Maternal-Fetal Medicine Practice Questions

Q: Main factor responsible for increased perinatal mortality in twin pregnancy is?

Prematurity. ***Prematurity*** - **Premature birth** is the leading cause of perinatal mortality in twin pregnancies, as twins are significantly more likely to be born before term compared to singletons. - Complications associated with prematurity, such as **respiratory distress syndrome**, **intraventricular hemorrhage**, and **necrotizing enterocolitis**, are major contributors to infant death. *Intrauterine growth restriction (IUGR)* - While IUGR is common in twin pregnancies and can increase perinatal morbidity and mortality, it is a **secondary complication** often associated with prematurity or underlying placental issues rather than the primary cause of mortality itself. - IUGR might lead to other complications, but **prematurity** has a more direct and widespread impact on survival. *Excess amniotic fluid (Polyhydramnios)* - **Polyhydramnios** can occur in twin pregnancies, especially in twin-to-twin transfusion syndrome, and may predispose to preterm labor and delivery. - However, it is a **risk factor for prematurity** rather than the direct primary cause of mortality. *Rupture of the uterus* - **Uterine rupture** is a rare but catastrophic event, typically associated with prior uterine surgery or grand multiparity, and **less commonly linked to twin pregnancy alone**. - While extremely serious, its infrequency makes it a far less common cause of overall perinatal mortality in twin pregnancies than prematurity.

Q: Most common cause of early abortion?

Genetic. ***Correct: Genetic*** - **Chromosomal abnormalities**, such as aneuploidy, are the most frequent cause of **spontaneous abortions**, especially early in pregnancy (accounting for **50-60% of first-trimester losses**). - These genetic errors often lead to **non-viable embryos**, resulting in early pregnancy loss. - Most common abnormalities include **trisomies** (especially trisomy 16), **monosomy X**, and **triploidy**. *Incorrect: Maternal* - While maternal factors like **diabetes** or **thyroid dysfunction** can contribute to abortion, they are less common causes of early abortion compared to genetic issues. - Systemic maternal health problems usually account for a smaller percentage of all miscarriages. *Incorrect: Immunologic* - **Autoimmune disorders** like **antiphospholipid syndrome** can cause recurrent pregnancy loss, but they are not the primary cause of the majority of early, sporadic abortions. - These are typically considered in cases of **recurrent miscarriages**, not usually the first or early spontaneous abortion. *Incorrect: Anatomic abnormalities* - **Uterine anomalies** (e.g., septate uterus) or **cervical incompetence** can lead to recurrent pregnancy loss, particularly in the later first or second trimester. - However, they are less frequently the cause of very early, isolated miscarriages compared to genetic factors.

Q: Which of the following is not typically given to a patient with preterm labor?

Beta blocker. ***Beta blocker*** - **Beta blockers** are generally avoided in preterm labor because they can worsen **fetal bradycardia** and **neonatal hypoglycemia**. - They are not used to manage uterine contractions or promote fetal lung maturity. *Glucocorticoids* - **Glucocorticoids** (e.g., **betamethasone**) are administered to promote **fetal lung maturity** and reduce the risk of **respiratory distress syndrome** in preterm infants. - They are a crucial intervention in managing preterm labor. *Tocolytic drugs* - **Tocolytic drugs** (e.g., **nifedipine**, **terbutaline**) are used to **suppress uterine contractions** and delay delivery in preterm labor. - This allows time for glucocorticoids to take effect and for transfer to a facility with neonatal intensive care. *Antibiotics* - Although not routinely given to all patients with preterm labor, **antibiotics** are prescribed if there is evidence of an **intrauterine infection** or if the patient is positive for **Group B Streptococcus (GBS)**. - Infection can be a trigger for preterm labor, and treating it can help prolong pregnancy or prevent neonatal sepsis.

Q: Least common site of ectopic pregnancy in the fallopian tubes is?

Interstitium. ***Interstitium*** - The **interstitial portion** of the fallopian tube is the narrowest and thickest part, making it the least common site for an ectopic pregnancy within the tube itself. - While less frequent, interstitial pregnancies are associated with a **higher risk of rupture** and hemorrhage due to the surrounding myometrial tissue. *Ampulla* - The **ampulla** is the most common site of ectopic pregnancy in the fallopian tube, accounting for about 80% of all tubal ectopics. - Its wider diameter and convoluted lumen easily trap the fertilized egg. *Infundibulum* - The **infundibulum**, or fimbrial end, is a relatively common site for ectopic pregnancies after the ampulla, accounting for about 5% of cases. - Pregnancies here are often referred to as **fimbrial ectopic pregnancies**. *Isthmus* - The **isthmus** is the second most common site for tubal ectopic pregnancies, accounting for approximately 12% of cases. - This section is narrower than the ampulla but still more hospitable than the interstitial portion.

Q: Clinical alarming sign of MgSO4 toxicity is?

Loss of knee jerk. ***Loss of knee jerk*** - **Magnesium sulfate (MgSO4)** toxicity manifests as central nervous system and neuromuscular depression. - The **knee jerk reflex** (patellar reflex) is one of the first deep tendon reflexes to be lost as magnesium levels approach toxic ranges, typically at serum levels of 7-10 mg/dL. *Loss of superficial abdominal reflexes* - Superficial reflexes are less sensitive indicators of impending **MgSO4 toxicity** compared to deep tendon reflexes. - While magnesium can cause muscle relaxation, the loss of these reflexes is not the primary or earliest clinical alarming sign. *Loss of pin prick sensation* - **Pinprick sensation** tests sensory pathways and is not directly affected by the neuromuscular blocking effects of magnesium sulfate. - Magnesium toxicity primarily affects motor function and deep tendon reflexes, not sensory perception. *Loss of proprioception* - **Proprioception** is the sense of joint position and movement, which is also a sensory function. - Magnesium toxicity does not typically cause a direct loss of proprioception; its effects are predominantly on motor nerve conduction and muscle contraction.

Q: What is the approximate fetal weight to placental weight ratio at 24 weeks of gestation?

2:1. ***2:1*** - The fetal weight to placental weight ratio at **24 weeks of gestation** varies across different references, with this ratio being cited in some older literature. - However, **current obstetric literature** suggests the ratio at 24 weeks is typically **higher (approximately 5:1 to 6:1)**, as the fetus (600-700g) significantly outweighs the placenta (100-120g) by this stage. - At 24 weeks, the fetus undergoes **rapid growth**, while placental growth rate has stabilized, leading to an increasing fetal-to-placental weight ratio. *1.5:1* - This ratio suggests the **fetus is only slightly heavier** than the placenta. - Such a ratio is typically observed **earlier in pregnancy (around 16-18 weeks)**, when placental mass is still relatively large compared to fetal mass. *3:1* - This ratio would indicate the fetus is **three times heavier** than the placenta. - While closer to physiologic values at 24 weeks, this still **underestimates** the typical fetal-to-placental weight ratio at this gestational age. *4:1* - This ratio suggests the fetus is **four times heavier** than the placenta. - This is **more consistent with mid-to-late second trimester** values and approaches the expected range, though current evidence suggests even higher ratios (5-6:1) at 24 weeks. **Note:** The fetal-to-placental weight ratio progressively increases throughout pregnancy, starting below 1:1 in early pregnancy and reaching 6-7:1 at term. Standard teaching suggests ratios of 5-6:1 at 24 weeks, though variation exists across references.

Q: Which is the most common presentation in twin pregnancy?

Vertex - vertex. ***Vertex - vertex*** - This is the most common presentation in **twin pregnancies**, occurring in approximately **40-45%** of cases. - Both twins are positioned head-down, which is the optimal presentation for a vaginal delivery. *Vertex - breech* - This presentation, where the first twin is head-down and the second twin is feet- or buttocks-first, occurs in about **30%** of twin pregnancies. - While relatively common, it is still less frequent than the vertex-vertex presentation. *Breech - breech* - This presentation, where both twins are positioned feet- or buttocks-first, is less common, occurring in less than **10%** of twin pregnancies. - It usually necessitates a **cesarean section** due to increased risks associated with vaginal breech delivery for both twins. *Vertex - Footling* - **Footling breech** is a specific type of breech presentation where one or both feet present first. - While a vertex presentation for the first twin and a footling breech for the second twin can occur, it's a less common overall presentation for twin pairs compared to vertex-vertex.

Q: Which of the following is NOT a common cause of maternal death in patients with hypertensive disorders of pregnancy?

Chronic renal failure. ***Chronic renal failure*** - While chronic kidney disease can worsen during pregnancy and complicate hypertensive disorders, it is **NOT a common direct cause of maternal death** in hypertensive disorders of pregnancy. - The acute complications that arise (such as **acute kidney injury**, **eclampsia**, or **severe pre-eclampsia**) are the actual life-threatening events, rather than pre-existing chronic renal failure itself. - In contrast to the other options listed, **chronic renal failure** as a primary cause of maternal mortality is significantly less frequent in the setting of hypertensive disorders of pregnancy. *Cardiac failure* - **Pre-eclampsia** and **eclampsia** significantly increase cardiac workload and can lead to **acute heart failure**, especially with pre-existing cardiac disease or severe hypertension. - This is a **well-recognized and common cause** of maternal death in patients with severe hypertensive disorders of pregnancy. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** is a severe complication of **pre-eclampsia** and **eclampsia**, often due to pulmonary edema from capillary leak and fluid overload. - It is a **critical and potentially fatal** respiratory complication representing one of the common causes of maternal death in severe hypertensive disorders. *Cerebral hemorrhage* - **Severe hypertension** in **pre-eclampsia** and **eclampsia** can lead to hemorrhagic stroke. - **Cerebral hemorrhage** is a **leading cause of maternal mortality** in women with severe hypertensive disorders of pregnancy, particularly eclampsia.

Q: What is the typical placenta-to-baby weight ratio at term?

1 : 6. ***1 : 6*** * The placenta-to-baby weight ratio at term is typically 1:6, meaning the placenta weighs approximately one-sixth of the baby's weight. * This ratio reflects the normal physiological balance required for adequate **fetal growth** and **nutrient exchange**. *1 : 3* * A 1:3 ratio would imply a proportionally much **larger placenta** relative to the baby's weight, which is not typical at term. * Such a ratio might be seen in cases of placental abnormalities or fetal growth restriction, but not as a normal physiological state. *1 : 4* * A 1:4 ratio indicates a **larger placenta** than physiologically normal at term, suggesting potential placental issues. * This is not the standard ratio observed in healthy pregnancies at term. *1 : 5* * While closer to the normal range than 1:3 or 1:4, a 1:5 ratio still suggests a slightly **larger placenta** than average. * The most commonly accepted healthy average at term is 1:6.

Question 1

Main factor responsible for increased perinatal mortality in twin pregnancy is?

Accepted Answer

Prematurity

Answer

Intrauterine growth restriction (IUGR)

Answer

Excess amniotic fluid (Polyhydramnios)

Answer

Rupture of the uterus

Question 2

Most common cause of early abortion?

Accepted Answer

Genetic

Answer

Maternal

Answer

Immunologic

Answer

Anatomic abnormalities

Question 3

Which of the following is not typically given to a patient with preterm labor?

Accepted Answer

Beta blocker

Answer

Tocolytic drugs

Answer

Antibiotics

Answer

Glucocorticoids

Question 4

Least common site of ectopic pregnancy in the fallopian tubes is?

Accepted Answer

Interstitium

Answer

Ampulla

Answer

Infundibulum

Answer

Isthmus

Question 5

Clinical alarming sign of MgSO4 toxicity is?

Accepted Answer

Loss of knee jerk

Answer

Loss of superficial abdominal reflexes

Answer

Loss of pin prick sensation

Answer

Loss of proprioception

Question 6

What is the recommended management for intrauterine hydronephrosis detected at 32-34 weeks of gestation?

Accepted Answer

Serial USG monitoring and evaluation for associated anomalies

Answer

Intrauterine drainage

Answer

Immediate delivery

Answer

Postnatal evaluation at 3 weeks

Question 7

What is the approximate fetal weight to placental weight ratio at 24 weeks of gestation?

Accepted Answer

2:1

Answer

1.5:1

Answer

3:1

Answer

4:1

Question 8

Which is the most common presentation in twin pregnancy?

Accepted Answer

Vertex - vertex

Answer

Vertex - breech

Answer

Breech - breech

Answer

Vertex - Footling

Question 9

Which of the following is NOT a common cause of maternal death in patients with hypertensive disorders of pregnancy?

Accepted Answer

Chronic renal failure

Answer

Cardiac failure

Answer

ARDS

Answer

Cerebral hemorrhage

Question 10

What is the typical placenta-to-baby weight ratio at term?

Accepted Answer

1 : 6

Answer

1 : 3

Answer

1 : 4

Answer

1 : 5

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?