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Part 2 exam > GTG 31 - small for gestational age fetus > Flashcards

GTG 31 - small for gestational age fetus Flashcards

1
Q

How is SGA defined?

A

EFW or AC <10th centile

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2
Q

How is low birth weight defined?

A

<2.5kg

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3
Q

Which patients require direct referral for serial scans?

A

Patients with 1 major risk factor for SGA and patients in who SFH cannot be accurately measured (large fibroids, BMI >35)

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4
Q

Which patients require uterine artery Doppler screening?

A

Patients with 3 or more minor risk factors for SGA

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5
Q

Which medical conditions are major risk factors for SGA?

A

APS
chronic hypertension
renal impairment
diabetes with vasculopathy

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6
Q

Is a history of PET, a major or minor risk factor for SGA?

A

Minor risk factor

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7
Q

Is a history of previous SGA, a major or minor risk factor for SGA?

A

Major risk factor

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8
Q

Is a maternal smoking history, a major or minor risk factor for SGA?

A

Dose dependent: 1-10/day = minor, >/= 11 = major

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9
Q

Is cocaine use, a major or minor risk factor for SGA?

A

Major risk factor

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10
Q

Which findings on screening (biochemical or anomaly) are major risk factors for SGA?

A

PAPP-A <0.4 MOM or fetal echogenic bowel

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11
Q

How does pregnancy interval influence risk of SGA?

A

<6 months or >60 months (5 years) are both minor risk factors for SGA

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12
Q

Is bleeding in early pregnancy, similar to a menstrual period, a risk factor for SGA?

A

Yes, major risk factor

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13
Q

How does maternal age influence risk of SGA?

A

> 40 years old = major risk factor, >35 years old = minor risk factor

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14
Q

How does BMI influence risk of SGA?

A

Underweight <20 = minor risk factor,
Overweight 25-34.9= minor risk factor for SGA,
obese >35 requires serial scanning because SFH inaccurate

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15
Q

Which medical conditions are not considered risk factors for SGA (in this guideline)?

A

Asthma, inflammatory bowel disease, thyroid disease. SLE = maybe, but insufficient evidence

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16
Q

When in the pregnancy should serial scans of fetal growth start?

A

26-28 weeks

17
Q

When in the pregnancy should uterine artery Doppler be screened?

A

20-24 weeks (it should not be repeated – risk of SGA remains, even if it normalises)

18
Q

What features would classify a uterine artery Doppler as abnormal?

A

PI >95th centile +/- notching

19
Q

What is the odds ratio of an SGA baby with PAPP-A <0.4?

A

<10th centile = 2.7, <3rd centile = 3.6

20
Q

How might SFH measurements lead to a growth scan referral?

A

SFH <10th centile on customised growth chart, or indication of FGR, however no evidence on the number of centiles that need to be crossed for a referral to be made

21
Q

What time interval is recommended between growth scans to minimise false positive for FGR?

A

3 weeks between growth scans

22
Q

What proportion of SGA pregnancies are associated with infection (which infections)?

A

5% - CMV, Toxoplasmosis, syphilis and malaria

23
Q

What proportion of SGA pregnancies are associated with chromosomal abnormalities?

A

19% - triploidy most common <26/40, trisomy 18 most common >26/40

24
Q

How should severe, early onset SGA be managed?

A

Severe SGA identified at 18-20/40 anomaly scan should be referred to FMU for detailed anatomy survey, uterine artery Doppler, consideration for karyotyping and serological screening

25
Q

How should SGA babies with a normal UAD be monitored?

A

Two weekly AC, EFW, UAD and MCA after 32 weeks

26
Q

When should SGA babies with consistent growth and normal serial measurements UAD and MCA be delivered?

A

Offer delivery by 37/40

27
Q

When should SGA babies with static growth over 3 weeks with a normal UAD or a raised PI but EDF is present be delivered?

A

Consider delivery >34/40

28
Q

When should SGA babies with normal UAD but an MCA <5th centile be delivered?

A

Recommend delivery by 37/40

29
Q

How should SGA babies high UAD PI but EDF is present be monitored?

A

Weekly AC and EFW, twice weekly UAD

30
Q

When should SGA babies with high UAD PI but EDF is present be delivered?

A

Delivery recommended by 37/40

31
Q

How should SGA babies with absent or reversed end diastolic flow in UAD be monitored?

A

If baby is <32/40, they will need weekly AC and EFW and daily UAD, DV or computerised CTG

If baby >32/40, they will likely need delivery

32
Q

When should SGA babies with absent or reversed end diastolic flow in UAD be delivered?

A

If DV or CTG abnormal, deliver before 32 weeks - Once viable (>24/40 or >500g) and steroid mature

If DV normal, recommend delivery by 32/40 and consider delivery 30-32/40

33
Q

What is the perinatal mortality associated with AREDV in the UAD?

A

12%

34
Q

What is the perinatal mortality associated with high PI or absent/reverse a wave in DV?

A

High Pi = 39%, absent/reversed a wave = 41%

35
Q

What is considered abnormal variability on computerised CTG?

A

<3m/s

Part 2 exam (39 decks)

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