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Abnormal Foetal Growth LGA/SGA - Coggle Diagram
Abnormal Foetal Growth LGA/SGA
LGA/SGA Identification
Observation
Inspection
Measurement
Symphysis fundal height - serial
Ultrasound
Fetal biometry
Referencing
Percentile charts
Large SFH
AC >90th percentile
Abdominal circumference
Causes
Large fetus
Polyhydramnios
Mutliple pregnancy
Maternal obesity
Uterine fibroid
Ultrasound Scan
Fetal biometry
HC / BPD
Head circumference
AC
Abdominal circumference
FL - Femur length
EFW
Amniotic fluid
Fetal anatomy
Uterine anatomy
Reference centile charts
Large for Gestational Age / Macrosomia
Aetiology
Contitutionally large fetus in parental size and other measurements (AC, FL, HC)
Abormal large fetus - genetic syndrome
Accelerated fetal growth
Pre-existing DM
Gestational DM
Obesity / excess intake
Risks
Perinatal death
Neonatal birth trauma
Neonatal hypoglycaemia
BPI / fracture
Obstructed labour / emergency CE / intrumental delilvery
Shoulder dystocia
Maternal birth trauma
PPH
Perineal tears
Management
Booking hx, BMI, Dating scan - reliable EDD
Anomaly scan
Glucose screening / GTT/ Dietary advice
Monitoring - glucose / fetal growth (every 2wks) / amniotic fluid (every 2wk)
Clinical identification
Timing of delivery
Mode of delivery
Counselling
Timing / Mode of Delivery
Individualise
Past obs hx
Maternal size
Favourability for labour - lie, engagement, cervix, etc
Maternal preference
GDM
Control
Polyhydramnios
Fetal size
IOL or CS at 38-39 weeks
Small SFH
AC / EFW <10th percentile
Aetiology
Small fetus
Oligohydramnios
Maternal size /Low BMI
Deepl engages
Transverse lie
Ultrasound
Fetal biometry
HC / BPD
AC
FL
EFW
Amniotic fluid
Fetal anatomy
Small for Gestational Age SGA
Aetiology
Constitutionally small fetus - parental size
Abnormal small fetus
Genetic syndrome
Fetal infection
Alcohol
Fetal growth restriction
PET
Medical
Multiple gestation
Smoker
Idiopathic
Risks for FGR / IUGR
Perinatal death
Perinatal hypoxia / CP
Prematurity
Neonatal hypoglycaemia
Neonatal jaundice
Feeding problems
Operative delivery
PET
Management
Booking hx / BMI / Dating scan - ensure correct EDD
Anomaly scan / NIPS or invasive testings / TORCH
Clinical identification
Monitoring - growth / amniotic fluid / Dopplers
Antenatal corticosteroids / MgSO4
Timing of delivery
Mode of delivery
Councelling - obstetric / neonatal / anaesthetic
Monitoring FGR
Serial Growth Scanrs - 2 weekly
Amniotic fluid index (AFI) twice weekly
CTG daily / twice daily
Biophysical profile as required
Fetal Hypoxia
Redistribution in blood flow - Brain Sparing Effect
Increased flow:
Brain
Heart
Adrenals
Decreased flow:
Lungs
Kidneys
GIT
Timing of Delivery
Individualise
Past obs hx
Favourability for labour
Fetal status / gestational age
Maternal preferences
IOL
≥ 37 weeks +/- continous EFM
CS
Fetal compromise
Preterm < 34 weeks
