Small for gestational age GTG

Question 1

Defination SGA

Answer 1

<10th centile

Question 2

Definition severe SGA

Answer 2

<3rd centile

Question 3

Low birth weight refers to below which weight at delivery?

Answer 3

<2500g

Question 4

SGA categorised into which 3 main categories?

Answer 4

Constitutionally small

Non placenta mediated growth restriction

Placental medicated growth restriction
(Maternal: Low weight, poor nutrition, substance misuse/Medical PET, thrombophilias, renal , DM

Question 5

According to this guideline, what are the major risks factors for SGA?

Answer 5

AGe >40, maternal/paternal SGA, Cocaine use, daily rigorous exercise, Smoke >10/day, Chronic HTN, Diabetic vascular disease, renal impairment, APS, Heavy PVB

Low PAPP-A, echo genic bowe

Unsuitable for SFH

Question 6

If major RF when should scans be offered?

Answer 6

umbilical artery doppler 26-28 weeks and serial growth USS

Question 7

What are minor risk factors for SGA

Answer 7

Age 35+
IVF
P0
BMI 25-35
Smokes 1/10 day
Low fruit intake
Previous PET
Preg interval < 6month >60 months

Question 8

What number of risk factors necessitates additional USS

Answer 8

3+ minor RF

Question 9

What scan should be offered to women with 3+ minor RF

Answer 9

uterine artery dopper at 20-24 weeks

Question 10

If uterine artery doppler is positive (PI >95th or notching)

Answer 10

Refer for umbilical artery doppler from 26-28 weeks

Question 11

If uterine artery doppler is negative

Answer 11

Refer for 1 USS fetal size and UAD in 3rd trimester

Question 12

For which women is SFH inaccurate?

Answer 12

BMI >35
Large fibroids
Polyhydramnios

Question 13

When to offer karyotyping for SGA

Answer 13

Severe SGA with structural anomalies, if detected <23 weeks, especially if UAD is normal

Question 14

What bloods should be done for severe SGA

Answer 14

TORCH - CMV & Toxo

If high risk syphilus and malaria

Question 15

If smoking stopped by which gestation is the risk the same as non smokers?

Answer 15

15 weeks

Question 16

To minimise risk of false positive FGR, how long between a measurement of AC or EFW

Answer 16

3 weeks

Question 17

What should happened if SGA Dx 18-20 weeks

Answer 17

Refer to FMU and UAD

Question 18

When to consider AN steroids if delivery for SGA anticipated

Answer 18

24+0 and 35+6 weeks

Question 19

What is the primary surveillance tool in the SGA fetus.

Answer 19

Umbilical artery doppler

Question 20

In SGA foetus if umbilical artery Doppler flow indices are normal, how often should they be repeated?

Answer 20

Every 2 weeks

If severely SGA consider more regular

Question 21

If umbilical artery doppler flow abnormal (pulsatility or resistance +SDs mea), delivery not indicated and end–diastolic velocities present, how often should repeat surveillance?

Answer 21

twice weekly

Question 22

If umbilical artery doppler flow abnormal (pulsatility or resistance +SDs mea), delivery not indicated and absent/reversed end diastolic velocity, how often should repeat surveillance?

Answer 22

Daily

Question 23

Interpretation of the CTG should be based on what for SGA foetus?

Answer 23

Short term variation on computerised system

<3ms within 24 hrs of delivery associated with higher rate academia and NND

Question 24

Interpretation of amniotic fluid volume should be based on what in SGA foetus?

Answer 24

Deepest vertical pool

Question 25

Should middle cerebral artery (MCA) Doppler be used for preterm infant to predict adverse outcome/time delivery

Answer 25

No

Question 26

Should middle cerebral artery (MCA) Doppler be used for preterm infant to predict adverse outcome/time delivery

Answer 26

Yes - an abnormal middle cerebral artery Doppler (PI < 5th centile) has moderate predictive value for acidosis at birth and should be used to time delivery.

Question 27

What can be use in preterm babies to time delivery if abnormal umbilical artery doppler?

Answer 27

Ductus venosus Doppler

Question 28

When to delivery in preterm <32 weeks with umbilical artery AREDV (absent end diastolic velocity)

Answer 28

Ductus venosus dopplers abnormal, UV pulsations appear

Question 29

If MCA doppler abnormal, what is the latest the baby should be delivered?

Answer 29

37 weeks

Question 30

If SGA detected after 32 weeks and abnormal umbilical artery doppler, latest time to deliver

Answer 30

No later than 37 weeks

Question 31

If SGA after 32 weeks with normal artery doppler

Answer 31

Offer delivery at 37 weeks

Question 32

How should babies with umbilical artery AREDV be delivered?

Answer 32

By CS