Small for dates of pregnancy

Question 1

Define Small for dates of pregnancy and IUGR, RF

Answer 1

EFW = Estimated Foetal Weight; AC = Abdominal Circumference; GA = Gestational Age
SGA - derived from birth weight - with AC or EFW <10 centile - 5% of pregnancies

IUGR- derivered from growth rate - reduced - baby becomes SGA
all IUGR are SGA, but not all SGA are IUGR

RF -
biggest RF - Prevous stillbirth, AntiPhosphLS, Renal disease, cocaine, Maternal age, smoking, previous SGA,
Foetal RF - chromosomal (symetrical IUGR), Infections, Multiple preg
Other- placental insufficiency -asymetrical IUGR

Question 2

Ix of Small for dates of pregnancy and IUGR

Answer 2

RF at booking crucial -
1st - if 1> maj RF, 3minor - reassess at 20w

2nd - at 20w, if still at risk -
Minor >3rf - uterine artery doppler - if abnormal -serial USS from 26-28w
(so if minor, do doppler then if abnormal go to Major RF pathway)
Major risk >1 - foetal size and umbilical artery doppler + serial USS

+ detect congenital infections

Reasses at 3rd trimester

Question 3

Mx of Small for dates of pregnancy and IUGR

Answer 3

Smoking, alcohol, drugs should be stopped.
Low dose aspirin might help preventing IUGR in high risk preg
but no widely accepted treatment

Monitor - Risk status determine,
confirm SGA with foetal biometry at 20w
Uterine artery doppler at 24w

Delivery -
Indications of immediate delivery - abnormal CTG/reduced foetal movement
Reversal end-diastolic flow

deliver at 37w usually necessary - steroids at 36w.
consultant lead clinic

Question 4

complications of Small for dates of pregnancy and IUGR

Answer 4

Stillborth, PTL, intrapartum foetal distreess
birth asphyxia, meconium aspiration, post natal hypoglycemia
neurodevelopemtal delay
risk of HTN/DM in life

Prog-increase perinatal morb and mortality