Maternal-Fetal Medicine Practice Questions

Q: A pregnant woman presents at 22 weeks gestation for a routine prenatal visit. Physical examination demonstrates ankle edema and new onset hypertension. Urinalysis reveals marked proteinuria. Development of which of the following would justify a diagnosis of eclampsia?

Seizures. ### Explanation **Correct Answer: C. Seizures** The clinical presentation of new-onset hypertension and marked proteinuria after 20 weeks of gestation defines **Preeclampsia**. The progression from preeclampsia to **Eclampsia** is defined specifically by the occurrence of **generalized tonic-clonic seizures** that cannot be attributed to other neuropsychiatric causes (e.g., epilepsy or brain tumors). In this patient at 22 weeks, the presence of the "classic triad" (hypertension, proteinuria, and edema) points toward preeclampsia. The development of seizures is the pathognomonic feature that justifies the diagnosis of eclampsia. **Why other options are incorrect:** * **A. Diabetes mellitus:** While a risk factor for developing preeclampsia, it is a metabolic disorder and not a diagnostic criterion for eclampsia. * **B. Hyperuricemia:** Elevated serum uric acid is a common finding in preeclampsia due to decreased renal clearance and is often used as a marker of disease severity, but it does not define eclampsia. * **D. Systemic lupus erythematosus (SLE):** SLE can mimic preeclampsia (lupus nephritis) or coexist with it, but it is an autoimmune pathology, not a diagnostic stage of hypertensive disorders of pregnancy. **High-Yield Clinical Pearls for NEET-PG:** * **Definition:** Eclampsia = Preeclampsia + Seizures. * **Drug of Choice (DOC):** **Magnesium Sulfate ($MgSO_4$)** is the DOC for both the prophylaxis and control of eclamptic seizures (Pritchard Regimen). * **Antidote:** Always keep **Calcium Gluconate** (10 ml of 10% solution) ready at the bedside to treat $MgSO_4$ toxicity. * **Timing:** Eclampsia can occur antepartum (50%), intrapartum (25%), or postpartum (25%). * **Management:** The definitive treatment for eclampsia, regardless of gestational age, is the **stabilization of the mother followed by delivery.**

Q: What is the most common tumor of the ovary found in pregnancy?

Dermoid cyst. **Explanation:** The most common ovarian tumor encountered during pregnancy is the **Dermoid cyst (Mature Cystic Teratoma)**. This is a germ cell tumor that typically occurs during the reproductive years, coinciding with the peak age of pregnancy. While most are asymptomatic and discovered incidentally during routine prenatal ultrasound, they carry a risk of complications like **ovarian torsion** (most common in the second trimester) or rupture. **Analysis of Options:** * **Dermoid Cyst (Correct):** It accounts for approximately 25–40% of all ovarian masses identified during pregnancy. They are usually benign and unilateral. * **Epithelial Tumors:** While common in the general population, they are less frequent than dermoids in pregnant women. Serous cystadenomas are the second most common benign tumors after dermoids. * **Dysgerminoma:** This is the most common **malignant** germ cell tumor found in pregnancy, but it is far less common than the benign dermoid cyst. * **Sex Cord Tumors:** These (e.g., Granulosa cell tumors) are rare during pregnancy. **NEET-PG High-Yield Pearls:** * **Most common ovarian mass in pregnancy:** Corpus Luteum Cyst (Functional). * **Most common benign neoplasm in pregnancy:** Dermoid Cyst. * **Most common malignancy in pregnancy:** Dysgerminoma. * **Management:** If an ovarian mass is >5–6 cm or symptomatic, the ideal time for surgical intervention (Laparoscopy/Laparotomy) is the **early second trimester (14–18 weeks)** to minimize miscarriage risk and avoid technical difficulties of a large uterus. * **Complication:** Torsion is the most frequent complication of ovarian cysts during pregnancy.

Q: Which of the following is a risk factor for pre-eclampsia?

Primigravida. **Explanation:** Pre-eclampsia is a multisystem disorder characterized by new-onset hypertension (≥140/90 mmHg) and proteinuria (or end-organ dysfunction) after 20 weeks of gestation. **Why Primigravida is Correct:** Primigravida (nulliparity) is a well-established major risk factor for pre-eclampsia. The underlying pathophysiology involves **defective trophoblastic invasion** of the spiral arteries. In a first pregnancy, the maternal immune system has not been previously exposed to paternal antigens, leading to an altered immune response that contributes to placental ischemia and subsequent endothelial dysfunction. **Analysis of Incorrect Options:** * **Thin build:** Obesity (BMI >30) is a significant risk factor, not a thin build. Adiposity promotes a pro-inflammatory state and insulin resistance, both of which exacerbate endothelial damage. * **Smoking:** Paradoxically, smoking is associated with a **reduced risk** of pre-eclampsia. It is hypothesized that nicotine or carbon monoxide may inhibit the release of anti-angiogenic factors (like sFlt-1), though smoking is still discouraged due to risks of IUGR and abruption. * **Placenta previa:** There is no direct causal link between placenta previa and pre-eclampsia. However, **Placental Abruption** is a known complication of pre-eclampsia. **High-Yield Clinical Pearls for NEET-PG:** * **Highest Risk Factor:** A prior history of pre-eclampsia is the strongest predictor for recurrence. * **Other Risk Factors:** Multiple pregnancy (increased placental mass), Maternal age (>40 or <18), Chronic hypertension, Diabetes Mellitus, and Antiphospholipid Syndrome (APLA). * **Prophylaxis:** Low-dose Aspirin (75–150 mg) started before 16 weeks of gestation is recommended for high-risk women. * **Definitive Treatment:** Delivery of the fetus and placenta.

Q: A 32-year-old G5P1 presents for her first prenatal visit. Classically, cervical incompetence is characterized by delivery in the second trimester preceded by which of the following?

Painless dilatation. ### Explanation **Correct Answer: C. Painless dilatation** **Medical Concept:** Cervical incompetence (now often termed **Cervical Insufficiency**) is defined as the inability of the uterine cervix to retain a pregnancy in the second trimester in the absence of clinical contractions, labor, or both. The hallmark of this condition is the **painless, progressive dilatation and effacement** of the cervix. This occurs because the structural integrity of the cervical tissue is compromised, leading to the "silent" prolapse of fetal membranes into the vagina, followed by premature rupture of membranes (PROM) and expulsion of a premature fetus. **Analysis of Incorrect Options:** * **A. Fever:** Fever is suggestive of **Chorioamnionitis** or systemic infection. While infection can be a consequence of cervical incompetence (due to exposed membranes), it is not the preceding characteristic. * **B. Heavy bleeding:** This is more characteristic of **Abruptio Placentae** or **Placenta Previa**. Cervical incompetence may involve "show" or light spotting, but heavy hemorrhage is not typical. * **D. Painful contractions:** This is the defining feature of **Preterm Labor**. In cervical incompetence, the cervix fails *without* the presence of uterine contractions. **NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Usually clinical, based on a history of repeated mid-trimester losses. * **Ultrasonography (TVS):** A cervical length **<25 mm** or the presence of **"funneling"** (beaking of the internal os) before 24 weeks is a significant marker. * **Treatment:** The primary intervention is **Cervical Cerclage** (e.g., McDonald or Shirodkar techniques), typically performed between **12–14 weeks** of gestation. * **Classic History:** A patient describing a "sudden pressure" followed by the rapid, relatively painless delivery of a normal-appearing fetus in the second trimester.

Q: What is the earliest sign of uteroplacental insufficiency detected by Doppler ultrasound?

Diastolic notch. ### Explanation **1. Why "Diastolic Notch" is correct:** The earliest sign of uteroplacental insufficiency is the persistence of the **diastolic notch** in the uterine artery waveform. In a normal pregnancy, the physiological remodeling of spiral arteries by trophoblasts (low-resistance, high-flow system) causes the diastolic notch to disappear by **20–24 weeks** of gestation. If this remodeling fails, high resistance persists, resulting in a sharp drop in blood flow at the beginning of diastole (the notch). This serves as a predictive marker for pre-eclampsia and Intrauterine Growth Restriction (IUGR). **2. Why other options are incorrect:** * **Reversal of diastolic flow (B):** This is a **late and critical sign** of fetal compromise, typically seen in the umbilical artery. It indicates severe placental resistance and impending fetal demise. * **Blunting of systolic flow (C):** This is not a standard Doppler descriptor for early insufficiency. Doppler indices focus on the relationship between systolic and diastolic velocities (like the S/D ratio). * **Absent mid-diastolic flow (D):** While "Absent End Diastolic Velocity" (AEDV) is a significant marker of worsening insufficiency, it occurs much later in the disease spectrum than the appearance of a notch. **3. Clinical Pearls for NEET-PG:** * **Uterine Artery Doppler:** Best used for **screening** high-risk pregnancies (at 20–24 weeks). * **Umbilical Artery Doppler:** Best for **monitoring** a growth-restricted fetus. * **Sequence of deterioration:** Increased S/D ratio → Absent End Diastolic Velocity (AEDV) → Reversed End Diastolic Velocity (REDV). * **Ductus Venosus:** Reversal of the 'a' wave is the most ominous sign, indicating fetal heart failure.

Q: Anencephaly is best diagnosed using which of the following methods?

Ultrasound (USG). **Explanation:** **Anencephaly** is a lethal neural tube defect (NTD) characterized by the absence of the cranial vault (acrania) and the cerebral hemispheres. **Why Ultrasound (USG) is the Correct Answer:** Ultrasound is the **gold standard and investigation of choice** for diagnosing anencephaly. It can reliably detect the condition as early as the late first trimester (11–14 weeks). The classic sonographic findings include the **"Frog-eye appearance"** (Mickey Mouse sign) due to prominent orbits and the absence of the calvarium above the level of the orbits. USG is preferred because it is non-invasive, provides real-time visualization, and has nearly 100% sensitivity for this condition after the first trimester. **Analysis of Incorrect Options:** * **Maternal Serum Alpha-Fetoprotein (MSAFP):** While MSAFP is a screening tool for NTDs (levels are elevated), it is not diagnostic. High levels require confirmation via ultrasound. * **Amniotic Fluid Alpha-Fetoprotein (AFAFP):** This is an invasive procedure (amniocentesis). While it shows elevated AFP and Acetylcholinesterase, it is rarely used for diagnosis today because USG provides a definitive diagnosis non-invasively. * **X-ray:** Historically used to show the absence of the skull vault, but it is now obsolete due to radiation risks to the fetus and the superior resolution of USG. **Clinical Pearls for NEET-PG:** * **Earliest Diagnosis:** Can be suspected at 10-14 weeks (Acrania-Anencephaly sequence). * **Associated Finding:** **Polyhydramnios** is common in the second trimester because the fetus lacks the swallowing reflex. * **Key Sign:** "Frog-eye" or "Mickey Mouse" appearance on coronal/axial views. * **Screening:** Elevated MSAFP (>2.5 MoM) is the first step in screening for open NTDs.

Q: A 6-week pregnant primigravida presents with severe, acute abdominal pain. Ultrasound confirms an ectopic pregnancy. Which of the following has the least risk of ectopic pregnancy?

Condoms. **Explanation:** The risk of ectopic pregnancy is assessed in two ways: the **absolute risk** (the chance of any pregnancy occurring) and the **relative risk** (the chance that, if a pregnancy occurs, it will be ectopic). **1. Why Condoms are the Correct Answer:** Condoms are a barrier method of contraception. They prevent pregnancy by preventing sperm from reaching the egg. Because they significantly reduce the overall (absolute) risk of conception without altering the anatomy or physiology of the fallopian tubes, they carry the **least risk** of ectopic pregnancy among the given options. **2. Analysis of Incorrect Options:** * **Tubectomy:** While it is a highly effective permanent sterilization method, if a pregnancy *does* occur (due to recanalization or fistula), there is a very high relative risk (approx. 30-50%) that it will be ectopic. * **Infertility (>1 year):** Infertility is often caused by Pelvic Inflammatory Disease (PID) or endometriosis, both of which cause tubal scarring and ciliary dysfunction. This significantly increases the risk of an ectopic gestation. * **Copper T (IUD):** IUDs are excellent at preventing intrauterine pregnancies. However, they do not prevent ovulation. If the IUD fails, the relative risk of the pregnancy being ectopic is higher than in the general population because the device prevents implantation in the uterus more effectively than in the tube. **Clinical Pearls for NEET-PG:** * **Highest Risk Factor:** Previous history of ectopic pregnancy (10-fold increase). * **Most Common Site:** Ampulla of the fallopian tube. * **Most Common Site for Rupture:** Isthmus (due to its narrow lumen). * **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVS) + Serial β-hCG levels. * **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases).

Question 1

A pregnant woman presents at 22 weeks gestation for a routine prenatal visit. Physical examination demonstrates ankle edema and new onset hypertension. Urinalysis reveals marked proteinuria. Development of which of the following would justify a diagnosis of eclampsia?

Accepted Answer

Seizures

Answer

Diabetes mellitus

Answer

Hyperuricemia

Answer

Systemic lupus erythematosus

Question 2

What is the most common tumor of the ovary found in pregnancy?

Accepted Answer

Dermoid cyst

Answer

Sex cord tumor

Answer

Epithelial tumor

Answer

Dysgerminoma

Question 3

Which of the following is a risk factor for pre-eclampsia?

Accepted Answer

Primigravida

Answer

Thin build

Answer

Smoking

Answer

Placenta previa

Question 4

A 25-year-old woman is G5, P0, Ab4. All of her previous pregnancies ended in spontaneous abortion in the first or second trimester. She is now in the 16th week of her fifth pregnancy and has had no prenatal problems. Laboratory findings include maternal blood type of A positive, negative serologic test for syphilis, and immunity to rubella. Which of the following laboratory studies would be most useful for determining a potential cause of recurrent fetal loss in this patient?

Accepted Answer

Amniocentesis with chromosomal analysis

Answer

Genetic analysis of the CFTR gene

Answer

Maternal serum antibody screening

Answer

Maternal serum a-fetoprotein determination

Question 5

A 32-year-old G5P1 presents for her first prenatal visit. Classically, cervical incompetence is characterized by delivery in the second trimester preceded by which of the following?

Accepted Answer

Painless dilatation

Answer

Fever

Answer

Heavy bleeding

Answer

Painful contractions

Question 6

What is the earliest sign of uteroplacental insufficiency detected by Doppler ultrasound?

Accepted Answer

Diastolic notch

Answer

Reversal of diastolic flow

Answer

Blunting of systolic flow

Answer

Absent mid-diastolic flow

Question 7

What is the first step in managing a patient presenting with a post-dated pregnancy?

Accepted Answer

Review menstrual history for accuracy

Answer

Perform Ultrasound (USG)

Answer

Conduct Non-stress Test (NST)

Answer

Obtain X-ray of the abdomen

Question 8

Anencephaly is best diagnosed using which of the following methods?

Accepted Answer

Ultrasound (USG)

Answer

Maternal serum alpha-fetoprotein

Answer

Amniotic fluid alpha-fetoprotein

Answer

X-ray

Question 9

An elderly gravida (G6P5) became disoriented, lightheaded, breathless, and cyanotic 20 minutes after an uncomplicated spontaneous vaginal term delivery. Her blood pressure is 80/40 mm Hg, pulse is 110/min, and respiratory rate is 30/min. O2 saturation is 75% on face mask. A generalized purpuric rash and bleeding from the I.V line site are seen. Which of the following is the most appropriate next step in management of this patient?

Accepted Answer

Intubation and mechanical ventilation

Answer

Abdominal ultrasound

Answer

Intramuscular magnesium sulfate

Answer

Intravenous heparin

Question 10

A 6-week pregnant primigravida presents with severe, acute abdominal pain. Ultrasound confirms an ectopic pregnancy. Which of the following has the least risk of ectopic pregnancy?

Accepted Answer

Condoms

Answer

Tubectomy

Answer

Infertility for more than 1 year

Answer

Copper T (Intrauterine Device)

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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