Gynecology

Intrauterine development of the fetus: causes, diagnosis, treatment, consequences

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  • Often asymptomatic.
  • The discrepancy between the weight gain of a pregnant woman and the one that is set for a given gestational age.
  • A slight increase in the abdominal circumference of a pregnant woman.
  • Increase or decrease in fetal motor activity.
  • Insufficient increase in fetal size according to fetal ultrasound (US).

The immediate cause of intrauterine growth retardation is placental insufficiency (malfunction of the uterus-placenta-fetus system), leading to insufficient blood flow to the fetus, and with it both oxygen and nutrients necessary for normal fetal development.

Risk factors for the development of fetal growth retardation are:

  • socio-biological features of the mother:
    • age less than 18 and over 30 years
    • malnutrition,
    • smoking,
    • alcohol and drug use
    • taking certain medications (anticonvulsants (for treating convulsions), ACE inhibitors (for lowering blood pressure), and others),
    • occupational hazards (contact with harmful chemicals, x-rays, vibration, extreme temperatures),
    • excessive physical and / or psycho-emotional stress.
  • Chronic diseases of the mother (diseases of the heart and blood vessels, kidney disease, diabetes mellitus (dysregulation of blood glucose), blood diseases and others).
  • Burdened obstetric and gynecological history:
    • menstrual dysfunction,
    • infertility,
    • miscarriage (spontaneous abortion (miscarriage), premature birth.
    • malformations of the uterus (two-horned, saddle-shaped uterus),
    • myoma of the uterus,
    • the presence of foci of chronic infection in the pelvic organs (inflammation of the appendages, chronic endometritis, pyelonephritis).
  • Complications of this pregnancy:
    • anomalies of the location and attachment of the placenta (children's place, the organ that carries out communication and interaction of the mother and fetus) - low attachment, placenta previa,
    • infectious diseases during pregnancy (influenza, ARVI, etc.),
    • multiple pregnancy (the presence of more than 1 fetus in the uterus),
    • preeclampsia (severe pregnancy with high blood pressure and kidney dysfunction),
    • maternal and fetal blood incompatibility according to:
      • Rh factor (protein on the surface of red blood cells (red blood cells),
      • blood group (according to the AB0 system).
  • Genetic (associated with the violation of the genetic set of cells) abnormalities of the fetus (Down syndrome, Patau syndrome). Lead to asymmetric delay of fetal growth.
  • Malformations of the fetus (malformations of the kidneys, central nervous system).

Obstetrician-gynecologist will help in the treatment of disease

Diagnostics

  • Analysis of the history of life: transferred infectious and chronic diseases of the mother, surgery, etc.
  • Analysis of obstetric and gynecological history - transferred gynecological diseases, surgical interventions, pregnancy, childbirth, especially their course, outcomes.
  • Physical examination of a pregnant woman - height, weight, analysis of weight gain.
  • External obstetric study:
    • abdominal circumference measurement
    • palpation (palpation) of the fetus through the anterior abdominal wall to determine its size,
    • measuring the height of the bottom of the uterus and determining its compliance with the norms for a given period.
  • Ultrasound examination (ultrasound) of the placenta (pediatric, organ that communicates and interacts with mother and fetus) - determining its maturity, size, position in the uterus.
  • Ultrasonic fetometry - determination of the size of the parts of the fetus, their ratio and compliance with the gestational period using ultrasound.
  • Cardiotocography (synchronous recording of fetal heart contractions, its physical activity and uterine contractions) - allows to determine the condition of the fetus, the presence of hypoxia (insufficient oxygen levels in the tissues of the fetus).
  • Assessment of the biophysical profile of the fetus - an analysis of motor activity and the tone of the fetus (muscle tension), the number of its respiratory movements, the volume of amniotic fluid and the degree of maturity of the placenta.
  • Dopplerometry is a study of blood flow in the arteries and veins of the uterus-placenta-fetus system.
  • Laboratory studies - determination of hormone levels and specific pregnancy proteins in the mother’s blood.

Complications and consequences

  • Fetal death of the fetus.
  • Damage to the fetus during labor.
  • Asphyxia of the fetus (choking) during labor.
  • Aspiration of meconium by the fetus (penetration of fetal calories into its lungs. Causes severe lung damage in the newborn).
  • Disruption of the development of the central nervous system of the fetus, leading to neurological disorders in the child in the future.
  • Transient hypothyroidism of the newborn (temporary insufficiency of thyroid hormones).
  • Activation of intrauterine infection in the newborn (occurs against the background of reduced immunity).

Prevention of intrauterine growth retardation

  • Pregnancy planning and timely preparation for it (elimination of unwanted pregnancy, timely detection and treatment of chronic and gynecological diseases of a woman before the onset of pregnancy).
  • Timely registration of pregnant women in the antenatal clinic (up to 12 weeks of pregnancy).
  • Regular visits to an obstetrician-gynecologist (1 time per month in 1 trimester, 1 time in 2-3 weeks in 2 trimester, 1 time in 7-10 days in 3 trimester).
  • Rational and balanced nutrition of a pregnant woman (eating foods high in fiber (vegetables, fruits, greens), avoiding fried, canned, too hot and spicy foods).
  • Full sleep.
  • Reception of vitamins and sedatives (if necessary).
  • Quitting smoking, drinking alcohol and drugs.
  • Elimination of excessive physical and psycho-emotional stress.
  • Regular gymnastics for pregnant women.

"Guidelines for outpatient care in obstetrics and gynecology", edited by V.I. Kulakov. - M .: "GEOTAR-Media", 2007
“Obstetrics: national leadership” ed. E.K. Aylamazyan. - M .: "GEOTAR-Media", 2013.

The main reasons for the development of IUGR

Delayed fetal development can occur at any time during pregnancy (usually in the third trimester) and is caused by the following reasons:

  1. Mother's bad habits (alcoholism, smoking, drug addiction),
  2. Extragenital diseases of a woman (diseases of the urinary, respiratory and circulatory systems, arterial hypertension, infectious diseases),
  3. Obstetric and gynecological diseases (menstrual disorders, primary infertility, a complicated course of previous pregnancies, anomalies of the structure of the uterus),
  4. Complications of this pregnancy (early and late gestosis, multiple pregnancy, anemia, low water, high hydration, premature detachment of the placenta, etc.),
  5. Fetal pathology (intrauterine infection, developmental abnormalities).

IUGR Classifications

informationThere are two forms of intrauterine growth retardation, which differ in clinical signs, developmental reasons, and prognosis of further development and viability of the fetus: a symmetrical and asymmetrical form.

With symmetric form characterized by a uniform decrease in 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), and harmful habits of the mother. Symmetrical lag can lead to the threat of having a baby with impaired development of the central nervous system.

With asymmetrical form there is a decrease in body weight with normal growth of the fetus (low-weight baby). The child has a lag in the development of 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 untreated, the head begins to shrink and the brain lags, which can lead to fetal death. 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 pregnancy complications.

There are threeIUGR severity:

  1. First degree (easy). The size of the fetus behind the normal indicators characteristic of this period of pregnancy, no more than two weeks,
  2. Second degree. Delayed fetal development within 2-4 weeks
  3. Third degree (heavy). Fetus sizes are four weeks or more behind normal levels. As a rule, the ZVUR of the third degree is irreversible and leads to the death of the fetus.

The main symptoms and diagnosis ZVUR

The main diagnostic methods Fetal developmental delays are:

  1. Measurement of abdominal circumference and the height of standing of the bottom of the uterus. When IUGR is characterized by the lag of these parameters from normal performance,
  2. Ultrasound. Ultrasound helps to determine the form of IUGR and its severity, assess the condition of the placenta,
  3. Dopplerometry (additional ultrasound method, which allows to investigate the nature and speed of 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,
  4. Cardiography (CTG). This is a method of functional diagnostics of the fetus, which studies the frequency and nature of its heartbeat, changes in heartbeats under the influence of external factors, the motor activity of the fetus itself and contractions of the uterus. When IUGR is characterized by an increase or decrease in the heartbeat of the fetus.

IUGR Treatment

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

  1. State of complete physical and emotional peace,
  2. Full sleep,
  3. Balanced diet,
  4. Drugs that reduce the tone of the uterus: antispasmodics (papaverine, no-shpa) and beta adrenomimetics (ginipral),
  5. Drugs that improve uteroplacental and fetal-placental blood flow (Actovegin, Curantil),
  6. Vitamin therapy,
  7. Infusion therapy to reduce blood viscosity,
  8. Hyperbaric oxygenation (inhalation of air enriched with oxygen)
  9. Daily cardiography,
  10. Dopplerometry every 3-4 days
  11. Fetal ultrasound (every 7-10 days).

Additionally If, against the background of the treatment, the fetal development indicators are improving, the pregnancy can be extended further. Delivery in this case is carried out not earlier than 37 weeks.

What is IUGR?

Intrauterine development of the fetus is usually diagnosed on the basis of ultrasound. 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 in which the mass of the fetus is indicated 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 standards for each term of pregnancy. The basic unit of measurement in such tables is the percentile. If the fetus is less than 10 percentile in this table, the doctor confirms the presence of pathology.

Fetal intrauterine growth retardation: causes

Sometimes when diagnosing IUGR, parents don't have to worry. It so happens that the baby is born small in size, as 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. Such a condition can lead to abnormalities in the development of the child or even death of the fetus. IUGR may indicate that the baby is poorly nourished in the womb. This means that it does not receive sufficient nutrients and oxygen. Lack of nutrition is usually due 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 trigger fetal intrauterine growth syndrome:

  • Multiple pregnancy.
  • The use of drugs without prior medical prescription.
  • Birth after 42 weeks.
  • Irrational food. Many women do not want to get better during pregnancy, so they exhaust themselves with diets. By this they provoke depletion of the body, which leads to the development of pathology.
  • Infectious diseases (toxoplasmosis, rubella, syphilis).

Clinical picture

What symptoms are associated with intrauterine growth retardation? Symptoms of pathology appear most often in the early stages (approximately 24-26 week). A woman is not able to define them on her own; only a doctor can do this. IUGR syndrome is diagnosed when the following indicators do not comply with the norms:

  • The size of the head and thigh of the baby.
  • Abdominal circumference at a certain level, the height of the bottom of the uterus.
  • Amniotic fluid volume.
  • Violation of the functioning of the placenta (changing its structure and size).
  • Fetal heart rate.
  • The rate of blood flow 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.

Degrees of severity

  • I degree. The intrauterine growth retardation of the first degree of the fetus is considered relatively easy, since the developmental delay from anthropometric data corresponding to a specific gestational age is only two weeks. Early treatment can be effective and minimize the likelihood of negative consequences for the baby.
  • II degree. The developmental delay is approximately 3-4 weeks, requires serious treatment.
  • III degree. It is considered the most severe form due to the lag of the parameters of the fetus for one month or more. This condition is usually accompanied by so-called organic changes. The delay of intrauterine development of the fetus of 3 degrees is often fatal.

Asymmetric form of pathology

In this case, there is a significant reduction in fetal weight with normal growth. A child is diagnosed with a lag in the formation of soft tissues of the chest and abdomen, and abnormal development of the body. Possible uneven growth systems of internal organs. 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 entails fetal death. The asymmetrical variant of IUGR syndrome occurs predominantly in the third trimester against the background of general placental insufficiency.

Symmetric form of pathology

In a symmetrical form, a uniform decrease in the mass, size of organs and growth of the fetus is observed. This pathology often develops during the initial stages of pregnancy due to fetal disease (infection, chromosomal abnormalities). Symmetric delay of intrauterine development of the fetus increases the likelihood of having a baby with a defectively formed central nervous system.

Diagnostic measures

If you suspect this pathology, a woman is recommended to undergo a full diagnostic examination. First of all, the doctor collects the patient's history, specifies the gynecological diseases transferred earlier, the features of the course of the previous pregnancy. Then a physical examination is carried out with the obligatory measurement of the abdominal circumference, the bottom of the uterus, the height and weight of the woman.

Additionally, you may need ultrasound, Doppler (assessment of blood flow in the arteries and veins) and cardiotocography (continuous recording of fetal heart rate, its activity and direct uterine contractions). Based on the results of the tests performed, the specialist can confirm the diagnosis or disprove it.

What treatment is required?

To determine the subsequent management tactics 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 basic principles of therapy should be focused on improving blood flow in the uterus-placenta-fetus system. All therapeutic interventions are carried out in stationary conditions. First of all, women need to ensure peace, balanced diet and good long sleep. An important element of therapy is to monitor the current state of the fetus. For these purposes, ultrasound is used every 7-14 days, cardiotocography and blood flow Doppler.

Drug treatment includes taking angioprotectors to protect the blood vessels, tocolytics against the muscular tension of the uterus (Papaverin, No-shpa), fortifying agents. In addition, all women, without exception, are prescribed drugs that reduce neuropsychic arousal (motherwort tincture, valerian) and improve blood flow in the placenta (Actovegin, Curantil).

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

Abortion

Early delivery, regardless of the duration of pregnancy, is recommended in the following cases:

  1. Absence of growth in fetus for 14 days.
  2. A marked deterioration in the condition of the baby inside the womb (for example, slowing blood flow in the vessels).

Pregnancy is preserved up to 37 weeks in the event that, thanks to drug therapy, there is an improvement in performance, when there is no need to talk about the diagnosis of intrauterine growth retardation.

Consequences and possible complications

After birth, babies with this pathology may have deviations of varying degrees of severity, their subsequent compatibility with ordinary life will largely depend on their parents.

The first effects appear already at delivery (hypoxia, violations of the neurological nature). The delay in fetal development inhibits maturation of the central nervous system and its functions, which affects all systems. These children usually have weakened body defenses; in later life there is an increased likelihood of cardiovascular diseases.

In children under five, slow weight gain, psychomotor retardation, abnormal formation of internal organ systems, and hyperexcitability are often diagnosed. In adolescence, high risk of diabetes. Such children are usually prone to corpulence, 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 simply need a little more attention to pay for their own food and daily physical exertion.

Some children who have been diagnosed with intrauterine growth retardation grade 2 and received appropriate treatment, do not differ from their peers. They lead a habitual way of life, play sports, communicate with friends and receive education.

How can I prevent ZVUR?

The best prevention of this pathology is planning for the upcoming pregnancy. For about six months, future parents must undergo a comprehensive examination and treat all existing chronic diseases. Refusal from harmful habits, a correct lifestyle, a balanced diet and daily dosed physical exertion are the best option to prevent IUGR.

A visit to the antenatal clinic on a regular basis, after registration, plays an important role in the diagnosis of intrauterine growth retardation. Treatment of timely detected pathology allows minimizing the risk of negative consequences.

Pregnant women should be well-built mode of operation and sleep. Proper and proper rest means 10 hours of sleep at night and 2 hours at daytime. This mode allows you to improve blood circulation and transport of nutrients between the mother and child.

Daily walks in the fresh air, measured physical activity not only improves the general state of health of the pregnant woman, but also normalizes the condition of the fetus inside the womb.

Conclusion

Do not leave aside such a pathology as intrauterine growth retardation, the consequences of which can be most dire. On the other hand, parents should not accept this diagnosis as a sentence. If he 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 recommendations of the doctor, 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 with anything!

Causes of delayed fetal development

A baby can be born small for several reasons. It is not excluded that this is his physiological feature. Perhaps mom or dad is small and the baby inherited it from their parents. But even in this case, the doctor will be diagnosed with intrauterine growth retardation.

This fact after birth is confirmed by the normal state of the child and the compliance of all the reflexes of the newborn with the period at which the baby was born. Then the doctors state that the diagnosis of intrauterine growth retardation was associated with inherited genetics and this condition does not require treatment.

But there are causes of intrauterine growth retardation, which can lead to fetal hypoxia, negative consequences of the development of a child after birth, and even fading of pregnancy. Delayed fetal development occurs when the baby not getting enough oxygen and nutrientswho play a major role in his life.

The reduction in the amount of substances entering the fetus and oxygen can be caused by the following factors:

    • violation of the development of the placenta or umbilical cord. The placenta may not be located there (the diagnosis of "wrong placenta previa"), be very small or flake off (the diagnosis of "placental abruption"),
    • maternal diseaseswhich may impede the flow of essential substances for the normal development of the fetus. Such diseases include chronic high blood pressure, diseases of the cardiovascular system, anemia, chronic respiratory diseases,
    • in the development of the fetus plays a huge role chromosome setwhich he receives from his parents at the time of conception. Sometimes it happens that there is a glitch or deviation in the chromosome set. For example, there is a disease - Down syndrome. Also, developmental pathologies such as a defect in the kidneys or the abdominal wall can affect the overall development of the baby in the womb,
    • doctors all over the world are talking about the negative impact bad habits on the human body. Particular attention is paid to the body of a woman who, at least once, but has to carry a child. A woman’s bad habits (even if she gets rid of them shortly before conception) can cause fetal intrauterine growth retardation,

    • transferring during pregnancy such infectious diseaseslike rubella, syphilis, toxoplasmosis, cytomegalovirus can stop or slow the development of the fetus. That is why it is so important to take root from infectious diseases even before conception (especially to women who work in hospitals, clinics and with children, because rubella is a childhood disease) and to be careful in choosing a sexual partner during pregnancy, if there is no permanent,
    • at every step of the pregnant woman they say that she must eat for two. And indeed it is. If the baby does not have enough nutrients, then it draws them from the mother's body, thereby worsening her overall well-being. But food for two does not mean that you need to eat everything. Meals should be healthy and balanced. During pregnancy you do not need to fear that you will get better, you can not sit on diets. Only if a large fetus is diagnosed to you and the doctor himself prescribes a proper and useful diet in this case. Malnutrition leads to a decrease in the weight of the child and developmental delays,
    • medications during pregnancy come to naught with any kind of disease. Their use is prescribed only in special cases when nothing else can be helped. Self-medication can lead not only to the development of pathologies in the fetus, but also to intrauterine growth retardation,
    • multiple pregnancy can cause a lag in the development of a single fetus or several at once. This happens due to the fact that nutrients are not enough for two or more fruits,
    • fetal intrauterine growth retardation syndrome is often put to women who live high above sea level. In such areas, there is increased pressure, and the fetus may suffer from hypoxia (lack of oxygen) for a long time, which also slows down the development in the womb.
    • Often children are born with a small weight, if childbirth occurs after 42 weeks of pregnancy.

    Consequences of intrauterine growth retardation

    For 9 months, the expectant mother can worry about the health of her future baby. Scheduled examinations in the antenatal clinic are conducted to ensure that the expectant mother and the doctor have the opportunity to really assess the situation and make a conclusion about the health of the child.

    The fear of deviations in the fetus most often causes these deviations. Stress is the first cause of impaired development. The baby feels everything. And there is such an expression "thoughts materialize." It is necessary to think only positively, and if someone told you that intrauterine growth retardation is a horror, then do not believe it.

    Every woman's pregnancy and childbirth take place individually. One with horror recalls 6 hours of the birth of the baby, and the other half an hour after the birth says to her husband that he wants another child. Similarly, with a diagnosis of "delayed fetal development."

    Yes, some difficulties and violations can occur during pregnancy and after birth. But the unsolvable problems with the level of today's medicine remained quite small.

    The degree of risk in such a diagnosis, first of all, depends on the cause of the phenomenon. So, if it is hereditary (parents of small stature), then the baby may be tiny, but with the normal development of all vital organs.

    There is also a difference in the risk of problems arising depending on the degree of developmental disorder, the period of pregnancy when the diagnosis is made and the period at which the baby is born.

    The highest indicator of the degree of risk is reached by children who are diagnosed with intrauterine growth retardation are born prematurely. Children born after such a diagnosis are more likely to develop diabetes, they are more than the other children, sensitive to infectious diseases, and it is difficult for them to maintain body temperature. That is why they are usually placed in special cells after birth. This is a necessary measure to preserve the vital activity of the organs of the baby, since the developmental delay speaks not only of low weight, but also of the insufficient degree of development of vital organs.

    Many babies who were diagnosed with developmental delay in the womb, after a while, are not at all different from their peers who were born with normal weight.

    Children with this diagnosis are prone to fullness and high blood pressure. But this does not mean that their existence will be reduced to life on drugs and in hospitals. It only says that it will be necessary to pay a little more attention to their nutrition and physical exertion. But what's wrong with a healthy lifestyle, proper nutrition and regular moderate physical exertion?

    Fetal intrauterine growth retardation: how to prevent?

    The best prevention of delayed fetal development is pregnancy planning. When planning a pregnancy, within six months, the couple should undergo a full examination of the body and treat all chronic diseases. Treatment of caries and urogenital area also should not fall out of attention. Rejecting bad habits for at least six months is the best option to prevent this diagnosis.

    Regular visits to female consultation after registering for pregnancy (and this must be done no later than 12 weeks), plays an important role in preventing negative consequences in the diagnosis of fetal growth retardation in the womb. The sooner the disease is detected and started to be treated, the more likely it is to avoid negative consequences in the development of the fetus during gestation and after birth.

    A pregnant woman should be properly built work and sleep mode. Full sleep during pregnancy (10 hours at night and 2 hours during the day) is a good prevention of intrauterine growth retardation. If you do not sleep during the day, rest in a horizontal position and with your eyes closed for 2 hours should be present in any case. Daytime rest helps to improve blood circulation between mother and child, gas exchange and transport of nutrients to the baby.

    Being in the open air moderate exercise in the form of gymnastics for pregnant women, full and proper nutrition with a full range of vitamins and minerals (frequent recommendation of a doctor when making such a diagnosis is eating foods high in carbohydrates) not only improve the mood of the pregnant, but also improve the health of the fetus in the womb. Read more about how to eat the expectant mother →

    The diagnosis of intrauterine growth retardation should not be a sentence for future parents. A major role is played by the cause of such a violation, but the seriousness of the reason is not a reason to refuse to give birth to a baby. There are no obstacles that can not be overcome. Believe, the happiness of motherhood is incomparable.

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