Diagnosis Of Fetal Growth Retardation Research Articles

The effect of acetylsalicylic acid intake on fetal adaptation in placental dysfunction

Placental dysfunction (PD) is one of the actual topics of research in the modern scientific world. Fetal growth retardation (FGR) is the leading clinical manifestation of chronic PD. Assessment of fetal growth is one of the key tasks in prenatal care. FGR is associated with an increased risk of perinatal morbidity and mortality, with long-term adverse outcomes for the child.Prenatal diagnosis of FGR is an important task for stillbirth prevention, up to 30% of cases of which are associated with this pathology or with a small-for-gestational-age fetus at the end of the III trimester.The objective: to study the influence of acetylsalicylic acid on the development of compensatory abilities of the fetus by PD.Materials and methods. 118 pregnancies with FGR and/or PD were analyzed. The women were divided into two groups: I group (67 persons) – patients with FGR and/or PD who used acetylsalicylic acid during pregnancy; II group (51 women) – pregnant women with FGR and/or PD who did not use acetylsalicylic acid during pregnancy. In all cases, the method of delivery was cesarean section due to fetal distress.Fetal distress was diagnosed using ultrasound examinations based on the following criteria: abnormal blood flow according to Doppler data (Volusun S10 ultrasound device), fetal biophysical profile indicators (Volusun S10 ultrasound device, Sonicaid Team fetal monitor) and cardiotocographic assessment of short-term variability (STV) fetal heart rate; STV > 4.5 according to the Sonicaid Team fetal monitor. Exclusion criteria: multiple pregnancy, antenatally confirmed fetal malformations.Results. The use of acetylsalicylic acid through placental regulation allows to achieve a longer gestation period before the development of fetal distress. The average gestational age before the appearance of this pathology in 50.75% of patients of the I group (34 persons) was larger – 33–36 weeks. On the other hand, 54.9% of women (28 individuals) in the II group had fetal distress earlier – at 28–32 weeks of gestation (p<0.05).Pathological blood flow in the umbilical artery or fetal biophysical profile <4 points was determined in 83.6% of cases in the I group (56 pregnant women) and in 23.5% in the II group (12 women). In women who used acetylsalicylic acid (I group) acute fetal distress diagnosed by STV was detected in 11 (16.4%) cases. In women who did not use acetylsalicylic acid (II group), distress manifested itself sharply – due to acidosis – in 39 (76.5%) cases (p<0.05).Conclusions. 1. In women who did not use acetylsalicylic acid, fetal distress manifested itself sharply – due to acidosis (STV<4.5 was recorded in 39 (76.5%) patients of the II group, while in women who used acetylsalicylic acid – in 11 pregnant women of the I group (16.4%; p<0.05). 2. Prophylactic use of acetylsalicylic acid allows to slow down the growth of placental dysfunction, which lets to the development of compensatory mechanisms and adaptation. 3. By use of acetylsalicylic acid the gestational period delivery closer to full term pregnancy. In women who used acetylsalicylic acid, most cases of fetal distress occurred at 33–36 weeks – 50.75%, while in the group that did not use acetylsalicylic acid most cases of fetal distress occurred at 28–32 weeks – in 54.9% (p<0.05).

The value of some indices of heart rate variability in the diagnosis of fetal growth retardation

Fetal growth retardation (FGR) is one of the most serious problems in current perinatology. This pathology leads not only to the deterioration of perinatal outcomes but also significantly increases morbidity during adult life. FGR is known to be featured by its delayed “neurological maturation”. This is manifested in a decrease in autonomic nervous regulation according to the fetal heart rate variability (HRV) scores and indices. The objective: to study HRV in fetuses with normal biometric indices compared to similar parameters of growth retarded fetuses. Materials and methods. The 47 pregnant women who had fetuses with normal biometric indices (I group) and 33 patients with fetal growth retardation (II group) were included in the study. The investigation of the fetal HRV was performed by processing the R–R intervals obtained via non-invasive electrocardiogram (ECG) and involved the following indices: STV (short term variations), LTV (long term variations), AC/DC (acceleration capacity/deceleration capacity), TP (total power), SI (stress index), SDNN (standard deviation of normal to normal intervals), EnRE (entropy of the time series), D2 (correlation dimension of the time series), Z (temporary irreversibility) і FL (measure of fuzzy logic, integrated measure of HRV). Results. The obtained data indicated that the indices of fetal HRV were reduced in the patients with FGR. These indices have utility in screening programs for the detection of fetal intrauterine nutrition and growth disturbances. The results of the study allow us to believe that the ability to accelerate heart rate patterns is partly preserved even during FGR. This may indicate a very ancient phylogenetic nature of the reaction of the heart system of the fetus to its motile activity. However, decelerations according to the DC were typical for FGR. A non-invasive fetal ECG could become a useful supplementary method in the current methods’ spectrum used in perinatal medicine. Conclusions. Therefore, the development of algorithms for the diagnosis of FGR requires the inclusion of the following HRV indices: STV, LTV, DC, TP, SI, SDNN, D2, Z, and FL. These biophysical markers of FGR can be used as a screening program in conditions of lack of access to high-quality ultrasound diagnostics or be a valuable addition to existing perinatal strategies.

Ультразвукові критерії затримки росту плода при передчасних пологах

Purpose - to increase the effectiveness of forecasting and early diagnosis of fetal growth retardation (FGR) in premature pregnancy on the basis of ultrasound examination. Materials and methods. 165 pregnant women were examined: 30 patients with an uncomplicated pregnancy that ended in physiological timely delivery - the control group (CG); 45 patients with premature birth (PB) (the Group I); 45 women with full-term pregnancy and FGR (the Group II) and 45 patients with PB and FGR (the Group III). Ultrasound examination included serial dynamic fetometry and placentography, dopplerography of vessels of the umbilical cord, ductus venosus, middle cerebral artery and fetal aorta with determination of systolic blood flow velocity and systolic peak velocity of blood flow, systolic-diastolic ratio, index resistance and pulsation index. Statistical processing of research results was carried out using standard programs «Microsoft Excel 5.0» and «Statistica 8.0». Results. А significant decrease in the parameters of the biparietal size of the fetal head in pregnant women of the Group III was detected at 24-25 weeks of pregnancy: in the CG - 66.4±0.65 mm, in the Group III - 65.02±0.31 mm (p<0.05), in the Group II - 66.2±0.46 mm. A more pronounced slowdown in the rate of growth of the biparietal size of the fetal head was found in pregnant women at 28-29 weeks of gestation, when a significant decrease (p<0.05) in its growth rate was observed in pregnant women of the Groups II and III. The peculiarities of the formation and functioning of the fetoplacental complex in this Groups were characterised by impaired fetal haemodynamics: increase in blood circulation velocity in the venous duct - 74.43±2.24 cm/s vs. 46.54±1.62 cm/s, respectively; p<0.05; increase in pulsatile index in the uterine artery - 1.611±0.04 vs. 1.424±0.07; p<0.05, and in the middle cerebral artery - 1.527±0.02 vs. 1.251±0.03; p<0.005, indicating the tension of subcompensatory reactions. Conclusions. Ultrasound feto- and placentametry in pregnant women with premature births against the backdrop of FGR showed that in patients with premature births, statistically significant deviations in the size of the fetus and placenta are observed from 24-25 weeks of gestation. Disruption of fetal hemodynamics is indicated by a significant increase in the speed of blood circulation in the ductus venosus in the Groups II and III (74.43±2.24 cm/s vs. 46.54±1.62 cm/s; p<0.05). The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Diagnosis of Fetal Growth Retardation and Placental Cyst during Labor

Diagnosis of Fetal Growth Retardation and Placental Cyst during Labor

Modern possibilities of correction of postcovid disorders in the fetoplacental complex

The objective: to determine the peculiarities of hormonal support, liver enzymatic function and the state of the fetal-placental complex (FPC) in unvaccinated women with fetal growth retardation (FGR) and placental dysfunction (PD) who was ill with the coronavirus disease during the current pregnancy, on the background of the proposed correction scheme of the disorders and evaluation of its effectiveness.Materials and methods. The study included 22 pregnant women with FGR and PD who were being treated and delivered in the Department of Pregnancy and Childbirth Pathology of the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova National Academy of Sciences of Ukraine» in 2021–2022 and suffered a coronavirus disease during the current pregnancy. All pregnant women had a general clinical examination and the following parameters were additionally determined: the level of placental lactogen (PL) in blood serum, indicators of liver enzyme activity (alanine aminotransferase – ALT, aspartate aminotransferase – AST, gamma-glutamyl transpeptidase – GHTP), the level of estriol in urine (after the 22d week of pregnancy). The examination was carried out before the start of treatment and preventive measures and 12–14 days after a 10-day course of therapy with simultaneous ultrasound (US) monitoring of the condition of the FPC. In the case of diagnosis of FGR and PD, a course of therapy was carried out, which included daily consecutive intravenous infusions of a balanced crystalloid infusion preparation with lactate and sorbitol in the amount of 200 ml and a solution of levocarnitine and arginine hydrochloride in the amount of 100 ml for 10 days, followed by ultrasound control of the condition of the fetus and FPC. The evaluation of the effectiveness of the treatment was carried out based on a combination of clinical, laboratory and instrumental indicators after 10 days of therapy. Results. All pregnant women had a moderate or mild course of the coronavirus disease at different terms of the current pregnancy. There were 9 (40.9 %) women who were infected with SARS-CoV-2 in the early terms of pregnancy (up to 12 weeks), and they were diagnosed the 2nd and 2nd-3rd degrees of FGR.The majority of pregnant women had gestational complications. Before treatment, 10 (45.5 %) women had oligohydramnios. FGR was diagnosed in 14 (63.6 %) pregnant women, among them: in 3 (13.6 %) persons – fetal growth retardation of the 2nd-3rd degree, in 6 (27.3 %) – of the 2nd degree, in 5 (22.7 %) – 1st degree. The analysis of laboratory indicators demonstrated the increase in the levels of ALT, AST and GHTP, and a decrease in the levels of estriol in urine. After the proposed course of treatment, oligohydramnios was found only in 2 (9.1 %) women. The average amniotic index before treatment was 10.1, after treatment – 15.3. 4 (18.2 %) women were diagnosed FGR after the treatment. As a result of the treatment, the improvement of all determined laboratory parameters and perinatal consequences were determined. Conclusions. The proposed scheme for correcting the identified disorders with the inclusion of balanced crystalloid infusion preparation with lactate and sorbitol and balanced crystalloid infusion preparation with lactate and sorbitol drugs made possible to improve microcirculation, metabolic processes, and to normalize the consequences of postcovid endotheliitis in the vascular system of pregnant women in general and in the FPC, in particular. This was manifested in the improvement of clinical, laboratory and instrumental indicators of conducted studies and had a positive effect on perinatal results.

Oral Anaerobic Microflora and Pregnancy Complication

Bacterial vaginosis and periodontal diseases share very similar pathogenesis. Each of these diseases occurs when healthy microbiome changes to predominately anaerobic bacterial flora. Bacterial vaginosis is proven factor for adverse pregnancy outcomes. In recent years it has been hypothesized that infection from distant sites of the fetoplacental unit may also elicit an inflammatory response in utero. Aim: The study is designed to determine whether the presence of specific oral anaerobic bacteria in subgingival sulcus of mother increase the risk of adverse obstetric outcomes. Material and Methods: Case-control study. Control group: 50 patients who gave birth to neonate whit normal birth weight at term. Group cases: I group - 40 pregnant women who were hospitalized with signs of preterm labor. II - 20 pregnant women, who have an ultrasound diagnosis of fetal growth retardation. Sub-gingival microbiological paper-point swab was taken in all patients. Results: The total number of isolated oral anaerobic bacteria was statistically significantly higher in the cases group compared to control group p <0.01. In our study, pregnant women who tested positive for Porphyrmonas gingivalis for 6.65 times were more likely to have preterm labor compare with pregnant women with negative oral swabs (95.0% CI: 1.38-32.11 / p <0.05), and for 2,79 times more likely to have fetus with intrauterine growth restriction (95.0% CI: 1.10-7.91 / p <0.05 Conclusions: The study confirmed the hypothesis of a statistically significant association between oral anaerobic infection and adverse pregnancy outcomes. In the future, more studies are needed to investigate the role of the microbial load, maternal immune response, pathophysiological pathway that leads to negative pregnancy outcome.

GESTATION-SPECIFIC LIVE-BORN TWIN BIRTH WEIGHT, LENGTH AND HEAD CIRCUMFERENCE PERCENTILES AND CURVES ADAPTED FOR NORTH-WESTERN RUSSIA

Until now, national percentiles and curves for twins based on population registry data have not been published. It complicates the diagnosis of fetal growth retardation. In the article, the algorithms of birth weight, length and head circumference percentiles and curves for twins born alive at gestational age 32-40 weeks are described. We used data from the population-based Murmansk County Birth Registry (2006-2011) and the Arkhangelsk County Birth Registry (2012-2014), Russian Federation. Data on 1 567, 1 631 и 1 628 newborns were used to create birth weight, length and head circumference percentiles, respectively. Gestational-specific curves present data on 10th, 50th and 90th percentiles. Mean birth weight and head circumference in males were higher compared to corresponding parameters in females at any gestational age. At 32 weeks of pregnancy mean birth length in females was higher compared to length in males. In our current study, the database was comprehensive enough to be representative for the population. Conclusively, the results of the study will be valuable for clinical practice across other regions of the Russian federation.

Factors potentiating the smoking-related risk of fetal growth retardation.

To estimate the risk of fetal growth retardation resulting from the interaction between maternal smoking during pregnancy and other recognized risk factors. Case-control study of prospectively recorded data. Department of Obstetrics and Gynaecology, University of Pavia, Italy. Three hundred and forty-seven singleton pregnancies with diagnosis of fetal growth retardation and 694 control pregnancies with appropriately grown fetuses. The overall odds ratio for fetal growth retardation associated with maternal smoking was 2.87 (95% confidence interval, 2.17-3.80). In logistic models the factors which independently increased the smoking-related risk of fetal growth retardation were a male fetus, nulliparity, maternal age 20 years or less, a history of first trimester haemorrhage and low (less than 50 kg) pre-pregnancy weight. The combined effect of smoking and caffeine consumption on the risk of fetal growth retardation was found to be additive rather than multiplicative. Several factors can affect the risk of fetal growth retardation associated with maternal smoking. The prenatal identification of these factors could help detect subgroups of women at high risk of fetal growth retardation.

The prognostic significance of antenatal diagnosis of fetal growth retardation.

Intrauterine growth retardation is associated with high risk of perinatal asphyxia. The neonatal mortality rate of small-for-gestational-age (SGA) infants (birthweight < or = 2 SD) in Sweden decreased from 5.6% in 1973 to 2.0% in 1987. During the same period, the number SGA infants with postnatal asphyxia (5 min Apgar score < 7) decreased from 10% to 5%. Based on antenatal diagnosis of fetal growth retardation, an optimal time of delivery reduces the risk of major neurological and developmental sequelae of the individual infant.

Umbilical flow waveforms versus fetal biophysical profile in hypertensive pregnancies

The pulsatility index (PI) of the umbilical arteries was measured in 40 hypertensive pregnancies. Doppler-velocimetric data were kept unknown to the clinical staff. An abnormal PI was found in 79% of cases in which an abnormal fetal growth in utero had been diagnosed by ultrasonographic measurements. Serial PI findings showed worsening figures in most of the cases with an abnormal fetal growth, irrespective of the last absolute value. Amniotic fluid estimation and PI data were significantly correlated. PI values were markedly abnormal in fetuses with non-reactive heart-rate tracings. A high sensitivity and an optimal specificity were found for umbilical PI versus the diagnosis of fetal growth retardation made by the coexistence of different biophysical criteria. However, false normal results may occur. 62% of the newborns weighed below the 5th percentile. The sensitivity of abnormal PI values to detect these light fetuses resulted to be only 67%. However the prevalence of neonatal morbidity in fetuses with abnormal PI values was 74%, while morbidity occurred only in 14% of cases with normal PI values. In hypertensive pregnancies, this simple velocimetric parameter proved to correlate with abnormal biophysical monitoring and complicated neonatal outcomes.

Umbilical blood waveforms in fetal surveillance of twins

Umbilical arterial velocity waveforms were recorded in 69 pairs of twins by means of continuous-wave Doppler analysis and an Angioscan spectrum analyzer. A systolic/diastolic ratio was measured for each twin. The sum of the systolic/diastolic ratio was calculated and the difference between each twin was expressed as the delta systolic/diastolic ratio. Significant differences in delta systolic/diastolic and neonatal weight were previously set at 0.4 and 350 gm, respectively. Sonography was used for fetal age confirmation and diagnosis of fetal growth retardation. All neonates were weighed; at birth gestational age was assigned by Dubowitz criteria and categorized as adequate-, small-, or large-for-gestational age. The sensitivity, specificity, and predictive value of the delta systolic/diastolic ratio were determined. The perinatal implications of this test in the management of twin pregnancy are discussed.

10 - Obstetric Management of the Growth Retarded Baby

Identification and modification of potential risk factors, early diagnosis, intensive prenatal surveillance, and appropriate, timely intervention is necessary for successful management of the pregnancy complicated by intrauterine growth retardation. Once an antepartum diagnosis of fetal growth retardation has been made, extensive evaluation including a thorough ultrasound examination and amniocentesis (if technically possible) for fetal lung profile studies and karyotype is indicated. Intensive fetal surveillance with nonstressed testing (in the absence of oligohydramnios) or contraction stress testing on a weekly basis (if normal) can usually assure one of fetal well being. A combination of NST/CST testing may increase the effectiveness of predicting perinatal morbidity. Daily increasing serial oestriol urinary values may be of some benefit in assuring fetal well being. Serial sonography to assess amniotic fluid volume and interval fetal growth is important. Use of the biophysical profile may significantly improve the perinatal outcome, but substantiation in a large group of growth retarded infants is lacking. Delay of delivery until 37–38 weeks’ gestational age (or, in the hypertensive patient, until fetal lung maturity is documented) currently appears optimal. However, in the face of fetal surveillance testing suggesting a deterioration in fetal status or lack of interval growth, delivery should be undertaken. The mode of delivery will depend rather on the indication for intervention. Caesarean section should be seriously considered in many cases of intrauterine growth retardation. At the time of delivery, the paediatric team should always be present and ready to resuscitate the infant if necessary and to anticipate potential problems associated with the growth retarded fetus.

Antepartum evaluation of the high-risk fetus: problems and prospects.

The chief obstetrical problems encountered today in the prenatal evaluation of the high-risk fetus are presented. Advantages and pitfalls or recent techniques utilized in the management of the high-risk pregnancy are discussed. They include: a prenatal scoring system for identifying the high-risk population; examination of the karyotype of cells in amniotic fluid, and quantitation of alpha-fetoprotein levels in maternal plasma and amniotic fluid for the early prenatal detection of birth defects; ultrasonography for the intrauterine diagnosis of fetal growth retardation and assessment of fetal maturity; the use of maternal urinary estriol excretion, maternal plasma human placental lactogen levels and the oxytocin stress test for the early detection of fetal distress; estimation of fetal maturity by amniotic fluid analysis of lecithin or lecithin-sphingomyelin ratios, creatinine and Blue Nile fetal cell staining. Newer, still experimental, techniques (e.g., fatal breathing movements, fetoscopy, and dehydroepiandrosterone plasma clearance) are viewed in light of further possible decreases in maternal and perinatal mortality.

COMPARISON BETWEEN URINARY OESTROGEN ASSAY AND SERIAL ULTRASONIC CEPHALOMETRY IN ASSESSMENT OF FETAL GROWTH RETARDATION

Urinary oestrogen assay and serial ultrasonic cephalometry were performed on 284 patients who were considered on clinical grounds to be at risk of having a growth-retarded fetus. It was found that ultrasonic cephalometry was significantly better than oestrogens in diagnosing the small-for-dates baby, but that there was no significant difference between the two methods in predicting perinatal asphyxia. Of the 14 stillbirths, three were in the normal ultrasonic growth rate group and five had normal oestrogen excretion. Both methods were found to be of value in the diagnosis of fetal growth-retardation, although cephalometry would seem to have some advantages, especially in distinguishing between fetal growth-retardation and mistaken maturity.