Small for Dates

Question 1

Definition of SGA

Answer 1

born with birth weight below 10th centile or abdominal circumference (AC)/estimated fetal weight below 10th centile on USS

Question 2

Definition of LBW

Answer 2

birth weight <2500g

Question 3

Definition of fetal growth restriction (FGR)

Answer 3

failure to achieve genetic potential for growth i.e. there’s a pathological restriction of potential growth,
AC or EFW below 3rd centile OR,
AC or EFW below 10th gentile & placental dysfunction evident

Question 4

Give the two findings that classify as placental dysfunction that can be used to determine presence of FGR

Answer 4

abnormal maternal uterine doppler at 20-24weeks gestation AND/OR,
abnormal umbilical artery doppler

Question 5

All SGA fetus are growth restricted, T/F?

Answer 5

False - up to 70% of SGA fetus are constitutionally small (just are small due to factors explained here)

Question 6

When should interventions for SGA should be considered and why?

Answer 6

When SGA below 3rd centile because more likely to have underlying pathology

Question 7

List 3 placental causes of SGA

Answer 7

infarcts,
abruption,
secondary to hypertension

Question 8

List 3 fetal causes of SGA

Answer 8

infection,
congenital abnormality e.g. absent kidneys,
chromosomal abnormalities

Question 9

List 3 fetal infections that can cause SGA

Answer 9

rubella,
CMV,
toxoplasma

Question 10

SGA and FGR increases risks of what for baby? (9)

Answer 10

stillbirth, 
iatrogenic preterm birth, 
antenatal and intrapartum hypoxia,
hypoglycaemia,
chronic asphyxia,
hypothermia, 
hyperbilirubinaemia, 
polycythaemia, 
abnormal neurodevelopment,

Question 11

List 8 causes of maternal poor cardiac reserve for the cardiovascular-placental axis

Answer 11

maternal age, 
obesity, 
ethnicity, 
diabetes, 
dyslipidaemia, 
auto-immune disease,
chronic HTx, 
CKD

Question 12

List 4 causes of fetal excessive demand on the cardiovascular-placental axis

Answer 12

fetal macrosomia,
twin pregnancy,
prolonged pregnancy,
excessive weight gain

Question 13

If mother has poor cardiac reserve this can affect pregnancy and baby can have fetal growth restriction. It can also lead to pre-eclampsia, list 4 signs of pre-eclamspia?

Answer 13

hypertension,
proteinuria,
cerebral oedema,
liver dysfunction

Question 14

How do you take a fundal height measurement?

Answer 14

non-elastic tape at top of fundus,
tape to top of pubic symphysis,
plot on chart

Question 15

Referrals for growth scan after fundal height measurement should be arranged if? (4)

Answer 15

first FH plots below 10th centile,
no growth,
slow growth,
excessive growth

Question 16

Growth scan comprises of what? (2/3)

Answer 16

USS for EFW, amniotic fluid assessment plus Doppler flow if scan suggest growth problems

Question 17

Symphsis-fundal height is done by midwife at each visit from how many weeks?

Answer 17

24 weeks

Question 18

How is SGA diagnosed?

Answer 18

US measurement of AC and calculation of EFW,

plotted on chart

Question 19

List 10 minor risk factors for SGA

Answer 19

maternal age >35, 
IVF pregnancy, 
nulliparity, 
BMI <20, 
BMI 25-34.9, 
smoker 1-10/day,
low fruit pre-pregnancy, 
previous pre-eclampsia, 
pregnancy interval <6 months, 
pregnancy interval >60 months

Question 20

List 13 major risk factors for SGA

Answer 20

maternal age >40, 
smoker >11/day, 
daily vigorous exercise, 
BMI >35, 
low PAPP-A,
paternal/maternal SGA, 
previous SGA,
previous stillbirth, 
pre-eclampsia previous, 
chronic HTx, 
diabetes, 
renal probs, 
antiphospholipid syndrome, 
known large fibroids,

Question 21

What sign at 20 weeks can indicate SGA?

Answer 21

presence of uterine artery notching at 20 weeks on dopplers

Question 22

How often USS with umbilical doppler and liquor volume done if moderate risk factors for SGA?

Answer 22

USS at 32 and 36 weeks

Question 23

How often USS with umbilical doppler and liquor volume done if major risk factors for SGA?

Answer 23

28, 32 and 36 weeks

Question 24

Who is given 150mg aspirin at night from 12 weeks?

Answer 24

Women with risk factors for pre-eclampsia,

or uterine artery notching at anomaly scan

Question 25

How are those with SGA surveilled? (5)

Answer 25

serial growth scans, 
measurement of liquor volume, 
use of umbilical artery doppler, 
maybe use of advanced doppler (middle cerebral artery, ductus venosus) 
maybe offer genetic testing.
 maybe offer infection screening,

Question 26

If SGA below 3rd gentile, offer delivery when and aim to deliver by when?

Answer 26

from 37 weeks,

aim to have delivered by 37+6

Question 27

If SGA between 3rd and 10th gentile, offer delivery when?

Answer 27

offer delivery at 39weeks

Question 28

Mode of delivery for SGA?

Answer 28

If dopplers normal and no other concern, vaginal delivery by induction of labour,
if umbilical doppler abnormal then c-section offered as increased chance of foetal distress in labour

Question 29

SGA labour is monitored how?

Answer 29

continuous CTG

Question 30

If early delivery is indicated, what is offered? (2)

Answer 30

steroids between 24-35+6weeks,

magensium sulphate below 32 weeks

Question 31

WHO target for 2025 and LBW?

Answer 31

reduce LBW by 30% by 2025

Question 32

What is uterine artery notching caused by?

Answer 32

increased uterine artery resistance

Question 33

Uterine artery notching after 20wks is associated with what 5 adverse pregnancy outcomes?

Answer 33

pregnancy induced hypertension (PIH),
pre-eclampsia,
placental abruption,
intrauterine growth restriction (IUGR),
increased maternal serum alpha fetoprotein (MSAFP)

Question 34

sFlt-1 is an antagonist of Placental growth factor (PlGF) and vascular endothelial growth factor. sFlt-1 causes vasoconstriction and endothelial damage so a high ratio of sFlt-1 to PlGF is associated with an increased risk of? (2)

Answer 34

FGR and pre-eclamspia