SMALL FOR GESTATIONAL AGE,LARGE FOR GESTATIONAL AGE -SSJ, CALICUT MEDICAL COLLEGE
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Transcript of SMALL FOR GESTATIONAL AGE,LARGE FOR GESTATIONAL AGE -SSJ, CALICUT MEDICAL COLLEGE
SMALL FOR GESTATIONAL AGE (SGA)
LARGE FOR GESTATIONAL AGE(LGA)
&
ADEQUATE FOR GESTATIONAL AGE (AGA)
SMALL FOR GESTATIONAL AGE (SGA)
LOW BIRTH WEIGHT ( < 2.5 kg)
PRETERM BABIES
SMALL FOR AGE BABIES
SMALL
FOR DAT
E
PRETERM
LBW
HOW DO WE DEFINE ?
• SGA: small for GA;BIRTH WT <10th percentile
FOR THE PERIOD OF GESTATION
• LGA: large for GA;BIRTH WT>90th percentile
• SGA : < 2SD FROM MEAN WEIGHT FOR THE PERIOD OF GESTATION
• LGA : >2 SD FROM MEAN WEIGHT FOR THE PERIOD OF GESTATION
SGA
< 10TH PERCENTILE
OF BIRTH WT
< 2SD FROM MEAN WT
Malnourished SGA
Hypoplastic SGA
Mixed SGA
Types of SGA
Malnourished SGA
Commonest type of SGAAsymmetric IUGR2/3 rd of IUGRmalnourishment during latter part of gestation – placental dysfunction (uteroplacental insufficiency)
MALNOURISHED SGA/ ASYMMETRIC IUGR
LONG,THIN & MARASMIC
Head Circumference,brain unaffectedInternal organs,liver grossly shrunkenHC > CC by 3cmLoose skin folds
Ponderal index ( g/cm3) < 2
ONLY DECREASE IN CELL SIZE, CELL NUMBER NORMAL
GROWTH POTENTIAL (+)
NUTRITIONAL REHABILITATION
NEONATAL PROGNOSIS - BETTER
Hypoplastic SGA
Symmetric IUGR 1/3 rd of IUGR Growth retardation in early pregnancy a/w
intrauterine infection genetic defects,
chromosomal aberrations Incidence of anomalies 10 – 20 times higher
FEATURES OF HYPOPLASTIC SGA
o DECREASE IN CELL NUMBERo ALL ORGANS AFFECTED,INCLUDING BRAINo ALL PARAMETERS ARE PROPORTIONATELY SMALLo PONDERAL INDEX - NORMALo POOR PROGNOSIS PERMANENT PHYSICAL & MENTAL RETARDATION
MIXED SGA ADVERSE FACTORS DURING BOTH EARLY & MID PREGNANCY
NEITHER OBVIOUS MALNOURISHED,NOR GROSSLY HYPOPLASTIC
DECREASE IN BOTH CELL SIZE AND COUNT
Causes of SGA
• Maternal• Fetal• Placental• Environmental
MATERNAL NUTRITION
PREVIOUS
HISTORY
GRAND MULTIP
ARAMATERN
AL DISEASES
SMOKING TOBACCOALCOHOL
POOR WEIGHT
GAIN
MATERNALFACTORS
FIRST BORN
GENETIC DEFECTS
MULTIPLE PREGNANC
Y
IU INFECTION
S
FETAL FACTORS
ABRUPTION
PLACENTA INFARCTS
STRUCTURAL
ABNORMALITY
VASCULAR THROMBO
SISPLACENTAL
Environmental factors
Ethnic/racial/geographicSocio-economic statusNutritional
COMMON PROBLEMS OF SGA BABIES
1. IUD2. BIRTH ASPHYXIA3. HYPOGLYCEMIA,HYPOCALCEMIA4. HYPOTHERMIA5. CONGENITAL MALFORMATOINS6. INFECTIONS7. POLYCYTHEMIA8. POOR GROWTH POTENTIAL
THOSE 3 LETTER WORDS!!
• RDS• ROP• IVH• PDA• NEC• BPD
MANAGEMENT OF SGA
• Emergency CS – fetal distress• Screening for cong.malformations• Early and adequate breast feeding (NGT/IVF)• Correct hypoglycemia,hypocalcemia,polycythemia• Control infections,temperature regulation
LARGE FOR GESTATIONAL AGE
• DEFINITION• CAUSES OF LGA• VARIOUS SYNDROMES a/w LGA• COMPLICATIONS DUE TO LGA BABIES• MANAGEMENT OF LGA
LGA babies have • Birth wt > 90th percentile for their
gestational age• birthweight >2 SD from the mean weight for
gestation
CAUSES OF LGA
1.GENETICS
TALL & HEAVY MOTHERS BIG BABY
2. Maternal Diabetes
COMMONEST CAUSE for LGA babies
• INFANT OF DIABETIC MOTHER
UTILISE LARGE AMOUNT OF TRANSPLACENTALLY TRANSMITTED GLUCOSE
ISLET CELL HYPERPLASIA & HYPERINSULINEMIA
INCREASE IN GROWTH FACTORS IGF-1 , IGF-2
INCREASED GROWTH & ADIPOSITY IN INSULIN DEPENDENT AREAS (FETAL TRUNK,SHOULDERS)
MACROSOMIA• ADIPOSITY• SKIN FOLD THICKNESS• VISCEROMEGALY (LIVER)
OTHER PROBLEMS IN GDM??
1) Hypoglycemia,Hypocalcemia 2) Increased incidence of birth defects-TGA 3) RDS 4) Hyperbilirubinemia 5) polycythemia 6)Birth trauma
• 3. Cretinism Mean birth wt is higher in babies withCongenital hypothyroidism
4.Hydrops fetalis large size is due to generalised anasarca rather
than due to somatic growth
• Birth weight may also be related to the amount of weight a mother gains during pregnancy.
• Excessive weight gain increased fetal weight.
Overgrown syndromes with advanced skeletal maturation…
a)Congenital adrenal hyperplasiab)Thyrotoxicosisc)Beckwith- Wiedemann syndromed)Marshall Smith Syndromee)Cerebral gigantism/ Sotos syndrome
Beckwith Wiedemann syndrome
• Visceromegaly• Exomphalos• Macroglossia• Characteristic groove in the
ear lobes
Marshall Smith Syndrome craniofacial characteristics:
large forehead,hypertelorism,micrognathia,long philtrum
Advanced maturation of carpal bones
Sotos syndrome(cerebral gigantism)
large babymacrognathia
large hands & feetmentally subnormal
& lag in maturation of carpal
bones
• Prolonged vaginal delivery time• Difficult birth• Birth injury• Increased risk of caesarean delivery
Why is LGA a concern…?
How is LGA diagnosed…?
> Ultrasound> A mother's weight gain
Prevention of LGA
Prenatal care.
Careful management of diabetes
Proper weight gain.
A G A
Appropriate for gestational age (AGA) describes a fetus or newborn infant whose size is within the normal range for his or her gestational age
• AGA: Appropriate for Gestational Age; birthweight b/w 10th & 90th percentile
An appropriate for gestational age full-term infant is heavier than 2500 grams and lighter than about 4000 grams
THANK YOU