SGA fetus GT31

Question 1

How many small babies are identified by routine antenatal care?

Answer 1

1 in 4

Question 2

What is the management of women with a major risk factor for SGA (OR >2) identified at booking?

Answer 2

Serial scans from 26-28/40

Question 3

What is the management of women with 3 minor risk factors for SGA?

Answer 3

Uterine artery Doppler at 20-24/40
If abnormal (PI > 95th centile, notching) for serial scans from 26-28/40
If normal, single scan in third trimester

Question 4

What is the management of a woman identified as severe SGA at the anatomy scan?

Answer 4

Refer to FMU for detailed scan
Uterine artery Dopplers
Karyotyping if scructural anomalies
CMV screening
Consider syphilis and malaria in high risk population

Question 5

How often should surveillance occur if umbilical Dopplers >95th centile in SGA fetus, and delivery is not indicated?

Answer 5

Twice weekly Dopplers if EDF present

OD if A/REDF

Question 6

What should be the method of monitoring preterm fetuses with abnormal umbilical artery Dopplers to aid decision for timing of delivery?

Answer 6

Ductus venosus Doppler

Question 7

When should a preterm SGA baby with AREDF be delivered by?

Answer 7

32/40
Consider 30-32/40
Earlier if abnormal DV Doppler or UV pulsations, provided viable and after steroids

Question 8

When should a SGA baby be delivered by with abnormal MCA Doppler?

Answer 8

No later than 37/40

Question 9

What is the recommended method of delivery of SGA fetus?

Answer 9

If AREDV Caesarean section

If normal umb artery Dopplers/raised PI but with normal EDV - consider IOL but higher rate of C/S

Question 10

How many SGA infants are constitutionally small?

Answer 10

50-70%

Question 11

What is the increased risk of SGA with previous SGA baby?

Answer 11

OR 3.9 (more after 2 prev SGA)

Question 12

Which other previous pregnancy conditions increase chance of SGA?

Answer 12

Previous pre-eclampsia
Previous stillbirth (esp previous preterm unexplained) OR 6.4
?recurrent miscarriage

Question 13

Which maternal medical conditions are associated with SGA?

Answer 13

Diabetes with vascular disease (OR 6)
Moderate/severe renal impairment (esp if hypertensive) (AOR 5.3)
APS (RR 6.22)
Chronic hypertension (ARR 2.5)
SLE
Cyanotic congenital heart disease

Question 14

What are the maternal risk factors for SGA?

Answer 14

Age =>35 (more if >40 OR 3.2)
African American/Asian
Nulliparity
Social deprivation
Unmarried
BMI <20
BMI >25
Maternal SGA (OR 2.64)
Paternal SGA (OR 3.47)
Daily vigorous exercise (OR 3.3)
Pregnancy interval <6/12 or >5years
Heavy PV bleeding in first trimester
Domestic violence
Singleton following IVF

Question 15

Which maternal exposures are associated with SGA?

Answer 15

Moderate alcohol intake
Drug use (esp cocaine OR 3.23)
Cigarette smoking - dose dependent (>10/day OR 2.21)
>= 300mg caffeine T3
Low fruit pre pregnancy

Question 16

Which screening test is a risk for SGA?

Answer 16

T1 PAPP-A (<0.415 MOM)

Question 17

What is the incidence of chromosomal abnormalities in SGA babies?

Answer 17

Up to 19% (espeicailly if present <23/40)

Question 18

How many SGA babies are associated with fetal infections?

Answer 18

5% (CMV, toxo, malaria, syphilis)

Question 19

What is the risk reduction /NNT for SGA and PET in women with aspirin <16/40?

Answer 19

RR 0.51, NNT = 10

Question 20

What is the risk reduction of LBW with smoking intervention?

Answer 20

0.83

If stop by 15/40 back to that of non smoker

Question 21

What is the incidence of AFI <= 5 in low risk population?

Answer 21

1.5% - if isolated no increased risk PN mortality/morbidity

But increased risk C/S and fetal distress

Question 22

What major risk factors in the current pregnancy increase the chance of SGA?

Answer 22

Heavy bleeding as menses AOR 2.6
Echogenic bowel AOR 2.1
PET AOR 2.26
Severe PIH RR 2.5
Unexplained APH OR 5.6
PAPPA <0.4 MoM OR 2.6