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Small for gestational age Dr.V.Ravimohan SpR
[object Object],[object Object],[object Object],[object Object],[object Object]
Definition ,[object Object],10  th  centile Abdominal circumference Estimated fetal weight
One of most frequently sited suboptimal care is the failure ,[object Object],[object Object],[object Object],[object Object]
Implications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ott Wj.The diagnosis of altered fetal growth.Obstet Gynecol Clin North Am 1988;15:237-63
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
Improving sensitivity… ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],more indicative of FGR than SGA diagnosis of SGA fetal wellbeing designed to predict size biophysical tests biometric tests
 
Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Causes of Growth restriction High risk pregnancy management options 2nd edition p300
  Chromosomal abnormalities
Surveillance ,[object Object],[object Object]
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
Doppler Absent/Reverse EDF EDF present Delay delivey till 37w* >34 weeks deliver <34 weeks (i)Admission (ii)Closed surveillance (iii)steroids
<34 weeks with RED/AED ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object]
Survival by birth weight
Survival by gestation
Growth Restriction Intervention Trial (GRIT)  ,[object Object]
588 babies (fetal compromise  between 24-36  weeks) Immediate delivery (296) Delivery when obstetrician  no longer uncertain (292)
OR 1.1(0.7-1.8)
Conclusion ,[object Object]
Mode of delivery ,[object Object],[object Object],[object Object],[object Object],Clinical obstetrics and Gynaecology 40:4:1997;p822
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Small For Gestational Age