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Fetal growth restriction — MCCQE Part 1 MCQ

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ModeratePregnancyFetal growth restrictionMCCQE Part 1

35-year-old woman at 34 weeks' gestation presents with fundal height lagging by 4 cm. Ultrasound shows estimated fetal weight below the 10th percentile and abnormal umbilical Doppler. Which of the following is the most appropriate next step?

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Correct answer: E — Arrange high-risk obstetric surveillance and delivery planning

Arrange high-risk obstetric surveillance and delivery planning is best because growth restriction with abnormal Doppler requires specialist surveillance. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Doppler findings influence timing of delivery.

Reference: SOGC fetal growth restriction guideline