Question 3: SGA/IUGR

Question 1

Diff diagnosis for fungal height 30cm at 36 weeks

Answer 1

incorrect dates
incorrect measurement
oligohydramnios
IUGR
transverse lie

Question 2

What history would you take?

Answer 2

1) VALIDITY OF DATING
LMP and reliability (e.g. regularity and length of menstrual cycle, how she recalls her LMP, if she was on hormonal contraception at time of conception or has PCOS)
Ask about the dating scan/first USS - earlier is more accurate.

2) SCREEN FOR IUGR
Fetal movements
Prev scans + GROW chart
HTN or smoking
Prev IUGR
APH this pregnancy can precede IUGR

Question 3

What examination would you perform?

Answer 3

BMI
Observations - e.g. blood pressure
abdo palpation, double check fundal height, lie + presentation,
Urinalysis could be done for proteinuria if BP was elevated

Question 4

3. What investigations would you perform?

Answer 4

CTG
Ultrasound (FHR, fetal parametes - head circumference, crown-rump length, liquor volume, doppler)

Question 5

Mx of future pregnancies if IUGR

Answer 5

Conflicting evidence on giving low dose aspirin from the 1st trimester

Uterine artery doppler 20/40 to determine how frequently we will do growth scans.