Small For Gestational Age And Fetal Growth Restriction Flashcards
Why is this important
Placenta huge factor in fetal growth ad is most often the cause of growth issues
SGA and IUGR babies are signigacnt more likely to experience still birth, neonatal death or poor outcomes long term.
Perinatal institute - 86% stullbirths with FGR were potentially avoidable
If we can identify Robles early we can monitor more closely an plan for appropriate delivery
SGA
Baby born below 10th centipede of weight at birth
They are categorised into constitutionally normal foetuses with no placental mediated growth restriction or placenta mediated growth restriction
Constitutionally normal
Normal birth weight less than 10th percentile because of internet factors such as maternal height,weight, ethnicity parity and in these infants there is no increased risk of perinatal mortality or morbidity
FGR
A baby that has not reaches its growth potential
Early FGR
30% approx
Growth restriction prior to 32 weeks gestation often associated with placental issues chromosomal abnormalities or maternal disease
Late FGR
70%
Growth restriction after 32 weeks often due to less specific placental factors
Static growth
Slow or static growth by serial SFHs is defined as a trajectory which is less than the slope of the curve/growth velocity indicated by the 1th centriole line on the customised chart over the same gestational age interval;
Slow or static growth by serial EFWs is defines as a trajectory tween the scan measurement which is slower than the slope of the 3rd centriole n the customised chart over the same gestational age interval
Symmetrical growth restriction
Implies a fetus whose entire body is proportionally small
Asymmetrical growt restriction
Fetus wo is undernourished and is directing most of its energy to mainting main organs such as brain and heart at the expense of the liver, muscle and fat.
Usually the result of placental insuffiency
What are early onset usually
SymmetricalFGR
What are late onset IUGR usually
Asymmetrical FGR
What is the uterine artery PI
Proc=vides a measurement of uteri placentaltall perfusion and high PI implies impaired plantation with consequent increased risk of developing preeclampsia, fetal growth restriction, abruption and stillbirth.
Pathophysiology behind FGR - maternal factors
Chronic medical condition - hypertension, renal disease, collagen vascular disease
Infections - toxoplasmosis, mallei’s
Cardiovascular disease
Nutritional status - low bmi,low weight, eating disorder
Substance misuse
Smoking
Severe stress
Obstretric complications - pre eclampsia
Pathophysiology factors behind FGR - fetal factors
Chris o al abnormalities
Placental abnormalities - single umbilical artery , placental haemangiomas, placenta prevail low lying placenta, chronic abruption
Genetic conditions- trisomy 21/18, blooom syndrome and achondroplasia
How do these fact;pers cause placental insuffiency or growth restriction
Maternal inflammation - obesity, diabetes, infection, PET
Limited nutrients and oxygen crossing the placenta to baby smokin and nutritional input, infections
Limited uteri placental blood flow through the cod and the placenta 9 causing hypoxia or lack of nutrtrients0 - placental abnormalities , PET, chronic hypertension
Implies maternal horses, growth factors and cytokines causing impaired trans placental nutrient and protein transport - insulin impairs this process in diabetes
Genetic factors/disorderd that change spiral artyerty formation or placental perfusion
Early onset FGR VS late onset
Identify risk factors early/potential causes
Often EARLY onset factors can’t b exchanged- more about identifying and managing/ close surveillance
Think PET - a lot of women with early onset will develop PET
How do we identify is k factors, monitor growth and manage a diagnosis
Booking - risk factors, health promotion of nutritional intake
Referral for making, alcohol and substance misuse - get it under control
Easy referral to feta medicine if concerns, serology, TORCH screening if SGA rises
Personalised growth chart - maternal height, weight, ethnicity and parity
Accurate SFH measurement and referral for USS
Indicividualised pathways under consultant led care for recurrent USS and monitoring causes of FGR
Careful information and stress importance of monitong fetal movements
Assesment of groth and timely delivery if Doppler/growth/FMs decline
Discuss carefully IOL vs CS early, if premature - consider corticosteroids and mag sulphate
SGA/FGR in labour
FIGO guildines - determine risk - a fetus that is compromised ahead i the uterus will have less reserves t withstand labour and delivery
Severely FGR babies may not be able to ope with the stress of labou at all
Think about blood flow in the placenta and cord in the normal labour - how would this impact a FGR baby
Complications more likely - abruption, fetal hypoxia, advance neonatal resus, IUFD, and intrapartum stillbirth
Careful CTG interpretation and care planning is key
Preparing for potential resusitation
Short and long term complication
Potential resus at delivery - hypoxia
Admission to NNU
Hypoglycaemia, hypothermia
Poor feeding, lack off energy
Increased chance of jaundice
Long term physical, developmental and psychological disabilities
