SGA/FGR Flashcards
List maternal medical conditions that predispose to SGA:
- Hypertensive disease
- Renal disease
- Diabetes
- Antiphospholipid syndrome
- Maternal history of SGA
List current pregnancy complications/developments that predispose to SGA:
- Preeclampsia
- First trimester bleeding
- Placenta abruption
- APH
- Gestational HTN
- Teratogenic exposure
- Low PAPP-A <0.4 MoM
- Echogenic bowel
List maternal risk factors that predispose to SGA:
- Low BMI
- High BMI
- AMA
- Nulliparity
- Smoking
- Substance abuse
- IVF
- Poor diet
- Excessive exercise
- Previous SGA
- Previous stillbirth
- Short interpregnancy interval
If UAPI is abnormal in an SGA fetus but delivery is not indicated, how often should you repeat the UAPI?
- Twice weekly if forward EDF.
- Daily if absent or reversed EDF.
List the benefits of UAPI surveillance (4):
- Reduction in perinatal deaths RR 0.71
- Reduction in IOLs RR 0.89
- Reduction in Caesarean section RR 0.90
- Reduced use of antenatal resources (monitoring occasions, hospital admissions, inpatient stay).
In an SGA fetus with normal UAPI, how often would you repeat the UAPI?
- Every 14 days.
When does RCOG recommend delivery of an SGA fetus with static growth over 3 weeks (UAPI normal or abnormal but with forward EDF)?
After 34 weeks.
At what gestation should an SGA fetus with reversed EDF but normal DV doppler be delivered by?
32 weeks
At what gestation should an SGA fetus with absent EDF but normal DV doppler by delivered by?
34 weeks
At what gestation should an SGA fetus with absent or reversed EDF and abnormal DV doppler be delivered by?
Between 30-32 weeks
Briefly describe the DIGITAT Trial
Aim: To compare the effect of IOL with expectant monitoring for IUGR near term
Participants: singleton, > 36/40, suspected IUGR
Interventions: Randomised to IOL OR expectant management
Conclusion: IOL babies were delivered 10 days earlier and weight less, but NO important differences in adverse outcomes or CS rates
Briefly describe the GRIT Trial
Aim: To compare the effect of delivery early with delaying birth for as long as possible
Inclusion: Fetal compromise, 24-36/40, UAPI recorded, clinical uncertainty about whether immediate delivery was indicated
Intervention: Randomised to Immediate delivery or Delayed deliver until the obstetrician was no longer uncertain
Results: No difference in mortality, or developmental quotient of survivors
Conclusion: Obstetricians are delivering sick preterm babies at about the correct moment to minimise mortality
