Risk factors for SGA

Question 1

Risk Factor for SGA: History

Answer 1

• Women who have a major risk factor should be referred for serial ultrasound with umbilical artery Doppler from 26–28 weeks of pregnancy
• Women who have three or more minor risk factors should be referred for uterine artery Doppler at 20–24
  weeks of gestation
• Previous SGA neonate have at least a twofold increased risk

Question 2

Placenta mediated risk factors for SGA

Answer 2

• Pre-eclampsia
• Prior stillbirth, in particular those with a
  history of previous preterm unexplained stillbirth

Question 3

Maternal medical conditions associated with an increased risk of SGA

Answer 3

• Diabetes with vascular disease
• Moderate and severe renal impairment (especially when associated with hypertension)
• Antiphospholipid syndrome
• Chronic hypertension
• Systemic lupus erythematosus
• Certain types of congenital heart disease, in particular cyanotic congenital heart disease

Question 4

Maternal risk factors associated with an increased risk of SGA

Answer 4

• Maternal age ≥ 35 years, with a
  further increase in those ≥ 40 years old
• African American or Indian/Asian ethnicity
• Nulliparity
• Social deprivation
• Unmarried status
• Body mass index (BMI) 25
• Maternal SGA
• A short ( 60 months) inter–pregnancy interval
• Heavy vaginal bleeding during the first trimester
• Smoking, dose dependent
• Maternal caffeine consumption ≥ 300 mg per day in the third trimester
• Low fruit intake pre–pregnancy
• Paternal history of SGA

Question 5

Biochemical markers used for Down Syndrome Screening and SGA

Answer 5

• A low level (

Question 6

Uterine artery Doppler and SGA

Answer 6

• In high risk pts, uterine artery Doppler at 20–24 weeks of pregnancy has a moderate predictive value. Women with multiple moderate risk should be offered it . Women of known high risk should go straight to serial scans from 26 weeks
• Abnormal uterine artery Doppler at 20–24 weeks no need to repeat as considered high risk even if it normalises
• Women with an abnormal uterine artery Doppler at 20–24 weeks (defined as a pulsatility index [PI]
  > 95th centile) and/or notching should have serial USS from 26–28 weeks of pregnancy
• If high risk patients have normal uterine Doppler, no serial scans but a growth scan in the third trimester
• 32% of pts with abnormal Doppler which persists after 26weeks will have SGA baby
• 9.5% pts where Doppler normalises will develop SGA

Question 7

Fetal echogenic bowel and SGA

Answer 7

• Independently ass with SGA

- Need serial scans

Question 8

Clinical examination and SGA

Answer 8

• Fundal height has limited value for SGA
• Women with a single SFH which plots below the 10th centile or serial measurements which demonstrate
  slow or static growth by crossing centiles should be referred
• Women were the SFH is inaccurate (BMI, Fibroids) need serial scans

Question 9

Which are the minor risk factors for SGA

Answer 9

• Maternal age > 35
• IVF Singleton pregnancy
• Smoker 1-10/day
• Pregnancy gap 60 months
• Nulliparity
• BMI

Question 10

Which are the major risk factors for SGA

Answer 10

• Maternal age 40
• Previous SGA
• Paternal SGA
• Maternal SGA
• Previous stillbirth
• Chronic hypertension
• Smoker > 10/day
• Cocaine
• Daily vigorous exercise
• Diabetes with vascular disease
• Renal impairment
• Antiphospholip syndrome
• Heavy bleeding in 1st trimester
• Low PAPP-A