Quiz 2: Assessment of Foetal Growth

Question 1

Which of the following statements about intra-uterine growth restriction is correct?

The cause of severe intra-uterine growth restriction is usually unknown.

Both maternal and fetal factors may cause intra-uterine growth restriction.

Primary placental insufficiency is a common cause of intra-uterine growth restriction.

Poor maternal weight gain during pregnancy is of great value in the diagnosis of intra-uterine growth restriction.

Answer 1

Both maternal and fetal factors may cause intra-uterine growth restriction.

Question 2

Which of the following is the best clinical method of determining uterine growth between 18 and 36 weeks of pregnancy?

An abdominal examination

The distance in centimetres between the upper edge of the symphysis pubis and the fundus of the uterus

Serial ultrasound examinations at each antenatal visit

The abdominal circumference measured with a tape at each antenatal visit

Answer 2

The distance in centimetres between the upper edge of the symphysis pubis and the fundus of the uterus

Question 3

Which of the following symphysis-fundus height measurements suggests intra-uterine growth restriction?

A slowing of the symphysis-fundus growth until 2 measurements are below the 10th centile

A slowing of the symphysis-fundus growth until one measurement is below the 10th centile

2 measurements the same irrespective of their positions on the centile lines

A measurement that is less than that recorded two visits before and falls below the 10th centile

Answer 3

A slowing of the symphysis-fundus growth until one measurement is below the 10th centile

Question 4

With severe intra-uterine growth restriction, the difference between the gestational age and the symphysis-fundus height measurement is:

2 weeks or more
3 weeks or more
4 weeks or more
5 weeks or more

Answer 4

4 weeks or more

Question 5

If the symphysis-fundus measurement suggests intra-uterine growth restriction at 32 weeks gestation, what is the correct management?

A vaginal examination must be done to determine whether the patient’s cervix is favourable for an induction.

The patient must return to the antenatal clinic at 36 weeks.

Fetal heart rate monitoring must be done at each antenatal visit.

The patient must be transferred to a level 2 hospital for a Doppler umbilical artery blood flow measurement.

Answer 5

The patient must be transferred to a level 2 hospital for a Doppler umbilical artery blood flow measurement.

Question 6

The fetal condition can best be determined during the antenatal period by:

Weighing the patient at every antenatal visit

Measuring the patient’s blood pressure

Counting the fetal heart rate

Counting fetal movements

Answer 6

Counting fetal movements

Question 7

During the antenatal period it is essential to determine the fetal condition from:

36 weeks
34 weeks
28 weeks
24 weeks

Answer 7

28 weeks

Question 8

Which of the following statements about fetal movements is correct?

The date when fetal movements are first felt is a good indication of the gestational age.

Good fetal movements do not necessarily indicate fetal wellbeing.

From 28 weeks, all patients should be told about the importance of fetal movements.

A decrease in fetal movements always indicates that the fetus is distressed.

Answer 8

From 28 weeks, all patients should be told about the importance of fetal movements.

Question 9

Which patients should use a fetal movement chart?

All patients, where there is reason to be worried about the fetal condition

All primigravidas

All pregnant patients from 28 weeks gestation

All patients who have had a previous Caesarean section

Answer 9

All patients, where there is reason to be worried about the fetal condition

Question 10

When will you be worried that a patient may have a decreased number of fetal movements?

15–20 movements per hour

10–15 movements per hour

5–10 movements per hour

Half as many fetal movements as previously counted

Answer 10

Half as many fetal movements as previously counted

Question 11

What would you advise if a patient felt only a few fetal movements during an hour?

The patient must go to her nearest clinic immediately and report that her fetus is only moving a little.

The patient should lie on her side for a further hour and count the fetal movements.

The patient should repeat the fetal movement count in the afternoon.

Antenatal fetal heart rate monitoring is indicated and, therefore, she must report to her nearest hospital.

Answer 11

The patient should lie on her side for a further hour and count the fetal movements.

Question 12

What management would be correct if a patient with reduced fetal movements presents at a hospital that does not have a cardiotocograph (CTG machine)?

The responsible doctor must see the patient immediately as a Caesarean section should be done.

Refer the patient urgently to a hospital that has a cardiotocograph.

Exclude the possibility of fetal death by listening for the fetal heart with a Doppler fetal heart rate monitor.

Fetal movements must be counted again the next day.

Answer 12

Exclude the possibility of fetal death by listening for the fetal heart with a Doppler fetal heart rate monitor.

Question 13

How should a doctor manage a patient which has decreased fetal movements and a viable fetus, without any signs of intra-uterine growth restriction? The duration of pregnancy is 36 weeks.

If the cervix is favourable for induction of labour, the membranes must be ruptured and the fetal heart must be monitored carefully.

An emergency Caesarean section must be performed immediately, irrespective of the state of the cervix.

If the cervix is unfavourable, a medical induction of labour, using prostaglandin E2, must be performed.

Delivery to only take place in a level 2 hospital with neonatal intensive care unit or a level 3 hospital.

Answer 13

If the cervix is favourable for induction of labour, the membranes must be ruptured and the fetal heart must be monitored carefully.

Question 14

Which of the following statements about antenatal fetal heart rate monitoring is correct?

Fetal heart rate monitoring should be done on all patients with pre-eclampsia, as fetal movements in these patients are an unreliable method of assessing the condition of the fetus.

All pregnant patients should routinely have antenatal fetal heart rate monitoring.

Antenatal fetal heart rate monitoring should be done on all patients with suspected intra-uterine growth restriction.

Antenatal fetal heart rate monitoring should be done on high-risk patients where fetal movements have not been shown to be a reliable method of assessing the fetal condition, such as insulin-dependent diabetics, prelabour rupture of the membranes and pre-eclampsia which is being managed conservatively.

Answer 14

Antenatal fetal heart rate monitoring should be done on high-risk patients where fetal movements have not been shown to be a reliable method of assessing the fetal condition, such as insulin-dependent diabetics, prelabour rupture of the membranes and pre-eclampsia which is being managed conservatively.

Question 15

If there is a non-reactive fetal heart rate pattern:

No decelerations occur despite uterine contractions.

Fetal distress should be suspected and intra-uterine resuscitation must be undertaken.

The test must be repeated after 45 minutes.

The variability must be assessed to determine the presence or absence of fetal wellbeing.

Answer 15

The variability must be assessed to determine the presence or absence of fetal wellbeing.

Question 16

Why must you repeat the test 45 minutes after a non-reactive fetal heart rate pattern, with poor variability, is obtained?

Supine hypotension or spontaneous hyperstimulation of the uterus may be present.

Such a fetal heart rate pattern indicates fetal distress and the test must be repeated immediately.

A sleeping fetus may produce a non-reactive fetal heart rate pattern with poor variability.

Cardiotocography must be repeated after 45 minutes whenever the fetal heart rate pattern indicates fetal distress.

Answer 16

A sleeping fetus may produce a non-reactive fetal heart rate pattern with poor variability.

Question 17

Which of the following results indicates an abnormal stress test?

No decelerations after 2 contractions that last at least 30 seconds each

Uterine contractions with late decelerations

A fetal tachycardia with a baseline rate above 160 beats per minute

No accelerations

Answer 17

Uterine contractions with late decelerations

Question 18

Which of the following indicates a late deceleration on a cardiotocogram?

The trough of the deceleration occurs at least 60 seconds after the peak of the contraction.

The trough of the deceleration occurs at least 45 seconds after the peak of the contraction.

The trough of the deceleration occurs at least 30 seconds after the peak of the contraction.

A deceleration during a contraction that takes 30 seconds or more after the end of the contraction to return to the baseline.

Answer 18

The trough of the deceleration occurs at least 30 seconds after the peak of the contraction.

Question 19

Which form of management will be correct if a fetal heart rate pattern, which indicates fetal distress, is obtained?

As the test result may be falsely abnormal due to postural hypotension or overstimulation of the uterus, these possibilities must first be ruled out.

Repeat the stress test on the same day.

Repeat the stress test 4 hours later.

Perform an immediate Caesarean section.

Answer 19

As the test result may be falsely abnormal due to postural hypotension or overstimulation of the uterus, these possibilities must first be ruled out.

Question 20

What is the correct method of intra-uterine resuscitation?

Suppressing uterine contractions and decreasing the uterine tone

Administering oxygen to the fetus by means of an intra-uterine catheter

Infusing oxytocin in order to stimulate uterine contractions

Rubbing the patient’s nipples so as to stimulate uterine contractions

Answer 20

Suppressing uterine contractions and decreasing the uterine tone