Intrauterine Growth Retardation

Question 1

Define small for gestational age (SGA)

Answer 1

A foetus that measures below the10th centilefor theirgestational age

Question 2

How is foetal size measured?

Answer 2

Estimated foetal weight

Foetal abdominal circumference

Question 3

Causes of small for gestational age

Answer 3

Constitutionally small (matching mother and others in family, growing appropriately)

Intrauterine growth restriction

Question 4

Risk factors for being small for gestational age

Answer 4

Previous SGA baby

Obesity

Smoking

Diabetes

Existing hypertension

Pre-eclampsia

Older mother (over 35 years)

Multiple pregnancy

Lowpregnancy‑associated plasma protein‑A (PAPPA)

Antepartum haemorrhage

Antiphospholipid syndrome

Question 5

Foetal aetiology for SGA

Answer 5

Chromosomal defetcs

Multiple pregnancy

Vertical infection e.g. CMV, rubella, toxoplasmosis

Question 6

Maternal aetiology for SGA

Answer 6

Maternal BMI and nutritional status

Co-morbidities e..g. diabetes, anaemia, HTN, infection etc

Cigarette smoking, alcohol and substance abuse

Structural uterine malformations

Question 7

Placental aetiology for SGA

Answer 7

Utero-placental insufficiency

Pre-eclampsia

Question 8

Sign that would indicate IUGR

Answer 8

Reduced amniotic fluid volume

Abnormal doppler studies

Reduced foetal movements

Abnormal CTG

Question 9

Investigations when a foetus is identified as SGA

Answer 9

BP and urine dipstick for pre-eclampsia

Uterine artery doppler scanning

Detailed foetal anatomy scan byfoetal medicine

Karyotyping for chromosomal abnormalities

Testing for infections (e.g. toxoplasmosis, CMV, syphilis and malaria)

Question 10

Monitoring women at risk or with SGA

Answer 10

Serial USS measuring:

Estimated foetal weight and abdominal circumference

Umbilical arterial pulsatility index to measure flow through umbilical artery

Amniotic fluid volume

Question 11

Management of SGA

Answer 11

Aspirin given to those at risk of pre-eclampsia

Treat modifiable risk factors (e.g. stop smoking)

Serial growth scans to monitor growth

Early delivery where growth is static, or there are other concerns

Question 12

Short term complications of SGA

Answer 12

Foetal death or stillbirth

Birth asphyxia

Neonatal hypothermia

Neonatal hypoglycaemia

Question 13

Long term increased risks of SGA

Answer 13

Cardiovascular disease, particularlyhypertension

Type 2 diabetes

Obesity

Moodandbehavioural problems