SGA
The document is a lecture note on “Small for Gestational Age” by Professor Lanka Dasanayake, a Professor of Obstetrics & Gynaecology at the University of Ruhuna in Sri Lanka. The note covers the following topics:
1. Definition of Small for Gestational Age (SGA), which includes failing to achieve a specific biometry or estimated fetal weight (EFW) threshold by a specific gestational age (GA), being just below the 10th centile for GA, and being categorized into two groups: constitutionally small and fetal growth restriction (FGR) due to placental insufficiency.
2. Significance of SGA, including risks such as stillbirth, intrapartum hypoxia, neonatal complications, impaired neurodevelopment, and the possibility of type 2 diabetes mellitus and hypertension in adult life (Barker’s Hypothesis).
3. Incidence of SGA, with approximately 9% of neonates being affected, 30% of which are due to FGR and 70% due to constitutionally small factors.
4. Risk factors for SGA, including maternal age, socio-economic status, weight, smoking, alcohol consumption, drug/substance abuse, previous low birth weight, anemia in pregnancy, chronic hypertension, polycystic ovary syndrome (PCOS), antepartum hemorrhage, multiple pregnancy, congenital infection, and congenital fetal defects.
5. Diagnosis of SGA using methods such as abdominal palpation, measurement of symphysis-fundal height (SFH), ultrasound (USS) for biometry and EFW, and the use of customized USS charts and growth velocity for improving sensitivity.
6. Management of SGA, including ultrasound survey for chromosome defects, umbilical artery Doppler (UAD) to predict poor perinatal outcome, cardiotocography (CTG) and biophysical profile, delivery considerations, use of steroids, and the importance of a tertiary care center with neonatal expertise and facilities.
7. Complications of SGA, such as spontaneous preterm labor (SPTL), respiratory distress syndrome (RDS), jaundice, hypoglycemia, hypocalcemia, intracranial hemorrhage (ICH), retinopathy, and cerebral palsy (CP).
8. Prognosis of SGA, including mortality risk and the risk of mortality during the first year.
Additionally, the note provides information on biometric and biophysical tests for predicting size and fetal wellbeing, causes of FGR, chromosomal abnormalities, and the use of Doppler and steroid in the management of SGA.
