SGA mx and SBL

Question 1

SGA definition

Answer 1

• EFW or AC <10th centile
• Severe SGA- EFW/AC <3rd

Question 2

RF for SGA

Answer 2

Major and minor
1x Major = serial growth scans from 26-28w
3 or > minor = Uterine artery doppler 20-24w

See chart for RF

Question 3

Uterine artery dopplers

Answer 3

• If notching or PI>95th cen- for serial scans

Question 4

SFH

Answer 4

• Measure from 24w
• Plot on cutomised GG
• Refer for scan if <10th

Question 5

Measurements at scan

Answer 5

• Growth scans 3 weeks apart to red false +
• Higher risk if both EFW +AC <10th
• Mean growth- AC 10mm/14d, EFW 200g/14days

Question 6

If SGA detected

Answer 6

• 18-20 weeks- Refer to Fetal med
• Karotyping if dopplers Normal
• Severe SGA- screen for CMV and toxoplasmosis
• Check hx for other inf- syphilis/malaria

Question 7

Aspirin

Answer 7

• Check RF
• Start before 16w to 36w

Question 8

Monitoring SGA

Answer 8

• Scans every 2-4 weeks
• Umbilical artery doppler every 2 weeks, more freq if severe SGA
• If abnormal- twice a week if +EDV
• Daily if AREDV

Question 9

MCA doppler

Answer 9

• Low accuracy in preterms
• Useful in >32w SGA to predict acidosis and timing of birth

Question 10

DV doppler

Answer 10

• If abnormal UA doppler, check DV doppler
• Good predictor for acidosis in preterm SGA

Question 11

Factors that should not be used to monitor SGA

Answer 11

• CTG- does not predict mortality
• BPP- not accurate
• AFI - not on its own

Question 12

Delivery timing

Answer 12

<32w - SGA + AREDV - deliver when DV abnormal or by 30-32w w steroids

Abnormal MCA- delivery by 37w

> 32w- SGA + normal dopplers- delivery by 37w

Question 13

MOD

Answer 13

• AREDV- CS
• +EDV- Offer IOL, higher risk of EmCS

Question 14

Smoking in preg

Answer 14

• Red smoking pt and household
• CO testing for all women at booking and 36w