Maternal-Fetal Medicine Practice Questions

Q: A 35-week pregnant patient presents with hydramnios and marked respiratory distress. What is the most appropriate management?

Amniocentesis. **Explanation:** The patient presents with **acute/symptomatic polyhydramnios** at 35 weeks gestation. When hydramnios causes maternal compromise—specifically **marked respiratory distress** or severe abdominal pain—the primary goal is to relieve the intra-abdominal pressure to stabilize the mother. **Why Amniocentesis is correct:** **Therapeutic Amniocentesis (Amnioreduction)** is the treatment of choice for symptomatic relief. By slowly removing excess amniotic fluid (usually 500 mL per hour, up to 1.5–2 L), the pressure on the diaphragm is reduced, immediately improving respiratory function. It is preferred over delivery at 35 weeks if the primary issue is mechanical distress, as it allows the pregnancy to gain further maturity while alleviating symptoms. **Why other options are incorrect:** * **A. Intravenous Furosemide:** Hydramnios is an accumulation of fluid in the amniotic sac, not maternal pulmonary edema or systemic fluid overload. Diuretics do not reduce amniotic fluid volume. * **B. Saline Infusion:** This would be used for oligohydramnios (amnioinfusion) or maternal dehydration; it would worsen the volume status in this context. * **D. Artificial Rupture of Membranes (ARM):** Performing ARM in a patient with polyhydramnios and a high presenting part carries a massive risk of **cord prolapse** and **abruptio placentae** due to the sudden decompression of the uterus. **NEET-PG High-Yield Pearls:** * **Definition:** Polyhydramnios is defined as an Amniotic Fluid Index (AFI) > 25 cm or a Single Deepest Pocket (SDP) > 8 cm. * **Indomethacin:** Can be used for medical management (decreases fetal urine output) but is generally avoided after **32 weeks** due to the risk of premature closure of the *ductus arteriosus*. * **Complication Risk:** Always perform amnioreduction slowly to prevent placental abruption.

Q: What is the most common symptom of an ectopic pregnancy?

Pain in the lower abdomen. **Explanation:** The classic clinical triad of ectopic pregnancy consists of **amenorrhea, abdominal pain, and vaginal bleeding**. However, this triad is present in only about 50% of cases. **1. Why "Pain in the lower abdomen" is correct:** Abdominal pain is the **most common presenting symptom**, occurring in approximately **95–99%** of patients. The pain is typically caused by the distension of the fallopian tube or peritoneal irritation from leaking blood. It is usually the first symptom that prompts a patient to seek medical attention. **2. Analysis of Incorrect Options:** * **Amenorrhea (B):** While a history of a missed period is common (75–90%), it is a *sign* or a historical finding rather than the primary *symptom* that defines the clinical presentation. Some patients may mistake early vaginal bleeding for a period, leading to a negative history of amenorrhea. * **Vaginal Bleeding (C):** This occurs in about 60–80% of cases. It is usually "scanty, dark brown (prune juice appearance), and spotting" in nature. While common, it occurs less frequently than abdominal pain. * **Fainting attack (D):** This is a sign of **ruptured ectopic pregnancy** leading to hemoperitoneum and hypovolemic shock. It is a late, life-threatening complication rather than the most common symptom of ectopic pregnancy in general. **NEET-PG High-Yield Pearls:** * **Most common site:** Fallopian tube (97%), specifically the **Ampulla** (most common overall). * **Most common site for rupture:** Isthmus (occurs early, at 6–8 weeks). * **Gold Standard Investigation:** Transvaginal Ultrasound (TVS) combined with quantitative β-hCG (Discriminatory zone: 1500–2000 mIU/mL). * **Arias-Stella Reaction:** Hypersecretory endometrium seen on curettage, suggestive of pregnancy but not specific to ectopic.

Q: In case of unstable lie of fetus, where is the placenta usually located?

Lower segment. **Explanation:** The correct answer is **Lower segment**. **1. Why the Lower Segment is Correct:** An unstable lie refers to a situation where the fetal longitudinal axis frequently changes (e.g., switching between transverse, oblique, and longitudinal) after 37 weeks of gestation. The most common anatomical cause for this is a **Placenta Previa** (placenta located in the lower uterine segment). When the placenta occupies the lower segment, it prevents the fetal head from engaging in the pelvic brim. This lack of engagement allows the fetus excessive mobility, leading to an unstable or transverse lie. **2. Why Other Options are Incorrect:** * **Cornual, Lateral wall, and Fundus:** These are all locations within the **upper uterine segment**. A placenta located in the upper segment is considered normal and does not obstruct the pelvic inlet. In these cases, the fetal head can easily engage, which typically stabilizes the fetus into a longitudinal lie (usually cephalic) as term approaches. **3. Clinical Pearls for NEET-PG:** * **Definition:** Unstable lie is only diagnosed after **37 weeks**; before this, it is common due to relatively high liquor volume. * **Management:** If an unstable lie persists at term, the primary goal is to exclude placenta previa via ultrasound. * **Risk:** The most dangerous complication of an unstable lie with ruptured membranes is **Cord Prolapse**. * **Other Causes:** Apart from placenta previa, consider pelvic tumors (fibroids), polyhydramnios, grand multiparity, and uterine anomalies (e.g., arcuate or subseptate uterus).

Q: All of the following is true about abruptio placentae except?

Bright red blood. **Explanation:** Abruptio placentae refers to the premature separation of a normally situated placenta from the uterine wall before the birth of the fetus. **Why Option B is the correct answer (False statement):** In abruptio placentae, the bleeding is typically **dark-colored (non-clotting)** because it is often retroplacental and undergoes changes before escaping through the cervix. In contrast, **bright red, painless bleeding** is the hallmark of **Placenta Previa**. Abruptio is usually associated with severe abdominal pain and uterine tenderness. **Analysis of other options:** * **Option A:** This is the standard definition of abruption. Unlike placenta previa (where the placenta is low-lying), abruption involves a placenta in the normal upper segment. * **Option C:** Recurrence is a significant risk factor. After one episode of abruption, the risk of recurrence in a subsequent pregnancy is approximately **5–15%**, and it rises to 25% after two episodes. * **Option D:** Abruption is statistically more common in **multigravida** women. Other major risk factors include pregnancy-induced hypertension (most common cause), trauma, smoking, and cocaine use. **NEET-PG High-Yield Pearls:** * **Couvelaire Uterus:** A complication of severe abruption where blood extravasates into the myometrium, giving it a port-wine/purplish appearance. * **Most common cause of DIC in pregnancy:** Abruptio placentae (due to release of thromboplastin). * **Clinical Triad:** Abdominal pain, vaginal bleeding (may be concealed), and uterine hypertonicity/tenderness. * **Management:** If the fetus is alive and at term, or if there is maternal instability, immediate delivery (usually via LSCS) is indicated.

Q: Which parameter on umbilical artery Doppler indicates imminent fetal demise?

Reversal of flow. **Explanation:** The umbilical artery Doppler is a critical tool for assessing placental vascular resistance and fetal well-being in cases of Fetal Growth Restriction (FGR). **1. Why "Reversal of Flow" is correct:** As placental insufficiency worsens, the resistance in the umbilical artery increases. Eventually, the pressure in the fetal systemic circulation becomes lower than the pressure in the placenta during diastole. This causes blood to flow backward toward the fetal heart (**Reversed End-Diastolic Velocity - REDV**). This represents extreme placental compromise (usually >70% of the placental bed is non-functional) and is a pre-terminal sign indicating **imminent fetal demise** or severe acidemia. Delivery is usually indicated urgently if the fetus is viable. **2. Analysis of Incorrect Options:** * **Increased S/D ratio:** This is the earliest sign of increased placental resistance. While it indicates placental insufficiency, it is not an immediate marker of fetal death. * **Absent diastolic flow (AEDV):** This occurs when resistance is high enough that flow stops during diastole. It is a serious sign and precedes reversal, but the risk of immediate demise is significantly higher once the flow reverses. * **Normal S/D ratio:** This indicates healthy placental perfusion and low resistance, which is the expected finding in a normal pregnancy. **3. High-Yield Clinical Pearls for NEET-PG:** * **Sequence of Deterioration:** Increased S/D ratio → Absent End Diastolic Velocity (AEDV) → Reversed End Diastolic Velocity (REDV). * **Ductus Venosus:** If REDV is noted in the umbilical artery, the next step is often checking the Ductus Venosus. **Reversal of the 'a' wave** in the Ductus Venosus is the most definitive predictor of imminent fetal heart failure. * **Management:** AEDV usually warrants delivery by 34 weeks; REDV usually warrants delivery by 32 weeks (after steroid cover).

Question 1

A 24-year-old woman is pregnant at 14 weeks with her first baby. She feels well and the pregnancy is uncomplicated. Routine screening is positive for chronic viral hepatitis for which perinatal transmission is of major epidemiologic significance. For this patient, what is the most likely viral agent?

Accepted Answer

Hepatitis B virus

Answer

Hepatitis A virus

Answer

Hepatitis C virus

Answer

Hepatitis D virus

Question 2

A 35-week pregnant patient presents with hydramnios and marked respiratory distress. What is the most appropriate management?

Accepted Answer

Amniocentesis

Answer

Intravenous furosemide

Answer

Saline infusion

Answer

Artificial rupture of membranes

Question 3

A 37-week pregnant woman presents with bleeding per vaginam. Investigations reveal a severe degree of placenta previa. What is the appropriate management?

Accepted Answer

Immediate Cesarean section

Answer

Blood transfusion

Answer

Conservative management

Answer

Medical induction of labor

Question 4

Which one of the following fetal functions is the last to be affected?

Accepted Answer

Tone

Answer

Movement

Answer

Heart rate reactivity

Answer

Breathing movements

Question 5

What is the most common symptom of an ectopic pregnancy?

Accepted Answer

Pain in the lower abdomen

Answer

Amenorrhea

Answer

Vaginal bleeding

Answer

Fainting attack

Question 6

In case of unstable lie of fetus, where is the placenta usually located?

Accepted Answer

Lower segment

Answer

Cornual

Answer

Lateral wall

Answer

Fundus

Question 7

A 35-year-old G2P1L1 presents at 35 weeks of gestation with leakage per vagina. Examination of the pooled fluid shows it turns red litmus paper blue and exhibits ferning. The patient's temperature is 102
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Accepted Answer

Administer antibiotics

Answer

Administer betamethasone

Answer

Administer tocolytics

Answer

Place a cervical cerclage

Question 8

All of the following is true about abruptio placentae except?

Accepted Answer

Bright red blood

Answer

Premature separation of normally attached placenta

Answer

Risk of recurrence is about 15% with previous abruption

Answer

More common in multigravida

Question 9

Which parameter on umbilical artery Doppler indicates imminent fetal demise?

Accepted Answer

Reversal of flow

Answer

Increased S/D ratio

Answer

Absent diastolic flow

Answer

Normal S/D ratio

Question 10

A hypertensive primigravida with completely subsided pre-eclamptic features, up to what gestational age should the pregnancy be continued?

Accepted Answer

37 weeks

Answer

35 weeks

Answer

39 weeks

Answer

40 weeks

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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