QUESTION 20

 A 28-year-old woman, gravida 1 para 0, at 41 weeks gestation comes to the hospital for antepartum fetal surveillance. She has had

less fetal movement than usual but no abdominal pain, leakage of fluid, or vaginal bleeding Blood pressure is 120/80 mm Hg The

patient's pre-pregnancy BMI was 40 kg/m2, and she has gained 20 kg (44 lb) during the pregnancy. Her pregnancy has otherwise

been uncomplicated Nonstress test shows a baseline fetal heart rate of 140/min, moderate variability, and no accelerations for >40

minutes. Two contractions are observed on the tocodynamometer. An episode of fetal heart rate decrease to 130/min began after the

peak of a contraction and lasted for a minute. Ultrasound shows a fetus in cephalic presentation, a loop of umbilical cord near the

fetal neck, an estimated fetal weight at the 35th percentile for gestational age, and a single deepest pocket of amniotic fluid of 1 cm.

The biophysical profile results are shown below.

Biophysical profile component Score

Nonstress test 0

Amniotic fluid volume 0

Fetal movements 2

Fetal tone 2

Fetal breathing movements 0

Which of the following is the most likely cause of this patient's biophysical profile results?

A Fetal head compression

0 B. Fetal sleep cycle

0 C. lntraamniotic infection

0 D. Nuchal cord

0 E. Polyhydramnios

0 F. Uteroplacental insufficiency