Fetal growth restriction Quiz: Ace Your Exams

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A 36-year-old woman, gravida 2, para 1, at 34 weeks estimated gestational age (EGA) dated by a first trimester ultrasound, with a dichorionic twin gestation and gestational diabetes mellitus (GDM), presents for routine antenatal care. She is asymptomatic. The anatomy ultrasound was normal at 20 weeks, the patient was diagnosed with GDM on routine screening at 28 weeks, and she has declined all aneuploidy screening. Her history is notable for one prior vaginal delivery, factor V Leiden mutation, and influenza in the first trimester that resolved with supportive care after several days. She takes prenatal vitamins, enoxaparin, and metformin. Temperature is 36.5°C (97.7°F), pulse is 80/min, respirations are 18/min, and blood pressure is 136/84 mmHg. On exam, the abdomen is non-tender, and the fundal height is 37 cm. A review of her glucose log shows good control over the past week. Results of routine growth scans are shown in the table. Which of the following from the patient’s history is responsible for twin A’s estimated fetal weight (EFW)?

Twin	26 weeks	30 weeks	34 weeks
A	19^th percentile	15^th percentile	8^th percentile
B	22^nd percentile	18^th percentile	17^th percentile

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Aneuploidy

First-trimester infection

Factor V Leiden mutation

Gestational diabetes

Multiple gestation