0 SGA. small gastinal age , .........pptx

small gastitnal age

1. Small for Gestational Age By 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 10 th centile . ( estimated fetal weight less than 10 th centile for a given gestational age.) Severe SGA is infant with EFW (or AC) less than 3 rd centile Intrauterine growth restriction (or fetal growth restriction): is pathological restriction of the genetic growth potential

4. 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

5. 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

6. 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

7. 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

8. IUGR … Screening History… includes accurate dating Symphysis – Fundus hight Uterine artery Doppler at 24 weeks

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

10. Umbilical Artery Doppler

11. Umbilical Artery Doppler

12. 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

13. 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

14. 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

15. IUGR … delivery A bsent or R eversed E nd D iastolic flow ( ARED ): Deliver between 32-34 , or as soon as it is diagnosed . Give steroids Usually by C/S Pathological CTG indicates immediate delivery

16. 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

17. IUGR .. Practical points

18. IUGR .. Practical points

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