Maternal-Fetal Medicine Practice Questions

Q: A pregnant woman is found to have excessive accumulation of amniotic fluid. Polyhydramnios is likely to be associated with all of the following conditions, except?

Bilateral renal agenesis. **Explanation:** The volume of amniotic fluid is a dynamic balance between production and removal. From the second trimester onwards, **fetal urine** is the primary source of amniotic fluid, while **fetal swallowing** is the primary route of removal. **Why Bilateral Renal Agenesis is the Correct Answer:** In bilateral renal agenesis (Potter’s sequence), the fetus lacks kidneys and cannot produce urine. Since urine is the major contributor to the amniotic pool, its absence leads to **Oligohydramnios** (decreased fluid), not polyhydramnios. This is a classic "must-know" distinction for NEET-PG. **Analysis of Other Options (Causes of Polyhydramnios):** * **Twinning:** Specifically in Monochorionic twins, Twin-to-Twin Transfusion Syndrome (TTTS) leads to polyhydramnios in the recipient twin due to volume overload and polyuria. * **Microanencephaly/Anencephaly:** Polyhydramnios occurs due to two reasons: 1) Failure of the swallowing reflex due to neurological deficit, and 2) Transudation of fluid from the exposed meninges/choroid plexus. * **Oesophageal Atresia:** This creates a mechanical obstruction in the gastrointestinal tract, preventing the fetus from swallowing and absorbing amniotic fluid, leading to its accumulation. **High-Yield Clinical Pearls for NEET-PG:** * **Definition:** Polyhydramnios is defined as an Amniotic Fluid Index (AFI) **>25 cm** or a Single Deepest Pocket (SDP) **>8 cm**. * **Maternal Cause:** The most common maternal cause of polyhydramnios is **Maternal Diabetes** (fetal hyperglycemia leads to osmotic diuresis/polyuria). * **Fetal Causes:** Any condition that impairs swallowing (CNS anomalies, GI atresias) or increases urine output (Hydrops fetalis, TTTS) results in polyhydramnios. * **Potter’s Sequence:** Bilateral renal agenesis → Oligohydramnios → Pulmonary hypoplasia and limb deformities.

Q: A primigravida at 36 weeks gestation has a USG revealing a complete placenta previa. The uterus is relaxed, but she starts to bleed heavily. All of the following are appropriate next steps, EXCEPT?

Administer intramuscular terbutaline. **Explanation:** In a case of **complete placenta previa** with **heavy bleeding**, the clinical priority is maternal stabilization and immediate delivery, regardless of gestational age. **1. Why Option A is the Correct Answer (The "Except"):** Terbutaline is a tocolytic agent used to suppress uterine contractions. In this scenario, the question states the **uterus is already relaxed**. More importantly, tocolytics are strictly **contraindicated** in cases of heavy antepartum hemorrhage (APH) with hemodynamic instability. Administering a beta-mimetic like terbutaline can cause maternal tachycardia and peripheral vasodilation, which would mask signs of hypovolemic shock and worsen the patient's cardiovascular status. **2. Why the other options are incorrect (Appropriate steps):** * **Option B & C:** Heavy bleeding in placenta previa is a life-threatening emergency. Immediate **resuscitation** with large-bore IV fluids and cross-matching **packed RBCs** (at least 4 units) is mandatory to maintain perfusion and prepare for an emergency Cesarean section. * **Option D:** **Urine output monitoring** (via Foley catheter) is the most sensitive non-invasive indicator of vital organ perfusion and renal function during obstetric hemorrhage. **Clinical Pearls for NEET-PG:** * **Management Gold Standard:** For complete placenta previa with active, heavy bleeding, the treatment of choice is **Immediate Cesarean Section**, irrespective of the period of gestation. * **Vaginal Examination:** Never perform a digital vaginal examination (PV) in a suspected case of APH until placenta previa is ruled out by USG, as it can provoke torrential hemorrhage (**"Stallworthy's sign"**). * **Expectant Management (Macafee & Johnson):** Only indicated if the bleeding is slight, the patient is stable, and the fetus is preterm (<37 weeks). It is NOT applicable in this scenario due to heavy bleeding.

Q: What is the most common abnormality found in first-trimester abortions?

Defective genes. **Explanation:** **1. Why "Defective Genes" is Correct:** The most common cause of spontaneous abortion in the first trimester (up to 80%) is **genetic factors**, specifically **chromosomal abnormalities**. Among these, **Autosomal Trisomies** are the most frequent (Trisomy 16 being the most common specific trisomy). These genetic defects lead to improper embryonic development, often resulting in a "blighted ovum" or early embryonic demise. This is nature’s way of screening out non-viable pregnancies. **2. Why Other Options are Incorrect:** * **Cervical Incompetence (B):** This is a classic cause of **second-trimester** (mid-trimester) habitual abortions, typically characterized by painless cervical dilatation and membrane prolapse. * **Placental and Membrane Abnormality (C):** While these can cause complications, they are rarely the primary cause of first-trimester loss. Placental issues usually manifest later in pregnancy (e.g., abruption or insufficiency). * **Uterine Retroversion (D):** A retroverted uterus is considered a normal anatomical variant in many women. It does not increase the risk of miscarriage unless it leads to "incarceration" of the gravid uterus, which is extremely rare. **Clinical Pearls for NEET-PG:** * **Most common chromosomal abnormality:** Autosomal Trisomy (50-60% of all cases). * **Most common single trisomy:** Trisomy 16. * **Most common single chromosomal anomaly:** Monosomy X (Turner Syndrome, 45,X). * **Triploidy** is the second most common numerical aberration. * **Timing:** 80% of spontaneous abortions occur within the first 12 weeks of pregnancy.

Q: Indications for termination of pregnancy include all of the following except:

Tricuspid stenosis. In maternal-fetal medicine, the decision to terminate a pregnancy is based on the risk of maternal mortality. Heart diseases are classified into risk groups, with certain conditions posing a prohibitively high risk (25–50% mortality). **Why Tricuspid Stenosis is the Correct Answer:** Tricuspid stenosis (TS) is generally well-tolerated during pregnancy. Unlike left-sided obstructive lesions, TS involves the low-pressure venous system. While it may cause peripheral edema and hepatic congestion, it rarely leads to life-threatening pulmonary edema or sudden cardiac death. Therefore, it is **not** an absolute indication for termination. **Analysis of Incorrect Options:** * **Eisenmenger Syndrome:** This carries the highest risk (up to 50% mortality). The drop in systemic vascular resistance during pregnancy worsens the right-to-left shunt, leading to severe hypoxemia and heart failure. Termination is strongly advised. * **Aortic Stenosis (Severe/Symptomatic):** This is a fixed-output state. The heart cannot increase cardiac output to meet pregnancy demands, leading to syncope, heart failure, or sudden death. * **NYHA Grade 4 Heart Disease:** Patients symptomatic at rest have minimal cardiac reserve. The physiological hemodilution and increased cardiac output of pregnancy often lead to decompensation and death. **Clinical Pearls for NEET-PG:** * **WHO Class IV Heart Diseases (Termination Recommended):** Eisenmenger syndrome, Pulmonary Arterial Hypertension (PAH), Severe Aortic Stenosis, Marfan Syndrome with aortic root >40mm, and previous Peripartum Cardiomyopathy with residual dysfunction. * **Mitral Stenosis:** The most common rheumatic valvular lesion in pregnancy; while dangerous, it is often managed medically or via valvuloplasty rather than mandatory termination unless refractory. * **Highest Risk Period:** The immediate postpartum period (first 24–48 hours) due to "autotransfusion" from the involuting uterus.

Q: What is the most common neurological disorder encountered in pregnancy?

Epilepsy. **Explanation:** **Epilepsy** is the most common major neurological disorder encountered in pregnancy, affecting approximately **0.5% to 1%** of all pregnant women. It is a high-yield topic for NEET-PG because it requires careful management of anti-epileptic drugs (AEDs) to balance maternal seizure control against the risk of fetal malformations. **Why the other options are incorrect:** * **Alzheimer’s Disease:** This is a neurodegenerative condition primarily affecting the elderly. It is extremely rare in the reproductive age group. * **Cerebrovascular Disorders:** While the risk of stroke and venous sinus thrombosis increases during pregnancy and the puerperium due to a hypercoagulable state, these events are statistically less frequent than pre-existing epilepsy. * **Multiple Sclerosis (MS):** MS is the second most common neurological disorder in pregnancy. While it frequently affects women of childbearing age, its prevalence in the pregnant population is lower than that of epilepsy. **High-Yield Clinical Pearls for NEET-PG:** 1. **Pre-conception:** Women should be started on **high-dose Folic Acid (5 mg/day)** to reduce the risk of neural tube defects associated with AEDs. 2. **Teratogenicity:** **Sodium Valproate** is the most teratogenic AED (associated with neural tube defects and lower IQ); **Lamotrigine and Levetiracetam** are generally considered the safest options. 3. **Seizure Frequency:** About 1/3 of patients experience increased seizure frequency, often due to physiological changes (increased volume of distribution) or non-compliance. 4. **Vitamin K:** Infants born to mothers on enzyme-inducing AEDs (e.g., Phenytoin, Phenobarbital) should receive Vitamin K at birth to prevent hemorrhagic disease of the newborn.

Q: Which of the following complications is usually not observed in gestational diabetes mellitus?

Oligohydramnios. **Explanation:** In **Gestational Diabetes Mellitus (GDM)**, the hallmark pathophysiology is maternal hyperglycemia leading to fetal hyperglycemia. This triggers **fetal osmotic diuresis**, resulting in **polyhydramnios** (excess amniotic fluid), not oligohydramnios. **Why Oligohydramnios is the correct answer:** Oligohydramnios is typically associated with conditions causing placental insufficiency or fetal renal anomalies. In GDM, the increased glucose load in the fetus leads to polyuria, which increases the amniotic fluid volume. Therefore, oligohydramnios is an "atypical" finding in GDM and is usually not observed unless there is co-existing fetal growth restriction (FGR) or premature rupture of membranes. **Analysis of Incorrect Options:** * **Abortion:** While more common in pre-gestational diabetes with poor glycemic control during organogenesis, poorly controlled GDM still carries a slightly increased risk of spontaneous pregnancy loss. * **Preeclampsia:** There is a strong clinical association between GDM and hypertensive disorders. Hyperinsulinemia and insulin resistance contribute to endothelial dysfunction, increasing the risk of preeclampsia. * **Infection:** Hyperglycemia impairs neutrophil function and provides a culture medium for pathogens, making GDM patients prone to monilial vaginitis and urinary tract infections (UTIs). **NEET-PG High-Yield Pearls:** * **Most common fetal complication in GDM:** Macrosomia (due to fetal hyperinsulinemia). * **Most common malformation (Pre-gestational DM):** Cardiac defects (VSD). * **Most specific malformation (Pre-gestational DM):** Caudal Regression Syndrome. * **Amniotic Fluid Index (AFI):** In GDM, look for Polyhydramnios (AFI >24-25 cm).

Question 1

A pregnant woman is found to have excessive accumulation of amniotic fluid. Polyhydramnios is likely to be associated with all of the following conditions, except?

Accepted Answer

Bilateral renal agenesis

Answer

Twinning

Answer

Microanencephaly

Answer

Oesophageal atresia

Question 2

A primigravida at 36 weeks gestation has a USG revealing a complete placenta previa. The uterus is relaxed, but she starts to bleed heavily. All of the following are appropriate next steps, EXCEPT?

Accepted Answer

Administer intramuscular terbutaline

Answer

Arrange for 4 units of packed red blood cells

Answer

Administer intravenous fluids

Answer

Monitor urine output strictly

Question 3

What is the most common abnormality found in first-trimester abortions?

Accepted Answer

Defective genes

Answer

Cervical incompetence

Answer

Placental and membrane abnormality

Answer

Uterine retroversion

Question 4

Indications for termination of pregnancy include all of the following except:

Accepted Answer

Tricuspid stenosis

Answer

Aortic stenosis

Answer

Eisenmenger syndrome

Answer

NYHA grade 4 heart disease

Question 5

A woman has a history of repeated first-trimester bleeding episodes. She is now 28 weeks of gestation. When discussing the prognosis for her pregnancy outcome, what increased risk should she be informed about?

Accepted Answer

All of the above

Answer

Preterm labor

Answer

Intrauterine growth restriction (IUGR)

Answer

Placental abruption

Question 6

What is the most common neurological disorder encountered in pregnancy?

Accepted Answer

Epilepsy

Answer

Alzheimer's disease

Answer

Cerebrovascular disorders

Answer

Multiple sclerosis

Question 7

An elderly multiparous woman with intrauterine fetal death was admitted with strong labor pains. The patient suddenly goes into shock with cyanosis, respiratory disturbances, and pulmonary edema. What is the most likely clinical diagnosis?

Accepted Answer

Amniotic fluid embolism

Answer

Rupture of uterus

Answer

Congestive heart failure

Answer

Concealed accidental hemorrhage

Question 8

A 19-year-old primigravida presents with 8 weeks of amenorrhea, light bleeding, and pain. On examination, the uterine size corresponds to the period of gestation, and the os is closed. Ultrasound reveals an intrauterine pregnancy. What is the preferred management in this case?

Accepted Answer

Bed rest and Progesterone

Answer

Estrogen plus Progesterone therapy

Answer

Dilatation and Curettage

Answer

Beta hCG

Question 9

A 24-year-old woman presents with mildly painful swelling of her right leg and acute shortness of breath. She is 32 weeks pregnant with her second child and has no other medical history. Which of the following statements is NOT true regarding this condition?

Accepted Answer

D-Dimer assay could be an important diagnostic tool.

Answer

Deep vein thrombosis and venous obstruction by the pregnant uterus are likeliest causes.

Answer

An ultrasound of the deep veins of the right leg should be performed.

Answer

A V/Q scan can be helpful in this condition.

Question 10

Which of the following complications is usually not observed in gestational diabetes mellitus?

Accepted Answer

Oligohydramnios

Answer

Abortion

Answer

Preeclampsia

Answer

Infection

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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