Small for gestational age

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A power point presentation on small for gestational age

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Small for gestational age : 

Small for gestational age Dr.V.Ravimohan SpR http://www.mrcogexam.net

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Thank you Visit my site http://www.mrcogexam.net

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Definition Implications Causes Diagnosis management

Definition : 

Definition SGA refers to a fetus that has failed to achieve a specific biometric or estimated weight threshold by a specific gestational age.

One of most frequently sited suboptimal care is the failure : 

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

Implications : 

Implications stillbirth birth hypoxia neonatal complications Neurodevelopment delay type 2 (non-insulin-dependent) diabetes and hypertension in adult life.

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Ott Wj.The diagnosis of altered fetal growth.Obstet Gynecol Clin North Am 1988;15:237-63

Improving sensitivity… : 

Improving sensitivity… Use customised ultrasound charts(maternal weight, maternal height, ethnic group and parity) Use growth velocity in addition to size

Management : 

Management (I) aetiology(ex.chromosomal defects) (ii)arrange surveillance (iii) delivery- when? how? where?

Causes of Growth restriction : 

Causes of Growth restriction High risk pregnancy management options 2nd edition p300

Chromosomal abnormalities : 

Chromosomal abnormalities

Surveillance : 

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.

Doppler indices : 

Doppler indices

<34 weeks with RED/AED : 

<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

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Survival by birth weight : 

Survival by birth weight

Survival by gestation : 

Survival by gestation

Growth Restriction Intervention Trial (GRIT) : 

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.

OR 1.1(0.7-1.8) : 

OR 1.1(0.7-1.8)

Conclusion : 

Conclusion The present study should discourage doctors who deliver fetuses (<30 weeks) before at which they delivery can be delayed no longer.

Mode of delivery : 

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

Summary : 

Summary Definition Implications Causes Diagnosis management