Maternal-Fetal Medicine Practice Questions

Q: What is the rate of uterine blood flow at term?

350-400 ml/min. ***350-400 ml/min*** - At term, the **uterine blood flow** significantly increases to meet the metabolic demands of the growing fetus and placenta. - This flow rate ensures adequate **oxygen and nutrient delivery** and waste removal for the uteroplacental unit. *50-75 ml/min* - This rate is characteristic of a **non-gravid uterus**, which has significantly lower metabolic needs. - It does not reflect the dramatic increase in blood supply required to sustain a full-term pregnancy. *150-200 ml/min* - This rate represents an increase from the non-gravid state but is still **insufficient for a term pregnancy**. - Uterine blood flow typically continues to rise progressively throughout gestation. *>600 ml/min* - While uterine blood flow is very high at term, exceeding 600 ml/min is generally an **overestimation of the average rate**. - The typical range for a normal term pregnancy is closer to 350-400 ml/min.

Q: Risk of recurrence of hydatidiform mole in future pregnancy is:

1-4%. ***1-4%*** - The risk of a **recurrent hydatidiform mole** in a subsequent pregnancy is generally cited to be between **1-2%**, with some sources extending it up to 4%. - This risk is significantly higher than that of the general population for a first mole (0.1%), but still relatively low. *8-10%* - This percentage represents a **significantly higher recurrence risk** than what is typically observed for hydatidiform moles. - Such a high risk would be more concerning for **persistent trophoblastic disease** or choriocarcinoma development after an initial mole, rather than for recurrence in a future pregnancy. *4-8%* - While higher than the typical 1-2%, a 4-8% recurrence risk is still considered **elevated** compared to the established data. - This range might be considered if there are **additional risk factors** or a history of multiple previous molar pregnancies, which are not specified in the question. *10-12%* - A 10-12% risk for recurrence of hydatidiform mole is **exceptionally high** and not consistent with current understanding. - Such a high figure would suggest almost certain recurrence, which is not the case for most patients.

Q: Earliest detectable congenital malformation by ultrasound (USG) is

Anencephaly. ***Anencephaly*** - **Anencephaly** is a severe neural tube defect resulting in the absence of a major portion of the brain, skull, and scalp, which can be reliably visualized as early as **11-12 weeks of gestation** due to the absent cranial vault. - The lack of a normal fetal head pole and the presence of the **"frog-eye" appearance** on ultrasound are characteristic early findings. - It is considered the **earliest consistently detectable major congenital malformation** by ultrasound due to its obvious and unmistakable appearance. *Spina bifida* - **Spina bifida** (an open neural tube defect) is typically detectable later than anencephaly, often around **18-22 weeks of gestation**, as it involves a vertebral arch defect. - While it is a significant congenital malformation, its ultrasound signs, such as the **"lemon sign"** and **"banana sign"**, tend to become apparent as the fetal brain and spinal cord structures further develop. *Meningocoele* - A **meningocoele** is a less severe form of spina bifida where only the meninges protrude through an opening in the spine. - This malformation is generally detected in the **second trimester** (around 18-22 weeks) during detailed anomaly scans, as the sac might be small and difficult to visualize earlier. *Cystic hygroma* - A **cystic hygroma** is a lymphatic malformation, typically a multiloculated cystic mass, most commonly found in the neck region. - While it can be detected early in the **first trimester** (10-14 weeks) during nuchal translucency screening, it is not classified as a major structural malformation in the same category as neural tube defects. - **Anencephaly** is considered the earliest detectable **major congenital malformation** because it is more consistently and reliably visualized as an obvious structural defect compared to cystic hygroma, which may vary in size and detectability.

Q: HIV transmission to the newborn is most effectively prevented by which of the following methods?

Antiretroviral therapy (ART). ***Antiretroviral therapy (ART)*** - **Antiretroviral therapy (ART)** for pregnant women with HIV significantly reduces the viral load, which is the primary determinant of vertical transmission risk. - Maternal ART, especially when administered throughout pregnancy and to the newborn, has been shown to reduce the rate of mother-to-child transmission to less than 1%. *Vaginal delivery* - While vaginal delivery can be an option for women with **well-controlled HIV and low viral loads**, it is not the most effective preventive measure on its own. - **Caesarean section** might be recommended for women with high viral loads near term to further reduce the risk of transmission through exposure to maternal blood and secretions. *Zidovudine prophylaxis* - **Zidovudine (AZT) prophylaxis** was historically one of the first effective interventions to reduce vertical transmission. - However, it is now considered part of a broader **ART regimen** and not as effective as a comprehensive, multi-drug ART approach in achieving the lowest possible transmission rates. *Breast feeding* - **Breastfeeding** is a known risk factor for **postnatal HIV transmission** from mother to child. - In developed countries where safe alternatives are available, mothers with HIV are generally advised to **avoid breastfeeding** to prevent transmission.

Q: Anencephaly can be diagnosed by ultrasound (USG) at

14-18 weeks of gestation. ***14-18 weeks of gestation*** - **Anencephaly**, characterized by the absence of a major portion of the brain and skull, can be reliably diagnosed by **ultrasound (USG)** during this gestational period. - At this stage, the fetal head structures are sufficiently developed to clearly visualize the **absence of the cranium and cerebral hemispheres**. *10-12 weeks of gestation* - While some gross anomalies might be suspected, the developing fetal skull and brain are often **too small** for a definitive diagnosis of anencephaly. - The **ossification of the calvaria** (skull bones) is still incomplete, making it difficult to confidently identify its absence. *20-24 weeks of gestation* - Anencephaly would be clearly detectable by this stage, but it is **later than the optimal window** for early diagnosis and intervention, if desired. - Many screening programs aim for diagnosis before this period to allow for more options for parental decision-making. *24-28 weeks of gestation* - At this advanced stage, the diagnosis of anencephaly would be evident, but it represents a **significantly delayed diagnosis** given the availability of earlier screening methods. - The primary purpose of **antenatal screening** is to detect such severe congenital anomalies in the mid-trimester.

Q: Which of the viruses listed below is not teratogenic?

Herpes simplex. ***Herpes simplex*** - HSV is **not considered a classic teratogen** and does not cause congenital malformations from intrauterine infection. - The primary risk is **neonatal HSV infection** acquired during vaginal delivery through an infected birth canal, not from transplacental transmission causing birth defects. - Neonatal HSV can cause serious disease (disseminated infection, encephalitis, skin/eye/mouth disease), but these are **postnatal infections**, not true teratogenic effects. *Rubella* - Rubella virus is a well-known **teratogen**, causing **congenital rubella syndrome (CRS)** if infection occurs early in pregnancy. - CRS can lead to severe birth defects including **cataracts**, **congenital heart defects**, and **sensorineural hearing loss** (classic triad). - Greatest risk when infection occurs in the **first trimester**. *Cytomegalovirus* - **Congenital CMV infection** is the most common congenital viral infection and a leading cause of birth defects. - Can cause **microcephaly**, **periventricular calcifications**, **sensorineural hearing loss**, **hepatosplenomegaly**, and **intellectual disability**. - Part of the **TORCH** screening panel for teratogenic infections. *Measles* - Measles (rubeola) during pregnancy can cause complications including **spontaneous abortion**, **premature delivery**, and **low birth weight**. - While less studied than rubella, measles has been associated with increased risk of pregnancy complications and adverse fetal outcomes. - Can cause maternal morbidity with increased risk of pneumonia and encephalitis during pregnancy.

Q: What is the most specific use of Doppler ultrasound in twin pregnancies?

Assessing twin-to-twin transfusion syndrome. ***Assessing twin-to-twin transfusion syndrome (TTTS)*** - Doppler ultrasound is crucial for diagnosing and monitoring **TTTS** by evaluating blood flow in the umbilical arteries and veins, and assessing fetal cardiac output and venous flow patterns. - It helps detect the characteristic signs of **TTTS**, such as unequal blood flow between twins and abnormal Doppler indices in the umbilical and middle cerebral arteries, guiding timely intervention. *Evaluating conjoined twins* - While ultrasound identifies **conjoined twins** and their anatomical connections, Doppler primarily assesses blood flow, not the structural fusion itself. - 2D and 3D ultrasound are more directly used for the anatomical evaluation of the degree and type of organ sharing in **conjoined twins**. *Monitoring fetal well-being in twins* - Though Doppler can contribute to **fetal well-being assessment** through blood flow analysis, its primary and most specific role in twin pregnancies is the diagnosis and management of **TTTS**. - Other parameters like **biophysical profile** and growth scans are also vital for general fetal well-being in twins. *All of the options* - This option is incorrect because while Doppler ultrasound might be part of a broader assessment in some scenarios, its most significant and specific application in twin pregnancies is for **TTTS**. - Its role in the direct evaluation of conjoined twin anatomy or general fetal well-being is secondary to specialized applications like **TTTS** diagnosis.

Q: Lowest frequency of twin pregnancy is seen in:

Japan. ***Japan*** - **Japan** has one of the **lowest rates of twin pregnancies globally**, characterized by a low incidence of both **monozygotic** and **dizygotic twins**. This is attributed to genetic predisposition and potentially lower use of assisted reproductive technologies. - The population's genetic background and reproductive practices contribute to the observed lower twinning rates compared to other regions. *Nigeria* - **Nigeria** has the **highest frequency of twin pregnancies in the world**, with birth rates significantly higher than the global average, particularly in certain ethnic groups like the **Yoruba**. - This high rate is primarily due to a genetic predisposition to **dizygotic twinning**, linked to specific dietary and genetic factors. *Philippines* - The **Philippines** has a relatively **moderate to high frequency of twin pregnancies** compared to some other Asian countries, though not as high as countries in Africa. - Genetic and possibly some socio-economic factors contribute to its twinning rate, which is higher than the lowest observed rates. *India* - **India** generally exhibits a **lower to moderate frequency of twin pregnancies** compared to African nations, but often higher than some East Asian countries. - While regional variations exist, the overall rate is influenced by a mix of genetic factors and the increasing, but still relatively limited, use of **assisted reproductive technologies (ART)**.

Q: Which type of eclampsia has the worst prognosis?

Late postpartum. ***Late postpartum*** - **Late postpartum eclampsia**, occurring more than 48 hours after delivery, often presents with a poorer prognosis due to delayed diagnosis and potential for more severe complications, such as **cerebral hemorrhage** or **status epilepticus**, as patients may no longer be under close medical supervision. - The delayed onset can lead to misinterpretation of symptoms, making treatment less timely and effective, thus contributing to higher rates of morbidity and mortality. *Antepartum* - **Antepartum eclampsia** occurs before labor and while serious, is often detected when the patient is under medical care for preeclampsia, allowing for earlier intervention and management. - Although it can lead to complications such as **placental abruption** and **fetal distress**, the mother is typically in a healthcare setting, which facilitates immediate care. *Early postpartum* - **Early postpartum eclampsia** occurs within 48 hours after delivery, and while still critical, is usually managed in the hospital setting where medical attention is readily available, allowing for prompt treatment of seizures and associated complications. - The patient remains under close observation during this period, enabling quick response to emergent conditions. *Intrapartum* - **Intrapartum eclampsia** occurs during labor and delivery, and like early postpartum eclampsia, benefits from the patient being in a hospital environment with immediate access to medical personnel and emergency interventions. - The prompt recognition and management of seizures during childbirth can help mitigate severe outcomes for both mother and baby.

Question 1

What is the rate of uterine blood flow at term?

Accepted Answer

350-400 ml/min

Answer

>600 ml/min

Answer

50-75 ml/min

Answer

150-200 ml/min

Question 2

Risk of recurrence of hydatidiform mole in future pregnancy is:

Accepted Answer

1-4%

Answer

8-10%

Answer

4-8%

Answer

10-12%

Question 3

Earliest detectable congenital malformation by ultrasound (USG) is

Accepted Answer

Anencephaly

Answer

Spina bifida

Answer

Meningocoele

Answer

Cystic hygroma

Question 4

HIV transmission to the newborn is most effectively prevented by which of the following methods?

Accepted Answer

Antiretroviral therapy (ART)

Answer

Breast feeding

Answer

Vaginal delivery

Answer

Zidovudine prophylaxis

Question 5

Anencephaly can be diagnosed by ultrasound (USG) at

Accepted Answer

14-18 weeks of gestation

Answer

20-24 weeks of gestation

Answer

24-28 weeks of gestation

Answer

10-12 weeks of gestation

Question 6

Anti-D prophylaxis is MOST critically indicated in which of the following situations?

Accepted Answer

Intra-uterine transfusion at 28 weeks

Answer

Amniocentesis at 16 weeks

Answer

Manual removal of placenta

Answer

MTP at 63 days

Question 7

Which of the viruses listed below is not teratogenic?

Accepted Answer

Herpes simplex

Answer

Rubella

Answer

Cytomegalovirus

Answer

Measles

Question 8

What is the most specific use of Doppler ultrasound in twin pregnancies?

Accepted Answer

Assessing twin-to-twin transfusion syndrome

Answer

Evaluating conjoined twins

Answer

Monitoring fetal well-being in twins

Answer

All of the options

Question 9

Lowest frequency of twin pregnancy is seen in:

Accepted Answer

Japan

Answer

Philippines

Answer

India

Answer

Nigeria

Question 10

Which type of eclampsia has the worst prognosis?

Accepted Answer

Late postpartum

Answer

Early postpartum

Answer

Intrapartum

Answer

Antepartum

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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