SGA guidelines (PSANZ, SOGC, RCOG)

Question 1

Define severe FGR

Answer 1

EFW or AC <3rd centile

Question 2

What proportion of FGR occurs in women with no risk factors?

Answer 2

50%

Question 3

List 5 risk factors with OR>2.0 for SGA

Answer 3

AMA >40yo, smoker >10 per day, previous stillbirth, previous SGA, maternal SGA, chronic hypertension, diabetes wth vascular disease, renal disease, APLS, paternal SGA.

Heavy bleeding similar to menses, echogenic bowel, PET, severe PIH, unexplained APH, low maternal weight gain.

Question 4

What is the OR for an SGA infant and severe SGA with PAPP-A <0.40 MoM?

Answer 4

OR 2.7 <10th

OR 3.66 <3rd

Question 5

An abnormal uterine artery doppler at 19-23 weeks may identify pregnancies at risk of what?

Answer 5

stillbirth
preterm delivery
IUGR
placental disease

Question 6

Compare use of DVP and AFI

Answer 6

AFI identified more cases of oligohydramnios and more women had IOL (RR1.92 95%CI 1.5-2.46) without an improvement in outcome

Question 6

Compare use of DVP and AFI

Answer 6

AFI identified more cases of oligohydramnios and more women had IOL (RR1.92 95%CI 1.5-2.46) without an improvement in outcome

Question 7

Discuss significance of UAPI >95th with absent or reversed EDF with regard to fetal and delivery outcomes.

Answer 7

predictive of fetal death (LR +4.37), acidosis (LR+2.74). NNT 203.

Use of UAPI in SGA results in reduction in perinatal deaths, fewer IOL, fewer Caesarean sections

Question 8

What is the best USS predictor of acidaemia?

Answer 8

Ductus venous doppler. Predicts intact survival past 29 weeks.

Question 9

What is the use of MCAPI <5th centile in timing delivery?

Answer 9

Low predictive value of acidosis in preterm SGA infants. Should not be used to time delivery.

Moderate predictive value acidosis in term SGA with normal UAPI. Reasonable to use to time delivery.

Question 10

What is the most predictive feature of acidaemia on CTG?

Answer 10

Short term variability on cCTG <3ms associated with acidaemia 54.2% vs. 10.5% and early neonatal death 8.3% vs. 0.5%.

Question 11

What are the features consistent with a pre-viable fetus?

Answer 11

<24 weeks, <500g.

Question 12

In the context of EFW/AC <10th centile and abnormal UAPI & +EDF, how often should USS be performed?

Answer 12

twice weekly UAPI + liquor

fortnightly biometry.

Question 13

How frequent should USS be performed if UAPI >95th & AREDV?

Answer 13

Daily dopplers (including DV), daily cCTG, fortnightly biometry.

Question 14

What placental histology may be associated with early FGR?

Answer 14

maternal vascular malperfusion, perivillous fibrin deposition, chronic intervillositis

Question 15

What percentage of severely SGA foetuses <23 weeks have chromosomal abnormalities

Answer 15

20% aneuploidy irrespective of structural anomalies.

Question 16

What percentage of SGA foetuses have congenital infections?

Answer 16

5%

Question 17

What percentage of SGA foetuses have congenital infections?

Answer 17

5%

Question 18

Is AFI predictive of acidaemia?

Answer 18

no
AFI <5cm = increased risk of LSCS for fetal distress (RR2.2 95% CI 1.5-3.4), and an Apgar score <7 at 5 minutes (RR 5.2, 95% CI 2.4-11.3), but not acidaemia.

Question 19

significance and prevalence of pemphigoid gestationis?

Answer 19

1/10,000-60,000

association with low birthweight, preterm and stillbirth.

Question 20

features of pemphigoid gestations?

Answer 20

pruritic rash —-> bullae after 2w.
umbilicus affected
can flare PP. Onset third trimester.

Question 21

Histological characteristic of pemphigoid gestationis?

Answer 21

C3 deposition basement membrane

Question 22

Histological characteristic of pemphigoid gestationis?

Answer 22

C3 deposition basement membrane