Small for gestational age

Question 1

Definition of small for gestational age

Answer 1

Below the 10th centile

Estimated fetal weight (EFW)
Fetal abdominal circumference (AC)

Question 2

Broad causes of SGA

Answer 2

Constitutional small

Intrauterine growth restriction

Question 3

Causes of Foetal growth restriction

Answer 3

Placenta mediated:

• Pre-eclampsia
• Maternal smoking or alcohol
• Anaemia
• Malnutrition
• Infection
• Maternal health conditions e.g. DM, renal disease

Non-placenta mediated:

• Genetic abnormalities
• Structural abnormalities
• Errors of metabolism
• Foetal infection

Question 4

Signs of IUGR

Answer 4

Low SFH
Reduced amniotic fluid volume
Abnormal doppler studies
Reduced foetal movements
Abnormal CTGs

Question 5

Complications of IUGR

Answer 5

Short term:

• Premature delivery
• Foetal death/stillbirth
• Birth asphyxia
• Neonatal hypothermia and hypoglycaemia

Long term - these babies have an increased risk of:

• Cardiovascular disease
• Type 2 diabetes
• Obesity

Question 6

Management of (SGA/) IUGR

Answer 6

Serial growth scans with umbilical artery doppler

Attempt to determine cause;

• Ultrasound for foetal anomalies
• Karyotype testing
• Testing for infections e.g. toxoplasmosis

Consider early delivery once favourable gestational age reached (>34w) if static growth or problems such as abnormal Doppler - to reduce risk of stillbirth

Corticosteroids given in early delivery

The goal is to maximize fetal maturity and growth but minimize the risks of perinatal mortality and morbidity