Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine Indian Medical PG Practice Questions and MCQs

Question 1271: A hypertensive pregnant woman at 34 weeks presents with a history of abdominal pain, bleeding per vaginum, and loss of fetal movements. On examination, the uterus is contracted with increased uterine tone, and fetal heart sounds are absent. Which of the following is the most likely diagnosis?

A. Polyhydramnios
B. Premature labour
C. Abruptio placenta (Correct Answer)
D. Placenta previa

Explanation: ***Abruptio placenta*** - The classic presentation of **abruptio placenta** includes **abdominal pain**, **vaginal bleeding**, **increased uterine tone**, and **loss of fetal movements** in a patient with **hypertension**. - **Hypertension** is a significant risk factor for abruptio placenta, and the absence of fetal heart sounds suggests **fetal demise**, which can occur due to severe abruption. *Polyhydramnios* - Characterized by an **excessive accumulation of amniotic fluid**, which leads to an abnormally large uterus. - It usually presents with **uterine distension** and shortness of breath, not abdominal pain, vaginal bleeding, or increased uterine tone. *Placenta previa* - Typically presents with **painless vaginal bleeding** in the second or third trimester. - The uterus is usually **soft and non-tender**, unlike the increased uterine tone seen in abruptio placenta. *Premature labour* - Defined by **regular uterine contractions** causing cervical change before 37 weeks of gestation. - While contractions cause abdominal pain, it does not typically present with significant **vaginal bleeding** or sustained **increased uterine tone** as described.

Question 1272: Supine hypotension syndrome is a characteristic finding of which trimester?

A. First trimester of pregnancy
B. 2nd trimester of pregnancy
C. 3rd trimester of pregnancy (Correct Answer)
D. All trimesters equally

Explanation: ***3rd trimester of pregnancy*** - **Supine hypotension syndrome** occurs when the gravid uterus in the supine position compresses the **inferior vena cava**, leading to decreased venous return and subsequent hypotension [1]. - This is most pronounced and symptomatic in the **third trimester** due to the significantly increased size and weight of the uterus and fetus [1]. *First trimester of pregnancy* - During the first trimester, the **uterus is still relatively small** and largely contained within the pelvis, making significant compression of the inferior vena cava unlikely. - Therefore, **supine hypotension syndrome is rare** at this stage. *2nd trimester of pregnancy* - While the uterus grows in the second trimester and begins to extend into the abdominal cavity, its size is generally **not large enough to cause severe inferior vena cava compression** leading to symptomatic supine hypotension. - The syndrome is less common and, if present, usually **milder** than in the third trimester [1]. *All trimesters equally* - This is incorrect because the physiological changes that cause supine hypotension syndrome, specifically the size and weight of the gravid uterus, **vary significantly across trimesters**. - The syndrome is dependent on significant uterine enlargement, which is not present in all trimesters equally [1].

Question 1273: A pregnant lady complains of headaches, feeling of excessive tiredness, and drowsiness whenever she lies down in the supine position. Her symptoms are relieved on sitting up and while lying on her side. What is the most likely diagnosis?

A. IVC compression
B. Increased intra-abdominal pressure
C. Reduced blood supply to the placenta
D. Supine hypotensive syndrome (Correct Answer)

Explanation: ***Supine hypotensive syndrome*** - This syndrome is characterized by **dizziness**, **lightheadedness**, and sometimes **syncope** when a pregnant woman lies in the supine position. - It occurs due to compression of the **inferior vena cava (IVC)** by the gravid uterus, leading to decreased venous return, reduced cardiac output, and subsequent **hypotension**. *IVC compression* - While **IVC compression** is the physiological mechanism causing supine hypotensive syndrome, it is not the diagnosis itself. - The compression leads to the constellation of symptoms defined as **supine hypotensive syndrome**. *Increased intra-abdominal pressure* - **Increased intra-abdominal pressure** can occur during pregnancy but is not directly responsible for the specific symptoms that resolve with position changes in this manner. - It relates more to discomfort, breathing difficulties, or gastroesophageal reflux rather than acute hypotensive symptoms upon lying supine. *Reduced blood supply to the placenta* - While **hypotension** can indeed lead to **reduced placental blood flow**, this is a *consequence* of the supine hypotensive syndrome, not the primary diagnosis explaining the mother's symptoms. - The mother's symptoms (headache, tiredness, drowsiness) stem from her own systemic hypoperfusion.

Question 1274: Most sensitive diagnostic test for ectopic pregnancy is which one?

A. Transvaginal USG (Correct Answer)
B. Serial monitoring of beta HCG
C. Culdocentesis
D. MRI

Explanation: ***Transvaginal USG*** - **Transvaginal ultrasonography (TVS)** is considered the most sensitive diagnostic test because it can directly visualize the presence or absence of an intrauterine pregnancy and detect an ectopic gestational sac or mass. - It allows for early detection of an ectopic pregnancy, often even before symptoms become severe, by identifying findings like an **adnexal mass**, **free fluid in the cul-de-sac**, or an **empty uterus** in the presence of positive hCG. *Serial monitoring of beta HCG* - While serial monitoring of **beta-hCG** levels is a crucial component in the diagnosis of ectopic pregnancy, particularly for early pregnancy of unknown location (PUL), it is not the most sensitive single diagnostic test. - It helps in discerning between a normal intrauterine pregnancy, an ectopic pregnancy, or a miscarriage based on the **rate of hCG rise**, but it does not directly localize the pregnancy. *Culdocentesis* - **Culdocentesis** involves aspirating fluid from the pouch of Douglas to detect non-clotting blood, which suggests a ruptured ectopic pregnancy. - It is an invasive procedure and has significantly decreased in use due to the availability of highly sensitive imaging techniques like TVS; it primarily identifies rupture rather than diagnosing the intact ectopic pregnancy itself. *MRI* - **Magnetic Resonance Imaging (MRI)** can be used to diagnose ectopic pregnancy, especially in complex or unusual locations, but it is typically reserved for cases where ultrasound is inconclusive or technically difficult. - It is **more expensive** and less readily available than TVS, and its sensitivity for routine ectopic pregnancy diagnosis does not surpass that of a high-quality TVS.

Question 1275: On USG finding of cystic hygroma in a fetus is suggestive of:

A. Down's syndrome
B. Marfan's syndrome
C. Turner's syndrome (Correct Answer)
D. Klinfelter's syndrome

Explanation: ***Turner's syndrome*** - **Cystic hygroma** is a significant fetal ultrasound marker associated with **Turner's syndrome (45,X)**, often due to lymphatic system abnormalities. - Other findings might include fetal hydrops, renal anomalies, and coarctation of the aorta. *Down's syndrome* - While **nuchal translucency** can be increased in Down's syndrome, a **cystic hygroma** is less specific and less common than in Turner's syndrome. - Other markers for Down's syndrome include **duodenal atresia**, **heart defects**, and **shortened long bones**. *Marfan's syndrome* - This is a **connective tissue disorder** not typically associated with cystic hygroma in utero. - Fetal manifestations are rare but can include significant **cardiac defects** like aortic root dilation. *Klinfelter's syndrome* - **Klinfelter's syndrome (47, XXY)** generally has subtle or no prenatal ultrasound findings. - **Cystic hygroma** is not a characteristic feature of this condition.

Question 1276: All of the following are associated with breech presentation at normal full-term pregnancy, except:

A. Fetal malformation
B. Uterine anomaly
C. Cornual implantation of placenta
D. Placenta accreta (Correct Answer)

Explanation: ***Placenta accreta*** - **Placenta accreta** is a condition where the placenta abnormally adheres to the uterine wall, which is typically associated with previous uterine surgery (e.g., C-sections) and **placenta previa**, not breech presentation. - While both can increase risks in pregnancy, there is no direct causal link or strong association between **placenta accreta** and **breech presentation** in a full-term pregnancy. *Fetal malformation* - **Fetal malformations**, particularly those affecting neural tube development, neuromuscular control, or fetal head/neck flexibility, can lead to a reduced ability of the fetus to turn into a cephalic presentation. - Conditions like **hydrocephalus** or **anencephaly** can hinder the spontaneous version to a head-down position. *Uterine anomaly* - **Uterine anomalies** such as a **septate uterus**, **bicornuate uterus**, or **fibroids** can alter the shape of the uterine cavity, restricting fetal movement and preventing the fetus from assuming a cephalic presentation. - These structural abnormalities can physically limit the space available for the fetus to turn. *Cornual implantation of placenta* - **Cornual implantation** or **fundal implantation** of the placenta can reduce the available space in the lower uterine segment, making it difficult for the fetus to turn and maintain a cephalic presentation. - The placenta's position can exert pressure or create an unfavorable environment that encourages the fetus to remain in a breech position.

Question 1277: Earliest detectable congenital malformation by ultrasound (USG) is

A. Anencephaly (Correct Answer)
B. Spina bifida
C. Meningocoele
D. Cystic hygroma

Explanation: ***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.

Question 1278: What is the rate of uterine blood flow at term?

A. >600 ml/min
B. 50-75 ml/min
C. 150-200 ml/min
D. 350-400 ml/min (Correct Answer)

Explanation: ***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.

Question 1279: Risk of recurrence of hydatidiform mole in future pregnancy is:

A. 8-10%
B. 1-4% (Correct Answer)
C. 4-8%
D. 10-12%

Explanation: ***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.

Question 1280: Anti-D prophylaxis is MOST critically indicated in which of the following situations?

A. Amniocentesis at 16 weeks
B. Manual removal of placenta
C. Intra-uterine transfusion at 28 weeks (Correct Answer)
D. MTP at 63 days

Explanation: ***Intra-uterine transfusion at 28 weeks*** - **Intra-uterine transfusion (IUT)** is an invasive procedure involving needle insertion into the fetal umbilical vein or peritoneal cavity to transfuse blood (typically O-negative) to treat severe fetal anemia. - This procedure carries a **very high risk of fetomaternal hemorrhage** due to the invasive nature of accessing fetal vessels, with potential for significant mixing of fetal and maternal blood. - The procedure is performed when the fetus is already at risk (Rh alloimmunization complications), and any additional sensitization could worsen the current or future pregnancies. - **Adequate anti-D prophylaxis is absolutely critical** to prevent exacerbation of alloimmunization. *Amniocentesis at 16 weeks* - **Amniocentesis** carries approximately 1% risk of fetomaternal hemorrhage, necessitating anti-D prophylaxis. - This is a standard indication for anti-D prophylaxis (300 mcg in second/third trimester). - The procedure is less invasive than intra-uterine transfusion. *Manual removal of placenta* - **Manual removal of the placenta** is associated with **very high risk of significant fetomaternal hemorrhage** (can exceed 30 mL of fetal blood) due to direct uterine manipulation and placental separation. - This is one of the **most important postpartum indications** for anti-D prophylaxis. - While extremely critical, this is a postnatal event, whereas IUT represents an ongoing high-risk antenatal situation in an already sensitized pregnancy scenario. *MTP at 63 days* - **Medical Termination of Pregnancy (MTP)** at 63 days (9 weeks) involves risk of fetomaternal hemorrhage, though typically smaller volumes due to early gestational age. - Anti-D prophylaxis (50 mcg for first trimester) is recommended for all Rh-negative women undergoing MTP. - The risk and volume of fetomaternal hemorrhage is generally less than with invasive antenatal procedures or traumatic delivery events.

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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