1. Small Babies IUGR and SGA

2. Small-for-gestational-age A baby whose birth weight or estimated fetal weight is below a specified centile for its gestation. Usually 10 th centile (2.7kg at 40 weeks). Normal constitutionally small babies (50 – 70%) + growth restricted babies.

3. Intrauterine Growth Restriction A fetus who has failed to reach its growth potential. May or may not be small for gestational age. Implies a pathological process.

5. Aetiology-Fetal factors Genetic: Maternal ethnicity Maternal size Chromosomal: Trisomy Fetal anomaly Fetal infection: CMV Rubella Toxoplasmosis Malaria

6. Maternal Factors Nutrition (extreme starvation) Drugs/Smoking Maternal Disease: Renal disease SLE Hypertension

7. Placental Factors Failure of the second wave of trophoblastic invasion uteroplacental insufficiency decrease in nutrient supply

8. Screening & Diagnosis Symphsio-fundal height measurement: Low sensitivity and high false-positive rates. Ultrasound – of no value in normal low-risk women. SGA suspected on examination – ultrasound to confirm.

9. Management SGA confirmed on ultrasound Assess for chromosomal/structural defects Assess liquor volume and umbilical artery Dopplers Assess growth velocity

10. Surveillance Fortnightly ultrasound for growth Twice-weekly Dopplers, liquor volume estimation and biophysical profile Management of maternal conditions CTG – no long term predictive value

11. Deliver at the appropriate time. When Dopplers normal – delay until 37 weeks. Abnormal Dopplers – consider delivery depending on gestation. Steroids and discussion with neonatologists.

12. Implications of IUGR Fetal abnormality Perinatal hypoxia long-term neurological morbidity Perinatal death Neonatal hypoglycaemia Necrotising enterocolitis Adult Type II diabetes and coronary artery disease Operative delivery