Maternal-Fetal Medicine Practice Questions

Q: A patient at 8 weeks of pregnancy is diagnosed to have a dermoid cyst. It should be removed at:

At 14-16 weeks. ***At 14-16 weeks*** - This period, the **second trimester**, is generally considered the safest time for **non-emergent surgery** during pregnancy. - Waiting until 14-16 weeks allows for the completion of **organogenesis**, reducing the risk of teratogenicity, and the risk of **spontaneous abortion** is lower compared to the first trimester. *Only when it undergoes torsion* - While **torsion** is a significant complication requiring immediate surgical intervention, waiting for it to occur would expose the patient to unnecessary pain, **ischemia**, and potential loss of the **ovary**. - Elective removal at a safer time is preferred to prevent emergencies. *At term along with LSCS* - Removing the cyst at term during a **cesarean section (LSCS)** is not ideal if the cyst is larger than 6 cm due to the increased risk of **torsion, rupture**, or **obstruction of labor** earlier in pregnancy. - If the cyst is small and uncomplicated, some obstetricians may consider this, but it is not the standard approach for a newly diagnosed cyst at 8 weeks. *Immediately* - Performing surgery at **8 weeks of gestation (first trimester)** carries a higher risk of **spontaneous abortion** due to surgical stress, anesthesia, and potentially interfering with critical stages of **embryonic development**. - Unless there is an emergency (like rupture or acute torsion), elective surgery is typically postponed.

Q: How do you manage placenta accreta?

Classical cesarean; hysterectomy. ***Classical cesarean; hysterectomy*** - A **classical cesarean section** (vertical incision in the upper uterine segment) allows for delivery of the fetus without disturbing the **placenta accreta** in the lower uterine segment. - Subsequent **hysterectomy** is often necessary due to the high risk of severe hemorrhage from the morbidly adherent placenta, which cannot be safely separated. *Low vertical cesarean; hysterectomy* - A **low vertical incision** is made in the lower uterine segment, which could potentially incise through the placenta accreta if it extends to that region, leading to significant hemorrhage. - While hysterectomy is likely indicated, the initial uterine incision might complicate management. *Low transverse cesarean; hysterectomy* - A **low transverse incision** is the most common type for routine cesarean sections but is contra-indicated in placenta accreta as the placenta is frequently implanted in the lower uterine segment. - Incising through the **placenta** during a low transverse cut would cause immediate massive hemorrhage, making this approach unsuitable. *Classical cesarean; myometrial resection* - While a **classical cesarean** would be the appropriate initial step for fetal delivery, **myometrial resection** to remove only the affected area of the myometrium is generally insufficient and carries a high risk of residual placental tissue and severe hemorrhage, often necessitating a hysterectomy anyway. - This approach is typically not recommended as a primary definitive management strategy for established placenta accreta.

Q: Retention of urine in a pregnant woman with a retroverted uterus is seen in which week?

12-16 weeks. ***12-16 weeks*** - Between **12-16 weeks**, the uterus typically rises out of the **pelvis**. A **retroverted uterus** can become trapped, causing pressure on the bladder neck and leading to **urinary retention**. - This period aligns with the timing when the growing uterus in a retroverted position would exert maximum pressure on the urethra, leading to **bladder outflow obstruction**. *20-24 weeks* - By **20-24 weeks**, the uterus is usually well out of the **pelvis**, making urinary retention due to uterine retroversion less likely as a primary cause. - If retained beyond 16 weeks, the uterus would likely have **spontaneously corrected its position** or the problem would have presented earlier. *28-32 weeks* - At **28-32 weeks**, the uterus is much larger and would typically be positioned high in the **abdomen**, far removed from the **pelvic outlet**, preventing entrapment. - Urinary retention at this stage may indicate other complications, such as **urinary tract infection** or **neurogenic bladder**, rather than uterine retroversion. *8-10 weeks* - At **8-10 weeks**, the uterus is generally still small and contained within the **pelvis**, and although retroversion is present, it is often not large enough to cause significant pressure on the **bladder neck** or entrapment. - **Urinary symptoms** at this stage are more commonly related to hormonal changes or increased blood flow to the kidneys, often characterized by **urinary frequency** rather than retention.

Q: In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?

Middle cerebral artery Doppler wave forms. ***Middle cerebral artery Doppler wave forms*** - This is currently the most widely accepted and **non-invasive** method for monitoring **fetal anemia** in Rh-sensitized pregnancies. - An increase in the **peak systolic velocity (PSV)** in the middle cerebral artery indicates that the fetus is increasing cardiac output to compensate for a reduced oxygen-carrying capacity due to anemia. *Biophysical profile* - The biophysical profile assesses various fetal parameters like **movement**, **tone**, **breathing**, and **amniotic fluid volume**, which are often altered late in the course of severe fetal anemia. - It is a **less sensitive** indicator of early or moderate fetal anemia compared to MCA Doppler. *Amniotic fluid spectrophotometry* - This method measures the **bilirubin levels** in amniotic fluid, which correlates with the severity of hemolysis. - It is an **invasive procedure** (amniocentesis) and has largely been replaced by non-invasive MCA Doppler due to associated risks and better predictive value of Doppler. *Fetal blood sampling* - Fetal blood sampling (cordocentesis) provides a direct measurement of **fetal hemoglobin** and other blood parameters. - While definitive, it is a **highly invasive procedure** with significant risks, reserved primarily for confirmation of severe anemia or for direct transfusion, not for routine monitoring.

Q: In Peripartum cardiomyopathy, cardiac failure occurs at:-

Within 5 months after delivery.. ***Within 5 months after delivery.*** - Peripartum cardiomyopathy (PPCM) is defined as the development of **cardiac failure** in the **last month of pregnancy** or within **5 months after delivery**, in the absence of any other identifiable cause. - Among the given options, "within 5 months after delivery" represents the **postpartum component** of the diagnostic timeframe and is the most complete answer. - This time frame is a key diagnostic criterion recognized by major cardiology societies (some recent guidelines extend this to 6 months postpartum). - **Note:** The complete definition includes both antepartum (last month of pregnancy) and postpartum (up to 5 months) periods. *Within 24 months after delivery.* - This timeframe is **too broad** and does not align with the standard diagnostic criteria for PPCM. - While some women may experience ongoing cardiac dysfunction or relapse, the initial diagnosis of PPCM is restricted to within 5 months postpartum. - Extended cardiac issues beyond 5 months may represent persistent PPCM or dilated cardiomyopathy rather than new-onset PPCM. *Within 6 weeks after delivery.* - While many cases of PPCM manifest within **6 weeks postpartum** (the traditional puerperium), this definition is **too restrictive**. - Symptoms can appear up to **5 months after delivery**, and using only 6 weeks would miss a significant proportion of cases. - This period captures the most acute presentations but doesn't encompass the entire recognized diagnostic window. *Within 7 days after delivery.* - The onset within **7 days after delivery** represents only the **immediate postpartum period** and is an overly narrow definition. - PPCM can develop much later in the postpartum period (up to 5 months), making this timeframe inadequate for diagnosis. - Using this restrictive criterion would result in many missed diagnoses.

Q: A woman with 18 weeks gestation presented to the OPD. On abdominal examination, the uterine size was 16 weeks. On USG, oligohydramnios was found, which of the following is suspected?

Renal agenesis. ***Renal agenesis*** - **Oligohydramnios** (low amniotic fluid) and a **smaller-than-expected uterine size** at 18 weeks gestation are strong indicators of fetal renal agenesis. - Fetal kidneys are crucial for producing amniotic fluid through urine excretion, so their absence or severe malfunction leads to insufficient fluid. *Jaundice* - Not directly associated with **oligohydramnios** or a smaller uterine size. - While it can occur in utero, it doesn't cause a reduction in amniotic fluid volume. *Fetal anemia* - Often associated with **hydrops fetalis** and **polyhydramnios** (excess amniotic fluid), due to increased cardiac output and fluid retention, rather than oligohydramnios. - Doesn't typically present with a uterus smaller than expected for gestational age. *Anencephaly* - A neural tube defect characterized by the absence of a major portion of the brain and skull. - It is usually associated with **polyhydramnios** (excess amniotic fluid) due to impaired fetal swallowing, making it inconsistent with the given findings.

Question 1

Regarding medical treatment of ectopic pregnancy, all are true except:

Accepted Answer

Initial beta HCG is an indicator for the number of doses required

Answer

Best prognostic indicator for success is initial HCG levels

Answer

Perform baseline CBC, LFT, KFT

Answer

Failure rates increase if cardiac activity is present

Question 2

A patient at 8 weeks of pregnancy is diagnosed to have a dermoid cyst. It should be removed at:

Accepted Answer

At 14-16 weeks

Answer

Only when it undergoes torsion

Answer

At term along with LSCS

Answer

Immediately

Question 3

How do you manage placenta accreta?

Accepted Answer

Classical cesarean; hysterectomy

Answer

Low vertical cesarean; hysterectomy

Answer

Low transverse cesarean; hysterectomy

Answer

Classical cesarean; myometrial resection

Question 4

The best method of evacuation of a missed abortion in uterus of more than 12 weeks:

Accepted Answer

Prostaglandin E1 vaginal misoprostol followed by evacuation of the uterus

Answer

Oxytocin infusion

Answer

Intramuscular prostaglandin (15 methyl PGF2a)

Answer

Suction evacuation

Question 5

All are signs / features of ectopic pregnancy on USG except –

Accepted Answer

Echogenic mass with multicystic spaces within endometrial cavity

Answer

Hyperechoic rim

Answer

Adnexal mass

Answer

Pseudo sac

Question 6

Retention of urine in a pregnant woman with a retroverted uterus is seen in which week?

Accepted Answer

12-16 weeks

Answer

20-24 weeks

Answer

28-32 weeks

Answer

8-10 weeks

Question 7

In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?

Accepted Answer

Middle cerebral artery Doppler wave forms

Answer

Biophysical profile

Answer

Amniotic fluid spectrophotometry

Answer

Fetal blood sampling

Question 8

In Peripartum cardiomyopathy, cardiac failure occurs at:-

Accepted Answer

Within 5 months after delivery.

Answer

Within 24 months after delivery.

Answer

Within 6 weeks after delivery.

Answer

Within 7 days after delivery.

Question 9

A 25-year-old lady, Neethu, in her 22nd week of pregnancy develops hypertension and mild proteinuria. Due to the baby's gestational age, her obstetrician chooses to carefully monitor the mother for any sign of developing complications rather than to immediately deliver the baby. Which of the following complications account for the most maternal deaths in preeclampsia?

Accepted Answer

Cerebral hemorrhage and acute respiratory distress syndrome

Answer

Cerebral edema and laryngeal edema

Answer

Convulsions and renal tubular necrosis

Answer

Hemolysis and hepatic infection

Question 10

A woman with 18 weeks gestation presented to the OPD. On abdominal examination, the uterine size was 16 weeks. On USG, oligohydramnios was found, which of the following is suspected?

Accepted Answer

Renal agenesis

Answer

Jaundice

Answer

Fetal anemia

Answer

Anencephaly

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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