## Why Refer for ultrasound assessment is right At 28 weeks gestation, the expected symphysis-fundal height (marked **A**) should be approximately 28 cm. A measurement of 24 cm represents a deviation of 4 cm below expected for gestational age — exceeding the 3 cm threshold that warrants investigation. According to Williams Obstetrics 26e and Dutta 9e, such deviation raises concern for intrauterine growth restriction (IUGR), oligohydramnios, or other pathology. Ultrasound is the gold standard for accurate fetal biometry, amniotic fluid assessment, and Doppler evaluation to confirm or exclude these conditions and guide further management. This is standard practice in Indian antenatal care protocols (ICMR/WHO guidelines). ## Why each distractor is wrong - **Reassure and routine follow-up**: Ignores a clinically significant deviation (>3 cm) from expected fundal height. Delayed investigation of potential IUGR or oligohydramnios increases fetal morbidity and mortality risk. - **Admit for inpatient monitoring and delivery**: Premature and not indicated at 28 weeks without confirmed fetal distress. Ultrasound must first establish the diagnosis; delivery at 28 weeks carries significant neonatal morbidity and is reserved for confirmed severe pathology with fetal compromise. - **Iron supplementation and repeat measurement in 2 weeks**: Addresses anemia (not the primary concern here) and delays diagnosis. Serial fundal height alone cannot reliably differentiate IUGR from constitutional small size; ultrasound is mandatory when deviation exceeds 3 cm. **High-Yield:** SFH deviation >3 cm from expected weeks (between 20–36 weeks) = ultrasound for fetal biometry, amniotic fluid, and Doppler; do not reassure or delay imaging. [cite: Williams Obstetrics 26e; Dutta 9e; ICMR/WHO Antenatal Care Guidelines]
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