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

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. HOW DO WE DEFINE ? SGA: small for GA; BIRTH WT <10 th percentile FOR THE PERIOD OF GESTATION LGA: large for GA; BIRTH WT>90 th percentile

5. SGA : < 2SD FROM MEAN WEIGHT FOR THE PERIOD OF GESTATION LGA : >2 SD FROM MEAN WEIGHT FOR THE PERIOD OF GESTATION

6. SGA < 10 TH PERCENTILE OF BIRTH WT < 2SD FROM MEAN WT

7. Malnourished SGA Commonest type of SGA Asymmetric IUGR 2/3 rd of IUGR malnourishment during latter part of gestation – placental dysfunction ( uteroplacental insufficiency)

8. MALNOURISHED SGA/ ASYMMETRIC IUGR

9. LONG,THIN & MARASMIC Head Circumference,brain unaffected Internal organs,liver grossly shrunken HC > CC by 3cm Loose skin folds Ponderal index ( g/cm 3 ) < 2

10. ONLY DECREASE IN CELL SIZE , CELL NUMBER NORMAL GROWTH POTENTIAL (+) NUTRITIONAL REHABILITATION NEONATAL PROGNOSIS - BETTER

11. 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

12. FEATURES OF HYPOPLASTIC SGA DECREASE IN CELL NUMBER ALL ORGANS AFFECTED,INCLUDING BRAIN ALL PARAMETERS ARE PROPORTIONATELY SMALL PONDERAL INDEX - NORMAL POOR PROGNOSIS PERMANENT PHYSICAL & MENTAL RETARDATION

13. MIXED SGA ADVERSE FACTORS DURING BOTH EARLY & MID PREGNANCY NEITHER OBVIOUS MALNOURISHED,NOR GROSSLY HYPOPLASTIC DECREASE IN BOTH CELL SIZE AND COUNT

14. Causes of SGA Maternal Fetal Placental Environmental

15. MATERNAL FACTORS

16. FETAL FACTORS

17. PLACENTAL

18. Environmental factors Ethnic/racial/geographic Socio-economic status Nutritional

19. COMMON PROBLEMS OF SGA BABIES IUD BIRTH ASPHYXIA HYPOGLYCEMIA,HYPOCALCEMIA HYPOTHERMIA CONGENITAL MALFORMATOINS INFECTIONS POLYCYTHEMIA POOR GROWTH POTENTIAL

20. THOSE 3 LETTER WORDS!! RDS ROP IVH PDA NEC BPD

21. 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

22. LARGE FOR GESTATIONAL AGE

23. DEFINITION CAUSES OF LGA VARIOUS SYNDROMES a/w LGA COMPLICATIONS DUE TO LGA BABIES MANAGEMENT OF LGA

24. LGA babies have Birth wt > 90th percentile for their gestational age birthweight >2 SD from the mean weight for gestation

25. CAUSES OF LGA

26. 1. GENETICS TALL & HEAVY MOTHERS BIG BABY 2 . Maternal Diabetes COMMONEST CAUSE for LGA babies

27. 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)

28. MACROSOMIA ADIPOSITY SKIN FOLD THICKNESS VISCEROMEGALY (LIVER)

29. OTHER PROBLEMS IN GDM?? 1) Hypoglycemia,Hypocalcemia 2) Increased incidence of birth defects-TGA 3) RDS 4) Hyperbilirubinemia 5) polycythemia 6)Birth trauma

30. 3. Cretinism Mean birth wt is higher in babies with Congenital hypothyroidism

31. 4 .Hydrops fetalis large size is due to generalised anasarca rather than due to somatic growth

32. Birth weight may also be related to the amount of weight a mother gains during pregnancy . Excessive weight gain increased fetal weight.

33. Overgrown syndromes with advanced skeletal maturation… Congenital adrenal hyperplasia Thyrotoxicosis Beckwith- Wiedemann syndrome Marshall Smith Syndrome Cerebral gigantism/ Sotos syndrome

34. Beckwith Wiedemann syndrome Visceromegaly Exomphalos Macroglossia Characteristic groove in the ear lobes

35. Marshall Smith Syndrome craniofacial characteristics: large forehead, hypertelorism , micrognathia , long philtrum Advanced maturation of carpal bones

36. Sotos syndrome (cerebral gigantism) large baby macrognathia large hands & feet mentally subnormal & lag in maturation of carpal bones

37. Prolonged vaginal delivery time Difficult birth Birth injury Increased risk of caesarean delivery Why is LGA a concern…?

38. How is LGA diagnosed…? > Ultrasound > A mother's weight gain

39. Prevention of LGA Prenatal care .  Careful management of diabetes Proper weight gain.  

40. A G A Appropriate for gestational age (AGA) describes a fetus or newborn infant whose size is within the normal range for his or her  gestational age

41. AGA: Appropriate for Gestational Age; birthweight b/w 10 th & 90 th percentile An appropriate for gestational age full-term infant is heavier than 2500 grams and lighter than about 4000 grams

42. THANK YOU