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Delayed intrauterine development of the fetus 1 degree treatment. Fetal growth retardation: how to correct the condition? Treatment of intrauterine growth retardation

Approximately every tenth woman in the position of the doctor diagnoses intrauterine growth retardation (IUGR). The specialist determines the presence of deviations, characterized by a discrepancy between the size of the baby and the normative indicators for a particular week of development. How dangerous this pathology is in reality and how it threatens the child, it is important for every mother to know, because absolutely no one is immune from such a phenomenon.

What is a ZVUR?

Symmetrical form of pathology

With a symmetrical form, a uniform decrease in the mass, size of organs and growth of the fetus is observed. This pathology most often develops in the early stages of pregnancy due to fetal diseases (infection, chromosomal abnormalities). Symmetrical intrauterine growth retardation increases the likelihood of having a child with an imperfectly formed CNS.

Diagnostic measures

If this pathology is suspected, a woman is recommended to undergo a complete diagnostic examination. First of all, the doctor collects the patient's medical history, clarifies the previous gynecological diseases, the features of the course of the previous pregnancy. Then a physical examination is carried out with the obligatory measurement of the circumference of the abdomen, the fundus of the uterus, the height and weight of the woman.

Additionally, ultrasound, dopplerometry (assessment of blood flow in the arteries and veins) and cardiotocography (continuous recording of the fetal heart rate, its activity and directly uterine contractions) may be required. Based on the results of the tests, the specialist can confirm the diagnosis or refute it.

What treatment is required?

To determine the subsequent tactics after confirming the diagnosis of intrauterine growth retardation, the causes of the pathology, the form and degree of the disease should be taken into account. The main principles of therapy should be focused on improving blood flow in the uterus-placenta-fetus system. All therapeutic measures are carried out in stationary conditions. First of all, a woman needs to ensure peace, rational nutrition and a good long sleep. An important element of therapy is the control of the current state of the fetus. For these purposes, ultrasound is used every 7-14 days, cardiotocography and blood flow dopplerometry.

Drug treatment includes the use of angioprotectors to protect blood vessels, tocolytics against uterine muscle tension (Papaverine, No-shpa), general tonic. In addition, all women, without exception, are prescribed drugs that reduce neuropsychic excitation (tincture of motherwort, valerian) and improve blood flow in the placenta (Actovegin, Curantil).

Depending on the severity of the pathology, the results of treatment may vary. usually responds well to therapy, the likelihood of further negative consequences is minimized. With more serious pathologies, a different approach to treatment is needed, while its results are quite difficult to predict.

Abortion

Early delivery, regardless of the gestational age, is recommended in the following cases:

Lack of fetal growth for 14 days.
A noticeable deterioration in the condition of the baby inside the womb (for example, a slowdown in blood flow in the vessels).

Pregnancy is maintained up to a maximum of 37 weeks if, due to drug therapy, there is an improvement in performance, when it is not necessary to talk about the diagnosis of intrauterine growth retardation.

Consequences and possible complications

Babies with such a pathology after birth may have deviations of varying severity, their subsequent compatibility with ordinary life will largely depend on their parents.

The first consequences appear already during delivery (hypoxia, neurological disorders). The intrauterine growth retardation of the fetus inhibits the maturation of the central nervous system and its functions, which affects all systems. In such children, the body's defenses are usually weakened; at a more mature age, there is an increased likelihood of ailments of the cardiovascular system.

In children under five years old, slow weight gain, psychomotor retardation in development, improper formation of internal organ systems, and hyperexcitability are often diagnosed. Teenagers are at high risk of developing diabetes. Such children are usually overweight, they have problems with blood pressure. This does not mean that their daily existence will be reduced to taking medications and living in hospitals. They just need to pay a little more attention to their own nutrition and daily physical activity.

Some children who have been diagnosed with grade 2 intrauterine growth retardation and treated appropriately do not differ from their peers. They lead a normal life, go in for sports, communicate with friends and get an education.

How can IUGR be prevented?

The best prevention of this pathology is the planning of an upcoming pregnancy. In about six months, future parents must undergo a comprehensive examination and treat all existing chronic diseases. Giving up bad habits, rational nutrition and daily dosed physical activity is the best way to prevent IUGR.

Visiting the antenatal clinic on a regular basis after registration plays an important role in the diagnosis of intrauterine growth retardation. Treatment of a timely detected pathology minimizes the risk of negative consequences.

Pregnant women should have a well-organized work and sleep schedule. Proper and proper rest means 10 hours of sleep at night and 2 hours during the day. This mode allows you to improve blood circulation and transport of nutrients between mother and child.

Daily walks in the fresh air, dosed physical activity not only improve the general well-being of the pregnant woman, but also normalize the condition of the fetus inside the womb.

Conclusion

Do not ignore such a pathology as intrauterine growth retardation, the consequences of which can be the most sad. On the other hand, parents should not take this diagnosis as a sentence. If it is delivered in a timely manner, the future woman in labor will take all necessary measures to eliminate its cause and will follow all the doctor's recommendations, the prognosis may be favorable. There are no obstacles in the world that cannot be overcome. It is important to remember that the happiness of motherhood is incomparable!

Intrauterine growth retardation (IUGR)) is a lag in the size of the fetus from normal indicators at a given gestational age.

The main reasons for the development of IUGR

Fetal growth retardation can occur at any stage of pregnancy (more often in the third trimester) and is caused by the following reasons:

mother's bad habits(alcoholism, drug addiction);
Extragenital diseases of a woman(diseases of the urinary, respiratory and circulatory systems, arterial hypertension, infectious diseases);
Obstetric and gynecological diseases(menstrual disorders, primary infertility, complicated course of previous pregnancies, anomalies in the structure of the uterus);
Complications of real pregnancy(early and late gestosis, multiple pregnancy, anemia, etc.);
Fetal pathologies(intrauterine infection,).

IUGR classifications

information There are two forms of intrauterine growth retardation, which differ in clinical signs, causes of development and prognosis of further development and viability of the fetus: symmetrical and asymmetric form.

With a symmetrical shape characterized by a uniform decrease in the mass, growth of the fetus and the size of all its organs. This form often develops in the early stages and is caused by fetal diseases (chromosomal abnormalities, intrauterine infection), bad habits of the mother. Symmetrical lag can lead to the threat of the birth of a child with an inferior development of the central nervous system.

With an asymmetrical shape there is a decrease in body weight with normal growth of the fetus (low birth weight). The child has a lag in the development of the soft tissues of the abdomen and chest, insufficient development of the body with normal head sizes. Perhaps the appearance of uneven development of internal organs. If left untreated, a decrease in the size of the head and a lag in the development of the brain begin, which can lead to the death of the fetus. The asymmetric form often occurs in the third trimester against the background of placental insufficiency and is caused by extragenital diseases of the mother and complications of pregnancy.

There are three severity of IUGR:

First degree(easy). The size of the fetus is no more than two weeks behind the normal indicators characteristic of a given gestational age;
Second degree. Delay in fetal development within 2-4 weeks;
Third degree(heavy). The size of the fetus is four weeks or more behind normal. As a rule, IUGR of the third degree is irreversible and leads to fetal death.

The main symptoms and diagnosis of IUGR

The main diagnostic methods fetal developmental delays are:

Measurement of abdominal circumference and fundal height. When IUGR is characterized by a lag of these parameters from normal indicators;
ultrasound. helps to determine the form of IUGR and its severity, assess the condition of the placenta;
Doppler(an additional ultrasound method that allows you to explore the nature and speed of the uteroplacental and fetal-placental blood flow). When IUGR is often characterized by the appearance of circulatory disorders in the arteries of the umbilical cord, aorta, venous duct of the fetus;
cardiotography(). This is a method of functional diagnostics of the state of the fetus, which studies the frequency and nature of its heartbeat, changes in heart rate under the influence of external factors, motor activity of the fetus itself and uterine contractions. IUGR is characterized by an increase or decrease in the fetal heart rate.

Treatment of IUGR

Treatment of intrauterine growth retardation should be carried out only in a hospital:

A state of complete physical and emotional rest;
Full sleep;
Balanced diet;
Drugs that reduce

Throughout pregnancy, the expectant mother and the development of the fetus are carefully monitored by doctors. This observation includes not only a general examination at the reception, measuring the circumference of the abdomen and the height of the uterus, probing the parts of the fetus and analyzes. One of the important examinations that are carried out during gestation at least three times are the placenta, as well as the uterus. Sometimes, after such a study, the ultrasound doctor writes the abbreviation "IUGR" or "intrauterine developmental delay" in the conclusion. Such diagnoses greatly frighten expectant mothers, who suspect the worst thing - something is wrong with the baby. How justified are the fears of pregnant women, what threatens such a diagnosis, and where does developmental delay come from, what needs to be done to eliminate it?

The concept of IUGR: terms, definitions

In articles on obstetrics, various terms flicker, in fact, reflecting approximately the same conditions associated with deviations from the normal development of the fetus inside the woman's uterus. Doctors use the concepts of “fetal hypotrophy”, or “intrauterine growth retardation”, “small growth and weight by gestational age”, “fetal retardation”, and many other terms. According to the international classification (ICD-10), such concepts are included in the general heading of pathologies of pregnancy (P05), and they are united by a single term - "growth retardation and malnutrition of the fetus".

Such a frightening, incomprehensible term IUGR will mean problems and pathologies of the fetus associated with the negative influence of external and internal factors, which leads to a reduced supply of oxygen molecules and nutrients necessary for growth to the baby. A similar diagnosis is made when, according to ultrasound or at birth, the body weight of a child by the gestational age is reduced by 10% or more. Among other things, a similar diagnosis will be made to those children who are immature for their gestational age (in other words, they look at a shorter gestational age, with a deviation of at least two weeks or more).

How often is intrauterine growth retardation diagnosed?

According to obstetricians, starting from the regions and the type of maternity institution (ordinary maternity hospital or a specialized perinatal center), a similar condition is recorded in 5-18% of pregnant women, while up to 20% of stillbirths occur precisely in this pathology. Such children have an 8-fold increased risk of early mortality in the first days of life due to complications and developing pathologies compared to healthy children.

note

Approximately half of children born with IUGR have acute infections or chronic pathologies at least once after birth. It is important to note that the number of children born with such a diagnosis depends on how long and often the harmful factor affects the mother's body and indirectly the fetus.

Currently, the number of children with IUGR has increased due to the general deterioration in the health of mothers and the practice of maintaining pregnancy in those women who were previously simply forbidden to give birth.

As a result, if the health of the mother herself is unsatisfactory, this leads to a pathological course of pregnancy, in which the baby grows more slowly than usual due to the fact that he is supplied with less oxygen and nutrition. About 10% of children diagnosed with IUGR are born to mothers who had no health complaints and any risk factors, young and quite strong, without the presence of chronic somatic diseases. In connection with this fact, observation by doctors from an early date is always necessary in order to detect deviations in the development of the crumbs in time and correct them.

How is IUGR formed?

Throughout pregnancy, the baby feeds on glucose, vitamins and other elements, "breathes" oxygen dissolved in the blood due to the uninterrupted supply of these substances from the mother's body by the placenta. The placenta is a unique organ that occurs only during pregnancy in order to communicate between mother and baby in both directions. It filters dangerous compounds that can enter the fetus, removes metabolic products, delivers oxygen from the mother's red blood cells and all the substances necessary for growth, while not mixing the fetal and maternal blood with each other.

If for some reason the placenta cannot fully cope with its functions, a special pathology is formed - FPN (). It gradually forms a state when the fetus receives less and less oxygen, and also “starves” due to the lack of amino acids, carbohydrate and fat molecules. This leads to a slowdown in his growth rates and weight gain.

If the fetus is behind the standards regulated by the results of ultrasound, experts expose its malnutrition, the presence of IUGR. Such a term does not mean that this is a disease, rather it is a complication of pregnancy that occurs under the influence of various negative factors that affect the structure and functions of the placenta.

Danger of IUGR for fetal development

But, it is worth noting right away the fact that, as a complication of pregnancy, the presence of IUGR in crumbs threatens him with the development of serious diseases, which will be dangerous after birth. Especially serious can be the consequences for various departments in the nervous system, as the most sensitive to. The easiest thing that can be expected from a child with IUGR is a violation of the processes of adaptation to new living conditions, which threatens with a decrease in immunity and frequent illnesses of the child after childbirth.

Also, IUGR is one of the components in the complex of genetic and chromosomal abnormalities or fetal malformations. It is quite natural that a fetus with defects will grow and develop worse. Therefore, if IUGR is detected, a mandatory detailed screening (both ultrasound and) is shown to detect chromosomal and gene abnormalities and the presence of defects in the brain and spinal cord, and internal organs.

Causes of intrauterine growth retardation

If we talk about all the negative factors that can lead to IUGR, there are a lot of them, ranging from bad habits and lifestyle of the future mother, ending with serious health problems, both reproductive and somatic.

note

It is worth mentioning right away that the small size of the fetus on ultrasound is not always the reason for the diagnosis of IUGR. A slender young mother of short stature with the same spouse, by definition, will not have a 4-kilogram child.

If we talk about harmful factors, they are divided into three groups:

maternal factors,
Problems related to the uterus and placenta, reproductive system and hormones,
fruit factors.

If we talk about the condition of the mother, many factors can become influencing factors:

Early age for pregnancy, from 13-14 years to 17,
The age of a woman after 35 years, when a load of mutations and somatic pathologies accumulates,
Low socio-economic status, poor nutrition, inability to provide medicines,
Features due to race and ethnicity, consanguineous marriage,
Constitutional features - mass, height, heredity.

Also, acute and prolonged illnesses of the mother during pregnancy, exacerbation of chronic pathology, work in hazardous and hazardous industries, overwork, various nutrition systems (veganism, diets, fasting), bad habits, as well as taking certain medications during gestation can also lead to the formation of developmental delays. .

The fetal risk factors for IUGR include:

Hereditary diseases, genetic abnormalities, chromosomal pathologies,
Defects of the heart, digestion, kidneys,
Problems in the development of the neural tube (anencephaly, spina bifida and others),
Intrauterine infection of the crumbs,
Multiple pregnancy with the syndrome of stealing one fetus from another.

Problems of the placenta in the genesis of IUGR, the course of pregnancy

A frequent reason for the development of IUGR is problems in the structure and functioning of the uterus and placenta. So, this includes uterine malformations (bicornuate, saddle-shaped, with partitions), and other tumors, defects in the structure of the placenta and umbilical cord, its presentation (full or partial), heart attacks in the thickness of the placenta, calcifications or with the formation of hematomas and bleeding. Threats of abortion, development and Rh conflict, incompatibility by blood type or other factors also have an impact.

Whatever the initial causes of IUGR, they all eventually lead to a violation of the delivery of oxygen and nutrition through the placenta, from which the baby suffers.

Classification, degree of intrauterine growth retardation

By origin, primary developmental delay and secondary are distinguished. Primary is present initially, from an early date, and is associated with severe influencing factors - poor nutrition, malformations, bad habits and the influence of drugs, it is diagnosed from the very first ultrasound. It is formed as an initial deficiency of nutrition and oxygen, usually has a severe degree.

Secondary type ZVUR they are detected not earlier than 2-3 trimesters, and often it occurs when the mother is ill, the presence of preeclampsia, severe anemia, or problems with the location of the placenta.

Three degrees can be identified according to the severity of the delay.. First degree IUGR characterized by a baby lagging behind in terms of 2-3 weeks from the expected, with second degree the lag reaches a period of 4 weeks, and when heavy third the fetus lags behind the terms of development by 5 or more weeks.

Types of IUGR according to the features of fetal development

According to ultrasound studies, it is customary for doctors to separate two types of IUGR: symmetrical and asymmetric, for which there are different features of the course of the pathology.

Symmetric delay type typical with a proportional decrease in height and weight, and this is usually associated with heredity and chromosomal abnormalities, the presence of intrauterine infection and fetal malformations, especially in the brain area. Mothers with bad habits, starving and not looking after their health can have similar problems. These phenomena can be detected after the second trimester, and in the presence of such a picture, additional screenings are necessary to exclude gene and chromosomal pathologies.

Asymmetric Delay manifests itself in the uneven development of the fetus, its head usually corresponds to the terms in size, and the body in development lags behind the terms. This is detected after 30 weeks of pregnancy, often associated with pathologies of the mother and complications of gestation (hypertension, multiple pregnancy). For such an IUGR, even if the baby’s body is 3-4 weeks behind in development, with timely treatment, the problem is quickly eliminated, the fetus grows and gains weight.

At mixed form, combining both previous forms, the prognosis is the most unfavorable.

Diagnosis of IUGR: tests and ultrasound

Suspicions of the presence of IUGR may arise from an obstetrician-gynecologist who manages a woman's pregnancy based on the results of examinations and the dynamics of changes in the size of the uterus and abdominal circumference by weeks. Starting from 15 weeks, when the uterus is palpable above the pubis, the height of its fundus is measured in centimeters. If the growths are less than the due date, the doctor will prescribe tests and ultrasound to confirm fetal malnutrition and the presence of IUGR.

Only ultrasound can show accurate data, since the size of the abdomen and the height of the fundus of the uterus depend on the physique, pelvic capacity and many other conditions. When a small size of the fetus is detected in time, the family is analyzed and heredity is assessed, defects and health problems are excluded. If IUGR is suspected, additional fetal and placental Doppler ultrasound is indicated to assess circulation.

Instrumental methods for assessing IUGR

An ultrasound scan can easily and painlessly diagnose and assess the severity of developmental delay, a form of pathology. According to ultrasound, based on the actual gestational age and the size of the fetus, compliance or developmental delay is determined, as well as the form of pathology. If necessary, dopplerometry will show problems with blood flow in the umbilical cord and placenta, which will make it possible to find out both the causes and the severity of IUGR.

Along with these methods, such modern studies are carried out as determining the level of placental hormones in the mother's blood: this is placental lactogen, the level of alkaline phosphatase, and some others. By the amount of these hormones, you can assess the degree of damage to the placenta. To assess the well-being of the fetus, CTG (cardiotocography) is performed with an assessment of the fetal heart rate, its reactions to uterine tone and movement, this shows whether the fetus has enough nutrition and oxygen for normal development.

Actions of doctors in the presence of IUGR

If, according to the data of all studies, a developmental delay is revealed, both general regimen measures and good nutrition, as well as medical support, are necessary. This leads to the enrichment of the placenta and uterus with oxygen, which helps the fetus to receive enough nutrients for development and growth, weight gain.

With a mild degree of fetoplacental insufficiency, a woman is treated at home, under the supervision of a antenatal clinic doctor, severe degrees of IUGR require inpatient treatment.

To date, there is a group of drugs that increase blood flow in the vessels of the fetoplacental complex, increase the resistance of the fetus to hypoxia and eliminate IUGR. The most basic treatment is to eliminate the cause that leads to developmental delay and fetal distress. The earlier the problem is identified and treatment is started, the better the prognosis for the baby will be.

They use drugs that reduce the tone of the uterus and eliminate vasospasm, reduce blood viscosity and saturate the blood with oxygen, as well as vitamins, iron and minerals necessary for the full functioning of the mother's body. The choice of drugs always remains with the doctor, based on the clinical situation, the tolerability of a particular treatment and the severity of FPI.

Monitoring the effectiveness of treatment is carried out every 2 weeks according to ultrasound and fetal cardiotocography, with the elimination of the causes that led to IUGR, usually growth and weight gain of the fetus quickly return to normal.

Alena Paretskaya, pediatrician

In every tenth case of pregnancy, a diagnosis is made - intrauterine growth retardation (the pathology is also known under the abbreviation IUGR). The doctor determines the deviations, which are characterized by a discrepancy between the size of the child and the normal indicators for a particular week of pregnancy. How dangerous this pathology is and what exactly is to be afraid of, it is useful for every future mother to know, because no one is immune from such a phenomenon.

Causes of the disease

Intrauterine growth retardation of the fetus is diagnosed at various stages of pregnancy. This happens if the baby does not receive enough nutrients and oxygen, which are actively involved in the formation of a small organism. The reasons for this can be very different:

placental pathology: incorrect presentation or detachment;
chronic diseases of the mother: high blood pressure, problems with the cardiovascular system, anemia, improper functioning of the respiratory tract;
deviations in the chromosome set: Down syndrome;
pathologies of intrauterine development: malformation of the abdominal wall or kidneys;
mother's bad habits;
infectious diseases suffered by a woman during pregnancy: rubella, toxoplasmosis, syphilis, cytomegalovirus;
inadequate or malnutrition;
constant stress;
gynecological diseases;
self-administration of medications during pregnancy without a doctor's prescription;
multiple pregnancy;
climatic conditions: living in an area that is located high above sea level.

Smoking and alcoholism during childbearing can lead to such a phenomenon as asymmetric fetal growth retardation, when, according to ultrasound, the child's skeleton and brain correspond to the term, but the internal organs remain undeveloped. It is especially important to supply the fetus with everything necessary in the last weeks of pregnancy so that it successfully adapts to the new environment.

Symptoms of IUGR

The first signs of the IUGR syndrome are detected already in the early stages of pregnancy (at 24–26 weeks), but the woman is not able to determine them on her own. This can only be done by a doctor. Symptoms are considered non-compliance with the norm of the following indicators:

abdominal circumference at a certain level, the height of the fundus of the uterus (palpable by hand by a gynecologist);
the size of the head, femur, belly of the baby;
growth with constant monitoring;
the amount of amniotic fluid;
violations of the functioning of the placenta (the size or structure may change);
blood flow velocity in the placenta and umbilical cord;
baby's heart rate.

Even doctors are often mistaken in the diagnosis, because sometimes the discrepancy between these parameters is nothing more than a genetic or hereditary predisposition. To avoid misdiagnosis, a survey of parents is conducted, with what weight they were born. Whereas a delay in fetal development for 2 weeks or more already gives serious reasons to believe that the diagnosis is accurate.

Treatment Methods

Treatment largely depends on the degree of observed abnormalities:

intrauterine growth retardation of the 1st degree - a lag of 2 weeks (therapy can be quite successful and negate the negative consequences for the further development of the baby);
2 degrees - a delay of 3-4 weeks (strong treatment will be required, and the results can be completely unpredictable);
3 degrees - a lag of more than a month (even the most intensive therapy will not be able to equalize such a large lag, and the child may be born with serious deviations from the norm).

Treatment includes:

therapy for maternal diseases;
treatment of pregnancy complications;
increasing the resistance of a small organism to hypoxia;
normalization of placental insufficiency (as a rule, drugs are prescribed to dilate blood vessels to improve the blood supply to the fetus and uterus, as well as means to relax the muscles of the uterus).

The treatment is carried out on a stationary basis so that the mother and child are constantly under medical supervision. The timing and methods of delivery depend on the well-being of the mother and the condition of the fetus.

Consequences of intrauterine growth retardation

The consequences that the syndrome of fetal growth retardation entails can be very different. Children with this diagnosis after birth can have serious health problems.

In infancy:

obstetric complications during childbirth: hypoxia, asphyxia, neurological disorders;
poor adaptation to new living conditions;
hyperexcitability;
increased or decreased muscle tone;
poor appetite;
small weight gain;
psychomotor retardation in development;
inability to maintain body temperature constant within the normal range;
insufficient degree of development of internal organs;
high susceptibility to infectious diseases.

At older age:

diabetes;
tendency to corpulence;
high blood pressure.

In adulthood:

cardiovascular diseases;
obesity;
non-insulin dependent diabetes mellitus;
elevated blood lipid levels.

However, many babies diagnosed with intrauterine growth retardation over time may not differ at all from their peers, catching up with them in terms of both height and weight, without any consequences for their health at any age.

Approximately every tenth woman in position, the doctor diagnoses "fetal growth retardation" (IUGR). The specialist determines the presence of deviations, characterized by a discrepancy between the size of the baby and the normative indicators for a particular week of development. How dangerous this pathology is in reality and how it threatens the child, it is important for every mother to know, because absolutely no one is immune from such a phenomenon.

What is a ZVUR?

Retardation of intrauterine development of the fetus is usually diagnosed on the basis of an ultrasound examination. Pathology is determined if the weight of the baby is less than the normative indicators characteristic of this period of development. In medical practice, specially designed tables are used that indicate the weight of the fetus in accordance with its gestational age, that is, the time since fertilization. This indicator is usually determined in weeks. In other words, there are certain norms for each stage of pregnancy. The basic unit of measure in such tables is the percentile. If the fetus is less than 10 percentiles on this table, the doctor confirms the presence of pathology.

Fetal growth retardation: causes

Sometimes, when diagnosed with IUGR, parents do not need to worry. It happens that a baby is born small in size, since his father and mother are not very tall. This physiological feature does not affect the activity of the child, his mental and physical development. During pregnancy and after birth, such a baby does not need narrowly targeted therapy.

In all other situations, special attention should be paid to the diagnosis. This condition can lead to deviations in the development of the child or even death of the fetus. IUGR may indicate that the baby in the womb is not eating well. This means that it does not receive sufficient nutrients and oxygen. Nutritional deficiencies are usually attributed to the following reasons:

Wrong chromosome set.
Bad habits of the mother (smoking, drinking alcohol and drugs).
Pathogenic diseases (hypertension, anemia, diseases of the cardiovascular system).
Incorrect location and subsequent formation of the placenta.

In addition, doctors call a number of other reasons that can also provoke intrauterine growth retardation syndrome:

Multiple pregnancy.
The use of drugs without a doctor's prescription.
Childbirth after 42 weeks.
Irrational nutrition. Many women do not want to get better during pregnancy, so they exhaust themselves with diets. By this they provoke the exhaustion of the body, which leads to the development of pathology.
Diseases of an infectious nature (toxoplasmosis, rubella, syphilis).

Clinical picture

What are the symptoms of intrauterine growth retardation? Signs of pathology appear most often in the early stages (approximately 24-26 weeks). A woman is not able to determine them on her own, this can only be done by a doctor. IUGR syndrome is diagnosed when the following indicators do not meet the standards:

The size of the head and femur of the baby.
Abdominal circumference at a certain level, the height of the fundus of the uterus.
Volume of amniotic fluid.
Violation of the functioning of the placenta (its structure and size change).
Fetal heart rate.
Blood flow velocity in the placenta and umbilical cord.

In some cases, the pathology develops quite quickly and progresses without any special disturbances, that is, it is asymptomatic.

Severity

I degree. The intrauterine growth retardation of the 1st degree is considered relatively mild, since the developmental lag from the anthropometric data corresponding to a certain gestational age is only two weeks. Timely prescribed therapy can be effective and minimize the likelihood of negative consequences for the baby.
II degree. The delay in development is approximately 3-4 weeks, serious treatment is required.
III degree. It is considered the most severe form due to the delay in fetal parameters by one month or more. This condition is usually accompanied by so-called organic changes. Delayed intrauterine development of the fetus of the 3rd degree often ends in death.

Asymmetric form of pathology

In this case, there is a significant decrease in the weight of the fetus with its normal growth. The child is diagnosed with a lag in the formation of soft tissues of the chest and abdomen, and an abnormal development of the trunk. Uneven growth of internal organ systems is possible. In the absence of adequate therapy, a gradual decrease in the size of the head and a lag in the development of the brain begin, which almost always leads to the death of the fetus. The asymmetric variant of the IUGR syndrome occurs mainly in the third trimester against the background of general placental insufficiency.

Symmetrical form of pathology

Diagnostic measures

What treatment is required?

To determine the subsequent management of pregnancy after confirming the diagnosis of intrauterine growth retardation, the causes of the pathology, the form and degree of the disease should be taken into account. The main principles of therapy should be focused on improving blood flow in the uterus-placenta-fetus system. All therapeutic measures are carried out in stationary conditions. First of all, a woman needs to ensure peace, rational nutrition and a good long sleep. An important element of therapy is the control of the current state of the fetus. For these purposes, ultrasound is used every 7-14 days, cardiotocography and blood flow dopplerometry.

Depending on the severity of the pathology, the results of treatment may vary. Delayed intrauterine development of the fetus of the 1st degree usually responds well to therapy, the likelihood of further negative consequences is minimized. With more serious pathologies, a different approach to treatment is needed, while its results are quite difficult to predict.

Abortion

Early delivery, regardless of the gestational age, is recommended in the following cases:

Lack of fetal growth for 14 days.
A noticeable deterioration in the condition of the baby inside the womb (for example, a slowdown in blood flow in the vessels).

Consequences and possible complications

Babies with such a pathology after birth may have deviations of varying severity, their subsequent compatibility with ordinary life will largely depend on their parents.

How can IUGR be prevented?

The best prevention of this pathology is the planning of an upcoming pregnancy. In about six months, future parents must undergo a comprehensive examination and treat all existing chronic diseases. Refusal of addictions, proper lifestyle, rational nutrition and daily dosed physical activity is the best option for preventing IUGR.

Daily walks in the fresh air, dosed physical activity not only improve the general well-being of the pregnant woman, but also normalize the condition of the fetus inside the womb.

Conclusion

Throughout pregnancy, the expectant mother and the development of the fetus are carefully monitored by doctors. This observation includes not only a general examination at the reception, measuring the circumference of the abdomen and the height of the uterus, probing the parts of the fetus and analyzes. One of the important examinations, which are carried out at least three times during gestation, is an ultrasound scan of the fetus and placenta, as well as the uterus. Sometimes, after such a study, the ultrasound doctor writes the abbreviation "IUGR" or "intrauterine developmental delay" in the conclusion. Such diagnoses greatly frighten expectant mothers, who suspect the worst thing - something is wrong with the baby. How justified are the fears of pregnant women, what threatens such a diagnosis, and where does developmental delay come from, what needs to be done to eliminate it?

Table of contents: The concept of IUGR: terms, definitions How often is intrauterine growth retardation diagnosed? How is IUGR formed? Danger of IUGR for fetal development Causes of intrauterine growth retardation Problems of the placenta in the genesis of IUGR, the course of pregnancy Classification, degrees of intrauterine growth retardation Types of IUGR according to the features of fetal development Diagnosis of IUGR: tests and ultrasound Instrumental methods for assessing IUGR Doctors' actions in the presence of IUGR

The concept of IUGR: terms, definitions

How often is intrauterine growth retardation diagnosed?

note

How is IUGR formed?

If for some reason the placenta cannot fully cope with its functions, a special pathology is formed - FPI (fetoplacental insufficiency). It gradually forms a state when the fetus receives less and less oxygen, and also “starves” due to the lack of amino acids, carbohydrate and fat molecules. This leads to a slowdown in his growth rates and weight gain.

Danger of IUGR for fetal development

But, it is worth noting right away the fact that, as a complication of pregnancy, the presence of IUGR in crumbs threatens him with the development of serious diseases, which will be dangerous after birth. The consequences for various departments in the nervous system, as the most sensitive to hypoxia, can be especially serious. The easiest thing that can be expected from a child with IUGR is a violation of the processes of adaptation to new living conditions, which threatens with a decrease in immunity and frequent illnesses of the child after childbirth.

Also, IUGR is one of the components in the complex of genetic and chromosomal abnormalities or fetal malformations. It is quite natural that a fetus with defects will grow and develop worse. Therefore, if IUGR is detected, a mandatory detailed screening (both ultrasound and laboratory) is shown to detect chromosomal and gene anomalies and the presence of defects in the brain and spinal cord, and internal organs.

Causes of intrauterine growth retardation

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If we talk about harmful factors, they are divided into three groups:

maternal factors,
Problems related to the uterus and placenta, reproductive system and hormones,
fruit factors.

If we talk about the condition of the mother, many factors can become influencing factors:

Early age for pregnancy, from 13-14 years to 17,
The age of a woman after 35 years, when a load of mutations and somatic pathologies accumulates,
Low socio-economic status, poor nutrition, inability to provide medicines,
Features due to race and ethnicity, consanguineous marriage,
Constitutional features - mass, height, heredity.

The fetal risk factors for IUGR include:

Hereditary diseases, genetic abnormalities, chromosomal pathologies,
Defects of the heart, digestion, kidneys,
Problems in the development of the neural tube (anencephaly, spina bifida and others),
Intrauterine infection of the crumbs,
Multiple pregnancy with the syndrome of stealing one fetus from another.

Problems of the placenta in the genesis of IUGR, the course of pregnancy

A frequent reason for the development of IUGR is problems in the structure and functioning of the uterus and placenta. So, this includes uterine malformations (bicornuate, saddle-shaped, with partitions), fibroids and other tumors, defects in the structure of the placenta and umbilical cord, its presentation (full or partial), heart attacks in the thickness of the placenta, calcifications or detachments with the formation of hematomas and bleeding. Threats of abortion, the development of anemia and Rhesus conflict, incompatibility by blood group or other factors also have an impact.

Whatever the initial causes of IUGR, they all eventually lead to a violation of the delivery of oxygen and nutrition through the placenta, from which the baby suffers.

Classification, degree of intrauterine growth retardation

Types of IUGR according to the features of fetal development

According to ultrasound studies, it is customary for doctors to separate two types of IUGR: symmetrical and asymmetric, for which there are different features of the course of the pathology.

Asymmetric Delay manifests itself in the uneven development of the fetus, its head usually corresponds to the terms in size, and the body in development lags behind the terms. This is detected after 30 weeks of pregnancy, often associated with pathologies of the mother and complications of gestation (preeclampsia, hypertension, diabetes, multiple pregnancy). For such an IUGR, even if the baby’s body is 3-4 weeks behind in development, with timely treatment, the problem is quickly eliminated, the fetus grows and gains weight.

At mixed form, combining both previous forms, the prognosis is the most unfavorable.

Diagnosis of IUGR: tests and ultrasound

Suspicions of the presence of IUGR may arise from an obstetrician-gynecologist who conducts a woman's pregnancy based on the results of examinations and the dynamics of changes in the size of the uterus and abdominal circumference by weeks. Starting from 15 weeks, when the uterus is palpable above the pubis, the height of its fundus is measured in centimeters. If the growths are less than the due date, the doctor will prescribe tests and ultrasound to confirm fetal malnutrition and the presence of IUGR.

Instrumental methods for assessing IUGR

Actions of doctors in the presence of IUGR

With a mild degree of fetoplacental insufficiency, a woman is treated at home, under the supervision of a antenatal clinic doctor, severe degrees of IUGR require inpatient treatment.

Alena Paretskaya, pediatrician

Fetal growth retardation is intrauterine retardation of the physical development of the fetus.

These babies are often referred to as "underweight". In 30% of cases, they are born as a result of premature birth (up to 37 weeks of gestation) and only in 5% of cases at full-term pregnancy (at 38-41 weeks).

There are two main forms of intrauterine growth retardation (abbreviated as IUGR): symmetrical and asymmetric. How do they differ from each other?

If the fetus has a deficiency in body weight, it lags behind in terms of growth length and head circumference from the normal values for a given gestational age, then a symmetrical form of IUGR is diagnosed.

The asymmetric form of IUGR is observed in those cases when the fetus, despite the lack of body weight, does not lag behind the normal indicators of growth length and head circumference. The asymmetric form of IUGR is more common than the symmetrical form.

There are also three degrees of severity of IUGR:

I degree - lag of the fetus for 2 weeks;
II degree - a lag of 2-4 weeks;
III degree - a lag in the development of the fetus for more than 4 weeks.

What causes can lead to the development of IUGR?

If we talk about symmetrical IUGR, then, as a rule, it occurs due to fetal chromosomal abnormalities, genetic metabolic disorders, hypothyroidism and pituitary dwarfism. An important role is also played by viral infections (rubella, herpes, toxoplasmosis, cytomegalovirus).

The asymmetric form of IUGR is caused by pathologies of the placenta in the third trimester of pregnancy, or rather, fetoplacental insufficiency (abbreviated FPI). FPI is a pathology in which the placenta cannot fully supply the fetus with nutrients that circulate in the mother's blood. As a result, FPI can cause fetal hypoxia, that is, oxygen starvation.

FPI can occur due to: late preeclampsia, abnormalities in the development of the umbilical cord, multiple pregnancies, placenta previa, vascular lesions of the placenta.

To provoke IUGR of any form can be adverse external factors - taking medications, exposure to ionizing radiation, smoking, alcohol and drug consumption. Also, the risk of IUGR increases with a history of abortion.

In many cases, the true cause of IUGR remains undetermined.

Symptoms of growth retardation and fetal development

Unfortunately, the symptoms of IUGR are quite erased. A pregnant woman is unlikely to be able to suspect such a diagnosis on her own. Only regular observation by an obstetrician-gynecologist throughout the pregnancy helps to diagnose and treat IUGR in a timely manner.

It is widely believed that if a pregnant woman gains little weight during pregnancy, then most likely the fetus is small. This is partly true. However, this is not always true. Of course, if a woman restricts food intake to 1500 calories per day and is fond of diets, then this can lead to FGR. But FGR also occurs among pregnant women who, on the contrary, have too much weight gain. Therefore, this sign is not reliable.

With a pronounced IUGR, the expectant mother may be alerted by more rare and sluggish than usual fetal movements. This is the reason for an emergency visit to the gynecologist.

Examination for fetal growth retardation

When examining a pregnant woman with IUGR, the doctor may be alerted by the discrepancy between the height of the fundus of the uterus and the standards for this period of pregnancy, that is, the uterus will be slightly smaller in size than normal.

The most reliable method for diagnosing IUGR is an ultrasound examination of the fetus, during which the ultrasound doctor measures the circumference of the fetal head, the circumference of the abdomen, hips, and the estimated weight of the fetus. In addition, with the help of ultrasound, you can determine how the internal organs of the fetus function.

If IUGR is suspected, a Doppler study (a type of ultrasound) is mandatory to assess blood flow in the vessels of the fetus and placenta.

An important method of research is cardiotocography (CTG) of the fetus, which also makes it possible to suspect IUGR. With the help of CTG, the baby's heartbeat is recorded. Normal fetal heart rate ranges from 120 to 160 beats per minute. If the fetus experiences a lack of oxygen, then the heartbeat quickens or slows down.

Regardless of the gestational age and the severity of the disease, IUGR must be treated in any case to maintain the vital functions of the fetus. In some cases, if there is a slight lag of the fetus from the norm (approximately 1-2 weeks according to ultrasound), then this should be considered as a variant of the norm or as a “tendency to VRT”. In this case, dynamic monitoring is carried out.

Treatment for growth retardation and intrauterine development of the fetus

For the treatment of IUGR in obstetrics, a large arsenal of medications is used that improve uteroplacental blood flow.

These include:

Tocolytic drugs that help relax the uterus: beta-agonists (Ginipral, Salbutamol), antispasmodics (Papaverine, No-shpa);
- infusion therapy with the appointment of glucose, blood substitute solutions to reduce blood viscosity;
- drugs to improve microcirculation and metabolism in tissues (Actovegin, Curantil);
- vitamin therapy (magne B6, vitamins C and E).

The drugs are prescribed for a long period with careful monitoring of CTG for the condition of the fetus.

The nutrition of a pregnant woman with IUGR should be balanced. Food should contain proteins, fats and carbohydrates. No need to "lean" on certain products. You can and should eat everything. Especially do not neglect meat and dairy products, since they contain the largest amount of animal proteins, the need for which increases by 50% by the end of pregnancy.

However, do not forget that the main goal of the treatment of IUGR is not to "fatten" the child, but to ensure normal growth and development. Therefore, overeating is not necessary.

Pregnant women are recommended daily walks in the fresh air, emotional peace. It is traditionally believed that an afternoon nap (if there is a desire, of course) has a beneficial effect on the physical condition of the fetus and mother.

Of the non-drug methods of treatment of IUGR, hyperbaric oxygenation (inhalation of air enriched with oxygen) and medical ozone are used.

The issue of delivery in the presence of IUGR is relevant. In each case, it should be decided individually, based on the condition of the fetus according to ultrasound and CTG, as well as on the state of health of the mother. If there is no certainty that a weakened child will be able to be born on his own, then a caesarean section is preferred. In severe cases, surgery is performed on an emergency basis.

Complications of IUGR:

Intrauterine fetal death;
- hypoxia (oxygen starvation) of the fetus;
- Anomalies in the development of the fetus.

Prevention of IUGR:

A healthy lifestyle, giving up bad habits before a planned pregnancy;
- refusal of abortions;
- timely examination and treatment of infectious diseases by a gynecologist before the planned pregnancy.

Consultation of an obstetrician-gynecologist on the topic of fetal growth retardation:

1. According to ultrasound, the placenta is too small, but the height, weight of the fetus and head circumference are normal. The doctor said that I have FPI. Is it so?
No. Only on the basis of the size of the placenta, such a diagnosis is not made.

2. Is it possible to cure IUGR if there is a lot?
Unless FGR is associated with chronic malnutrition. In other cases, a balanced diet should be in combination with the main treatment.

3. Does the weight of the fetus depend on the weight of the mother?
In part, the weight of the fetus depends on many factors, including the weight of the mother.

4. If the parents are small in height and weight, then the child must be small?
Most likely, and this is the norm. The diagnosis of IUGR is not made in such cases.

5. I was diagnosed with fetal hypotrophy by ultrasound. What does it mean?
Fetal hypotrophy and IUGR mean the same thing - a lag in the development of the fetus.

6. Is it necessary to go to the hospital if I have IUGR?
This should be decided by your obstetrician-gynecologist, based on the data of ultrasound and CTG in dynamics. With IUGR, if there are no signs of fetal hypoxia, hospitalization is not necessary. With IUGR II or III degree hospitalization is required.

7. I am 35 weeks pregnant, but on examination, the height of the fundus of the uterus corresponds to 32 weeks. What's this? ZVRP?
There may be small errors in the doctor's measurement of the height of the uterine fundus. If no abnormalities were detected during ultrasound and CTG, then everything is in order.

8. At the last ultrasound, I was told that the fetus's abdominal circumference is 3 weeks behind the due date, but all other indicators are normal. Is this a ZVRP? Need to be treated?
Most likely, this is an individual feature of the fetus, if other parameters are within the normal range. If Doppler and CTG do not reveal any abnormalities, then there is no IUGR and there is no need for treatment.

9. What is the “count to 10” test that is recommended for IUGR?
The “count to 10” test is a test for assessing fetal movements. It is recommended for all pregnant women from 28-30 weeks, and with IUGR it is especially relevant. A woman needs to count fetal movements every day between 9:00 am and 21:00 pm every day. Normally, there should be 10 or more. If there are fewer of them, this indicates oxygen starvation of the baby.

10. According to the ultrasound data, the child is 2 weeks behind in terms of parameters. CTG and dopplerometry are normal. Whether it is necessary to be treated?
A slight delay in fetal parameters by 1-2 weeks is possible and normal. You need to look at dynamics.

Obstetrician-gynecologist, Ph.D. Christina Frambos.

Syndrome of developmental delay (growth) of the fetus (SZRP), otherwise referred to as fetal malnutrition, is a lag in the size of the baby from their average values, established as the norm for the specified gestational age.

Symptoms of FGR

For the first time, SRHR may be suspected obstetrician-gynecologist, according to mandatory periodic measurements of the height of the day of the uterus.

The WMD, measured in centimeters, should correspond to the gestational age, measured in weeks (i.e., at 17 weeks, WMD = 17 cm, at 30 weeks, WMD = 30 cm). The lag of VDM indicators from the norm by 2 cm or more is the basis for the use of additional diagnostic methods.

For more information about the parameters of measuring the abdomen and their norms, read

Forms and degrees of SZRP

There are 2 forms of SZRP:

- symmetrical shape, at which the growth retardation of all indicators (head circumference, tummy circumference, femur length) is proportional. This form is observed in 10-30% of expectant mothers with sdfd;

-asymmetrical shape. It is observed in 70-90% of cases of pregnancies with sdfd and is characterized by lagging behind the norm in the size of the abdominal circumference with the size of the head and femur within the normal range.

The degree of SZRP depends on the period for which the backlog is noted. There are three degrees of SZRP:

1 degree (I) - the baby lags behind in size for up to 2 weeks;

2 degree (II) - lag in size from 2 to 4 weeks;

Grade 3 (III) - the fetus lags behind in development for a period of more than 4 weeks.

Reasons for FGR

All factors that can affect the development of fetal malnutrition can be combined into the following groups:

1.Social factors:

the age of the expectant mother is younger than 17 or older than 35;
bad habits of the expectant mother (active and passive smoking, the use of alcohol-containing drinks and drugs);
taking certain medications;
constant physical stress;
the predominance of low mood background, stress;
occupational hazards

2. Burdened obstetric history:

anomalies in the development of the uterus;
the presence of cases of miscarriage or their complicated course in history;
gynecological diseases.

3. Somatic factors of the mother:

acute and chronic diseases of the liver, kidneys, blood vessels, heart, gastrointestinal tract, endocrine and autoimmune diseases;
infectious diseases during pregnancy (flu, toxoplasmosis, ureaplasmosis, etc.).

4. Complications of the current pregnancy:

fetoplacental insufficiency;
toxicosis and;
the threat of termination of pregnancy;
violations in the system uteroplacental blood flow;
abruption or placenta previa;

5. Factors related to the characteristics of the fetus:

anomalies in the development of the baby;
genetic (chromosomal) disorders;
congenital diseases (for example, hypofunction of the thyroid gland);
intrauterine infections;
multiple pregnancy.

One of the most innocuous reasons for which the SZRP is placed is the anthropometric characteristics of the baby, in other words, the features of the constitution, when the child itself is short and medium-sized.

Consequences of FGR

Fetal growth retardation syndrome is a condition that can have serious consequences. The greater the severity of FGR, the more dangerous the consequences can be. Dangers are associated both with complications in the birth period (asphyxia, hypoxia) and in the neonatal period (difficulties in adapting to extrauterine life).

Also, according to statistics, children born weighing less than 2500 grams are more likely to suffer from the following diseases:

diseases of the endocrine system (diabetes mellitus, hypofunction or hyperfunction of the thyroid gland, etc.);
lung diseases;
diseases cardiovascular systems;
decreased immunity, frequent respiratory diseases;
neurological diseases.

In addition, in children who are low birth weight, with an increased frequency is observed:

delayed speech development;
hyperactivity disorder and attention deficit disorder;
delayed psychomotor development.

FGR diagnostics

The diagnosis of SZRP is made by a doctor based on the results of complex studies, which include:

External obstetric examination (external measurement of parameters such as abdominal circumference and uterine fundus height);

Ultrasound procedure. A study called ultrasound fetometry will determine the shape and degree of FGR, as well as identify some possible causes.

A more accurate diagnosis is possible with dynamic fetometry, with a difference of 2 weeks;

Doppler (). Scanning blood flow and determining its violations;

Cardiotocography () - determination of the reaction of the child's heart contractions in response to stimuli.

It is worth noting that with true sdfd, the Doppler and CTG readings will have deviations from the norm (the severity depends on the severity of sdfd), and with the so-called constitutional malnutrition (due to the peculiarities of the baby’s constitution), there will be no deviations.

FGR treatment

Treatment of FGR is prescribed by a doctor, based on data on the severity of FGR and the causes that caused it. The most common treatments for FGR include:

Treatment of chronic diseases of a pregnant woman and treatment of infections, correction of hemostasiogram;

Treatment aimed at normalizing the system uteroplacental blood flow. To do this, the doctor prescribes drugs that improve uteroplacental blood flow (actovegin, chimes), as well as having a relaxing effect on the muscles of the uterus (ginipral, no-shpa).

Mandatory during treatment is to monitor the condition of the baby in order to assess the effectiveness of the therapy:

Ultrasound examination (fetometry). It is carried out every 7-14 days to measure and assess the growth rate of the baby;

Doppler study. Conducted every three to five days to monitor uteroplacental blood flow;

Cardiotocography. Conducted at intervals of a day or daily, to assess the condition cardiovascular baby systems.

To evaluate the effectiveness of therapy, data from all three diagnostic methods in combination are required.

Based on these results, the doctor decides whether to continue the pregnancy or the need for urgent delivery, as well as the method of delivery itself (naturally or surgically).

What should the expectant mother do to improve the effectiveness of treatment?

try not to worry, as emotional stress and stress only harm the baby;
eat well, rest, sleep;
be more outdoors;
follow the recommendations of doctors on taking medications and diagnostic procedures.

FGR prevention

Preventive measures at the stage of planning and preparing for pregnancy include:

treatment of chronic diseases, diagnosis of infectious diseases, sanitation of the oral cavity (unhealed caries is also a source of infection);
giving up bad habits.

When pregnancy has already begun, it is important to prevent the development of sdfd:

proper nutrition, intake vitamin and mineral complexes; - avoidance of heavy physical labor, change of work and rest regimes, good sleep;
lack of stress;
regular visit obstetrician-gynecologist, carrying out all mandatory screening studies within the recommended time frame.

SZRP is not a sentence. Timely initiation of adequate treatment can minimize or even eliminate possible consequences and increase the chances of giving birth to a healthy baby.

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