SGA Flashcards
Risk factors for SGA
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
Severe or early SGA
Previous early SGA w del <34 weeks Anti-phospholipid syndrome Severe chronic HTN Maternal renal disease Autoimmmune condition
Abnormal uterine artery Doppler studies
60% risk of developing SGA or PET requiring delivery <34 weeks
Risk of SGA infant if have had previous
3 fold
Low PAPP-A requiring aspirin supplementation
<0.2 to commence at <16 weeks
IUGR definition
A fetus that is demonstrating failure to reach its biological growth potential due to impaired placental function
SGA definition
EFW <10th febrile for gestation
Early FGR
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
Late FGR
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
Why worry about SGA
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
Percentage constitutionally small
20%
Causes small babies
Constitutionally small
Wrong dates
Fetal abnormality (abnormal small)
FGR (hungry small)
Dopplers in relation to fetal well-being
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
Umbilical artery representation
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
Symmetrically small and <32/40
Chromosomal abnormality
Structural anomalies
Fetal infection
Suboptimal fetal growth
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
Monitoring when SGA and abnormal UA PI
Twice weekly fetal and maternal surveillance as an outpatient
SGA normal UAPI at higher risk of morbidity
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
Delivery method in SGA fetuses wit N UAPI and abn MCA (brain sparing)
55% require Caesarean section
SGA with AEDV or REDV del method
Caesarean
Common complications in neonates that are SGA
Hypoglycemia
Hypothermia
Jaundice
Perinatal mortality risk in bw <10th and <1st
3x higher
15x higher
FGR risk of adult life complications
Obesity
Type 2 DM
CVD
SGA minor risk factors that would necessitate increased surveillance
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*
