 34 weeks with live fetus d) Fetal malformation e) Unstable lie

ab. ***ab*** - **Active bleeding** in placenta previa is an absolute indication for immediate delivery (usually by cesarean section) due to the risk of life-threatening maternal and fetal hemorrhage. - **Active labour** with placenta previa is a critical indication for immediate cesarean delivery, as progressive cervical dilation causes placental separation leading to catastrophic hemorrhage. *acd* - While active bleeding is an indication, gestational age > 34 weeks alone does not mandate immediate delivery in stable placenta previa patients. Expectant management until 36-37 weeks is standard practice. *e* - Unstable lie is not an indication for termination of pregnancy in placenta previa. While it may necessitate cesarean section at term, it does not indicate immediate delivery. *abc* - Active bleeding and active labour are correct indications, but gestational age > 34 weeks with a live fetus is NOT an isolated indication for immediate delivery in stable patients without bleeding. *abd* - Active bleeding and active labour are correct indications, but fetal malformation is not a specific indication for termination in the context of placenta previa management. Fetal malformation decisions are made independently of placenta previa status.

Q: Risk for postnatal urinary abnormality is severe if Renal pelvic dilatation is ----- in third trimester?

> 15mm. ***> 15mm*** - A renal pelvic dilatation **greater than 15mm** in the third trimester is classified as **severe hydronephrosis**, indicating a high risk for significant postnatal urinary abnormalities. - This degree of dilatation often suggests an underlying **obstructive uropathy** or **vesicoureteral reflux (VUR)** that may require surgical intervention. *9 to <= 15mm* - This range typically indicates **moderate hydronephrosis**, which carries an intermediate risk for postnatal urinary issues compared to severe cases. - While follow-up is necessary, the likelihood of requiring surgical intervention is lower than with severe dilatation. *7 to < 9mm* - This range is usually considered **mild hydronephrosis**, and many cases resolve spontaneously after birth. - The risk of significant postnatal urinary abnormalities is relatively low, though monitoring is still recommended. *4 to < 7mm* - In the third trimester, a renal pelvic dilatation in this range is often considered **physiologic or very mild**, with a minimal risk of postnatal pathology. - Most cases will resolve without intervention, and significant urinary abnormalities are rare.

Q: Treatment of choice in placenta accreta :

Hysterectomy. ***Hysterectomy*** - In cases of **placenta accreta**, the placenta abnormally invades the uterine wall, making separation difficult and risking severe hemorrhage. - **Hysterectomy** is the treatment choice to prevent life-threatening bleeding and remove the abnormally adherent placenta along with the uterus. *Manual removal* - **Manual removal** is contraindicated in placenta accreta as it can lead to massive hemorrhage due to the abnormal placental adherence. - This method is typically used for uncomplicated, retained placentas that are not abnormally invasive. *Hysterotomy* - **Hysterotomy** is an incision into the uterus and is not a definitive treatment for placenta accreta. - While it may be used to deliver the baby in certain obstetric scenarios, it does not address the underlying issue of placental adherence. *Wait and watch* - A **wait and watch** approach (expectant management) is associated with a high risk of life-threatening hemorrhage and infection in placenta accreta. - This strategy is not recommended for cases of confirmed placenta accreta due to the significant maternal morbidity and mortality.

Q: Medical treatment of ectopic pregnancy is :

Methotrexate. ***Methotrexate*** - **Methotrexate** is the primary medical treatment for **unruptured ectopic pregnancies** in stable patients. - It works by inhibiting **folate reductase**, stopping rapidly dividing cells, which leads to the dissolution of the ectopic gestational tissue. *Oestrogen* - **Oestrogen** (estrogen) is a female sex hormone primarily involved in the development and regulation of the female reproductive system and secondary sex characteristics. - It is not used to treat ectopic pregnancies and may even promote growth of uterine tissue, which is not desired in this context. *Adriamycin* - **Adriamycin** (doxorubicin) is an **anthracycline chemotherapy agent** used primarily in the treatment of various cancers. - It has significant side effects and is not indicated for the treatment of ectopic pregnancy. *Progesterone* - **Progesterone** is a hormone essential for maintaining pregnancy and is often used to support early pregnancies, especially in cases of threatened miscarriage. - It would work against the goal of terminating an ectopic pregnancy and is therefore contraindicated.

Q: Soft markers on ultrasonography are helpful in diagnosing?

Chromosomal anomalies. ***Chromosomal anomalies*** - **Soft markers** are sonographic findings that, while not structural anomalies themselves, are **statistically associated** with an increased risk of chromosomal abnormalities, particularly **Down syndrome (Trisomy 21)** and other aneuploidies. - Common examples include **nuchal fold thickening**, **echogenic intracardiac focus**, **choroid plexus cysts**, **pyelectasis**, **shortened long bones**, and **echogenic bowel**. - These markers help identify pregnancies at higher risk for chromosomal anomalies and guide decisions about further diagnostic testing (e.g., amniocentesis, NIPT). *Site of pregnancy* - The site of pregnancy (intrauterine vs. ectopic) is determined by direct visualization of the **gestational sac** and **embryo** within or outside the uterine cavity. - Soft markers do not indicate pregnancy location. *Fetal size* - **Fetal size** is assessed through biometric measurements: **crown-rump length (CRL)** in the first trimester, and **biparietal diameter (BPD)**, **head circumference (HC)**, **abdominal circumference (AC)**, and **femur length (FL)** in later pregnancy. - These are growth parameters, distinct from soft markers for chromosomal risk. *Fetal age* - **Fetal age** (gestational age) is primarily determined by **crown-rump length (CRL)** in the first trimester, which is the most accurate method. - Later, BPD, HC, AC, and FL are used for dating, but soft markers do not determine fetal age.

Q: A lady with 10-12 wks pregnancy develops acute retention of urine. The likely cause is-

Retroverted uterus. ***Retroverted uterus*** - A **retroverted uterus** can become impacted in the **pelvic cavity** as it grows during pregnancy, causing compression of the urethra. - This impaction typically occurs between **10-14 weeks of gestation**, leading to acute urinary retention. *Prolapse uterus* - Uterine prolapse is less likely to cause acute urinary retention in early pregnancy, as the pregnant uterus tends to **ascend out of the pelvis** at this stage. - While prolapse can be associated with urinary symptoms, acute retention due to prolapse is more common in **non-pregnant** or **postpartum** states. *Fibroid* - A **fibroid**, especially a large one or one located in the lower uterine segment, can obstruct the bladder outlet. - However, the most classic cause of acute urinary retention in early pregnancy is a **retroverted uterus**, which is more commonly implicated than fibroids in this specific scenario. *Urinary tract infection* - A **urinary tract infection (UTI)** can cause dysuria, frequency, and urgency, and in severe cases, might lead to urinary retention due to urethral inflammation or bladder dysfunction. - While a UTI is possible, in the context of early pregnancy and acute retention, a **mechanical obstruction** from uterine displacement is a more specific and common cause.

Question 1

Ring of fire on USG signifies-

Accepted Answer

Ectopic pregnancy

Answer

H. mole

Answer

Aneuploidy

Answer

PCOD

Question 2

A 30-year-old lady develops retention of urine in the 2nd trimester. The most probable cause is:

Accepted Answer

Retroverted uterus

Answer

Bladder neck obstruction due to ovarian cyst

Answer

Fibroid uterus

Answer

Neurogenic bladder

Question 3

Termination of pregnancy in placenta previa is indicated in:
a) Active bleeding
b) Active labour
c) Gestational age > 34 weeks with live fetus
d) Fetal malformation
e) Unstable lie

Accepted Answer

ab

Answer

acd

Answer

e

Answer

abd

Answer

abc

Question 4

A 30-year-old G2P1 is undergoing an elective repeat caesarean section at term. The infant is delivered without any difficulties, but the placenta cannot be removed easily because a clear plane between the placenta and uterine wall cannot be identified. The placenta is removed in pieces. This is followed by uterine atony and haemorrhage. All of the following are true regarding the condition except:

Accepted Answer

If placenta invades muscle and reaches serosa it is known as placenta increta

Answer

May require obstetric hysterectomy

Answer

Absence of Nitabuch's membrane

Answer

Previous LSCS is a predisposing factor

Question 5

A 19-year-old woman presents to the emergency department reporting that she fainted at work earlier in the day. She has mild vaginal bleeding and her abdomen is diffusely tender and distended. She also complains of shoulder and abdominal pain. Her vital signs show temperature 97.6°F (36.4°C), pulse 120/min, and blood pressure 96/50 mmHg. To confirm the diagnosis suggested by the available clinical data, the best initial diagnostic procedure is

Accepted Answer

Transvaginal ultrasound

Answer

Serum beta-hCG levels

Answer

FAST (Focused Assessment with Sonography in Trauma)

Answer

Diagnostic laparoscopy

Question 6

Risk for postnatal urinary abnormality is severe if Renal pelvic dilatation is ----- in third trimester?

Accepted Answer

> 15mm

Answer

7 to < 9mm

Answer

9 to <= 15mm

Answer

4 to < 7mm

Question 7

Treatment of choice in placenta accreta :

Accepted Answer

Hysterectomy

Answer

Manual removal

Answer

Hysterotomy

Answer

Wait and watch

Question 8

Medical treatment of ectopic pregnancy is :

Accepted Answer

Methotrexate

Answer

Oestrogen

Answer

Adriamycin

Answer

Progesterone

Question 9

Soft markers on ultrasonography are helpful in diagnosing?

Accepted Answer

Chromosomal anomalies

Answer

Site of pregnancy

Answer

Fetal size

Answer

Fetal age

Question 10

A lady with 10-12 wks pregnancy develops acute retention of urine. The likely cause is-

Accepted Answer

Retroverted uterus

Answer

Prolapse uterus

Answer

Fibroid

Answer

Urinary tract infection

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?