Small for gestational age Dr.V.Ravimohan SpR

Definition Implications Causes Diagnosis management

Definition

Implications

Causes

Diagnosis

management

Definition SGA refers to a fetus that has failed to achieve a specific biometric or estimated weight threshold by a specific gestational age. 10 th centile Abdominal circumference Estimated fetal weight

SGA refers to a fetus that has failed to achieve a specific biometric or estimated weight threshold by a specific gestational age.

One of most frequently sited suboptimal care is the failure to suspect growth restriction in a mother with a previous history to detect to act on to monitor

to suspect growth restriction in a mother with a previous history

to detect

to act on

to monitor

Implications stillbirth birth hypoxia neonatal complications Neurodevelopment delay type 2 (non-insulin-dependent) diabetes and hypertension in adult life.

stillbirth

birth hypoxia

neonatal complications

Neurodevelopment delay

type 2 (non-insulin-dependent) diabetes and hypertension in adult life.

Ott Wj.The diagnosis of altered fetal growth.Obstet Gynecol Clin North Am 1988;15:237-63

50.6–83.8% 72.9–94.5% High risk ultrasound scan biometry(AC) 48% General customised fundal chart 88% 27% General SFH specificity sensitivity population

Improving sensitivity… Use customised ultrasound charts ( maternal weight, maternal height, ethnic group and parity) Use growth velocity in addition to size

Use customised ultrasound charts ( maternal weight, maternal height, ethnic group and parity)

Use growth velocity in addition to size

Doppler Amniotic fluid index CTG abdominal palpation symphyseal fundal height ultrasound biometry ultrasound estimated fetal weight more indicative of FGR than SGA diagnosis of SGA fetal wellbeing designed to predict size biophysical tests biometric tests

Doppler

Amniotic fluid index

CTG

abdominal palpation

symphyseal fundal height

ultrasound biometry

ultrasound estimated fetal weight

Management (I) aetiology(ex.chromosomal defects) (ii)arrange surveillance (iii) delivery- when? how? where?

(I) aetiology(ex.chromosomal defects)

(ii)arrange surveillance

(iii) delivery-

when?

how?

where?

Causes of Growth restriction High risk pregnancy management options 2nd edition p300

Chromosomal abnormalities

Surveillance Umbilical artery doppler is the primary surveillance tool frequency of monitoring in SGA fetuses with normal Doppler need not generally be more than once every fortnight.

Umbilical artery doppler is the primary surveillance tool

frequency of monitoring in SGA fetuses with normal Doppler need not generally be more than once every fortnight.

Doppler indices Systolic-end diastolic peak velocity Mean systolic velocity Pulsatility index Systolic-end diastolic peak velocity systolic peak velocity Resistance index Systolic peak velocity diastolic peak velocity S/D ratio

Doppler Absent/Reverse EDF EDF present Delay delivey till 37w* >34 weeks deliver <34 weeks (i)Admission (ii)Closed surveillance (iii)steroids

<34 weeks with RED/AED Daily CTG/Biophysical profile/Venous doppler Consider delivery Pathological CTG Biophysical score <4 Reversal of doppler velocities in ductus venosus during atrial contraction or umbilical vein pulsations

Daily CTG/Biophysical profile/Venous doppler

Consider delivery

Pathological CTG

Biophysical score <4

Reversal of doppler velocities in ductus venosus during atrial contraction or umbilical vein pulsations

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My web site:www.mrcogexam.net

MY blog :http://mrcogfacts.blogspot.com/

Survival by birth weight

Survival by gestation

Growth Restriction Intervention Trial (GRIT) Hypothesis:early delivery,to pre-empt intrauterine hypoxia,would alter brain development compared with delaying delivery for as long as possible ,to gain maturity.

Hypothesis:early delivery,to pre-empt intrauterine hypoxia,would alter brain development compared with delaying delivery for as long as possible ,to gain maturity.

588 babies (fetal compromise between 24-36 weeks) Immediate delivery (296) Delivery when obstetrician no longer uncertain (292)

OR 1.1(0.7-1.8)

Conclusion The present study should discourage doctors who deliver fetuses (<30 weeks) before at which they delivery can be delayed no longer.

The present study should discourage doctors who deliver fetuses (<30 weeks) before at which they delivery can be delayed no longer.

Mode of delivery Indications for LSCS (I)late decelerations in antenatal CTG (II)Reversed End diastolic flow (III)thick meconium during induction of labour Clinical obstetrics and Gynaecology 40:4:1997;p822

Indications for LSCS

(I)late decelerations in antenatal CTG

(II)Reversed End diastolic flow

(III)thick meconium during induction of labour

Summary Definition Implications Causes Diagnosis management

Definition

Implications

Causes

Diagnosis

management