Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs

Question 1261: Cardiac output increases maximum at which week?

A. 26-28 wks
B. 34-36 wks
C. 32-34 wks
D. 30-32 wks (Correct Answer)

Explanation: ***30-32 wks*** - **Cardiac output** in healthy pregnant women typically reaches its maximum increase of **30-50%** above pre-pregnancy levels between **28 and 32 weeks** of gestation. - This peak output is sustained until term, primarily driven by a significant increase in **stroke volume** and a moderate increase in **heart rate**. *26-28 wks* - While cardiac output steadily rises throughout pregnancy, the **peak increase** is generally not observed as early as **26-28 weeks**. - At this stage, the increase is substantial but is still progressing towards its **maximum point**. *32-34 wks* - The maximal cardiac output is usually achieved **before** this period, typically by **32 weeks**. - From **32 weeks** onwards, cardiac output tends to **plateau**, not increase further. *34-36 wks* - By **34-36 weeks**, cardiac output has generally already reached its peak and **stabilized**. - There is typically no further increase in cardiac output during this timeframe; rather, it is maintained at its maximal level.

Question 1262: Which drug is known to cause placental abruption?

A. Amphetamine
B. Fluoxetine
C. Methadone
D. Cocaine (Correct Answer)

Explanation: **Cocaine** - **Cocaine** use during pregnancy is strongly associated with an increased risk of **placental abruption** due to its vasoconstrictive effects on uterine blood vessels. - Its potent **vasoconstrictive properties** lead to uterine ischemia and contractions, which can cause the placenta to detach prematurely from the uterine wall. *Methadone* - While methadone use during pregnancy is associated with risks such as **neonatal abstinence syndrome**, it is not a primary cause of **placental abruption**. - It is often used as a maintenance therapy for opioid-dependent pregnant women to avoid the fluctuating levels of illicit drug use, which can have more severe consequences. *Amphetamine* - Amphetamine use can lead to adverse pregnancy outcomes like **preterm birth** and **low birth weight** due to its stimulant effects. - Although it causes vasoconstriction, its association with **placental abruption** is less direct and less pronounced compared to cocaine. *Fluoxetine* - Fluoxetine, an **SSRI antidepressant**, generally has a relatively safe profile in pregnancy, although some studies suggest a small increased risk of persistent **pulmonary hypertension** in neonates. - It is not known to be a cause of **placental abruption**.

Question 1263: 6 year old son of pregnant woman is suffering from chicken pox. Which of the following is given to pregnant woman?

A. Acyclovir + immunoglobulin
B. Only immunoglobulin (Correct Answer)
C. Vaccination
D. Acyclovir

Explanation: ***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.

Question 1264: What is the most common cause of hydrops fetalis in current medical practice?

A. Fetal infections (e.g., parvovirus B19)
B. Chromosomal abnormalities
C. Cardiac malformations (Correct Answer)
D. Rh incompatibility (historically significant)

Explanation: ***Cardiac malformations*** - **Cardiovascular abnormalities** are the **most common cause** of **non-immune hydrops fetalis** in current medical practice, accounting for **20-40%** of cases - Includes **structural heart defects** (septal defects, valvular abnormalities) and **arrhythmias** (supraventricular tachycardia, complete heart block) - These conditions lead to **heart failure** and **increased hydrostatic pressure**, causing fluid accumulation in fetal tissues and body cavities - With the near-elimination of Rh disease through immunoprophylaxis, cardiac causes have emerged as the leading etiology *Chromosomal abnormalities* - Account for **10-20%** of non-immune hydrops cases - **Turner syndrome (45,X)** is the most common chromosomal cause, associated with **cystic hygroma** and **lymphatic dysgenesis** - Other chromosomal conditions include **trisomy 21, 18, and 13**, which can cause hydrops through associated cardiac defects or other mechanisms - While significant, chromosomal causes are less common than cardiovascular causes overall *Fetal infections (e.g., parvovirus B19)* - Infections account for **5-10%** of non-immune hydrops cases - **Parvovirus B19** is the most common infectious cause, leading to severe **fetal anemia** through bone marrow suppression - Other infectious agents include **CMV**, **toxoplasmosis**, and **syphilis** - The TORCH screening helps identify treatable infectious causes *Rh incompatibility (historically significant)* - Historically the **leading cause** before the 1970s, accounting for most hydrops cases - Now accounts for **<10%** of cases due to routine **Rho(D) immune globulin (RhoGAM)** administration at 28 weeks and postpartum - Causes **immune hydrops** through maternal antibodies crossing the placenta and destroying fetal red blood cells, leading to severe anemia and heart failure - Still important in under-immunized populations or cases of missed prophylaxis

Question 1265: Which of the following statements about the contraction stress test (CST) is MOST accurate?

A. Invasive method
B. Detects fetal well being
C. Negative test is associated with good fetal outcome (Correct Answer)
D. Oxytocin is never used in the test

Explanation: ***Negative test is associated with good fetal outcome*** - A **negative CST** indicates that there are no late or significant variable decelerations in response to uterine contractions, suggesting the fetus can tolerate labor. - This finding is strongly correlated with **fetal well-being** and a low likelihood of fetal distress in the near future, with a **negative predictive value of approximately 99%**. *Invasive method* - The CST is considered a **non-invasive test**, as it involves external monitoring of fetal heart rate and uterine contractions. - No instruments are inserted into the body, differentiating it from truly invasive procedures like **amniocentesis**. *Detects fetal well being* - While the CST provides valuable information, it specifically assesses **uteroplacental function and fetal oxygenation reserve** during the stress of contractions, rather than comprehensive fetal well-being. - It identifies fetuses at risk for **uteroplacental insufficiency** but does not evaluate other parameters of fetal health. - Other tests like the **biophysical profile** offer a more comprehensive assessment of fetal well-being, including parameters like fetal breathing, movement, tone, and amniotic fluid volume. *Oxytocin is never used in the test* - **Oxytocin** is frequently used to induce uterine contractions if spontaneous contractions are insufficient for the test (oxytocin challenge test or OCT). - Alternatively, **nipple stimulation** can be used to achieve adequate contractions for the CST.

Question 1266: What is the best method to diagnose an unruptured ectopic pregnancy?

A. Endoscopy
B. UPT
C. USG (Correct Answer)
D. Culdocentesis

Explanation: ***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.

Question 1267: What is the definitive treatment for preeclampsia?

A. Delivery of the baby (Correct Answer)
B. Use of antihypertensive medications
C. Dietary modifications
D. Increased rest and monitoring

Explanation: ***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.

Question 1268: Which condition is associated with exclusively fetal blood loss?

A. Vasa previa (Correct Answer)
B. Placenta praevia
C. Polyhydramnios
D. Oligohydramnios

Explanation: ***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.

Question 1269: Which of the following is associated with macrosomia?

A. None of the options
B. Gestational diabetes mellitus (Correct Answer)
C. Hypothyroidism
D. Maternal anemia

Explanation: ***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.

Question 1270: Rule of Hasse is used to determine :

A. Height of an adult.
B. Race of a person.
C. Identification of fetal abnormalities.
D. Age of the fetus (Correct Answer)

Explanation: ***Age of the fetus*** - **Hasse's Rule** is a forensic pathology method used to estimate the **age of a dead fetus** (stillborn or aborted fetus) based on its physical length. - The rule states: **For months 1-5**: Age in months = Length in cm; **For months 6-10**: Age in months = Length in cm ÷ 5 - This is primarily used in **medico-legal contexts** and post-mortem examinations, not in routine obstetric practice. - The measurement is taken from **crown to heel** of the deceased fetus. *Height of an adult* - Hasse's Rule is specifically for estimating **fetal age** in forensic settings, not for determining adult height. - Adult height is determined by genetics, nutrition, and growth patterns during development. *Race of a person* - This rule is used solely for **fetal age estimation** in post-mortem examinations. - It has no application in determining racial characteristics. *Identification of fetal abnormalities* - Hasse's Rule is a **dating method** for deceased fetuses, not a diagnostic tool for abnormalities. - Fetal abnormalities are identified through detailed anatomical examination, imaging studies, and other specific diagnostic methods.

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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