SGA Flashcards
What is SGA classified as in pregnancy?
A foetus with an estimated fetal weight on a customised growth chart below the 10th percentile for gestational age
What is SGA classified as in a neonate?
Weight below the 10th percentile on customised growth chart
What is intrauterine growth restriction?
A baby that has failed to reach their growth potential e.g. SGA or growth dropping off/slowing down. Blood flow directs to vital organs like the brain = HC vs AC disportionate
What are the possible pathophysiologies of SGA?
- Placental insufficiency
- Constitutional small
- Intrinsic fetal
- Substance abuse
What is the pathophysiology of IUGR/FGR?
- Abnormal placental blood flow = reduced blood flow = reduced oxygen and nutrients delivered to foetus = blood directed to vital organs (brain, heart, placenta) = growth affected = characteristics seen on USS e.g. AC reduced vs HC
Risk factors for SGA/IUGR?
- Advanced maternal age
- Smoking/Drug use
- Obesity
- Underweight
- Previous SGA/stillborn
- Chronic hypertension
- Primiparity
Screening for SGA?
- Fundal height measurements plotted on customised growth chart
- Serial growth scans via USS
What perinatal period outcomes are you worried about for SGA?
- Preterm
- Asphyxia at birth
- Stillbirth
What neonatal period outcomes are you worried about for SGA?
- Hypoglycaemia
- Hypothermia
- Hypoxia
- Asphyxia
- Polycythemia = jaundice
- NICU asmissions
- SUDI
- Neonatal deaths
What is your management/care plan for a known SGA baby in pregnancy?
- Referral to obstetrician
- Serial growth scans
- Low dose aspirin if appropriate - decided by consultation/referral
What is your care plan for a SGA baby in labour?
- Decision re timing of birth in consultation depending on factors such as severity of SGA
- CTG monitoring
- Anticipate fetal distress, perinatal asphyxia, need for resus
- Paediatrician in attendance at birth
What is your care plan for an SGA baby after birth?
- Customised growth chart percentile to confirm SGA or not
- Preventing cold stress cycle: hypoxia, hypoglycaemia, hypothermia
- Warmer room, skin to skin, warm towels and blankets, beanie (prevent hypothermia)
- Early feeding (prevent hypoglycaemia)
- 3hrly effective feeding, may require top ups
- Monitor output closely
- Obs documented on NEWS chart for score
Why are SGA babies more at risk of hypothermia?
- The result of increases body surface to weight ratio augments heat loss. Requires more energy to try and keep themselves warm
Why are SGA babies more at risk of hypoglycaemia?
SGA neonates have reduced glycogen stores = less reserves to use as food and energy = requiring effective feeding to prevent low blood glucose concentration
What is low blood glucose levels associated with?
Brain damage
