Growth Restriction

Question 1

Risk of recurrence of SGA if happened in previous pregnancy?

Answer 1

20%

Question 2

Delivery of FGR > 3%ile w/ normal dopplers?

Answer 2

38w0d-39w0d

Question 3

Delivery of severe IUGR (< 3%ile) w/ normal dopplers?

Answer 3

37w0d

Question 4

Delivery w/ dopplers decreased end diastolic flow

Answer 4

37w0d

Question 5

Delivery w/ dopplers absent end diastolic flow?

Answer 5

33w0d-34w0d

Question 6

Delivery w/ dopplers reversed end diastolic flow

Answer 6

30w0d-32w0

Question 7

Maternal nutrition associated with FGR?

Answer 7

Only if poor protein intake or severe calorie restriction before 26 weeks

Question 8

What is the approximate risk of stillbirth in a fetus with EFW < 10th% for GA?

Answer 8

1.5%

Normal growth 0.75%
(EFW < 5%ile 2.5%)

Question 9

Define fetal growth restriction

Answer 9

EFW or abdominal circumference < 10%ile

Question 10

Define SGA

Answer 10

Birth Weight < 10%ile for gestational age

DETERMINED AFTER BIRTH

Question 11

Maternal Causes of FGR

Answer 11

PREgestational DM
Autoimmune Disease
Cyanotic congenital heart disease
Hypertensive Disorders
APS
Tobacco/Alcohol
Illicit Substance Use
Multiple Gestations
Infections (TORC, syphilis, varicella and malaria)

Question 12

Fetal Causes of FGR

Answer 12

Genetic Disorders (Trisomy 13 or 18)
Congenital Malformations (gastroschisis, congenital heart disease)

Question 13

Placental/Cord Causes of FGR

Answer 13

Placenta: abruption, infarction, circumvallate shape, hemangioma, and chorioangioma

Cord: velamentous, marginal cord

**All can cause placental insufficiency

Question 14

Placenta accreta associated with IUGR

Answer 14

No

Question 15

Placenta Previa associated with IUGR?

Answer 15

No

Question 16

Single Umbilical Artery associated with IUGR?

Answer 16

No

Question 17

Differential Diagnosis for small fetus?

Answer 17

1. Fetal Growth Restriction (can be symmetric or asymmetric, will get worse as pregnancy grows)
2. Constitutionally small fetus (always symmetric, maintains small growth)
3. Incorrect gestational dating

Question 18

How do you differentiate between a constitutionally small fetus and FGR?

Answer 18

Constitutionally small with is always symmetric and consistently stay at the same percentile throughout the pregnancy

FGR can be asymmetric, progressively will get worse during pregnancy