Intrauterine Growth Restriction — MCQs
A woman with an obstetric score of G2P1 comes to the clinic at 14 weeks of gestation for her antenatal checkup. A uterine artery doppler was suggested by the doctor. What would it detect?
Which of the following is NOT a cause of oligohydramnios?
What is the primary maternal cause of fetal macrosomia (large birth weight) in newborns?
Placenta grade 3, 35+3 weeks pregnancy, and absent end diastolic flow Doppler; next management is:
Full-term, small-for-date babies are at high risk of:
A 28-year-old primigravida at 32 weeks of gestation presents for a routine prenatal visit. She has no significant past medical history. During the ultrasound examination, various parameters are assessed to evaluate fetal growth and well-being. Which of the following is NOT a criterion used to diagnose Intrauterine Growth Restriction (IUGR)?
Uterine height is greater than gestational age of the patient in a case of all except -
Cause of Fetal growth restriction may be: 1. Chromosomal abnormality 2. Congenital abnormality 3. Abnormal cord insertion Which of the statements given above is/are correct?
Which drug is known to cause placental abruption?
In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?
Intrauterine Growth Restriction Indian Medical PG Practice Questions and MCQs
Question 1: A woman with an obstetric score of G2P1 comes to the clinic at 14 weeks of gestation for her antenatal checkup. A uterine artery doppler was suggested by the doctor. What would it detect?
- A. Risk of early-onset preeclampsia (Correct Answer)
- B. Risk of late-onset preeclampsia
- C. Risk of placenta accreta
- D. Fetal growth restriction risk
Explanation: **Risk of early-onset preeclampsia** - **Uterine artery Doppler** at 11-14 weeks of gestation is used to screen for **preeclampsia risk**, particularly **early-onset preeclampsia**, which is associated with impaired placental development. - An increased **pulsatility index (PI)** or presence of **bilateral notching** in the uterine arteries indicates high resistance to blood flow, suggesting a higher risk of developing this condition. *Risk of late-onset preeclampsia* - While uterine artery Doppler can indicate a general risk for preeclampsia, its predictive value is significantly lower for **late-onset preeclampsia** (after 34 weeks). - Late-onset preeclampsia often has different underlying causes, not solely related to abnormal **trophoblast invasion** detectable by early Doppler. *Risk of placenta accreta* - **Placenta accreta** is typically associated with previous **cesarean sections** or other uterine surgeries, leading to abnormal placental implantation. - It is diagnosed by the absence of a clear retroplacental hypoechoic zone and features such as **lacunae** on **ultrasound**, not primarily by uterine artery Doppler. *Fetal growth restriction risk* - Uterine artery Doppler at 11-14 weeks can offer some indication of **fetal growth restriction (FGR)** risk, particularly if severe and related to **placental insufficiency**. - However, the primary surveillance for FGR later in pregnancy often involves **umbilical artery Doppler** and fetal biometry, not solely early uterine artery Doppler.
Question 2: Which of the following is NOT a cause of oligohydramnios?
- A. Renal agenesis
- B. Amnion nodosum
- C. Chorioangioma (Correct Answer)
- D. IUGR
Explanation: ***Chorioangioma*** - A **chorioangioma** is a benign placental tumor that causes **polyhydramnios** (excess amniotic fluid), which is the **opposite** of oligohydramnios. - Large chorioangiomas lead to increased transudation from the tumor's vascular channels, fetal anemia, and high-output cardiac failure, resulting in increased fetal urine production. - This is clearly **NOT a cause** of oligohydramnios, making it the correct answer. *IUGR* - **Intrauterine growth restriction (IUGR)**, particularly with placental insufficiency, is a common cause of **oligohydramnios**. - Reduced placental perfusion leads to decreased **fetal renal blood flow** and diminished urine production. - Since fetal urine is the main source of amniotic fluid after 16 weeks, reduced output causes oligohydramnios. *Renal agenesis* - **Bilateral renal agenesis** (Potter syndrome) is a classic and severe cause of **oligohydramnios/anhydramnios**. - Complete absence of kidneys means **no fetal urine production**, eliminating the primary source of amniotic fluid in the second and third trimesters. - Results in severe oligohydramnios with associated pulmonary hypoplasia and Potter facies. *Amnion nodosum* - **Amnion nodosum** refers to small, grayish-yellow nodules on the fetal surface of the amnion, composed of aggregated fetal squamous epithelial cells and vernix. - These nodules are a **pathological finding** that occurs as a **consequence** of chronic oligohydramnios, not a cause. - They form due to prolonged contact between the fetal skin and amnion when amniotic fluid is severely reduced. - While technically "not a cause," it is strongly **associated with** oligohydramnios, whereas chorioangioma causes the opposite condition entirely.
Question 3: What is the primary maternal cause of fetal macrosomia (large birth weight) in newborns?
- A. Hyperglycemia (Correct Answer)
- B. Hyperinsulinemia
- C. Multiparity
- D. Post maturity
Explanation: ***Hyperglycemia*** - Maternal **hyperglycemia**, often due to **gestational diabetes**, leads to increased glucose transfer across the placenta to the fetus. - This excess glucose stimulates increased fetal insulin production, which acts as a growth hormone causing macrosomia. *Hyperinsulinemia* - While fetal **hyperinsulinemia** directly causes macrosomia by increasing fetal growth, it is a **consequence** of maternal hyperglycemia, not the primary cause itself. - Fetal insulin acts as an anabolic hormone, promoting fat and protein synthesis and overall growth. *Multiparity* - **Multiparity** (having given birth to multiple children) is generally associated with moderately higher birth weights, but it is not the primary cause of macrosomia. - The effect is far less significant and consistent than that of maternal hyperglycemia. *Post maturity* - **Post-term pregnancy** (post maturity) can sometimes be associated with a larger birth weight, but this is less common and less pronounced than macrosomia caused by hyperglycemia. - Fetal growth often slows or even declines in prolonged pregnancies due to placental insufficiency.
Question 4: Placenta grade 3, 35+3 weeks pregnancy, and absent end diastolic flow Doppler; next management is:
- A. Monitor
- B. Terminate after 37 weeks
- C. Dexamethasone and terminate after 48 hours (Correct Answer)
- D. Consult pediatrician and plan immediate delivery
Explanation: ***Dexamethasone and terminate after 48 hours*** - Absent end diastolic flow (AEDF) at 35+3 weeks indicates **severe uteroplacental insufficiency** and significant fetal compromise, requiring intervention. - Administering **dexamethasone** (corticosteroids) for 48 hours helps to accelerate **fetal lung maturity** before delivery, reducing the risk of respiratory distress syndrome. *Monitor* - Simply monitoring is an inappropriate and potentially harmful management strategy given the presence of **absent end diastolic flow**, which reflects **critical fetal hypoxia**. - Delaying intervention in cases of AEDF significantly increases the risk of **fetal demise** and severe morbidity. *Terminate after 37 weeks* - Waiting until 37 weeks is too long. **Absent end diastolic flow** at 35+3 weeks significantly increases the risk of **fetal compromise** and death if delivery is delayed. - The goal is to balance the risks of prematurity with the risks of continued intrauterine compromise. *Consult pediatrician and plan immediate delivery* - While immediate delivery might be considered in some scenarios of fetal distress, delivering without prior **corticosteroid administration** (dexamethasone) at 35+3 weeks would increase the risk of **neonatal respiratory distress syndrome**. - The 48-hour window allows for **fetal lung maturation** while still addressing the urgent need for delivery due to AEDF.
Question 5: Full-term, small-for-date babies are at high risk of:
- A. Hypoglycemia (Correct Answer)
- B. Intraventricular haemorrhage
- C. Bronchopulomonary dysplasia
- D. Hyperthermia
Explanation: ***Hypoglycemia*** - **Small-for-date** babies often have reduced glycogen stores due to **intrauterine growth restriction (IUGR)**, making them prone to hypoglycemia. - Their increased metabolic rate relative to their small size further exacerbates the risk of glucose depletion. *Intraventricular haemorrhage* - This condition is primarily associated with **prematurity**, particularly in very low birth weight infants, due to the fragility of their germinal matrix vessels. - While small-for-date babies can be premature, being **full-term** significantly reduces this specific risk. *Bronchopulomonary dysplasia* - **Bronchopulmonary dysplasia (BPD)** is a chronic lung disease predominantly observed in **premature infants** who have received prolonged mechanical ventilation and oxygen therapy. - A **full-term** infant, even if small-for-date, is much less likely to develop BPD. *Hyperthermia* - Small-for-date babies are generally at higher risk of **hypothermia** due to their larger surface area to volume ratio and reduced subcutaneous fat. - While any neonate can experience hyperthermia from external factors (e.g., overheating), it is not a specific risk related to their small-for-date status.
Question 6: A 28-year-old primigravida at 32 weeks of gestation presents for a routine prenatal visit. She has no significant past medical history. During the ultrasound examination, various parameters are assessed to evaluate fetal growth and well-being. Which of the following is NOT a criterion used to diagnose Intrauterine Growth Restriction (IUGR)?
- A. Fetal weight below the 3rd percentile (-3 SD)
- B. Abdominal circumference (AC) below the 3rd percentile (-3 SD)
- C. Uterine artery Doppler showing Pulsatility Index (PI) above the 95th percentile (Correct Answer)
- D. Absent End-Diastolic Flow (AEDF) in the umbilical artery
Explanation: ***Uterine artery Doppler showing Pulsatility Index (PI) above the 95th percentile*** - While an elevated **uterine artery PI** at this gestational age can indicate increased resistance and risk for **placental insufficiency**, it is a **risk factor for IUGR**, not a direct diagnostic criterion for **fetal growth restriction** itself. - Diagnostic criteria for **IUGR** focus on the actual growth parameters of the fetus and **umbilical artery Doppler** findings, rather than maternal uterine artery flow. *Fetal weight below the 3rd percentile (-3 SD)* - **Fetal weight** below the **3rd percentile** for gestational age is a definitive criterion for severe **Intrauterine Growth Restriction (IUGR)**. - This indicates significant **growth restriction** and is associated with increased perinatal morbidity and mortality. *Abdominal circumference (AC) below the 3rd percentile (-3 SD)* - An **abdominal circumference (AC)** below the **3rd percentile** for gestational age is a key indicator of **IUGR**, particularly in cases of **asymmetric IUGR** where the abdominal growth is disproportionately affected. - This reflects reduced **liver glycogen stores** and **subcutaneous fat**, which are often compromised in fetuses with **placental insufficiency**. *Absent End-Diastolic Flow (AEDF) in the umbilical artery* - **Absent End-Diastolic Flow (AEDF)** in the **umbilical artery** is a critical and severe finding in the diagnosis of **IUGR**, indicating significantly increased **placental resistance** and compromise. - It signifies severe impairment of **oxygen** and **nutrient delivery** to the fetus, often warranting close monitoring or delivery.
Question 7: Uterine height is greater than gestational age of the patient in a case of all except -
- A. Fibroid uterus
- B. Wrong dates
- C. Polyhydramnios
- D. IUGR (Correct Answer)
Explanation: ***IUGR*** - In **Intrauterine Growth Restriction (IUGR)**, the fetus is smaller than expected for gestational age, leading to a **fundal height** that measures less than the actual gestational age. - This condition is characterized by a **restricted growth rate** of the fetus, causing the uterine size to be disproportionately small. *Fibroid uterus* - The presence of **uterine fibroids** (leiomyomas) can increase the overall size of the uterus beyond what would be expected for a given gestational age. - These benign tumors add bulk to the uterine wall, leading to a **larger-than-expected uterine height**. *Wrong dates* - Incorrect estimation of the **Last Menstrual Period (LMP)** or date of conception can lead to a miscalculation of gestational age. - If the gestational age is **underestimated**, the actual uterine height will appear greater than the calculated gestational age. *Polyhydramnios* - **Polyhydramnios** is a condition characterized by an **excessive accumulation of amniotic fluid**, which distends the uterus. - Increased amniotic fluid volume leads to a significantly **larger uterine size** and a fundal height greater than the gestational age.
Question 8: Cause of Fetal growth restriction may be: 1. Chromosomal abnormality 2. Congenital abnormality 3. Abnormal cord insertion Which of the statements given above is/are correct?
- A. 1 and 3 only
- B. 1 and 2 only
- C. 1, 2 and 3 (Correct Answer)
- D. 2 and 3 only
Explanation: ***Correct: 1, 2 and 3*** All three statements represent established causes of **Fetal Growth Restriction (FGR)**: - **Chromosomal abnormalities** (trisomy 13, 18, 21, Turner syndrome) cause **intrinsic poor growth potential** of the fetus by disrupting normal cellular development and metabolism, directly leading to FGR. - **Congenital abnormalities** (cardiac defects, renal malformations, CNS anomalies) impair fetal development and nutrient utilization through structural and functional deficits, resulting in FGR. - **Abnormal cord insertion** (velamentous or marginal cord insertion) compromises the efficiency of **nutrient and oxygen transfer** from the placenta to the fetus by reducing vascular support, thus causing placental insufficiency and FGR. *Incorrect: 1 and 3 only* This incorrectly excludes **congenital abnormalities**, which are a well-established independent cause of FGR. Structural malformations directly impair fetal growth through metabolic and functional deficits. *Incorrect: 1 and 2 only* This incorrectly excludes **abnormal cord insertion**, which directly impacts placental function and nutrient supply—a key pathway for uteroplacental insufficiency leading to FGR. *Incorrect: 2 and 3 only* This incorrectly excludes **chromosomal abnormalities**, which are a major genetic cause of intrinsic FGR. Chromosomal defects (e.g., trisomies) are fundamental causes of impaired fetal growth potential.
Question 9: Which drug is known to cause placental abruption?
- A. Amphetamine
- B. Fluoxetine
- C. Methadone
- D. Cocaine (Correct Answer)
Explanation: **Cocaine** - **Cocaine** use during pregnancy is strongly associated with an increased risk of **placental abruption** due to its vasoconstrictive effects on uterine blood vessels. - Its potent **vasoconstrictive properties** lead to uterine ischemia and contractions, which can cause the placenta to detach prematurely from the uterine wall. *Methadone* - While methadone use during pregnancy is associated with risks such as **neonatal abstinence syndrome**, it is not a primary cause of **placental abruption**. - It is often used as a maintenance therapy for opioid-dependent pregnant women to avoid the fluctuating levels of illicit drug use, which can have more severe consequences. *Amphetamine* - Amphetamine use can lead to adverse pregnancy outcomes like **preterm birth** and **low birth weight** due to its stimulant effects. - Although it causes vasoconstriction, its association with **placental abruption** is less direct and less pronounced compared to cocaine. *Fluoxetine* - Fluoxetine, an **SSRI antidepressant**, generally has a relatively safe profile in pregnancy, although some studies suggest a small increased risk of persistent **pulmonary hypertension** in neonates. - It is not known to be a cause of **placental abruption**.
Question 10: In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?
- A. Biophysical profile
- B. Amniotic fluid spectrophotometry
- C. Middle cerebral artery Doppler wave forms (Correct Answer)
- D. Fetal blood sampling
Explanation: ***Middle cerebral artery Doppler wave forms*** - This is currently the most widely accepted and **non-invasive** method for monitoring **fetal anemia** in Rh-sensitized pregnancies. - An increase in the **peak systolic velocity (PSV)** in the middle cerebral artery indicates that the fetus is increasing cardiac output to compensate for a reduced oxygen-carrying capacity due to anemia. *Biophysical profile* - The biophysical profile assesses various fetal parameters like **movement**, **tone**, **breathing**, and **amniotic fluid volume**, which are often altered late in the course of severe fetal anemia. - It is a **less sensitive** indicator of early or moderate fetal anemia compared to MCA Doppler. *Amniotic fluid spectrophotometry* - This method measures the **bilirubin levels** in amniotic fluid, which correlates with the severity of hemolysis. - It is an **invasive procedure** (amniocentesis) and has largely been replaced by non-invasive MCA Doppler due to associated risks and better predictive value of Doppler. *Fetal blood sampling* - Fetal blood sampling (cordocentesis) provides a direct measurement of **fetal hemoglobin** and other blood parameters. - While definitive, it is a **highly invasive procedure** with significant risks, reserved primarily for confirmation of severe anemia or for direct transfusion, not for routine monitoring.
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