Maternal-Fetal Medicine Practice Questions

Q: Missed abortion is not diagnosed if

USG shows fetus with cardiac activity. ***USG shows fetus with cardiac activity*** - The presence of **fetal cardiac activity** on ultrasound is the definitive sign of a viable pregnancy, ruling out missed abortion. - Missed abortion is characterized by a **non-viable intrauterine pregnancy** (no cardiac activity) with a closed cervix, and would not be diagnosed if cardiac activity is detected. *uterus is smaller than gestational age* - A uterus consistently smaller than expected for gestational age can be a sign of a **non-viable pregnancy** or **intrauterine growth restriction**, both of which could be associated with missed abortion. - However, this finding alone is not diagnostic and needs confirmation with ultrasound to assess fetal viability. *external os is closed* - A **closed external os** is characteristic of a missed abortion, where the products of conception are retained within the uterus. - In a missed abortion, the cervix often remains closed, preventing the expulsion of the non-viable pregnancy. *vaginal bleed is brownish in colour* - **Brownish vaginal bleeding** indicates old or deoxygenated blood, which is a common symptom of a threatened abortion or missed abortion. - This type of bleeding suggests that the pregnancy may not be progressing normally and often prompts further investigation to assess fetal viability.

Q: Which of the following fetal infections is MOST commonly associated with significant intrauterine growth restriction?

Cytomegalovirus infection. ***Cytomegalovirus infection*** - **Cytomegalovirus (CMV)** is the **most common congenital infection** and the **leading cause of intrauterine growth restriction (IUGR)** among the TORCH infections. - CMV has a direct cytopathic effect on fetal tissues and significantly impairs placental function, leading to severe and consistent growth restriction. - Congenital CMV infection affects approximately **0.5-1% of all live births**, with **IUGR being one of the most prominent features** in symptomatic cases. - Other manifestations include microcephaly, intracranial calcifications, hepatosplenomegaly, sensorineural hearing loss, and neurodevelopmental impairment. *Human papillomavirus infection* - **Human papillomavirus (HPV)** is primarily associated with genital warts and cervical dysplasia in mothers. - While vertical transmission can occur (causing juvenile-onset recurrent respiratory papillomatosis), HPV **does not cause IUGR**. - HPV is **not part of the TORCH infections** and has no association with fetal growth restriction. *Rubella infection* - **Congenital rubella syndrome** is characterized by the classic triad: cataracts, cardiac defects (patent ductus arteriosus), and sensorineural hearing loss. - While rubella **can cause IUGR**, it is far less common in modern practice due to widespread **MMR vaccination**. - The incidence of congenital rubella has dramatically decreased, making it a less frequent cause of IUGR compared to CMV. *Toxoplasmosis* - **Congenital toxoplasmosis** presents with the classic triad: hydrocephalus, intracranial calcifications, and chorioretinitis. - While toxoplasmosis **can contribute to growth restriction**, IUGR is not its most prominent or consistent feature. - **CMV remains the most common and most consistently associated** TORCH infection with significant IUGR in clinical practice.

Q: "Variable decelerations" on an electronic fetal heart rate monitor imply

Umbilical cord compression. ***Umbilical cord compression*** - **Variable decelerations** are characterized by an **abrupt decrease** in fetal heart rate, which varies in timing, depth, and duration relative to uterine contractions. - This pattern is most commonly caused by **umbilical cord compression**, which temporarily reduces blood flow to the fetus, leading to immediate baroreceptor-mediated bradycardia. *Fetal head compression* - **Early decelerations** are typically associated with **fetal head compression** during contractions. - These are characterized by a gradual decrease in fetal heart rate that mirrors the contraction, with the nadir coinciding with the peak of the contraction. *Utero-placental insufficiency* - **Late decelerations** are associated with **utero-placental insufficiency**, indicating inadequate oxygen delivery to the fetus. - These are characterized by a gradual decrease in fetal heart rate that begins after the peak of the contraction and recovers after the contraction has ended. *Fetal anemia* - **Fetal anemia** can lead to a variety of fetal heart rate abnormalities, including **sinusoidal patterns** or **tachycardia**, as the fetus attempts to compensate for reduced oxygen-carrying capacity. - It does not typically present as isolated variable decelerations.

Q: The following changes may be seen in pre-eclampsia except

Hemodilution. ***Hemodilution*** - Pre-eclampsia is characterized by generalized **vasoconstriction** and **reduced plasma volume**, leading to **hemoconcentration**, not hemodilution. - The elevated hematocrit sometimes observed is a consequence of this reduced plasma volume. *Thrombocytopenia* - **Thrombocytopenia** (platelet count < 100,000/µL) is a common finding in severe pre-eclampsia and is part of the HELLP syndrome criteria. - It results from increased platelet consumption and destruction due to widespread endothelial dysfunction. *Decreased antithrombin III* - **Decreased antithrombin III** levels are characteristic of pre-eclampsia, reflecting disseminated intravascular coagulation (DIC) and increased consumption of coagulation factors. - This contributes to the procoagulant state often seen in severe pre-eclampsia. *Elevated uric acid* - **Elevated uric acid** is a common and early biochemical marker in pre-eclampsia, often correlating with disease severity. - It results from reduced renal clearance and increased production, reflecting renal impairment and widespread endothelial dysfunction.

Q: What is the most commonly observed fetal effect in women receiving magnesium sulphate therapy for pre-eclampsia/eclampsia ?

Respiratory depression. ***Respiratory depression*** - Magnesium sulfate readily crosses the placenta, leading to elevated magnesium levels in the fetus, which can cause **central nervous system depression** and **respiratory depression** at birth. - This is the **most commonly observed fetal effect**, manifesting as neonatal hypermagnesemia with respiratory compromise, hypotonia, and decreased reflexes. - The effect is due to magnesium's role as a **neuromuscular blocker**, reducing acetylcholine release at the neuromuscular junction. *Intestinal obstruction* - There is no direct link between maternal magnesium sulfate therapy and an increased risk of **fetal intestinal obstruction**. - Intestinal obstruction in neonates is typically associated with **structural anomalies** or conditions like meconium ileus, not magnesium exposure. *Variability in fetal heart rate pattern* - While magnesium sulfate can cause **decreased fetal heart rate variability** as a monitoring finding, this is not the "most commonly observed fetal effect." - Decreased variability is a **transient monitoring change** during therapy, whereas respiratory depression is a direct clinical effect observed at birth. - The question asks for the most common **fetal effect**, and respiratory depression at delivery is more clinically significant and commonly encountered. *Cerebral palsy* - Magnesium sulfate is actually used as a **neuroprotective agent** in preterm births to **reduce the risk of cerebral palsy**. - It does not cause cerebral palsy; rather, it provides fetal neuroprotection when given for preterm labor <32 weeks gestation.

Q: The maximum chances of HIV infection being transmitted to the fetus/infant in an HIV infected mother are during

During labour. ***During labour*** - The **highest risk** of mother-to-child HIV transmission occurs during labor and delivery due to the infant's exposure to maternal blood and genital secretions. - The process of passing through the **birth canal** can lead to inoculation with HIV-infected cells and viral particles. *Third trimester* - While some transmission can occur in the third trimester, the risk is significantly **lower** than during labor. - The placenta generally provides a barrier, though there's a risk of **transplacental passage** if the placental integrity is compromised. *First trimester* - The **lowest risk** of HIV transmission occurs during the first trimester. - The developing fetus is relatively protected by the placenta, and the viral load in maternal blood might be lower compared to later stages without intervention. *During breast feeding* - **Breastfeeding** is a known route of HIV transmission, but its risk is generally **lower per exposure** compared to labor and delivery, especially if the mother is on antiretroviral therapy. - The risk is **cumulative** over the duration of breastfeeding.

Q: Which of the following statements is true for maternal rubella infection?

The primary infection is responsible for birth defects. ***The primary infection is responsible for birth defects*** - **Primary maternal rubella infection** during pregnancy is the primary cause of congenital rubella syndrome, as the virus can cross the placenta and infect the developing fetus. - The risk and severity of **birth defects** are highest when the mother is infected during the first trimester. *24% incidence of congenital infection if acquired during the last month of pregnancy* - While rubella infection late in pregnancy can still lead to fetal infection, the incidence of **congenital rubella syndrome** is significantly lower in the last trimester (typically less than 1%) compared to the first trimester. - The reported incidence of 24% is excessively high for an infection acquired in the **last month of pregnancy**. *It leads to abortions before 16 weeks of gestation* - While **rubella infection** can increase the risk of spontaneous abortion, especially if acquired early in pregnancy, it is not the *only* or *guaranteed* outcome. Many infected pregnancies continue to term with varying degrees of fetal compromise. - The statement suggests a direct and absolute causal link to abortion before 16 weeks, which is too definitive. *It causes blindness with recurrent infection* - **Congenital rubella syndrome** can cause ocular defects such as **cataracts**, **glaucoma**, and **retinopathy**, which can lead to blindness. - However, rubella infection typically confers **lifelong immunity**, making **recurrent infection** extremely rare and thus not a common mechanism for causing blindness.

Q: What is the commonest cause of retention of urine at 12-14 weeks of pregnancy ?

Retroverted gravid uterus. ***Retroverted gravid uterus*** - A **retroverted uterus** can become "trapped" in the pelvis as it enlarges during pregnancy, causing the **cervix to push against the urethra, leading to outflow obstruction**. - This typically occurs between **12-14 weeks of gestation** before the uterus ascents out of the pelvis. *Diminished bladder tone* - While bladder tone can be affected in pregnancy, it's not the primary or most common cause of **acute urinary retention** at this specific gestational age. - **Decreased bladder sensation** and volume capacity changes are more gradual and less likely to cause acute retention until later stages. *Prolapse of uterus* - **Uterine prolapse** is more common in **multiparous women** and tends to cause symptoms like pressure, discomfort, and potentially urinary incontinence, rather than acute retention, particularly in early pregnancy. - A prolapsed uterus is usually located **lower in the pelvic cavity**, which would not typically obstruct the urethra in the manner of a retroverted uterus. *Impacted pelvic tumour* - An **impacted pelvic tumour** could cause urinary retention, but it is a **less common cause** than a retroverted gravid uterus in the context of a healthy 12-14 week pregnancy. - This would be a more serious and typically pre-existing condition, often with other associated symptoms, and not a physiological consequence of pregnancy.

Question 1

Missed abortion is not diagnosed if

Accepted Answer

USG shows fetus with cardiac activity

Answer

uterus is smaller than gestational age

Answer

external os is closed

Answer

vaginal bleed is brownish in colour

Question 2

Which of the following fetal infections is MOST commonly associated with significant intrauterine growth restriction?

Accepted Answer

Cytomegalovirus infection

Answer

Human papillomavirus infection

Answer

Rubella infection

Answer

Toxoplasmosis

Question 3

"Variable decelerations" on an electronic fetal heart rate monitor imply

Accepted Answer

Umbilical cord compression

Answer

Fetal head compression

Answer

Utero-placental insufficiency

Answer

Fetal anemia

Question 4

The following changes may be seen in pre-eclampsia except

Accepted Answer

Hemodilution

Answer

Thrombocytopenia

Answer

Decreased antithrombin III

Answer

Elevated uric acid

Question 5

Spiegelberg's criteria for diagnosis of ovarian pregnancy include the following except

Accepted Answer

Gestational sac is connected with infundibulopelvic ligament

Answer

Gestational sac must occupy the position of ovary

Answer

Ovarian tissue should be present in the wall of gestational sac on histopathology

Answer

Tube on the affected side must be intact

Question 6

What is the most commonly observed fetal effect in women receiving magnesium sulphate therapy for pre-eclampsia/eclampsia ?

Accepted Answer

Respiratory depression

Answer

Intestinal obstruction

Answer

Variability in fetal heart rate pattern

Answer

Cerebral palsy

Question 7

Which one of the following statements is not correct about obstetric cholestasis ?

Accepted Answer

Associated with markedly high bilirubin and raised liver enzymes

Answer

It results in pruritus without rash

Answer

It is an indication of termination of pregnancy at 37 weeks

Answer

Risk of recurrence is high in future pregnancies

Question 8

The maximum chances of HIV infection being transmitted to the fetus/infant in an HIV infected mother are during

Accepted Answer

During labour

Answer

Third trimester

Answer

First trimester

Answer

During breast feeding

Question 9

Which of the following statements is true for maternal rubella infection?

Accepted Answer

The primary infection is responsible for birth defects

Answer

24% incidence of congenital infection if acquired during the last month of pregnancy

Answer

It leads to abortions before 16 weeks of gestation

Answer

It causes blindness with recurrent infection

Question 10

What is the commonest cause of retention of urine at 12-14 weeks of pregnancy ?

Accepted Answer

Retroverted gravid uterus

Answer

Diminished bladder tone

Answer

Prolapse of uterus

Answer

Impacted pelvic tumour

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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