Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs

Question 1161: Which drug is commonly used to promote fetal lung maturity?

A. Betamethasone (Correct Answer)
B. Hydrocortisone
C. Dexamethasone
D. Prednisolone

Explanation: ***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.

Question 1162: Which of the following is NOT a feature of mild or non-severe pre-eclampsia?

A. Diastolic BP <100 mm Hg
B. Systolic BP< 160 mm Hg
C. Premonitory symptoms present (Correct Answer)
D. Mild IUGR

Explanation: ***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 1163: What is the most common heart disease in pregnancy?

A. Aortic Stenosis (AS)
B. Mitral Regurgitation (MR)
C. Mitral Stenosis (MS) (Correct Answer)
D. Wolff-Parkinson-White (WPW) syndrome

Explanation: **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.

Question 1164: Which of the following conditions is NOT contraindicated in pregnancy?

A. Marfan's with aortic root dilation
B. Primary Pulmonary Hypertension
C. Eisenmenger's syndrome
D. WPW syndrome (Correct Answer)

Explanation: **WPW syndrome** - **Wolff-Parkinson-White (WPW) syndrome** is a condition involving an extra electrical pathway in the heart, leading to episodes of rapid heart rate. - While it can cause arrhythmias, severe complications in pregnancy are rare, and it is generally *not* considered an absolute contraindication for pregnancy. *Primary Pulmonary Hypertension* - **Primary Pulmonary Hypertension (PPH)** carries a very high maternal mortality rate (25-50%) due to the physiological changes of pregnancy on the cardiovascular system. - The increased blood volume and cardiac output in pregnancy can lead to severe decompensation and right heart failure in women with PPH. *Eisenmenger's syndrome* - **Eisenmenger's syndrome** is a severe form of pulmonary hypertension with a right-to-left shunt, associated with an extremely high maternal mortality rate (30-50%). - Pregnancy significantly increases the risk of **pulmonary hypertensive crisis**, right heart failure, and thromboembolic events, making it highly contraindicated. *Marfan's with aortic root dilation* - **Marfan's syndrome** with **aortic root dilation** is a significant contraindication due to the high risk of **aortic dissection** and rupture. - The hemodynamic stress of pregnancy, including increased blood volume and cardiac output, places immense strain on the dilated aorta, increasing the risk of life-threatening events.

Question 1165: After IUFD, when does the mother develop DIC?

A. 48 hours
B. 1-2 weeks
C. 3-4 weeks (Correct Answer)
D. 6 weeks

Explanation: ***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.

Question 1166: A 30-year-old woman is 14 weeks pregnant and has a history of two painless deliveries at 16 weeks. What is the next line of management?

A. Cervical encerclage
B. Evaluation for diabetes mellitus and thyroid disorders
C. Cervical length assessment (Correct Answer)
D. Tocolytics

Explanation: ***Cervical length assessment*** - With a history of **two painless preterm deliveries at 16 weeks**, the patient is at high risk for **cervical insufficiency** (incompetent cervix). - While this history may warrant **history-indicated cerclage**, many current protocols recommend **cervical length assessment** via transvaginal ultrasound as the next step to objectively evaluate cervical status and guide management decisions. - An **ultrasound-indicated approach** allows for selective cerclage placement if cervical shortening is documented, avoiding unnecessary procedures in some cases. - Cervical length <25 mm before 24 weeks indicates need for intervention. *Cervical encerclage* - **Prophylactic cerclage** (history-indicated) is an evidence-based option for women with ≥2 prior spontaneous second-trimester losses, and can be placed at 12-14 weeks. - However, the **ultrasound-indicated approach** (assess first, then place cerclage if indicated) is also widely accepted and may prevent unnecessary cerclage in patients with adequate cervical length. - Both approaches are supported by evidence; the question favors assessment first. *Evaluation for diabetes mellitus and thyroid disorders* - While **diabetes mellitus** and **thyroid disorders** can contribute to pregnancy complications, they are not the primary cause of recurrent **painless mid-trimester losses**. - The clinical presentation strongly suggests **cervical insufficiency**, which requires specific cervical evaluation and management. - Medical screening is not the most immediate priority in this scenario. *Tocolytics* - **Tocolytics** are used to suppress **preterm labor contractions**. - This patient's history of **painless deliveries** indicates cervical insufficiency rather than preterm labor with contractions, making tocolytics inappropriate for prevention.

Question 1167: A lady with 35 weeks of pregnancy is admitted in view of first episode of painless bout of bleeding yesterday. On examination Hb 10g%, BP 120/70 mmHg, uterus relaxed, and cephalic floating. FHS regular. Next line of management is ?

A. Induction of labor
B. Wait and watch (Correct Answer)
C. Blood transfusion
D. Cesarean section

Explanation: ***Correct: Wait and watch*** - The patient presented with **first episode of painless bleeding yesterday** which has now **stopped**, with stable vitals (BP 120/70 mmHg) and regular FHS, suggesting **placenta previa**. - At **35 weeks gestation**, with bleeding resolved and hemodynamic stability, **expectant management** is the appropriate next step to allow fetal maturity to 37-38 weeks. - The goal is to **avoid preterm delivery** complications while monitoring closely for recurrent bleeding. Patient should be kept in hospital with cross-matched blood ready. - **Ultrasound** should be performed to confirm placenta location, and delivery planned at 37-38 weeks if patient remains stable. *Incorrect: Cesarean section* - While Cesarean section is the **definitive mode of delivery** for placenta previa, it is not indicated immediately in this stable patient at 35 weeks. - Indications for emergency Cesarean would include: **active ongoing bleeding**, maternal or fetal compromise, or reaching 37-38 weeks gestation. - Performing Cesarean at 35 weeks would result in unnecessary **preterm delivery complications** when expectant management is safe. *Incorrect: Induction of labor* - **Absolutely contraindicated** in suspected placenta previa due to high risk of torrential hemorrhage as cervix dilates. - Vaginal delivery is not attempted when placenta previa is suspected. *Incorrect: Blood transfusion* - Hemoglobin of **10g%** indicates mild anemia but does not require immediate transfusion in a stable patient. - Blood should be **cross-matched and kept ready** for emergency use, but transfusion is indicated only if bleeding recurs with significant drop in hemoglobin or hemodynamic instability.

Question 1168: Which of the following procedures is associated with the least risk of feto-maternal hemorrhage?

A. Amniocentesis (Correct Answer)
B. Chorionic villus sampling
C. External cephalic version
D. Cordocentesis

Explanation: ***Amniocentesis*** - This procedure involves sampling **amniotic fluid**, which is primarily fetal urine and cells, not directly blood. - The needle typically avoids the placenta and fetal vessels, making **feto-maternal hemorrhage less likely** compared to procedures directly accessing fetal blood or placental tissue. - Risk of FMH is approximately **1-2%**, the lowest among invasive prenatal procedures. *Cordocentesis* - This procedure involves direct **percutaneous umbilical blood sampling** from the umbilical cord. - Due to direct needle puncture of fetal blood vessels, the potential for **feto-maternal hemorrhage is 40-50%**. - Highest risk among diagnostic procedures listed. *Chorionic villus sampling* - This procedure involves taking a sample of the **placenta** (chorionic villi), which contains fetal cells and is rich in blood vessels. - Disrupting the placental-uterine interface can lead to **feto-maternal hemorrhage in 10-15%** of cases. - Higher risk than amniocentesis due to placental manipulation. *External cephalic version* - This procedure involves **manual manipulation** of the fetus through the maternal abdomen to convert breech to cephalic presentation. - The mechanical pressure and manipulation can cause **placental separation or disruption**, leading to FMH in approximately **2-6%** of cases. - Risk is higher than amniocentesis due to physical manipulation of the gravid uterus.

Question 1169: A 28-year-old pregnant woman presents with severe hypertension and proteinuria. What is the most appropriate initial management?

A. Emergency cesarean section
B. Induction of labor if stable
C. Anticonvulsant and antihypertensive therapy (Correct Answer)
D. Observation and monitoring

Explanation: ***Anticonvulsant and antihypertensive therapy*** - The patient presents with **severe preeclampsia** (hypertension and proteinuria in pregnancy), which carries a risk of seizures (**eclampsia**). - **Magnesium sulfate** is the first-line anticonvulsant for the prevention and treatment of eclamptic seizures, and **antihypertensive agents** (e.g., labetalol, hydralazine) are necessary to control blood pressure and prevent maternal complications. *Emergency cesarean section* - An emergency cesarean section is indicated for **fetal distress**, **maternal instability** not responsive to conservative management, or **failed induction of labor**. - Without information about fetal compromise or maternal organ dysfunction, immediate surgical delivery is not the initial step. *Induction of labor if stable* - Induction of labor is a consideration for delivery in cases of **preeclampsia at term** or when expectant management is no longer safe. - However, the immediate priority in severe preeclampsia is to stabilize the mother with **anticonvulsant and antihypertensive therapy** first. *Observation and monitoring* - **Close monitoring** is essential in preeclampsia, but simply observing without active intervention in severe cases would be irresponsible. - Severe hypertension and proteinuria require **active management** to prevent progression to eclampsia or other severe maternal and fetal complications.

Question 1170: Up to what gestational age is the corpus luteum essential for pregnancy maintenance, such that its surgical excision would result in miscarriage?

A. Before 6 weeks
B. 8-10 weeks (Correct Answer)
C. 6-8 weeks
D. 10-12 weeks

Explanation: ***8-10 weeks*** - The corpus luteum produces **progesterone** that is essential for maintaining early pregnancy until the **luteal-placental shift** occurs. - This shift, where the **placenta takes over progesterone production**, typically completes between **7-9 weeks** of gestation. - However, to ensure safety and account for individual variation, the corpus luteum should be considered essential **up to 10 weeks**. - Surgical excision of the corpus luteum **before 10 weeks** carries significant risk of miscarriage, while removal **after 10 weeks** is generally safe as the placenta has established autonomous progesterone production. *Before 6 weeks* - While removal before 6 weeks would certainly cause miscarriage, this is not the **maximum gestational age** at which the corpus luteum remains essential. - The critical dependency extends well beyond 6 weeks. *6-8 weeks* - During this period, the corpus luteum is still **absolutely essential** for progesterone production. - The luteal-placental shift is typically **incomplete** during this timeframe. - Removal would result in miscarriage, but this is still not the maximum safe window. *10-12 weeks* - By 10-12 weeks, the **placenta has fully taken over** progesterone production. - At this stage, the corpus luteum is no longer functionally necessary, and its removal does **not increase miscarriage risk**.

Practice by Chapter

Fetal Assessment Techniques

Practice Questions

Hypertensive Disorders in Pregnancy

Practice Questions

Intrauterine Growth Restriction

Practice Questions

Multiple Gestation

Practice Questions

Rh Isoimmunization and Other Blood Group Incompatibilities

Practice Questions

Intrauterine Fetal Therapy

Practice Questions

Prenatal Diagnosis and Genetic Counseling

Practice Questions

Placental Abnormalities

Practice Questions

Preterm Labor and Delivery

Practice Questions

Management of Medical Disorders in Pregnancy

Practice Questions

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