Maternal-Fetal Medicine Practice Questions

Q: Which of the following statements concerning placenta previa is true?

The initial hemorrhage is usually painless and rarely fatal. **Explanation:** Placenta previa occurs when the placenta implants in the lower uterine segment, partially or completely covering the internal os. **Why Option B is correct:** The hallmark of placenta previa is **painless, bright red vaginal bleeding**. This occurs because, as the lower uterine segment stretches and thins in the third trimester, the placental attachments are disrupted. The initial bleed (sentinel bleed) is typically self-limiting and **rarely fatal** to the mother, as it is not usually associated with the massive coagulopathy or concealed hemorrhage seen in placental abruption. **Why the other options are incorrect:** * **Option A:** While maternal age is a risk factor, the **strongest risk factor** is a history of previous Cesarean sections or uterine surgeries (e.g., myomectomy). * **Option C:** The "double setup" (preparing for a vaginal delivery in an OR ready for immediate CS) is largely **obsolete**. Modern management relies on ultrasound for diagnosis. If placenta previa is confirmed, a scheduled Cesarean section is the standard of care. * **Option D:** Digital vaginal examination is **strictly contraindicated** (the "No PV" rule) until placenta previa is ruled out by ultrasound. A finger passed through the cervix can cause catastrophic, life-threatening hemorrhage by piercing the placental substance. **NEET-PG High-Yield Pearls:** * **Best Initial Investigation:** Transabdominal Ultrasound (95% accuracy). * **Gold Standard Investigation:** Transvaginal Ultrasound (TVS) – it is safe and more accurate for measuring the distance from the internal os. * **Maclean-Johnson Protocol:** Expectant management (bed rest, steroids, observation) used for preterm patients (<37 weeks) who are hemodynamically stable. * **Stallworthy’s Sign:** A dip in the fetal heart rate when the head is pushed into the pelvis, suggestive of posterior placenta previa.

Q: The classic triad of ruptured ectopic pregnancy includes all EXCEPT?

Fainting. The classic clinical triad of ectopic pregnancy is a high-yield concept for NEET-PG. Understanding the difference between the "classic triad" and "symptoms of rupture" is key to answering this question correctly. ### **Explanation** The **classic triad** of ectopic pregnancy consists of: 1. **Abdominal pain:** The most common symptom (95–100%), usually localized to the iliac fossa. 2. **Amenorrhea:** A history of a missed period (75–90%), typically 6–8 weeks prior. 3. **Vaginal bleeding:** Usually slight, dark brown "spotting" (70%), occurring after the onset of pain. **Fainting (Option A)** is the correct answer because it is **not** part of the classic triad. While fainting or syncope occurs in ruptured ectopic pregnancy due to intraperitoneal hemorrhage and hypovolemic shock, it is considered a **sign of rupture/complication** rather than a component of the primary diagnostic triad. ### **Analysis of Incorrect Options** * **Abdominal Pain (Option B):** The primary presenting symptom caused by tubal distension or peritoneal irritation. * **History of Amenorrhea (Option C):** Essential for the suspicion of any pregnancy-related pathology. * **Vaginal Bleeding (Option D):** Caused by the shedding of the decidua due to falling progesterone levels; it is a core component of the triad. ### **Clinical Pearls for NEET-PG** * **Gold Standard Investigation:** Transvaginal Ultrasound (TVS) + Serum β-hCG. * **Discriminatory Zone:** The β-hCG level (usually 1500–2000 mIU/mL) at which a gestational sac should be visible on TVS. * **Arias-Stella Reaction:** Hypersecretory endometrium seen on curettage, characteristic of (but not pathognomonic for) ectopic pregnancy. * **Most Common Site:** Ampulla of the Fallopian tube. * **Most Common Site of Rupture:** Isthmus (occurs early, around 6–8 weeks).

Q: What is the management of choice for placenta previa at 32 weeks gestation?

Conservative treatment. **Explanation:** The primary goal in managing placenta previa before term (less than 37 weeks) is to prolong the pregnancy to allow for fetal lung maturity, provided there is no active, life-threatening hemorrhage. This approach is known as **MacAfee’s Conservative Management**. **Why Conservative Treatment is Correct:** At 32 weeks, the fetus is preterm. If the maternal and fetal conditions are stable (bleeding is not profuse), the patient is managed with bed rest, corticosteroids (for lung maturity), and close monitoring. This reduces the risks associated with prematurity while keeping the patient in a facility equipped for an emergency Cesarean section if bleeding recurs. **Why Other Options are Incorrect:** * **Oxytocin & Ergometrine:** These are uterotonic agents. Oxytocin is used for induction of labor or postpartum hemorrhage (PPH) management, and Ergometrine is strictly for PPH. Using them in placenta previa before delivery is contraindicated as they cause uterine contractions, which can lead to massive placental separation and fatal hemorrhage. * **Per Vaginal (PV) Examination:** This is **strictly contraindicated** in suspected placenta previa. A digital exam can dislodge a clot or tear the placenta, leading to torrential, life-threatening bleeding. PV exams should only be performed in a "Double Setup" (in an OT ready for immediate surgery). **High-Yield Clinical Pearls for NEET-PG:** * **MacAfee’s Criteria:** Pregnancy <37 weeks, bleeding is not active/profuse, and the mother/fetus are stable. * **Investigation of Choice:** Transvaginal Ultrasound (TVS) is the gold standard (safe and more accurate than transabdominal). * **Delivery Timing:** In stable cases of placenta previa, elective delivery is usually planned at **36–37 weeks**. * **Stallworthy’s Sign:** A drop in fetal heart rate when the head is pressed into the pelvis (seen in posterior placenta previa).

Q: Karyotyping of the fetus can be done through all of the following invasive methods except?

Fetal skin biopsy. **Explanation:** The core objective of prenatal karyotyping is to obtain viable fetal cells that can be cultured to visualize chromosomes. While several invasive procedures yield these cells, the choice of method depends on the gestational age and the specific diagnostic requirement. **Why Fetal Skin Biopsy is the Correct Answer:** Fetal skin biopsy is a highly specialized, invasive procedure used primarily for diagnosing **severe genodermatoses** (e.g., Epidermolysis bullosa or Ichthyosis) when DNA-based testing is unavailable. While skin cells contain the fetal genome, it is **not** a standard or routine method for karyotyping because it carries a significantly higher risk of fetal injury and pregnancy loss compared to other methods. It is considered a "last resort" for structural skin defects, not chromosomal analysis. **Analysis of Other Options:** * **Chorionic Villus Sampling (CVS):** Performed at **10–13 weeks**. It involves sampling trophoblastic tissue. It is the earliest invasive method for karyotyping. * **Amniocentesis:** The "gold standard" for prenatal diagnosis, typically performed at **15–20 weeks**. It collects fetal thyrocytes, skin cells, and gastrointestinal cells shed into the amniotic fluid. * **Cordocentesis (Percutaneous Umbilical Blood Sampling):** Performed after **18 weeks**. It provides rapid karyotyping (within 48–72 hours) by culturing fetal lymphocytes. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Karyotyping:** CVS (10 weeks). * **Most Common Method:** Amniocentesis. * **Rapid Karyotyping:** Cordocentesis (useful for late presenters or mosaicism confirmation). * **Risk of Procedure-Related Loss:** CVS (~0.5–1%) > Amniocentesis (~0.1–0.5%). * **Pre-procedure Requirement:** Always check maternal Rh status; administer Anti-D immunoglobulin if the mother is Rh-negative.

Question 1

Which of the following statements concerning placenta previa is true?

Accepted Answer

The initial hemorrhage is usually painless and rarely fatal

Answer

Its incidence increases with maternal age

Answer

Management still includes a double setup

Answer

Vaginal examination should be done immediately on suspicion of placenta previa

Question 2

Which of the following is a non-invasive test used to diagnose fetal Rh genotype in Rh D alloimmunization?

Accepted Answer

Cell-free fetal DNA analysis

Answer

Chorionic villus sampling

Answer

Amniocentesis

Answer

Middle cerebral artery peak systolic velocity

Question 3

Which of the following statements is true?

Accepted Answer

Phosphatidyl glycerol in amniotic fluid is 100% confirmatory of lung maturity.

Answer

Glyburide is absolutely contraindicated for GDM.

Answer

Patients with GDM/DM should be delivered between 34 and 36 weeks of gestation due to the risk of sudden IUFD at full term.

Answer

PTH crosses the placenta.

Question 4

What is the treatment for acute hydramnios with respiratory depression?

Accepted Answer

Amniocentesis

Answer

Termination of pregnancy

Answer

Diuretics

Answer

Sedation

Question 5

USG abdomen of a 30-year-old SLE patient who cannot feel her baby moving for the past 7 days. What is the earliest appearance of Spalding sign?

Accepted Answer

7 days

Answer

3 days

Answer

4 days

Answer

6 days

Question 6

The classic triad of ruptured ectopic pregnancy includes all EXCEPT?

Accepted Answer

Fainting

Answer

Abdominal pain

Answer

History of amenorrhea

Answer

Vaginal bleeding

Question 7

What is the management of choice for placenta previa at 32 weeks gestation?

Accepted Answer

Conservative treatment

Answer

Oxytocin infusion

Answer

Ergometrine intravenous

Answer

Per vaginal examination and artificial rupture of membranes (ARM)

Question 8

A young lady with 6 weeks amenorrhea presents with nausea, vomiting, and severe abdominal pain. Her BP is 100/80 mm Hg. Examination reveals a 5 x 5 cm adnexal mass. What is the plan of management?

Accepted Answer

Plan for immediate laparoscopic surgery

Answer

beta-hCG

Answer

Methotrexate

Answer

Give IV fluids, keep NPO and observe for 4-5 days

Question 9

Karyotyping of the fetus can be done through all of the following invasive methods except?

Accepted Answer

Fetal skin biopsy

Answer

Chorionic villus sampling

Answer

Cordocentesis

Answer

Amniocentesis

Question 10

Antiphospholipid antibody detection is indicated in all of the following conditions except:

Accepted Answer

Gestational Diabetes

Answer

Three or more consecutive first trimester pregnancy losses

Answer

Unexplained cerebrovascular accidents

Answer

Early onset severe pre-eclampsia

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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