The fetus is categorized into the small, average, or large growth percentiles while assessing for ?

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Infants whose weight is < the 10th percentile for gestational age are classified as small for gestational age. Complications include perinatal asphyxia, meconium aspiration, polycythemia, and hypoglycemia.

Fenton growth chart for preterm boys

Fenton T, Kim J: A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatrics 13:59, 2013. doi: 10.1186/1471-2431-13-59; used with permission. Available at www.biomedcentral.com.

Fenton growth chart for preterm girls

Causes may be divided into those in which the growth restriction is

Symmetric: Height, weight, and head circumference are about equally affected.
Asymmetric: Weight is most affected, with a relative sparing of growth of the brain, cranium, and long bones.

Symmetric growth restriction usually results from a fetal problem that begins early in gestation, often during the first trimester. When the cause begins relatively early in gestation, the entire body is affected, resulting in fewer cells of all types. Common causes include

Genetic disorders
First-trimester congenital infections (eg, with cytomegalovirus Congenital and Perinatal Cytomegalovirus Infection (CMV) Cytomegalovirus infection may be acquired prenatally or perinatally and is the most common congenital viral infection. Signs at birth, if present, are intrauterine growth restriction, prematurity... read more
, rubella virus Congenital Rubella Congenital rubella is a viral infection acquired from the mother during pregnancy. Signs are multiple congenital anomalies that can result in fetal death. Diagnosis is by serology and viral... read more , or Toxoplasma gondii Congenital Toxoplasmosis Congenital toxoplasmosis is caused by transplacental acquisition of Toxoplasma gondii. Manifestations, if present, are prematurity, intrauterine growth restriction, jaundice, hepatosplenomegaly... read more
)

Asymmetric growth restriction usually results from placental or maternal problems that typically manifest in the late second or the third trimester. When the cause begins relatively late in gestation, organs and tissues are not equally affected, resulting in asymmetric growth restriction. Common causes include

Placental insufficiency resulting from maternal disease involving the small blood vessels (eg, preeclampsia Preeclampsia and Eclampsia Preeclampsia is new-onset or worsening of existing hypertension with proteinuria after 20 weeks gestation. Eclampsia is unexplained generalized seizures in patients with preeclampsia. Diagnosis... read more , hypertension Hypertension in Pregnancy Recommendations regarding classification, diagnosis, and management of hypertensive disorders (including preeclampsia) are available from the American College of Obstetricians and Gynecologists... read more , renal disease Renal Insufficiency in Pregnancy Pregnancy often does not worsen renal disorders; it seems to exacerbate noninfectious renal disorders only when uncontrolled hypertension coexists. However, significant renal insufficiency ... read more , antiphospholipid antibody syndrome Antiphospholipid Antibody Syndrome (APS) Antiphospholipid antibody syndrome is an autoimmune disorder in which patients have autoantibodies to phospholipid-bound proteins. Venous or arterial thrombi may occur. The pathophysiology is... read more , long-standing diabetes Diabetes Mellitus in Pregnancy Pregnancy aggravates preexisting type 1 (insulin-dependent) and type 2 (non–insulin-dependent) diabetes but does not appear to exacerbate diabetic retinopathy, nephropathy, or neuropathy ( 1)... read more )
Placental involution accompanying postmaturity
Maternal malnutrition

Many SGA infants are healthy but just constitutionally small, and not all infants whose growth was restricted in utero are SGA (ie, weight is < the 10th percentile for gestational age).

Symptoms and Signs of SGA Infant

Despite their size, SGA infants have physical characteristics (eg, skin appearance, ear cartilage, sole creases) and behavior (eg, alertness, spontaneous activity, zest for feeding) similar to those of normal-sized infants of like gestational age. However, they may appear thin with decreased muscle mass and subcutaneous fat tissue. Facial features may appear sunken, resembling those of an elderly person ("wizened facies"). The umbilical cord can appear thin and small.

Complications

Full-term SGA infants do not have the complications related to organ system immaturity that preterm infants of similar size have. They are, however, at risk of

Perinatal asphyxia
Meconium aspiration

Hypoglycemia often occurs in the early hours and days of life because of a lack of adequate glycogen synthesis and thus decreased glycogen stores and must be treated quickly with IV glucose.

Polycythemia may occur when SGA fetuses experience chronic mild hypoxia caused by placental insufficiency. Erythropoietin release is increased, leading to an increased rate of erythrocyte production. The neonate with polycythemia at birth appears ruddy and may be tachypneic or lethargic.

Hypothermia may occur because of impaired thermoregulation, which involves multiple factors including increased heat loss due to the decrease in subcutaneous fat, decreased heat production due to intrauterine stress and depletion of nutrient stores, and increased surface to volume ratio due to small size. SGA infants should be in a thermoneutral environment to minimize oxygen consumption.

If asphyxia can be avoided, neurologic prognosis for term SGA infants is quite good. However, later in life there is probably increased risk of ischemic heart disease, hypertension, and stroke, which are thought to be caused by abnormal vascular development.

Infants who are SGA because of genetic factors, congenital infection, or maternal drug use often have a worse prognosis, depending on the specific diagnosis. If intrauterine growth restriction is caused by chronic placental insufficiency, adequate nutrition may allow SGA infants to demonstrate remarkable “catch-up” growth after delivery.

Supportive care

Underlying conditions and complications are treated. There is no specific intervention for the SGA state, but prevention is aided by prenatal advice on the importance of avoiding alcohol, tobacco, and illicit drugs.

Infants whose weight is < the 10th percentile for gestational age are small for gestational age (SGA).
Disorders early in gestation cause symmetric growth restriction, in which height, weight, and head circumference are about equally affected.
Disorders late in gestation cause asymmetric growth restriction, in which weight is most affected, with relatively normal growth of the brain, cranium, and long bones.
Although small, SGA infants do not have the complications related to organ system immaturity that preterm infants of similar size have.
Complications are mainly those of the underlying cause but generally also include perinatal asphyxia, meconium aspiration, hypoglycemia, polycythemia, and hypothermia.

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What does fetal growth percentile mean?

The higher the percentile number, the bigger a child is compared with other kids of the same age and gender, whether it's for height or weight. The lower the percentile number, the smaller the child is.

What is used to measure or assess a fetal growth?

The fetal biometric parameters measured most commonly are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur diaphysis length (FL). These biometric measurements can be used to estimate fetal weight (EFW) using various different formulae1.

What is the most commonly used measure of fetal growth?

Ultrasound biometry of the fetus is now the gold standard for assessing fetal growth (Figure 2). The measurements most commonly used are the biparietal diameter, head circumference, abdominal circumference and femur length.

What is small and large for gestational age?

Babies may be called large for gestational age if they weigh more than 9 in 10 babies or 97 of 100 babies of the same gestational age. In the U.S., this means babies born at 40 weeks' gestation who weigh more than 8 pounds 13 ounces (4,000 grams) or 9 pounds, 11 ounces (4,400 grams) at birth.

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