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SMALL FOR GESTATIONAL AGE,LARGE FOR GESTATIONAL AGE -SSJ, CALICUT MEDICAL COLLEGE
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SMALL FOR GESTATIONAL AGE,LARGE FOR GESTATIONAL AGE -SSJ, CALICUT MEDICAL COLLEGE

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  • 1. SMALL FOR GESTATIONAL AGE (SGA) LARGE FOR GESTATIONAL AGE(LGA) & ADEQUATE FOR GESTATIONAL AGE (AGA)
  • 2. SMALL FOR GESTATIONAL AGE (SGA)
  • 3. LOW BIRTH WEIGHT ( < 2.5 kg) PRETERM BABIES SMALL FOR AGE BABIES
  • 4. SMALL FOR DATE PRETERM LBW
  • 5. HOW DO WE DEFINE ? • SGA: small for GA; BIRTH WT <10th percentile FOR THE PERIOD OF GESTATION • LGA: large for GA; BIRTH WT>90th percentile
  • 6. • SGA : < 2SD FROM MEAN WEIGHT FOR THE PERIOD OF GESTATION • LGA : >2 SD FROM MEAN WEIGHT FOR THE PERIOD OF GESTATION
  • 7. SGA < 10TH PERCENTILE OF BIRTH WT < 2SD FROM MEAN WT
  • 8. Types of SGA Malnourished SGA Hypoplastic SGA Mixed SGA
  • 9. Malnourished SGA Commonest type of SGA Asymmetric IUGR 2/3 rd of IUGR malnourishment during latter part of gestation – placental dysfunction (uteroplacental insufficiency)
  • 10. MALNOURISHED SGA/ ASYMMETRIC IUGR
  • 11. LONG,THIN & MARASMIC Head Circumference,brain unaffected Internal organs,liver grossly shrunken HC > CC by 3cm Loose skin folds Ponderal index ( g/cm3) < 2
  • 12.  ONLY DECREASE IN CELL SIZE, CELL NUMBER NORMAL  GROWTH POTENTIAL (+)  NUTRITIONAL REHABILITATION  NEONATAL PROGNOSIS - BETTER
  • 13. Hypoplastic SGA  Symmetric IUGR  1/3 rd of IUGR  Growth retardation in early pregnancy a/w intrauterine infection genetic defects, chromosomal aberrations  Incidence of anomalies 10 – 20 times higher
  • 14. FEATURES OF HYPOPLASTIC SGA o o o o o DECREASE IN CELL NUMBER ALL ORGANS AFFECTED,INCLUDING BRAIN ALL PARAMETERS ARE PROPORTIONATELY SMALL PONDERAL INDEX - NORMAL POOR PROGNOSIS PERMANENT PHYSICAL & MENTAL RETARDATION
  • 15. MIXED SGA  ADVERSE FACTORS DURING BOTH EARLY & MID PREGNANCY  NEITHER OBVIOUS MALNOURISHED,NOR GROSSLY HYPOPLASTIC  DECREASE IN BOTH CELL SIZE AND COUNT
  • 16. Causes of SGA • • • • Maternal Fetal Placental Environmental
  • 17. MATERNAL NUTRITION POOR WEIGHT GAIN PREVIOUS HISTORY MATERNAL FACTORS SMOKING GRAND MULTIPARA TOBACCO ALCOHOL MATERNAL DISEASES
  • 18. FIRST BORN IU INFECTIONS FETAL FACTORS MULTIPLE PREGNANCY GENETIC DEFECTS
  • 19. ABRUPTION VASCULAR THROMBOSIS PLACENTAL STRUCTURAL ABNORMALITY PLACENTA INFARCTS
  • 20. Environmental factors Ethnic/racial/geographic Socio-economic status Nutritional
  • 21. COMMON PROBLEMS OF SGA BABIES 1. 2. 3. 4. 5. 6. 7. 8. IUD BIRTH ASPHYXIA HYPOGLYCEMIA,HYPOCALCEMIA HYPOTHERMIA CONGENITAL MALFORMATOINS INFECTIONS POLYCYTHEMIA POOR GROWTH POTENTIAL
  • 22. THOSE 3 LETTER WORDS!! • • • • • • RDS ROP IVH PDA NEC BPD
  • 23. MANAGEMENT OF SGA • • • • • Emergency CS – fetal distress Screening for cong.malformations Early and adequate breast feeding (NGT/IVF) Correct hypoglycemia,hypocalcemia,polycythemia Control infections,temperature regulation
  • 24. LARGE FOR GESTATIONAL AGE
  • 25. • • • • • DEFINITION CAUSES OF LGA VARIOUS SYNDROMES a/w LGA COMPLICATIONS DUE TO LGA BABIES MANAGEMENT OF LGA
  • 26. LGA babies have • Birth wt > 90th percentile for their gestational age • birthweight >2 SD from the mean weight for gestation
  • 27. CAUSES OF LGA
  • 28. 1.GENETICS TALL & HEAVY MOTHERS 2. Maternal BIG BABY Diabetes COMMONEST CAUSE for LGA babies
  • 29. • INFANT OF DIABETIC MOTHER UTILISE LARGE AMOUNT OF TRANSPLACENTALLY TRANSMITTED GLUCOSE ISLET CELL HYPERPLASIA & HYPERINSULINEMIA INCREASE IN GROWTH FACTORS IGF-1 , IGF-2 INCREASED GROWTH & ADIPOSITY IN INSULIN DEPENDENT AREAS (FETAL TRUNK,SHOULDERS)
  • 30. MACROSOMIA • ADIPOSITY • SKIN FOLD THICKNESS • VISCEROMEGALY (LIVER)
  • 31. OTHER PROBLEMS IN GDM?? 1) Hypoglycemia,Hypocalcemia 2) Increased incidence of birth defects-TGA 3) RDS 4) Hyperbilirubinemia 5) polycythemia 6)Birth trauma
  • 32. • 3. Cretinism Mean birth wt is higher in babies with Congenital hypothyroidism
  • 33. 4.Hydrops fetalis large size is due to generalised anasarca rather than due to somatic growth
  • 34. • Birth weight may also be related to the amount of weight a mother gains during pregnancy. • Excessive weight gain increased fetal weight.
  • 35. Overgrown syndromes with advanced maturation… a)Congenital adrenal hyperplasia b)Thyrotoxicosis c)Beckwith- Wiedemann syndrome d)Marshall Smith Syndrome e)Cerebral gigantism/ Sotos syndrome skeletal
  • 36. Beckwith Wiedemann syndrome • • • • Visceromegaly Exomphalos Macroglossia Characteristic groove in the ear lobes
  • 37. Marshall Smith Syndrome craniofacial characteristics: large forehead, hypertelorism, micrognathia, long philtrum Advanced maturation of carpal bones
  • 38. Sotos syndrome (cerebral gigantism) large baby macrognathia large hands & feet mentally subnormal & lag in maturation of carpal bones
  • 39. Why is LGA a concern…? • • • • Prolonged vaginal delivery time Difficult birth Birth injury Increased risk of caesarean delivery
  • 40. How is LGA diagnosed…? > Ultrasound > A mother's weight gain
  • 41. Prevention of LGA Prenatal care. Careful management of diabetes Proper weight gain.
  • 42. AGA Appropriate for gestational age (AGA) describes a fetus or newborn infant whose size is within the normal range for his or her gestational age
  • 43. • AGA: Appropriate for Gestational Age; birthweight b/w 10th & 90th percentile An appropriate for gestational age full-term infant is heavier than 2500 grams and lighter than about 4000 grams
  • 44. THANK YOU