Small For Gestational Age

Slideshow Transcript

1. Slide 1: Small for gestational age Dr.V.Ravimohan SpR
2. Slide 2: • Definition • Implications • Causes • Diagnosis • management
3. Slide 3: Definition SGA refers to a fetus that has failed to achieve a specific biometric or estimated weight threshold by a specific gestational age. 10 th centile Abdominal circumference Estimated fetal weight
4. Slide 4: One of most frequently sited suboptimal care is the failure  to suspect growth restriction in a mother with a previous history  to detect  to act on  to monitor
5. Slide 5: Implications • stillbirth • birth hypoxia • neonatal complications • Neurodevelopment delay • type 2 (non-insulin-dependent) diabetes and hypertension in adult life.
6. Slide 6: Small for gestational babies Small for gestational babies Fetal growthgrowth Fetal restriction restriction30% 30% constituninal small babies constitutional Fetal growth restriction constituninal Fetal growth restrictio small babies constitutional 70% 70% Ott Wj.The diagnosis of altered fetal growth.Obstet Gynecol Clin North Am 1988;15:237-63
7. Slide 7: population sensitivity specificity SFH General 27% 88% customised General 48% fundal chart ultrasound High risk 72.9–94.5% 50.6–83.8% scan biometry(AC)
8. Slide 8: Improving sensitivity… – Use customised ultrasound charts(maternal weight, maternal height, ethnic group and parity) – Use growth velocity in addition to size
9. Slide 9: biometric tests biophysical tests designed to predict size fetal wellbeing •abdominal palpation •Doppler •symphyseal fundal height •Amniotic fluid index •ultrasound biometry •CTG •ultrasound estimated fetal weight diagnosis of SGA more indicative of FGR than SGA
10. Slide 11: Management • (I) aetiology(ex.chromosomal defects) • (ii)arrange surveillance • (iii) delivery- » when? » how? » where?
11. Slide 12: Causes of Growth restriction 6% 8% 12% Sever e UP dysf ucti on Chr omosomal abnor mal i ty Str uctur al mal f or mati on Congeni tal i nf ecti on 54% mi scel l aneous 20% High risk pregnancy management options 2nd edition p300
12. Slide 13: Chromosomal abnormalities th 10 Centile 7% th 5 Centile 19%
13. Slide 14: Surveillance • Umbilical artery doppler is the primary surveillance tool – frequency of monitoring in SGA fetuses with normal Doppler need not generally be more than once every fortnight.
14. Slide 15: Doppler indices Systolic peak velocity S/D ratio diastolic peak velocity Systolic-end diastolic peak velocity Resistance index systolic peak velocity Systolic-end diastolic peak velocity Pulsatility index Mean systolic velocity
15. Slide 16: Doppler EDF present Absent/Reverse EDF Delay delivey till 37w* <34 weeks >34 weeks (i)Admission (ii)Closed surveillance deliver (iii)steroids
16. Slide 17: <34 weeks with RED/AED • Daily CTG/Biophysical profile/Venous doppler • Consider delivery » Pathological CTG » Biophysical score <4 » Reversal of doppler velocities in ductus venosus during atrial contraction or umbilical vein pulsations
17. Slide 19: • My web site:www.mrcogexam.net • MY blog :http://mrcogfacts.blogspot.com/
18. Slide 20: Survival by birth weight
19. Slide 21: Survival by gestation
20. Slide 22: Growth Restriction Intervention Trial (GRIT) • Hypothesis:early delivery,to pre-empt intrauterine hypoxia,would alter brain development compared with delaying delivery for as long as possible ,to gain maturity.
21. Slide 23: 588 babies (fetal compromise between 24-36 weeks) Immediate delivery Delivery when obstetrician no longer uncertain (296) (292)
22. Slide 24: D e a t h a n d s e v e r e d i s a b il i t y a t 2 y r s I m m e d ia t e d e liv e r y 5 5 ( 1 9 % ) D e la y e d d e liv e r y 4 4 ( 1 6 % ) OR 1.1(0.7-1.8)
23. Slide 25: Conclusion • The present study should discourage doctors who deliver fetuses (<30 weeks) before at which they delivery can be delayed no longer.
24. Slide 26: Mode of delivery Indications for LSCS (I)late decelerations in antenatal CTG (II)Reversed End diastolic flow (III)thick meconium during induction of labour Clinical obstetrics and Gynaecology 40:4:1997;p822
25. Slide 27: Summary • Definition • Implications • Causes • Diagnosis • management