7: Reduced foetal movements & SGA

Question 1

After ___ weeks foetal movements are a reliable indicator of wellbeing

Answer 1

28

Question 2

Define SGA

Answer 2

A baby that is <10th customised centile for gestational age

Question 3

Difference in SGA growth patterns

Answer 3

Symmetrical: insults in early pregnancy affecting cell division e.g. infection, chromosomal abnormalities, drugs, congenital malformations

Asymmetrical: abdominal circum disproportionately low compared to head circ secondary to extrinsic insult LATER in pregnancy (placental insufficiency) e.g. HTN

Question 4

What are customised foetal growth charts and why is their use now considered best practice?

Answer 4

Customised growth charts account for maternal factors that might influence baby’s size e.g. ethnicity, maternal height and weight, parity.

More useful at detecting normal and abnormal smallness.

Question 5

What might cause short/long fundal height?

Answer 5

Short measure: foetal descent, SGA, oligohydramnios, sideways position

Longer measure: multiple pregnancy, LGA, gestational diabetes, polyhydramnios, breech

Question 6

Common causes of SGA

Answer 6

Non pathological: constitutional smallness, incorrect dates

Maternal: low weight, malnutrition, anaemia, HTN, autoimmune disease, thrombophilia, renal disease, diabetes, substance abuse and smoking

Placental: small, abruption, praevia

Non-placental: chromosomal, congenital anomaly, metabolic error, infection

Question 7

Cx of SGA

• Perinatal
• long term (foetal)
• long term (maternal)

Answer 7

Perinatal: IU death, poor temp regulation, low resistance to infection, hypoglycaemia, hypoxia, feeding problems, jaundice

Long term (foetal): short stature, neurodevelopment, cerebral palsy

Maternal: HTN, diabetes, CVD

Question 8

Smoking cessation by __ weeks reduces risk to non smoker

Answer 8

15 weeks

Question 9

Monitoring during pregnancy for SGA

Answer 9

1. Weekly clinical check

2. Fortnightly growth scan

Question 10

Recommendations for monitoring foetal movement

Answer 10

Get to know your baby’s schedule and pattern of movements. If youre concerned in a reduction after 28 weeks contact your LMC.

If you’re unsure if movements have been reduced after 28 weeks, lie still and focus on foetal movements for 2 hours. If you do not feel 10 or more discrete movements in 2 hours, contact immediately.