Maternal-Fetal Medicine Practice Questions

Q: Clinical signs of hydramnios can be demonstrated when amniotic fluid collection is more than:

2 liters. **Explanation:** **1. Understanding the Correct Answer (B):** Hydramnios (Polyhydramnios) is defined pathologically as an amniotic fluid volume exceeding **2,000 ml (2 liters)**. While the normal volume at term is approximately 600–800 ml, clinical signs such as an overdistended abdomen, "fluid thrill," and difficulty palpating fetal parts typically manifest only when the volume crosses the **2-liter threshold**. In clinical practice, this is often diagnosed via ultrasound using an Amniotic Fluid Index (AFI) ≥ 25 cm or a Single Deepest Pocket (SDP) ≥ 8 cm. **2. Analysis of Incorrect Options:** * **A (1 liter):** While 1 liter is above the average volume at term, it is still within the physiological upper limit (up to 1.5 liters can be normal in some pregnancies). It does not meet the diagnostic criteria for polyhydramnios. * **C & D (3 and 4 liters):** These volumes represent severe polyhydramnios. While clinical signs are certainly present at these levels, the question asks for the minimum threshold at which hydramnios can be demonstrated, which is 2 liters. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most Common Cause:** Idiopathic (approx. 50–60%). * **Maternal Cause:** Diabetes Mellitus is the most common maternal association. * **Fetal Causes:** Tracheoesophageal fistula, anencephaly (lack of swallowing/antidiuretic hormone), and fetal hydrops. * **Complications:** Preterm labor (due to uterine overdistension), Cord Prolapse (due to sudden rupture of membranes), and Postpartum Hemorrhage (PPH) due to uterine atony. * **Management:** Therapeutic amniocentesis (amnionreduction) or Indomethacin (decreases fetal urine output, but used with caution due to risk of premature closure of ductus arteriosus).

Q: Which of the following is true regarding accidental hemorrhage?

Uterus is tender. **Explanation:** **Accidental hemorrhage** is the clinical term for **Abruptio Placentae**, which refers to the premature separation of a normally situated placenta. **1. Why the correct answer is right:** In Abruptio Placentae, bleeding occurs between the uterine wall and the placenta. This leads to the formation of a retroplacental clot. The blood often infiltrates the myometrium (Couvelaire uterus), causing irritation and increased intrauterine pressure. This manifests clinically as **uterine tenderness** and a "woody hard" or board-like rigidity of the uterus on palpation. **2. Why the incorrect options are wrong:** * **Option A:** Bleeding in Abruptio Placentae is characteristically **painful**. Painless, causeless, and recurrent bleeding is the hallmark of *Placenta Previa*. * **Option C:** In the "concealed" or "mixed" variety of abruption, the retroplacental clot causes the **uterine size to be greater than the period of gestation**. * **Option D:** While fetal distress is common, fetal heart sounds (FHS) are **not always absent**. They may be present, irregular, or absent depending on the severity of the separation. FHS are typically absent only in severe (Grade 3) abruption. **Clinical Pearls for NEET-PG:** * **Risk Factors:** Pregnancy-induced hypertension (most common), trauma, sudden uterine decompression, and cocaine use. * **Classic Triad:** Painful vaginal bleeding + Uterine tenderness + Increased uterine tone. * **Complications:** DIC (Disseminated Intravascular Coagulation) is more common in abruption than in any other obstetric condition. * **Diagnosis:** Primarily clinical; Ultrasound is unreliable for ruling out abruption as it only detects about 25-50% of cases.

Q: Which of the following complications is NOT caused by malaria in pregnancy?

HELLP syndrome. **Explanation:** Malaria in pregnancy, particularly when caused by *Plasmodium falciparum*, leads to significant maternal and fetal morbidity due to **placental sequestration**. In this process, parasitized erythrocytes express ligands (like VAR2CSA) that bind to chondroitin sulfate A in the placenta. This triggers an inflammatory response, leading to placental insufficiency and vascular damage. **Why HELLP Syndrome is the Correct Answer:** HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe manifestation of the **preeclampsia spectrum**, primarily driven by abnormal trophoblastic invasion and generalized endothelial dysfunction. While malaria can cause hemolysis and thrombocytopenia, it does not etiologically cause the specific multi-organ triad of HELLP syndrome. **Why the other options are incorrect:** * **IUGR (Option B):** Placental sequestration of parasites leads to chronic placental insufficiency and nutrient deprivation, making IUGR one of the most common complications of malaria in pregnancy. * **IUD (Option C):** Severe maternal anemia, high-grade fever (hyperpyrexia), and acute placental damage can lead to fetal hypoxia and subsequent intrauterine death. * **Preterm Delivery (Option D):** The systemic inflammatory cytokine response (TNF-α, IL-1) triggered by malaria can stimulate uterine contractions, leading to spontaneous preterm labor. **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication:** Maternal anemia and Low Birth Weight (LBW). * **Drug of Choice:** According to WHO/National guidelines, **Artesunate-based Combination Therapy (ACT)** is now recommended for uncomplicated malaria in all trimesters. **Quinine** is an alternative in the first trimester if ACT is unavailable. * **Prophylaxis:** Intermittent Preventive Treatment (IPTp) with Sulfadoxine-Pyrimethamine is recommended in endemic areas.

Q: What is the best time for detecting chorionicity in a twin pregnancy on ultrasound?

10-14 weeks. **Explanation:** Determining chorionicity is the most critical step in managing twin pregnancies, as monochorionic twins carry significantly higher risks (e.g., TTTS). The **best time for detecting chorionicity is 10–14 weeks** (late first trimester). **Why 10–14 weeks is the Correct Answer:** During this window, the ultrasound signs are most distinct. The presence of the **'Lambda' (λ) sign** (or twin-peak sign) indicates a dichorionic pregnancy, where the thick chorion projects into the base of the inter-twin membrane. Conversely, the **'T' sign** indicates a monochorionic pregnancy, where a thin amnion meets the placenta without intervening chorionic tissue. After 14 weeks, the chorion frondosum regresses, and the layers of the inter-twin membrane fuse, making these signs difficult to visualize. **Analysis of Incorrect Options:** * **A (8–12 weeks):** While chorionicity can be seen as early as 7–8 weeks by counting the number of gestational sacs, the definitive membrane signs (Lambda vs. T) are best visualized after 10 weeks when the amniotic sac has expanded. * **C & D (14–24 weeks):** Beyond 14 weeks, the "Lambda sign" often disappears (the "vanishing" Lambda sign) as the chorion laeve regresses. Accuracy drops significantly in the second trimester, often requiring less reliable methods like fetal sex or placental location. **High-Yield Clinical Pearls for NEET-PG:** * **Lambda Sign:** Dichorionic Diamniotic (DCDA). * **T Sign:** Monochorionic Diamniotic (MCDA). * **Gold Standard:** Ultrasound in the first trimester is the gold standard for chorionicity. * **Membrane Thickness:** A membrane >2 mm usually suggests DCDA; 13 days: Conjoined twins

Q: A woman treated for infertility presents with 6 weeks of amenorrhea and urinary retention. What is the most likely etiology?

Impacted cervical fibroid. **Explanation:** The clinical presentation of **6 weeks of amenorrhea** (suggestive of early pregnancy) combined with **acute urinary retention** is a classic triad seen when a pelvic mass becomes "impacted" in the pouch of Douglas, displacing the cervix anteriorly. **1. Why "Impacted Cervical Fibroid" is correct:** In a woman being treated for infertility, a pre-existing cervical or low-lying posterior wall fibroid is common. As the uterus enlarges during early pregnancy (around 6–10 weeks), the fibroid can become incarcerated in the hollow of the sacrum. This pushes the cervix upward and forward against the symphysis pubis, stretching the urethra and compressing the bladder neck, leading to acute urinary retention. **2. Analysis of Incorrect Options:** * **Retroverted Uterus:** While an incarcerated gravid retroverted uterus is a classic cause of urinary retention at 12–14 weeks, it is less likely at only 6 weeks, as the uterus is not yet large enough to fill the pelvic cavity and cause impaction. * **Pelvic Hematocoele:** Usually associated with a ruptured ectopic pregnancy. While it causes pelvic pain and shock, it rarely presents with acute urinary retention as the primary symptom. * **Carcinoma Cervix:** While it can cause urinary symptoms through direct invasion (ureteric obstruction), it typically presents with post-coital bleeding or discharge in older women, not acute retention and amenorrhea in an infertility patient. **Clinical Pearls for NEET-PG:** * **The "12-week rule":** Retroverted gravid uterus typically causes retention at **12–14 weeks** when the fundus gets stuck under the sacral promontory. * **Mechanism:** Retention is due to the **elongation of the urethra** and compression of the bladder neck, not direct pressure on the bladder itself. * **Management:** Immediate catheterization followed by manual correction of the uterine position (if retroverted).

Question 1

In a nulliparous woman, what is the treatment of choice for a ruptured ectopic pregnancy?

Accepted Answer

Linear salpingostomy

Answer

Salpingectomy and end-to-end anastomosis

Answer

Salpingo-oophorectomy

Answer

Expectant management (Wait and watch)

Question 2

A 32-week-pregnant woman with a history of two previous mid-trimester abortions presents with regular uterine contractions. The cervix is 2 cm dilated. All the following are done except?

Accepted Answer

Emergency encirclage

Answer

Tocolytics

Answer

Dexamethasone

Answer

Antibiotics

Question 3

Clinical signs of hydramnios can be demonstrated when amniotic fluid collection is more than:

Accepted Answer

2 liters

Answer

1 liter

Answer

3 liters

Answer

4 liters

Question 4

Which of the following is true regarding accidental hemorrhage?

Accepted Answer

Uterus is tender

Answer

Painless bleeding per vagina

Answer

Uterine size is less than period of gestation

Answer

Fetal heart sounds are always absent

Question 5

Which of the following complications is NOT caused by malaria in pregnancy?

Accepted Answer

HELLP syndrome

Answer

Intrauterine growth restriction (IUGR)

Answer

Intrauterine death (IUD)

Answer

Preterm delivery

Question 6

What is the best time for detecting chorionicity in a twin pregnancy on ultrasound?

Accepted Answer

10-14 weeks

Answer

8-12 weeks

Answer

14-18 weeks

Answer

16-24 weeks

Question 7

What is the most common type of heart disease encountered in pregnancy?

Accepted Answer

Mitral Stenosis (MS)

Answer

Atrial Septal Defect (ASD)

Answer

Ventricular Septal Defect (VSD)

Answer

Mitral Regurgitation (MR)

Question 8

A woman treated for infertility presents with 6 weeks of amenorrhea and urinary retention. What is the most likely etiology?

Accepted Answer

Impacted cervical fibroid

Answer

Retroverted uterus

Answer

Pelvic hematocoele

Answer

Carcinoma cervix

Question 9

In the Manning scoring system of biophysical profile for fetal monitoring, which parameter is not included?

Accepted Answer

Oxytocin challenge test

Answer

Fetal tone

Answer

Fetal gross body movements

Answer

Non-stress test

Question 10

Congenital anomalies are most severe in which of the following infections?

Accepted Answer

Rubella infection

Answer

Mumps

Answer

Cytomegalovirus (CMV)

Answer

Toxoplasma

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?