Expectant management of intrauterine growth restriction pregnancy: perinatal outcome
Keywords:
Intrauterine growth restriction, Early neonatal period, Delivery managementAbstract
Background: Intrauterine growth restriction (IUGR) is the reason for increased morbidity and mortality in all periods of human life. The development of this pathology defines a variety of factors many of which are preventable. There is still no developed effective tactics for pregnancy and delivery, which would protect both mother and child from undesirable consequences.
Methods: The research was made in Riga Maternity hospital in Latvia. In the research were included 96 neonates with the weight below 10th percentile (IUGR group) as well there was compiled the control group. We evaluated the condition of neonate by 13 criteria and studied its frequency depending on the gestational period. The weight of neonates was estimated using the percentile scales - intrauterine growth curves based on U.S. data.
Results: In the subgroup of 37-39th week in the IUGR group in comparison with 40-42nd week subgroup, statistically more often was noticed hypoglycaemia, polycythaemia, acidosis, poor feeding, neurological abnormalities, transportation to an intensive care unit, transportation to another hospital for the further treatment and there was a higher number of days spent in the hospital. In the subgroup of 37-39th week in the control group were just 2 criteria that were statistically more frequent.
Conclusions: Recognizing the IUGR to the fetus, there is justified the temporizing tactics with regard to resolution of pregnancy if only the health status of mother allows that and preeclampsia is excluded.References
Gardosi J. Normal fetal growth. In: Edmonds DK, eds. Dewhurst’s Textbook of Obstetrics & Gynaecology. 7th ed. Oxford, UK: Blackwell Publishing; 2007: 28-33.
Fabre E, González de Agüero R, de Agustín JL, Ezquerra A. Intrauterine growth restriction: concept and epidemiology. In: Kurjak A, Chervenak FA, eds. Textbook of Perinatal Medicine. 2nd ed. London, UK: Informa; 2006: 1238-1246.
Stanisic Chou T, Toohey JS. Fetal growth disorders. In: Di Saia PJ, Chaudhuri G, Giudice LC, Moore TR, Porto M, Smith LH, eds. Women’s Health Review: A Clinical Update in Obstetrics-Gynecology. Philadelphia, PA: Elsevier Saunders; 2012: 97-100.
Albu AR, Anca AF, Horhoianu VV, Horhoianu IA. Predictive factors for intrauterine growth restriction. J Med Life. 2014;7(2):165-71.
Harkness UF, Mari G. Diagnosis and management of intrauterine growth restriction. Clin Perinatol. 2004;31:743-64.
Ernst SA, Reeske A, Spallek J, Petersen K, Brand T, Zeeb H. Care-related factors associated with antepartal diagnosis of intrauterine growth restriction: a case–control study. BMC Pregn Childbirth. 2014;14(1):371.
Smith GCS, Lees CC. Disorders of fetal growth and assessment of fetal well-being. In: Edmonds DK, eds. Dewhurst’s Textbook of Obstetrics & Gynaecology. 7th ed. Oxford, UK: Blackwell Publishing; 2007: 159-165.
Baraibar R, Sánchez L. Growth-restricted newborns: characteristics and management. In: Kurjak A, Chervenak FA, eds. Textbook of Perinatal Medicine. 2nd ed. London, UK: Informa; 2006: 1313-1325.
Gonzalez JM, Stamilio DM, Ural S, Macones GA, Odibo AO. Relationship between abnormal fetal testing and adverse perinatal outcomes in intrauterine growth restriction. Am J Obstet Gynecol. 2007;196(5):e48-51.
Carrera JM, Figueras F, Devesa R, Mallafré J. Management of small-for-gestational-age fetuses: antenatal and intrapartum strategies. In: Kurjak A, Chervenak FA, eds. Textbook of Perinatal Medicine. 2nd ed. London, UK: Informa; 2006: 1296-1312.
Lees C, Marlow N, Arabin B, Bilardo CM, Brezinka C, Derks JB, et al. Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound Obstet Gynecol. 2013;42:400-8.
Boers KE, Vijgen SMC, Bijlenga D, van der Post JAM, Bekedam DJ, Kwee A, et al. Induction versus expectant monitoring for intrauterine growth restriction at term: randomized equivalence trial (DIGITAT). BMJ. 2010;341:c7087.
