Maternal-Fetal Medicine Practice Questions

Q: Which of the following methods does not improve fetoplacental function in women with IUGR?

Allyl estranol. **Explanation:** Intrauterine Growth Restriction (IUGR) is primarily managed by improving uteroplacental blood flow and optimizing maternal nutrition. **Why Allyl estranol is the correct answer:** Allyl estranol is a synthetic progestogen. While it was historically used to prevent miscarriage or preterm labor, large-scale clinical trials and Cochrane reviews have proven that it has **no role** in improving fetoplacental function or treating IUGR. It does not increase placental perfusion or fetal weight. In modern obstetrics, its use for growth restriction is considered obsolete and ineffective. **Why the other options are incorrect:** * **High protein diet:** Maternal malnutrition is a modifiable risk factor. Supplementing the mother with a balanced, high-protein diet ensures adequate amino acid transfer to the fetus, which is essential for cellular growth and improving fetal weight. * **Left lateral position:** This is a fundamental nursing intervention. It prevents **aortocaval compression** by the gravid uterus, thereby increasing venous return to the heart, improving cardiac output, and maximizing uterine artery blood flow to the placenta. * **Intermittent O2 therapy:** Administering oxygen to the mother increases the oxygen concentration gradient across the placenta. This can temporarily improve fetal oxygenation and is sometimes used in cases of suspected fetal distress or severe growth restriction. **Clinical Pearls for NEET-PG:** * **Bed Rest:** The most effective non-pharmacological "treatment" for IUGR is bed rest in the left lateral position. * **Low-dose Aspirin (75-150 mg):** If started before 16 weeks, it can help prevent IUGR in high-risk women by improving trophoblastic invasion. * **Definitive Management:** The only definitive "cure" for IUGR is delivery once the fetus has reached a viable age or if fetal surveillance (Doppler/NST) indicates compromise.

Q: All of the following are complications in a pregnant woman with systemic lupus erythematosus (SLE) disease except?

Post-term delivery. **Explanation:** Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disorder that significantly impacts pregnancy outcomes. The core pathophysiology involves immune complex deposition and vasculitis, which compromises placental function. **Why Post-term delivery is the correct answer:** In SLE, the primary concern is **placental insufficiency** caused by decidual vasculopathy. This leads to complications that necessitate early delivery, either due to spontaneous onset (preterm labor) or medical induction (fetal distress/preeclampsia). Therefore, SLE is associated with **preterm delivery**, not post-term delivery. **Analysis of Incorrect Options:** * **Preterm Labor:** This is a hallmark complication of SLE, occurring in up to 30-50% of cases due to premature rupture of membranes, placental abruption, or iatrogenic delivery for maternal/fetal indications. * **Thrombophilia:** SLE is frequently associated with **Antiphospholipid Syndrome (APS)**. The presence of Lupus Anticoagulant or Anticardiolipin antibodies creates a hypercoagulable state, leading to venous/arterial thrombosis and placental infarctions. * **Eclampsia:** SLE patients have a significantly higher risk of **Preeclampsia and Eclampsia**. Differentiating between a "Lupus Nephritis flare" and "Preeclampsia" is a common clinical challenge; however, both conditions predispose the patient to hypertensive crises and seizures. **High-Yield Clinical Pearls for NEET-PG:** * **Best time to conceive:** When SLE has been in remission for at least **6 months**. * **Neonatal Lupus:** Caused by transplacental passage of **Anti-Ro (SS-A)** and **Anti-La (SS-B)** antibodies. The most serious permanent complication is **Congenital Heart Block**. * **Drug of Choice:** **Hydroxychloroquine** is safe and should be continued throughout pregnancy to prevent flares. * **Flare Marker:** Low complement levels (**C3, C4**) usually indicate an SLE flare rather than preeclampsia.

Q: In a primigravida patient experiencing preterm labor, which of the following can be used as a tocolytic agent?

Ritodrine and MgSO4. **Explanation:** **1. Why Option B is Correct:** Tocolytics are drugs used to suppress uterine contractions to delay delivery, typically for 48 hours, allowing for corticosteroid administration or maternal transport. * **Ritodrine** is a **Beta-2 adrenergic agonist** that increases intracellular cAMP, leading to smooth muscle relaxation (uterine quiescence). * **Magnesium Sulfate (MgSO4)** acts as a calcium antagonist, competing with calcium at the motor endplate and inhibiting myometrial contractility. In preterm labor, MgSO4 serves a dual purpose: tocolysis and **fetal neuroprotection** (reducing the risk of cerebral palsy). **2. Analysis of Incorrect Options:** * **Option A & D:** **Dexamethasone** is a corticosteroid used for fetal lung maturity (to prevent RDS, IVH, and NEC). While it is essential in preterm labor management, it is **not a tocolytic agent** as it has no effect on uterine contractions. * **Option C:** **Propranolol** is a non-selective **Beta-blocker**. Since Beta-2 stimulation causes uterine relaxation, a Beta-blocker would theoretically increase uterine activity and is contraindicated when tocolysis is desired. **3. High-Yield Clinical Pearls for NEET-PG:** * **First-line Tocolytic:** Currently, **Nifedipine** (Calcium Channel Blocker) is the preferred first-line agent due to its oral efficacy and better safety profile compared to Ritodrine. * **Atosiban:** A competitive Oxytocin receptor antagonist; highly specific with fewer side effects but expensive. * **Indomethacin:** A COX inhibitor used as a tocolytic, but contraindicated after **32 weeks** due to the risk of premature closure of the *ductus arteriosus* and oligohydramnios. * **Ritodrine Side Effects:** Maternal tachycardia, pulmonary edema, and hyperglycemia.

Q: What is the most common presentation in twin pregnancies?

Both Vertex. **Explanation:** In twin pregnancies, the presentation of the fetuses is determined by the available intrauterine space and the tendency of the fetuses to accommodate the oval shape of the uterus. **1. Why "Both Vertex" is correct:** Cephalic (Vertex) presentation is the most common presentation for a single fetus (95%), and this trend continues in multifetal gestations. **Vertex-Vertex** is the most frequent combination, occurring in approximately **40–50%** of all twin pregnancies. This is the most favorable presentation for a planned vaginal delivery, provided there are no other contraindications. **2. Analysis of Incorrect Options:** * **Vertex + Breech (Option C):** This is the second most common presentation, occurring in about **30–35%** of cases. While common, it is statistically less frequent than both being vertex. * **Vertex + Transverse (Option A):** This occurs in approximately **10%** of cases. It is less common because the transverse lie is unstable and usually converts to longitudinal as the pregnancy progresses. * **Both Breech (Option D):** This is relatively rare, occurring in only about **10%** of twin pregnancies. **3. High-Yield Clinical Pearls for NEET-PG:** * **Management Rule:** If the first twin (Twin A) is non-vertex, a Cesarean Section is generally indicated regardless of the presentation of Twin B. * **Internal Podalic Version:** This is a classic obstetric maneuver that may be used for the delivery of a **second twin** (Twin B) if it is in a non-vertex presentation (like transverse) after the successful vaginal birth of Twin A. * **Locked Twins:** A rare but serious complication (1 in 1000 twin births) most commonly seen when **Twin A is Breech and Twin B is Vertex**. Their chins become interlocked, necessitating a C-section.

Q: Supine hypotension syndrome occurs in which condition?

Advanced pregnancy. ### Explanation **Supine Hypotension Syndrome** (also known as Aortocaval Compression Syndrome) occurs primarily in **advanced pregnancy** (usually after 20 weeks of gestation). #### Why Advanced Pregnancy is Correct: The underlying mechanism is the **mechanical compression** of the **Inferior Vena Cava (IVC)** and the abdominal aorta by the gravid uterus when the woman lies in a supine position. 1. **Venous Return:** Compression of the IVC leads to a significant decrease in venous return to the heart (preload). 2. **Cardiac Output:** Reduced preload results in decreased stroke volume and cardiac output. 3. **Hypotension:** This manifests as a drop in maternal blood pressure, leading to symptoms like dizziness, nausea, pallor, and syncope. It can also cause fetal distress due to reduced placental perfusion. #### Why Other Options are Incorrect: * **Early Pregnancy:** The uterus is still a pelvic organ or not large enough to exert significant pressure on the retroperitoneal vessels. * **Obesity & Ascites:** While these conditions increase intra-abdominal pressure, they rarely cause the acute, posture-dependent vascular collapse seen in pregnancy. The gravid uterus is a unique, solid, and heavy mass that specifically targets the IVC when supine. #### NEET-PG High-Yield Pearls: * **Management:** The immediate treatment is the **Left Lateral Position**, which shifts the uterus off the IVC, restoring venous return. * **Aortic Compression:** While IVC compression causes maternal hypotension, compression of the **Aorta** can lead to "Poseiro Effect" (fetal hypoxemia without maternal hypotension). * **Clinical Tip:** During CPR in a pregnant woman, manual **Left Uterine Displacement (LUD)** is a critical step to ensure effective chest compressions.

Q: Which of the following conditions is the most frequent cause of spontaneous abortion in the first trimester of pregnancy?

Chromosomal abnormalities. **Explanation:** **1. Why Chromosomal Abnormalities is Correct:** Chromosomal abnormalities are the single most common cause of spontaneous abortion, accounting for approximately **50-60%** of all first-trimester miscarriages. Among these, **Autosomal Trisomies** are the most frequent (Trisomy 16 being the most common specific trisomy), followed by Monosomy X (Turner Syndrome) and Polyploidy. These genetic errors usually occur de novo during gametogenesis or early fertilization, leading to non-viable embryos that the body naturally expels. **2. Why Other Options are Incorrect:** * **Abruptio Placentae (A):** This is the premature separation of the placenta, typically occurring in the **third trimester**. It is a cause of antepartum hemorrhage and fetal distress, not first-trimester spontaneous abortion. * **Chorioamnionitis (B):** This is an intra-amniotic infection usually associated with prolonged rupture of membranes. While it can cause mid-trimester loss or preterm labor, it is not the leading cause of early first-trimester miscarriage. * **Placenta Previa (D):** This refers to the placenta covering the internal os. Like abruption, it is a cause of **late-pregnancy bleeding** (antepartum hemorrhage) and does not cause first-trimester spontaneous abortion. **3. NEET-PG High-Yield Pearls:** * **Most common Trisomy in miscarriages:** Trisomy 16. * **Most common single chromosomal anomaly:** Monosomy X (45, X). * **Second most common cause of miscarriage:** Maternal endocrine factors (e.g., Luteal Phase Defect, uncontrolled Diabetes). * **Recurrent Pregnancy Loss (RPL):** Defined as $\geq$ 2 consecutive spontaneous abortions; the most common treatable cause is Antiphospholipid Antibody Syndrome (APS).

Question 1

Which of the following methods does not improve fetoplacental function in women with IUGR?

Accepted Answer

Allyl estranol

Answer

High protein diet

Answer

Left lateral position

Answer

Intermittent O2 therapy

Question 2

All of the following are complications in a pregnant woman with systemic lupus erythematosus (SLE) disease except?

Accepted Answer

Post-term delivery

Answer

Preterm labor

Answer

Thrombophilia

Answer

Eclampsia

Question 3

What advice should be given to an HIV-positive primigravida near term regarding labor and delivery?

Accepted Answer

Cesarean section would decrease transmission of HIV to the baby.

Answer

Treatment should be started before labor.

Answer

Avoid mixing of blood intrapartum.

Answer

Vaginal delivery is preferred.

Question 4

In a primigravida patient experiencing preterm labor, which of the following can be used as a tocolytic agent?

Accepted Answer

Ritodrine and MgSO4

Answer

Ritodrine and Dexamethasone

Answer

Ritodrine and Propranolol

Answer

MgSO4 and Dexamethasone

Question 5

What is the most common presentation in twin pregnancies?

Accepted Answer

Both Vertex

Answer

Vertex + Transverse

Answer

Vertex + Breech

Answer

Both Breech

Question 6

The Kleihaeur-Betke test is performed to detect:

Accepted Answer

Fetomaternal hemorrhage

Answer

Cephalopelvic disproportion

Answer

Karyotype of a normal fetus

Answer

Fetal infections

Question 7

In Erythroblastosis fetalis, why is the first child typically spared?

Accepted Answer

Sensitization of Rh-negative mothers by a Rh-positive fetus generally occurs at birth.

Answer

The immune response during a second exposure is rapid.

Answer

Small amounts of fetal blood leak into the maternal circulation at the time of delivery.

Answer

Mothers develop significant titers of anti-Rh agglutinins during the postpartum period.

Question 8

A 20-year-old woman, gravida 3, para 2, has a screening ultrasound at 18 weeks' gestation that shows hydrops fetalis but no malformations. The woman's two previous pregnancies ended at term in live births. The current pregnancy results in a live birth at 36 weeks. Physical examination shows marked hydrops of the neonate and placenta. Laboratory studies show a cord blood hemoglobin level of 9.2 g/dL and total bilirubin concentration of 20.2 mg/dL. Which of the following laboratory findings is most likely to be present in this case?

Accepted Answer

Positive Coombs test result on cord blood

Answer

Diminished glucocerebrosidase activity in fetal cells

Answer

Elevated maternal serum alpha-fetoprotein level

Answer

Positive maternal hepatitis B surface antigen

Question 9

Supine hypotension syndrome occurs in which condition?

Accepted Answer

Advanced pregnancy

Answer

Obesity

Answer

Ascites

Answer

Early pregnancy

Question 10

Which of the following conditions is the most frequent cause of spontaneous abortion in the first trimester of pregnancy?

Accepted Answer

Chromosomal abnormalities

Answer

Abruptio placentae

Answer

Chorioamnionitis

Answer

Placenta previa

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?