Maternal-Fetal Medicine Practice Questions

Q: All of the following are the most commonly used ultrasonographic fetal growth parameters for estimating gestational age of the fetus, except:

Transcerebellar diameter. ***Transcerebellar diameter*** - While it can be used for gestational age estimation, especially in cases of **intrauterine growth restriction (IUGR)** or during the third trimester, it is **not one of the most commonly used** or primary parameters for routine gestational age assessment in early pregnancy. - The transcerebellar diameter is less affected by **growth disturbances** compared to other parameters but is not part of the standard set of measurements. *Biparietal diameter* - This is a **primary and highly reliable parameter** for estimating gestational age, particularly in the **second trimester**. - It measures the distance between the two parietal bones of the fetal skull. *Head circumference* - **Head circumference** is another **standard and essential parameter** for estimating gestational age and assessing fetal growth. - It provides a comprehensive measurement of the fetal head. *Femur length* - **Femur length** is a **routinely used parameter** for estimating gestational age, especially from the end of the first trimester through the third trimester. - It measures the longest bone in the fetal body, the femur.

Q: The immediate complication of vesicular mole evacuation is:

Hemorrhage. **Hemorrhage** - **Excessive bleeding** is the most common and immediate complication following the evacuation of a **vesicular mole**, due to the highly vascularized nature of the molar pregnancy tissue and the dilated uterine vessels. - The risk of hemorrhage is increased with larger uterine size or more aggressive suction curettage, necessitating careful monitoring and prompt intervention. *Post-operative infection* - While a potential complication, **infection** typically manifests with a slight delay (hours to days post-procedure) rather than being an immediate concern. - Prophylactic antibiotics are often given to mitigate this risk. *Residual tissue* - The presence of **residual molar tissue** is a common and important long-term complication leading to persistent trophoblastic disease, but it is usually not an immediate event that poses a direct threat to the patient's immediate stability upon evacuation. - It requires subsequent monitoring of hCG levels and potentially further intervention. *Septic shock* - **Septic shock** is a severe, life-threatening condition resulting from an uncontrolled infection, which is a rare and delayed complication of molar evacuation, not an immediate one. - It would typically be preceded by signs of infection and severe systemic inflammation.

Q: Fetal immune response to Treponema pallidum becomes detectable at which week of pregnancy?

18th week. ***Correct: 18th week*** - The **fetal immune system** is sufficiently developed by the **18th week of gestation** to mount a detectable immune response to *Treponema pallidum* - This marks the earliest point during pregnancy when **fetal IgM antibodies** specific to syphilis can be produced - Maternal treatment before 18 weeks can prevent fetal infection because the fetus cannot yet respond immunologically *Incorrect: 4th week* - At the **4th week of gestation**, the fetus is still in the **early embryonic stage**, and its immune system is not yet formed - No detectable **immune response** to any pathogen can be mounted at this very early stage *Incorrect: 8th week* - By the **8th week**, organogenesis is largely complete, but the **immune system is still immature** and not capable of a significant immune response - **Fetal antibody production** is extremely limited, if present at all, at this stage *Incorrect: 28th week* - While the fetal immune system is more robust by the **28th week**, the *Treponema pallidum* immune response is **detectable much earlier** (by 18 weeks) - A response by 28 weeks would indicate a **delayed diagnosis**, as the infection could have been identified sooner if screening occurred around 18 weeks

Q: A 37-week G2P1L1 is admitted with abdominal pain for 2 hours. On examination, the patient has a hemoglobin level of 9 g%, blood pressure of 150/90 mmHg, and urine albumin positivity. Palpation reveals a 36-week fetus with good fetal heart rate and regular uterine contractions with uterine tenderness on palpation. Per vaginal examination shows 6 cm dilation. Artificial rupture of membranes (ARM) reveals blood-stained amniotic fluid. What is the next line of management?

Immediate cesarean section. ***Immediate cesarean section*** - The presence of **uterine tenderness**, **blood-stained amniotic fluid** following rupture of membranes, and **abdominal pain** in a patient with **hypertension and proteinuria (preeclampsia)** strongly suggests **placental abruption**. - Given the maternal and fetal instability (potential for further bleeding, risk of fetal hypoxia), **expeditious delivery** via cesarean section is indicated to prevent severe complications for both mother and fetus. - Although the patient is 6 cm dilated, the signs of abruption with preeclampsia warrant immediate operative delivery rather than awaiting vaginal delivery. *Observation and monitoring* - This approach is inappropriate and potentially dangerous given the clinical signs suggestive of **placental abruption**, which can rapidly escalate to severe hemorrhage and fetal distress. - Close monitoring alone would delay definitive intervention and increase risks. *Blood transfusion if necessary* - While a **blood transfusion** may be necessary due to the low hemoglobin level and potential for further blood loss, it is a supportive measure, not the primary management for **placental abruption**. - Addressing the cause of bleeding (delivery) is paramount, after which transfusion can be given as needed. *Oxytocin administration* - **Oxytocin** is used to augment labor or prevent postpartum hemorrhage but is **contraindicated** in cases of suspected **placental abruption** with unconfirmed fetal well-being or significant maternal bleeding. - It would increase uterine contractions which could worsen the abruption and fetal distress.

Q: In a case of suspected Rh incompatibility in a pregnant woman, what is the next step in the investigation?

Indirect Coomb's test. ***Indirect Coomb's test*** - The **indirect Coomb's test** (also known as the indirect antiglobulin test) identifies **Rh antibodies** in the mother's serum, indicating she has been sensitized to Rh-positive blood. - This test is crucial for determining if the mother is at risk of producing antibodies that could attack a subsequent Rh-positive fetus. *RhoGAM* - **RhoGAM** (Rh immunoglobulin) is a **preventive treatment** given to Rh-negative mothers, not a diagnostic test. - It works by neutralizing fetal Rh-positive red blood cells in the maternal circulation, preventing the mother's immune system from developing antibodies. *Direct Coomb's test* - The **direct Coomb's test** (or direct antiglobulin test) is performed on the **infant's blood** postnatal to detect antibodies already coating the infant's red blood cells. - This indicates that the infant's red blood cells have been attacked by maternal antibodies, suggesting hemolysis. *Detection of fetal cells in maternal circulation* - Detecting **fetal cells in maternal circulation** (e.g., using the Kleihauer-Betke test) is used to quantify the amount of **feto-maternal hemorrhage**. - This quantification helps determine the appropriate dose of RhoGAM needed after a potential exposure, such as trauma or delivery, but it doesn't diagnose the mother's sensitization status.

Q: Nonimmune hydrops fetalis is caused by which of the following?

Parvovirus B19. ***Parvovirus B19*** - **Parvovirus B19** infection in the fetus can lead to severe **anemia** due to its tropism for erythroid progenitor cells, which then causes **high-output cardiac failure** and subsequent **nonimmune hydrops fetalis**. - The anemia results in impaired oxygen delivery, leading to generalized edema and fluid accumulation in multiple fetal compartments, characteristic of hydrops fetalis. *Cytomegalovirus (CMV)* - While **CMV** is a common congenital infection and can cause significant fetal morbidity and mortality, it typically leads to symptoms like **microcephaly**, periventricular calcifications, and **sensorineural hearing loss**, rather than nonimmune hydrops fetalis as its primary presentation. - Though severe CMV can cause anemia and liver dysfunction, it is less commonly associated with the widespread edema and fluid accumulation seen in nonimmune hydrops compared to Parvovirus B19. *Herpes Simplex Virus (HSV)* - **HSV** infection in neonates is usually acquired during birth and can cause severe **skin lesions**, encephalitis, and disseminated disease, but it does not typically present as **nonimmune hydrops fetalis**. - Congenital HSV is very rare and symptoms when present are usually neurological or dermatological. *Human Immunodeficiency Virus (HIV)* - **HIV** infection in the fetus primarily results in **immunodeficiency** and increased susceptibility to opportunistic infections, often presenting with symptoms such as **failure to thrive**, recurrent infections, and developmental delays. - It is not a direct cause of **nonimmune hydrops fetalis**, which is characterized by widespread fluid accumulation due to circulatory or lymphatic issues.

Q: Ectopic pregnancy typically lasts longer before rupture in which location?

Interstitial. ***Interstitial*** - An **interstitial ectopic pregnancy** occurs in the portion of the fallopian tube that passes through the **uterine muscular wall**, allowing for greater distention. - This anatomical location provides more space for the pregnancy to grow before rupture occurs, often leading to a later presentation and more catastrophic hemorrhage when rupture does happen. *Cervical* - A **cervical ectopic pregnancy** implants in the endocervical canal, an area not designed to support a growing pregnancy. - These pregnancies typically present with heavy bleeding early on and do not usually have a prolonged course before significant complications arise. *Isthmic* - **Isthmic ectopic pregnancies** occur in the narrowest part of the fallopian tube, which has a limited capacity for expansion. - Due to the small lumen and muscular wall, these pregnancies tend to rupture earlier, often within 6-8 weeks, and are associated with a high risk of hemorrhage. *Ampullary* - **Ampullary ectopic pregnancies** are the most common type, occurring in the widest part of the fallopian tube. - While they can grow to a larger size than isthmic pregnancies, the thin wall of the ampulla means they typically rupture earlier than interstitial pregnancies, usually by 8-10 weeks.

Q: What is the condition characterized by fetal blood vessels crossing or running near the cervical os?

Vasa previa. ***Vasa previa*** - This condition involves **fetal blood vessels** unprotected by placental tissue or umbilical cord, lying over or in close proximity to the **internal cervical os**. - It carries a high risk of **fetal exsanguination** and death if these vessels rupture during labor when the membranes rupture. *Marginal placenta* - This term, also known as **placenta previa marginalis**, refers to a placenta that touches the edge of the internal cervical os but does not cover it. - While it can cause bleeding, it does not involve **fetal vessels** directly crossing the os in the same dangerous manner as vasa previa. *Velamentous placenta* - In a **velamentous umbilical cord insertion**, the umbilical cord inserts into the **chorioamniotic membranes** rather than directly into the placental mass. - The umbilical vessels then travel through the membranes to reach the placenta, which can make them vulnerable to compression, but this condition is distinct from **vasa previa** unless these exposed vessels specifically cross the cervical os. *Battledore placenta* - Also known as **marginal cord insertion**, this describes an umbilical cord that inserts directly into the **edge or margin of the placenta**. - While it may be associated with certain fetal growth restrictions, it does not typically involve **fetal vessels** exposed or crossing the internal cervical os.

Question 1

All of the following are the most commonly used ultrasonographic fetal growth parameters for estimating gestational age of the fetus, except:

Accepted Answer

Transcerebellar diameter

Answer

Biparietal diameter

Answer

Head circumference

Answer

Femur length

Question 2

The immediate complication of vesicular mole evacuation is:

Accepted Answer

Hemorrhage

Answer

Post-operative infection

Answer

Residual tissue

Answer

Septic shock

Question 3

A female of 36 weeks' gestation presents with severe hypertension, blurring of vision, and headache. Her blood pressure readings are 180/120 mmHg and 174/110 mmHg after 20 minutes. What is the most appropriate management for this patient?

Accepted Answer

Admit the patient, start antihypertensives, administer MgSO4, and plan for delivery.

Answer

Admit the patient and monitor her condition.

Answer

Discharge the patient with oral antihypertensives and schedule a follow-up.

Answer

Admit the patient, initiate antihypertensive therapy, and continue the pregnancy until term.

Question 4

Fetal immune response to Treponema pallidum becomes detectable at which week of pregnancy?

Accepted Answer

18th week

Answer

4th week

Answer

8th week

Answer

28th week

Question 5

A 37-week G2P1L1 is admitted with abdominal pain for 2 hours. On examination, the patient has a hemoglobin level of 9 g%, blood pressure of 150/90 mmHg, and urine albumin positivity. Palpation reveals a 36-week fetus with good fetal heart rate and regular uterine contractions with uterine tenderness on palpation. Per vaginal examination shows 6 cm dilation. Artificial rupture of membranes (ARM) reveals blood-stained amniotic fluid. What is the next line of management?

Accepted Answer

Immediate cesarean section

Answer

Observation and monitoring

Answer

Blood transfusion if necessary

Answer

Oxytocin administration

Question 6

In a case of suspected Rh incompatibility in a pregnant woman, what is the next step in the investigation?

Accepted Answer

Indirect Coomb's test

Answer

RhoGAM

Answer

Detection of fetal cells in maternal circulation

Answer

Direct Coomb's test

Question 7

A 24-year-old primigravida with HIV serology positive is in the antenatal outpatient department. Her CD4 count is 600 cells/μL, and her HIV-1 viral load is 2,680 copies/mL. Which of the following is the best method of reducing maternal-fetal transmission of HIV infection?

Accepted Answer

Triple antiretroviral therapy for the mother throughout pregnancy

Answer

Elective cesarean section

Answer

Pooled intravenous immunoglobulin G therapy for the infant

Answer

Nevirapine therapy for the infant after birth

Question 8

Nonimmune hydrops fetalis is caused by which of the following?

Accepted Answer

Parvovirus B19

Answer

Cytomegalovirus (CMV)

Answer

Herpes Simplex Virus (HSV)

Answer

Human Immunodeficiency Virus (HIV)

Question 9

Ectopic pregnancy typically lasts longer before rupture in which location?

Accepted Answer

Interstitial

Answer

Isthmic

Answer

Ampullary

Answer

Cervical

Question 10

What is the condition characterized by fetal blood vessels crossing or running near the cervical os?

Accepted Answer

Vasa previa

Answer

Marginal placenta

Answer

Velamentous placenta

Answer

Battledore placenta

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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