Early detection allows for antenatal management for better neonatal outcomes. Your patient is 32 weeks gestation, gravida 5 para 4 and after a routine ultrasound she is told her baby is very small and has IUGR. She asks you what causes this and you tell her:

Choice A reason: The incidence of hepatitis C is not decreasing, but rather increasing, especially among young people who inject drugs. Hepatitis C is a chronic infection that can lead to liver damage and cancer.

Choice B reason: Hepatitis B is more contagious than HIV, as it can be transmitted by blood, semen, vaginal fluids, and other body fluids. Hepatitis B can also cause chronic infection and liver problems.

Choice C reason: A vaccine exists for hepatitis B but not for hepatitis C. Hepatitis B vaccine is recommended for all infants, children, and adults who are at risk of exposure. Hepatitis C vaccine is still under development.

Choice D reason: Hepatitis A is caused by eating contaminated food or drinking polluted water. It is an acute infection that usually resolves on its own. Hepatitis A vaccine is available for travelers and people who live in areas with poor sanitation.

Choice A reason: This is not an appropriate response by the nurse, as an ultrasound is not a screening tool for spina bifida. Spina bifida is a birth defect that occurs when the spine and spinal cord do not form properly. It can be detected by a blood test that measures the level of alpha-fetoprotein (AFP) or by a detailed ultrasound that shows the spine and the brain.

Choice B reason: This is not an appropriate response by the nurse, as an ultrasound is not necessary to determine if there is more than one fetus. Multiple fetuses can be detected by other methods, such as listening to the fetal heartbeats, measuring the fundal height, or feeling the fetal movements.

Choice C reason: This is an appropriate response by the nurse, as an ultrasound assists in identifying the location of the placenta and fetus. This is important for an amniocentesis, which is a procedure that involves inserting a needle through the abdomen and the uterus to collect a sample of amniotic fluid. The ultrasound helps to guide the needle and avoid injuring the placenta or the fetus.

Choice D reason: This is not an appropriate response by the nurse, as an ultrasound is not useful for estimating fetal age at 36 weeks of gestation. Fetal age can be estimated by an ultrasound in the first trimester, when the fetus is growing at a predictable rate and has distinct features. However, in the third trimester, the fetus grows at different rates and has more variations in size and shape. Therefore, an ultrasound is less accurate and reliable for estimating fetal age at this stage.