MCQ Obstetrics Answer 33

The correct answer is B.

Fundal height measurement is a portion of the physical examination that should be performed routinely during prenatal care. It is performed by placing a measuring tape on the pubic symphysis and measuring to the top of the fundus. Between the gestational ages of 18 to 34 weeks, there is a rough correlation between weeks of gestation and fundal height in centimeters. For example, a woman at 26 weeks' gestation should have a fundal height that is roughly 26 centimeters. This patient is at 30 weeks' gestation and has a fundal height of 27 centimeters.

Furthermore, and perhaps more importantly, there has been no change in the fundal height over the past four weeks. These findings are concerning for intrauterine growth restriction (IUGR). IUGR is a disorder in which the fetus is not growing appropriately. It is most commonly defined as an estimated fetal weight less than the 10th percentile for a given gestational age. Given that this patient's fundal height does not appear to have increased over the past 4 weeks and that it is 3 centimeters less than expected, IUGR is of concern and this patient should be sent for an ultrasound to evaluate fetal size.

This patient is unlikely to have an inaccurate estimated date of delivery (due date) (choice A) because her due date was determined by a 7-week ultrasound. Ultrasound dating of a pregnancy is more accurate the earlier in pregnancy that it is performed and a 7-week ultrasound is considered excellent for establishing a due date.

Premature labor (choice C) would not be a concern in this patient with no contractions and no other symptoms.

A twin gestation (choice D) should have been seen on the 7-week ultrasound. Furthermore, a fundal height that is less than the gestational age would predict makes twins less likely.

Uterine cancer (choice E) is very uncommon during pregnancy and would not be expected to present as decreased fundal height.

Category: Obstetrics MCQs