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Test 2: Assessment of fetal growth and condition during pregnancy

  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.
  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
  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
  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
  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.
  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
  7. During the antenatal period it is essential to determine the fetal condition from:
    • 36 weeks
    • 34 weeks
    • 28 weeks
    • 24 weeks
  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.
  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
  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
  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.
  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 stethoscope.
    • Fetal movements must be counted again the next day.
  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.
  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.

    (Questions 15 to 20 need only be answered by students who studied sections 2-27 to 2-37 on antenatal fetal heart rate monitoring.)

  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.
  16. Why must you repeat the test 45 minutes after a non-reactive fetal heart rate pattern, with poor beat-to-beat 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 beat-to-beat variability.
    • Cardiotocography must be repeated after 45 minutes whenever the fetal heart rate pattern indicates fetal distress.
  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
  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.
  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.
  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