The primigravida at 22 weeks' gestation has a fundal height palpated slightly below the umbilicus. Which of the following statements would best describe to the client why she needs to be seen by a physician today?
1. "Your baby is growing too much and getting too big."
2. "Your uterus might have an abnormal shape."
3. "The position of your baby can't be felt."
4. "Your baby might not be growing enough."
4
Rationale:
1. The fundal height at 20 weeks should be about even with the umbilicus. At 22 weeks, the fundus should be above the umbilicus. At 22 weeks' gestation, a fundal height below the umbilicus could indicate fetal death in utero.
2. Uterine shape can be assessed only with diagnostic imaging techniques such as ultrasound or CT scan.
3. The position of the baby is not noted until 36 weeks' gestation because as the presenting part descends into the pelvis in preparation for labor, it is important that the fetus be in a vertex presentation.
4. The fundal height at 20 weeks should be about even with the umbilicus. At 22 weeks, the fundus should be above the umbilicus. At 22 weeks' gestation, a fundal height below the umbilicus could indicate fetal death in utero.
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