Maternal-Fetal Medicine Practice Questions

Q: The perinatal complications of a diabetic pregnancy include : 1. Small for Gestational Age baby 2. Stillbirth 3. Hypoglycaemia 4. Respiratory distress syndrome Select the correct answer from the code given below :

2 and 3 only. ***2 and 3 only*** - **Stillbirth** is a major perinatal complication of diabetic pregnancy due to placental insufficiency, fetal hyperglycemia, and maternal ketoacidosis, occurring in up to 2-5% of poorly controlled cases. - **Neonatal hypoglycemia** occurs in 25-40% of infants of diabetic mothers due to fetal hyperinsulinemia. After delivery, the sudden withdrawal of maternal glucose supply while fetal insulin levels remain elevated leads to profound hypoglycemia within 1-2 hours of birth. - While **respiratory distress syndrome (RDS)** is also a recognized complication (due to delayed surfactant production from hyperinsulinemia), this question focuses on the most characteristic and immediate life-threatening perinatal complications requiring urgent monitoring and intervention. *1 and 2 only* - **Small for Gestational Age (SGA)** is NOT a typical complication of diabetic pregnancy. The classic presentation is **macrosomia** (Large for Gestational Age) due to fetal hyperinsulinemia driving increased glucose uptake and fat deposition. - SGA may occur in pre-gestational diabetes with severe vasculopathy, but this represents a minority of cases and is not the typical pattern. *1 and 4 only* - **Small for Gestational Age** is incorrect for the reasons stated above - diabetic pregnancies characteristically produce macrosomic infants, not growth-restricted ones. - **Respiratory distress syndrome** is indeed a complication, but the inclusion of the incorrect statement 1 makes this option wrong. *1 and 3 only* - **Small for Gestational Age** is fundamentally inconsistent with the pathophysiology of diabetic pregnancy, which involves fetal hyperglycemia and hyperinsulinemia leading to excessive growth. - **Hypoglycemia** is correct, but this option is invalidated by the inclusion of SGA.

Q: Abortions in the second trimester mainly occur due to

congenital anomalies of the foetus. ***congenital anomalies of the foetus*** - Among the given options, **fetal congenital anomalies** (chromosomal abnormalities and structural malformations) are a significant cause of second-trimester pregnancy loss. - These anomalies often become apparent during routine prenatal screenings or ultrasounds performed in the second trimester, leading to spontaneous loss or termination. - **Note:** In clinical practice, **cervical incompetence** is actually the most common cause of second-trimester abortion, but it is not listed among the options in this question. *congenital anomalies of the uterus* - **Uterine anomalies** like septate or bicornuate uterus are more commonly associated with **recurrent first-trimester miscarriages** or **preterm labor** in the third trimester. - While they can contribute to pregnancy loss, they are less frequently the primary cause of second-trimester abortions compared to fetal anomalies. *retroflected gravid uterus* - A **retroflected gravid uterus** typically resolves spontaneously as the uterus grows and rises out of the pelvis by 12-14 weeks. - If it remains retroverted and becomes incarcerated, it can cause **pelvic pain** and **urinary retention**, but this is a very rare cause of miscarriage, especially in the second trimester. *hormonal deficiencies* - **Hormonal deficiencies**, such as insufficient **progesterone** production by the corpus luteum, are a more common cause of **first-trimester miscarriages**. - By the second trimester, the placenta has taken over progesterone production (by 8-10 weeks), making hormonal deficiencies a much less common cause of abortion during this period.

Q: Which one of the following is diagnosed by Spiegelberg criteria?

Ovarian pregnancy. ***Ovarian pregnancy*** - Spiegelberg criteria are specifically used to diagnose an **ovarian ectopic pregnancy**, which is a rare form of ectopic pregnancy where the fertilized egg implants in the ovary. - The criteria include: the **fallopian tube and fimbria are intact** and separate from the ovary, the gestational sac is in the ovarian cortex, it is connected to the uterus by the **ovarian ligament**, and ovarian tissue can be histologically demonstrated in the sac wall. *Molar pregnancy* - This is a type of **gestational trophoblastic disease** characterized by abnormal growth of trophoblastic tissue, resulting in a non-viable pregnancy. - Diagnosis involves high levels of **hCG**, a "snowstorm" appearance on ultrasound, and histopathological examination, not Spiegelberg criteria. *Twin pregnancy* - This refers to the presence of **two fetuses** in a single pregnancy. - Diagnosis is primarily made via **ultrasound imaging** showing two distinct gestational sacs or two fetuses, and is unrelated to Spiegelberg criteria. *Uterine pregnancy* - This is a **normal intrauterine pregnancy** where the fertilized egg implants within the uterine cavity. - It is diagnosed by visualizing a gestational sac and eventually an embryo/fetus within the uterus by **ultrasound**, not by Spiegelberg criteria.

Q: The fetal well-being can be assessed by all of the following, except

Kleihauer-Betke test. ***Kleihauer-Betke test*** - The **Kleihauer-Betke test** is used to quantify the amount of **fetal hemoglobin** that has entered the maternal circulation, typically in cases of **fetomaternal hemorrhage**. - It does assess fetal red blood cells in maternal circulation but does not directly assess current fetal well-being in terms of **cardiac activity**, **movement**, or **oxygenation**. *non-stress test* - The **non-stress test (NST)** monitors **fetal heart rate (FHR)** accelerations in response to fetal movement as an indicator of adequate **fetal oxygenation** and **autonomic nervous system function**. - A **reactive NST** with appropriate accelerations is considered a sign of **fetal well-being**. *ultrasound* - **Ultrasound** is a versatile tool for assessing fetal well-being, providing information on **fetal growth**, **anatomy**, **amniotic fluid volume**, and **biophysical profile (BPP)**. - The BPP, which includes ultrasound observations of **fetal breathing**, **movement**, **muscle tone**, and **amniotic fluid volume**, along with an **NST**, offers a comprehensive assessment of fetal status. *contraction stress test* - The **contraction stress test (CST)** evaluates the response of the **fetal heart rate** to uterine contractions, which temporarily reduce placental blood flow. - A **negative CST** (no late decelerations) indicates good **fetal oxygen reserve** and is a reliable sign of **fetal well-being**.

Q: Multiple pregnancy is associated with an increased incidence of the following EXCEPT:

Post date pregnancy. ***Post date pregnancy*** - **Multiple pregnancies** are instead associated with a significantly **increased risk of preterm birth** due to uterine overdistension and increased fetal-placental hormonal signaling. - Due to the high risk of complications for both mother and fetuses, multiple pregnancies are often delivered before the estimated due date or by **elective induction**/ **cesarean section**, making post-date pregnancy extremely rare. *Congenital malformations* - The incidence of **congenital malformations** is **increased in multiple pregnancies**, particularly in **monochorionic twins**, partly due to increased vascular anastomoses and potential for discordant growth or twin-to-twin transfusion syndrome (TTTS). - Both **monozygotic** and **dizygotic twins** have a higher risk of various malformations compared to singletons, including neural tube defects and cardiac anomalies. *Hyperemesis gravidarum* - **Hyperemesis gravidarum (severe nausea and vomiting)** is more common in multiple pregnancies due to higher levels of pregnancy hormones, especially **beta-human chorionic gonadotropin (β-hCG)**. - The increased placental mass in multiple gestations leads to **elevated hCG** levels, which are strongly correlated with the severity of nausea and vomiting. *Pregnancy induced hypertension* - **Pregnancy-induced hypertension (PIH)**, including **gestational hypertension** and **preeclampsia**, is significantly more prevalent in multiple pregnancies. - The **larger placental mass** and increased maternal physiological burden contribute to a higher risk of developing PIH, often with **earlier onset** and **increased severity**.

Q: Which of the following genital infections is associated with preterm labour?

Bacterial vaginosis. ***Bacterial vaginosis*** - Bacterial vaginosis (BV) is strongly associated with an increased risk of **preterm labor** and **premature rupture of membranes** due to the production of proteases and phospholipases by anaerobic bacteria. - The imbalance of vaginal flora, particularly the overgrowth of anaerobic bacteria, can lead to ascending infection and inflammation of the **chorioamniotic membranes**. - BV has the **strongest and most consistent** evidence linking it to preterm birth among genital infections. *Human Papilloma Virus* - HPV infection is primarily known for causing **genital warts** and increasing the risk of **cervical dysplasia** and cancer. - It is not directly linked to an increased risk of preterm labor. *Monilial vaginitis* - Monilial vaginitis, or **vulvovaginal candidiasis** (yeast infection), is a common cause of vaginal discomfort, itching, and discharge. - While uncomfortable, it is not consistently associated with an increased risk of preterm labor or other adverse pregnancy outcomes. *Trichomonas vaginalis* - *Trichomonas vaginalis* infection is a sexually transmitted infection that can cause **vaginitis**, cervicitis, and urethritis. - While some studies suggest a possible association with adverse pregnancy outcomes, the evidence is **inconsistent and significantly weaker** compared to bacterial vaginosis, making BV the most established cause of preterm labor among these options.

Q: Medical management of tubal ectopic pregnancy can be done in the following EXCEPT:

β HCG level more than 10,000 IU. ***β HCG level more than 10,000 IU*** - A **β-HCG level greater than 5,000-10,000 IU/L** is generally considered a contraindication for successful medical management of ectopic pregnancy with methotrexate. - Higher β-hCG levels are associated with a **larger ectopic mass**, making it less likely to respond to medical treatment and increasing the risk of rupture. *Period of gestation 5 weeks* - A **gestational age of 5 weeks** is often within the timeframe where medical treatment with methotrexate can be highly effective. - Early diagnosis and intervention within the first 6-7 weeks of gestation are crucial for successful medical management. *Absent foetal cardiac activity* - The **absence of fetal cardiac activity** is a favorable prognostic indicator for medical management, as it suggests the tissue is less viable and more likely to respond to methotrexate. - Methotrexate targets rapidly dividing cells, and the lack of a heartbeat indicates less metabolic activity. *Gestational sac diameter 3 cm.* - An **ectopic sac diameter of 3 cm** (or less than 3.5-4 cm) is generally within the size limits for successful medical management. - Larger sac diameters increase the risk of treatment failure and rupture, pushing towards surgical intervention.

Question 1

The perinatal complications of a diabetic pregnancy include :

1. Small for Gestational Age baby
2. Stillbirth
3. Hypoglycaemia
4. Respiratory distress syndrome

Select the correct answer from the code given below :

Accepted Answer

2 and 3 only

Answer

1 and 2 only

Answer

1 and 4 only

Answer

1 and 3 only

Question 2

Abortions in the second trimester mainly occur due to

Accepted Answer

congenital anomalies of the foetus

Answer

congenital anomalies of the uterus

Answer

retroflected gravid uterus

Answer

hormonal deficiencies

Question 3

Which one of the following is diagnosed by Spiegelberg criteria?

Accepted Answer

Ovarian pregnancy

Answer

Molar pregnancy

Answer

Twin pregnancy

Answer

Uterine pregnancy

Question 4

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→3  B→4  C→1  D→2

Answer

A→1  B→4  C→3  D→2

Answer

A→2  B→4  C→1  D→3

Answer

A→4  B→1  C→3  D→2

Question 5

The fetal well-being can be assessed by all of the following, except

Accepted Answer

Kleihauer-Betke test

Answer

non-stress test

Answer

ultrasound

Answer

contraction stress test

Question 6

With reference to the transmission of HIV from mother to child, which one of the following statements is not correct?

Accepted Answer

Single dose of 200 mg nevirapine at the onset of labour eliminates the risk of HIV transmission to the newborn

Answer

The rate of transmission of HIV from mother to child is between 15-48%

Answer

HIV is transmitted through breast milk

Answer

In majority of cases, transmission of virus occurs during intrapartum period

Question 7

Multiple pregnancy is associated with an increased incidence of the following EXCEPT:

Accepted Answer

Post date pregnancy

Answer

Congenital malformations

Answer

Hyperemesis gravidarum

Answer

Pregnancy induced hypertension

Question 8

Which of the following genital infections is associated with preterm labour?

Accepted Answer

Bacterial vaginosis

Answer

Human Papilloma Virus

Answer

Monilial vaginitis

Answer

Trichomonas vaginalis

Question 9

Medical management of tubal ectopic pregnancy can be done in the following EXCEPT:

Accepted Answer

β HCG level more than 10,000 IU

Answer

Period of gestation 5 weeks

Answer

Absent foetal cardiac activity

Answer

Gestational sac diameter 3 cm.

Question 10

A case of ante-partum haemorrhage is seen at a Primary Health Centre. The treatment will consist of:

Accepted Answer

Assessment of general condition of the patient, intravenous drip and reference to a hospital

Answer

Packing the vagina to stop the bleeding and then reference to a hospital

Answer

Internal podalic version and delivery

Answer

Vaginal examination and reference to a hospital only if diagnosed as placenta praevia

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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