small for gestational age Flashcards
1
Q
risk factors for SGA
A
- lifestyle: smoking, alcohol, and drugs (cocaine use)
- v low or high BMI
- age
- maternal disease e.g. hypertension, renal disease
2
Q
placental causes of SGA?
A
- infarctions
- abruption (APH)
- association w hypertensive disease
3
Q
fetal causes of SGA?
A
- infectione.g. rubella, CMV, toxoplasmosis
- congenital anomalies
- chromosomal abnormalities
4
Q
what is small for gestational age?
A
- abdominal circumference or EFW less than 10th centile
- severe SGA = AC or EFW <3rd centile
5
Q
what is fetal growth restriction
A
- failure of fetus to attain growth potential
- difficult to identify in practice
- evidence of abnormal doppler studies or reduced liquor volume
6
Q
what is considered a low birth weight?
A
- any baby born w weight less than 2.5kg at any gestation
7
Q
who is unsuitable for SFH and will require growth scans?
A
- inc BMI
- fibroid uterus
- multiple pregnancy
8
Q
prevention of SGA?
A
- aspirin those at risk of pre-eclampsia
- smoking cessation - stopping before 15 weeks reduces risk to same as non-smoker
- drugs problems - service input for those who require support
- LMWH in those w antiphospholipid syndrome
9
Q
high risk of FGR?
A
- previous severe SGA
- previous stillbirth
- chronic hypertension on tx
- diabetes
- renal disease e.g. nephropathy
- antiphospholipid syndrome
- lupus
- abnormal uterine artery doppler
10
Q
what should we offer to those at high risk of FGR?
A
- growth scans every 4 weeks from 28 weeks (sometimes 24)
11
Q
other reasons to provide growth scan at 32 and 36 weeks?
A
- IVF pregnancy
- > 40
- fibroids > 6cm
- smoker
- low PAPP-A
- BMI >35
- BMI <19
- echogenic bowel
- previous SGA baby
12
Q
identify structures on US for assessing fetal growth - abdominal circumference
A
13
Q
identify structures on US for assessing fetal growth - head circumference
A
14
Q
dopplers - middle cerebral artery assesses what?
A
- indicates brain perfusion
- redistribution of blood to vital organs e.g. brain
- reduced PI in a compromised fetus
- inc peak systolic velocity in fetal anaemia
- useful additional marker in SGA/FGR after 32 weeks
15
Q
dopplers - ductus venosus
A
- direct reflection of fetal heart function
- A-wave -> flow during atrial contraction of fetal heart, becomes progressively deeper as fetal condition WORSENS
- used to time delivery
- useful in preterm FGR
- mod predicitive value of fetal acidaemia and adverse outcomes
