Small for gestational age Flashcards
What is small for gestational age defined as?
Measures below 10th centile
What measures on US are used to assess foetal size?
Estimated foetal weigth
Foetal abdominal circumference - AC
What do customised growth charts consider?
Ethnic group
Weight
Heigth
Parity
Of mother
What is severe SGA
Below 3rd centile for GA
What is low BW defined as
<2500g
Circulating volume of a baby
10ml/kg
Categories of causes of SGA
Constitutionally small
Foetal Growth Restriction - IUGR
What is intrauterine growth restriction?
Small foetus due to pathology reducing amount of nutritents and O2 being delivered to foetus through the placenta
Categories of causes of IUGR
Placenta mediated
Non placenta mediated
Causes of placenta mediated IUGR
Idiopathic
Pre-eclampsia
Maternal smoking
Maternal alcohol
Anaemia
Malnutrition
Infection
Maternal health conditions
Causes of non placenta mediated IUGR
Genetic abnoramlities
Strutural abnormalities
Foetal infection
Errors of metabolism
Signs of IUGR
Reduced amniotic fluid volume
Abnormal dopple studies
Reduced foetal movements
Abnormal CTGs
Complications of IUGR short term
Foetal death or stillbirth
Birth asphyxia
Neonatal hypoglycaemia
Neonatal hypothermia
IUGR longterm increased risk for:
CVD esp HPTN
T2DM
obesity
Mood and behavioural problems
Risk factors for SGA
Prev SGA baby
Obesity
Smoking
Diabetes
Existing HPTN
Pre-eclampsia
Older mother >35
Multiple pregnancy
Low pregnancy ass plasama protein - PAPPA
Antepartum haemorrhage
Antiphospholipid syndrome
What is Preganancy ass plasma protein?
What is monitored in low risk women?
Symphysis fundal height
What is monitored in low risk women to check for SGA and when is this done?
Symphysis fundal height at every antenatal appointment from 24 weeks
What happens if the symphysis fundal height is less than the 10th centile?
Serial growth scans with umbilical artery doppler
When are women booked for serial growth scans with umbilical artery doppler?
Three or more minor risk factors
One or more major risk factors
Issues measuring symphysis fundal heigth
What can affect ability to measuresymphysis fundal heigth
Large fribroids
BMI > 35
How are women at risk or with SGA monitored in pregnancy
Serial ultrasound scans that measure -
Estimated foetal weigth and abdominal circumference to determine growth velocity
Umbilical arterial pulsatility index (UA-PI) to measure flow through umbilical artery
Amniotic fluid volume
What is typical recommendation for initiation and fequency of US for SGA?
Every 4 weeks from 28 weeks gestation
What is typical recommendation for initiation and fequency of US for SGA?
Every 4 weeks from 28 weeks gestation
When is US frequency increased in SGA?
Reduced growth velocity
Problems with umbilical flow
Management of SGA
Identifying those at risk
Aspirin if at risk pre eclampsia
Treat modifiable risk factors - smoking cessation
Serial growth scans to monitor growth
Early delivery where growth static pr other concerns
Investigations into underlying cause when infant determined SGA
BP and urine sipstick for pre-exlampsia
Uterine artery doppler scannig
Detailed foetal anatomy can be foetal medicine
Karyotyping for chromsomal abnormalities
Testing for infections
What give womena at risk fo pre eclampsia
ASpririn
What infections test for in SGA?
Toxoplasmosis, cytomegalovirus, syphilis and malaria
When is early delivery considered?
Growth static on charts
Other problems identified ef abnormal doppler results
Reduces stillbirth risk
What given before C section planned early induction
Corticosteroids
