Maternal-Fetal Medicine Practice Questions

Q: Modified biophysical profile is:

NST + AFI. ***Correct Answer: NST + AFI*** - The **modified biophysical profile (mBPP)** consists of a **nonstress test (NST)** and an **amniotic fluid index (AFI)**. - This combination is used to evaluate fetal well-being, with the NST assessing **acute hypoxia** and the AFI reflecting **chronic placental function**. - The mBPP is a **simplified version** of the full biophysical profile, designed for efficient antepartum fetal surveillance. *Incorrect: NST + Fetal Tone* - While both are components of the **full biophysical profile (BPP)**, this specific combination does not define the modified biophysical profile. - **Fetal tone** (flexion/extension of extremities) is a component of the full BPP but is omitted in the modified version to streamline the assessment. *Incorrect: Fetal Tone + AFI* - This combination is not a recognized standard for evaluating fetal well-being. - A **nonstress test (NST)** is a crucial component for assessing **acute fetal oxygenation** and is always included in the modified biophysical profile. *Incorrect: NST + Fetal Tone + AFI* - This combination represents three of the five components of the **full biophysical profile**, which also includes **fetal breathing** and **gross body movements**. - The **modified biophysical profile** specifically simplifies this by including only the **NST** and **AFI**.

Q: A primigravida with 36 weeks of pregnancy is in labor with 3 cm dilatation and minimal uterine contraction. On rupture of membranes, fresh bleeding is noted with late fetal deceleration up to 50 beats/min. The patient was taken for LSCS but fetus could not be saved. No abruptio or placenta previa was seen. The likely diagnosis is ?

Vasa previa. ***Vasa previa*** - The sudden onset of **painless vaginal bleeding** upon membrane rupture, combined with **fetal heart rate deceleration** (bradycardia), is highly suggestive of **vasa previa**. This condition involves fetal vessels coursing within the membranes over the cervical os, unprotected by placental tissue or Wharton's jelly, making them prone to rupture. - The **fetal origin of the bleeding** (leading to fetal hypovolemia and distress) and the absence of placental complications like abruptio or previa further support this diagnosis. *Placenta previa* - This condition involves the **placenta covering the cervical os**, leading to painless bright red bleeding, especially in the third trimester. - However, the question explicitly states "No abruptio or placenta previa was seen," directly ruling out this diagnosis. *Revealed abruptio* - **Placental abruption** is the premature detachment of the placenta, typically causing **painful vaginal bleeding**, uterine tenderness, and often hypertonic contractions. - The scenario describes **minimal uterine contraction** and a lack of overt abdominal pain, and explicitly states "No abruptio or placenta previa was seen," making abruptio unlikely. *Circumvallate placenta* - A **circumvallate placenta** has a folded double layer of amnion and chorion at its margin, which can cause bleeding in pregnancy due to detachment of the rolled margin. - While it can cause bleeding, it typically doesn't present with the acute, severe fetal distress (late decelerations with bradycardia) immediately following membrane rupture that indicates direct fetal blood loss, unlike vasa previa.

Q: HCG levels at which Expectant management of Ectopic pregnancy can be done :

1000 IU/L. ***1000 IU/L*** - Expectant management for ectopic pregnancy is most appropriate when **hCG levels are < 1000-1500 IU/L and declining**. - This approach is suitable for **hemodynamically stable** patients with no signs of rupture, minimal symptoms, and a small ectopic pregnancy on ultrasound. - The key requirement is that **hCG levels must be declining**, indicating spontaneous resolution. - **1000 IU/L** represents the safest and most widely accepted threshold for expectant management. *2500 IU/L* - An hCG level of **2500 IU/L** is generally **too high** for expectant management of ectopic pregnancy. - Most guidelines recommend expectant management only when hCG is **< 1000-1500 IU/L** (some extend to < 2000 IU/L). - At 2500 IU/L, the risk of **rupture** is significantly higher, and active intervention (medical or surgical) is typically indicated. *10000 IU/L* - An hCG level of **10,000 IU/L** is far too high for expectant management. - Such elevated levels indicate a **larger, active ectopic pregnancy** with high rupture risk. - This level typically requires **immediate medical (methotrexate) or surgical intervention**. *5000 IU/L* - An hCG level of **5000 IU/L** is well above the threshold for expectant management. - At this level, **medical treatment with methotrexate or surgical management** is indicated. - The risk of rupture and treatment failure with conservative approaches is too high for expectant management.

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

Anticonvulsant and antihypertensive therapy. ***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.

Q: 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 ?

Wait and watch. ***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.

Q: What is the earliest sign of fetal death?

Absence of fetal heart sounds. ***Absence of fetal heart sounds*** - **Absence of fetal heart sounds** detected by **Doppler ultrasound** or **real-time ultrasound** is the **earliest and most definitive sign** of fetal death. - Cardiac activity ceases **immediately at the moment of fetal demise**, making this the **primary diagnostic criterion** for intrauterine fetal death. - **Ultrasound showing absent cardiac activity** is the gold standard for confirming fetal death and can detect it within minutes to hours. *Absence of fetal movements* - Absence of fetal movements is often the **first maternal perception** of potential fetal demise, typically noticed within hours to days. - However, it is **subjective and non-specific**, as fetal movements can naturally decrease during sleep cycles or may be less perceptible in some pregnancies. - While important for prompting further evaluation, it is not as definitive as absent cardiac activity on ultrasound. *Spalding sign* - The **Spalding sign** (overlapping of fetal skull bones) is a **late radiological sign** of fetal death that appears **1-2 weeks post-mortem**. - It occurs due to **brain liquefaction and decomposition**, causing collapse of the cranial vault and overlapping of skull sutures. - This is a **confirmatory sign of prolonged fetal demise**, not an early indicator. *Adipocere formation* - **Adipocere formation** (saponification of soft tissues) is a **very late post-mortem change** occurring **weeks to months** after death. - It represents advanced decomposition in a moist environment and is rarely seen in modern obstetric practice due to early detection and intervention. - This is the latest sign among all the options listed.

Q: What is the most common cancer in pregnancy?

Breast carcinoma. ***Breast carcinoma*** - **Breast cancer** is the most frequently diagnosed cancer during pregnancy, affecting approximately 1 in 3,000 pregnant women - Its high prevalence is due to the rising maternal age and the general incidence of breast cancer in women of reproductive age - Pregnancy-associated breast cancer (PABC) often presents at more advanced stages due to delayed diagnosis *Melanoma* - While **melanoma** is a significant concern during pregnancy due to hormonal influences on tumor growth, it is not the most common cancer overall - It ranks among the top three most common malignancies but is less frequent than breast cancer *Gastric carcinoma* - **Gastric carcinoma** is rare in young women and thus has a very low incidence during pregnancy - Its presence usually indicates a more aggressive form of the disease *Thyroid carcinoma* - **Thyroid cancer** is one of the more common cancers diagnosed during pregnancy, often due to increased thyroid nodule detection, but it is less common than breast cancer - Most cases are **papillary thyroid carcinomas**, which often have a good prognosis despite pregnancy

Q: Couvelaire uterus is associated with which condition?

Abruptio placentae. ***Abruptio placentae*** - **Couvelaire uterus**, also known as uteroplacental apoplexy, is a complication of severe **abruptio placentae** where blood infiltrates the myometrium, giving the uterus a bruised, purplish appearance. - This condition occurs when the **retroplacental hemorrhage** is extensive enough to dissect into the uterine muscle fibers. *Placenta previa* - **Placenta previa** is characterized by the placenta covering the cervical os, leading to painless vaginal bleeding, and is not associated with myometrial hemorrhage or a Couvelaire uterus. - The bleeding in placenta previa is typically from the placental villi or exposed maternal vessels in the lower uterine segment, not internal uterine dissection. *Placenta accreta* - **Placenta accreta** involves abnormal adherence of the placenta to the uterine wall (into the myometrium), which causes difficulty with placental separation after birth and significant hemorrhage, but not the myometrial infiltration seen in Couvelaire uterus. - The primary issue is the **abnormal invasion** of placental villi into the uterine wall, not bleeding dissecting within the myometrium. *Velamentous placenta* - A **velamentous placenta** is a condition where the umbilical cord inserts into the fetal membranes then courses to the placenta, leaving fetal vessels exposed, which can rupture during labor causing fetal hemorrhage. - It does not involve abnormalities of the uterine wall or extensive myometrial bleeding found in a Couvelaire uterus.

Q: According to limited observational studies, in cases where fetal movement has significantly decreased, approximately how long may elapse before fetal heart rate cessation occurs?

12 hrs. ***Correct: 12 hrs*** - Limited observational studies suggest that in cases of significantly decreased fetal movement, **fetal heart rate cessation** may occur approximately **12 hours** later. - This timeframe highlights the urgency of investigating decreased fetal movement to prevent **fetal demise**. - This observation forms the basis for clinical recommendations to evaluate decreased fetal movement **urgently within 12-24 hours**. *Incorrect: 1 hr* - This is generally too short a period; **fetal heart rate cessation** typically does not occur within 1 hour of decreased fetal movement. - While immediate evaluation is crucial for decreased fetal movement, **perinatal outcomes** are rarely impacted this quickly unless direct acute events occur (e.g., placental abruption, cord accident). *Incorrect: 2 hrs* - While **fetal compromise** can occur rapidly, 2 hours is often too short for complete **fetal heart rate cessation** after only decreased movement. - This timeframe still allows for potential **intervention** if the cause of decreased movement is identified quickly. *Incorrect: 6 hrs* - Although more plausible than 1 or 2 hours, 6 hours is still generally considered too short for **fetal cardiac arrest** after significantly decreased movement based on observational data. - Urgent evaluation is still recommended within this window to avoid **adverse fetal outcomes**.

Question 1

Modified biophysical profile is:

Accepted Answer

NST + AFI

Answer

NST + Fetal Tone

Answer

Fetal Tone + AFI

Answer

NST + Fetal Tone + AFI

Question 2

A primigravida with 36 weeks of pregnancy is in labor with 3 cm dilatation and minimal uterine contraction. On rupture of membranes, fresh bleeding is noted with late fetal deceleration up to 50 beats/min. The patient was taken for LSCS but fetus could not be saved. No abruptio or placenta previa was seen. The likely diagnosis is ?

Accepted Answer

Vasa previa

Answer

Placenta previa

Answer

Revealed abruptio

Answer

Circumvallate placenta

Question 3

HCG levels at which Expectant management of Ectopic pregnancy can be done :

Accepted Answer

1000 IU/L

Answer

10000 IU/L

Answer

5000 IU/L

Answer

2500 IU/L

Question 4

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

Accepted Answer

Anticonvulsant and antihypertensive therapy

Answer

Emergency cesarean section

Answer

Induction of labor if stable

Answer

Observation and monitoring

Question 5

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 ?

Accepted Answer

Wait and watch

Answer

Induction of labor

Answer

Blood transfusion

Answer

Cesarean section

Question 6

What is the earliest sign of fetal death?

Accepted Answer

Absence of fetal heart sounds

Answer

Adipocere formation

Answer

Absence of fetal movements

Answer

Spalding sign

Question 7

What is the most common cancer in pregnancy?

Accepted Answer

Breast carcinoma

Answer

Melanoma

Answer

Gastric carcinoma

Answer

Thyroid carcinoma

Question 8

Couvelaire uterus is associated with which condition?

Accepted Answer

Abruptio placentae

Answer

Placenta previa

Answer

Velamentous placenta

Answer

Placenta accreta

Question 9

According to limited observational studies, in cases where fetal movement has significantly decreased, approximately how long may elapse before fetal heart rate cessation occurs?

Accepted Answer

12 hrs

Answer

1 hr

Answer

2 hrs

Answer

6 hrs

Question 10

Which of the following statements is false regarding the management of intrauterine fetal death?

Accepted Answer

Fibrinogen levels should be checked weekly

Answer

In 50% of cases spontaneous expulsion occurs in 2 weeks

Answer

Delivery by medical induction is preferred if spontaneous expulsion does not occur

Answer

Caesarian section has limited place in management of intrauterine fetal death

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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