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Obstetrics and gynaecology > Small for gestational age > Flashcards

Small for gestational age Flashcards

1
Q

Define small for gestational age

A

An infant with a birth weight <10th centile for its gestational age

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2
Q

Define severe small for gestational age

A

A birth weight <3rd centile

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3
Q

Define foetal SGA

A

An estimated foetal weight or abdominal circumference <10th centile

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4
Q

Define foetal growth restriction

A

When a pathological process has restricted genetic growth potential

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5
Q

What can foetal growth restriction present with?

A

Features of foetal compromise including reduced liquor volume or abnormal doppler studies

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6
Q

What does low birth weight refer to?

A

An infant with birth weight <2500g

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7
Q

List some causes for an infant/foetus being small for gestational age

A

Normal (constitutionally) small

Placenta mediated growth restriction

Non-placenta mediated growth restriction

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8
Q

What percentage of SGA fetuses/infants are constitutionally small?

A

50-70%

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9
Q

Describe constitutionally small fetus/infants

A

Small size at all stages but growth following centiles

No pathology present

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10
Q

What contributes to a fetus/infant being constitutionally small?

A

Ethnicity
Sex
Parental height

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11
Q

Describe placenta mediated growth restriction

A

Growth is usually normal initially but slows in utero

Placental insufficiency

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12
Q

Give some maternal factors which can result in placental insufficiency

A 
Low pre-pregnancy weight
Substance abuse
Autoimmune disease
Renal disease
Diabetes
Chronic hypertension
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13
Q

Describe non-placenta mediated growth restriction

A

Growth is affected by foetal factors such as a chromosomal or structural anomaly - error in metabolism or foetal infection

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14
Q

List some risk factors for small for gestational age

A 
Maternal age >40
Smoker >11/day
Previous SGA baby 
Maternal/paternal SGA
Previous stillbirth
Cocaine use
Daily vigorous exercise
Maternal disease - Chronic hypertension, renal impairment, diabetes with vascular disease and antiphospholipid syndrome 
Heavy bleeding
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15
Q

When are women assessed for risk factors for SGA

A

At booking and again at 20 weeks gestation

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16
Q

How is SGA diagnosed?

A

Ultrasound - ratio of head circumference and abdominal circumference may be significant

17
Q

What is symmetrically small foetus most likely caused by?

A

Constitutional

18
Q

What is asymmetrically small foetus most likely caused by?

A

Placental insufficiency

19
Q

What can placental insufficiency result in?

A

Impaired foetal renal function and reduced amniotic fluid

20
Q

What other investigations may be useful in SGA?

A

Detailed foetal anatomical survey

Uterine artery doppler

Karyotyping

Screening for infections - congenital cytomegalovirus, toxoplasmosis, syphilis and malaria

21
Q

How is SGA prevented?

A

Modifying risk factors - promote smoking cessation and optimise maternal disease

22
Q

What drug should women at high risk of pre-eclampsia be started on and when?

A

75mg aspirin 16 weeks gestation until delivery

23
Q

How is SGA monitored?

A

Uterine artery doppler is primary surveillance tool - if normal repeat every 14days

Symphysis fundal height

Middle cerebral artery doppler

Ductus venosus doppler

CTG

Amniotic fluid volume

24
Q

What should be given if delivery between 24-35+6 weeks gestation is considered?

A

Single dose antenatal steroids

25
Q

Before 37 weeks what would be an indication for delivery and which mode of delivery would be used?

A

Absent/reverse end diastolic flow on doppler

C-section

26
Q

By 37 weeks what would be an indication for delivery and which mode of delivery would be used?

A

Abnormal UAD or MCA doppler

Induction

27
Q

At 37 weeks what would be an indication for delivery and which mode of delivery would be used?

A

Normal UAD

Induction

28
Q

What monitoring is required during labour after onset of contractions and why?

A

CTG - continuous foetal heart rate monitoring as high rate of C-sections

29
Q

List the neonatal complications of SGA

A 
Birth asphyxia
Meconium aspiration
Hypothermia
Hypo/hyperglycaemia
Polycythaemia
Retinopathy of prematurity 
Persistent pulmonary hypertension 
Pulmonary haemorrhage
Necrotising enterocolitis
30
Q

List the long term complications of SGA

A 
Cerebral palsy 
T2DM
Obesity 
Hypertension 
Precocious puberty 
Behavioural problems
Depression 
Alzheimer's disease
Cancer - breast, lung, ovarian, colon and blood

Obstetrics and gynaecology (67 decks)

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