SGA

1. A 38-year-old primigravida undergoes first trimester screening and the result shows a low placental-associated plasma protein (PAPP-A) of <0.4 MoM (multiples of the median). What is the implication of this result?

2. A 32-year-old pregnant woman had a history of a previous small-for-gestational-age baby. Her uterine artery Doppler shows notching at 22 weeks’ gestation, which normalizes when repeated two weeks later. How will you continue her antenatal care?

3. You are caring for a 33-year-old pregnant woman who is diagnosed with a small-forgestational- age fetus. At 31 weeks she showed an umbilical flow plasticity index of >+2 standard deviations (SDs) above the mean for gestational age. What indices should you use to time delivery?

4. A woman is referred by the community midwife with suspected small for dates pregnancy at 33 weeks gestation. Ultrasound assessment confirms a small for gestation (SGA) fetus with reduced liquor volume and reversed end diastolic flow on umbilical artery (UA) Doppler. Cardiotocograph (CTG) is normal. What is the most appropriate management?

5. The velocimetry measurement of blood vessels can be used to improve perinatal outcomes in high-risk pregnancies. Which vessel is assessed?

6. A primigravida aged 37 is seen at booking. This is a pregnancy following assisted conception. Her BMI is 19 and the ultrasound scan has confirmed a singleton fetus appropriate for the period of gestation. What is the recommended investigation to identify fetus at risk of SGA age?

7. You are seeing a patient at antenatal clinic at 16 weeks’ gestation to make a plan for her antenatal care. T e midwife wants to know if the woman has any major risk factors for an SGA fetus. Which of the following is a major risk factor for this?

8. A 35-year-old para 1 at 32 weeks’ gestation is being monitored for an SGA fetus a er her midwife plotted symphysis fundal height on a customized growth chart suggested static growth. Her antenatal care has previously been uneventful other than a course of steroids at 26+3 weeks’ gestation during an admission for threatened preterm labour. Her rst delivery was 3 years ago at 39 weeks with the delivery of a healthy male infant weighing 2950 g. She has had tuberculosis as a child living in India, but is otherwise t and well. Ultrasound scan today reveals the fetal abdominal circumference to be around the 7th centile on a customized chart, with an UA pulsatility index greater than 2 standard deviations from the mean for gestational age. End diastolic flow is present. What would be the best initial follow-up plan for her?

9. A 32-year-old primigravida at 33+6 weeks’ gestation has been under close surveillance a er a diagnosis of an SGA fetus. She attends for ultrasound in the morning clinic. Fetal abdominal circumference remains less than the 10th centile, DVP of liquor measures 1.2 cm and the UA Doppler shows reversed end diastolic ow. T e C G is normal. A course of antenatal corticosteroids was completed 2 days ago. She had a large breakfast 4 hours ago. T e labour ward is busy, an elective caesarean section has just been commenced, but you have access to open an emergency second operating theatre. She is keen for a vaginal delivery. What would be the best management plan you would advise for her?

10. Important Question: A 28 years old primigravida pregnant woman , at 22 weeks 6 days gestation admitted with pain abdomen and delivered a live baby. The baby then died after few hours ?

11. Important Question: The small-for-gestational-age (SGA) neonates are more prone for?

12. Important Question: Which of the following is the major risk factor for SGA ?