Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs

Question 1191: What is the recommended management for a fetus diagnosed with severe anemia in Liley's Zone 3 at 35 weeks of gestation?

A. Preterm delivery of the fetus (Correct Answer)
B. Intrauterine blood transfusion
C. Observation and follow-up
D. Cord blood sampling

Explanation: ***Preterm delivery of the fetus*** - At **35 weeks gestation**, the fetus is in the **late preterm period** with good chances of neonatal survival and minimal complications from prematurity. - For a fetus with **severe anemia in Liley's Zone 3** at this gestational age, **immediate delivery** is the preferred management as it allows for prompt neonatal resuscitation and postnatal blood transfusion. - The risks of **intrauterine transfusion** (fetal bradycardia, bleeding, infection, fetal demise) outweigh the minimal risks of late preterm delivery at 35 weeks. - After delivery, neonatal intensive care can provide **direct transfusion**, phototherapy for hyperbilirubinemia, and comprehensive supportive care. *Intrauterine blood transfusion* - **Intrauterine blood transfusion (IUT)** is the treatment of choice for severe fetal anemia **before 34-35 weeks** of gestation when the risks of prematurity are significant. - At **35 weeks or beyond**, delivery is generally preferred over IUT because the procedural risks are no longer justified by the benefits of prolonging pregnancy. - IUT would be considered if delivery were contraindicated or if there were compelling reasons to delay delivery. *Observation and follow-up* - This approach is completely inappropriate for a fetus with **severe anemia in Liley's Zone 3**, regardless of gestational age. - Zone 3 indicates a high risk of **hydrops fetalis** and **intrauterine fetal demise** without immediate intervention. - Expectant management would result in preventable fetal death or severe hypoxic injury. *Cord blood sampling* - **Cordocentesis** (percutaneous umbilical blood sampling) is a diagnostic procedure to confirm fetal anemia by measuring hemoglobin and hematocrit levels. - While it may be performed before IUT in earlier gestations, at 35 weeks with known Zone 3 anemia, immediate action (delivery) is warranted. - It is not a therapeutic intervention and would only delay definitive management at this gestational age.

Question 1192: Couvelaire uterus is associated with which condition?

A. Placenta previa
B. Abruptio placentae (Correct Answer)
C. Velamentous placenta
D. Placenta accreta

Explanation: ***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.

Question 1193: Monozygotic twin with one healthy baby born at term and one dead mummified fetus is suggestive of?

A. Fetus acardiacus
B. Fetus papyraceous (Correct Answer)
C. Hydatidiform mole
D. Vanishing twin

Explanation: ***Fetus papyraceous*** - This term describes a **mummified fetus** that has been flattened and compressed due to the growth of a co-twin, often observed in **monochorionic twin pregnancies** where one twin dies in utero. - The presence of one healthy, term baby and one dead, mummified fetus is the classic presentation of **fetus papyraceous**. *Fetus acardiacus* - This is a rare anomaly where one twin, typically in a **monochorionic-monoamniotic pregnancy**, lacks a functional heart and other upper body structures, relying on the healthy twin's circulation. - An acardiac twin would present as an underdeveloped, often malformed structure, not a mummified, flattened fetus. *Hydatidiform mole* - A **hydatidiform mole** is an abnormal pregnancy characterized by the growth of many cysts (grape-like vesicles) within the uterus, resulting from an issue with fertilization, often leading to a non-viable pregnancy. - It does not involve the presence of a healthy twin alongside a dead mummified one. *Vanishing twin* - **Vanishing twin syndrome** occurs when one of two or more embryos or fetuses in a multiple pregnancy dies and is completely reabsorbed by the mother or the surviving twin. - While it involves the death of a twin, the reabsorption typically means there's no mummified fetus remaining by the time of birth; if a remnant is found, it's typically much smaller and not described as "papyraceous."

Question 1194: Estimation of fetal hemoglobin is done by?

A. Kleihauer-Betke Acid Elution Test (KB Test) (Correct Answer)
B. Apt test
C. Flow cytometry
D. Spectrophotometry

Explanation: ***Kleihauer-Betke Acid Elution Test (KB Test)*** - The **Kleihauer-Betke test** is a widely used laboratory method to quantify the amount of **fetal hemoglobin** in a maternal blood sample. - This test is crucial in situations involving **fetomaternal hemorrhage** for calculating the dose of Rh immunoglobulin. *Apt test* - The Apt test is used to determine if blood in a **neonate's stool or vomitus** is of fetal or maternal origin. - It differentiates between **fetal hemoglobin (HbF)**, which is resistant to alkaline denaturation, and adult hemoglobin (HbA), which is not. *Flow cytometry* - **Flow cytometry** is a powerful technique used for sorting and counting cells, detecting **biomarkers**, and analyzing cell characteristics. - While it can be adapted to detect cells containing fetal hemoglobin (e.g., in research settings), it is not the primary or standard method for estimating the **total amount of fetal hemoglobin** in a sample for clinical purposes. *Spectrophotometry* - **Spectrophotometry** measures the absorption or transmission of light through a sample at different wavelengths. - It is used in many biochemical assays but is not the specific or sensitive method for **quantifying fetal hemoglobin** due to the similar absorption spectra of different hemoglobin types.

Question 1195: Vasa previa is associated with which type of placental vessel insertion?

A. Central
B. Peripheral
C. Velamentous (Correct Answer)
D. None of the options

Explanation: ***Velamentous*** - **Vasa previa** occurs when **fetal blood vessels** from a **velamentous cord insertion** cross the internal cervical os, unprotected by placental tissue or Wharton's jelly. - In a **velamentous insertion**, the umbilical cord inserts into the **chorioamniotic membranes** distant from the placental margin, with the vessels then coursing through the membranes to the placenta. *Central* - A **central placental vessel insertion** is the normal and healthy insertion point, typically near the center of the placenta. - This type of insertion is **not associated** with vasa previa, as the vessels are well-protected within the umbilical cord. *Peripheral* - A **peripheral placental vessel insertion** refers to the cord inserting at the margin of the placenta. - While considered marginal, it is **not directly associated** with vasa previa, which specifically involves vessels traversing unprotected membranes over the cervical os. *None of the options* - This option is incorrect because **velamentous cord insertion** is a direct and well-documented cause of vasa previa. - There is a specific and known association between velamentous insertion and vasa previa.

Question 1196: What is the lower end of the estimated risk of recurrence of anencephaly in subsequent pregnancies?

A. 2% (Correct Answer)
B. 4%
C. 1%
D. 3%

Explanation: ***2%*** - The estimated risk of recurrence for anencephaly in subsequent pregnancies ranges from 2% to 5%. - This 2% represents the **lower end** of the typical recurrence risk for anencephaly, a severe **neural tube defect (NTD)**. *1%* - A 1% recurrence risk is generally considered too low for a previous NTD such as anencephaly. - While it's lower than the recurrence risk for the general population (0.1%), it's still below the consensus range for a subsequent pregnancy. *4%* - A 4% recurrence risk falls within the accepted range (2-5%) and represents a **higher end** estimate. - This value would be plausible for the recurrence risk, but the question specifically asks for the *lower end*. *3%* - A 3% recurrence risk falls within the accepted range (2-5%) but is not the **lower end** of that range. - While a clinically relevant risk, it is not the minimum value requested in the question.

Question 1197: All of the following are causes of oligohydramnios except:

A. Postmaturity
B. Maternal dehydration
C. IUGR
D. Labetalol (Correct Answer)

Explanation: ***Labetalol*** - **Labetalol** is a beta-blocker commonly used to treat **hypertension in pregnancy** and is generally considered safe. - It does not cause oligohydramnios; in fact, there is some evidence that it may slightly increase **amniotic fluid volume** by improving placental perfusion. *IUGR* - **Intrauterine growth restriction (IUGR)** leads to shunting of blood flow away from the kidneys to vital organs, reducing **fetal urine production**, a major contributor to amniotic fluid. - Reduced fetal urine output directly results in decreased **amniotic fluid volume**, causing oligohydramnios. *Postmaturity* - In **post-term pregnancies** (gestation beyond 40 weeks), there is a physiological decline in **amniotic fluid volume** due to aging placenta and reduced fetal urine output. - This natural reduction in fluid production often leads to **oligohydramnios** in postmature fetuses. *Maternal dehydration* - **Maternal dehydration** can reduce **maternal blood volume** and placental perfusion, consequently affecting **fetal fluid balance** and urine production. - This reduced fluid availability can diminish the amount of **amniotic fluid**, contributing to oligohydramnios.

Question 1198: How many days does it take for a zygote with zona pellucida to reach the uterine cavity after fertilization?

A. 2 days
B. 4 days (Correct Answer)
C. 5 days
D. 6 days

Explanation: ***4 days*** - Following fertilization in the **ampulla** of the fallopian tube, the zygote undergoes cleavage divisions as it travels towards the uterus. - The **zona pellucida** remains intact during this journey, and the embryo (typically at the **morula** or early blastocyst stage) enters the uterine cavity around **Day 3-4** post-fertilization. - **Day 4** is the most commonly cited timeframe for entry into the uterine cavity with zona pellucida intact. *2 days* - At 2 days post-fertilization, the embryo is usually in the **2- to 4-cell stage** and is still located within the fallopian tube. - It has not yet completed its journey through the fallopian tube to reach the uterine cavity. *5 days* - By Day 5, the embryo has typically developed into a **blastocyst** and has already been in the uterine cavity for approximately 1-2 days. - This represents a later stage of development after the embryo has already reached the uterine cavity, not the initial arrival time. *6 days* - On Day 6, the blastocyst is typically **hatching out of the zona pellucida** and beginning implantation into the endometrium. - The zona pellucida is no longer intact at this stage, and the embryo has already been in the uterine cavity for approximately 2 days.

Question 1199: Spiegelberg criteria is used for?

A. Ovarian pregnancy (Correct Answer)
B. Ovarian malignancy
C. Cervical pregnancy
D. Cervical malignancy

Explanation: ***Ovarian pregnancy*** - **Spiegelberg criteria** are a set of diagnostic criteria specifically used to confirm a rare form of **ectopic pregnancy** localized to the ovary. - These criteria include the **fallopian tube and fimbriae being intact**, the **gestational sac being located in the ovary**, the **ovarian tissue forming part of the sac wall**, and the **sac being connected to the uterus by the utero-ovarian ligament**. *Ovarian malignancy* - Diagnosis of **ovarian malignancy** primarily relies on imaging studies (e.g., ultrasound, CT), tumor markers (e.g., CA-125), and histological examination of biopsy samples. - The Spiegelberg criteria are not relevant for distinguishing between benign and malignant ovarian tumors as they are diagnostic for a specific type of ectopic pregnancy. *Cervical pregnancy* - **Cervical pregnancy** is diagnosed by findings such as a **barrel-shaped cervix**, internal os opening into a distended cervical canal, and a gestational sac located below the level of the internal os within the cervix. - While also an ectopic pregnancy, its diagnostic criteria are distinct from those for ovarian pregnancy and do not involve the Spiegelberg criteria. *Cervical malignancy* - Diagnosis of **cervical malignancy** involves **Pap smears**, **HPV testing**, **colposcopy with directed biopsies**, and histological confirmation. - The Spiegelberg criteria have no application in the diagnosis or staging of cervical cancer.

Question 1200: What is the most common cancer in pregnancy?

A. Melanoma
B. Breast carcinoma (Correct Answer)
C. Gastric carcinoma
D. Thyroid carcinoma

Explanation: ***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

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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