Clinical Expert Series
A Practical Approach to Fetal Growth Restriction
Joshua A. Copel, MD, and Mert Ozan Bahtiyar, MD
Obstet Gynecol 2014;123:1057–69
Continuing Medical Education credit is provided through joint sponsorship with
The American College of Obstetricians and Gynecologists.
ACCME Accreditation
The American College of Obstetricians and Gynecologists (the College) is accredited by the Accreditation Council for
Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
AMA PRA Category 1 Credit(s)™
The American College of Obstetricians and Gynecologists designates this enduring material for a maximum of 2 AMA PRA
Category 1 Credits.™ Physicians should claim only the credit commensurate with the extent of their participation in the activity.
College Cognate Credit(s)
The American College of Obstetricians and Gynecologists designates this enduring material for a maximum of 2 Category 1
College Cognate Credits. The College has a reciprocity agreement with the AMA that allows AMA PRA Category 1 Credits™ to be
equivalent to College Cognate Credits.
Disclosure Statement
Current guidelines state that continuing medical education (CME) providers must ensure that CME activities are free from the
control of any commercial interest. All authors, reviewers, and contributors have disclosed to the College all relevant financial
relationships with any commercial interests. The authors, reviewers, and contributors declare that neither they nor any business
associate nor any member of their immediate families has financial interest or other relationships with any manufacturer of
products or any providers of services discussed in this program. Any conflicts have been resolved through group and outside
review of all content.
Submission
Before submitting this form, please print a completed copy as confirmation of your program participation.
College Fellows: To obtain credits, complete and return this form by e-mail (obgyn@greenjournal.org) or fax (202-479-0830).
Your score, and a copy of the answer key, will be e-mailed to you after receipt of a completed quiz. Credit will be recorded for
those participants answering 80–100% of questions correctly. College Fellows may check their transcripts online at
http://www.acog.org, and any questions related to transcripts may be directed to educationcme@acog.org. For other queries,
please contact the Obstetrics & Gynecology Editorial Office, 202-314-2317 (phone) or obgyn@greenjournal.org (e-mail).
Non–College Fellows: To obtain credits, submit the printout of the completed quiz to your accrediting institution. The printout of
the completed quiz is documentation for your continuing medical education credits.
Continuing medical education credit for “A Practical Approach to Fetal Growth Restriction” will be available through May
2017.
1. As defined by the authors, fetal growth restriction affects what percent of all pregnancies?
3%
5%
10%
15%
20%
CME Quiz for the Clinical Expert Series
Obstet Gynecol 2014;123(5)
Credit available through May 2017
Page 1 of 3
2. When compared to normally grown infants at term, infants at the 3rd percentile of growth have a
neonatal mortality that is:
Twofold less
Unchanged
Twofold greater
Fivefold greater
Tenfold greater
3. The authors recommend a fetal growth ultrasound examination at 32 weeks of gestation for patients
with:
Unexplained reduced maternal serum alpha-fetoprotein less than 2.0 multiples of the
median (MoM)
Pregnancy-associated plasma protein-A (PAPP-A) less than the 2.5th percentile
Fasting serum glucose above 135 g/dL at 26 weeks of gestation
β-hCG greater than or equal to 20,000 international units at 8 weeks of gestation
Hemoglobin levels less than or equal to 10 g/dL at their initial visit
4. In a fetus suspected of having fetal growth restriction, the ultrasonographic finding of intracranial or
hepatic calcifications suggests:
Gestational age greater than dates
Congenital infection
Chronic reverse end-diastolic flow
Maternal substance abuse
Fetal umbilical cord abnormalities
5. The highest end-diastolic umbilical artery flow velocity waveforms will be found when the
measurements are taken near:
The abdominal umbilical cord insertion
The mid-portion of the umbilical cord
A free-floating loop of the umbilical cord
Portions of the umbilical cord receiving external compression
The placental umbilical cord insertion
6. Maximizing systolic and diastolic ultrasonographic frequency shifts is facilitated by the:
Frequency of the transducer used
Angle of insonation (angle between the ultrasound beam and the direction of flow in the
interrogated vessel)
Age of the fetus
Use of a vaginal ultrasonography probe
State of maternal hydration
CME Quiz for the Clinical Expert Series
Obstet Gynecol 2014;123(5)
Credit available through May 2017
Page 2 of 3
7. A decrease in the Doppler cerebro-placental ratio, defined as cerebral resistance index divided by
umbilical artery resistance index, suggest the presence of:
Placental hydrops
Fetal brain sparing
Fetal anoxia
Umbilical cord compression
Fetal anemia
8. Ductus venosus flow pattern directly reflect pressure changes within the:
Left ventricle
Right atrium
Placenta
Umbilical artery flow
Cerebral hemisphere
9. With regard to Doppler flow studies of the ductus venosus, the most ominous finding is:
Triphasic blood flow
Reversed flow during atrial systole (“a wave”)
Altered flow during fetal breathing movements
Increased absolute velocities than seen in other veins
Concomitant retrograde flow during end diastole in the hepatic vein
10. The Growth Restriction Intervention Trial (GRIT) of immediate compared with deferred delivery of
growth restricted fetuses at ages 2 years and 9 years showed:
Significantly better outcomes with immediate delivery
Slightly better outcomes with immediate delivery
No difference in outcomes
Slightly better outcomes with delayed delivery
Significantly better outcomes with delayed delivery
College ID Number:
Name:
Address:
City/State/Zip:
E-mail Address:
Actual time spent completing this activity (you may record up to 2 hours):
CME Quiz for the Clinical Expert Series
Obstet Gynecol 2014;123(5)
Credit available through May 2017
Page 3 of 3