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Intrauterine fetal growth inhibition - definition
Each child in the womb has a genetically determined one growth potential (the possibility of achieving specific body dimensions and degree of maturity), which, depending on fetal, maternal, placental or environmental factors, can be fully or partially used. Thus, the concept of intrauterine growth retardation applies only to those babies who, slightly simplifying, had a chance to grow bigger than they were before they were born.
Intrauterine growth retardation and the concept of hypotrophy
Concepts of hypotrophy (SGA - newborn too small in relation to his gestational age, which for a full-term child is equal to body weight less than 2500 grams) is often confused with the term IUGR. It should be remembered, however, that intrauterine inhibition of fetal growth is always conditioned by the untapped potential of growth, and hypotrophy in most cases (30-70%) results from the lower potential used, but initially (the child, even under optimal developmental conditions, cannot grow larger).
Intrauterine fetal growth inhibition - symmetrical and asymmetrical
Intrauterine growth retardation is traditionally divided into two types:
- Symmetrical type (diagnosed in the first half of pregnancy) - affects 25% of children with IUGR and is associated with low birth weight and small head and tummy circumferences. In his case, postnatal growth pace is rarely observed, which results from permanent impairment of growth potential at early stages of fetal development (genetic defects, chromosomal abnormalities, or exposure to harmful chemicals and drugs).
- Asymmetrical type (recognized in the second half of pregnancy) - is associated with low birth weight and relatively normal tummy and head circumferences, which gives the baby a distinctive appearance (disproportionately large head and long and lean limbs). Unlike symmetrical IUGR, it is associated with the frequent phenomenon of postnatal catching-up growth, because most often in his case the growth potential is preserved (usually it is the result of gestational hypertension or maternal nicotinism).
Intrauterine growth retardation - causes
As we mentioned earlier, the baby's growth potential can be inhibited by fetal, maternal, placental and environmental factors:
- Fetal factors - genetic defects, chromosomal abnormalities, birth defects, metabolic blocks, or intrauterine infections (especially TORCH infections).
- Maternal factors - diabetes, hyperthyroidism, cardiovascular disease, kidney disease, very young mother age (under 16 years), or medications taken during pregnancy (e.g. beta-blockers, anticonvulsants, glucocorticosteroids).
- Bearing factors - mainly abnormalities of placental structure and function (e.g. placental abruption, hematoma, or single umbilical artery).
- Environmental factors - malnutrition of the mother, exposure to harmful chemicals and addictions (mainly alcohol and nicotine).
Of course, some of the reasons we mention are independent of the mother, but no doubt avoiding stimulants, a healthy lifestyle, and regular visits to the doctor significantly reduce the risk of having IUGR.
Pregnancy complicated by intrauterine fetal growth inhibition - management
Pregnancy complicated by intrauterine growth retardation is treated as high risk pregnancy and requires special supervision over the mother and the unborn child. In some cases hospitalization is required during the last weeks of pregnancy, earlier termination of pregnancy or delivery via Caesarean section.
Intrauterine growth retardation - prognosis
Statistic data shows that 80-85% percent of children with IUGR (especially asymmetrical) align their dimensions with their peers during the first two years of life. In other cases, high hopes are associated with growth hormone therapy (in our country there is a drug program in this area). Nevertheless, IUGR-burdened children require increased follow-up throughout the entire development period, especially during the perinatal period (perinatal mortality may reach 10%).
In summary, IUGR is a relatively common disorder and in most cases, fortunately, is characterized by a relatively good prognosis as to the health and life of the unborn toddler, followed by the newborn.