Fetal Growth Williams Study Guide 23, 24.

25 ed

1 In the diagram below, fetal growth rates are depicted. Which of

the following iscorrect?
a. 10 g/d at 15 weeks' gestation
b. 10to 15 g/d at 24 weeks' gestation
c. 20 to 30 g/d at 35 weeks' gestation
d. 30 to 35 g/d at 34 weeks' gestation

2. Which of the following is a risk factor for poor fetal growth?

a. Malaria
b. Tuberculosis
c. Cytomegalovirus
d. Allof the above

3. Which of the following statements is closely associated with the characteristics of

human fetal growth?
a. Needa narrow pelvis to walk upright
b. A large head is needed for a large brain
c. The ability to growth restrict may be adaptive
d. All of the above

and
4. Referencing the graphic below, what can be said about dating
ultrasonography in obstetrics?
a. Postterm birthweights were relatively lower using menstrual
dating.
b. Best obstetric estimates were mainly based on menstrual dating.
the use of best obstetric
C. Preterm birthweights were overestimated prior to
estimates.
d. All of the above
differentiated?
5. How is symmetrical versus asymmetrical growth restriction
small.
a. Symmnetrically growth restricted fetuses were proportionately
ratio is used to differentiate
b. The abdominal circumference to head circumference
between the two.
lagging head
c. Asymmetrically growth restricted fetuses had a disproportionately
compared with abdominal growth.
d. All of the above
sparing and growth
6. Which of the following statements is true regarding brain
restriction?
restricted fetuses.
a. Brain sparing is restricted to symmetrically growth
b. With limited nutrients, there is preferential shunting of oxygen and nutrients
to the brain.
growth restricted infant, brain sparing is
C. During the last 12 weeks of growth in the ofthe normal 2:1.
demonstrated by a brain-to-liver weight ratio of 3:1instead

laag Pa
 d. Allofthe above
7 Growing evidence suggests that fetal growth restriction
especially which of the following?
affects organ development,
a. Brain
b. Heart
c. Kidney
d Thyroid
8 Risk factors for impaired fetal growth are divided into mother, fetus,
and placenta.
Which of the following is a common risk factor to allthree sources?
a. Infection
b. Drugs and teratogens
c. Genetic abnormalities
d. Maternal medical conditions

9. What risk factors are associated with fetal growth restriction in women with
pre
gestational diabetes?
a. Maternal vascular disease
b. Congenital malformations
c. Worsening White classification
d. All of the above

10. Compared to women who do not undergo psychosocial risk factor screening during
pregnancy, those that do have which of the following?
a. Lower preterm birth rates
b. More appropriate interventions
c. Lower rates of low-birthweight newborns
d. Allof the above

11. The presence of which of thefollowing vascular diseases during

highest perinatal morbidity rates? pregnancy leads to the
a. Class F diabetes
b. Valvular heart disease
c. Ischenmic heart disease
d. Chronic hypertension
12. Which of thefollowing
a. Chronic hypertensionconditions is associated with chronic hypoxia?
b. Living in Dallas, Texas
c. Sporadic marijuana
d. None of the above smoking
 13. Given the graphic below, at what gestational age does
begin to differentiate due to order ofmultifetal gestation? growth
a. 15-20 weeks
b. 20-25 weeks
c. 25-30 weeks
d. After 30 weeks

14. Between 18and 30 weeks, which of the following fundal

height measurements would
suggest that fetal growth should be checked by ultrasound?
a. Current gestational age of 16 weeks and fundal height
measuring 18 cm
b. Current gestational age of 22 weeks and fundal height
c. Current gestational age of 25 weeks and fundal height
measuring 20 cm
measuring 22 cm
d. Current gestational age of 13 weeks and fundal height measuring 32 cm

15. Which of the following antiphospholipid antibodies are associated with fetal growth
restriction?
a. G20210A mutation
b. Lupus anticoagulant
C. Anti-ß2 glycoprotein antibodies
d. Allof the above

16. Which of the following is true regarding oligohydramnios?

a. It is associated with fetal growth restriction.
b. It is associated with a higher cesarean delivery rate.
c. It is associated with congenital fetal malformations.
d. Allof the above

17. What can be said concerning sonographic diagnosis of fetal

a. First-trimester ultrasound is superior for growth restriction?
b. Second-trimester ultrasound is predicting small-for-gestational-age infants.
superior to first trimester ultrasound for
predicting small-for gestational-age infants.
c. The most common method for
weights to gestational age by femuridentifying
length.
poor fetal growth is standard indexing of
d. None of the above

18. What can be said about the

umbilical artery? following Doppler waveforms of the
a. The S/D ratio in B is
b. The S/D abnormal.
ratio is
c. The S/D ratio is greater in B than A.
d. None of the greater in A than B.
above
19, What can be said
about the following
umbilical artery? Doppler waveform of the
a. The S/D ratio is
b. This between 2 and 4.
represents reversed end-diastolic flow.
 C. This is only considered clinically usefulin an infant with growth restriction.
d None of the above

20 Your patient arrives late in her care. She brought a copy of her
ultrasound from 12wecks' gestation which matched her dates of
32 weeks. Ultrasound performed in your office reveals an
estimated fetal weight <3rd percentile for gestational age.
Doppler velocimetry of the umbilical artery reveals the waveform 150, minimal
below. Continuous fetal monitor detects a fetal baseline heart rate of
action?
variability. and repetitive late decelerations. What is your next course of
a. Proceed with primary cesarean delivery
b. Give betamethasone, wait 48 hours, and deliver
c. Admit to the floor for daily fetal surveillance
d. Any of the above would be reasonable
virtually always present?
21. In which chromosomal aneuploidy is fetal-growth restriction
a. 45, X
b. Trisomy 13
C. Trisomy 18
d Trisomy 21
growth?
22. Which of the following drugs and chemicals is capable of limiting fetal
a. Alcohol
b. Cocaine
c. Cigarettes
d. All of the above

23. Which ofthe following practices may prevent or limit fetal growth restriction?
a. Smoking cessation
b. Increase caloric requirements for women with a growth restricted infant.
c. Even with normal fundal height and presumed growth, it is reasonable to perform
Doppler velocimetry and fetal surveillance on the current pregnancy if the woman had
an infant with growth restriction previously.
d. All of the above

24. Ms. Smith is a 37-year-old multigravida who presents to your oftice at 32 weeks'
gestation as calculated by her last menstrual period. Her hematocrit is 29%, and she has
sickle-cll rait During sonographic evaluation, the letus has biometric values that
correlate with a 28-wek fetus. What is the most likely explanation?
a Ancuploidy
b. Chronic bypoxia
c. Poor pregnancy dating
d First-trimester
cytomegalovirus infection
25. For the patient in Question above, when willyou
a. Iweek reevaluate fetal growth?
 b. 2 weeks
C. 3weeks
d. 6weeks

26. Elevated C-peptide levels are associated with which of the following?
a. Hyperinsulinemia
b. Hypercholesterolemia
c. Fetal-growth restriction
d. All of the above

27. Amino acids undergo which type of transport fromn maternal to fetal circulation?
a. Active transport
b. Passive diffusion
c.Facilitated difusion
d. None of the above

28. This graph depicts the relationship between birthweight percentile -rar

and perinatal mortality and morbidity rates. Below which

threshold value of birthweight percentile do perinatal mortality
rates increase most rapidly?
a. 3
b. 5
c. 7
d. 10

29.Symmetrical growth restriction is characterized by a reduction in which of the

following?
a. Head size
b. Bodysize
c. Both body and head size
d. Both body and femur length
30. Which of the following correctly represents current thinking on asymmetrical versus
symmetrical growth restriction?
a. Neonatal morbidity rates are higher with asymmetricalgrowth restriction.
b. Uteroplacental insufficiency leads to asymmetrical growth restriction in most cases
of preeclampsia.
c. Assigning specific morbidity to speciflc fetal growth restriction patterns is a straight
forward process.
d. None of the above

31. Compared with appropriatdy grown fetuses of

equivalent gestational age,
growth restricted foetuses have which of the following perinatal
a. Lower stillbirth rate advantages?
b. Lower perinatal mnortality rate
c. Lower rate of respiratory distress
syndrome
 d. None of the above

32. Which of the following is true regarding women with pregravid weights less than 1001b
compared with normal~weight women?
a. They have a twofold risk of having growth~restricted fetuses.
b. They have a slightly incrcased risk of having a fetus with ancuploidy.
c. The risk of fetal-growth restriction may be modulated by appropriate maternal
gestational weight gain.
d. All of the above

33.Which of the following is true regarding maternal nutrition during pregnaney?

a. Providing micronutrient supplementation to undernourished women consistently
lowers rates of small-for gestational-~age newborns.
b. For all maternal weight categories, excessive maternal weight gain during
pregnancy is associated with large-forgestational-age newborns.
c. For all maternal weight categories, maternal weight gain in the second and third
trimesters that is less than recommended is associated with fetal-growth restriction.
d. All of the above

34. Which of the following is true concerning diabetes in pregnancy?

a. Compared with type 1 diabetics, type 2 diabetics have a higher risk of delivering a
large-forgestational-age (LGA) newborn.
b. Type 1 diabetics have a proportionately higher risk of delivering a
small-forgestational-age (SGA) than an LGA newborn.
c. Type 1diabetics without vascular involvement have a proportionately higher
risk of delivering an LGA newborn than an SGA one.
d. None of the above

35. Which of the following are true concerning chronic hypoxia?

a. Women with cyanotic heart disease have a higher rate of growth~restricted fetuses.
b. Neonates born at lower altitudes havea lower risk of being small for gestational age.
c. Neonates born at higher altitudes have a lower risk of being large for gestational age.
d. All of the above

36. Regarding maternal anemia, which of the following istrue?

a. It confers a high associated risk of fetal-growth restriction.
b. Fetal-growth restriction rates are higher in women with sickle-cell trait.
C. Fetal-growth restriction is related to restricted maternal blood volume
expansion.
d. All of the above

37. Which of the following is the primary autoantibody that predicts obstetrical
antiphospholipid antibody syndrome?
a. Lupus anticoagulant
b. Anticardiolipin antibodies
c. Anti-beta-glycoprotein-l antibodies
 d. Anti-double-stranded DNA antibodies
38. Fetal-growth restriction is associated with all EXCEPT which of the following?
a. Prior infertility
b. Placental chorangioma
c. Inherited thrombophilia
d. Velamentous cord insertion

39. The graph below suggests which of the following regarding fetal
growth restriction and multifetal pregnancy?
quadruplet
a. Most growth-restricted neonates result from
pregnancies.
gestation
b. Fetal-growth restriction can be detected at 20 weeks'
in quadruplets.
typically becomes apparent in
c. In multifetal gestations, fetal-growth restriction
the early third trimester.
d. All of the above

with fetal-growth restriction?

40. Which of the following drugs are associated
a. Metoclopramide
b. Diphenhydramine
c. Cyclophosphamide
d. Low-dose aspirin
at 36 weeks' gestation. All EXCEPT
which
41. This growth-restricted newborn was born
fetal-growth restriction?
of the following are infectious causes of
a. Congenital syphilis
b. Maternal tuberculosis
infection
c. First-trimester primary cytonmegalovirus for toxoplasmosis
d. Antepartum maternal seroconversion
serial fundal height measurements to detect
42. Which of the following is true regarding
fetal-growth restriction?
50%
a. Sensitivity < 25%, specificity <
b. Sensitivity < 35%, specificity > 90%
c. Sensitivity < 70%, specificity < 50%
d. Sensitivity < 85%, specificity > 90%
fetal-growth restriction is the most
43. Which of the following sonographic assessments of
predictive of obstetrical outcome?
a. Biometric growth<3rd percentile
b. Biometric growth < Sth percentile
c. Biometric growth < 3rd percentile and abnormal umbilical artery Doppler
velocimetry results
d. Biometric growth <Sth percentile and absent end-diastolic flow noted during
umbilical artery Doppler velocimetry study
44. Which of the following is true concerning the prevention of fetal-growth restriction?
a. In the United States, malaria prophylaxis assists prevention.
b. Preconceptional and antepartum smoking cessation assists prevention.
c. For the gravida with chronic hypertension, antihypertensive therapy assists
prevention.
d. Aspirin therapy assists prevention and is recommended by the American College of
Obstetricians and Gynecologists.
45. Your next obstetrical sonographic evaluation of the patient in Question 25 is performed
4 weeks after the first one and now at an estimated gestational age of 36 weeks. The
fetus now has measurements similar to a 30-week fetus. Growth restriction seens more
likely.What is appropriate at this time?
a. Delivery
b. Strict bed rest
c. Umbilical artery Doppler velocimetry
d. Sonographic fetal biometry in Iweek
diastolic (SID) ratio of 4, and
46. For the patient in Question 25, studies indicate systolic/ is appropriate at this time?
the patient has an amnionic fluid index (AFI) of9 em. What
a. Delivery
b. Betamethasone administration
c. Sonographic fetal biometry in 1 week
AFI assessment
d. Serial umbilical artery Doppler studies and

47. For the patient in Question 25, during the next week, umbilical artery Doppler
(REDF), and the amnionic fluid index
velocimetry indicates reversed end-diastolic flow
(AFI)is 4 cm. What is appropriate at this time?
a. Deliver the fetus
b. Plan delivery at 38 weeks after amniocentesis for pulmonary maturity
c. Continue serial umbilical artery Doppler
studies and AFI assessment
d. Allare reasonable
week approximates which of the
48. The average weight gain (grams per day)after 32
following?
a. 5-10 g/d
b. 20 g/d
c. 30 gld
d. 40 g/d

49. Which of the following cell growth phases occurs during the first 16 weeks of
gestation?
a. Cellular hyperplasia and hypertrophy
b.Cellular hyperplasia
c. Cellular hypertrophy
d. Apoptosis
50. Mostclinically
what percentile?meaningful adverse outcomes are in neonates bonweighing below
a. 20th
b. 10th
c. 5th
d. 3rd

51. Which of the following suggests a possible role for

abnornal, immune activation and
abnormal placentation in the genesis of growth-restricted
a. Elevated triglyceride levels infants and preeclampsia?
b. Hypoglycemia
c. Elevated endothelin-1 levels
d. Increased insulin sensitivity
52. Which perinatal complication is not associated with fetal growth restriction?
a. Birth asphyxia
b. Sepsis
c. Hypoglycemia
d. Hypothermia

53. Lack of maternal weight gain in which period especially correlates with decreased fetal
birthweight?
a. Preconception
b. First trimester
c. Second trimester
d. Third trimester

54. Placental mosaicism of which of the following trisomies may be responsible for
previously unexplained cases of fetal growth restriction?
a. Trisomy 13
b. Trisomy 16
c. Trisomy 18
d. Trisomy 21

55. Serial fundal height measurements detect what percentage of fetal growth restriction
cases?
a. 25
b. 40
c. 70
d. 85

S6 Afetal abdominal circumference below which of the

following percentiles is highly
suggestive of fetal growth restriction?
a. 15
b. 10
 c. 5
d. 3

57. Which of the following is the most

restriction? significant method of preventing fetal growth
a. Antihypertensive medication
b. Low-dose aspirin
c. Accurate pregnancy dating
d. Iron therapy

S8. What percentage of growth-restricted fetuses can be detected by sonography if

performed within 4 weeks of delivery?
a. 30
b. 50
C. 70
d. 90

s9. As shown in this figure, perinatal mortality rates are lowest with
which of the following largest-vertical-pocket measurements?
a. < 2cm
b. 2cm
C. 7 cm
d. > 8 cm

60. In this umbilical artery Doppler velocimetry study, which

flow?
pattern represents absent end diastolic
a. A
b. B
c. C
d. None of the above

61. With fetal growth restriction near term (34 weeks) and oligohydramnios, which of the
following is the most appropriate management?
a. Fetal surveillance and delivery by 37 weeks
b.Cordocentesis and diagnostic karyotyping
c. Delivery
d. Bed rest and fetal surveillance