Maternal-Fetal Medicine Practice Questions

Q: Vasa previa is a complication of which of the following types of placenta?

All of these. ***All of these*** - **Vasa previa** is a condition where fetal blood vessels run through the membranes covering the internal cervical os, unprotected by placental tissue or umbilical cord. - It is associated with **velamentous cord insertion** (most common), where the umbilical cord inserts into the fetal membranes rather than directly into the placental mass, leaving vessels exposed. - **Succenturiate (accessory) lobe** can also lead to vasa previa when connecting vessels between the main placenta and accessory lobe cross over the cervical os. - **Bilobed placenta** may have communicating vessels between the two lobes that traverse the lower uterine segment. - All these placental abnormalities increase the risk of vasa previa, which can cause catastrophic fetal hemorrhage if the vessels rupture during labor or membrane rupture. *Note: The images demonstrate these placental variations associated with vasa previa.*

Q: Which of the following is correct about the placenta shown below? (Recent NEET Pattern 2016-17)

Battledore placenta. ***Battledore placenta*** - This image depicts a **marginal insertion of the umbilical cord** into the placenta, where the cord attaches to the edge rather than the center or a more central part of the placental disc. This is characteristic of a battledore placenta. - The name "battledore" refers to the resemblance of the placenta and cord to a **tennis racket (battledore)**, where the cord is the handle and the placenta is the head. *Velamentous cord insertion* - In velamentous insertion, the **umbilical vessels diverge in the membranes before reaching the placental disc**, making them unprotected. - In this image, the cord clearly inserts into the edge of the placenta, rather than having vessels spread out in the membranes. *Placental chorioangioma* - A placental chorioangioma is a **benign tumor of the placenta**, characterized by an abnormal proliferation of fetal vessels within the chorionic villi. - This condition is a **mass within the placenta** itself and is not depicted by an anomalous cord insertion pattern. *Circumvallate placenta* - A circumvallate placenta has a **thickened, rolled amnion and chorion** due to a fold of the fetal membranes on the fetal side limiting the expansion of the placenta. - This describes a **membrane abnormality** affecting the shape of the placenta, not directly related to the cord insertion site shown.

Q: What is the type of placenta shown below?

Battledore placenta. ***Battledore placenta*** - The image clearly displays the **umbilical cord inserted into the margin** of the placenta, which is the defining characteristic of a battledore placenta (also known as a marginal cord insertion). - This type of insertion is generally benign but can be associated with some complications, such as **intrauterine growth restriction (IUGR)** or **preterm birth**. *Velamentous placenta* - In a **velamentous insertion**, the umbilical cord inserts into the **chorioamniotic membranes** some distance from the placental margin. - The umbilical vessels then travel unprotected within the membranes before reaching the placental disc, increasing the risk of **vasa previa** and fetal hemorrhage. *Placental chorioangioma* - A **chorioangioma** is a benign vascular tumor of the placenta that appears as a well-defined mass of varying size. - It is not a type of placental insertion and typically presents as a **focal lesion** within the placental tissue, which is not depicted in the image. *Circumvallate placenta* - A **circumvallate placenta** is characterized by a double fold of amnion and chorion around the fetal surface of the placenta, causing a thick, raised ring at the margin where the chorionic plate ends. - This morphology is distinctly different from the marginal cord insertion shown in the image.

Q: The image shows:

PUBS. **PUBS** - The image displays a procedure where a needle is inserted through the maternal abdomen and into the **umbilical cord blood vessel** of the fetus, which is characteristic of **Percutaneous Umbilical Blood Sampling (PUBS)**. - PUBS, also known as **cordocentesis**, is used to obtain fetal blood for diagnostic purposes, such as detecting chromosomal abnormalities, genetic disorders, or fetal infections. *Amniocentesis* - **Amniocentesis** involves sampling **amniotic fluid** from the sac surrounding the fetus, not directly from the umbilical cord. - The needle in amniocentesis typically targets the amniotic sac, while in the image, it clearly targets an umbilical vessel. *Chorionic villus sampling* - **Chorionic villus sampling (CVS)** involves obtaining tissue from the **placenta** (chorionic villi), either transabdominally or transcervically. - The image clearly shows the needle entering the umbilical cord, not the placental tissue. *Fetal scalp sampling* - **Fetal scalp sampling** is performed during labor to assess fetal well-being by analyzing **fetal blood pH** from a small incision on the fetal scalp. - This procedure is performed late in pregnancy during labor and involves accessing the fetal scalp via the cervix, which is distinct from the transabdominal umbilical cord access shown.

Q: The least common site of ectopic pregnancy is:

4. ***4*** - The image shows the 4 regions of the fallopian tube. Number 4 points to the **fimbriae**, which are finger-like projections at the end of the fallopian tube closest to the ovary. - While technically part of the fallopian tube, implantation in the fimbriae is extremely rare. More commonly, ectopic pregnancies occur in the ampulla or isthmus. It's the least common region of the fallopian tube for an ectopic pregnancy to occur. *1* - Number 1 points to the **interstitial** (or cornual) part of the fallopian tube, which is embedded within the muscular wall of the uterus. - While less common than ampullary pregnancies, interstitial pregnancies still account for about 2-4% of all ectopic pregnancies and have a higher risk of rupture due to the rich vascular supply and muscular distensibility of this region. *2* - Number 2 points to the **isthmus** of the fallopian tube, which is the narrow, thick-walled section connecting the ampulla to the uterine fundus. - Ectopic pregnancies in the isthmus account for approximately 12% of all ectopic pregnancies, making it the second most common site after the ampulla. *3* - Number 3 points to the **ampulla** of the fallopian tube, which is the widest and longest section, and where fertilization typically occurs. - The ampulla is the **most common site** for ectopic pregnancies, accounting for about 80% of all cases.

Q: The image shows an ultrasound-guided procedure with a needle inserted into the umbilical cord. What is this procedure called?

PUBS. ***PUBS*** - The image clearly depicts a needle inserted into the **umbilical cord**, which is characteristic of **Percutaneous Umbilical Blood Sampling (PUBS)**. - **PUBS**, also known as cordocentesis, involves sampling fetal blood from the umbilical cord for diagnostic purposes. *Amniocentesis* - This procedure involves withdrawing **amnionic fluid** from the sac surrounding the fetus, not directly from the umbilical cord. - The needle in amniocentesis would typically be shown entering the amniotic sac to aspirate fluid, not targeting the umbilical vessel. *Chorionic villus sampling* - This involves taking a sample of **chorionic villi** from the placenta, usually earlier in pregnancy than shown in the image. - The depicted needle insertion is into the umbilical cord itself, not placental tissue. *Fetal scalp sampling* - This procedure is performed during labor to measure fetal **pH** by taking a small blood sample from the fetal scalp. - The image shows an antenatal procedure targeting the umbilical cord, not the fetal scalp during labor.

Q: A 25-year-old lady had tubal rupture due to ectopic pregnancy at 6 weeks. The most common site of rupture of ectopic pregnancy amongst the following is:

2. ***Option 2 (Ampulla)*** - The image shows the **ampulla** of the fallopian tube labeled with '2'. This is the **most common site** for ectopic pregnancies, accounting for approximately **80-90%** of all tubal ectopic pregnancies. - The ampulla is the widest and longest part of the fallopian tube, making it a frequent location for implantation outside the uterus. Despite being wider, rupture is common here due to the thin wall and progressive distension from the growing pregnancy. *Option 1 (Interstitial/Cornual)* - The image points to the **interstitial** (or cornual) portion of the fallopian tube, labeled '1'. This is the **least common site** for ectopic pregnancy, accounting for only **2-4%** of cases. - While rare, rupture here can be **catastrophic** due to proximity to the uterine blood supply and rich vascular anastomoses, leading to severe hemorrhage. *Option 3 (Isthmus)* - The image highlights the **isthmus** of the fallopian tube with '3'. Ectopic pregnancies in the isthmus account for approximately **12%** of cases. - Rupture in the isthmus typically occurs **earlier** (around 6-8 weeks) than in the ampulla due to its narrower lumen and thicker muscular wall, which limits its ability to accommodate the growing pregnancy. *Option 4 (Infundibulum/Fimbriae)* - The image points to the **infundibulum** and **fimbriae**, labeled '4'. Fimbrial ectopic pregnancies are **extremely rare**, accounting for less than **5%** of cases. - The fimbriae are involved in capturing the ovum after ovulation. Implantation here is uncommon and may result in fimbrial abortion rather than rupture.

Q: A 25-year-old presents with amenorrhea of 8 weeks. What does the USG show?

Partial mole. ***Partial mole*** - The ultrasound image shows a **thickened placenta** with **multiple cystic spaces** (vesicles), often described as a "grape-like cluster" or "Swiss cheese" appearance, which is characteristic of a partial hydatidiform mole. - In a partial mole, there is often **fetal tissue present**, which may be seen as a small, abnormal fetus or amniotic sac, although sometimes it can be difficult to identify in early stages or if very rudimentary. *Complete mole* - A **complete mole** would typically show a **uterus filled with hydropic villi** and no evidence of fetal parts or an amniotic sac. - The "snowstorm" appearance due to diffuse hydropic villi is more characteristic of a complete mole, and while there are vesicles here, the presence of what appears to be some organized placental tissue with vesicles within it is more typical of a partial mole. *PCOS* - **Polycystic Ovary Syndrome (PCOS)** is characterized by **multiple small follicles (cysts)** arranged peripherally in the ovaries, and it would not present with this kind of uterine contents, which is clearly a product of conception. - PCOS is a hormonal disorder leading to chronic anovulation and hyperandrogenism, and its ultrasound findings are distinct from placental abnormalities. *Endometrioma* - An **endometrioma** is a type of **ovarian cyst** filled with old blood, presenting as a **homogenous, hypoechoic mass** with internal echoes, often described as a "ground glass" appearance. - This image clearly depicts contents within the uterine cavity related to a pregnancy, not an ovarian cyst.

Q: Between the three studies of fetal umbilical artery velocimetry by Doppler USG, which one will have the highest chances of fetal compromise?

B. ***B*** - Pattern B shows **reversed end-diastolic flow** in the umbilical artery. This indicates severe placental insufficiency and **fetal hypoxemia and acidosis**, signifying the highest risk of fetal compromise and poor perinatal outcomes. - Reversed end-diastolic flow suggests that the fetal heart is working against extremely high resistance in the placenta, leading to a backflow of blood during diastole, which drastically **reduces oxygen and nutrient delivery** to the fetus. *A* - Pattern A shows **absent end-diastolic flow**, meaning there is no forward blood flow through the umbilical artery during diastole. While concerning, it is generally considered less severe than reversed flow. - Absent end-diastolic flow indicates significantly increased placental resistance and is associated with increased fetal morbidity and mortality, but the fetus may still compensate for some time. *C* - Pattern C demonstrates **positive end-diastolic flow**, which is a normal finding in umbilical artery Doppler velocimetry. - The presence of continuous forward flow during diastole indicates normal placental resistance and **adequate blood perfusion** to the fetus. *All of the above equally* - This option is incorrect because the three patterns (A, B, and C) represent different degrees of compromise, with **reversed end-diastolic flow (B) being the most severe**. - A normal Doppler tracing (C) suggests a healthy fetus, while absent (A) and reversed (B) end-diastolic flows signify progressively worse fetal conditions due to placental insufficiency.

Q: A pregnant lady was admitted with diagnosis of PIH for monitoring and bed rest. When lying in supine position, which of the following complications is depicted in the image below?

Supine venocaval syndrome. ***Supine venocaval syndrome*** - The image depicts a pregnant woman lying in a **supine position**, where the **gravid uterus** compresses the **inferior vena cava (IVC)** and potentially the aorta against the vertebral column. - This compression of the IVC leads to reduced venous return to the heart, causing a drop in cardiac output and blood pressure, known as **supine venocaval syndrome** or **aortocaval compression syndrome**. *Abdominal aorta syndrome* - While the aorta can also be compressed in the supine position by the gravid uterus, symptoms primarily arise from **venous compression (IVC)** due to its lower pressure, which is more easily obstructed. - Significant symptoms solely from **aortic compression** are less common than those from IVC compression. *Ascending aorta syndrome* - The **ascending aorta** is located in the chest, not in the abdomen, and would not be compressed by the gravid uterus. - This condition generally refers to issues like ascending aortic aneurysm or dissection, unrelated to uterine compression. *Superior vena cava syndrome* - **Superior vena cava (SVC) syndrome** results from obstruction of the SVC, typically by **mediastinal tumors** or **thrombosis**. - The SVC is in the upper chest and is not affected by the gravid uterus in a supine position.

Question 1

Vasa previa is a complication of which of the following types of placenta?

Accepted Answer

All of these

Answer

Velamentous insertion of cord

Answer

Succenturiate lobe

Answer

Bilobed placenta

Question 2

Which of the following is correct about the placenta shown below? (Recent NEET Pattern 2016-17)

Accepted Answer

Battledore placenta

Answer

Velamentous cord insertion

Answer

Placental chorioangioma

Answer

Circumvallate placenta

Question 3

What is the type of placenta shown below?

Accepted Answer

Battledore placenta

Answer

Velamentous placenta

Answer

Placental chorioangioma

Answer

Circumvallate placenta

Question 4

The image shows:

Accepted Answer

PUBS

Answer

Amniocentesis

Answer

Chorionic villus sampling

Answer

Fetal scalp sampling

Question 5

The least common site of ectopic pregnancy is:

Accepted Answer

4

Answer

1

Answer

2

Answer

3

Question 6

The image shows an ultrasound-guided procedure with a needle inserted into the umbilical cord. What is this procedure called?

Accepted Answer

PUBS

Answer

Amniocentesis

Answer

Chorionic villus sampling

Answer

Fetal scalp sampling

Question 7

A 25-year-old lady had tubal rupture due to ectopic pregnancy at 6 weeks. The most common site of rupture of ectopic pregnancy amongst the following is:

Accepted Answer

2

Answer

1

Answer

3

Answer

4

Question 8

A 25-year-old presents with amenorrhea of 8 weeks. What does the USG show?

Accepted Answer

Partial mole

Answer

Complete mole

Answer

Endometrioma

Answer

PCOS

Question 9

Between the three studies of fetal umbilical artery velocimetry by Doppler USG, which one will have the highest chances of fetal compromise?

Accepted Answer

B

Answer

A

Answer

C

Answer

All of the above equally

Question 10

A pregnant lady was admitted with diagnosis of PIH for monitoring and bed rest. When lying in supine position, which of the following complications is depicted in the image below?

Accepted Answer

Supine venocaval syndrome

Answer

Abdominal aorta syndrome

Answer

Ascending aorta syndrome

Answer

Superior vena cava syndrome

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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