Small For Gestational Age

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A presentation about small for gestational age.

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  • Small For Gestational Age

    1. 1. Small for gestational age Dr.V.Ravimohan SpR
    2. 2. <ul><li>Definition </li></ul><ul><li>Implications </li></ul><ul><li>Causes </li></ul><ul><li>Diagnosis </li></ul><ul><li>management </li></ul>
    3. 3. Definition <ul><li>SGA refers to a fetus that has failed to achieve a specific biometric or estimated weight threshold by a specific gestational age. </li></ul>10 th centile Abdominal circumference Estimated fetal weight
    4. 4. One of most frequently sited suboptimal care is the failure <ul><li>to suspect growth restriction in a mother with a previous history </li></ul><ul><li>to detect </li></ul><ul><li>to act on </li></ul><ul><li>to monitor </li></ul>
    5. 5. Implications <ul><li>stillbirth </li></ul><ul><li>birth hypoxia </li></ul><ul><li>neonatal complications </li></ul><ul><li>Neurodevelopment delay </li></ul><ul><li>type 2 (non-insulin-dependent) diabetes and hypertension in adult life. </li></ul>
    6. 6. Ott Wj.The diagnosis of altered fetal growth.Obstet Gynecol Clin North Am 1988;15:237-63
    7. 7. 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
    8. 8. Improving sensitivity… <ul><ul><li>Use customised ultrasound charts ( maternal weight, maternal height, ethnic group and parity) </li></ul></ul><ul><ul><li>Use growth velocity in addition to size </li></ul></ul>
    9. 9. <ul><li>Doppler </li></ul><ul><li>Amniotic fluid index </li></ul><ul><li>CTG </li></ul><ul><li>abdominal palpation </li></ul><ul><li>symphyseal fundal height </li></ul><ul><li>ultrasound biometry </li></ul><ul><li>ultrasound estimated fetal weight </li></ul>more indicative of FGR than SGA diagnosis of SGA fetal wellbeing designed to predict size biophysical tests biometric tests
    10. 11. Management <ul><li>(I) aetiology(ex.chromosomal defects) </li></ul><ul><li>(ii)arrange surveillance </li></ul><ul><li>(iii) delivery- </li></ul><ul><ul><ul><ul><ul><li>when? </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>how? </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>where? </li></ul></ul></ul></ul></ul>
    11. 12. Causes of Growth restriction High risk pregnancy management options 2nd edition p300
    12. 13.   Chromosomal abnormalities
    13. 14. Surveillance <ul><li>Umbilical artery doppler is the primary surveillance tool </li></ul><ul><ul><li>frequency of monitoring in SGA fetuses with normal Doppler need not generally be more than once every fortnight. </li></ul></ul>
    14. 15. 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
    15. 16. Doppler Absent/Reverse EDF EDF present Delay delivey till 37w* >34 weeks deliver <34 weeks (i)Admission (ii)Closed surveillance (iii)steroids
    16. 17. <34 weeks with RED/AED <ul><li>Daily CTG/Biophysical profile/Venous doppler </li></ul><ul><li>Consider delivery </li></ul><ul><ul><ul><ul><ul><li>Pathological CTG </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Biophysical score <4 </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Reversal of doppler velocities in ductus venosus during atrial contraction or umbilical vein pulsations </li></ul></ul></ul></ul></ul>
    17. 19. <ul><li>My web site:www.mrcogexam.net </li></ul><ul><li>MY blog :http://mrcogfacts.blogspot.com/ </li></ul>
    18. 20. Survival by birth weight
    19. 21. Survival by gestation
    20. 22. Growth Restriction Intervention Trial (GRIT) <ul><li>Hypothesis:early delivery,to pre-empt intrauterine hypoxia,would alter brain development compared with delaying delivery for as long as possible ,to gain maturity. </li></ul>
    21. 23. 588 babies (fetal compromise between 24-36 weeks) Immediate delivery (296) Delivery when obstetrician no longer uncertain (292)
    22. 24. OR 1.1(0.7-1.8)
    23. 25. Conclusion <ul><li>The present study should discourage doctors who deliver fetuses (<30 weeks) before at which they delivery can be delayed no longer. </li></ul>
    24. 26. Mode of delivery <ul><li>Indications for LSCS </li></ul><ul><li>(I)late decelerations in antenatal CTG </li></ul><ul><li>(II)Reversed End diastolic flow </li></ul><ul><li>(III)thick meconium during induction of labour </li></ul>Clinical obstetrics and Gynaecology 40:4:1997;p822
    25. 27. Summary <ul><li>Definition </li></ul><ul><li>Implications </li></ul><ul><li>Causes </li></ul><ul><li>Diagnosis </li></ul><ul><li>management </li></ul>

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