Question

A 36-year-old G1 woman presents at 36 weeks gestation. She had early prenatal care and is dated by an eight week ultrasound. Her medical history is significant for hypertension for eight years and class F diabetes for five years (baseline proteinuria = 1 g). She smokes two cigarettes per day. At her 32 week visit, her fundal height was 28 cm. This prompted an ultrasound at 33 weeks gestation, which revealed biometry consistent with 31-3/7, estimated fetal weight 1827 g, 25th percentile. Today, ultrasound reveals limited fetal growth over the past three weeks. Biometry is consistent with 31-5/7, estimated fetal weight 1900 g, 2nd percentile.

What is the most likely cause of this growth restriction?
A) Congenital anomaly

B) Tobacco use

C) Uteroplacental insufficiency

D) Perinatal infection

E) Genetic factors

Answer 1

Step-by-step explanation:

Based on the information provided, the most likely cause of the fetal growth restriction in this case would be C) Uteroplacental insufficiency.

Uteroplacental insufficiency refers to inadequate blood flow and oxygen supply to the placenta, which can result in restricted fetal growth. Several factors in the patient's medical history contribute to this possibility:

1. Hypertension: Chronic hypertension can affect blood vessels and reduce blood flow to the placenta, limiting the oxygen and nutrients available to the growing fetus.

2. Class F diabetes: Diabetes can lead to vascular complications, including damage to the blood vessels supplying the placenta. This can result in reduced blood flow and inadequate nutrient delivery to the fetus.

3. Baseline proteinuria: Proteinuria, the presence of excessive protein in the urine, is a sign of kidney damage. Kidney dysfunction can contribute to impaired blood flow and nutrient supply to the fetus.

While smoking (choice B) is a known risk factor for fetal growth restriction, the patient's smoking habit of only two cigarettes per day is relatively low compared to heavy smoking. Although smoking can contribute to reduced fetal growth, it is less likely to be the primary cause in this case.

Congenital anomalies (choice A), perinatal infection (choice D), and genetic factors (choice E) are less likely to be the primary causes of the observed growth restriction in this patient, given the history of uteroplacental insufficiency risk factors and the absence of specific indications pointing towards these factors.

It's important to note that only a healthcare professional can provide an accurate diagnosis and determine the exact cause of the growth restriction based on a comprehensive evaluation of the patient's medical history, clinical examination, and further diagnostic tests.