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Gaby’s Green Top Guidelines > 2024 31 SGA & FGR > Flashcards

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
Q

What is the pathway for FGR at 32-36+6?

A
  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
Q

What is the pathway for FGR from 37/40 onwards?

A
  1. Fortnightly EFW
  2. Weekly UA Dopplers
  3. Deliver if AC/EFW < 3rd centile by 37+6, signs of cerebral redistribution, Doppler abnormalities
27
Q

How should fetuses with FGR be prepared for birth?

A
  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
Q

In what FGR circumstances is CS recommended?

A
  1. Abnormal cCTG STV
  2. DV alteration
  3. Absent or reversed end diastolic flow velocities
  4. Ideally after steroids & MgSO4

Gaby’s Green Top Guidelines (51 decks)

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