SGA and FGR

Question 1

What does the pneumonic SERPENT stand for?

Answer 1

S- storage
E- endocrine
R- respiration
P- protection
E- excretion
N- nutrition
T- transfer

Question 2

Placenta and SGA, IUFD

Answer 2

-placenta plays huge role in fetal growth
-SGA and IUGR babies are likely to face IUFD and poor outcomes
- 86% of FGR stillbirth were avoidable (perinatal institute)

Question 3

Define SGA:

Answer 3

Baby born below 10th centipede of weight at birth
Can be placenta mediated growth restriction or non-placental

Question 4

Define FGR

Answer 4

baby has not reached its growth potential

Question 5

Define early FGR

Answer 5

Growth restriction prior to 32/40 associated with placental issues, chromosomal or maternal disease

Question 6

Define late FGR

Answer 6

Growth restriction after 32/40 due to less specific placental issues

Question 7

Define static growth

Answer 7

Serial SFHs where trajectory is slower than curve on customised chart or estimated fetal weight trajectory is slower than slope

Question 8

Define symmetrical growth restriction

Answer 8

Babys body is proportionally small

Question 9

Define Asymmetrical growth restriction

Answer 9

Undernourished baby who’s energy has been directed to vital organs such as brain and heart, so head is usually bigger

Question 10

Difference between SGA and FGR

Answer 10

-taking into maternal height, ethnicity and weight to decide if this is baby is constitutionally normal

Question 11

Maternal factors for FGR

Answer 11

-stress
-CHD
-chronic medical conditions and infections
-nutrition

Question 12

Fetal factors for FGR

Answer 12

-chromosomal antibodies
-placental abnormalities
-genetic conditions

Question 13

How do these factors cause FGR

Answer 13

-insufficiency in placental blood flow
-limited nutrients and oxygen going to baby
-impaired placental protien transport due to impaired maternal hormones
-genetic factors changing placental shape

Question 14

How to identify risk factors and monitor growth:

Answer 14

-identify risks at booking
-refer for smoking, etc
-personal growth chart and USS if SFH is low
-importance on FM is SGA confirmed
- extra USS and discuss IOL

Question 15

SGA/FGR in labour:

Answer 15

-compromised fetus will have less reserves to withstand labour
-careful CTG interpretation
-escalate any issues quickly
-consider resus and paed review

Question 16

Complications with SGA/FGR

Answer 16

-potential resuscitation
- NNU
- poor feeding, hypoglycaemia
- long term physical and developmental disabilities