1) 137. A 32-year-old woman in her first pregnancy is seen at 28 weeks of gestation. She

has had a growth scan due to a symphysis fundal height measurement below

the 10th centile. The growth scan shows an EFW of <5th centile with normal

amniotic fluid volume and umbilical artery Doppler.

2) 139. An 18-year-old woman in her first pregnancy has a growth scan at 28 weeks

of gestation due to her high BMI of 37 kg/m2

. The growth scan shows an EFW

<10th centile. Amniotic fluid volume is normal and the umbilical artery Doppler

shows a raised pulsatility index of >2 standard deviations with end-diastolic flow

positive.

3) A  19-year-old primigravida with a BMI of 30  reports after her first trimester serum

screening and NT scan, which shows low PAPP–A.

4) A 42-year-old primigravida has come to discuss her antenatal care at 10 weeks of

gestation. She is concerned about the chances of her baby’s growth being subopti-

mal. Which of the following interventions will you offer her in this regard?

5) A 27-year-old second gravida is referred by her midwife for small dates on palpation

at 28 weeks gestation. Her BMI is 18. Her first trimester serum screening was negative.

In  her first pregnancy, she delivered a 4.8-pound (2177 g) baby at term. Ultrasound

shows all fetal parameters less than 5th centile with normal Doppler indices.

6) A  28-year-old second gravida attends the antenatal clinic after her anomaly scan at

20 weeks, which shows symmetrical IUGR and normal fetal anatomy. The fetal bowel

appears echogenic uterine artery Doppler is normal. She  has not  had any antenatal

visits earlier in the current pregnancy. Her first pregnancy ended with spontaneous

miscarriage at 16 weeks gestation.

7) 108. A woman is referred from the antenatal clinic with reduced fetal movements at

29 weeks of gestation. Computerised CTG (cCTG) is normal with a short-term

variation (STV) of 8 ms. Ultrasound shows an estimated fetal weight plotting

below the 10th centile, with reversed end-diastolic flow in the umbilical artery.

Middle cerebral artery (MCA) Doppler and ductus venosus Doppler are normal.

She was given a course of steroids 2 weeks previously for a threatened preterm

labour.

What is the recommended management?

8) A 34-year-old primigravida presents at 35 weeks gestation with reduced perception of

fetal movements. She is a non-smoker with a BMI of 27 and clinically small for dates

baby. Ultrasound reports fetal biometry uniformly less than the 2nd percentile, amniotic

fluid index of 6, and umbilical artery Doppler shows a reversed end diastolic flow.

For answers, see 2.26

9) ANC64

Which of the following is a major risk factor for developing an SGA fetus?

10) 136. A 28-year-old woman has a growth scan as her previous baby was born with a

weight below the 5th centile. She is now at 28 weeks of gestation. The growth

scan for obstetric history shows that the estimated fetal weight (EFW) is on

the 50th centile. Amniotic fluid volume and umbilical artery Doppler are

normal.

11) 138. A 26-year-old patient is seen in the antenatal clinic. She is at 29 + 5 weeks of

gestation and has a symphysis fundal height below the 10th centile. She has an

ultrasound scan that shows EFW below the 5th centile and a normal amniotic

fluid volume with absent end-diastolic flow in the umbilical artery. The CTG is

normal.