Question

A 36-year-old female G1 presents for her prenatal care visit at 35 weeks gestation. She has good dating criteria that were confirmed by a first trimester ultrasound. Her previous medical history is positive for hypertension and type 2 diabetes. You have been following fetal growth with serial ultrasounds. At this visit, ultrasound reveals limited fetal growth over the past three weeks. Biometry is consistent with 32-5/7, EFW 2175 g, <10th percentile. What is the most appropriate next test indicated in the management of this patient?

1) Amniotic fluid volume, umbilical artery Doppler systolic: diastolic ratio, non-stress test
2) Daily fetal kick counts with follow up ultrasound to reassess fetal growth in one week
3) Amniocentesis for fetal lung maturity
4) Twice daily fetal kick counts with delivery at 37 weeks gestation
5) None, delivery is indicated

Answer 1

The appropriate next step for a 35-week pregnant woman with a 32-week size fetus and IUGR is to perform amniotic fluid volume assessment, umbilical artery Doppler, and a non-stress test to ensure fetal well-being.

Step-by-step explanation:

In a 35 weeks gestation pregnant woman with a history of hypertension and type 2 diabetes, an ultrasound revealing limited fetal growth consistent with intrauterine growth restriction (IUGR) prompts further assessment. Given the circumstances, the most appropriate next test to evaluate the well-being of the fetus would be combined testing, which includes: amniotic fluid volume assessment, umbilical artery Doppler for systolic to diastolic ratio, and a non-stress test (NST). These tests can provide valuable information regarding the placental function, fetal oxygenation, and overall fetal health. An amniocentesis could be considered to assess fetal lung maturity if the decision to deliver prematurely is being contemplated. However, it is not the immediate next step before completing the combined testing. Fetal kick counts are a form of self-monitoring for fetal activity and well-being but would not suffice given the history and ultrasound findings of IUGR.