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Test 2: Assessment of fetal growth and condition during pregnancy

  1. What is normal fetal growth?
    • Will be present if a patient gains weight during pregnancy.
    • The fetal weight is within the expected range of the duration of the pregnancy.
    • Can only be accurately assessed by regular ultrasound assessment.
    • Will be present if the amount of liquor is normal.
  2. Which of the following maternal factors can cause intra-uterine growth restriction?
    • Tobacco smoking.
    • Alcohol intake.
    • Pre-eclampsia.
    • All of the above.
  3. 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.
  4. 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.
    • Recording the fetal heart rate at each antenatal visit.
    • The abdominal circumference measured with a tape at each antenatal visit.
  5. The ability to detect abnormalities in symphysis-fundus growth is improved if:
    • More persons are involved in assessing patients at antenatal visits.
    • Patients are also weighed at each antenatal visit.
    • The same person sees the patient at every antenatal visit.
    • Ultrasound examinations are done at every second visit.
  6. Which of the following symphysis-fundus height measurements is used to screen for intra-uterine growth restriction?
    • A slowing of the symphysis-fundus growth until two measurements are below the 10th centile.
    • A slowing of the symphysis-fundus growth until one measurement is below the 10th centile.
    • Two 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.
  7. 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.
  8. Does descent of the presenting part affect your interpretation of the symphysis-fundus growth?
    • Yes, after 36 weeks with progressively less fetal head palpable above the pelvic inlet the criteria to diagnose intra-uterine restriction will no longer be valid.
    • No, the curve is designed to take descent of the presenting part into account.
    • No, as it is no longer necessary to palpate the amount of fetal head palpable above the pelvic inlet once it has been established that it is not a breech presentation at 34 weeks.
    • No, as palpation of the amount of fetal head above the pelvic inlet is inaccurate.
  9. What action is required if the symphysis-fundus height measurement at a gestational age of 30 weeks suggests intra-uterine growth restriction?
    • Patients who smoke should stop smoking.
    • Give advice about a high-energy diet and if necessary food parcels.
    • Careful attention must be given to counting fetal movements.
    • All of the above.
  10. 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.
  11. What should be done if measures to improve symphysis-fundus growth were unsuccessful?
    • Nothing as the fetus is small but healthy.
    • With moderate intra-uterine growth restriction and good fetal movements delivery at 38 weeks should be considered.
    • The patient can continue to smoke and no further action is required.
    • Pre-eclampsia can be excluded as intra-uterine growth restriction and pre-eclampsia never occur together.
  12. 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.
  13. During the antenatal period it is essential to determine the fetal condition from:
    • 36 weeks.
    • 34 weeks.
    • 28 weeks.
    • 24 weeks.
  14. 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.
    • All patients should be told about the importance of fetal movements.
    • A decrease in fetal movements always indicates that the fetus is distressed.
  15. 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.
  16. When during the day would you advise a patient to count fetal movements?
    • Fetal movement should be counted and recorded for a period of an hour per day after breakfast.
    • Fetal movement should be counted and recorded for a period of an hour per day before breakfast.
    • Fetal movement should be counted and recorded for a period of an hour per day after lunch.
    • Fetal movement should be counted and recorded for a period of an hour per day after supper.
  17. How would you advise a patient to count fetal movements?
    • She should preferably do it together with other work as physical activity stimulates the fetus to move.
    • She should preferably do it while resting on her side.
    • She should preferably do it while lying flat on her back.
    • While commuting to work in a taxi.
  18. 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.
  19. 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.
  20. 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.