Fetal heart rate abnormalities US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Fetal heart rate abnormalities. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Fetal heart rate abnormalities US Medical PG Question 1: A 29-year-old woman, gravida 1, para 0, at 36 weeks' gestation is brought to the emergency department after an episode of dizziness and vomiting followed by loss of consciousness lasting 1 minute. She reports that her symptoms started after lying down on her back to rest, as she felt tired during yoga class. Her pregnancy has been uncomplicated. On arrival, she is diaphoretic and pale. Her pulse is 115/min and blood pressure is 90/58 mm Hg. On examination, the patient is lying in the supine position with a fundal height of 36 cm. There is a prolonged fetal heart rate deceleration to 80/min. Which of the following is the most appropriate action to reverse this patient's symptoms in the future?
- A. Performing the Muller maneuver
- B. Gentle compression with an abdominal binder
- C. Lying in the supine position and elevating legs
- D. Lying in the left lateral decubitus position (Correct Answer)
- E. Performing the Valsava maneuver
Fetal heart rate abnormalities Explanation: ***Lying in the left lateral decubitus position***
- This position relieves **aortocaval compression** by moving the uterus off the **inferior vena cava (IVC)** and aorta.
- Alleviating IVC compression increases **venous return** to the heart, improving **cardiac output** and blood pressure, thereby resolving the patient's symptoms and improving **fetal oxygenation**.
*Performing the Muller maneuver*
- The **Muller maneuver** involves forced inspiration against a closed glottis, creating **negative intrathoracic pressure**.
- This maneuver is used to evaluate **upper airway compromise** and would not address the underlying issue of aortocaval compression.
*Gentle compression with an abdominal binder*
- An **abdominal binder** would apply external pressure to the abdomen, which could worsen rather than alleviate **aortocaval compression**.
- This would further reduce **venous return** and potentially exacerbate the patient's **hypotension** and fetal distress.
*Lying in the supine position and elevating legs*
- Lying in the **supine position** is the cause of the patient's symptoms due to **aortocaval syndrome**.
- While **elevating the legs** can temporarily increase venous return from the legs, it would not relieve the compression of the IVC by the gravid uterus.
*Performing the Valsava maneuver*
- The **Valsalva maneuver** involves forced exhalation against a closed glottis, which increases **intrathoracic pressure** and decreases **venous return**.
- This would further reduce **cardiac output** and worsen the symptoms of **hypotension** and **fetal compromise**.
Fetal heart rate abnormalities US Medical PG Question 2: A 30-year-old woman, gravida 2, para 1, comes for a prenatal visit at 33 weeks' gestation. She delivered her first child spontaneously at 38 weeks' gestation; pregnancy was complicated by oligohydramnios. She has no other history of serious illness. Her blood pressure is 100/70 mm Hg. On pelvic examination, uterine size is found to be smaller than expected for dates. The fetus is in a longitudinal lie, with vertex presentation. The fetal heart rate is 144/min. Ultrasonography shows an estimated fetal weight below the 10th percentile, and decreased amniotic fluid volume. Which of the following is the most appropriate next step in this patient?
- A. Serial nonstress tests (Correct Answer)
- B. Emergent cesarean delivery
- C. Amnioinfusion
- D. Reassurance only
- E. Weekly fetal weight estimation
Fetal heart rate abnormalities Explanation: ***Serial nonstress tests***
- This patient presents with **intrauterine growth restriction (IUGR)** and **oligohydramnios**, placing her fetus at high risk for fetal compromise and stillbirth.
- **Serial nonstress tests (NSTs)** are essential for monitoring fetal well-being in such high-risk pregnancies, as they assess fetal heart rate accelerations in response to fetal movement, indicating a healthy central nervous system and adequate oxygenation.
*Emergent cesarean delivery*
- While the fetus has IUGR and oligohydramnios, there is no immediate evidence of **fetal distress** (e.g., severe decelerations or persistent bradycardia) that would warrant an **emergent** delivery at 33 weeks.
- Delivery at 33 weeks increases the risk of **neonatal complications** associated with prematurity, so conservative management with close monitoring is preferred if the fetus is not in acute distress.
*Amnioinfusion*
- **Amnioinfusion** involves introducing saline into the amniotic cavity and is primarily used to alleviate **umbilical cord compression** during labor by increasing amniotic fluid volume.
- It is **not indicated** for chronic oligohydramnios in the antepartum period as a primary treatment and does not address the underlying pathology of IUGR.
*Reassurance only*
- Given the findings of **IUGR** (estimated fetal weight below 10th percentile) and **oligohydramnios**, the situation is not benign and requires active management and monitoring.
- **Reassurance only** would be inappropriate and potentially harmful, as these conditions significantly increase the risk of adverse perinatal outcomes.
*Weekly fetal weight estimation*
- While **fetal weight estimation** is important for diagnosing and tracking IUGR, performing it **weekly** is unnecessarily frequent and not the primary method for ongoing surveillance of fetal well-being.
- **Biophysical profiles (BPPs)** or **nonstress tests (NSTs)** combined with amniotic fluid index measurements are more appropriate for regular surveillance of fetal compromise in IUGR.
Fetal heart rate abnormalities US Medical PG Question 3: A 27-year old primigravid woman at 37 weeks' gestation comes to the emergency department because of frequent contractions for 4 hours. Her pregnancy has been complicated by hyperemesis gravidarum which subsided in the second trimester. The contractions occur every 10–15 minutes and have been increasing in intensity and duration since onset. Her temperature is 37.1°C (98.8°F), pulse is 110/min, and blood pressure is 140/85 mm Hg. Uterine contractions are felt on palpation. Pelvic examination shows clear fluid in the vagina. The cervix is 50% effaced and 3 cm dilated. After 4 hours the cervix is 80% effaced and 6 cm dilated. Pelvic examination is inconclusive for the position of the fetal head. The fetal heart rate is reassuring. Which of the following is the most appropriate next step?
- A. Administer oxytocin
- B. Perform external cephalic version
- C. Administer misoprostol
- D. Perform Mauriceau-Smellie-Veit maneuver
- E. Perform ultrasonography (Correct Answer)
Fetal heart rate abnormalities Explanation: ***Perform ultrasonography***
- The examination notes that the **pelvic examination is inconclusive for the position of the fetal head**, which is a critical piece of information needed for safe delivery. **Ultrasonography** is the most appropriate next step to ascertain the fetal presentation and position, especially given the dilated cervix.
- Determining fetal position is essential to rule out **malpresentation**, such as **breech** or **transverse lie**, which would significantly impact the delivery plan and potentially necessitate a **cesarean section**.
*Administer oxytocin*
- **Oxytocin** is used to induce or augment labor when contractions are insufficient or labor is prolonged, but in this case, the cervix is progressing well (from 3 cm to 6 cm dilation in 4 hours), indicating **active labor**.
- Without knowing the fetal presentation, administering oxytocin could exacerbate issues if there's a **malpresentation**, potentially leading to **fetal distress** or **uterine rupture**.
*Perform external cephalic version*
- **External cephalic version (ECV)** is performed to change a **breech presentation** to a **cephalic presentation** by external manipulation, typically done before labor onset or early in labor at term.
- This patient is already in **active labor** with significant cervical dilation (6 cm), making ECV less likely to be successful and potentially increasing risks like **placental abruption** or **umbilical cord compression**.
*Administer misoprostol*
- **Misoprostol** is a prostaglandin analog used for **cervical ripening** and **labor induction** in cases where the cervix is unfavorable or labor needs to be initiated.
- This patient is already in **active labor** with progressive cervical dilation, making misoprostol unnecessary and potentially harmful due to the risk of **uterine hyperstimulation**.
*Perform Mauriceau-Smellie-Veit maneuver*
- The **Mauriceau-Smellie-Veit maneuver** is a technique used during a **vaginal breech delivery** to deliver the fetal head, specifically in cases of **frank or complete breech** that are being delivered vaginally.
- This maneuver is only performed *during* delivery of a breech baby, and the fetal position is currently unknown. It would be premature and inappropriate to consider this maneuver without first confirming a **breech presentation** and the decision for vaginal delivery.
Fetal heart rate abnormalities US Medical PG Question 4: A 29-year-old G1P0 female at 32 weeks gestation presents to the emergency department with vaginal bleeding. She has had minimal prenatal care to-date with only an initial visit with an obstetrician after a positive home pregnancy test. She describes minimal spotting that she noticed earlier today that has progressed to larger amounts of blood; she estimates 30 mL of blood loss. She denies any cramping, pain, or contractions, and she reports feeling continued movements of the baby. Ultrasound and fetal heart rate monitoring confirm the presence of a healthy fetus without any evidence of current or impending complications. The consulted obstetrician orders blood testing for Rh-status of both the mother as well as the father, who brought the patient to the hospital. Which of the following represents the best management strategy for this situation?
- A. After 28 weeks gestation, administration of RhoGAM will have no benefit
- B. If mother is Rh-positive and father is Rh-negative then administer RhoGAM
- C. If mother is Rh-negative and father is Rh-negative then administer RhoGAM
- D. If mother is Rh-negative and father is Rh-positive, RhoGAM administration is not needed
- E. If mother is Rh-negative and father is Rh-positive then administer RhoGAM (Correct Answer)
Fetal heart rate abnormalities Explanation: ***If mother is Rh-negative and father is Rh-positive then administer RhoGAM***
- This combination creates a risk for **Rh incompatibility**, meaning the fetus could be Rh-positive and the mother's immune system could form antibodies against fetal red blood cells, which can harm the fetus in future pregnancies.
- **RhoGAM (Rh immunoglobulin)** administration prevents the mother from forming these antibodies when there's a risk of maternal-fetal blood mixing, as indicated by vaginal bleeding.
*After 28 weeks gestation, administration of RhoGAM will have no benefit*
- This statement is incorrect; **RhoGAM is routinely administered around 28 weeks gestation** as prophylaxis in Rh-negative mothers, even without bleeding episodes, to prevent sensitization.
- In cases of potential fetal-maternal hemorrhage, such as vaginal bleeding, RhoGAM is indicated regardless of gestational age beyond the first trimester.
*If mother is Rh-positive and father is Rh-negative then administer RhoGAM*
- This scenario does not pose a risk for **Rh incompatibility hemolytic disease of the newborn**, as the mother already possesses the Rh antigen.
- RhoGAM is specifically given to Rh-negative mothers to prevent their immune system from reacting to an Rh-positive fetus.
*If mother is Rh-negative and father is Rh-negative then administer RhoGAM*
- In this case, both parents are **Rh-negative**, meaning the fetus will also be Rh-negative.
- There is no risk of **Rh incompatibility** or sensitization, so RhoGAM administration is not indicated.
*If mother is Rh-negative and father is Rh-positive, RhoGAM administration is not needed*
- This statement is incorrect and represents a critical misunderstanding of **Rh incompatibility prophylaxis**.
- This specific genetic combination creates the highest risk for **Rh sensitization** during pregnancy, especially with events like vaginal bleeding, making RhoGAM administration essential.
Fetal heart rate abnormalities US Medical PG Question 5: A 24-year-old primigravida at 28 weeks gestation presents to the office stating that she “can’t feel her baby kicking anymore.” She also noticed mild-to-moderate vaginal bleeding. A prenatal visit a few days ago confirmed the fetal cardiac activity by Doppler. The medical history is significant for GERD, hypertension, and SLE. The temperature is 36.78°C (98.2°F), the blood pressure is 125/80 mm Hg, the pulse is 70/min, and the respiratory rate is 14/min. Which of the following is the next best step in evaluation?
- A. Confirmation of cardiac activity by Doppler (Correct Answer)
- B. Order platelet count, fibrinogen, PT and PTT levels
- C. Abdominal delivery
- D. Speculum examination
- E. Misoprostol
Fetal heart rate abnormalities Explanation: ***Confirmation of cardiac activity by Doppler***
- The patient presents with **decreased fetal movement** and **vaginal bleeding** at 28 weeks, which are concerning signs for complications like **placental abruption** or **fetal demise**.
- The immediate priority is to assess **fetal viability** by confirming the presence of a **fetal heartbeat**, with **Doppler ultrasonography** being the quickest and most accessible method.
*Order platelet count, fibrinogen, PT and PTT levels*
- While **coagulation studies** are important in cases of significant vaginal bleeding, especially if **placental abruption** is suspected, they are not the *next best step*.
- Assessing **fetal well-being** takes precedence, as the presence or absence of a **fetal heart rate** will guide subsequent emergency management.
*Abdominal delivery*
- **Abdominal delivery (C-section)** is a definitive intervention and should only be considered *after* an immediate assessment of **fetal status** and maternal stability.
- Delivery at 28 weeks gestation would be considered **preterm**, and careful evaluation is needed before making such a critical decision.
*Speculum examination*
- A **speculum examination** is used to investigate the source of vaginal bleeding, assess the cervix, and rule out causes such as **cervical lesions** or **cervical dilation**.
- However, given the *decreased fetal movement* and the potential for severe obstetrical emergencies, **fetal viability** must be confirmed first.
*Misoprostol*
- **Misoprostol** is a **prostaglandin analog** used to induce cervical ripening and uterine contractions, primarily for **labor induction** or **abortion**.
- It is not indicated as an initial diagnostic or therapeutic step in a patient with *decreased fetal movement* and *vaginal bleeding* without a clear diagnosis or indication for delivery.
Fetal heart rate abnormalities US Medical PG Question 6: Five minutes after initiating a change of position and oxygen inhalation, the oxytocin infusion is discontinued. A repeat CTG that is done 10 minutes later shows recurrent variable decelerations and a total of 3 uterine contractions in 10 minutes. Which of the following is the most appropriate next step in management?
- A. Restart oxytocin infusion
- B. Emergent Cesarean section
- C. Administer terbutaline
- D. Monitor without intervention
- E. Amnioinfusion (Correct Answer)
Fetal heart rate abnormalities Explanation: ***Amnioinfusion***
- **Recurrent variable decelerations** persisting after discontinuing oxytocin and changing maternal position often indicate **cord compression**, which can be relieved by amnioinfusion.
- Adding fluid to the amniotic cavity **cushions the umbilical cord**, reducing compression during uterine contractions.
*Restart oxytocin infusion*
- Reinitiating oxytocin would likely **worsen the recurrent variable decelerations** by increasing uterine contraction frequency and intensity, thereby exacerbating cord compression.
- The goal is to alleviate fetal distress, not to intensify uterine activity that is already causing issues.
*Emergent Cesarean section*
- While an emergent Cesarean section is indicated for **unresolved fetal distress**, it's usually considered after less invasive measures, such as amnioinfusion, have failed.
- There is still an opportunity for a simpler intervention to resolve the issue before resorting to surgery.
*Administer terbutaline*
- Terbutaline is a **tocolytic agent** used to reduce uterine contractions, which can be helpful in cases of tachysystole or hyperstimulation.
- In this scenario, the contraction frequency is low (3 in 10 minutes), so reducing contractions is not the primary aim; rather, the focus is on resolving the cord compression causing decelerations.
*Monitor without intervention*
- **Recurrent variable decelerations** are an concerning sign of **fetal distress** and require intervention to prevent potential harm to the fetus.
- Simply monitoring without intervention would be inappropriate and could lead to worsening fetal hypoxemia and acidosis.
Fetal heart rate abnormalities US Medical PG Question 7: A 30-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the hospital for regular, painful contractions that have been increasing in frequency. Her pregnancy has been complicated by gestational diabetes treated with insulin. Pelvic examination shows the cervix is 50% effaced and 4 cm dilated; the vertex is at -1 station. Ultrasonography shows no abnormalities. A tocometer and Doppler fetal heart monitor are placed on the patient's abdomen. The fetal heart rate monitoring strip shows a baseline heart rate of 145/min with a variability of ≥ 15/min. Within a 20-minute recording, there are 7 uterine contractions, 4 accelerations, and 3 decelerations that have a nadir occurring within half a minute. The decelerations occur at differing intervals relative to the contractions. Which of the following is the most appropriate next step in the management of this patient?
- A. Vibroacoustic stimulation
- B. Routine monitoring (Correct Answer)
- C. Administer tocolytics
- D. Emergent cesarean delivery
- E. Placement of fetal scalp electrode
Fetal heart rate abnormalities Explanation: ***Routine monitoring***
- The presented FHR tracing exhibits a **normal baseline rate** (145/min), **moderate variability** (≥15/min), and the presence of **accelerations**, indicating a reassuring fetal status.
- The described decelerations are **variable decelerations** due to their sudden onset, nadir within 30 seconds, and variable relationship to contractions, which are generally benign unless prolonged, deep, or repetitive. Given the otherwise reassuring status, continued routine monitoring is appropriate.
*Vibroacoustic stimulation*
- This intervention is used to elicit **fetal accelerations** or movement during non-stress tests (NSTs) when the fetus is quiet or shows a non-reactive pattern.
- In this case, the fetus is already showing **accelerations** and moderate variability, so stimulation is not needed to assess fetal well-being.
*Administer tocolytics*
- **Tocolytics** are used to stop or slow down labor, typically in cases of preterm labor or uterine tachysystole causing fetal distress.
- This patient is at **38 weeks' gestation** and in active labor, and there are no signs of fetal distress warranting the cessation of contractions.
*Emergent cesarean delivery*
- **Emergent cesarean delivery** is indicated for acute fetal distress, such as prolonged decelerations, significant bradycardia, or absent variability in conjunction with other concerning FHR patterns.
- The FHR tracing described is largely reassuring with moderate variability and accelerations, and the variable decelerations are not indicative of immediate threat, making emergent delivery unnecessary.
*Placement of fetal scalp electrode*
- A **fetal scalp electrode** provides a more accurate and continuous measure of the FHR, often used when external monitoring is difficult or when there are concerns about the reliability of the tracing.
- While it can be useful in some situations, the current tracing is **interpretable as reassuring**, making invasive monitoring currently unnecessary.
Fetal heart rate abnormalities US Medical PG Question 8: A 15-year-old girl is brought to the physician by her mother because of lower abdominal pain for the past 5 days. The pain is constant and she describes it as 7 out of 10 in intensity. Over the past 7 months, she has had multiple similar episodes of abdominal pain, each lasting for 4–5 days. She has not yet attained menarche. Examination shows suprapubic tenderness to palpation. Pubic hair and breast development are Tanner stage 4. Examination of the external genitalia shows no abnormalities. Pelvic examination shows bulging, bluish vaginal tissue. Rectal examination shows an anterior tender mass. Which of the following is the most effective intervention for this patient's condition?
- A. Administer gonadotropin-releasing hormone agonist therapy
- B. Administer ibuprofen
- C. Perform vaginal dilation
- D. Administer oral contraceptives pills
- E. Perform hymenotomy (Correct Answer)
Fetal heart rate abnormalities Explanation: ***Perform hymenotomy***
- The patient's inability to achieve **menarche** despite advanced **Tanner staging** (indicating hormonal maturity) and cyclical lower abdominal pain strongly suggests **cryptomenorrhea** due to an **imperforate hymen**.
- A **hymenotomy** is a surgical procedure to incise the hymen, allowing the accumulated menstrual blood (hematocolpos) to drain, resolving the pain and preventing complications.
*Administer gonadotropin-releasing hormone agonist therapy*
- **GnRH agonists** are used to suppress ovulation and menstrual cycles, typically for conditions like endometriosis or precocious puberty.
- This patient's issue is a physical obstruction to menstrual flow, not a hormonal imbalance requiring suppression.
*Administer ibuprofen*
- **Ibuprofen (NSAIDs)** can alleviate pain, but it would only mask the symptoms without addressing the underlying obstruction.
- The patient has **hematocolpos** due to an imperforate hymen, which requires a definitive surgical solution.
*Perform vaginal dilation*
- **Vaginal dilation** is used to treat conditions causing vaginal stenosis or agenesis, like **Mayer-Rokitansky-Küster-Hauser syndrome**.
- This patient has a physically obstructed hymen, not a narrowed or absent vagina, so dilation is not appropriate.
*Administer oral contraceptives pills*
- **Oral contraceptive pills (OCPs)** regulate menstrual cycles and can reduce menstrual pain or flow.
- They would not resolve the physical obstruction caused by an **imperforate hymen** and would still lead to accumulation of menstrual blood.
Fetal heart rate abnormalities US Medical PG Question 9: A 37-year-old woman, gravida 2, para 1, at 35 weeks' gestation is brought to the emergency department for the evaluation of continuous, dark, vaginal bleeding and abdominal pain for one hour. Her first child was delivered by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. The patient has a history of hypertension and has been noncompliant with her hypertensive regimen. Her medications include methyldopa, folic acid, and a multivitamin. Her pulse is 90/min, respirations are 16/min, and blood pressure is 145/90 mm Hg. The abdomen is tender, and hypertonic contractions can be felt. There is blood on the vulva, the introitus, and on the medial aspect of both thighs. The fetus is in a breech presentation. The fetal heart rate is 180/min with recurrent decelerations. Which of the following is the cause of fetal compromise?
- A. Rupture of the uterus
- B. Placental tissue covering the cervical os
- C. Rupture of aberrant fetal vessels
- D. Abnormal position of the fetus
- E. Detachment of the placenta (Correct Answer)
Fetal heart rate abnormalities Explanation: ***Detachment of the placenta***
- The presentation of **continuous, dark vaginal bleeding**, **abdominal pain**, and **hypertonic contractions** in a pregnant woman with hypertension strongly indicates **placental abruption**.
- **Fetal compromise**, evidenced by a fetal heart rate of 180/min with recurrent decelerations, results from the compromised oxygen and nutrient exchange due to placental detachment.
*Rupture of the uterus*
- Uterine rupture typically presents with **sudden sharp abdominal pain**, **vaginal bleeding**, and often **cessation of uterine contractions**, which is contradicted by hypertonic contractions.
- A previous C-section scar is a risk factor, but the clinical picture with continuous dark bleeding and hypertonic contractions points more strongly to abruption.
*Placental tissue covering the cervical os*
- This describes **placenta previa**, which typically causes **painless, bright red vaginal bleeding** and usually does not present with abdominal pain or hypertonic contractions.
- The characteristics of pain and dark bleeding make placenta previa less likely.
*Rupture of aberrant fetal vessels*
- This condition, known as **vasa previa**, involves the rupture of fetal blood vessels, leading to **fetal blood loss** and rapid fetal compromise.
- However, the presenting symptoms usually include **sudden onset of bleeding with concurrent fetal bradycardia** or distress, and the vaginal bleeding is typically bright red fetal blood, not dark maternal blood as described.
*Abnormal position of the fetus*
- An abnormal fetal position, such as **breech presentation**, can complicate delivery but does not directly cause dark vaginal bleeding, abdominal pain, or hypertonic uterine contractions.
- While the fetus is breech, this finding does not explain the acute maternal symptoms or the signs of placental compromise.
Fetal heart rate abnormalities US Medical PG Question 10: A 26-year-old pregnant woman (gravida 2, para 1) presents on her 25th week of pregnancy. Currently, she has no complaints. Her previous pregnancy was unremarkable. No abnormalities were detected on the previous ultrasound (US) examination at week 13 of pregnancy. She had normal results on the triple test. She is human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV)-negative. Her blood type is III(B) Rh+, and her partner has blood type I(0) Rh-. She and her husband are both of Sardinian descent, do not consume alcohol, and do not smoke. Her cousin had a child who died soon after the birth, but she doesn't know the reason. She does not report a history of any genetic conditions in her family, although notes that her grandfather “was always yellowish-pale, fatigued easily, and had problems with his gallbladder”. Below are her and her partner’s complete blood count and electrophoresis results.
Complete blood count
Patient Her husband
Erythrocytes 3.3 million/mm3 4.2 million/mm3
Hb 11.9 g/dL 13.3 g/dL
MCV 71 fL 77 fL
Reticulocyte count 0.005 0.008
Leukocyte count 7,500/mm3 6,300/mm3
Platelet count 190,000/mm3 256,000/mm3
Electrophoresis
HbA1 95% 98%
HbA2 3% 2%
HbS 0% 0%
HbH 2% 0%
The patient undergoes ultrasound examination which reveals ascites, liver enlargement, and pleural effusion in the fetus. Further evaluation with Doppler ultrasound shows elevated peak systolic velocity of the fetal middle cerebral artery. Which of the following procedures can be performed for both diagnostic and therapeutic purposes in this case?
- A. Fetoscopy
- B. Cordocentesis (Correct Answer)
- C. Percutaneous fetal thoracentesis
- D. Chorionic villus sampling
- E. Amniocentesis
Fetal heart rate abnormalities Explanation: ***Cordocentesis***
- **Cordocentesis** involves obtaining a fetal blood sample from the umbilical cord, which is crucial for diagnosing fetal anemia and can also be used for **intrauterine blood transfusions** if severe anemia is detected.
- The ultrasound findings of **ascites**, **liver enlargement**, **pleural effusion** (suggesting **hydrops fetalis**), and elevated peak systolic velocity of the fetal middle cerebral artery are highly indicative of severe fetal anemia, making cordocentesis a diagnostic and therapeutic option.
*Fetoscopy*
- **Fetoscopy** currently has limited diagnostic and therapeutic applications in cases of fetal anemia and is primarily used for direct visualization and certain surgical procedures like **laser coagulation** in twin-twin transfusion syndrome, which is not the primary issue here.
- While it offers direct visualization, it is more invasive and carries higher risks compared to cordocentesis for the specific diagnosis and management of fetal anemia.
*Percutaneous fetal thoracentesis*
- **Percutaneous fetal thoracentesis** is used to drain fetal pleural effusions, which is a symptom of hydrops fetalis, but it does not address the underlying cause of fetal anemia itself.
- It is a therapeutic procedure for a specific complication, not a diagnostic tool for anemia or a therapy for the anemia itself.
*Chorionic villus sampling*
- **Chorionic villus sampling (CVS)** is typically performed earlier in pregnancy (10-13 weeks) for **chromosomal analysis** and genetic disorders.
- It provides genetic information but cannot assess the current state of fetal anemia or provide therapeutic intervention like blood transfusion.
*Amniocentesis*
- **Amniocentesis** is primarily used for **genetic testing** and evaluating fetal lung maturity, usually performed after 15 weeks.
- It involves sampling amniotic fluid and does not directly provide a fetal blood sample for diagnosing or treating anemia.
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