Maternal-Fetal Medicine Practice Questions

Q: Which of the following is an indication for medical management in ectopic pregnancy?

Size <4 cm. ***Correct: Size 4 cm) have higher failure rates with medical management. *Incorrect: Presence of fetal heart activity* - The presence of **fetal heart activity** is a **contraindication** for medical management with methotrexate. - **Absence of fetal cardiac activity** is required for medical management eligibility. - When cardiac activity is present, surgical intervention is preferred due to **lower success rates** of methotrexate and increased risk of **persistent ectopic pregnancy** or **rupture**. *Incorrect: Gestation 1500* - For medical management eligibility, **β-hCG should be 1500 mIU/mL doesn't define suitability; rather, levels **>5000 mIU/mL** are associated with decreased efficacy and increased failure rates.

Q: Umbilical artery Doppler is done to assess

Placental function. ***Placental function*** - Umbilical artery Doppler assesses **blood flow resistance** within the placenta, which is a direct indicator of its functional capacity. - Increased resistance, indicated by a high **systolic/diastolic (S/D) ratio** or absent/reversed end-diastolic flow, suggests inadequate placental perfusion and function. *Fetal weight* - Fetal weight is primarily assessed through **ultrasound biometry**, measuring parameters like head circumference, abdominal circumference, and femur length. - While compromised placental function can affect fetal growth, Doppler itself does not directly measure fetal weight. *Fetal oxygenation* - Fetal oxygenation is more directly assessed through **non-stress tests (NST)**, **biophysical profiles (BPP)**, and fetal scalp blood sampling for pH. - Abnormal umbilical artery Doppler findings can *indirectly* suggest potential for reduced oxygenation due to placental insufficiency, but it's not a direct measure. *Fetal maturity* - Fetal maturity, particularly lung maturity, is assessed by analyzing **amniotic fluid** for ratios like **lecithin/sphingomyelin** or presence of **phosphatidylglycerol**. - Umbilical artery Doppler provides no information about fetal organ development or gestational age-related maturity.

Q: Placenta increta means:

Villi invade myometrium. ***Villi invade myometrium*** - **Placenta increta** is a condition where the **chorionic villi** invade into the **myometrium** (the muscular layer of the uterus) but do not penetrate through it. - This deep invasion prevents the normal separation of the placenta after birth, leading to significant complications like **hemorrhage**. *Villi are attached to lower uterine segment* - This describes **placenta previa**, where the placenta implants in the lower uterine segment, covering or nearly covering the cervical os. - While it can cause bleeding, it does not involve abnormal placental adherence to the uterine wall. *Villi are attached to myometrium* - This description is too general and most closely aligns with **placenta accreta**, where the villi attach to the myometrium without invading or penetrating it. - **Placenta accreta** is the least severe form of abnormally invasive placenta. *Villi penetrate through myometrium* - This describes **placenta percreta**, the most severe form of abnormally invasive placenta. - In **placenta percreta**, the chorionic villi penetrate **through the entire myometrium** and may invade adjacent organs like the bladder or rectum.

Q: Which of the following STDs causes fetal abnormality?

Syphilis. ***Syphilis*** - **Congenital syphilis**, resulting from maternal infection, can lead to severe fetal abnormalities such as **bone deformities**, **saddle nose**, **Hutchinson's teeth**, and **neurological problems**. - It can also cause stillbirth, prematurity, or hydrops fetalis, emphasizing the importance of early detection and treatment during pregnancy. *Herpes* - While **neonatal herpes** can be life-threatening and cause neurological damage, it is typically acquired during passage through the birth canal and does not cause **fetal abnormalities** during gestation. - Herpes simplex virus primarily causes localized lesions and systemic infection in the neonate, not developmental defects. *Gonorrhea* - Gonorrhea primarily causes **ophthalmia neonatorum** (conjunctivitis) in newborns through exposure during birth, which can lead to blindness if untreated. - It does not typically cause **fetal abnormalities** or congenital defects through transplacental transmission. *Hepatitis B* - Hepatitis B can be transmitted to the fetus during birth, leading to **chronic hepatitis B infection** in the infant. - Although it causes a chronic disease, it does not typically result in **fetal abnormalities** or congenital malformations.

Q: Most safe and effective evacuation in a patient with missed abortion at 14-16 weeks can be achieved with

Misoprostol. ***Misoprostol*** - **Misoprostol** is a **prostaglandin E1 analog** that ripens the cervix and stimulates uterine contractions, making it highly effective for inducing labor and expelling uterine contents in cases of missed abortion, especially in the second trimester (14-16 weeks). - Its oral or vaginal administration offers a **non-invasive**, safe, and cost-effective approach for uterine evacuation, minimizing the risks associated with surgical procedures. *Extra-amniotic ethacrydyl lactate* - Extra-amniotic ethacrydyl lactate is an older method that is **not commonly used** for cervical ripening and uterine evacuation due to better, safer, and more effective alternatives. - This method involves injecting a substance outside the amniotic sac, which can carry a **higher risk of infection** and potentially incomplete evacuation compared to modern approaches. *Carboprost* - **Carboprost** is a **prostaglandin F2 alpha analog** primarily used to manage **postpartum hemorrhage** and is less commonly the first-line agent for evacuating missed abortions at this gestation. - While it can induce contractions, its side-effect profile (e.g., **bronchospasm**, **gastrointestinal upset**) and specific indications make it less ideal for routine induction for missed abortion compared to misoprostol. *Oxytocin* - **Oxytocin** is effective in stimulating uterine contractions mainly when the cervix is already ripe or near term, but it is **less effective** for cervical ripening and prolonged induction in the second trimester for missed abortion. - In cases of missed abortion at 14-16 weeks, the uterus is less responsive to oxytocin alone, and large doses may be needed, which could carry increased risks.

Q: Fetus starts hearing by what time in intrauterine life:

20 weeks. ***20 weeks*** - The **cochlea** and auditory structures of the inner ear reach **structural maturity** around **20 weeks of gestation**, marking the anatomical basis for hearing capability. - At this gestational age, the **cochlear hair cells** and **spiral ganglion** are sufficiently developed to transmit auditory signals. - This is the **conventional answer** in medical education, representing when the anatomical structures necessary for hearing are first functional. - While more consistent behavioral responses occur later (24-26 weeks), the initial capacity for sound perception begins around 20 weeks. *14 weeks* - At 14 weeks, the **basic structures** of the ear are forming but remain immature. - The cochlea is still undergoing development, and the auditory pathway is not yet functional. - Sound perception capability is not present at this early stage. *32 weeks* - By 32 weeks, the auditory system is **highly mature** and well-developed. - The fetus demonstrates robust responses to various sounds and can distinguish between different voices. - However, this represents advanced auditory function, not the **onset** of hearing, which occurs much earlier at 20 weeks. *33 weeks* - At 33 weeks, the fetal brain shows **significant activity** in response to auditory stimuli with well-established neural pathways. - This is a stage of **refined hearing**, not the initial development of hearing capability. - The ability to hear has already been established weeks earlier.

Q: A pregnant female presents with pain in abdomen. On examination, tenderness is found in right lumbar region. TLC is 12000/cmm and urine examination is normal. The most appropriate diagnostic test is:

Ultrasound abdomen. ***Ultrasound abdomen*** - This is the **safest and preferred initial imaging modality** for abdominal pain in pregnant women, as it avoids **ionizing radiation**. - It can effectively visualize the **appendix**, **gallbladder**, **kidneys**, and **uterus/adnexa**, helping to identify common causes of right lumbar pain like **appendicitis**, **pyelonephritis**, or **adnexal pathology**. *Laparoscopy* - While diagnostic, laparoscopy is an **invasive surgical procedure** and is typically reserved for cases where non-invasive imaging is inconclusive or if a **therapeutic intervention** is required. - It carries risks such as **anesthesia complications** and **uterine injury** in pregnancy, making it unsuitable as a primary diagnostic test. *Non-contrast CT abdomen* - **CT scans** involve **ionizing radiation**, which should be avoided in pregnancy due to potential risks to the **fetus**, especially if a less harmful alternative is available. - While it offers detailed anatomical information, the risk-benefit ratio for a **pregnant patient with a normal urine analysis** does not justify its initial use over ultrasound. *Chest X-ray with abdominal shield* - A **chest X-ray** primarily evaluates the **lungs and heart** and would not provide adequate visualization of the abdominal organs responsible for the right lumbar pain. - While a shield minimizes fetal exposure, the information gained would be **irrelevant to the presenting abdominal symptoms**, making it an inappropriate diagnostic choice.

Q: Snow storm appearance on an ultrasound is seen in:

Vesicular mole. ***Vesicular mole*** - The classic ultrasound finding in a **complete hydatidiform mole** is a **"snowstorm" appearance**, characterized by a uterine cavity filled with echogenic, vesicular tissue and no fetal parts. - This appearance is due to the **swollen chorionic villi** and **trophoblastic proliferation**. *Chronic ectopic pregnancy* - While an ectopic pregnancy involves an implantation outside the uterus, it typically presents with an **adnexal mass**, sometimes with a **"ring of fire" sign** on Doppler, but not a snowstorm pattern within the uterine cavity. - Chronic ectopic pregnancies may show a more complex adnexal mass with varying echogenicity due to hemorrhage and organization, but this is distinct from the diffuse uterine changes in a hydatidiform mole. *Hydatid cyst* - A **hydatid cyst**, caused by *Echinococcus granulosus*, is typically found in the liver or lungs and appears as a **well-defined, anechoic lesion** with possible internal septations or daughter cysts (often called a "water lily" sign if ruptured) but not a diffuse snowstorm pattern within the uterus. - This condition is a parasitic infection, entirely unrelated to pregnancy. *Dermoid cyst* - A **dermoid cyst** (mature cystic teratoma) is an ovarian tumor that typically appears as a **complex adnexal mass** with characteristic features like a **"Rokitansky nodule"**, fat-fluid levels, and highly echogenic components (e.g., hair, teeth). - Its appearance is localized to the ovary and does not mimic the widespread uterine findings of a vesicular mole.

Q: In pregnancies complicated by intrauterine growth restriction (IUGR) with otherwise reassuring fetal surveillance, what is the recommended gestational age for planned delivery to optimize neonatal outcomes?

38 weeks. ***38 weeks*** - For pregnancies complicated by **IUGR (Intrauterine Growth Restriction)** with reassuring fetal surveillance, planned delivery at **38-39 weeks** is recommended by **ACOG guidelines** to optimize neonatal outcomes. - Among the given options, **38 weeks** represents the earliest point in this recommended range, balancing the risks of continued intrauterine compromise with the risks of **prematurity** such as **respiratory distress syndrome**. - This timing is appropriate for **mild to moderate IUGR** without concerning Doppler findings or other complications. *39 weeks* - **39 weeks** is actually within the acceptable range (38-39 weeks) for IUGR delivery per current guidelines. - However, many obstetricians prefer **38 weeks** to minimize the risk of continued **fetal compromise** from **placental insufficiency**, making 38 weeks the more commonly cited benchmark. - The distinction between 38 and 39 weeks is nuanced and depends on individual case factors and surveillance findings. *37 weeks* - Delivery at **37 weeks** is considered **early term** and carries higher risk of **neonatal morbidities**, particularly **respiratory complications** and **hypoglycemia**. - This timing may be appropriate for **severe IUGR** with abnormal **umbilical artery Doppler** findings, **absent or reversed end-diastolic flow**, or other concerning features, but not for routine IUGR with reassuring surveillance. - It is not the standard recommendation for uncomplicated IUGR to optimize outcomes. *40 weeks* - Delivering at **40 weeks** in an IUGR pregnancy is **not recommended** due to increased risk of **stillbirth** and complications from ongoing **placental insufficiency**. - The risks of adverse outcomes escalate with expectant management beyond 38-39 weeks in IUGR pregnancies. - Minimal additional fetal growth occurs beyond this point while risks continue to increase.

Question 1

Which of the following is an indication for medical management in ectopic pregnancy?

Accepted Answer

Size <4 cm

Answer

Presence of fetal heart activity

Answer

Gestation <6 weeks

Answer

β-hCG>1500

Question 2

Umbilical artery Doppler is done to assess

Accepted Answer

Placental function

Answer

Fetal weight

Answer

Fetal oxygenation

Answer

Fetal maturity

Question 3

Placenta increta means:

Accepted Answer

Villi invade myometrium

Answer

Villi are attached to lower uterine segment

Answer

Villi are attached to myometrium

Answer

Villi penetrate through myometrium

Question 4

Which of the following STDs causes fetal abnormality?

Accepted Answer

Syphilis

Answer

Herpes

Answer

Gonorrhea

Answer

Hepatitis B

Question 5

Most safe and effective evacuation in a patient with missed abortion at 14-16 weeks can be achieved with

Accepted Answer

Misoprostol

Answer

Extra-amniotic ethacrydyl lactate

Answer

Carboprost

Answer

Oxytocin

Question 6

Fetus starts hearing by what time in intrauterine life:

Accepted Answer

20 weeks

Answer

14 weeks

Answer

32 weeks

Answer

33 weeks

Question 7

A pregnant female presents with pain in abdomen. On examination, tenderness is found in right lumbar region. TLC is 12000/cmm and urine examination is normal. The most appropriate diagnostic test is:

Accepted Answer

Ultrasound abdomen

Answer

Laparoscopy

Answer

Non contrast CT abdomen

Answer

Chest Xray with abdominal shield

Question 8

Snow storm appearance on an ultrasound is seen in:

Accepted Answer

Vesicular mole

Answer

Chronic ectopic pregnancy

Answer

Hydatid cyst

Answer

Dermoid cyst

Question 9

In pregnancies complicated by intrauterine growth restriction (IUGR) with otherwise reassuring fetal surveillance, what is the recommended gestational age for planned delivery to optimize neonatal outcomes?

Accepted Answer

38 weeks

Answer

39 weeks

Answer

37 weeks

Answer

40 weeks

Question 10

What is the WHO definition of abortion?

Accepted Answer

Pregnancy termination or loss occurring before 22 weeks of gestation.

Answer

Pregnancy termination or loss occurring before 24 weeks of gestation.

Answer

Pregnancy termination or loss occurring before 12 weeks of gestation.

Answer

Pregnancy termination or loss occurring before 20 weeks of gestation.

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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