SGA GTG

Question 1

Definition of FGR in current pregnancy?

Answer 1

EFW or AC <3rd centile
EFW or AC <10th centile with evidence of placental dysfunction: abnormal uterine artery doppler (PI >95th C) or abnormal umbilical artery doppler (absent/reversed EDF or PI >95th)

Question 2

Risk factors for FGR?

Answer 2

Previous FGR/SGA
Previous stillbirth
Previous PTB
Cocaine use
Age >40
BMI <18.5 and low gestational weight gain
Bariatric surgery
Smoking - dose dependent
High maternal caffeine intake

Question 3

Biochemical risk factors for FGR?

Answer 3

Low PAPP-A
Raised AFP, raised inhibin

Question 4

Anomaly scan features which increase risk of SGA?

Answer 4

echogenic bowel
single umbilical artery
fetal biometry if EFW<10th

Question 5

In which patients is SFH measurement inaccurate?

Answer 5

BMI>35
large fibroids
Polyhydramnios

Question 6

How to monitor women at high risk of FGR?

Answer 6

Uterine artery doppler at 20-25w

If normal - can start serial growth scans from 32w

If abnormal (PI >95th C) - start serial scans from 24-29w

Question 7

How to monitor women at moderate risk of FGR?

Answer 7

Serial USS from 32w
Their risk is of late-onset FGR

Question 8

How should women with diagnosed SGA/FGR be monitored?

Answer 8

2 weekly USS, including umbilical artery doppler

Question 9

What use is MCA?

Answer 9

In a term SGA fetus, abnormal MCA can predict acidosis at birth and should be used to time delivery
Should not be used to time delivery before 37w

Question 10

What use is STV?

Answer 10

If STV <3.5 at 32-34 weeks should deliver
If STV <4.5 at 34w+ should deliver

Question 11

An abnormal umbilical artery doppler is…

Answer 11

Absent or reversed EDF
Raised imbilical PI >95th centile

Question 12

What should trigger delivery in early FGR (before 32w)?

Answer 12

Unprovoked decelerations
Abnormal ductus venosus a wave or low STV

Question 13

When should MgSO4 be administered?

Answer 13

24-30 weeks
Consider up to 34 weeks
Reduces risk of cerebral palsy

Question 14

Which pregnancies complicated by FGR should be investigated further?
And how?

Answer 14

SGA <3rd or <10th AND abnormal uterine artery doppler at anomaly scan
Invasive testing if severe SGA and structural anomalies - look for microdeletions/insertions
Screen for CMV and toxoplasmosis
Consider testing for zika and malaria in high risk populations

Question 15

What is an abnormal MCA?

Answer 15

PI <5th centile