Small for Gestational Age Flashcards
What classes a Foetus as Small for Gestational Age?
Foetus below 10th centile for their gestational age
What measurements on the US are used to assess foetal size? (2 things)
- Estimated foetal weight (EFW)
- Abdominal circumference (AC)
What measurements are used to see if a foetus is Symmetrically / Assymetrically small? (2 things)
- Head circumference
- Abdominal circumference (AC)
What cause of SGA is Symmetrically small foetus likely to be?
Constitutionally small
What cause of SGA is Asymmetrically small foetus likely to be?
Placental insuffiency
What features of the mother are used to make Customised Growth Charts for the foetus? (4 things)
- Ethnic group
- Weight
- Height
- Parity
What is SEVERE SGA?
Foetus below 3rd centile for their gestational age
What is Low Birth Weight?
Birth weight less than 2500g
What are the causes of SGA? (3 things)
- Constitutionally Small
- Placenta mediated Growth Restriction
- Non-placenta mediated Growth Restriction
What does Constitutionally small mean? (2 points)
- Foetus matches mother + others in family
- Growing appropriately on growth chart
What does Placenta mediated Growth restriction refer to?
Conditions affecting transfer of nutrients across placenta
What are the causes of Placenta Mediated Growth restriction? (7 things)
- Idiopathic
- Pre-eclampsia
- Maternal smoking / alcohol
- Anaemia
- Malnutrition
- Inf
- Maternal health conditions
What does Non-Placenta Mediated Growth restriction refer to?
Pathology of foetus itself
What are the causes of Non-Placenta Mediated Growth restriction? (4 things)
- Genetic abn
- Structural abn
- Foetal inf
- Metabolism errors
Other than being SGA, what other signs could indicate Foetal Growth Restriction? (4 things)
- Reduced amniotic fluid volume
- Abn Doppler studies
- Reduced foetal movements
- Abnormal CTGs
How is Reduced Amniotic fluid volume caused? (3 things)
- Placental insufficiency
- Impaired foetal kidney function
- Reduced amniotic fluid volume
When should pregnant women be assessed for RF of SGA? (2 times)
- At booking
- At 20 wks
What are the RF for SGA? (10 things)
- Previous SGA baby
- Obesity
- Smoking
- DM
- HTN
- Pre-eclampsia
- Age 35+
- Multiple pregnancy
- Antepartum haemorrhage
- Antiphospholipid syndrome
What is the main obv investigation done for SGA?
US
What other investigations can be done for SGA? (4 things)
- Detailed foetal anatomical survey
- Uterine Artery Doppler (UAD)
- Karyotyping
- Inf screening
What are some Modifiable RF that should be advised about for SGA? (2 things)
- Smoking cessation
- Managing maternal conditions well (e.g DM / HTN)
What are women who are at high risk of Pre-eclampsia started on? What’s the time frame?
- 75mg aspirin
- From 16 weeks till delivery
What is the primary surveillance tool for SGA?
Uterine Artery Doppler (UAD)
How long should you repeat Uterine Artery Doppler (UAD) for SGA? (2 points)
- Every 14 days if normal
- More often if abn
When should early delivery of a SGA foetus be considered? (2 things)
- Growth is static
- Other problems (e.g abn Doppler)
What is the point of an early delivery of a SGA foetus?
Reduces risk of stillbirth
What should be given if delivery of a SGA foetus between 24-35+6 weeks is being considered?
Single course of antenatal steroids
What are the SHORT term complications of SGA? (5 things)
- Death / stillbirth
- Birth asphyxia (brain doesn’t get enough oxygen at birth)
- Neonatal hypothermia
- Neonatal hypoglycaemia
- Polycythaemia
What are the LONG term complications of SGA? (4 things)
- CVS disease (esp HTN)
- T2DM
- Obesity
- Mood / behavioural problems
