SGA

Question 1

Risk factors for SGA

Answer 1

Hx of previous SGA or stillborn infant
Advanced maternal age
Maternal or paternal hx of being SGA at birth
Smoking>10 cigarettes per day
Cocaine use
Chronic hypertension, renal disease, diabetes w vascular disease, anti-phospholipid syndrome
Heavy exercise
OR complications in current preg:
Heavy early preg bleeding
Fetal echogenic bowel
PET
PIH
APH or abruption
Low gestation weight gain

Question 2

Severe or early SGA

Answer 2

Previous early SGA w del <34 weeks
Anti-phospholipid syndrome
Severe chronic HTN
Maternal renal disease
Autoimmmune condition

Question 3

Abnormal uterine artery Doppler studies

Answer 3

60% risk of developing SGA or PET requiring delivery <34 weeks

Question 4

Risk of SGA infant if have had previous

Answer 4

3 fold

Question 5

Low PAPP-A requiring aspirin supplementation

Answer 5

<0.2 to commence at <16 weeks

Question 6

IUGR definition

Answer 6

A fetus that is demonstrating failure to reach its biological growth potential due to impaired placental function

Question 7

SGA definition

Answer 7

EFW <10th febrile for gestation

Question 8

Early FGR

Answer 8

GA< 32 weeks, in absence of congenital anomalies
AC/EFW <3rd centipedes or UA-AEDF
OR
AC/EFW<10th combined with UtA PI>95th and or UAPI 95th centile

Question 9

Late FGR

Answer 9

GA> or =32, in absence of congenital abnormalities
AC/EFW <3rd
OR at least two out of three of the following
AC/EFW <10th
AC/EFW crossing ve tiles > 2 quartile on growth centiles
CPR<5th centile or UA PI >95th centile

Question 10

Why worry about SGA

Answer 10

28-45% of non anomalous SBs
Higher rates of neurodevelopmental delay, obesity, and cardio metabolic disease
If recognize SGA before birth, surveillance and timely delivery leads to a 4-5 fold reduction in mortality and or severe morbidity

Question 11

Percentage constitutionally small

Answer 11

20%

Question 12

Causes small babies

Answer 12

Constitutionally small
Wrong dates
Fetal abnormality (abnormal small)
FGR (hungry small)

Question 13

Dopplers in relation to fetal well-being

Answer 13

Uterine arteries - uteroplacental function and placental implantation
Umbilical arteries - fetal response to placental resistance
Mca - fetal response to oxygen and nutrient supple - “brain sparing”
Ductus ventouse - fetal cardiac function and end-stage indication of cardiac failure

Question 14

Umbilical artery representation

Answer 14

Relationship between fetal bp and placental resistance
Increased impedance represents a calcified or tough placental circulation
Absent EDF not necessarily fetal tissue hypoxia/need for urgent del: REDF stronger association with tissue hypoxia….requires about 2/3 of loss of placental function for AREDF, so late-onset FGR usually only elevated resistance or “high normal” - NOT AREDF

Question 15

Symmetrically small and <32/40

Answer 15

Chromosomal abnormality
Structural anomalies
Fetal infection

Question 16

Suboptimal fetal growth

Answer 16

AC <5th
Discrepancy between head and AC
AC >5th but crossing centiles by >30 centiles
Change in AC or <5mm over 14 days
EFW on GROW <10th
EFW on GROW is crossing centiles with > = 1/3 reduction in EFW percentile

Question 17

Monitoring when SGA and abnormal UA PI

Answer 17

Twice weekly fetal and maternal surveillance as an outpatient

Question 18

SGA normal UAPI at higher risk of morbidity

Answer 18

Abnormal MCA
Abnormal CPR
Abnormal uterine artery Doppler studies at the time of dx on SGA
Extreme SGA w EFW<3rd

All of these babies do have growth restriction
RECOMMEND DEL BY 38 WEEKS OR EARLIER IF ADDITIONAL CONCERNS

Question 19

Delivery method in SGA fetuses wit N UAPI and abn MCA (brain sparing)

Answer 19

55% require Caesarean section

Question 20

SGA with AEDV or REDV del method

Answer 20

Caesarean

Question 21

Common complications in neonates that are SGA

Answer 21

Hypoglycemia
Hypothermia
Jaundice

Question 22

Perinatal mortality risk in bw <10th and <1st

Answer 22

3x higher

15x higher

Question 23

FGR risk of adult life complications

Answer 23

Obesity
Type 2 DM
CVD

Question 24

SGA minor risk factors that would necessitate increased surveillance

Answer 24

Previous PET
Mat age > = 35
Daily vigorous exercise
BMI <20 or >35
*all should have uterine artery Doppler 20-24/40 and further monitoring depending on Doppler*