Obstetrics and Gynecology Quiz: Intrauterine Fetal Demise
This article presents information about intrauterine fetal demise (IUFD) through a series of multiple-choice questions, aiming to provide readers with insights into this critical topic.
Note: This article is for informational purposes only and should not be considered a substitute for professional medical advice. Please consult a doctor for proper diagnosis and treatment.
Multiple Choice Questions
-
Which of the following is a common cause of intrauterine fetal demise?
- A. Post-term pregnancy.
- B. Pregnancy-induced hypertension.
- C. Diabetes.
- D. All of the above.
>> D
Explanation:
- Post-term pregnancy: A post-term pregnancy can lead to fetal distress, oxygen deprivation, and ultimately, IUFD.
- Pregnancy-induced hypertension: Hypertension during pregnancy can restrict blood flow to the fetus, causing oxygen deprivation and IUFD.
- Diabetes: Diabetes can cause vascular problems that compromise fetal growth and lead to IUFD.
-
The primary cause of coagulation disorders in IUFD is:
- A. Reduced thromboplastin.
- B. Reduced fibrinogen.
- C. Reduced fibrinolysin.
- D. Reduced factor VIII.
>> B
Explanation:
- Reduced fibrinogen: Fibrinogen is crucial for blood clotting. After IUFD, the mother’s body releases fetal degradation products into the bloodstream, leading to decreased fibrinogen levels and coagulation disorders.
-
Intrauterine fetal demise is defined as:
- A. Fetal death during the first trimester of pregnancy.
- B. Fetal death when the fetus weighs over 2500g.
- C. Fetal death and retention in the uterus for more than 48 hours.
- D. Fetal death during labor.
>> C
Explanation:
- Intrauterine fetal demise: This refers to the situation where a fetus dies in the womb and remains there for longer than 48 hours.
-
Fetal demise under 12 weeks presents as:
- A. Red vaginal bleeding.
- B. Positive hCG in urine.
- C. Small uterus.
- D. Empty gestational sac on ultrasound.
>> D
Explanation:
- Empty gestational sac on ultrasound: Ultrasound is the most accurate method for diagnosing IUFD under 12 weeks. An empty gestational sac or a fetus without a heartbeat is a telltale sign.
-
hCG levels in urine become negative approximately:
- A. 1 week
- B. 2 weeks
- C. 3 weeks
- D. 4 weeks
>> B
Explanation:
- hCG decreases after fetal demise: hCG levels in urine decline after IUFD. Typically, an hCG test will be negative about 2 weeks after the fetal demise.
-
All of the following can cause IUFD except:
- A. Post-term pregnancy.
- B. Cord entanglement.
- C. Ectopic pregnancy.
- D. Blood group incompatibility between mother and fetus.
>> C
Explanation:
- Ectopic pregnancy: Ectopic pregnancy occurs when a fertilized egg implants outside the uterus and is not related to IUFD in the uterus.
-
Which of the following tests is NOT useful for diagnosing IUFD?
- A. Ultrasound.
- B. hCG.
- C. X-ray.
- D. Coagulation studies.
>> D
Explanation:
- Coagulation studies: Coagulation studies can detect clotting disorders, but they cannot diagnose IUFD directly.
-
Which test is valuable in diagnosing IUFD?
- A. Ultrasound.
- B. hCG.
- C. X-ray.
- D. Fibrinogen blood level.
>> A
Explanation:
- Ultrasound: Ultrasound is the most reliable method for diagnosing IUFD. Ultrasound can detect the absence of fetal heartbeat, fetal shrinkage, and other abnormalities.
-
The Spalding sign is:
- A. A bright border around the skull due to scalp separation.
- B. A bright border around the fetus due to generalized skin separation.
- C. Overlapping of skull bones.
- D. Folded spine with overlapping vertebrae.
>> C
Explanation:
- Spalding sign: This sign is seen on X-ray images and shows overlapping skull bones, indicating fetal demise in the womb.
-
In IUFD with a gestational age of over 20 weeks, which clinical symptom is least common?
- A. Absence of fetal movement.
- B. Gradual decrease in abdominal size.
- C. Vaginal bleeding.
- D. Associated medical conditions or reduced nausea/vomiting.
>> C
Explanation:
- Vaginal bleeding: Vaginal bleeding is not a typical symptom of IUFD over 20 weeks.
-
Which type of amniotic sac is characteristic of IUFD?
- A. Protruding amniotic sac.
- B. Flat amniotic sac.
- C. Pear-shaped amniotic sac.
- D. No amniotic sac formation.
>> C
Explanation:
- Pear-shaped amniotic sac: A pear-shaped amniotic sac is a hallmark of IUFD, resulting from the pressure of the fetus on the amniotic sac as the fetus ceases to grow.
-
As a rule, coagulation disorders occur after IUFD:
- A. Immediately after fetal demise.
- B. After 2 weeks.
- C. After 4 – 6 weeks.
- D. They occur after evacuation or miscarriage.
>> C
Explanation:
- Coagulation disorders after IUFD: Coagulation disorders typically appear 4-6 weeks after fetal demise due to the release of fetal degradation products into the mother’s bloodstream.
-
In IUFD, CIVD is:
- A. Secondary fibrinolysis.
- B. Disseminated intravascular coagulation in organs.
- C. Disseminated intravascular coagulation in blood vessels.
- D. Disseminated intravascular coagulation in blood vessels and fibrinolysis.
>> D
Explanation:
- CIVD: This stands for Disseminated Intravascular Coagulation (DIC) and fibrinolysis. It occurs due to the release of clotting and fibrinolytic factors from the deceased fetus into the mother’s bloodstream.
-
IUFD is more common in:
- A. Mothers with chronic medical conditions.
- B. Mothers with acute infections.
- C. Mothers with a history of multiple pregnancies.
- D. Both A and B are correct.
>> D
Explanation:
- Chronic medical conditions: Chronic illnesses like diabetes and hypertension increase the risk of IUFD.
- Acute infections: Acute infections can compromise fetal health and contribute to IUFD.
-
All of the following symptoms are true for IUFD under 8 weeks EXCEPT:
- A. Persistent, continuous dark red vaginal bleeding.
- B. Uterine size may be normal.
- C. No fetal echo on ultrasound.
- D. E.hCG levels double every 48 hours.
>> D
Explanation:
- hCG decreases after fetal demise: hCG levels decrease after fetal demise, not double every 48 hours.
-
IUFD under 20 weeks does NOT present with the following symptom:
- A. Dark red, non-clotting vaginal bleeding.
- B. Occasional abdominal pain.
- C. Absence of fetal movement.
- D. Abdominal growth or shrinkage.
>> C
Explanation:
- Absence of fetal movement: Fetal movement is a crucial sign of a living fetus. With IUFD, fetal movement ceases.
-
Definitive diagnosis of IUFD over 20 weeks relies on the following signs:
- A. Absence of fetal movement, colostrum secretion from both breasts, soft uterus, unclear fetal parts, and uterus larger than gestational age.
- B. Absence of fetal movement, colostrum secretion from both breasts, soft uterus, unclear fetal parts, and uterus smaller than gestational age.
- C. Absence of fetal movement, colostrum secretion from both breasts, soft uterus, unclear fetal parts, no fetal heartbeat with a regular stethoscope.
- D. Absence of fetal movement, colostrum secretion from both breasts, soft uterus, unclear fetal parts, no fetal heartbeat with a regular stethoscope, no fetal heartbeat on ultrasound.
>> D
Explanation:
- No fetal heartbeat on ultrasound: Ultrasound is the most accurate method for diagnosing IUFD over 20 weeks, as it can detect the absence of fetal heartbeat.
-
Management of IUFD in the uterus is:
- A. Estrogen administration.
- B. Evacuation like a normal pregnancy.
- C. Oxytocin infusion.
- D. Management based on fibrinolysis results and gestational age.
>> D
Explanation:
- Management of IUFD: The management of IUFD depends on the gestational age, the mother’s health status, and the results of fibrinolysis testing.
-
IUFD needs to be differentiated from the following conditions EXCEPT:
- A. Multiple pregnancy.
- B. Miscarriage.
- C. Ectopic pregnancy.
- D. Molar pregnancy.
>> A
Explanation:
- Multiple pregnancy: Multiple pregnancy refers to carrying more than one fetus and is unrelated to IUFD.
-
Which sign is NOT valuable in diagnosing IUFD over 20 weeks?
- A. Colostrum secretion.
- B. Amniotic fluid showing reddish-brown color.
- C. X-ray showing the Spalding sign.
- D. Ultrasound showing no fetal movement or heartbeat.
>> A
Explanation:
- Colostrum secretion: Colostrum secretion is a normal occurrence during pregnancy and is not linked to IUFD.
-
IUFD can cause:
- A. Preeclampsia.
- B. Placental abruption.
- C. Placenta previa.
- D. Coagulation disorders.
>> D
Explanation:
- Coagulation disorders: IUFD can cause coagulation disorders due to the release of fetal degradation products into the mother’s bloodstream.
-
In the later stages of pregnancy, the earliest sign of IUFD is:
- A. Mother experiencing colostrum secretion.
- B. Mother not feeling fetal movement.
- C. Negative hCG levels.
- D. X-ray showing the Spalding sign.
>> B
Explanation:
- Mother not feeling fetal movement: Lack of fetal movement is the earliest and most significant indicator of IUFD.
-
Which paraclinical sign is NOT characteristic of IUFD?
- A. Air pockets in the fetus’s large blood vessels.
- B. Spalding sign.
- C. Bright border around the fetal skull on X-ray.
- D. Honeycomb pattern in the uterine cavity.
>> D
Explanation:
- Honeycomb pattern in the uterine cavity: A honeycomb pattern in the uterine cavity is a sign of endometritis (uterine inflammation) and is unrelated to IUFD.
-
Which of the following tests is most crucial for identifying coagulation disorders in IUFD?
- A. Red blood cell count and Hct.
- B. Bleeding and clotting time.
- C. Platelet count and concentration.
- D. Fibrinogen.
>> D
Explanation:
- Fibrinogen: Fibrinogen testing is the most important for evaluating coagulation disorders in IUFD, as fibrinogen is a key factor in the clotting process.
-
After delivery of an IUFD, the uterus needs to be monitored because of:
- A. Retained placenta.
- B. To remove blood from the uterus.
- C. To rule out cervical lacerations.
- D. To minimize uterine atony after delivery.
>> A
Explanation:
- Retained placenta: After delivery of an IUFD, the uterus must be monitored to rule out a retained placenta, which can cause postpartum bleeding.
-
Coagulation disorders in IUFD are due to:
- A. Reduced thromboplastin.
- B. Reduced fibrinogen.
- C. Reduced fibrinolysin.
- D. Increased fibrinogen.
>> B
Explanation:
- Reduced fibrinogen: Reduced fibrinogen is the primary cause of coagulation disorders in IUFD.
-
Intrauterine fetal demise can cause coagulation disorders. T/F
>> T
-
IUFD is defined as fetal death when the weight is 1000g or more. T/F
>> F
-
Many cases of fetal demise are unexplained. T/F
>> T
-
Uterine malformations do not increase the risk of IUFD. T/F
>> F
-
Most maternal illnesses increase the risk of IUFD. T/F
>> T
-
In cases of IUFD under 20 weeks, ultrasound is not valuable for early and accurate diagnosis. T/F
>> F
-
Women over 40 years old who are pregnant have a 5-fold increased risk of IUFD compared to younger women. T/F
>> T
-
Severe or mild preeclampsia does not increase the risk of fetal demise. T/F
>> F
-
Poor nutrition, strenuous labor, and difficult living conditions are not contributing factors to IUFD. T/F
>> F
-
If the fetus dies in the first week of pregnancy, it can be completely reabsorbed. T/F
>> T
-
A fetus that dies in the third or fourth month becomes mummified. T/F
>> F
-
IUFD infected with bacteria will lead to putrefaction. T/F
>> T
-
The uterus does not become smaller than the gestational age in cases of IUFD. T/F
>> F
-
Natural, slight vaginal bleeding, without abdominal pain, dark red or brownish-black in color, is a common sign of IUFD under 20 weeks. T/F
>> T
-
Ultrasound is a low-value diagnostic tool for IUFD. T/F
>> F
-
Potential fetal causes of IUFD include:
- A. Abnormal fetal presentation. T/F
- B. Fetal malformations. T/F
- C. Blood group incompatibility between mother and fetus. T/F
- D. Post-term pregnancy. T/F
>> A. F
B. T
C. T
D. T
-
Potential fetal causes of IUFD include:
- A. Cord entanglement. T/F
- B. Placenta implanted at the fundus of the uterus. T/F
- C. Placental degeneration and fibrosis. T/F
- D. Placental edema. T/F
- E. Placental abruption. T/F
>> A. T
B. F
C. T
D. T
E. T
-
Amniotic fluid remains sterile in IUFD. T/F
>> T
-
IUFD usually progresses gradually without any warning signs. T/F
>> T
-
Fibrinolysis testing is valuable in diagnosing IUFD. T/F
>> F
-
List two major risks for women experiencing IUFD: …(Coagulation disorders)… …(Infection)…
-
The most common medication used for labor induction in IUFD is …(Misoprostol)…
-
Approximately …(90)…% of IUFD cases lead to spontaneous labor, with the fetus being expelled 2-3 weeks after death.
-
Why is IUFD not immediately expelled?
- A. The cervix is not ripe due to a lack of prostaglandins.
- B. Due to a lack of oxytocin receptors.
- C. The deceased fetus releases a substance that relaxes smooth muscles.
- D. The reason is unknown.
>> D
-
What is the typical ultrasound image in IUFD under 12 weeks?
- A. Gestational sac without a fetus or with a fetus without a heartbeat.
- B. Folded fetus.
- C. Overlapping skull bones.
- D. Fetal length smaller than gestational age.
>> A
-
Which characteristic is NOT typical of labor in IUFD?
- A. Weak uterine contractions.
- B. Slow cervical dilation due to the loss of amniotic sac tension.
- C. High incidence of malpresentation.
- D. High risk of genital tract injury.
>> D
-
Infection in IUFD:
- A. Never occurs.
- B. Always happens in all cases.
- C. Only occurs in preterm pregnancies.
- D. Occurs in cases of prolonged rupture of membranes.
>> D
-
In a 7-month IUFD after delivery, examination reveals that the skin of the lower extremities has peeled off. Estimate the time of fetal demise:
- A. 3 days
- B. 4 days
- C. 6 days
- D. 8 days
>> B
-
On ultrasound, which of the following is the most crucial sign to confirm IUFD?
- A. Absence of fetal movement.
- B. No fetal heartbeat activity.
- C. Empty sac sign.
- D. Spalding sign.
>> B
-
Massive degradation products from the deceased fetus flooding into the mother’s circulation cause acute coagulation disorders when:
- A. About 4 weeks after fetal demise.
- B. When the uterus contracts or when there is intervention in the uterine cavity.
- C. After a few hours of intervention.
- D. They can occur at any time.
>> B
-
Which symptom is most notable in diagnosing IUFD?
- A. Uterus growing slowly compared to gestational age.
- B. Difficulty identifying fetal parts.
- C. Uterus becoming smaller than it was in previous examinations.
- D. Soft uterine consistency, not corresponding to gestational age.
>> C
-
Identify the incorrect statement about the characteristics of labor in IUFD:
- A. Uterine contractions are less effective.
- B. Cervical dilation is slow.
- C. The risk of maternal genital tract injury is high due to rapid labor.
- D. Postpartum bleeding is common due to clotting disorders.
>> C
-
Which medication is not commonly used to treat clotting disorders in IUFD?
- A. Fibrinogen.
- B. Fresh whole blood.
- C. Erythrocyte concentrate.
- D. Heparin.
>> D
-
Cervical dilation and evacuation of IUFD is indicated for:
- A. Uterine size smaller than a uterus with a pregnancy less than 3 months.
- B. Uterine volume smaller than a uterus with a pregnancy less than 2 months.
- C. Pregnancy under 3 months.
- D. Pregnancy of 4-5 months.
>> A
-
Partial hysterectomy is indicated for complications related to:
- A. Bleeding due to coagulation disorders.
- B. Bleeding due to uterine atony.
- C. Severe bleeding from the above causes, with a response to medical treatment.
- D. Severe bleeding, with no response to medical treatment.
>> D
-
The X-ray image of an IUFD over 20 weeks shows:
- A. Piszkacsek sign.
- B. Noble sign.
- C. Spalding sign.
- D. Bandl-Frommel sign.
>> C
-
Labor in IUFD typically presents with:
- A. Flat amniotic sac.
- B. Good fetal presentation.
- C. Prolonged labor.
- D. Risk of uterine rupture.
>> C
-
Which of the following is incorrect regarding IUFD?
- A. Can cause coagulation disorders.
- B. Causes anxiety and distress for the mother.
- C. Labor typically progresses quickly because the fetus is easily expelled.
- D. Active uterine management after delivery is often necessary due to the risk of retained placenta.
>> C
-
For IUFD over 4 months, vaginal prostaglandin E1 (or buccal) can be used to induce miscarriage:
- A. In all primary care settings.
- B. In facilities with obstetric specialists.
- C. In specialized facilities with surgical capabilities.
- D. In places with obstetric specialists.
>> C
-
Which of the following is NOT recommended for managing IUFD in primary care settings?
- A. The procedure should be performed as soon as possible.
- B. In case of postpartum hemorrhage, active resuscitation, calling for emergency specialist consultation, and if the pregnancy is under 20 weeks, perform evacuation as quickly as possible. Following evacuation, use oxytocin to contract and retract the uterus.
- C. In case of infection, transfer to a specialized facility as soon as possible.
- D. Explain the severity of the patient’s condition to the family if complications arise.
>> A
-
The most valuable clinical symptom for diagnosing IUFD over 20 weeks is:
- A. No fetal movement.
- B. Dark vaginal bleeding.
- C. Fundal height measurement smaller than gestational age.
- D. No fetal heartbeat.
>> D
-
In which of the following situations should an IUFD be delivered via cesarean section
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