Maternal-Fetal Medicine Practice Questions

Q: Which of the following conditions can lead to blood loss of fetal origin?

Vasa previa. **Explanation:** In obstetric hemorrhage, it is crucial to distinguish between maternal and fetal sources of bleeding. **Why Vasa Previa is correct:** In **Vasa previa**, fetal vessels (unprotected by Wharton’s jelly or placental tissue) run across the internal os, usually due to a velamentous cord insertion or a succenturiate lobe. When the membranes rupture (ROM), these vessels are easily lacerated. Since the blood contained within these vessels belongs to the fetus, the resulting hemorrhage is of **fetal origin**. Because the total fetal blood volume is small (~80-100 mL/kg), even a minor bleed can rapidly lead to fetal exsanguination, distress, and demise, while the mother remains hemodynamically stable. **Why other options are incorrect:** * **Placenta Previa:** The bleeding occurs from the premature separation of the placenta from the lower uterine segment. This blood is primarily **maternal** in origin (from the uterine sinuses). * **Abruptio Placenta:** This involves the premature separation of a normally situated placenta. The hemorrhage occurs into the decidua basalis and is **maternal** blood. * **Circumvallate Placenta:** This is a morphological variation where the chorionic plate is smaller than the basal plate. While it increases the risk of abruption or preterm labor, any associated bleeding is **maternal**. **High-Yield Clinical Pearls for NEET-PG:** * **Apt Test / Ogita Test / Loendersloot Test:** These tests are used to differentiate fetal hemoglobin (HbF) from maternal hemoglobin (HbA) based on alkali resistance. * **Classic Triad of Vasa Previa:** (1) Rupture of membranes, (2) Painless vaginal bleeding, and (3) Fetal bradycardia/distress. * **Diagnosis:** Best diagnosed via **Color Doppler Ultrasound** showing vessels crossing the internal os.

Q: Which of the following is highly effective in preventing convulsions in a woman with severe preeclampsia?

Magnesium sulfate. **Explanation:** **Magnesium Sulfate (MgSO₄)** is the drug of choice for both the prevention of seizures in severe preeclampsia (prophylaxis) and the control of seizures in eclampsia. Its efficacy was definitively established by the **MAGPIE trial**, which demonstrated that MgSO₄ reduces the risk of eclampsia by more than 50% compared to placebo. **Mechanism of Action:** It acts primarily as a **NMDA receptor antagonist** in the brain, raising the seizure threshold. It also causes cerebral vasodilation, reducing ischemia, and acts as a calcium channel blocker at the neuromuscular junction, which provides a mild sedative effect on the central nervous system. **Why other options are incorrect:** * **Phenytoin (A):** While an effective anti-epileptic, clinical trials (e.g., Lucas et al.) showed it is significantly less effective than MgSO₄ in preventing eclamptic seizures and carries a higher risk of toxicity. * **Diazepam (C):** Benzodiazepines are associated with a higher rate of recurrent seizures and increased maternal/neonatal respiratory depression compared to MgSO₄. * **Levetiracetam (D):** Although used in general epilepsy, there is insufficient evidence to support its use as a first-line agent in preeclampsia/eclampsia over MgSO₄. **High-Yield Clinical Pearls for NEET-PG:** * **Regimen:** The **Pritchard Regimen** (IM) and **Zuspan Regimen** (IV) are the standard protocols. * **Monitoring:** Always monitor the **Patellar reflex** (first sign of toxicity to disappear), **Respiratory rate** (>12/min), and **Urine output** (>30ml/hr or 100ml/4hr) as MgSO₄ is excreted renally. * **Antidote:** **10% Calcium Gluconate** (10ml IV over 10 minutes) must be kept at the bedside. * **Therapeutic Range:** 4–7 mEq/L. Loss of patellar reflex occurs at 8–10 mEq/L; respiratory paralysis at >12 mEq/L.

Q: All the following are advised in an epileptic woman preconceptionally except?

Supplement folic acid with a dose of 1mg/day.. **Explanation:** The management of epilepsy in pregnancy focuses on balancing seizure control with minimizing teratogenic risks. **Why Option B is the correct answer (The "Except"):** Women taking Anti-Epileptic Drugs (AEDs) are at a significantly higher risk of having a child with Neural Tube Defects (NTDs) because many AEDs (especially Valproate and Carbamazepine) interfere with folate metabolism. To counteract this, the recommended preconception dose of **Folic Acid is 4–5 mg/day**, starting at least one month before conception and continuing through the first trimester. The standard dose of 0.4 mg or 1 mg is insufficient for this high-risk group. **Analysis of Incorrect Options:** * **Option A:** Monotherapy is the gold standard. Polytherapy significantly increases the risk of congenital malformations compared to a single agent. * **Option C:** If a patient has been seizure-free for **>2 years**, a supervised trial of tapering and withdrawing medication may be attempted before pregnancy to eliminate fetal drug exposure. * **Option D:** Teratogenicity is dose-dependent and drug-specific. For example, Valproate carries the highest risk (up to 10%), while Levetiracetam and Lamotrigine are considered safer alternatives. **NEET-PG High-Yield Pearls:** * **Drug of Choice:** Lamotrigine or Levetiracetam are preferred in pregnancy. * **Avoid:** Valproate (highest risk of NTDs and cognitive impairment). * **Vitamin K:** If the mother is on enzyme-inducing AEDs (e.g., Phenytoin, Phenobarbital), 10 mg of Vitamin K is given to the mother in the last month of pregnancy, and 1 mg is given to the neonate at birth to prevent Hemorrhagic Disease of the Newborn. * **Breastfeeding:** Generally encouraged as the benefits outweigh the risks of drug excretion in milk.

Q: Which of the following drugs are used for the medical treatment of ectopic pregnancy?

Mifepristone (RU-486). **Explanation:** The medical management of ectopic pregnancy aims to terminate the pregnancy while preserving the fallopian tube. **Why Mifepristone (RU-486) is the correct answer:** Mifepristone is a **progesterone receptor antagonist**. Since progesterone is essential for maintaining the decidua and the viability of the pregnancy, blocking its receptors leads to decidual breakdown and detachment of the trophoblast. In clinical practice, Mifepristone is often used as an **adjunct to Methotrexate** to increase the success rate of medical management, particularly in cases with higher baseline β-hCG levels. **Analysis of Incorrect Options:** * **A. Methotrexate (MTX):** While MTX is the **first-line** and most common drug used for ectopic pregnancy (a folic acid antagonist that inhibits DNA synthesis in rapidly dividing trophoblastic cells), the question asks which drug *is used*, and in many standardized formats, Mifepristone is highlighted for its specific role in combined regimens. *Note: If this were a single-choice question where both MTX and Mifepristone were options, MTX is typically the primary answer unless "combination therapy" is specified.* * **B. Actinomycin-D:** This is a chemotherapy agent used primarily for Gestational Trophoblastic Neoplasia (GTN) or Wilms tumor, not for routine ectopic pregnancy. * **C. Human Chorionic Gonadotropin (HCG):** HCG is used to *induce* ovulation or support the corpus luteum; it would worsen or maintain an ectopic pregnancy, not treat it. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Candidate for Medical Management:** Hemodynamically stable, adnexal mass 15% decline** in β-hCG levels between Day 4 and Day 7 after administration.

Q: All are complications of hyperemesis gravidarum, EXCEPT?

Hiatus hernia. **Explanation:** Hyperemesis Gravidarum (HG) is a severe form of nausea and vomiting in pregnancy characterized by dehydration, electrolyte imbalance, and weight loss. **Why Hiatus Hernia is the Correct Answer:** A **Hiatus Hernia** is a structural anatomical defect where the stomach protrudes through the esophageal hiatus of the diaphragm. While HG involves forceful vomiting that increases intra-abdominal pressure, it does not *cause* a hiatus hernia. Conversely, a pre-existing hiatus hernia may actually be a predisposing factor or a differential diagnosis for severe vomiting, but it is not a complication resulting from HG. **Analysis of Incorrect Options (Complications of HG):** * **Mallory-Weiss Tears:** Forceful, repeated vomiting causes longitudinal mucosal lacerations at the gastroesophageal junction, leading to hematemesis. * **Wernicke’s Encephalopathy:** This is a critical complication caused by **Thiamine (Vitamin B1) deficiency** due to prolonged vomiting. It presents with the classic triad of ataxia, ophthalmoplegia, and confusion. * **Renal Failure:** Severe dehydration and hypovolemia lead to decreased renal perfusion, resulting in **Prerenal Azotemia** and potentially acute kidney injury. **High-Yield Clinical Pearls for NEET-PG:** * **Electrolyte Imbalance:** The most common pattern is **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Korsakoff Psychosis:** If Wernicke’s is left untreated, it can progress to irreversible memory loss and confabulation. * **Management Tip:** Always supplement **Thiamine before administering Dextrose** fluids in HG patients to prevent precipitating Wernicke’s encephalopathy. * **Other Complications:** Central Pontine Myelinolysis (due to rapid sodium correction), Boerhaave syndrome (esophageal rupture), and Vitamin K deficiency (coagulopathy).

Q: What is the earliest sign of pregnancy-induced hypertension?

High blood pressure. **Explanation:** The diagnosis of Pregnancy-Induced Hypertension (PIH) or Preeclampsia is clinically defined by the new onset of hypertension (BP ≥140/90 mmHg) after 20 weeks of gestation. **High blood pressure** is considered the earliest and most reliable sign because it is the primary diagnostic criterion. While physiological changes occur earlier at the molecular level (vasospasm and endothelial dysfunction), hypertension is the first clinical manifestation that alerts a clinician to the condition. **Analysis of Incorrect Options:** * **Rapid gain in weight:** While often the first *warning sign* (due to occult edema/fluid retention), it is non-specific. Many healthy pregnancies involve weight gain, and it is no longer a formal diagnostic criterion for PIH. * **Edema:** Pathological edema (swelling of the face, hands, or abdominal wall) was previously part of the diagnostic triad but has been removed because it occurs in up to 80% of normal pregnancies. It is a common symptom but not the earliest diagnostic sign. * **Albuminuria (Proteinuria):** This is usually a later manifestation indicating glomerular damage (endotheliosis). In modern guidelines, preeclampsia can be diagnosed even in the absence of proteinuria if other signs of end-organ damage are present. **NEET-PG High-Yield Pearls:** * **Definition:** BP ≥140/90 mmHg on two occasions, at least 4 hours apart, after 20 weeks in a previously normotensive woman. * **Roll-over Test:** Used as a predictive test for PIH between 28–32 weeks; a rise in diastolic BP >20 mmHg when turning from lateral to supine is positive. * **Drug of Choice:** Labetalol is the first-line antihypertensive; Magnesium Sulfate ($MgSO_4$) is the drug of choice for seizure prophylaxis (Eclampsia).

Q: All of the following are true about anencephaly except?

Enlarged adrenal gland. ### Explanation **Anencephaly** is a lethal neural tube defect characterized by the absence of the cranial vault and cerebral hemispheres. **Why Option C is the Correct Answer (The "Except"):** In anencephaly, there is a failure of development of the hypothalamus and the pituitary gland. This leads to a lack of **Adrenocorticotropic Hormone (ACTH)** secretion. Since the fetal adrenal cortex (specifically the fetal zone) depends on ACTH for growth, the **adrenal glands are characteristically hypoplastic (atrophied)**, not enlarged. **Analysis of Other Options:** * **A. Face Presentation:** Due to the absence of the bony vault (calvarium), the head cannot engage normally. The face becomes the leading part, making face presentation a common clinical finding. * **B. Increased Alpha-Fetoprotein (AFP):** Anencephaly is an "open" neural tube defect. This allows AFP to leak from the fetal circulation into the amniotic fluid and subsequently into the maternal serum. Maternal Serum AFP (MSAFP) is a key screening tool. * **D. Polyhydramnios:** This occurs due to two reasons: 1) The fetus lacks the swallowing reflex due to neurological deficit, and 2) Transudation of fluid from the exposed meninges/choroid plexus. **High-Yield Clinical Pearls for NEET-PG:** * **Frog-like Appearance:** The characteristic facies due to prominent, bulging eyes. * **Shoulder Dystocia:** Common due to the large size of the trunk relative to the absent head. * **Post-term Pregnancy:** Often occurs because the lack of the fetal pituitary-adrenal axis delays the hormonal triggers for labor. * **Prevention:** 400 mcg of Folic acid daily (pre-conceptionally); 4 mg daily if there is a previous history of NTD. * **Diagnosis:** Best made via Ultrasound (10–14 weeks); "Mickey Mouse sign" in early scans.

Question 1

Which of the following conditions can lead to blood loss of fetal origin?

Accepted Answer

Vasa previa

Answer

Placenta previa

Answer

Abruptio placenta

Answer

Circumvallate placenta

Question 2

A 23-year-old G1P0 woman at 10 weeks' gestation presents for her initial evaluation. She reports several hospitalizations for asthma exacerbations, but has never required intubation or ICU admission. She is controlled on daily inhaled corticosteroids and albuterol with adequate symptom relief. She is concerned about taking these medications during pregnancy. Which of the following is true regarding asthma medications in pregnancy?

Accepted Answer

Both beta-2 agonists and inhaled corticosteroids are safe in pregnancy.

Answer

Beta-2 agonists are contraindicated during pregnancy.

Answer

Both beta-2 agonists and inhaled corticosteroids are contraindicated in pregnancy.

Answer

Beta-2 agonists and inhaled corticosteroids are both safe in pregnancy but only during the second and third trimesters.

Question 3

Which of the following is highly effective in preventing convulsions in a woman with severe preeclampsia?

Accepted Answer

Magnesium sulfate

Answer

Phenytoin

Answer

Diazepam

Answer

Levetiracetam

Question 4

Regarding appendicitis in pregnancy, which of the following statements is false?

Accepted Answer

Conservative management with antibiotics should be attempted.

Answer

It is the most common cause of acute abdomen in the first trimester.

Answer

Pregnancy does not increase the risk of appendicitis.

Answer

After rupture, fetal mortality is around 30-40%.

Question 5

All the following are advised in an epileptic woman preconceptionally except?

Accepted Answer

Supplement folic acid with a dose of 1mg/day.

Answer

Attempt to achieve seizure control with monotherapy.

Answer

Medication withdrawal is considered if a woman is seizure-free for 2 years or more.

Answer

Risk of congenital abnormalities in the fetus is dependent on the type, number, and dose of antiepileptic drugs.

Question 6

Fetal cells can be detected in maternal blood using which test?

Accepted Answer

Kleihauer-Betke test

Answer

DCT

Answer

LET

Answer

Bubble test

Question 7

Which of the following drugs are used for the medical treatment of ectopic pregnancy?

Accepted Answer

Mifepristone (RU-486)

Answer

Methotrexate (MTX)

Answer

Actinomycin-D

Answer

Human Chorionic Gonadotropin (HCG)

Question 8

All are complications of hyperemesis gravidarum, EXCEPT?

Accepted Answer

Hiatus hernia

Answer

Mallory-Weiss tears

Answer

Wernicke's encephalopathy

Answer

Renal failure

Question 9

What is the earliest sign of pregnancy-induced hypertension?

Accepted Answer

High blood pressure

Answer

Rapid gain in weight

Answer

Albuminuria

Answer

Edema

Question 10

All of the following are true about anencephaly except?

Accepted Answer

Enlarged adrenal gland

Answer

Facial presentation

Answer

Increased alpha-fetoprotein

Answer

Polyhydramnios

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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