Maternal-Fetal Medicine Practice Questions

Q: Which drug is commonly used to promote fetal lung maturity?

Betamethasone. ***Betamethasone*** - **Betamethasone** is the preferred corticosteroid for promoting **fetal lung maturity** in women at risk of preterm delivery (24-34 weeks gestation). - It stimulates **surfactant production** in fetal lungs, reducing the risk of **respiratory distress syndrome (RDS)** and neonatal mortality. - Recommended regimen: **12 mg IM, two doses 24 hours apart**. - Evidence suggests betamethasone may have advantages over dexamethasone, including **reduced risk of intraventricular hemorrhage** and possibly better neurodevelopmental outcomes. *Dexamethasone* - **Dexamethasone** is also an effective corticosteroid for fetal lung maturation and is commonly used in many settings. - While both drugs are acceptable, **betamethasone** is generally preferred based on meta-analyses showing slightly better outcomes. - Dexamethasone regimen: 6 mg IM every 12 hours for 4 doses. *Hydrocortisone* - **Hydrocortisone** has poor placental transfer due to metabolism by placental 11β-hydroxysteroid dehydrogenase. - Its shorter half-life and lower potency make it unsuitable for antenatal corticosteroid therapy. - Not used for fetal lung maturation. *Prednisolone* - **Prednisolone** is also extensively metabolized by the placenta and has poor fetal exposure. - Not effective for promoting fetal lung maturity. - Used for maternal conditions but not for fetal indication.

Q: Which of the following parameters is most critical to monitor in a patient with pre-eclampsia?

Blood pressure. ***Blood pressure*** - **Hypertension** is the hallmark of pre-eclampsia and directly correlates with the severity of the disease and the risk of complications such as **eclampsia** and **HELLP syndrome**. - Precise and frequent monitoring of blood pressure guides treatment decisions, including the initiation or adjustment of **antihypertensive medications**. *Proteinuria* - While **proteinuria** is a diagnostic criterion for pre-eclampsia, it is not the most critical parameter for ongoing management and predicting immediate adverse outcomes. - The quantity of proteinuria does not reliably predict the severity of maternal or fetal complications. *Platelet count* - **Thrombocytopenia** can occur in severe pre-eclampsia and **HELLP syndrome**, indicating disease progression. - While important for assessing coagulation status, it is a secondary monitoring parameter compared to blood pressure, which is central to diagnosis and acute management. *Liver function tests (LFTs)* - Elevated **LFTs** signify liver involvement, particularly in severe pre-eclampsia and **HELLP syndrome**. - Monitoring LFTs helps in assessing organ damage but is less immediate for day-to-day management decisions than blood pressure, which is the primary driver of intervention.

Q: What is the most common heart disease in pregnancy?

Mitral Stenosis (MS). **Mitral Stenosis (MS)** - **Mitral stenosis** is the most common form of **rheumatic heart disease**, which is the leading cause of heart disease in pregnant women. - Pregnancy exacerbates MS symptoms due to **increased blood volume** and **cardiac output**, leading to increased left atrial pressure and pulmonary congestion. *Aortic Stenosis (AS)* - While **aortic stenosis** can occur during pregnancy, it is less common than mitral stenosis as a primary cause of symptomatic heart disease. - The fixed outflow obstruction in AS can lead to complications, but its prevalence is lower compared to rheumatic MS. *Mitral Regurgitation (MR)* - **Mitral regurgitation** is generally better tolerated in pregnancy than stenotic lesions due to reduced afterload during gestation. - Although it can cause symptoms, it is not the most common heart disease encountered. *Wolff-Parkinson-White (WPW) syndrome* - **WPW syndrome** is an electrical conduction disorder, not a structural heart disease. - While it can manifest with arrhythmias exacerbated by pregnancy, it is not considered the most common structural heart disease in this population.

Q: What is the drug of choice (DOC) for medical management of ectopic pregnancy?

Methotrexate (Intramuscular). ***Methotrexate (Intramuscular)*** - **Methotrexate** is the **drug of choice** for the medical management of **ectopic pregnancy** that meets specific criteria (e.g., hemodynamically stable, small unruptured ectopic mass, and absence of fetal cardiac activity). - It works by inhibiting **dihydrofolate reductase**, thereby interfering with **DNA synthesis** and cell proliferation of the rapidly dividing trophoblastic tissue. *Actinomycin D* - **Actinomycin D** is an **antineoplastic antibiotic** that is used in the treatment of various cancers, such as Wilms' tumor and gestational trophoblastic disease. - While it has anti-proliferative effects, it is not the standard first-line treatment for **ectopic pregnancy** given the effectiveness and established safety profile of methotrexate. *Prostaglandin F2 alpha* - **Prostaglandin F2 alpha** (e.g., dinoprost) is primarily used for **induction of labor**, **abortion**, or management of **postpartum hemorrhage** due to its myometrial contraction stimulation properties. - It does not specifically target the trophoblastic tissue of an ectopic pregnancy and is not indicated for its medical management. *Mifepristone* - **Mifepristone** is an **anti-progestin** used to induce medical abortion, often in combination with misoprostol. - While it terminates intrauterine pregnancies by blocking progesterone receptors, it is not effective as a standalone treatment for **ectopic pregnancy**, as it does not directly target the ectopic trophoblastic tissue.

Q: After IUFD, when does the mother develop DIC?

3-4 weeks. ***3-4 weeks*** - Following intrauterine fetal demise (IUFD), **Disseminated Intravascular Coagulation (DIC)** can develop due to the continuous release of thromboplastin from the degenerating fetal tissue into the maternal circulation. - While the risk is present earlier, significant changes leading to symptomatic DIC typically manifest around **3-4 weeks** after the demise if the fetus is retained. *48 hours* - The development of DIC within **48 hours** of IUFD is less common. - This time frame is generally too short for enough thromboplastin to accumulate and trigger a full DIC syndrome in most cases. *1-2 weeks* - While some changes in coagulation parameters might begin within **1-2 weeks**, overt clinical DIC is usually not observed during this period. - The placental and fetal tissue breakdown products require more time to induce a profound coagulopathy. *6 weeks* - By **6 weeks** after IUFD, if the fetus is still retained, the risk of DIC becomes very high, and the process is usually already well underway or has been identified earlier. - Early management, such as evacuating the uterus, is crucial to prevent DIC from reaching this advanced stage.

Q: Patient with 3 months amenorrhoea, c/o hyperemesis and vaginal bleeding since one month. O/E=uterus 16 weeks with absent fetal heart sound. The diagnosis is ?

Molar pregnancy. ***Molar pregnancy*** - This diagnosis aligns with the presence of **hyperemesis**, **vaginal bleeding**, and a **uterus size larger than expected for gestational age** (16 weeks for 3 months amenorrhoea) with an **absent fetal heart sound**. - **Hyperemesis** is often pronounced due to very high hCG levels produced by the molar tissue. - The **size-dates discrepancy** (uterus larger than expected) is a pathognomonic feature of molar pregnancy. *Ectopic pregnancy* - While it can cause **vaginal bleeding** and **amenorrhoea**, the uterus size is typically **normal or smaller** than expected for gestational age, not 16 weeks. - **Fetal heart sounds** would also be absent but the marked uterine enlargement is the key differentiating factor. *Abruptio placentae* - This typically occurs in the **later stages of pregnancy** (second half or third trimester) and presents with painful vaginal bleeding and uterine tenderness. - The symptoms described, particularly the uterus size discrepancy and hyperemesis in early pregnancy, do not fit abruptio placentae. *Intrauterine fetal death (IUFD)* - While IUFD is characterized by an **absent fetal heart sound** and can occur with spotting, the uterine size would typically be **appropriate for gestational age or smaller**, not significantly larger. - IUFD also does not explain the presence of severe hyperemesis or the size-dates discrepancy.

Q: G3P2L2 with previous 2 LSCS with anterior placenta previa has got a very high risk of which complication?

Placenta accreta. ***Placenta accreta*** - A history of **previous cesarean sections (LSCS)** and **placenta previa** significantly increases the risk of placenta accreta, where the placenta abnormally adheres to the uterine wall. - The combination of a disrupted uterine wall from previous surgeries and a low-lying placenta on a scarred segment predisposes to deep placental invasion. *Vasa previa* - This condition involves **fetal blood vessels** running within the membranes over the cervical os, susceptible to rupture, not abnormal placental adherence to the uterine wall. - While it can occur with placenta previa, the primary risk for **vasa previa** is typically with velamentous cord insertion or bilobate placenta, not directly linked to prior LSCS as a direct cause. *Abruption* - **Placental abruption** is the premature separation of the placenta from the uterine lining, often associated with **hypertension**, trauma, or smoking. - While previous LSCS can increase the risk of certain placental complications, it's not the primary risk factor for abruption compared to the strong association with **placenta accreta** in this clinical scenario. *None of the options* - Given the specific clinical presentation of **prior LSCS** and **anterior placenta previa**, there is a very high and well-documented risk of **placenta accreta**.

Q: Which of the following is NOT a feature of mild or non-severe pre-eclampsia?

Premonitory symptoms present. ***Premonitory symptoms present*** - The **presence of premonitory symptoms** (such as **severe headache**, **visual disturbances**, **epigastric pain**, or **altered mental status**) is a defining feature of **severe pre-eclampsia**, NOT mild or non-severe pre-eclampsia. - These symptoms indicate impending eclampsia or serious end-organ involvement, which classifies the condition as severe. - This is the correct answer as it is NOT a feature of mild pre-eclampsia. *Diastolic BP <100 mm Hg* - In mild pre-eclampsia, the **diastolic blood pressure** is typically **elevated** (≥90 mmHg) but remains **below 110 mmHg**. - This is a defining characteristic of mild pre-eclampsia, differentiating it from severe pre-eclampsia where diastolic BP is ≥110 mmHg. - This IS a feature of mild pre-eclampsia. *Systolic BP <160 mm Hg* - A **systolic blood pressure** below **160 mmHg** (but ≥140 mmHg) is consistent with mild or non-severe pre-eclampsia. - Severe pre-eclampsia is characterized by a systolic BP of ≥160 mmHg, making this range indicative of milder disease. - This IS a feature of mild pre-eclampsia. *Mild IUGR* - **Mild intrauterine growth restriction (IUGR)** can occur in mild pre-eclampsia due to **placental insufficiency**. - While more severe IUGR is associated with severe pre-eclampsia, mild IUGR can be seen in non-severe cases. - This IS a feature that can occur in mild pre-eclampsia.

Question 1

Which of the following conditions is least likely to be classified as a high-risk pregnancy?

Accepted Answer

History of manual removal of placenta

Answer

Severe anemia

Answer

Gestational diabetes

Answer

Obesity in pregnancy

Question 2

Which drug is commonly used to promote fetal lung maturity?

Accepted Answer

Betamethasone

Answer

Hydrocortisone

Answer

Dexamethasone

Answer

Prednisolone

Question 3

Which of the following parameters is most critical to monitor in a patient with pre-eclampsia?

Accepted Answer

Blood pressure

Answer

Proteinuria

Answer

Platelet count

Answer

Liver function tests (LFTs)

Question 4

A 21-year-old female presents to the emergency ward with 2 months of amenorrhea, abdominal pain, and shock. Her blood pressure is 90/60 mmHg and hemoglobin is 6 gm%. A urine pregnancy test is positive. What is the next immediate line of treatment?

Accepted Answer

Laparotomy

Answer

Medical management

Answer

IV fluids and cross match

Answer

Laparoscopy

Question 5

What is the most common heart disease in pregnancy?

Accepted Answer

Mitral Stenosis (MS)

Answer

Aortic Stenosis (AS)

Answer

Mitral Regurgitation (MR)

Answer

Wolff-Parkinson-White (WPW) syndrome

Question 6

What is the drug of choice (DOC) for medical management of ectopic pregnancy?

Accepted Answer

Methotrexate (Intramuscular)

Answer

Actinomycin D

Answer

Prostaglandin F2 alpha

Answer

Mifepristone

Question 7

After IUFD, when does the mother develop DIC?

Accepted Answer

3-4 weeks

Answer

48 hours

Answer

1-2 weeks

Answer

6 weeks

Question 8

Patient with 3 months amenorrhoea, c/o hyperemesis and vaginal bleeding since one month. O/E=uterus 16 weeks with absent fetal heart sound. The diagnosis is ?

Accepted Answer

Molar pregnancy

Answer

Ectopic pregnancy

Answer

Abruptio placentae

Answer

Intrauterine fetal death (IUFD)

Question 9

G3P2L2 with previous 2 LSCS with anterior placenta previa has got a very high risk of which complication?

Accepted Answer

Placenta accreta

Answer

Vasa previa

Answer

Abruption

Answer

None of the options

Question 10

Which of the following is NOT a feature of mild or non-severe pre-eclampsia?

Accepted Answer

Premonitory symptoms present

Answer

Diastolic BP <100 mm Hg

Answer

Systolic BP< 160 mm Hg

Answer

Mild IUGR

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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