Small for Gestational Age

Question 1

What is it defined as using the charts they use to measure size?

2 causes:
Constitutional and ?

What is the pathological cause of SGA?

Answer 1

Weight <10th centile

IUGR - Intrauterine growth restriction:
- Baby does not reach it’s genetically determined potential size
- Due to slowing or cessation of growth

Question 2

Other terms:

Under what weight (kg ) is it classed as LBW?

Answer 2

<2.5 kg

Question 3

Fetal growth restriction:
2 categories:

Placenta mediated causes?

Non-placenta mediated causes (pathology of foetus)?

Answer 3

Idiopathic
PE
Smoking
Alcohol
Anaemia
Malnutrition
Infection

Genetic abnormalities
Structural abnormalities
Fetal infection

Question 4

Why does smoking cause SGA? - 2 mechanisms

Answer 4

(1) CO in the blood causes hypoxaemia = impaired growth,

(2) Compensatory polycythaemia (High number of RBC in the blood) in mum.

Increased viscosity

Impaired blood flow to the foetus

Question 5

Monitoring:

2 investigations?

Answer 5

Serial USS
Umbilical artery doppler from 26 wks

Fetal USS

Question 6

Diagnosis:

Asymmetric IUGR:
- Cause of this?
- What fetal redistribution do?

Symmetric IUGR:
- Common causes?
- Why is it called symmetrical?

Answer 6

Placental insufficiency

Spares the head as it redirects it towards there
Abdomen growth is slowed

Chromosomal
Infection

Head and abdomen both restricted

Question 7

Management:

Prevention:
- What is prescribed if at risk of PET?
- What lifestyle factor if stopped will reduce risk?

Monitoring:
- If SGA on US or doppler, abnormal, what monitoring is done?

Answer 7

Aspirin

Serial US measurements
Umbilical artery doppler

Question 8

Management:

Delivery if static growth on charts

• What should be administered before delivery for the baby?
• What are growth-restricted babies more susceptible to?

Answer 8

Steroids

Hypoxia

Question 9

Management:

Postnatal:
- Where should the SGA baby be put into to regulate temperature?
- Where should they be transferred to if unable to handle feeding?
- Why are neonates likely to become hypoglycemic if they are not fed within 2 hours?

Answer 9

Incubator

SCBU

They have no stored glycogen.

Question 10

Complications:

Perinatal risks to the baby

Childhood - 1

Adulthood

Answer 10

Risk of low fetal oxygen so needs to be monitored during labour
Hypoglycemia
Anaemia
Jaundice
Hypoglycaemia
Infection

Mild cognitive problems, but these usually resolve

HTN
IHD
T2DM
Autoimmune thyroid disease

Question 11

Large for gestational age:

Above what weight is classed as large?

Causes?

Complications with vaginal birth

Answer 11

4.5 kg

Constitutionally large
Gestational DM
Obesity

Shoulder dystocia