Review Question - QID 109108

A 38-year-old G4P3 woman presents to her obstetrician’s office for her 20-week anatomy ultrasound. She feels well and has not experienced any contractions or vaginal bleeding and notes good fetal movement. The patient declined prenatal screening earlier in the pregnancy but would now like an anatomy ultrasound to ensure the fetus is growing appropriately. The patient’s previous pregnancies were uncomplicated and she delivered 3 healthy babies at full term. Her temperature is 98.6°F (37°C), blood pressure is 115/71 mmHg, pulse is 72/min, and respirations are 12/min. On the ultrasound, the technician observes a male fetus with likely intrauterine growth restriction. She also notes microcephaly, convex-rounded feet, and clenched fists with overlapping fingers. The technician further notes a medium-sized ventricular septal defect. The amniotic fluid index (AFI) is 26 cm. Which of the following additional findings is most likely to be observed in this fetus?