FETAL GROWTH REVIEWER Flashcards
G1P0 recovered from a severe COVID-19 infection at 14 weeks of gestation. Fetal biometry at 28 weeks showed EFW at the 3rd percentile, AC at the 10th percentile, HC at the 10th percentile, and SVP at 2.2cm. Doppler studies showed normal indices of the umbilical artery and middle cerebral artery. A nonstress test was reactive. Which of the following is recommended?
A. Induction of labor at 37 weeks
B. Repeat fetal monitoring every 2 weeks
C. Antenatal steroids then deliver
D. Amino acid supplementation
A. Induction of labor at 37 weeks
High-Yield Rationale:
Weekly Umbilical Artery Doppler is performed.
If consistently normal, delivery is considered at 38-39 weeks (can be extended to less frequent intervals).
If abnormal, delivery may be needed earlier.
Which of the following conditions is associated with asymmetric fetal growth restriction?
A. Transverse presentation
B. Gestational diabetes mellitus
C. Chromosomal abnormalities
D. Chronic hypertension
D. Chronic hypertension
High-Yield Rationale:
Asymmetrical IUGR follows a late pregnancy insult such as placental insufficiency due to chronic hypertension.
Why the other choices are incorrect:
A. Transverse presentation – Not a cause of IUGR.
B. Gestational diabetes mellitus – Causes macrosomia, not IUGR.
C. Chromosomal abnormalities – Associated with symmetrical IUGR.
A 33-year-old G4P3 (3003) with preeclampsia with severe features had an ultrasound showing EFW at the 5th percentile, with a 105g interval weight gain in 10 days, HC at the 25th percentile, AC at the 9th percentile, and SVP at 1.5cm. Biophysical profile showed no fetal gross trunk movements and no fetal extremity extension/flexion, but 2 fetal breathing movements in 30 minutes. CTG is shown below.
What is the recommended management?
A. Deliver
B. No fetal indication for intervention at this time
C. Repeat testing per protocol
D. Repeat testing the same day then deliver if BPS <6/10
A. Deliver
High-Yield Rationale:
Fetal compromise is present (EFW < 10th percentile, abnormal BPP).
Immediate delivery is required for fetal well-being.
Why the other choices are incorrect:
B. No fetal indication for intervention – Incorrect, fetal compromise is evident.
C. Repeat testing per protocol – Delayed intervention risks fetal demise.
D. Repeat testing the same day then deliver if BPS <6 – BPS already suggests fetal distress, necessitating immediate delivery.
The term small-for-gestational-age (SGA) is used to designate newborns whose birth weight is less than what percentile?
A. 15%
B. 3%
C. 10%
D. 5%
C. 10%
High-Yield Rationale:
SGA = Birth weight below the 10th percentile for gestational age.
A G4P0 (0030) with antiphospholipid antibody syndrome was diagnosed with asymmetric fetal growth restriction. Doppler at 34+2 weeks showed umbilical artery with absent end-diastolic flow, middle cerebral artery with brain-sparing effect. What is the recommended management?
A. Give antenatal steroids then deliver
B. Repeat sonography for fetal growth every 2 weeks
C. Continue fetal surveillance until 38 weeks then deliver
D. Perform emergency delivery
A. Give antenatal steroids then deliver
High-Yield Rationale:
Absent end-diastolic flow is an indication for immediate delivery after antenatal steroid administration to enhance fetal lung maturity.
Delay in delivery increases the risk of fetal hypoxia and stillbirth.
A neonate weighing 4600g was delivered via low segment cesarean section to a 37-year-old G1P1 with gestational diabetes. Which of the following complications should be anticipated?
A. Vaginal lacerations
B. Shoulder dystocia
C. Postpartum hemorrhage
D. Uterine rupture
C. Postpartum hemorrhage
High-Yield Rationale:
Uterine overdistension due to fetal macrosomia leads to uterine atony, increasing postpartum hemorrhage (PPH) risk.
Why the other choices are incorrect:
A. Vaginal lacerations – Associated with operative vaginal deliveries (forceps, vacuum).
B. Shoulder dystocia – More common in vaginal delivery, not CS.
D. Uterine rupture – More common with classical incisions, not low segment CS.
A 38-year-old G5P4 (4004) with overt diabetes had an ultrasound at 34 weeks showing EFW at the 92nd percentile, AC at the 90th percentile, and AFI of 27.5cm. What is the likely etiology of these findings?
A. Multiparity
B. Advanced maternal age
C. Overt diabetes
D. Polyhydramnios
C. Overt diabetes
High-Yield Rationale:
Diabetes mellitus is a major risk factor for fetal macrosomia (>4000g birth weight).
Hyperglycemia → Fetal hyperinsulinemia → Increased fat deposition and excessive growth.
A fetus with symmetric growth restriction at 28 weeks had a BPS of 6/10, an SVP of 1.7cm, increased umbilical artery indices, and normal middle cerebral artery indices. What is the recommended management?
A. Repeat testing the same day and deliver if BPS <6
B. No fetal indication for intervention
C. Deliver immediately
D. Observe and repeat testing per protocol
A. Repeat testing the same day and deliver if BPS <6
High-Yield Rationale:
BPS of 6/10 with abnormal umbilical artery Doppler suggests fetal compromise.
Delivery is indicated if fetal well-being continues to deteriorate.
Which of the following ultrasound findings suggests asymmetric growth restriction?
A. Abdominal circumference bigger than head circumference
B. All biometric parameters <10th percentile for gestational age
C. Head circumference bigger than abdominal circumference
D. EFW at the 15th percentile for gestational age
C. Head circumference bigger than abdominal circumference
High-Yield Rationale:
Asymmetric IUGR: Head-sparing phenomenon → Head circumference remains normal, but abdominal circumference is reduced due to placental insufficiency.
Why the other choices are incorrect:
A. Abdominal circumference bigger than head circumference – Opposite of correct answer.
B. All biometric parameters <10th percentile – Suggests symmetrical IUGR.
D. EFW at the 15th percentile – Not diagnostic for IUGR (IUGR is <10th percentile).
A G4P0 with chronic hypertension had an EFW < 10th percentile at 26 weeks. Repeat biometry at 28 weeks showed: EFW at 8th percentile with 90g interval weight gain, AC at 5th percentile, HC at 25th percentile. What is the impression?
A. Growth appropriate for gestational age
B. Constitutionally small for gestational age
C. Asymmetric fetal growth restriction
D. Symmetric fetal growth restriction
C. Asymmetric fetal growth restriction
High-Yield Rationale:
Asymmetric IUGR occurs due to placental insufficiency, commonly caused by chronic hypertension.
Hallmark feature: AC <10th percentile while HC is preserved (head-sparing effect).
What is the most commonly used definition of intrauterine growth restriction (IUGR) in terms of estimated fetal weight (EFW)?
A. < 5th percentile
B. < 3rd percentile
C. < 10th percentile
D. < 15th percentile
C. < 10th percentile
High-Yield Rationale:
IUGR definition: Birth weight < 10th percentile for gestational age.
Differentiation:
SGA (Small-for-Gestational-Age): Normal variant if growth velocity, placental function, and Dopplers are normal.
Pathologic IUGR: Associated with abnormal growth patterns and Doppler findings.
What is the definition of fetal macrosomia?
A. EFW > 92nd percentile for age
B. EFW > 90th percentile for age
C. EFW > 95th percentile for age
D. EFW > 97th percentile for age
B. EFW > 90th percentile for age
High-Yield Rationale:
Macrosomia threshold: EFW > 90th percentile for gestational age.
ACOG definition: ≥ 4,500 grams at birth.
Repeat biometry at 28 weeks showed EFW at the 8th percentile, 90g interval weight gain, AC at 5th percentile, HC at 25th percentile. Doppler ultrasound showed:
Umbilical artery: Increased resistance indices
Middle cerebral artery: Decreased resistance indices
What is the impression?
A. Symmetric fetal growth restriction with brain-sparing
B. Asymmetric fetal growth restriction without brain-sparing
C. Symmetric fetal growth restriction without brain-sparing
D. Asymmetric fetal growth restriction with brain-sparing
D. Asymmetric fetal growth restriction with brain-sparing
High-Yield Rationale:
Asymmetrical IUGR hallmark: AC <10th percentile, HC preserved → due to placental insufficiency (e.g., chronic hypertension).
Brain-sparing effect:
Increased umbilical artery resistance → placental insufficiency.
Middle cerebral artery dilation → Compensation to direct blood flow to the brain.
Loss of brain-sparing effect is a pre-terminal event.
A G1P0 with gestational diabetes underwent ultrasound at 36 weeks, showing:
AC at the 95th percentile for gestational age
EFW at the 90th percentile for gestational age
What is the recommended management?
A. Immediate cesarean section
B. Induction of labor at 37 weeks
C. Observe and await spontaneous labor
D. Elective cesarean section at 38 weeks
C. Observe and await spontaneous labor
High-Yield Rationale:
If EFW >90th percentile but no complications, spontaneous labor can be awaited.
Early intervention (induction or CS) is only warranted if:
Fetal macrosomia >4500g
Maternal complications (e.g., GDM with poor glycemic control, prior shoulder dystocia, fetal distress).
Second trimester fetal growth is characterized by:
A. Predominantly cellular hypertrophy
B. Both cellular hyperplasia and hypertrophy
C. Predominantly cellular hyperplasia
D. None of the choices is correct
B. Both cellular hyperplasia and hypertrophy
High-Yield Rationale:
Cellular hyperplasia → First 16 weeks
Cellular hyperplasia + hypertrophy → Until 32 weeks
Cellular hypertrophy → After 32 weeks, fetal mass increases primarily by hypertrophy
📖 Source: Williams Obstetrics, p. 823
Which of the following newborns has macrosomia?
A. All choices are correct
B. Birthweight 3SD above the mean
C. Birthweight at 97th percentile for age
D. Birthweight 4800 grams
A. All choices are correct
High-Yield Rationale:
Macrosomia Criteria:
Birth weight >90th percentile for age
>4500g at birth (ACOG definition)
>97th percentile = 2SD from mean (~4500g at 39 weeks)
📖 Source: Williams Obstetrics, p. 832-833
An 18-year-old G1P0 with rubella infection at 10 weeks was noted to have the following findings at 28 weeks:
EFW at 8th percentile
Decreased HC and AC
Normal AFI and umbilical artery Doppler
What is the impression?
A. Symmetrical growth restriction
B. Asymmetrical growth restriction
C. Normal fetal growth
D. Fetal overgrowth
A. Symmetrical growth restriction
High-Yield Rationale:
Symmetrical IUGR occurs when the fetus is proportionally small (HC & AC both reduced).
Etiology: Early teratogenic exposure (e.g., rubella) affects cell number → generalized fetal reduction.
A 31-week AOG fetus was noted to have asymmetric growth restriction, normal AFI, increased umbilical artery resistance indices, and normal CTG.
What is the recommended management?
A. Give steroids then deliver
B. Await spontaneous delivery
C. Repeat Doppler after 1 week
D. Emergency cesarean delivery
C. Repeat Doppler after 1 week
High-Yield Rationale:
Umbilical artery Doppler should be done every 1-2 weeks to monitor deterioration.
Delivery is considered if Doppler shows worsening blood flow (e.g., absent/reversed end-diastolic flow).
A fetus with chromosomal anomaly is noted to have EFW at 8th percentile for gestational age.
Which of the following fetal biometry findings is expected?
A. Decreased HC / decreased AC
B. Decreased HC / normal AC
C. Normal HC / normal AC
D. Normal HC / decreased AC
A. Decreased HC / decreased AC
High-Yield Rationale:
Chromosomal anomalies typically cause symmetrical IUGR → both HC and AC are reduced.
A G1P0 with severe preeclampsia had:
EFW at 8th percentile
SVP 1.8 cm
BPP: 2 fetal breathing, 4 fetal gross movements, 2 limb flexions
NST reactive
What reflects the fetal status at this time?
A. Possible fetal asphyxia
B. Normal non-asphyxiated fetus
C. Chronic fetal asphyxia suspected
D. Almost certain fetal asphyxia
C. Chronic fetal asphyxia suspected
High-Yield Rationale:
BPP Score: 8/10 with decreased AFI (SVP 1.8cm) → Chronic Fetal Asphyxia Suspected
Normal AFI = 2-8cm.
Which of the following best differentiates true (pathologic) fetal growth restriction from small for gestational age?
A. Fetal growth of 5g/day in the second trimester
B. Fetal abdominal circumference <10th percentile for gestational age
C. Umbilical artery Doppler resistance indices within normal range
D. Fetal weight <10th percentile for age
B. Fetal abdominal circumference <10th percentile
High-Yield Rationale:
FGR is diagnosed based on:
Abdominal circumference <10th percentile
Growth velocity assessments
Umbilical artery Doppler changes
SGA infants may be constitutionally small but with normal growth velocity & Dopplers.
A monochorionic-diamniotic twin pregnancy at 34 weeks had the following ultrasound findings:
Twin A (Breech): EFW appropriate for gestational age
Twin B (Cephalic): EFW <10th percentile for age
Both SVP normal
What is the next BEST step?
A. Follow up every 2 weeks
B. Expectant management up to 37 weeks
C. Doppler velocimetry, NST, BPS
D. Deliver now by CS
C. Doppler velocimetry, NST, BPS
High-Yield Rationale:
Fetal growth restriction in twin pregnancies requires close monitoring with Doppler, BPS, and NST.
Delivery is indicated only if worsening Doppler findings occur.
Which of the following findings is suggestive of preferential shunting of oxygen and nutrients to the brain in a growth-restricted fetus?
A. Increased resistance to uterine artery
B. Absent fetal heart rate variability
C. Decreased resistance in middle cerebral artery
D. Amniotic fluid index of 4.0 cm
C. Decreased resistance in middle cerebral artery
High-Yield Rationale:
Brain-sparing effect occurs as the middle cerebral artery dilates to maintain oxygen supply to the brain in response to placental insufficiency.
An 18-year-old G1P0 with rubella infection at 10 weeks was noted to have fetal growth restriction at 29 weeks.
What is the most likely cause?
A. Young age
B. Primiparity
C. Rubella infection
D. All choices are correct
C. Rubella infection
High-Yield Rationale:
Rubella and CMV are teratogenic infections associated with symmetrical FGR.
A 30-year-old G1P0 at 30 weeks AOG had a fundal height of 25cm. What is the next BEST step?
A. Request congenital anomaly scan
B. Do abdominal palpation
C. Establish gestational age
D. Repeat fundal height measurement
C. Establish gestational age
High-Yield Rationale:
Correct gestational age must be confirmed first before diagnosing FGR.
What is the recommended management for fetal growth restriction diagnosed at 23 weeks AOG?
A. Terminate pregnancy
B. Await spontaneous delivery
C. Repeat sonography every 3-4 weeks
D. Give steroids then deliver
C. Repeat sonography every 3-4 weeks
High-Yield Rationale:
Early-onset FGR requires serial growth scans every 3-4 weeks to monitor progression.
