SGA Flashcards

1
Q

What are the major risk factors for SGA (OR>2.0)?

A

1.Maternal age >40yrs
2.Maternal SGA
3. Chtn
4. Dm w/ vascular disease
5. APL syndrome
6. Moderate to severe kidney disease
7. Prev sga baby
8. Prev SB
9. Prev unexplained preterm SB
10. Paternal SGA
11. Smoking >11cig/day
12. Cocaine
13. Daily vigorous exercise

  • reassess risks at 20-24weeks:
    14. PAPP-A <0.4MoM
    15. Echogenic bowel
    16. Poor weight gain
    17. Unexplained APH
    18. Severe PIH
    19. Heavy bleeding

Need only one for surveiĺlance!

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2
Q

What are the minor risk factors for SGA (OR <1 to <2.0)?

A
  1. Maternal age 35 and above
  2. Nulliparity
  3. African-American/Indian/Asian ethnicity
  4. BMI <20 or >25
  5. IVF singleton pregnancy
  6. Pre-eclamsia
  7. Pregnancy interval <6mth or >60mths (5yrs)
  8. Heavy T1 bleeding
  9. Smoker 1- 10cig/day
  10. Moderate alcohol intake
  11. Maternal caffeine intake >300mg per day
  12. Low fruit intake prepregnancy
  13. Low socioeconomic status
  14. Unmarried
  15. Domestic abuse
  • reassess risks at 20-24weeks:
    16. Mild PIH
    17. Placental abruption
    18.
    Need at least 3 for surveillance!
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3
Q

What is the surveillance for women with a major or 3 minor risk factors for SGA?

A

**1Major - serial efw and UmAD starting at 26-28 weeks

** 3/more Minor- UtAD screening at 20-24 weeks

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4
Q

If the UtAD is abnormal at 20-24 on dopper assessment. What next?
- compare to what would be done initially was normal?

A

Abnormal UtAD at 20-24 weeks —- do SEFIAL efw and UmAD at 26-28weeks.

If the UtAD was normal then do ONE scan for efw and UmAD in T3.

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5
Q

What is echogenic bowel associated with?

A

SGA
Fetal demise

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6
Q

A. How is SGA diagnosed?
B. How often are measurements made to assess for SGA?

A

A. <10th centile for EFW and AC.
- use of customized charts adjusted for maternal wt, ht, ethnicity and Parity improve prediction.

B. 2 measurements of EFW and AC must be AT LEAST 3 weeks apart to minimize false pos rates

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7
Q

T/F. Serial growth velocity measures are superior to a single measurement in estimating FGR and poor perinatal outcomes?

A

True. 2 readings AT LEAST 3wks apart reduces the false positive rates

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8
Q

What is the expected AC and EFW mean growth rates after 30 weeks?

A

10mm/14days - AC
200mg/14days - EFW

14 days as assessment are usually every 2 weeks!

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9
Q

An AC mean growth rate of ____indicates FGR?

A

<5mm/14days

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10
Q

T/F. Amniotic fluid volume useful to diagnose FGR?

A

False

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11
Q

T/F. The use of uterine a. doppler is limited to predict FGR?

A

True

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12
Q

How would you investigate a severely SGA fetus detected on anomaly scan?

A
  • Detailed anatomy scan with Umbilical Artery Doppler assessment.
  • Karyotyping if structural anomalies are detected before 23 weeks.
    —- because chromosomal abnormalities are seen in up to 19% of SGA fetuses
    —– most common chromosomal defect is triploidy fetuses before 26 weeks, and trisomy 18 in those after 26 weeks
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13
Q

What percentage of SGA occurs secondary to infections?
Which infections should be screened for?

A

5%

  • cmv
  • toxo
  • syphilis & malaria in High-risk pops
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14
Q

How do you determine the mode of delivery for an SGA fetus?

A

SGA plus:

  1. UmAD AREDV - deliver by csection
  2. Normal UmAD - IOL
  3. Abnormal Umbilical a. PI but
    PEDV - IOL
  • IOL has an increased risk of csection. Monitor with continuous CTG monitoring from the ONSET of uterine contractions.
  • Deliver in a unit with access to neonatologists/ paediatricians and a neonatal ICU
  • Neonataologist present if extremely preterm or severe FGR.
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15
Q

What is the purpose of fetal surveillance?

A

To predict fetal academia, thereby allowing TIMELY delivery before 1) irreversible end organ damage and 2)intrauterine death.

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16
Q

What is the timing of delivery for an SGA fetus?

A

Delivery by 37 weeks (the latest in all scenarios!!!)

  1. Normal efw & UmAD = 37 weekss
    —-deliver >34 weeks if:
    ——static growth over 3-4wks
    ——- MCA PI < 5th centile
  2. PEDV with PI or R1 >2SDs = 37wks
    ——- deliver >34 wks if:
    ————-static growth over 3wks
  3. AREDV = deliver BY 32 wks
    — Consider delivery at 30-32 wks even if ductus venosusnis normal
    —- RECOMMEND delivery <32wks if:
    ——— 1) abnormal ductus venosus doppler AND/OR 2) abnormal CTG
    provided GA>24 & EFW>500g
17
Q

In a preterm, SGA fetus, which doppler assessment should be used for surveillance and to time delivery? Why?

A

The ductus venous doppler (DtV)

DtV dopper has a moderate predictive value for acidaemia and adverse outcome.

18
Q

What does a reduced MCA PI indicate?

A

It is an early sign of Fetal Hypoxia in SGA fetuses
- due to the brain sparing effect where chronic hypoxia - vasodilation & increased diastolic - decreased MCA doppler indices

19
Q

Why is MCA not used to determine the time of delivery?

A

Because the MCA doppler has limited accuracy to predict:
-Acidaemia and
-Adverse outcomes

20
Q

What’s the benefit of UmAD measurements? How often is surveillance?

A

They reduce perinatal morbidity and mortality in patients at high risk for SGA.
- UmAD surveillance is every 14 days once normal.
— if severe SGA, the more often surveillance may be warranted.

21
Q

Which UmAD indices (PI, RI, systolic/diastolic ratio and diastolic average ratio) is best to predict adverse perinatal outcomes?

*pulsatility index (PI), resistance index (RI)

A

UmAD RI has the best discriminatory ability to predict a range of perinatal adverse outcomes.

22
Q

How often is UmAD surveillance when PEDV or AREDV?

A

PEDV- twice weekly
AREDV - daily