GTG - investigation and management of SGA fetus 2013-14 Flashcards
How many risk factors to recommend uterine artery doppler at 20-24 weeks gestation
3 or more minor risk factors
What is considered a low level of first trimester PAPP-A
<0.415 MoM
What is the significance of a low first trimester PAPP-A?
It is a major risk factor for delivery of a SGA neonate
How should women with abnormal uterine artery doppler (raised PI or notching) at 20-24 weeks be managed?
they should be referred for serial growth and dopplers from 26-28 weeks
How should women with a normal uterine artery doppler at 20-24 weeks be managed?
The do not require serial growth or dopplers but should be offered a single scan in the third trimester for growth and dopplers.
What should women with fetal echogenic bowel be offered?
Serial US assessment of growth and dopplers
If severe SGA is detected at the anomally scan, what action recommended?
Detailed anatomy scan and Uterine Artery doppler by a fetal medicine specialist.
What additional investigation should be undertaken in babies with severe SGA and ultrasound detected structural anomalies before 23 weeks?
Karyotyping should be offered, especially if the uterine artery doppler is normal.
What serological testing should be undertaken in severely SGA fetuses?
Serological testing for CMW and toxoplasmosis.
Should MCA doppler be used to time delivery in the PRETERM SGA fetus?
MCA doppler has limited accuracy to predict acidaemia and adverse outcome and should not be used in the PRETERM SGA fetus to time delivery.
In the TERM SGA fetus, can MCA doppler be used to time delivery?
In the TERM SGA fetus MCA doppler has moderate predictive value for acidosis at birth and should be used to time delivery.
Is the abnormal ductus venosus doppler predictive
Ductus venosus doppler should be used in the PRETERM SGA fetus with an abnormal umbilical artery doppler to time delivery
Ductus venosus doppler has a moderate predictive value for acidaemia and adverse outcome.
