Small for gestational age GTG Flashcards
Defination SGA
<10th centile
Definition severe SGA
<3rd centile
Low birth weight refers to below which weight at delivery?
<2500g
SGA categorised into which 3 main categories?
Constitutionally small
Non placenta mediated growth restriction
Placental medicated growth restriction
(Maternal: Low weight, poor nutrition, substance misuse/Medical PET, thrombophilias, renal , DM
According to this guideline, what are the major risks factors for SGA?
AGe >40, maternal/paternal SGA, Cocaine use, daily rigorous exercise, Smoke >10/day, Chronic HTN, Diabetic vascular disease, renal impairment, APS, Heavy PVB
Low PAPP-A, echo genic bowe
Unsuitable for SFH
If major RF when should scans be offered?
umbilical artery doppler 26-28 weeks and serial growth USS
What are minor risk factors for SGA
Age 35+
IVF
P0
BMI 25-35
Smokes 1/10 day
Low fruit intake
Previous PET
Preg interval < 6month >60 months
What number of risk factors necessitates additional USS
3+ minor RF
What scan should be offered to women with 3+ minor RF
uterine artery dopper at 20-24 weeks
If uterine artery doppler is positive (PI >95th or notching)
Refer for umbilical artery doppler from 26-28 weeks
If uterine artery doppler is negative
Refer for 1 USS fetal size and UAD in 3rd trimester
For which women is SFH inaccurate?
BMI >35
Large fibroids
Polyhydramnios
When to offer karyotyping for SGA
Severe SGA with structural anomalies, if detected <23 weeks, especially if UAD is normal
What bloods should be done for severe SGA
TORCH - CMV & Toxo
If high risk syphilus and malaria
If smoking stopped by which gestation is the risk the same as non smokers?
15 weeks
To minimise risk of false positive FGR, how long between a measurement of AC or EFW
3 weeks
What should happened if SGA Dx 18-20 weeks
Refer to FMU and UAD
When to consider AN steroids if delivery for SGA anticipated
24+0 and 35+6 weeks
What is the primary surveillance tool in the SGA fetus.
Umbilical artery doppler
In SGA foetus if umbilical artery Doppler flow indices are normal, how often should they be repeated?
Every 2 weeks
If severely SGA consider more regular
If umbilical artery doppler flow abnormal (pulsatility or resistance +SDs mea), delivery not indicated and end–diastolic velocities present, how often should repeat surveillance?
twice weekly
If umbilical artery doppler flow abnormal (pulsatility or resistance +SDs mea), delivery not indicated and absent/reversed end diastolic velocity, how often should repeat surveillance?
Daily
Interpretation of the CTG should be based on what for SGA foetus?
Short term variation on computerised system
<3ms within 24 hrs of delivery associated with higher rate academia and NND
Interpretation of amniotic fluid volume should be based on what in SGA foetus?
Deepest vertical pool
Should middle cerebral artery (MCA) Doppler be used for preterm infant to predict adverse outcome/time delivery
No
Should middle cerebral artery (MCA) Doppler be used for preterm infant to predict adverse outcome/time delivery
Yes - an abnormal middle cerebral artery Doppler (PI < 5th centile) has moderate predictive value for acidosis at birth and should be used to time delivery.
What can be use in preterm babies to time delivery if abnormal umbilical artery doppler?
Ductus venosus Doppler
When to delivery in preterm <32 weeks with umbilical artery AREDV (absent end diastolic velocity)
Ductus venosus dopplers abnormal, UV pulsations appear
If MCA doppler abnormal, what is the latest the baby should be delivered?
37 weeks
If SGA detected after 32 weeks and abnormal umbilical artery doppler, latest time to deliver
No later than 37 weeks
If SGA after 32 weeks with normal artery doppler
Offer delivery at 37 weeks
How should babies with umbilical artery AREDV be delivered?
By CS
