Maternal-Fetal Medicine Practice Questions

Q: Twin pregnancy is least associated with:

Young female. ***Young female*** - **Young maternal age** is generally associated with a *lower* incidence of twin pregnancies, particularly dizygotic twins. - The likelihood of dizygotic twinning *increases with maternal age* up to about 35-39 years. *Multigravida* - **Multiparity** (being a multigravida) is associated with an *increased* likelihood of twin pregnancies. - The chance of having twins increases with each successive pregnancy. *Genetic* - There is a **genetic predisposition** to dizygotic twinning, often running in families. - A family history of twinning, especially on the maternal side, increases the chances of having twins. *Patient receiving fertilization treatment* - **Assisted reproductive technologies (ART)**, such as *in vitro fertilization (IVF)*, significantly *increase* the risk of multiple pregnancies, including twins. - This is due to the transfer of multiple embryos or ovarian stimulation leading to multiple ovulations.

Q: In an antepartum cardiotocogram, consider the following findings: absence of deceleration and a sinusoidal pattern. Which of the following findings indicates fetal well-being?

Absence of deceleration only. ***Absence of deceleration only*** - The **absence of decelerations** (late or variable) on a cardiotocogram (CTG) is generally considered a sign of **fetal well-being**, indicating adequate placental perfusion and oxygenation. - This suggests that the fetus is not experiencing significant hypoxic stress during contractions or in response to umbilical cord compression. *Both findings indicate fetal well-being* - A **sinusoidal pattern** is a sign of severe fetal compromise, not well-being, and indicates urgent intervention is needed. - Therefore, combining it with the absence of decelerations does not result in an overall indication of fetal well-being. *Absence of deceleration and sinusoidal pattern* - This option incorrectly groups the **absence of decelerations** (fetal well-being) with a **sinusoidal pattern** (fetal distress). - A sinusoidal pattern is a distinct, ominous finding associated with severe fetal anemia, hypoxemia, and acidosis. *Sinusoidal pattern only* - A **sinusoidal pattern** on a CTG is a highly abnormal and concerning finding, indicative of severe **fetal anemia**, **hypoxemia**, or **acidosis**. - It is a strong indicator of **fetal distress** and requires immediate assessment and intervention, not fetal well-being.

Q: On transvaginal sonography, which of the following shapes of the cervix indicates preterm labor?

U. ***U*** - A **U-shaped cervix** on transvaginal sonography indicates **significant cervical funneling** and effacement, which is the classic finding strongly predictive of **impending preterm labor**. - This shape represents advanced cervical dilation from the internal os, indicating the cervix is actively shortening and opening, signifying high risk for preterm delivery. *T* - A **T-shaped cervix** typically represents a **normal, closed cervix**, with the internal os remaining intact and funneling absent or minimal. - This shape suggests a **low risk of preterm labor**, as the cervix maintains its structural integrity. *Y* - A **Y-shaped cervix** indicates **mild cervical funneling**, where the internal os has started to open but is not yet significantly dilated. - While it may suggest a **higher risk** of preterm labor than a T-shaped cervix, it is less indicative of imminent preterm labor than a U-shaped cervix. *O* - An **O-shaped cervix** refers to a **completely dilated cervix**, indicating active labor is already established. - This shape signifies that both the internal and external os are widely open, representing an advanced stage of cervical dilation beyond the predictive phase.

Q: All the following are indications for termination of pregnancy in APH patient except:

Transverse lie. ***Transverse lie*** - A **transverse lie** is an **abnormal fetal presentation** that requires a **cesarean section** for delivery, but it is **not an indication for delivery** in the context of an APH (Antepartum Hemorrhage) patient. - While it determines the **mode of delivery** (cesarean vs vaginal), it does not by itself indicate the need to deliver the baby due to hemorrhage. - The timing of delivery in APH is based on maternal-fetal compromise, not fetal presentation. *Continuous bleeding* - **Continuous, active vaginal bleeding** in an APH patient is an **absolute indication for delivery** to save the mother's life. - Uncontrolled hemorrhage can lead to **maternal shock**, disseminated intravascular coagulation (DIC), and maternal mortality if delivery is not expedited. *37 weeks* - If a patient with APH, especially due to **placenta previa**, reaches **37 weeks gestation**, delivery is indicated because the fetus has achieved **term maturity**. - Continuing the pregnancy beyond this point increases the risk of further hemorrhagic complications without additional fetal benefit. *IUD (Intrauterine Death)* - The presence of an **intrauterine fetal demise** in an APH patient is an indication for **delivery**. - A dead fetus, especially with ongoing bleeding, can lead to maternal coagulopathy and infection if retained. - Delivery prevents these maternal complications.

Q: Which of the following is NOT a recognized risk factor associated with macrosomia?

Short Stature. ***Short Stature*** - **Short stature** in mothers is generally associated with an **increased risk of small-for-gestational-age (SGA)** infants due to potential pelvic inlet limitations and reduced uterine capacity, not macrosomia. - While short stature can influence birth outcomes, it is not considered a direct or independent **risk factor for delivering a macrosomic infant**. *Maternal obesity* - **Maternal obesity** leads to increased **glucose and insulin levels** in the mother, crossing the placenta and stimulating fetal growth, significantly increasing the risk of macrosomia. - Obese mothers often have **larger placental nutrient transfer capacity**, contributing to excessive fetal growth. *Prolonged Pregnancy* - **Prolonged pregnancy** (post-term pregnancy) allows more time for continuous fetal growth and deposition of fat, which directly increases the likelihood of a fetus becoming **macrosomic**. - Fetuses in prolonged pregnancies continue to gain weight, and **fetal growth restriction** is less common in this context than continued growth. *Previous large infant* - A history of a **previous large infant** strongly indicates a maternal predisposition (e.g., genetic factors, undiagnosed glucose intolerance) to carrying and delivering larger babies in subsequent pregnancies. - This is one of the most significant risk factors, as **recurrence rates for macrosomia** are high.

Q: Pregnancy is contraindicated in which of the following cardiac conditions?

Primary pulmonary hypertension. ***Primary pulmonary hypertension*** - Pregnancy is **contraindicated** in primary pulmonary hypertension due to the significant risk of **maternal mortality**, which can be as high as 30-50%. - The physiological changes of pregnancy, such as increased **cardiac output** and blood volume, exacerbate pulmonary vascular resistance and can lead to **right heart failure** and sudden death. *Mitral stenosis* - While mitral stenosis can cause complications in pregnancy, it is not an absolute contraindication for all cases, especially if it is **mild to moderate** and well-managed. - The main concern is the increased **blood volume** and heart rate during pregnancy, which can worsen pulmonary congestion, but careful monitoring can often mitigate risks. *Aortic stenosis* - Severe aortic stenosis can be problematic during pregnancy due to the heart's inability to increase **cardiac output** adequately in response to increased demand. - However, pregnancy is typically not absolutely contraindicated, and management often involves close monitoring and in some cases, **balloon valvuloplasty** before or during pregnancy. *Mitral regurgitation* - Mitral regurgitation is generally **well-tolerated** during pregnancy because the reduced systemic vascular resistance in pregnancy makes it easier for blood to flow forward into the aorta, actually reducing the regurgitant volume. - While severe cases require careful monitoring, it is generally **not a contraindication** to pregnancy.

Q: A 32-year-old primigravida at 39 weeks of gestational age has a blood pressure reading of 150/100 mmHg obtained during a routine visit, which is an elevation from her baseline blood pressure of 120/70 mmHg. She denies any headache, visual changes, nausea, vomiting, or abdominal pain. Her repeat BP is 160/90 mmHg, and urinalysis is negative for protein. Which of the following is the most likely diagnosis?

Gestational hypertension. ***Gestational hypertension*** - This patient presents with **new-onset hypertension** (BP > 140/90 mmHg) after 20 weeks of gestation, without **proteinuria** or signs of **end-organ damage**. - The absence of proteinuria and severe features distinguishes it from preeclampsia, making gestational hypertension the most likely diagnosis. *Preeclampsia* - Preeclampsia requires new-onset hypertension combined with **proteinuria** (≥300 mg in 24 hours or protein/creatinine ratio ≥0.3) or signs of **end-organ dysfunction**, neither of which are described here. - While hypertension is present, the **lack of proteinuria** or other severe features rules out this diagnosis. *Chronic hypertension with superimposed preeclampsia* - This diagnosis applies to women with **pre-existing hypertension** (diagnosed before pregnancy or before 20 weeks) who then develop new-onset proteinuria or worsening hypertension with severe features. - The patient's baseline blood pressure was normal (120/70 mmHg), indicating no chronic hypertension, and no proteinuria or severe features are present. *Eclampsia* - Eclampsia is defined by the occurrence of **generalized tonic-clonic seizures** in a woman with preeclampsia, which is a life-threatening obstetric emergency. - The patient described has no signs of seizures or even severe preeclampsia.

Q: Which delivery method is associated with the least risk of HIV transmission during childbirth?

Cesarean section. ***Cesarean section*** - **Elective Cesarean section** (scheduled at 38 weeks) reduces the risk of **mother-to-child HIV transmission** when maternal **viral load is >1000 copies/mL** or unknown near delivery. - It avoids exposure to maternal blood and genital secretions during passage through the birth canal. - With effective **antiretroviral therapy (ART)** and viral suppression (<50 copies/mL), vaginal delivery is safe and C-section offers **no additional benefit**. - Among delivery methods compared without considering viral suppression, C-section has the **lowest transmission risk**. *Forceps delivery* - **Forceps delivery** increases risk of fetal trauma and scalp lacerations, potentially increasing exposure to maternal blood. - May cause **vaginal lacerations** in the mother, increasing blood exposure. - Should be avoided when possible in HIV-positive mothers, especially with detectable viral loads. *ARM (Artificial Rupture of Membranes)* - **ARM** prolongs duration of ruptured membranes, increasing fetal exposure time to potentially infected genital tract secretions. - Removes the protective barrier of intact membranes. - While not a delivery method per se, prolonged rupture of membranes (>4 hours) is associated with **increased transmission risk**. *Vacuum delivery* - **Vacuum delivery** can cause scalp abrasions, cephalohematomas, or subgaleal hemorrhage, creating portals for viral entry. - Increases trauma to both fetal scalp and maternal birth canal. - Should be avoided in HIV-positive mothers when other options are available.

Q: At what gestational age should a pregnancy with cholestasis of pregnancy be terminated?

38 weeks. ***38 weeks*** - For pregnancies complicated by **cholestasis of pregnancy**, induction of labor at **38 weeks** is generally recommended. - This timing balances the risk of stillbirth associated with cholestasis against the risks of **preterm birth**. *34 weeks* - Induction at 34 weeks would be considered **too early** unless there are additional severe complications, as it increases the risk of **neonatal morbidity** associated with prematurity. - While cholestasis does increase stillbirth risk, this risk significantly rises **after 37-38 weeks**, making earlier induction unnecessary in most cases. *36 weeks* - Induction at 36 weeks is generally considered **too early** given the potential for **neonatal complications** related to prematurity. - The elevated risk of adverse fetal outcomes in cholestasis of pregnancy typically occurs closer to term, making 38 weeks a more optimal balance. *40 weeks* - Allowing pregnancy to continue to 40 weeks with **cholestasis of pregnancy** would be associated with an **unacceptable increased risk of stillbirth**. - The risk of adverse perinatal outcomes, including **sudden fetal death**, significantly rises in pregnancies with cholestasis that extend beyond 38 weeks.

Q: What does the presence of a macerated fetus indicate in a clinical context?

Stillborn. ***Stillborn*** - A **macerated fetus** refers to a fetus that has undergone **autolysis** due to prolonged retention in utero after fetal death. - The presence of maceration is a definitive sign that the fetus was **stillborn** and not alive at the time of delivery. *Fetal distress* - **Fetal distress** indicates a fetus that is currently experiencing **compromise during labor** or prior, but is still alive. - While fetal distress can precede fetal death, its presence alone does not imply maceration or a stillborn outcome at the time of diagnosis. *Live born* - A **live born** infant shows any sign of life (e.g., breathing, heartbeat, umbilical cord pulsation, definite voluntary muscle movement) after complete expulsion or extraction from its mother. - The descriptor "macerated" directly contradicts the definition of a live birth, as **maceration occurs post-mortem**. *Intrauterine Growth Restriction (IUGR)* - **IUGR** describes a fetus that has not reached its **growth potential** in utero. - While IUGR can be a risk factor for stillbirth, **maceration** itself is not a diagnostic feature of IUGR but rather a post-mortem finding.

Question 1

Twin pregnancy is least associated with:

Accepted Answer

Young female

Answer

Genetic

Answer

Patient receiving fertilization treatment

Answer

Multigravida

Question 2

In an antepartum cardiotocogram, consider the following findings: absence of deceleration and a sinusoidal pattern. Which of the following findings indicates fetal well-being?

Accepted Answer

Absence of deceleration only

Answer

Both findings indicate fetal well-being

Answer

Absence of deceleration and sinusoidal pattern

Answer

Sinusoidal pattern only

Question 3

On transvaginal sonography, which of the following shapes of the cervix indicates preterm labor?

Accepted Answer

U

Answer

T

Answer

Y

Answer

O

Question 4

All the following are indications for termination of pregnancy in APH patient except:

Accepted Answer

Transverse lie

Answer

Continuous bleeding

Answer

37 weeks

Answer

IUD

Question 5

Which of the following is NOT a recognized risk factor associated with macrosomia?

Accepted Answer

Short Stature

Answer

Prolonged Pregnancy

Answer

Previous large infant

Answer

Maternal obesity

Question 6

Pregnancy is contraindicated in which of the following cardiac conditions?

Accepted Answer

Primary pulmonary hypertension

Answer

Mitral regurgitation

Answer

Aortic stenosis

Answer

Mitral stenosis

Question 7

A 32-year-old primigravida at 39 weeks of gestational age has a blood pressure reading of 150/100 mmHg obtained during a routine visit, which is an elevation from her baseline blood pressure of 120/70 mmHg. She denies any headache, visual changes, nausea, vomiting, or abdominal pain. Her repeat BP is 160/90 mmHg, and urinalysis is negative for protein. Which of the following is the most likely diagnosis?

Accepted Answer

Gestational hypertension

Answer

Preeclampsia

Answer

Chronic hypertension with superimposed preeclampsia

Answer

Eclampsia

Question 8

Which delivery method is associated with the least risk of HIV transmission during childbirth?

Accepted Answer

Cesarean section

Answer

Forceps delivery

Answer

ARM

Answer

Vacuum delivery

Question 9

At what gestational age should a pregnancy with cholestasis of pregnancy be terminated?

Accepted Answer

38 weeks

Answer

34 weeks

Answer

36 weeks

Answer

40 weeks

Question 10

What does the presence of a macerated fetus indicate in a clinical context?

Accepted Answer

Stillborn

Answer

Fetal distress

Answer

Live born

Answer

Intrauterine Growth Restriction (IUGR)

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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