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?

A. Amniotic fluid volume, umbilical artery Doppler systolic: diastolic ratio, non-stress test
B. Daily fetal kick counts with follow up ultrasound to reassess fetal growth in one week
C. Amniocentesis for fetal lung maturity
D. Twice daily fetal kick counts with delivery at 37 weeks gestation
E. None, delivery is indicated

Answer 1

The correct test to manage a pregnancy with signs of IUGR at 35 weeks gestation is the combination of amniotic fluid volume, umbilical artery Doppler systolic: diastolic ratio, and a non-stress test to assess fetal well-being and potential placental insufficiency.

Step-by-step explanation:

A 36-year-old female at 35 weeks gestation with a history of hypertension and type 2 diabetes has shown limited fetal growth over the past three weeks, with biometry corresponding to 32-5/7 weeks and estimated fetal weight (EFW) being <10th percentile. Considering these signs of intrauterine growth restriction (IUGR), the most appropriate next test indicated in the management of this patient would be A. Amniotic fluid volume, umbilical artery Doppler systolic: diastolic ratio, non-stress test. These tests together would assess the well-being of the fetus, check for signs of placental insufficiency, and monitor for potential asphyxia.

The amniotic fluid volume would inform us about the amniotic fluid index (AFI) which is essential for fetal health. The umbilical artery Doppler helps to identify any impedance to blood flow, which could signal placental insufficiency. Lastly, a non-stress test (NST) will record fetal heart rates and movements, providing further evidence of fetal distress or well-being.