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Intrauterine growth retardation: causes, diagnosis, treatment, consequences. Intrauterine growth retardation: causes, treatment and prevention Intrauterine growth retardation of an asymmetrically shaped fetus

Intrauterine growth retardation: causes, diagnosis, treatment, consequences. Intrauterine growth retardation: causes, treatment and prevention Intrauterine growth retardation of an asymmetrically shaped fetus

25.11.2023

In every tenth case of pregnancy, a diagnosis is made of intrauterine growth retardation (pathology is also known by the abbreviation IUGR). The doctor determines deviations, which are characterized by a discrepancy between the baby’s size and normal values at a particular week of pregnancy. How dangerous this pathology is and what exactly should be feared is useful for every expectant mother to know, because no one is immune from this phenomenon.

Causes of the disease

Intrauterine growth retardation 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 the small organism. The reasons for this can be very different:

pathologies of the placenta: malpresentation or detachment;
chronic diseases of the mother: high blood pressure, problems with the cardiovascular system, anemia, improper functioning of the respiratory tract;
abnormalities in the chromosome set: Down syndrome;
pathologies of intrauterine development: defect of the abdominal wall or kidneys;
mother's bad habits;
infectious diseases suffered by a woman during pregnancy: rubella, toxoplasmosis, syphilis, cytomegalovirus;
insufficient or unhealthy nutrition;
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 while carrying a baby can lead to a phenomenon such as asymmetrical delay in fetal development, 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 provide the fetus with everything it needs in the last weeks of pregnancy so that it successfully adapts to the new environment.

Symptoms of IUGR

The first signs of 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. Only a doctor can do this. Symptoms are considered to be non-compliance with the following indicators:

abdominal circumference at a certain level, height of the uterine fundus (palpated manually by a gynecologist);
the size of the baby’s head, femur, and abdomen;
growth with constant monitoring;
amount of amniotic fluid;
dysfunction of the placenta (size or structure may change);
blood flow rates in the placenta and umbilical cord;
baby's heart rate.

Even doctors often make mistakes in diagnosis, because sometimes the discrepancy between these parameters is nothing more than a genetic or hereditary predisposition. To avoid misdiagnosis, parents are asked what weight they were born with. Whereas a delay in fetal development of 2 weeks or more already gives serious grounds 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 delay 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 (intensive treatment will be required, and the results may be completely unpredictable);
3 degrees - a delay of more than a month (even the most intensive therapy will not be able to compensate for such a large delay, and the child may be born with serious deviations from the norm).

Treatment includes:

therapy of 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 blood supply to the fetus and uterus, as well as drugs to relax the muscles of the uterus).

Treatment is carried out on an inpatient basis so that 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 fetal growth retardation syndrome entails can be very different. Children with this diagnosis may experience serious health problems after birth.

In infancy:

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

At an older age:

diabetes;
tendency to corpulence;
high blood pressure.

In adulthood:

cardiovascular diseases;
obesity;
non-insulin-dependent diabetes mellitus;
elevated levels of lipids in the blood.

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

Approximately every tenth pregnant woman is diagnosed by a doctor with “intrauterine growth restriction” (IUGR). The specialist determines the presence of deviations, characterized by a discrepancy between the baby’s size and standard indicators at a particular week of development. It is important for every mother to know how dangerous this pathology really is and how it threatens the child, because absolutely no one is immune from this phenomenon.

What is IUGR?

Intrauterine growth restriction is usually diagnosed based on ultrasound examination. Pathology is determined if the baby’s weight 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 defined in weeks. In other words, there are certain norms for each stage of pregnancy. The basic unit of measurement in such tables is the percentile. If the fetus is less than the 10th percentile on this table, the doctor confirms the presence of pathology.

Intrauterine growth restriction: 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 child’s activity, mental and physical development. During pregnancy and after birth, such a baby does not need highly 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 the 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 deficiency is usually due to the following reasons:

Incorrect 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 name a number of other reasons that can also provoke intrauterine growth retardation syndrome:

Multiple pregnancy.
Use of medications without prior doctor's prescription.
Childbirth after 42 weeks.
Poor nutrition. Many women do not want to gain weight during pregnancy, so they exhaust themselves with diets. By doing this, they provoke exhaustion of the body, which leads to the development of pathology.
Diseases of an infectious nature (toxoplasmosis, rubella, syphilis).

Clinical picture

What symptoms accompany intrauterine growth retardation? Signs of pathology most often appear 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 baby's head and femur.
Abdominal circumference at a certain level, height of the uterine fundus.
Volume of amniotic fluid.
Impaired functioning of the placenta (its structure and size change).
Fetal heart rate.
The speed 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.

Severity

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

Asymmetrical form of pathology

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

Symmetrical form of pathology

With a symmetrical form, there is a uniform decrease in weight, organ size and fetal growth. This pathology most often develops in the initial stages of pregnancy due to fetal diseases (infection, chromosomal abnormalities). Symmetrical intrauterine growth restriction increases the likelihood of having a child with an incompletely formed central nervous system.

Diagnostic measures

If this pathology is suspected, a woman is recommended to undergo a full diagnostic examination. First of all, the doctor collects the patient’s medical history, clarifies previous gynecological diseases, and the characteristics of the previous pregnancy. Then a physical examination is carried out with mandatory measurement of the abdominal circumference, uterine fundus, height and weight of the woman.

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

What treatment is required?

To determine subsequent pregnancy management 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 basic principles of therapy should be focused on improving blood flow in the uterus-placenta-fetus system. All therapeutic measures are carried out in a hospital setting. First of all, a woman needs to ensure peace, balanced nutrition and good, long sleep. Monitoring the current condition of the fetus is considered an important element of therapy. For these purposes, ultrasound examination every 7-14 days, cardiotocography and Doppler blood flow are used.

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

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

Abortion

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

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

Pregnancy is maintained until a maximum of 37 weeks if, thanks to drug therapy, there is an improvement in indicators, when there is no need 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). Intrauterine growth retardation 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; in later life, there is an increased likelihood of developing cardiovascular diseases.

Children under five years of age are often diagnosed with slow weight gain, psychomotor retardation, improper formation of internal organ systems, and hyperexcitability. During adolescence, there is a high risk of diabetes. Such children usually tend to be overweight and have problems with blood pressure. This does not mean that their daily existence will be reduced to taking medications and living in hospitals. They will simply need to pay a little more attention to their own nutrition and daily physical activity.

Some children who have been diagnosed with stage 2 intrauterine growth retardation and given appropriate treatment do not differ from their peers. They lead a normal lifestyle, play sports, communicate with friends and get an education.

How can IUGR be prevented?

The best prevention of this pathology is planning for the upcoming pregnancy. About six months in advance, future parents must undergo a comprehensive examination and treat all existing chronic diseases. Giving up bad habits, a healthy lifestyle, a balanced diet and daily dosed physical activity are the best options for preventing IUGR.

Visiting 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.

A pregnant woman should have a well-structured work and sleep schedule. Proper and complete rest implies 10 hours of sleep at night and 2 hours during the day. This regimen improves blood circulation and transport of nutrients between mother and child.

Daily walks in the fresh air and 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

You should not ignore such a pathology as intrauterine growth retardation, the consequences of which can be the most tragic. On the other hand, parents should not perceive this diagnosis as a death sentence. If it is diagnosed in a timely manner, the expectant mother will take all necessary measures to eliminate its cause and 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!

Throughout pregnancy, doctors carefully monitor the expectant mother and the development of the fetus. This observation includes not only a general examination at the appointment, measuring the circumference of the abdomen and the height of the uterus, palpating parts of the fetus and tests. One of the important examinations, which are carried out at least three times during gestation, is ultrasound scanning of the fetus and placenta, as well as the uterus. Sometimes, after such a study, the ultrasound doctor writes in the conclusion the abbreviation “IUGR” or “intrauterine developmental delay.” 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 are the dangers of 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 restriction diagnosed? How is IUGR formed? Danger of IUGR for fetal development Causes of intrauterine growth retardation Placental problems in the genesis of IUGR, course of pregnancy Classification, degrees of intrauterine growth retardation Types of IUGR according to the characteristics of fetal development Diagnosis of IUGR: tests and ultrasound Instrumental methods for assessing IUGR Actions of doctors in the presence of IUGR

The concept of IUGR: terms, definitions

In articles on obstetrics, various terms flash, essentially reflecting approximately the same conditions associated with deviations from the normal development of the fetus inside a woman’s uterus. Doctors use the concepts of “fetal hypotrophy”, or “intrauterine growth retardation”, “small height and weight for gestational age”, “fetal retardation”, and many other terms. According to the international classification (ICD-10), such concepts are included in the general category of pregnancy pathologies (P05), and they are combined under a single term - “growth retardation and nutritional deficiency of the fetus”.

Such a frightening, incomprehensible term IUGR will imply 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 nutritional components necessary for growth to the baby. A similar diagnosis is made when, according to ultrasound or at birth, the child’s body weight by the time of pregnancy is reduced by 10% or more. In addition, a similar diagnosis will be given to those babies 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 restriction diagnosed?

According to obstetricians, based on the region and type of maternity facility (regular maternity hospital or specialized perinatal center), a similar condition is registered in 5-18% of pregnant women, while up to 20% of stillbirths occur due to 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 develop acute infections or chronic pathologies immediately after birth. It is important to note that the number of children born with this 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 of maternal health and the practice of continuing pregnancy in those women who were previously simply prohibited from giving 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 have no health complaints or any risk factors, who are young and quite strong, without the presence of chronic somatic diseases. In connection with this fact, it is always necessary to be monitored by doctors from an early stage in order to promptly identify deviations in the development of the baby 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 appears only during pregnancy in order to communicate between mother and baby in both directions. It filters dangerous compounds that can reach the fetus, removes metabolic products, delivers oxygen from the mother’s red blood cells and all the substances necessary for growth, without mixing fetal and maternal blood with each other.

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 smaller and smaller volumes of oxygen, and also “starves” due to a lack of amino acids, carbohydrate and fat molecules. This leads to a slowdown in his growth rates and weight gain.

If the fetus lags behind the standards regulated by ultrasound results, specialists identify its malnutrition and the presence of IUGR. This term does not mean that it is a disease; rather, it is a complication of pregnancy that occurs under the influence of various negative factors affecting the structure and function of the placenta.

The danger of IUGR for fetal development

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

IUGR is also one of the components in a 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, mandatory detailed screening (both ultrasound and laboratory) is indicated to identify chromosomal and gene abnormalities and the presence of defects of the brain, 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 quite a lot of them, ranging from bad habits and lifestyle of the expectant mother to 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 immediately a reason for making a diagnosis of IUGR. By definition, a slender young mother of short stature with the same spouse 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 sphere and hormones,
Fruit factors.

When it comes to the mother’s condition, many influencing factors can include:

Early age for pregnancy, from 13-14 years to 17,
A woman’s age after 35 years, when the burden of mutations and somatic pathologies accumulates,
Low socio-economic status, poor nutrition, inability to provide medications,
Features due to race and ethnicity, consanguineous marriage,
Constitutional features - weight, height, heredity.

Also, developmental delay can be caused by acute and long-term 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. .

Fetal risk factors for IUGR include:

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

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

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

Whatever the initial causes of IUGR, they all ultimately lead to disruption of the delivery of oxygen and nutrition through the placenta, which causes the baby to suffer.

Classification, degrees of intrauterine growth retardation

Based on their origin, developmental delay is divided into primary and secondary. Primary is present initially, from an early stage, and is associated with severe influencing factors - poor nutrition, developmental defects, 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 severe degrees.

Secondary type IUGR It is detected no earlier than the 2-3 trimester, and it often occurs when the mother is ill, has gestosis, severe anemia, or problems with the location of the placenta.

According to the severity of the delay, three degrees can be identified. First degree IUGR characterized by a baby falling behind in terms of term within 2-3 weeks from the expected time, with second degree the lag reaches a period of 4 weeks, and when severe third the fetus is 5 or more weeks behind its developmental stage.

Types of IUGR according to fetal development characteristics

According to ultrasound studies, doctors usually distinguish two types of IUGR: symmetrical and asymmetrical, for which there are different features of the course of the pathology.

Symmetrical delay type is 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 defects, especially in the brain area. Mothers with bad habits, who are hungry and who do not take care of their health may have similar problems. These phenomena can be detected after the second trimester, and in the presence of such a picture, it is necessary to conduct additional screenings in order to exclude gene and chromosomal pathologies.

Asymmetric Latency manifests itself in the uneven development of the fetus, its head usually corresponds to the terms in size, and the body lags behind the terms in development. This is detected after 30 weeks of pregnancy and is often associated with pathologies of the mother and complications of gestation (preeclampsia, hypertension, diabetes, multiple pregnancy). For such IUGR, even if the baby’s body lags behind in development by 3-4 weeks, 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 monitors 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 week. Starting from 15 weeks, when the uterus is palpated above the pubis, the height of its fundus is measured in centimeters. If the gains are less than expected, the doctor will prescribe tests and an ultrasound to confirm fetal malnutrition and the presence of IUGR.

Only an ultrasound can show accurate data, since the size of the abdomen and the height of the uterine fundus depend on the body build, pelvic capacity and many other conditions. If the fetus is small in size, a family analysis is carried out and heredity is assessed, defects and health problems are excluded. If suspicion of IUGR remains, additional ultrasound with Doppler ultrasound of the fetus and placenta is indicated to assess blood circulation.

Instrumental methods for assessing IUGR

An ultrasound can easily and painlessly make a diagnosis and assess the severity of developmental delay and the form of pathology. According to ultrasound data, based on the actual gestational age and size of the fetus, compliance or developmental delay, as well as the form of pathology, are determined. If necessary, Dopplerometry will show problems with blood flow in the area of the vessels of the umbilical cord and placenta, which will help determine both the causes and the severity of IUGR.

Along with these methods, modern studies are carried out such 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, the degree of damage to the placenta can be assessed. To assess the well-being of the fetus, CTG (cardiotocography) is performed to assess the fetal heart rate, its reactions to uterine tone and movements, this shows whether the fetus has enough nutrition and oxygen for normal development.

Actions of doctors in the presence of IUGR

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

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

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

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, tolerability of a particular treatment and the severity of FPN.

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

Alena Paretskaya, pediatrician

Fetal growth retardation is an intrauterine delay in the physical development of the fetus.

Such babies are often called “low birth weight”. In 30% of cases they are born as a result of premature birth (before 37 weeks of gestation) and only in 5% of cases during full-term pregnancy (at 38-41 weeks).

There are two main forms of intrauterine growth retardation (IUGR for short): symmetrical and asymmetrical. How are they different from each other?

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

The asymmetric form of IUGR is observed in cases where the fetus, despite the lack of body weight, does not lag behind the normal indicators of height length and head circumference. The asymmetric form of IUGR is more common than the symmetric one.

There are also three degrees of severity of IUGR:

I degree - fetal delay by 2 weeks;
II degree - delay by 2-4 weeks;
III degree - delay in fetal development for more than 4 weeks.

What reasons can lead to the development of IUGR?

If we talk about symmetrical IUGR, then, as a rule, it occurs due to chromosomal abnormalities of the fetus, genetic metabolic disorders, hypofunction of the thyroid gland and pituitary dwarfism. Viral infections (rubella, herpes, toxoplasmosis, cytomegalovirus) also play an important role.

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

FPN can occur due to: late gestosis, abnormal development of the umbilical cord, multiple pregnancies, placenta previa, placental vascular damage.

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

In many cases, the true cause of IUGR cannot be determined.

Symptoms of retarded fetal growth and 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 pregnancy helps to timely diagnose and treat IUGR.

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 limits her food intake to 1500 calories per day and is addicted to diets, this can lead to IUGR. But IUGR also occurs among pregnant women who, on the contrary, experience too much weight gain. Therefore, this sign is not reliable.

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

Examination for fetal growth restriction

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

The most reliable method for diagnosing IUGR is an ultrasound examination of the fetus, during which the ultrasound specialist measures the fetal head circumference, abdominal circumference, hip circumference, and estimated fetal weight. In addition, using ultrasound, you can determine how the internal organs of the fetus function.

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

An important research method is fetal cardiotocography (CTG), which also allows one to suspect IUGR. Using CTG, the baby's heartbeat is recorded. Normally, the fetal heart rate ranges from 120 to 160 beats per minute. If the fetus lacks oxygen, the heartbeat becomes faster or slower.

Regardless of the stage of pregnancy 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 FGR”. In this case, dynamic observation is carried out.

Treatment for growth retardation and intrauterine development

To treat 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 administration 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 CTG monitoring of the condition of the fetus.

The diet of a pregnant woman with IUGR should be balanced. Food should contain proteins, fats and carbohydrates. There is no need to “lean” on certain products. You can and should eat everything. You should especially 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, we should not forget that the main goal of treatment for IGR is not to “fatten” the child, but to ensure normal growth and development. Therefore, there is no need to overeat.

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

Non-drug methods for treating FGR include hyperbaric oxygenation (inhalation of oxygen-enriched air) and medical ozone.

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

Complications of IUGR:

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

Prevention of IUGR:

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

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

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 FPN. Is it so?
No. Such a diagnosis is not made based solely on the size of the placenta.

2. Is it possible to cure FGR if you eat a lot?
Unless IUGR is associated with chronic malnutrition. In other cases, a balanced diet should be combined 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 should also 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 delay in fetal development.

6. Is it necessary to go to hospital if you have IUGR?
This should be decided by your obstetrician-gynecologist, based on ultrasound and CTG data over time. In case of stage I IUGR, if there are no signs of fetal hypoxia, there is no need for hospitalization. For grade II or III IUGR, hospitalization is required.

7. I am 35 weeks pregnant, but upon examination, the height of the uterine fundus corresponds to 32 weeks. What is this? ZVRP?
There may be slight errors when the doctor measures the height of the uterine fundus. If ultrasound and CTG reveal no abnormalities, then everything is in order.

8. At the last ultrasound, I was told that the fetal abdominal circumference is 3 weeks behind the due date, but all other indicators are normal. Is this ZVRP? Need treatment?
Most likely, this is an individual characteristic of the fetus, if other parameters are within normal limits. If Doppler and CTG also do not reveal any deviations, then there is no IUGR and there is no need for treatment.

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

10. According to ultrasound data, the child is 2 weeks behind in parameters. CTG and Doppler are normal. Do I need treatment?
A slight lag in fetal parameters by 1-2 weeks is possible and normal. You need to look at the dynamics.

Obstetrician-gynecologist, Ph.D. Christina Frambos.

The period of bearing a child is extremely important for every mother. It is very good if this baby is desired and the woman’s health is in ideal condition. This pregnancy usually proceeds without problems. But in life it often happens differently. Many factors can combine with each other, leading to such a phenomenon as intrauterine growth retardation. Today we’ll look at what it is, why it occurs and how to avoid it.

Multicomponent concept

Now you can see this for yourself. Indeed, it is very difficult to answer the question of what intrauterine growth retardation is. By the way, doctors still use the term “fetal hypotrophy.” This concept is very complex, it is a whole complex of disorders or deviations in the development of the baby. Since he has not yet been born, the child's growth has to be assessed. If the baby’s size lags behind the average values, which at this stage are considered normal, then developmental delay is diagnosed. Lack of nutrients and oxygen usually entails such consequences.

Causes

There are quite a lot of them, so it will be easier to divide them into two large categories. This makes it easier to understand why intrauterine growth retardation is observed. The first group is social reasons. According to statistics, this phenomenon is often observed if the mother’s age has not reached 17 years. The situation is similar with late children. Those at risk are those who decide to give birth after 45. The second risk factor is the woman’s low weight. This may indicate a metabolic disorder, when a number of substances are simply not absorbed, which will provoke intrauterine growth retardation.

Lifestyle

Psychologists note another reason. Intrauterine growth retardation can be a consequence of a woman's nervous tension. A difficult financial situation, poor family relationships, work that does not bring material satisfaction - all this also affects the baby. Difficult working conditions also have a negative impact.

The last risk factor in this group is bad habits. Intrauterine growth restriction syndrome is directly related to lifestyle. If alcohol enters the body, not to mention drugs, then it is not surprising that the child lags behind in development.

Medical reasons

In approximately 30% of cases, this diagnosis is made in low birth weight babies, although low birth weight may also be associated with genetic characteristics. In this case, you can hear this concept for the first time after the baby is born, when the baby is absolutely healthy. However, there are other reasons. IUGR is the result of insufficient oxygen and nutrient intake. This also has a number of reasons:

Signs

The earlier the diagnosis is made, the easier the consequences will be. Stage 1 intrauterine growth retardation is not a death sentence, but only a guide to action. You won't feel it on your own. An obstetrician-gynecologist must measure the height of the uterine fundus. The indicators are compared with the norm. That is, at the 17th week, the UMR is 17 cm, at the 30th - 30 cm. The doctor must draw a diagram on the card to visualize the dynamics. A lag of two or more centimeters is a reason for additional diagnostics.

At what week does IUGR become obvious?

Signs of intrauterine growth retardation are almost invisible in the first trimester. Usually at 24-26 weeks the doctor can already assume the presence of a lag. Usually at this time the symmetrical form is diagnosed. Whether this is good or bad must be assessed in each case individually. In this case, there is a delay in the growth of all indicators. That is, the circumference of the head and abdomen and the length of the femur lag behind. But their proportionality relative to each other remains. If a lag in size is diagnosed for up to 2 weeks, then a diagnosis of “1st degree intrauterine growth retardation” is made. The main thing at this stage is to identify the cause and begin correction in time.

Clarifying examination

The simplest method of monitoring fetal development is to regularly measure the size of the uterus. At about 4 months it becomes possible to easily palpate it above the womb, and now at each visit the doctor will take readings. This allows the doctor to judge the size of the fetus. But the data are not very objective, because they do not take into account the thickness of the anterior abdominal wall and the amount of amniotic fluid. The only thing that can be visually determined is the woman’s build and physique. Therefore, ultrasound is now used to confirm the diagnosis. This is the most accurate study that allows you to evaluate many parameters at once, the condition of the uterus and placenta, the size of all parts of the fetal body.

Establishing diagnosis

In order to confirm his suspicions, the doctor may additionally refer the pregnant woman for a Doppler examination of blood vessels. In this case, the specialist must evaluate the speed and nature of blood flow in them. Cardiotocography complements the examination and records the heartbeat. If the data is normal, then even with a low weight of the baby, its development is considered successful. Doppler examinations are performed free of charge upon referral from a doctor.

Asymmetrical shape

Approximately 70% of pregnancies with IUGR are characterized by developmental delay in one of the indicators, be it head circumference, abdominal circumference or thigh length. All other indicators are within normal limits. As you can see, there is nothing terrible about this form. If in the case of symmetrical IUGR we can talk about the normal development of the baby due to his individual characteristics (fragile physique), then anatomical features and individual developmental periods interfere here.

Three degrees

It would be logical to assume that the smaller the lag, the faster it can be corrected, especially if the cause is found and eliminated. Doctors have identified a gradation that includes three degrees of IUGR:

We have already discussed the first above. If the baby lags behind in development for up to two weeks, we can say that mild IUGR occurs.
Stage 2 intrauterine growth retardation is the next stage, when the lag in size is already within two to four weeks. That is, the obstetrician sets the term at 32 weeks, and the baby’s size fits the parameters of 28 weeks. Four weeks for an embryo is a whole life, and therefore such a lag can be regarded as quite serious. But again, everyone will have their own reasons.
Stage 3 intrauterine growth retardation. This means that the fetus is delayed by more than 4 weeks. It is necessary to prescribe medications to improve the blood supply to the placenta, as well as mild sedatives for the mother in order to level out excessive stress.

Of course, treatment and its effectiveness are directly related to the severity of the disease. Infants with any IUGR usually survive, but may be weak after birth. There are special techniques that allow you to care for newborns.

Dangers of IUGR

The consequences of intrauterine growth retardation are difficult to assess in absentia; in each specific case, an examination by a professional neonatologist is required. This condition can have a significant impact on subsequent development, although this directly depends on the severity of the delay. If the doctor puts the first degree, then the risk of complications is very small, and everything can be corrected. But the third degree is quite serious. In this case, complications during the birth period, hypoxia and asphyxia cannot be ruled out. In addition, difficulties can be observed in the neonatal period. Most often they are associated with difficulties in adapting to life outside the womb. Diseases of the endocrine and cardiovascular systems can be predicted. With regular monitoring by a doctor, symptoms can be leveled out, so that the baby will grow up like all his peers.

Treatment

Timely therapy allows the development of the fetus to return to normal faster. Most often, doctors make corrections by improving blood supply. Vasodilators are used for this. They improve blood supply to the uterus and fetus. At the same time, medications are prescribed to relax the muscles of the uterus, since its contractions can compress the blood vessels. Depending on the severity of the mother's condition and the threat to fetal development, outpatient or inpatient treatment is recommended. If doctors insist on hospitalization, then do not refuse. As soon as your condition improves, you will be sent home under the supervision of a district obstetrician.

Prevention

Considering the causes and consequences of intrauterine growth retardation, I would like to note that this problem is easier to prevent than to treat. There is nothing complicated about this, you just need to carefully plan your pregnancy and undergo the necessary examination several months in advance. Be sure to treat foci of chronic infection. This could be the kidneys and bladder, teeth, give up bad habits.

The sooner you register, the better. The doctor will regularly examine you and make recommendations, which will help you avoid many problems. In addition, he can notice any disease at its earliest stages and prescribe treatment. This will avoid negative effects on the fetus.

Good nutrition and rest are the most effective means for preventing IUGR. A woman must sleep 8 hours at night and preferably 1-2 hours during the day. If you don’t want to sleep, then you just need to wish and listen to music. During pregnancy, you must take special vitamin and mineral supplements, agreed with your doctor.

Instead of a conclusion

Every mother worries about her baby, and such diagnoses sound all the more frightening because it is not completely clear what the threat is. It has already been proven that the fear of problems and deviations often causes these deviations, so calm down. A medical error cannot be ruled out, so don’t beat yourself up about it. This diagnosis is not so scary, especially since the level of modern medicine allows us to solve many problems, some of which are much more serious. The risk of developing various abnormalities and diseases after childbirth is higher in those children who were born ahead of schedule. They are prone to infectious diseases and allergies. Such children are prone to obesity and high blood pressure. But this is not a death sentence, but only a reason to more closely monitor the health of a growing baby.

Modern medicine has various means of diagnosing this condition, and in each specific case the doctor selects an individual method of treatment.

Fetal growth retardation is a special pathological condition characterized by slower growth and malnutrition of the fetus as a result of a decrease in the supply of oxygen and nutrients to it. In 8-10% of patients, intrauterine growth retardation is diagnosed with a seemingly successful pregnancy and the absence of aggravating factors. This once again confirms the need for medical monitoring of pregnancy, because if this condition is detected in time and treated correctly, then the pregnancy will end successfully.

During the period of intrauterine life, the nutrition and respiration of the fetus is provided by a temporary organ - the placenta, which supplies it with the substances necessary for life, receiving them from the circulating blood of the mother. A condition in which the placenta does not cope sufficiently with its responsibilities is called fetoplacental insufficiency (FPI). Over time, FPN leads to the fact that the fetus, without receiving the required amount of nutrients, weighs less than normal. This condition is called intrauterine growth restriction (IUGR) and may also be referred to as fetal malnutrition, intrauterine fetal growth restriction (IUGR), or intrauterine growth restriction syndrome (IUGR). IUGR is not an independent disease, but a complication that arises as a result of any pathological changes.

This pathological syndrome quite often complicates pregnancy and can lead to various diseases of the fetus and newborn. A decrease in the rate of fetal weight gain during intrauterine life, as well as its hypoxia (lack of oxygen) can be combined with damage and (or) defective development of the central nervous system. This worsens the newborn’s adaptation after childbirth and causes frequent illnesses. Subsequently, these children require long-term follow-up and corrective therapy. The prognosis for their further development depends on the reasons that led to the growth retardation and the degree of its severity.

Diagnosis of intrauterine growth restriction

An obstetrician-gynecologist observing a pregnant woman can suspect fetal developmental delay by simply measuring the size of the uterus. As soon as the uterus enlarges so much that it begins to be easily palpable above the womb (by about 16 weeks), he measures the height of its fundus, and later the circumference of the abdomen at the level of the navel (in the second half of pregnancy). The doctor records the results obtained in the outpatient diaries and then compares them in dynamics and with the norms for the given period. If the size of the uterus increases! slower than necessary, or do not increase at all, then we can assume that this is fetal malnutrition. But it should be borne in mind that the measurement results may be influenced by the thickness of the anterior abdominal wall, the amount of amniotic fluid and other factors. In addition, low fetal weight is not always a pathology (for example, in a situation where the parents are short, thin, fragile, and (or) themselves were born with low body weight, such fetal weight will not be a deviation. In any case, if intrauterine retardation is suspected fetal growth, additional studies are carried out (ultrasound, Doppler), and if it turns out that the fetus does not have developmental abnormalities, then no treatment is carried out.

Along with this, newer methods are also used - determination of hormone levels produced by the placenta in the mother's blood - placental lactogen, alkaline phosphatase and some others. A healthy placenta produces hormones in sufficient quantities, while a placenta affected by a pathological process does the opposite.

Helps in diagnosing IUGR cardiotocography(CTG) is a research method in which fetal cardiac activity is recorded using a specialized ultrasound sensor on a special tape and on a screen. The purpose of this test is to make sure that the fetus is not lacking oxygen. The heart rate is calculated (normally, the number of fetal heartbeats is 120-160 beats per minute, with a lack of oxygen it decreases or increases), as well as some other parameters.

Causes of intrauterine growth retardation

The factors contributing to the formation of a low-weight fetus are diverse. I would also like to note that a decrease in fetal body weight does not always imply the presence of any pathology.

Conventionally, we can distinguish several main groups of reasons leading to the development of IUGR:

from mother's side:

age under 15-17 and over 30-35 years;
socioeconomic status;
racial and ethnic characteristics;
constitutional features (height, weight of future parents at birth);
various chronic diseases of the pregnant woman;
harmful working conditions;
inadequate nutrition and other factors (smoking, alcohol, medications);

uteroplacental:

developmental anomalies of the uterus (bicornuate, saddle-shaped uterus, etc.) and placenta (short umbilical cord, etc.);
pathology of the placenta (previa - the placenta blocks the exit from the uterus, partial placental abruption, placental infarction - non-functioning areas of the placenta, etc.);
complicated course of pregnancy (threat of miscarriage, anemia - lack of hemoglobin in red blood cells, etc.);
incompatibility of mother and fetus based on Rh factor or blood group;
multiple pregnancy;
from the fetus;
hereditary syndromes (Down's disease, etc.);
intrauterine infections;
fetal anomalies; congenital malformations of the cardiovascular, genitourinary and central nervous systems, single umbilical cord artery, etc.

However, regardless of the factors contributing to the development of pathology, its immediate cause is placental insufficiency, which occurs against the background of circulatory disorders in the uteroplacental complex.

Ultrasound for diagnosing intrauterine growth restriction

Ultrasound is the most common and one of the most accurate methods for diagnosing intrauterine growth restriction syndrome. Based on the results of ultrasound, the degree and form of fetal growth restriction can be determined. With the help of modern ultrasound equipment, it is possible to establish with a high degree of accuracy not only the discrepancy between the weight of the fetus and the normal one for a given stage of pregnancy, but also find out how proportionate and harmonious the development of the fetus is, how the internal organs of the fetus function, and whether the placenta and umbilical cord have a normal structure. Using a type of ultrasound - Doppler study - you can obtain information about the speed and direction of blood movement through the vessels of the umbilical cord and large arteries of the fetus. Analysis of blood flow in the fetal vessels helps to assess the severity of fetal growth restriction.

An obstetrician-gynecologist observing a pregnant woman can suspect fetal developmental delay by simply measuring the size of the uterus.

Classification of intrauterine growth restriction

Fetal growth retardation can be primary or secondary.

Primary manifests itself from the very beginning of pregnancy, in the first trimester. Its causes include genetic disorders, infections, socio-economic and household factors (malnutrition, smoking, alcoholism, drug addiction), as well as the use of certain medications in the first trimester of pregnancy, in particular those that lead to the formation of fetal malformations.

Secondary IUGR develops in the second and third trimesters of pregnancy. This is facilitated by maternal illnesses and pregnancy complications that begin in the second half of pregnancy (increased blood pressure, decreased hemoglobin levels, threat of miscarriage).

Depending on the severity of signs of delay in fetal development from the gestational age, 3 degrees of severity of IUGR are distinguished;

I degree the severity of intrauterine growth restriction of the fetus - there is a lag in the size of the fetus by up to 2 weeks from the average size, which should correspond to this period (frequency - 34.2%);

II degree- the fetus lags behind the average size by 2-4 weeks (56.6%);

III degree- the lag period is more than 4 weeks (9.2%).

There are two main types of intrauterine growth restriction; symmetrical and asymmetrical growth retardation.

Symmetrical growth retardation- with this form there is a proportional decrease in all sizes of the fetus (occurs in 10-30% of cases). This form of fetal growth disorder is usually associated with hereditary diseases and chromosomal abnormalities: Down syndrome, Shereshevsky-Turner syndrome, etc., infectious diseases (rubella, toxoplasmosis, herpes, syphilis, cytomegalovirus infection). As well as developmental anomalies (microcephaly, single umbilical cord artery, congenital heart defects, etc.). In addition, the cause of the development of a symmetrical form of fetal growth retardation may be the bad habits of the mother (smoking, alcoholism, drug addiction), malnutrition, etc.

This form of fetal growth restriction is most often detected in the second trimester of pregnancy. In this regard, when a symmetrical form of fetal growth retardation is detected, special studies may be prescribed to exclude hereditary and genetic pathologies;

Amniocentesis- collection of amniotic fluid for biochemical, immunological, cytological and genetic studies, allowing one to judge the condition of the fetus. The collection is carried out through the vagina (during pregnancy up to 16-20 weeks) or through the abdominal wall (after 20 weeks);

Chorionic villus biopsy- obtaining chorionic villi cells to determine gene and chromosomal abnormalities. Samples are taken through the cervical canal or through the abdominal wall in a period of 8 to 12 weeks under the control of ultrasound scanning;

Cordocentesis- sampling of fetal blood from the umbilical cord vein for genetic and immunological studies. The study can be carried out after 18 weeks of pregnancy, optimally at 22-25 weeks.

The pregnant woman is also examined for viral and bacterial infections - for this, blood and swabs are taken from the genital tract and urethra. Correct diagnosis of symmetrical growth retardation is possible by establishing the exact duration of pregnancy or with regular dynamic ultrasound monitoring.

Asymmetrical growth retardation characterized by uneven development of the fetus; the size of the body may lag behind the normal size of the head (observed in 70-90% of cases of fetal growth disorders). In most observations, the asymmetric form of fetal growth restriction develops in later stages of pregnancy (at 30-34 weeks). It is caused by maternal diseases and pregnancy complications leading to placental insufficiency (hypertension, diabetes mellitus, gestosis, multiple pregnancy, pathological changes in the placenta, bleeding during pregnancy). In these cases, with a slight lag in fetal size (by 2-4 weeks), the prognosis is , as a rule, favorable: after birth, babies gain weight fairly quickly.

In some cases, it is possible to form a “mixed” form of intrauterine growth retardation, characterized by a disproportionate lag in all sizes of the fetus with the most pronounced lag in the size of the abdomen. This form of intrauterine growth restriction is the most unfavorable.

Elimination of intrauterine growth restriction

If during the examination a diagnosis of intrauterine growth retardation is made, then treatment is necessary. The principles of treatment are based on eliminating the cause that led to fetal growth retardation, normalizing metabolic processes, improving blood flow in the uteroplacental complex and maintaining the vital functions of the fetus.

Currently, a large number of drugs have been proposed aimed at eliminating disturbances in uteroplacental blood flow and increasing the fetus’s resistance to oxygen deficiency. Treatment in each case is selected individually, taking into account the cause of FGR. The effectiveness of therapy largely depends on how timely it is started.

Treatment of fetal malnutrition is carried out on an outpatient basis or in a hospital setting, depending on the severity and is always complex. For this purpose, tocolytic drugs, vasodilators and agents that reduce blood viscosity are widely used.

Tocolytic agents (PARTHUSISTEN, GINIPRAL) relax the muscles of the uterus, prevent its contraction and help improve blood flow to the uteroplacental complex. Vasodilators (EUPHYLLINE, THEOPHYLLINE) dilate blood vessels, including small ones (capillaries), thereby increasing uteroplacental blood flow. Drugs that reduce blood viscosity (CURANTIL, ASPIRIN) have a good effect; this helps accelerate blood flow in small vessels, resulting in improved uteroplacental blood flow. The drug ACTO-VEGIN has proven itself well in the treatment of placental insufficiency - it activates metabolic processes in cells by improving the delivery of oxygen to them and some other effects.

In addition, in the complex treatment of intrauterine fetal retention, vitamins (ASCORBIC ACID, RIBOXIN, TOCOPHEROL, FOLIC ACID), amino acids (METHIONINE) are used, which also helps to normalize metabolic processes and eliminate fetal malnutrition.

In addition, non-medicinal means are also used for the treatment of FGR: medical ozone (intravenous administration of ozonated solutions), hyperbaric oxygenation (therapeutic procedure - breathing oxygen-enriched air under conditions of increased barometric pressure), etc.

And of course, the expectant mother should not forget that for the normal development of her unborn child, a nutritious diet rich in vitamins and animal proteins, a healthy lifestyle (no smoking, alcohol, etc.), as well as a restricted diet are very important. physical activity (in this case, it is recommended to spend the day in bed in a position on your side for at least 6 hours).

The effectiveness of the therapy is monitored using ultrasound and CTG, which are usually prescribed at intervals of 2 weeks (CTG, if necessary, more often). Typically, intrauterine growth retardation syndrome responds well to treatment, and only in rare cases, in the absence of treatment effect, when an ultrasound shows a lack of fetal growth and oligohydramnios, Doppler indicators worsen, and CTG shows signs of oxygen deficiency, does the question of emergency delivery arise .

pathologies of the placenta: malpresentation or detachment;
chronic diseases of the mother: high blood pressure, problems with the cardiovascular system, anemia, improper functioning of the respiratory tract;
abnormalities in the chromosome set: Down syndrome;
pathologies of intrauterine development: defect of the abdominal wall or kidneys;
mother's bad habits;
infectious diseases suffered by a woman during pregnancy: toxoplasmosis, syphilis, cytomegalovirus;
insufficient or unhealthy nutrition;
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.