Maternal-Fetal Medicine Practice Questions

Q: In which part of the fallopian tube is there a high chance of rupture in a tubal pregnancy?

Isthmus. ***Isthmus*** - The **isthmus** is the narrowest and most muscular part of the fallopian tube. Due to its limited ability to stretch, an ectopic pregnancy here is highly prone to rupture **earlier** than in other segments (typically 6-8 weeks). - The **isthmic portion's** small lumen and thick muscular wall make rupture a rapid and common complication, often before significant fetal growth, giving it the **highest chance of rupture** when an ectopic pregnancy implants there. *Ampulla* - The **ampulla** is the most common site for ectopic pregnancies (approximately 70%) due to its wider lumen and being the usual site of fertilization. - However, rupture in the ampulla tends to occur **later** than in the isthmus (8-12 weeks) as it can accommodate the growing embryo for a longer period due to its greater distensibility. - While more ectopic pregnancies occur here in absolute numbers, each individual ampullary pregnancy has a **lower chance of rupture** compared to isthmic pregnancies. *Interstitial* - The **interstitial** (or cornual) part is the segment within the uterine wall, making it a rare site for ectopic pregnancies (2-4%). - Ruptures in the interstitial portion occur **latest** (12-16 weeks) but are often the most dangerous, leading to severe hemorrhage due to the surrounding vascularity of the uterus and proximity to uterine and ovarian arteries. *Fimbrial* - The **fimbrial** end is the portion closest to the ovary and is exceedingly rare for ectopic implantation. - Implantation near the fimbriae usually leads to an **"abdominal pregnancy"** if the embryo is extruded, or could result in early "tubal abortion" rather than a true rupture.

Q: What is the most common presenting feature of a complete mole?

Bleeding per vaginum. ***Bleeding per vaginum (Correct)*** - **Vaginal bleeding** in the first or early second trimester is the **most common presenting symptom** of a complete hydatidiform mole, occurring in approximately 80-90% of cases - This bleeding can vary in amount and color, often described as **prune juice-like** discharge with passage of grape-like vesicles in some cases - Typically presents between **6-16 weeks of gestation** as the most frequent initial clinical sign *Vomiting (Incorrect)* - While nausea and vomiting are common in normal pregnancies, this is **not the most common presenting feature** of a complete mole - Vomiting may occur but is less specific and typically occurs after or in conjunction with vaginal bleeding - When severe, it manifests as hyperemesis gravidarum (a separate entity) *Hyperemesis gravidarum (Incorrect)* - This condition, characterized by **severe, persistent nausea and vomiting**, is more prevalent in molar pregnancies due to **excessively high hCG levels** - Occurs in approximately **25-30% of complete moles**, making it a significant but not the most common presentation - It is a **consequence** of the molar pregnancy, often presenting **after** initial bleeding, and is not the most frequent first clinical sign *Amenorrhoea (Incorrect)* - **Amenorrhoea** (absence of menstruation) is a **universal symptom** of any pregnancy, including a molar pregnancy - While it indicates conception, it does **not differentiate** a molar pregnancy from a normal pregnancy or other causes of amenorrhoea - Therefore, it is not the most specific or common **presenting feature** that would lead to diagnosis of a molar pregnancy

Q: The 'T' sign is associated with which condition?

Monochorionic twin pregnancy. ***Monochorionic twin pregnancy*** - The **'T' sign** on ultrasound is highly suggestive of a **monochorionic twin pregnancy**, indicating shared placenta and a thin inter-twin membrane that meets the chorion at a sharp, T-shaped angle. - This sign identifies the absence of a chorionic plate extending into the inter-twin membrane, distinguishing it from thick-membraned dichorionic pregnancies. *Dichorionic twin pregnancy* - Dichorionic pregnancies typically exhibit the **'lambda' or 'twin peak' sign**, where the chorion extends into the inter-twin membrane, creating a triangular projection, not a 'T' shape. - This sign indicates two separate placentas (or fused but distinct placentas) and two chorions, leading to a thicker inter-twin membrane. *Normal singleton pregnancy* - A normal singleton pregnancy involves only one fetus, and therefore no inter-twin membrane or associated signs like the 'T' or 'lambda' sign are present. - The concept of chorionicity and amnionicity is specific to multiple gestations, particularly twin pregnancies. *Multiple gestation* - While a monochorionic twin pregnancy is a type of multiple gestation, the term "multiple gestation" is too broad and does not specifically identify the **'T' sign**. - Multiple gestation can be either monochorionic or dichorionic, and only monochorionic pregnancies are associated with the 'T' sign.

Q: Which of the following is associated with macrosomia?

Gestational diabetes mellitus. ***Gestational diabetes mellitus*** - **Gestational diabetes mellitus (GDM)** is a common cause of macrosomia because high maternal glucose levels lead to increased fetal insulin production, which promotes growth and fat deposition. - The **hyperglycemic environment** in GDM stimulates fetal overgrowth, resulting in larger-than-average babies. *Hypothyroidism* - **Maternal hypothyroidism** is typically associated with **fetal growth restriction** and lower birth weight, not macrosomia. - Undiagnosed or poorly controlled hypothyroidism can lead to complications such as **preterm labor** and **preeclampsia**, but not increased fetal size. *None of the options* - This option is incorrect because **gestational diabetes mellitus** is directly associated with macrosomia. - There is a clear and well-documented link between maternal hyperglycemia and increased fetal growth. *Maternal anemia* - **Maternal anemia**, especially severe anemia, is generally associated with an **increased risk of fetal growth restriction** and **low birth weight**. - Anemia limits oxygen and nutrient delivery to the fetus, thereby hindering optimal growth.

Q: Which condition is associated with exclusively fetal blood loss?

Vasa previa. ***Vasa previa*** - Vasa previa occurs when **fetal blood vessels** from the umbilical cord traverse the membranes over the cervical os, underneath the fetal presenting part. - Rupture of these unprotected vessels, which can happen during labor or membrane rupture, leads to **exclusively fetal blood loss**, posing a high risk of fetal exsanguination and death. *Placenta praevia* - This condition involves the **placenta implanting low** in the uterus, potentially covering the internal cervical os. - Bleeding in placenta previa is typically **maternal** in origin, resulting from the detachment of the placenta from the uterine wall as the cervix dilates. *Polyhydramnios* - Polyhydramnios is characterized by an **excessive amount of amniotic fluid**. - It is not directly associated with antepartum or intrapartum bleeding, but rather with conditions that affect fetal swallowing or urination, such as **fetal gastrointestinal anomalies** or maternal diabetes. *Oligohydramnios* - Oligohydramnios refers to an **insufficient amount of amniotic fluid**. - While it can be associated with various fetal and maternal complications, such as **renal agenesis** or premature rupture of membranes, it does not typically cause blood loss.

Q: What is the definitive treatment for preeclampsia?

Delivery of the baby. ***Delivery of the baby*** - **Preeclampsia** is a multisystem disorder of pregnancy; its pathogenesis is directly linked to the **placenta**. - **Removal of the placenta** through delivery is the only definitive cure for preeclampsia, leading to the resolution of symptoms. *Use of antihypertensive medications* - Antihypertensive medications are used to **manage blood pressure** in preeclampsia, preventing complications like stroke. - They **do not address the underlying cause** of the disease and are not a curative treatment. *Dietary modifications* - While a healthy diet is important during pregnancy, **dietary modifications** alone cannot resolve the pathological processes of preeclampsia. - There is **no specific diet** proven to cure or prevent preeclampsia. *Increased rest and monitoring* - **Increased rest and close monitoring** are supportive measures that can help manage symptoms and detect complications. - These interventions **do not reverse the disease process** and are not a definitive treatment.

Q: What is the best method to diagnose an unruptured ectopic pregnancy?

USG. ***Correct Answer: USG*** - **Transvaginal ultrasound (TVS)** is the most common and effective method for diagnosing an unruptured ectopic pregnancy. It allows for visualization of a gestational sac outside the uterus or an adnexal mass. - In conjunction with **serum beta-hCG levels**, TVS helps to differentiate between an intrauterine pregnancy and an ectopic pregnancy, especially when hCG levels are above the discriminatory zone (typically 1500-2000 mIU/mL). - TVS has high sensitivity and specificity for detecting ectopic pregnancy and is **non-invasive**. *Incorrect: Endoscopy* - **Endoscopy** (such as laparoscopy) is a surgical procedure, primarily used for direct visualization and treatment of ectopic pregnancies, not for initial diagnosis. - It is *too invasive* for routine diagnostic purposes in an unruptured ectopic pregnancy. *Incorrect: UPT* - A **urine pregnancy test (UPT)** confirms pregnancy but *cannot determine the location* of the pregnancy. - A positive UPT only indicates the presence of **hCG**, which is elevated in both intrauterine and ectopic pregnancies. *Incorrect: Culdocentesis* - **Culdocentesis** involves aspirating fluid from the cul-de-sac and is used to detect the presence of *free blood* in the peritoneal cavity, indicating a **ruptured** ectopic pregnancy. - It is not useful for diagnosing an **unruptured ectopic pregnancy** and is largely replaced by ultrasound in modern practice.

Q: In a severely anaemic pregnant patient presenting with cardiac failure, what is the most appropriate choice of transfusion?

Exchange transfusion. ***Exchange transfusion*** - In **severe anaemia with cardiac failure**, exchange transfusion simultaneously **removes** and **replaces** blood volume, correcting anaemia without **net volume increase** that could worsen cardiac failure. - This procedure is the **safest option** as it avoids **fluid overload** while effectively improving **oxygen-carrying capacity** in cardiac-compromised pregnant patients. *Platelets* - **Platelets** are indicated for **thrombocytopenia** or **platelet dysfunction** to prevent bleeding, not for correcting anaemia. - They provide no benefit for **oxygen transport** or the underlying cause of cardiac failure in this anaemic patient. *Packed cells* - **Packed red blood cells** still add **net volume** to circulation, which can precipitate **pulmonary edema** and worsen cardiac failure despite slower infusion. - Even with **diuretics**, the risk of **fluid overload** remains significant in patients with pre-existing cardiac compromise. *Whole blood* - **Whole blood** contains **plasma volume** that significantly increases circulatory load, making it particularly dangerous in cardiac failure. - The large **volume expansion** can rapidly lead to **congestive heart failure** and **pulmonary edema** in already compromised patients.

Q: 6 year old son of pregnant woman is suffering from chicken pox. Which of the following is given to pregnant woman?

Only immunoglobulin. ***Only immunoglobulin*** - Giving **immunoglobulin** to a pregnant woman exposed to **chickenpox** provides immediate passive immunity, which is crucial as she is at risk of infection from her child. - This is particularly important because chickenpox during pregnancy can lead to severe maternal disease and congenital varicella syndrome in the fetus. *Acyclovir + immunoglobulin* - **Acyclovir** is an antiviral that treats active varicella infection but is not typically given prophylactically in combination with immunoglobulin for exposure unless the woman is already immunocompromised or develops symptoms. - The primary goal for exposed pregnant women is preventing infection through passive immunity, not immediately treating a potential infection. *Vaccination* - **Varicella vaccine** is a live attenuated vaccine and is **contraindicated** during pregnancy due to the theoretical risk of fetal infection. - It is used for pre-conception immunity or post-exposure prophylaxis in non-pregnant individuals if given within a short window, but not for pregnant women. *Acyclovir* - **Acyclovir** is an antiviral medicine used to treat active chickenpox infections, not to prevent infection immediately after exposure. - It would be considered if the pregnant woman develops symptoms of chickenpox, but not as a primary prophylactic measure in this scenario.

Q: Which of the following statements about cholestasis of pregnancy is false?

Most common cause of jaundice in pregnancy. ***Most common cause of jaundice in pregnancy*** - This statement is **FALSE** - while **intrahepatic cholestasis of pregnancy (ICP)** is the most common **pregnancy-specific** cause of jaundice, it is NOT the most common cause of jaundice overall in pregnancy. - **Viral hepatitis** (especially hepatitis A, B, and E) remains the **most common cause of jaundice in pregnancy** worldwide, accounting for approximately 40-50% of cases. - ICP accounts for about 20-25% of jaundice cases in pregnancy, making it the leading obstetric-specific cause but not the overall leading cause. *Bilirubin level >2mg%* - In ICP, **bilirubin levels** are typically **normal or only mildly elevated** (usually 10 μmol/L), not bilirubin. *Oestrogen is involved* - **TRUE** - Elevated **estrogen and progesterone levels** during pregnancy play a key role in ICP pathophysiology. - These hormones affect **hepatic bile salt transporters** (particularly BSEP and MDR3), leading to impaired bile secretion in genetically susceptible individuals. *Manifestations usually appear in last trimester* - **TRUE** - ICP typically presents in the **third trimester** (usually after 28 weeks), with **pruritus** as the predominant symptom. - Symptoms resolve within days to weeks after delivery, correlating with declining hormone levels.

Question 1

In which part of the fallopian tube is there a high chance of rupture in a tubal pregnancy?

Accepted Answer

Isthmus

Answer

Interstitial

Answer

Fimbrial

Answer

Ampulla

Question 2

What is the most common presenting feature of a complete mole?

Accepted Answer

Bleeding per vaginum

Answer

Vomiting

Answer

Hyperemesis gravidarum

Answer

Amenorrhoea

Question 3

The 'T' sign is associated with which condition?

Accepted Answer

Monochorionic twin pregnancy

Answer

Dichorionic twin pregnancy

Answer

Normal singleton pregnancy

Answer

Multiple gestation

Question 4

Which of the following is associated with macrosomia?

Accepted Answer

Gestational diabetes mellitus

Answer

None of the options

Answer

Hypothyroidism

Answer

Maternal anemia

Question 5

Which condition is associated with exclusively fetal blood loss?

Accepted Answer

Vasa previa

Answer

Placenta praevia

Answer

Polyhydramnios

Answer

Oligohydramnios

Question 6

What is the definitive treatment for preeclampsia?

Accepted Answer

Delivery of the baby

Answer

Use of antihypertensive medications

Answer

Dietary modifications

Answer

Increased rest and monitoring

Question 7

What is the best method to diagnose an unruptured ectopic pregnancy?

Accepted Answer

USG

Answer

Endoscopy

Answer

UPT

Answer

Culdocentesis

Question 8

In a severely anaemic pregnant patient presenting with cardiac failure, what is the most appropriate choice of transfusion?

Accepted Answer

Exchange transfusion

Answer

Platelets

Answer

Packed cells

Answer

Whole blood

Question 9

6 year old son of pregnant woman is suffering from chicken pox. Which of the following is given to pregnant woman?

Accepted Answer

Only immunoglobulin

Answer

Acyclovir + immunoglobulin

Answer

Vaccination

Answer

Acyclovir

Question 10

Which of the following statements about cholestasis of pregnancy is false?

Accepted Answer

Most common cause of jaundice in pregnancy

Answer

Bilirubin level >2mg%

Answer

Oestrogen is involved

Answer

Manifestations usually appear in last trimester

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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