small gastitnal age

1. Dr Omaima Anan
MBBS, MD, MRCOG

2. SGA

3. SGA… Definition
Small for Gestational Age fetus or neonate( SGA) :
An infant born with birth weight less than 10th centile.
(estimated fetal weight less than 10th centile for a given
gestational age.)
Severe SGA is infant with EFW (or AC) less than 3rd
centile
Intrauterine growth restriction (or fetal growth
restriction): is pathological restriction of the genetic
growth potential

6. SGA… Definition… Cont.
50-70% 0f SGA are constitutionally small
Not all IUGR babies are SGA
IUGR or FGR is not is not synonymous with SGA

7. IUGR… Risk factors
maternal Fetal
 Extreme of age
 Smoking and recreational
drugs
 Previous IUGR baby
 Thrombophilias
 Maternal medical disease eg
hypertention
 Recurrent APH
 Placenta insufficiency
 Chromosomal abnormalities
eg aneuploidy
 Structual malformation
 Multiple pregnancy(TTTS)
 Infections

8. IUGR Types
Symmetrical IUGR: A symmetrical IUGR:
 both head and body growth
are reduced.
 Occurs early in pregnancy
 Usually it is due to fetal
infection or chromosomal
abnormalities
 Liqour may be normal,
reduced or increased.
 head growth is preserved
 Occurs relatively late
 Usually due to placental
insufficiency
 Usually associated with
reduced liqour and
abnormal UA Doppler

9. IUGR… Pathology
Chronic hypoxia leads to peripheral vasoconstriction
Redistribution of fetal cardiac output away from skin,
limbs (thin baby), kidneys (reduced urine & amniotic
fluid) to the brain, heart and adrenals, (normal head
size)
Reduced liver glycogen store (small abdominal
circumference) & reduced fetal movement

10. IUGR … Screening
1. History… includes accurate dating
2. Symphysis –Fundus hight
3. Uterine artery Doppler at 24 weeks

11. IUGR… diagnosis
Confirmation is by serial Ultrasound Scans
1. Reduced fetal biometry: AC (abdominal
circumference), FL (femur length) & EFW(estimated
fetal weight
2. High HC(head circumference)/AC ratio
3. Reduced liqour
4. Abnormal UA Doppler flow

12. Umbilical Artery Doppler

13. Umbilical Artery Doppler

14. IUGR.. management
The aim is to identify & treat the possible cause and
to deliver the fetus as mature as possible & before
the hypoxic damage has occurred. (timed delivery)
Early onset (symmetrical) IUGR:
 Confirm the GA
 Screening for infections (Toxo, Rubella,
Cytomegalovirus)
 karyotyping
 Screening for structural malformations

15. IUGR.. management
Asymmetrical IUGR
Treat maternal conditions eg hypertension and
substance abuse
Advise for bed rest ???
Re-scan for structural malformation
Serial U/S for growth and liqour: every 2 weeks for
growth velocity
UA Doppler : every 2 weeks. More frequent if initially
abnormal.
 CTG: if there is an abnormal Doppler

16. IUGR… delivery
Normal UA Doppler:
 Deliver by 37 weeks
 Vaginal delivery is possible (continuous CTG)
 Give steroids if delivery is by C/S
Reduced UA Doppler
 delivery by 37 weeks
 deliver earlier if static growth over 3 weeks
 Give steroids
 Usually by C/S

17. IUGR… delivery
Absent or Reversed End Diastolic flow (ARED):
 Deliver between 32-34, or as soon as it is diagnosed.
 Give steroids
 Usually by C/S
Pathological CTG indicates immediate delivery

18. IUGR… Consequences
Antepartum Intrapartum
Slow growth
Oligohydramnios
Reduced fetal movement
Abnormal fetal heart
rate
Iatrogenic prematurity
Intrauterine fetal death
 Fetal distress (abnormal
HR)
 Passage of meconium
 Intrauterine fetal death
 Operative delivery
Neonatal
 asphyxia
 Hypoglycemia
 Neonatal death
 Long term complications

19. IUGR.. Practical points

20. IUGR.. Practical points

21. Quiz
Which of the following statements best describe
the asymmetrical intrauterine growth
restriction ( IUGR) ?
A. Occurs relatively late and it is usually due to fetal
infections
B. Both head and body growth are reduced.
C. Is usually associated with abnormal Uterine Artery
Doppler
D. Head growth is preserved but the fetal weight is
reduced
E. The fetal weight is usually less than 50th centile