Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs

Question 1171: 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 1172: 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 1173: 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 1174: At what day after fertilization is the utero-placental circulation typically established?

A. 5
B. 20
C. 10
D. 15 (Correct Answer)

Explanation: ***Day 15 (Correct Answer)*** - **Utero-placental circulation** is established around day 15 after fertilization, coinciding with the development of the **chorionic villi** and their vascularization. - At this stage, the **trophoblast** has invaded the maternal decidua, allowing for the formation of lacunae filled with maternal blood, facilitating early nutrient and waste exchange. - The **primary chorionic villi become vascularized**, creating the functional connection between maternal and fetal circulations. *Day 5 (Incorrect)* - By day 5, the embryo is typically at the **blastocyst stage** and is undergoing **hatching** from the zona pellucida before implantation. - There is no significant utero-placental circulation established at this very early stage; the embryo relies on diffusion for nourishment. *Day 10 (Incorrect)* - Around day 10, the **blastocyst is actively implanting** into the uterine wall, and the trophoblast differentiates into **cytotrophoblast** and **syncytiotrophoblast**. - While lacunae are forming within the syncytiotrophoblast and beginning to fill with maternal blood, a fully established circulatory system with functional villi is not yet present. *Day 20 (Incorrect)* - By day 20, the **utero-placental circulation** is already well-established and functional, having begun several days prior. - This later stage marks a more mature state of placental development, where the villi are more complex and efficient for exchange.

Question 1175: What is the term used to describe the phenomenon of a fetus making a sound in utero?

A. Vagitus uterinus (Correct Answer)
B. Neonatal cry
C. Fetal vocalization
D. Intrauterine sound

Explanation: ***Vagitus uterinus*** - This term specifically refers to the phenomenon of a fetus crying or making a sound while still inside the intact **uterus** or during a **breech delivery** before the head is delivered. - It is a rare event, often occurring when air enters the uterus during delivery or a procedure, allowing the vocal cords to vibrate. *Neonatal cry* - This term describes the cry of a **newborn baby** after birth, once completely exposed to the external environment and able to take its first breath of air. - It does not specifically refer to sounds made while still within the uterus. *Fetal vocalization* - This is a more general term that could imply any sound made by a fetus, but it is not the specific medical term for a cry within the uterus. - It lacks the precise historical and medical connotation of sound made from a fetus still in the womb. *Intrauterine sound* - This is a broad term that encompasses any sound originating from within the uterus, such as **fetal heart sounds**, maternal bowel sounds, or blood flow, but not necessarily a vocal cry by the fetus. - It does not specifically refer to the act of crying by the fetus.

Question 1176: 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**.

Question 1177: Which of the following parameters is most critical to monitor in a patient with pre-eclampsia?

A. Proteinuria
B. Blood pressure (Correct Answer)
C. Platelet count
D. Liver function tests (LFTs)

Explanation: ***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.

Question 1178: 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 1179: Earliest sign after IUFD is ?

A. Hyperflexion of spine
B. Overlapping of skull bones
C. Overcrowding of ribs
D. Gas in great vessel (Correct Answer)

Explanation: ***Gas in great vessel*** - The presence of **intravascular gas** (often in the heart or great vessels) is considered the **earliest reliable sonographic sign of fetal death**, appearing within 1-2 hours after demise. - This gas is thought to result from post-mortem **autolysis** and bacterial activity. *Overlapping of skull bones* - Known as **Spalding's sign**, this indicates skull bone collapse due to liquefaction of brain tissue and typically appears **several days (3-7 days)** after fetal demise. - It reflects a more advanced stage of fetal decomposition rather than an immediate post-mortem change. *Hyperflexion of spine* - This sign, along with abnormal fetal posture, can be seen with fetal demise but is generally evident **later than intravascular gas**, as fetal muscle tone diminishes. - It is a less specific and later indicator compared to intravascular gas. *Overcrowding of ribs* - This is an inconsistent and non-specific finding that may be observed in IUFD but does not serve as an **early diagnostic marker**. - It generally reflects changes in fetal soft tissue and skeletal structures due to maceration, occurring much later.

Question 1180: Which of the following is a complication of pre-eclampsia?

A. Eclampsia (Correct Answer)
B. HELLP syndrome
C. Postdatism
D. Disseminated Intravascular Coagulation (DIC)

Explanation: ***Eclampsia*** - **Eclampsia** is defined as the occurrence of **generalized tonic-clonic seizures** in a woman with pre-eclampsia that cannot be attributed to other causes - It represents the **direct neurological progression** of pre-eclampsia and is the **most characteristic complication** - Eclampsia occurs in approximately **1-2%** of women with pre-eclampsia and is a **life-threatening emergency** - The seizures result from cerebral vasospasm, edema, and ischemia associated with the hypertensive disorder *HELLP syndrome* - **HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets)** is indeed a **recognized complication** of pre-eclampsia, occurring in **10-20% of severe cases** - However, HELLP represents a **specific multiorgan manifestation** involving hepatic dysfunction and hematological abnormalities, rather than the classic progression pathway - While both are serious complications, **eclampsia** is considered the **prototypical complication** that defines disease progression from pre-eclampsia - HELLP can occur with or without the full clinical picture of severe pre-eclampsia *Postdatism* - **Postdatism** (post-term pregnancy) refers to pregnancy extending beyond **42 weeks of gestation** - This is **completely unrelated** to pre-eclampsia, which is a hypertensive disorder of pregnancy - Pre-eclampsia typically occurs in the **third trimester** and is actually an indication for **delivery**, not prolonged pregnancy *Disseminated Intravascular Coagulation (DIC)* - **DIC** is a severe coagulopathy involving widespread activation of clotting cascades - While DIC can complicate severe pre-eclampsia, it is **not a primary or direct complication** - DIC more commonly develops as a consequence of **eclampsia, HELLP syndrome, placental abruption**, or other severe obstetric emergencies - It represents a **secondary complication** rather than a direct progression of pre-eclampsia itself

Practice by Chapter

Fetal Assessment Techniques

Practice Questions

Hypertensive Disorders in Pregnancy

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Intrauterine Growth Restriction

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Multiple Gestation

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Rh Isoimmunization and Other Blood Group Incompatibilities

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Intrauterine Fetal Therapy

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Prenatal Diagnosis and Genetic Counseling

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Placental Abnormalities

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Preterm Labor and Delivery

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Management of Medical Disorders in Pregnancy

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