Obstetrics & Gynecology>>>>>Obstetrical Complications of Pregnancy
Question 3#

A 24-year-old G1P0 presents at 30 weeks’ gestation for a new OB visit. She provides you with the official report of a dating ultrasound performed at 12 weeks; however, shortly thereafter, she moved out of state and has not had prenatal care. She has no medical problems, and has a normal BMI. She reports some abdominal cramping and shortness of breath. During her visit, you examine her cervix and it is closed. You measure her fundal height at 50 cm.

What is the next best step in management?

a. Order an ultrasound
b. Tell the patient that she is most likely having twins
c. Teach her how to do fetal kick counts, and instruct her to return in 1 week
d. Tell her that her baby will be very large and recommend a caesarean delivery
e. Order a glucose tolerance test

Correct Answer is A


This patient has an abnormally large fundal height. A fundal height should typically measure within 3 cm of the patient’s gestational age. In this case, the gestational age is known because the patient had an early ultrasound, and was able to produce the report for confirmation. Given this early ultrasound, it is unlikely that the patient is having twins, as this would have been identified at her 12-week ultrasound. Gestational diabetes is sometimes associated with polyhydramnios, and the patient does need a glucose tolerance test as part of her prenatal care, but this is not the next best step. It is possible she will have a large baby, but this alone would not explain the size greater than dates measurement. A fundal height of 50 cm requires further investigation, and the best next step is ultrasound.