2024 31 SGA & FGR Flashcards

1
Q

When should women be assessed for FGR risk factors?

A

Booking, by 14/40
Update with midtrimester scan

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2
Q

What steps can be taken to reduce FGR caused by smoking?

A

CO testing
Trained tobacco dependence team

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3
Q

What reduces the rate of SGA & FGR in women at risk of placental dysfunction?

A

Aspirin 12/40-36/40

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4
Q

What is the pathway for women at high risk of fetal growth disorders?

A
  1. Uterine artery Dopplers 18-23+6
  2. If normal, serial scans from 32/40
  3. If normal but SGA, serial scans from 26-28/40
  4. If abnormal, serial scans from 28/40
  5. If abnormal & SGA, FMU
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5
Q

What is the pathway for women at low risk of fetal growth disorders?

A

SFH at every CMW appt from 24/40

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6
Q

What is the pathway for women at moderate risk of fetal growth disorders?

A
  1. Serial growth scans from 32/40
  2. 4-weekly scan intervals until birth
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7
Q

Which model should be used for calculating EFW?

A

Hadlock 3-parameter model

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8
Q

How should fetuses identified as SGA be monitored?

A

Ultrasound biometry every 2 weeks
Umbilical artery Doppler as primary surveillance tool, at least every 2 weeks

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9
Q

In SGA with EFW 3rd-10th centile, what birth plans should be made?

A
  1. Don’t deliver before 39/40 unless maternal or fetal concerns
  2. Consider from 39/40
  3. Recommend birth by 39+6
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10
Q

In early FGR, prior to 32/40, what is the management?

A
  1. Tertiary level care
  2. Fetal biometry every 2 weeks
  3. Fetal wellbeing including cCTG &/or ductus venosus
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11
Q

How should late FGR be managed?

A

Birth 37-37+6

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12
Q

How are SGA & FGR defined?

A

SGA: < 10th centile
FGR: < 3rd centile or SGA with Doppler abnormalities
Early up to 31+6, late from 32/40

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13
Q

What is the definition of static growth?

A

No forward growth velocity
In EFW or AC
Measured at least 14 days apart

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14
Q

What are the potential reasons for a small fetus?

A
  1. Constitutionally small
  2. Non-placenta-mediated:
    * structural anomaly
    * chromosomal anomaly
    * inborn errors of metabolism
    * fetal infection
  3. Placenta-mediated:
    * placental dysfunction
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15
Q

What maternal factors can affect placental transfer of nutrients?

A
  1. Low pre-pregnancy weight
  2. Undernutrition
  3. Substance misuse
  4. Severe anaemia
  5. Medical conditions (separate card)
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16
Q

What maternal medical conditions can affect placental implantation & vasculature?

A
  1. Pre-eclampsia
  2. Autoimmune disease
  3. Thrombophilias
  4. Renal disease
  5. Diabetes
  6. Cardiac disease
  7. Essential hypertension
17
Q

What is the pathology in early vs late FGR?

A

Early:
Significant abnormal placentation
Increased hypoxia & cardiovascular adaptations
Often coexists with mat med
Late:
Milder deficit, but harder to detect so significant proportion of adverse outcomes

18
Q

For which women is SFH inappropriate, and how is this managed?

A
  1. BMI > 35
  2. Fibroids
    —> serial scans from 32/40
  3. Congenital uterine anomalies
    —> serial scans from 28/40
19
Q

What are the moderate risk factors for FGR?

A
  1. Previous SGA
  2. Previous stillbirth (normal growth)
  3. Current smoker
  4. Drug misuse
  5. Age ≥ 40
  6. BMI < 18.5
  7. Gastric bypass surgery
  8. Previous PTB or 2nd trim MC
20
Q

What are the maternal medicine high risk factors for FGR?

A
  1. CKD
  2. HTN
  3. Autoimmune disease
  4. Complex cardiac disease
21
Q

What are the obstetric history high risk factors for FGR?

A
  1. Previous FGR
  2. HTN in previous pregnancy
  3. Previous SGA stillbirth
22
Q

What are the current pregnancy high risk factors for FGR?

A
  1. PAPP-A < 5th centile
  2. Inhibin A > 2 MoM (2nd trim)
  3. AFP > 2 MoM (2nd trim)
  4. Echogenic bowel
  5. Significant bleeding
  6. EFW < 10th centile
  7. Single umbilical artery
23
Q

What is the pathway if early FGR is identified?

A
  1. Fortnightly EFW
  2. Weekly UA Dopplers
  3. If AREDF, twice weekly cCTG +/- DV
  4. Deliver if DV a-wave absent or STV reduced
  5. Deliver by 32/40 if REDF
  6. Deliver by 34/40 if AEDF
24
Q

In FGR with AREDF, what STV indicates delivery at different gestations?

A

26-28+6: <2.6ms
29-31+6: <3.0ms
32-33+6: <3.5ms
34-36+6: <4.5ms

25
What is the pathway for FGR at 32-36+6?
1. Fortnightly EFW 2. Weekly UA Dopplers 3. If PI > 95th centile, twice weekly cCTG 4. Deliver if DV a-wave absent, reduced STV, deliver by 36-36+6 if PI > 95th
26
What is the pathway for FGR from 37/40 onwards?
1. Fortnightly EFW 2. Weekly UA Dopplers 3. Deliver if AC/EFW < 3rd centile by 37+6, signs of cerebral redistribution, Doppler abnormalities
27
How should fetuses with FGR be prepared for birth?
1. Steroids for 24-34+6, ideally 48 hours before birth 2. Magnesium sulphate for 24-29+6 (consider to 33+6 as FGR may require neuroprotection for longer)
28
In what FGR circumstances is CS recommended?
1. Abnormal cCTG STV 2. DV alteration 3. Absent or reversed end diastolic flow velocities 4. Ideally after steroids & MgSO4