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Year 4 Obstetrics > Small for Gestational Age > Flashcards

Small for Gestational Age Flashcards

1
Q

Small for Gestational Age

A

Fetus that measures below the 10th centile for their gestational age

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2
Q

How is fetal size assessed

A

USS:

  • Estimated fetal weight (EFW)
  • Fetal abdominal circumference (AC)
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3
Q

How are growth charts standardised

A

Different growth charts used based on the mother’s:

Ethnic group
Weight
Height
Parity

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4
Q

Severe Small for gestational age

A

Below the 3rd centile for their gestational age

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5
Q

Low birth weight

A

< 2500g

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6
Q

Causes of small for gestation age

A

Constitutionally small

Fetal growth restriction (FGR) - intrauterine growth restriction (IUGR)

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7
Q

Constitutionally small

A

Matching the mother and others in the family, and growing appropriately on the growth chart

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8
Q

Intrauterine 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

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9
Q

Causes of fetal growth restriction

A
  • Placenta mediated growth restriction

- Non-placenta mediated growth restriction

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10
Q

Non-placenta mediated growth restriction

A

Baby is small due to a genetic or structural abnormality

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11
Q

Causes of placenta mediated growth restriction

A

Conditions that affect the transfer of nutrients across the placenta

  • Idiopathic
  • Pre-eclampsia
  • Maternal smoking or alcohol
  • Anaemia
  • Malnutrition
  • Infection
  • Maternal health conditions
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12
Q

Causes of non-placenta medicated growth restriction

A

Genetic abnormalities
Structural abnormalities
Fetal infection
Errors of metabolism

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13
Q

Signs of fetal growth restriction

A

Reduced amniotic fluid volume

Abnormal Doppler studies

Reduced fetal movements

Abnormal CTGs

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14
Q

Complications of fetal growth restriction

A

Fetal death or stillbirth

Birth asphyxia

Neonatal hypothermia

Neonatal hypoglycaemia

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15
Q

Long term complications of fetal growth restriction

A

Increased risk of:

  • Cardiovascular disease, particularly HTN
  • Type 2 diabetes
  • Obesity
  • Mood and behavioural problems
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16
Q

Risk factors for SGA

A 
Previous SGA baby
Obesity
Smoking
Diabetes
Existing hypertension
Pre-eclampsia
Older mother (over 35 years)
Multiple pregnancy
Low pregnancy‑associated plasma protein‑A (PAPPA)
Antepartum haemorrhage
Antiphospholipid syndrome
17
Q

Monitoring of SGA

A

Low-risk women - monitoring of the symphysis fundal height (SFH) at every antenatal appointment from 24 weeks onwards to identify potential SGA.

If the symphysis fundal height is < 10th centile, serial growth scans with umbilical artery doppler.

18
Q

Which women are booked for serial growth scans with umbilical artery doppler

A
  • 3+ minor risk factors
  • 1+ major risk factors
  • Issues with measuring the symphysis fundal height (e.g. large fibroids or BMI > 35)
19
Q

What do serial ultrasound scans measure

A
  • Estimated fetal weight (EFW) and abdominal circumference (AC) to determine the growth velocity
  • Umbilical arterial pulsatility index (UA-PI) to measure flow through the umbilical artery
  • Amniotic fluid volume
20
Q

Management of SGA

A
  • Identifying those at risk of SGA
  • Aspirin if at risk of pre-eclampsia
  • Treating modifiable risk factors (e.g. stop smoking)
  • Early delivery - if growth is static, or there are other concerns
21
Q

What investigations are done for SGA

A

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)

22
Q

When is early delivery considered in SGA

A

When growth is static on the growth charts, or other problems are identified (e.g. abnormal Doppler results)

23
Q

Why may early delivery occur

A

Reduce the risk of stillbirth

24
Q

What is given when planning an early delivery

A

Corticosteroids, particularly when delivered by caesarean section.

Paediatricians involvement at birth - help with neonatal resuscitation and management if required

Year 4 Obstetrics (60 decks)

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