small for gestational age

Question 1

risk factors for SGA

Answer 1

• lifestyle: smoking, alcohol, and drugs (cocaine use)
• v low or high BMI
• age
• maternal disease e.g. hypertension, renal disease

Question 2

placental causes of SGA?

Answer 2

• infarctions
• abruption (APH)
• association w hypertensive disease

Question 3

fetal causes of SGA?

Answer 3

• infectione.g. rubella, CMV, toxoplasmosis
• congenital anomalies
• chromosomal abnormalities

Question 4

what is small for gestational age?

Answer 4

• abdominal circumference or EFW less than 10th centile
• severe SGA = AC or EFW <3rd centile

Question 5

what is fetal growth restriction

Answer 5

• failure of fetus to attain growth potential
• difficult to identify in practice
• evidence of abnormal doppler studies or reduced liquor volume

Question 6

what is considered a low birth weight?

Answer 6

• any baby born w weight less than 2.5kg at any gestation

Question 7

who is unsuitable for SFH and will require growth scans?

Answer 7

• inc BMI
• fibroid uterus
• multiple pregnancy

Question 8

prevention of SGA?

Answer 8

• aspirin those at risk of pre-eclampsia
• smoking cessation - stopping before 15 weeks reduces risk to same as non-smoker
• drugs problems - service input for those who require support
• LMWH in those w antiphospholipid syndrome

Question 9

high risk of FGR?

Answer 9

• previous severe SGA
• previous stillbirth
• chronic hypertension on tx
• diabetes
• renal disease e.g. nephropathy
• antiphospholipid syndrome
• lupus
• abnormal uterine artery doppler

Question 10

what should we offer to those at high risk of FGR?

Answer 10

• growth scans every 4 weeks from 28 weeks (sometimes 24)

Question 11

other reasons to provide growth scan at 32 and 36 weeks?

Answer 11

• IVF pregnancy
• > 40
• fibroids > 6cm
• smoker
• low PAPP-A
• BMI >35
• BMI <19
• echogenic bowel
• previous SGA baby

Question 12

identify structures on US for assessing fetal growth - abdominal circumference

Answer 12

Question 13

identify structures on US for assessing fetal growth - head circumference

Answer 13

Question 14

dopplers - middle cerebral artery assesses what?

Answer 14

• indicates brain perfusion
• redistribution of blood to vital organs e.g. brain
• reduced PI in a compromised fetus
• inc peak systolic velocity in fetal anaemia
• useful additional marker in SGA/FGR after 32 weeks

Question 15

dopplers - ductus venosus

Answer 15

• direct reflection of fetal heart function
• A-wave -> flow during atrial contraction of fetal heart, becomes progressively deeper as fetal condition WORSENS
• used to time delivery
• useful in preterm FGR
• mod predicitive value of fetal acidaemia and adverse outcomes

Question 16

monitoring for SGA 3rd-10th centile?

Answer 16

• fortnightly scans fetal growth, DVP, dopplers
• ensure reg BP and urine check
• advice on symptoms of preeclampsia
• advice about inc risk of still birth and report reduced movements asap
• offer IOL 39 weeks!

Question 17

monitoring and timing delivery SGA <3rd centile?

Answer 17

• once weekly monitoring fetal dopplers
• computerised CTG as adjunct
• monitor for preecalmpsia
• advice on stillbirth risk
• advise on symptoms of preeclapmpsia
• delivery at 37 weeks if no other maternal or fetal concerns

Question 18

what are two reasons you would not offer IOL and vaginal birth at term?

Answer 18

• abnormal fetal dopplers
• other obestetric indication for birth by caesarean

Question 19

planning for pre term birth - what medication do you give?

Answer 19

• steroids up to 34 weeks
• magnesium sulphate for fetal neuroproteciton