Intrauterine Fetal Death (IUD) MCQs

The drug likely to cause tooth discoloration and mottling is doxycycline. Tetracyclines, including doxycycline, are known to cause this when used during pregnancy. The other antibiotics listed do not typically cause this effect.

The appropriate management is to perform an ultrasound immediately. Decreased fetal movement warrants urgent investigation, even with a normal FHR. An ultrasound can assess fetal well-being and identify potential problems. Oxygen administration and kick count charts are not sufficient in this situation.

The best advice is to go for pregnancy with folic acid supplementation and to refer her to a neurologist. Folic acid can help reduce the risk of neural tube defects associated with phenytoin. Neurological consultation is essential for optimizing seizure control and medication management before and during pregnancy. Avoiding or delaying pregnancy may not be necessary with proper management. Increasing phenytoin dose without neurological input is not advisable.

Erythromycin and Metformin are generally considered safe for use in the first trimester. Gentamicin, doxycycline, and co-trimoxazole have potential risks and are generally avoided or used with caution.

The likely drug is a retinoid. Systemic retinoids, like isotretinoin, are known teratogens and can cause severe congenital abnormalities, including limb defects.

Sodium valproate has the highest teratogenicity among the listed antiepileptic drugs. It is associated with an increased risk of neural tube defects, developmental delay, and other congenital malformations.

The appropriate advice is that she will need to adjust the dose of thyroxin during pregnancy. Thyroid hormone requirements often increase during pregnancy, so dose adjustment is necessary. Regular monitoring of thyroid function is essential.

The most common drug causing abnormal limb development in this scenario is a retinoid, likely isotretinoin. Retinoids are known teratogens. The other options are generally not associated with this specific defect.

The most appropriate management is cardiac assessment. The patient has signs suggestive of an atrial septal defect (ASD). Cardiac assessment is crucial *before* pregnancy. Oral iron therapy is appropriate for the anemia, but the cardiac condition is the priority. Contraception and rubella vaccination can be addressed after the cardiac evaluation.

Unsafe drugs during pregnancy include enalapril and methotrexate. Digoxin, frusemide, and sildenafil are generally considered safe, with appropriate monitoring and indication.

Regarding antenatal surveillance: SFH *can* be used as a screening method for small for gestational age. Fetal movement is a component of the biophysical profile. Growth scans are offered selectively, not to every pregnancy. CTG is used to assess fetal well-being, not diagnose FGR. MCA Doppler studies are important in the *assessment* of FGR, not routine screening.

Teratogenic drugs include ACE inhibitors, isotretinoin, and lithium. Combined oral contraceptives and glibenclamide are not considered teratogenic.

Regarding antenatal care: A positive VDRL test *does* require treatment with penicillin. Dating scans are best performed between 11-13+6 weeks. Nuchal translucency is best measured between 11-13+6 weeks. Screening for HIV *is* recommended for all pregnant women in Sri Lanka. The triple test includes assessment of serum AFP, hCG, and estriol.

Sodium valproate is the most teratogenic of the listed drugs. It is associated with neural tube defects and other malformations. Carbamazepine, phenobarbitone, and phenytoin are also teratogenic but to a lesser extent. Diazepam and lamotrigine are generally considered to have a lower risk.

Regarding drugs used in pregnancy: ACE inhibitors *do* cause renal damage in the fetus. Glibenclamide *is* contraindicated. Heparin does *not* cross the placenta. Propylthiouracil *does* suppress fetal thyroid function. Warfarin *does* cause embryopathy, particularly in the first trimester, not primarily in the third.

The most important next management is IV broad-spectrum antibiotics. The clinical picture suggests sepsis following a missed abortion. Prompt antibiotic treatment is crucial. Induction of labor is necessary but secondary to controlling infection. LSCS is contraindicated in the presence of infection. Amniocentesis and blood culture are not the primary steps in this acute presentation.

The most appropriate management is to start aspirin and LMWH immediately. The patient has antiphospholipid syndrome (APS) and a history of both miscarriage and intrauterine death. Immediate anticoagulation and antiplatelet therapy are required. Starting at 12 weeks is too late, and unfractionated heparin is less convenient for long-term use.

Absolute indications for low-dose aspirin include antiphospholipid syndrome and previous death in utero. Pre-existing diabetes mellitus, previous history of PIH at 37 weeks of POA, and twin pregnancy are relative, not absolute, indications.