Maternal-Fetal Medicine Practice Questions

Q: Which of the following describes sonological findings of Placenta accreta?

Large intraplacental lacunae. **Explanation:** **Placenta accreta** is a clinical condition where there is an abnormal adherence of the placenta to the underlying myometrium due to the partial or total absence of the **Decidua basalis** and the imperfect development of the **Nitabuch’s layer**. **Why Option B is correct:** The presence of **large, irregular intraplacental lacunae** (often described as a "moth-eaten" appearance) is the most predictive sonographic sign of placenta accreta. These lacunae represent areas of high-velocity blood flow within the placental substance, resulting from the abnormal invasion of chorionic villi into the myometrium and its vasculature. **Why other options are incorrect:** * **Option A (Ring of fire appearance):** This is a classic Doppler finding in **Ectopic Pregnancy** (representing hypervascularity around the gestational sac) or a Corpus Luteum cyst. * **Option C (Thickening of retroplacental myometrium with clots):** This describes **Abruptio Placentae**. In Placenta accreta, the retroplacental myometrial zone is typically **thinned or absent** (<1 mm), rather than thickened. **High-Yield Clinical Pearls for NEET-PG:** * **Most important risk factor:** Previous Cesarean section + Placenta previa. * **Other USG findings:** Loss of the "retroplacental hypoechoic zone," bladder wall interruption, and "bridging vessels" on color Doppler. * **Gold Standard Diagnosis:** Histopathology (post-hysterectomy). * **Management:** Planned Cesarean hysterectomy is the standard of care to prevent life-threatening postpartum hemorrhage.

Q: A 20-year-old married woman with a history of congenital heart disease presents for pre-conceptional counseling. Which of the following is the most likely adverse event she might face during pregnancy?

Arrhythmia. **Explanation:** In women with congenital heart disease (CHD), **arrhythmias** are the most common cardiovascular complication encountered during pregnancy. This is primarily due to the physiological changes of pregnancy—such as increased plasma volume, elevated heart rate, and increased sympathetic activity—which act as triggers for underlying arrhythmogenic substrates (e.g., surgical scars from previous repairs or dilated cardiac chambers). Atrial arrhythmias, particularly supraventricular tachycardia (SVT), are the most frequent manifestations. **Analysis of Options:** * **A. Heart Failure:** While a significant cause of morbidity and the leading cause of maternal death in cardiac patients, it occurs less frequently than arrhythmias in the overall population of women with CHD. * **B. Thromboembolism:** Pregnancy is a hypercoagulable state, and the risk is elevated in patients with cyanotic heart disease or mechanical valves; however, it is not the *most likely* event compared to rhythm disturbances. * **C. Hemorrhage:** While obstetric hemorrhage is a general risk, it is not a specific "cardiac" adverse event directly resulting from the pathophysiology of CHD. * **D. Arrhythmia (Correct):** Multiple prospective studies (like CARPREG and ZAHARA) have consistently identified arrhythmias as the most prevalent complication in pregnant women with CHD. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cardiac complication in pregnancy:** Arrhythmia. * **Most common cause of maternal death in heart disease:** Heart Failure (specifically in the peripartum period). * **Highest risk period:** The immediate postpartum period (first 24–48 hours) due to the sudden "autotransfusion" of blood from the involuting uterus and relief of IVC compression. * **CARPREG Risk Score:** Key predictors of adverse events include prior cardiac events (TIA/stroke/arrhythmia), NYHA Class >II, left-sided obstruction, and ejection fraction <40%.

Q: A primigravida in the 2nd trimester tested positive for toxoplasmosis. Vertical transmission of toxoplasmosis MOST commonly occurs in which trimester?

3rd trimester. The risk of vertical transmission in congenital toxoplasmosis follows a specific inverse relationship between the **rate of transmission** and the **severity of fetal damage**. ### Why the 3rd Trimester is Correct The risk of vertical transmission **increases as gestational age progresses**. It is highest in the **3rd trimester (60–80%)** due to increased placental blood flow and a thinner placental barrier, which facilitates the passage of *Toxoplasma gondii* tachyzoites from the mother to the fetus. ### Why Other Options are Incorrect * **1st Trimester:** While the risk of transmission is lowest here (approx. 10–15%), the **severity** of fetal involvement is highest, often leading to miscarriage or severe neurological damage. * **2nd Trimester:** The transmission rate is intermediate (approx. 25–30%). * **During Delivery:** Unlike HIV or Herpes, Toxoplasmosis is primarily a transplacental infection occurring *in utero*, not typically an intrapartum event. ### High-Yield Clinical Pearls for NEET-PG * **The Classic Triad (Sabin’s Triad):** Chorioretinitis (most common), Hydrocephalus, and Intracranial calcifications (diffuse). * **Diagnosis:** Maternal screening is done via IgM/IgG. Fetal diagnosis is best confirmed via **PCR of Amniotic Fluid** (Gold Standard). * **Treatment:** * If maternal infection is suspected but fetal infection is not confirmed: **Spiramycin** (prevents transmission). * If fetal infection is confirmed: **Pyrimethamine, Sulfadiazine, and Folinic acid**. * **Key Rule:** Transmission risk is **highest** in the 3rd trimester; Severity is **highest** in the 1st trimester.

Q: A 28-year-old woman, gravida 4 para 3 living 2 abortion 1, at 35 weeks of gestation with a monochorionic monoamniotic twin pregnancy was admitted for safe confinement. Three days following admission, the Non-stress test (NST) showed the following finding: What is the finding shown in the NST?

Variable deceleration. ***Variable deceleration*** - **Variable decelerations** are the hallmark finding in **monochorionic monoamniotic (MoMo)** twin pregnancies due to high risk of **cord entanglement** between the twins sharing the same amniotic sac. - These decelerations have **variable timing, duration, and depth** in relation to uterine contractions, caused by **intermittent cord compression** from entangled umbilical cords. *Reactive NST* - A **reactive NST** shows **two or more fetal heart rate accelerations** of at least 15 bpm lasting 15 seconds within a 20-minute period. - This finding indicates **fetal well-being** and adequate **oxygenation**, which would not be expected with cord entanglement in MoMo twins. *Early deceleration* - **Early decelerations** are **gradual decreases** in fetal heart rate that **mirror uterine contractions**, starting and ending with the contraction. - They result from **fetal head compression** during contractions and are considered **physiologic**, not pathologic like cord entanglement. *Sinusoidal pattern* - **Sinusoidal pattern** shows a **smooth, sine wave-like** undulating baseline with **regular oscillations** of 5-15 bpm. - This pattern is associated with **severe fetal anemia**, **Rh isoimmunization**, or **fetal-maternal hemorrhage**, not cord compression.

Q: Which of the following is NOT associated with hydramnios?

Renal agenesis. **Explanation:** The correct answer is **Renal agenesis**. To understand this, one must recall the physiology of amniotic fluid: from the second trimester onwards, fetal urine is the primary contributor to amniotic fluid volume. 1. **Why Renal Agenesis is the correct answer:** In renal agenesis (Potter’s Syndrome), the fetal kidneys fail to develop. Consequently, there is no urine production, leading to **Oligohydramnios** (decreased fluid), not hydramnios. This lack of fluid often results in pulmonary hypoplasia and limb deformities due to compression. 2. **Analysis of Incorrect Options:** * **Premature labor:** Hydramnios causes overdistension of the uterus. This stretches the myometrium, leading to increased uterine irritability and the premature onset of contractions. * **Gestational diabetes:** Maternal hyperglycemia leads to fetal hyperglycemia, which causes **osmotic diuresis** in the fetus (increased fetal polyuria), resulting in hydramnios. * **Increased amniotic fluid:** This is the literal definition of hydramnios (Amniotic Fluid Index >24 cm or Single Deepest Pocket >8 cm). **High-Yield Clinical Pearls for NEET-PG:** * **Common Causes of Polyhydramnios:** Fetal structural anomalies that interfere with swallowing (e.g., Esophageal/Duodenal atresia, Anencephaly), Maternal Diabetes, and Rh-isoimmunization. * **Common Causes of Oligohydramnios:** Renal agenesis, Posterior Urethral Valves (in males), Premature Rupture of Membranes (PROM), and Placental Insufficiency. * **Amniotic Fluid Index (AFI):** Normal range is 5–24 cm. 24 cm is Polyhydramnios.

Question 1

Which of the following describes sonological findings of Placenta accreta?

Accepted Answer

Large intraplacental lacunae

Answer

Ring of fire appearance

Answer

Thickening of retroplacental myometrium with retroplacental clots

Answer

None of the above

Question 2

A 20-year-old married woman with a history of congenital heart disease presents for pre-conceptional counseling. Which of the following is the most likely adverse event she might face during pregnancy?

Accepted Answer

Arrhythmia

Answer

Heart Failure

Answer

Thromboembolism

Answer

Hemorrhage

Question 3

A patient at 17 weeks gestation is diagnosed with intrauterine fetal demise on ultrasound. She presents 5 weeks after the scan without expelling the fetus, reporting occasional spotting. What is the primary risk for this patient?

Accepted Answer

Consumptive coagulopathy with hypofibrinogenemia

Answer

Septic abortion

Answer

Recurrent abortions in the future

Answer

Rupture uterus

Question 4

Which of the following is recommended for a woman with antiphospholipid antibodies and a history of prior abortions or stillbirth?

Accepted Answer

Aspirin plus low molecular weight heparin

Answer

Aspirin only

Answer

Aspirin plus low molecular weight heparin plus prednisolone

Answer

No treatment

Question 5

A primigravida in the 2nd trimester tested positive for toxoplasmosis. Vertical transmission of toxoplasmosis MOST commonly occurs in which trimester?

Accepted Answer

3rd trimester

Answer

1st trimester

Answer

2nd trimester

Answer

During delivery

Question 6

Which of the following statements regarding listeriosis in pregnancy is FALSE?

Accepted Answer

The primary mode of transmission of Listeria monocytogenes is not sexual.

Answer

Listeriosis in pregnancy is associated with meningoencephalitis of the newborn.

Answer

Listeriosis may present with a skin rash.

Answer

In cases of listeriosis during pregnancy, amniotic fluid may be meconium stained.

Question 7

In which of the following clinical scenarios is Anti-D prophylaxis not recommended?

Accepted Answer

Spontaneous miscarriage at 14 weeks in a sensitized RhD-negative woman

Answer

Therapeutic termination of pregnancy by medical method in a 10-week non-sensitized RhD-negative woman

Answer

Medically managed ectopic pregnancy at 8 weeks in a non-sensitized RhD-negative woman

Answer

Threatened miscarriage in a 13-week non-sensitized RhD-negative woman

Question 8

What is the most common congenital heart disease during pregnancy?

Accepted Answer

Atrial Septal Defect (ASD)

Answer

Ventricular Septal Defect (VSD)

Answer

Tetralogy of Fallot (TOF)

Answer

Aortic Stenosis (AS)

Question 9

A 28-year-old woman, gravida 4 para 3 living 2 abortion 1, at 35 weeks of gestation with a monochorionic monoamniotic twin pregnancy was admitted for safe confinement. Three days following admission, the Non-stress test (NST) showed the following finding: What is the finding shown in the NST?

Accepted Answer

Variable deceleration

Answer

Reactive NST

Answer

Early deceleration

Answer

Sinusoidal pattern

Question 10

Which of the following is NOT associated with hydramnios?

Accepted Answer

Renal agenesis

Answer

Premature labor

Answer

Gestational diabetes

Answer

Increased amniotic fluid

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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