Small for Gestational Age Flashcards
What is the definition for small for gestational age?
A fetus that measures below the 10th centile for their gestational age.
What measurements on ultrasound are used to assess fetal size?
- Estimated fetal weight (EFW)
* Fetal abdominal circumference (AC)
What is severe SGA?
When the fetus is below the 3rd centile for their gestational age.
What are the 2 categories for the causes of SGA?
Constitutionally small
Fetal growth restriction (FGR),
What does constitutionally small mean?
Match the mother and others in the family, and growing appropriately on the growth chart
What is another term for fetal growth restriction/
Intrauterine growth restriction
What is fetal growth restriction?
A small fetus (or a fetus that is not growing as expected) due to a pathology reducing the amount of nutrients and oxygen being delivered to the fetus through the placenta
What can fetal growth restriction be divided into?
- Placenta mediated growth restriction
* Non-placenta mediated growth restriction
What is non-placental mediated growth restriciton?
Baby is small due to a genetic or structural abnormality
What does placental mediated growth restriction refer to?
Conditions that affect the transfer of nutrients across the placenta
What are examples of placental mediated growth restrictions?
- Idiopathic
- Pre-eclampsia
- Maternal smoking
- Maternal alcohol
- Anaemia
- Malnutrition
- Infection
- Maternal health conditions
What are examples of non-placental mediated growth restrictions Pathology of the fetus)?
- Genetic abnormalities
- Structural abnormalities
- Fetal infection
- Errors of metabolism
What are other signs of fetal growth restriction that aren’t SGA?
- Reduced amniotic fluid volume
- Abnormal Doppler studies
- Reduced fetal movements
- Abnormal CTGs
What are possible short term complications of fetal growth restriction?
- Fetal death or stillbirth
- Birth asphyxia
- Neonatal hypothermia
- Neonatal hypoglycaemia
What are possible long term complications of growth restricted babies?
- Cardiovascular disease, particularly hypertension
- Type 2 diabetes
- Obesity
- Mood and behavioural problems
What are possible risk factors for SGA?
- Previous SGA baby
- Obesity
- Smoking
- Diabetes
- Existing hypertension
- Pre-eclampsia
- Older mother (over 35 years)
What is the monitoring for low risk women?
Monitoring of the symphysis fundal height (SFH) at every antenatal appointment from 24 weeks onwards to identify potential SGA
What is the management of a woman if the symphysis fundal height is less than the 10th centile?
Women are booked for serial growth scans with umbilical artery doppler
When are women booked for serial growth scans with umbilical artery doppler?
They are booked for scans with an umbilical artery doppler if:
• Three or more minor risk factors
• One or more major risk factors
• Issues with measuring the symphysis fundal height (e.g. large fibroids or BMI > 35)
When a fetus is identified as SGA what investigations can be done to identify the underlying cause?
- Blood pressure and urine dipstick for pre-eclampsia
- Uterine artery doppler scanning
- Detailed fetal anatomy scan by fetal medicine
- Karyotyping for chromosomal abnormalities
- Testing for infections (e.g. toxoplasmosis, cytomegalovirus, syphilis and malaria)
What is considered when the growth is static on the growth charts?
Early delivery
Why is early delivery considered for fetus with SGA?
Reduces the chance of stillbirth
What medication needs to be given with a fetus affected by SGA during delivery?
Corticosteroids
