Treatment Of Intrauterine Growth Retardation Research Articles

Global newborn health research priorities identified in 2014: A review to evaluate the uptake.

SummaryBackgroundIn 2014, World Health Organization published global research priorities for newborn health till 2025. We conducted this review to summarize completed or ongoing research on the twenty priorities.MethodsWe conducted searches for twenty questions on MEDLINE via PubMed, Cochrane CENTRAL, Web of Science, clinical trial registries, and funder websites between July 2014 and May 2022. Studies addressing research questions using adequate design were included. Adequacy of uptake of a priority was assessed based on predefined criteria.FindingsThe uptake of research priorities was high for 8 (40%), moderate for 11 (55%), and one priority, effectiveness of training community health workers (CHWs) to treat neonatal sepsis at home remains unaddressed. Priorities with moderate uptake include effectiveness of simplified neonatal resuscitation programme, simple clinical algorithms for CHWs to neonatal infection, CHWs training in basic neonatal resuscitation, community-initiated kangaroo mother care, perinatal audits, and novel tocolytic agents, scaling-up chlorhexidine cord application, stable surfactant with simpler administration, accurate, affordable methods to diagnose fetal distress, strategies for prevention and treatment of intrauterine growth retardation, and causal pathways for antenatal stillbirths.InterpretationAdequate research was undertaken on pressing global concerns in newborn health. Funders and researchers should reflect on and address less researched areas.FundingNone.

Birth Weight Reference for Triples in Korea

An estimation of the baseline value of birth weight depending on gestational age is helpful for reducing morbidity and mortality following the early diagnosis and treatment of intrauterine growth retardation. In Korea, there are established baseline values for singletons and twins. But no definite criteria exist for triplets yet. Given the above background, we obtained the baseline value of birth weight depending on the gestational age in triplets with a gestational age of 27-38 weeks using a raw data about birth records which had been obtained during a 10-yr period from 1998 to 2007. This baseline value was compared with those of singletons and twins. During the 10-yr period, the total number of newborns who were born between gestational age 27 and 38 was 1,330,822. Of these, the number of singletons, twins and triplets was 1,330,822, 90,245, and 840, respectively. A mean gestational age was 37.3±1.5 weeks, 36.0±2.0 weeks and 33.3±2.4 weeks in the corresponding order. A mean birth weight was 3,071±490 g, 2,414±455 g, and 1,836±454 g in the corresponding order. A comparison of the birth weight depending on the gestational age of triplets was made with the normal value of singletons and twins. According to this, in the overall gestational age ranging from weeks 27 to 38, it was relatively smaller as compared with the birth weight of twins and singletons. The current study was of significance in that it first obtained the normal value of birth weight of triplets in the overall gestational age ranging from weeks 27 to 38, whose results are expected to be helpful for studies or treatments of triplets.

Effects and mechanisms of action of sildenafil citrate in human chorionic arteries

ObjectivesSildenafil citrate, a specific phosphodiesterase-5 inhibitor, is increasingly used for pulmonary hypertension in pregnancy. Sildenafil is also emerging as a potential candidate for the treatment of intra-uterine growth retardation and for premature labor. Its effects in the feto-placental circulation are not known. Our objectives were to determine whether phosphodiesterase-5 is present in the human feto-placental circulation, and to characterize the effects and mechanisms of action of sildenafil citrate in this circulation.Study DesignEx vivo human chorionic plate arterial rings were used in all experiments. The presence of phosphodiesterase-5 in the feto-placental circulation was determined by western blotting and immunohistochemical staining. In a subsequent series of pharmacologic studies, the effects of sildenafil citrate in pre-constricted chorionic plate arterial rings were determined. Additional studies examined the role of cGMP and nitric oxide in mediating the effects of sildenafil.ResultsPhosphodiesterase-5 mRNA and protein was demonstrated in human chorionic plate arteries. Immunohistochemistry demonstrated phosphodiesterase-5 within the arterial muscle layer. Sildenafil citrate produced dose dependent vasodilatation at concentrations at and greater than 10 nM. Both the direct cGMP inhibitor methylene blue and the cGMP-dependent protein kinase inhibitor Rp-8-Br-PET-cGMPS significantly attenuated the vasodilation produced by sildenafil citrate. Inhibition of NO production with L-NAME did not attenuate the vasodilator effects of sildenafil. In contrast, sildenafil citrate significantly enhanced the vasodilation produced by the NO donor sodium nitroprusside.ConclusionPhosphodiesterase-5 is present in the feto-placental circulation. Sildenafil citrate vasodilates the feto-placental circulation via a cGMP dependent mechanism involving increased responsiveness to NO.

A systematic review of experimental and clinical studies of sildenafil citrate for intrauterine growth restriction and pre-term labour

SummarySildenafil could be an alternative in the treatment of intrauterine growth retardation (IUGR) and premature delivery. In order to systematically review the reproductive-related effects of sildenafil, a search was made on PubMed and the Science Citation Index for studies evaluating the effects of sildenafil on uterine vessels or myometrium either in vitro or in experimental animal models as well as for any clinical trial or case reporting the outcome of pregnant women treated with sildenafil. The information was obtained from: three in vitro studies, five studies performed in experimental animal models, four studies on women with fertility and sterility disorders receiving 100 mg/day of sildenafil intravaginally, and two case reports of pregnant women who received sildenafil for the treatment of pulmonary hypertension. Incubation with sildenafil of different in vitro preparations resulted in vasodilator and uterine relaxant effects. No evidence of teratogenicity was observed in the studies performed in mice, rats and dogs. Sildenafil increased fetal weight in rats. In women, contradictory results on uterine blood flow and endometrial development were reported after the intravaginal administration of sildenafil. No adverse fetal outcomes were reported in the two pregnant women with pulmonary hypertension receiving sildenafil late in their pregnancy. In conclusion, there is still limited information about the efficacy of sildenafil for the treatment of IUGR and premature delivery. However, studies in experimental animal models and two human case reports have reported no deleterious effects on the mother or offspring.

3587: The clinical observation of the effectiveness of hyperbaric oxygen combined with routine methods in the treatment of intrauterine growth retardation

3587: The clinical observation of the effectiveness of hyperbaric oxygen combined with routine methods in the treatment of intrauterine growth retardation

Study on relativity between oxygen free radical and thromboxane B2, 6-keto-PGF1α during ligustrazine treatment of intrauterine growth retardation

To study the pathophysiological changes and effective treatment of intrauterine growth retardation (IUGR). Eighty-five cases with normal pregnancy and 58 IUGR women maternal red blood cell superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), serum lipid peroxide (LPO) and thromboxane B2 (TXB2), 6-keto-PGF1 alpha(6KP) were examined. IUGR group was divided into Ligustrazine group (LIG, 47 cases) and amino acid group (AAG, 11 cases) and treated accordingly. In IUGR group, LPO increased and SOD, GSH-Px activity, 6KP value decreased abnormally, TXB2/6KP ratio significantly increased, which was negative correlated with SOD, GSH-Px activity and positive correlated with LPO level markedly. After treatment, all the changes were improved and almost reached normal range. The fetal outcome showed that the total effective rate was 95.7% in LIG, markedly higher than that in AAG (81.8%, P < 0.05), there was significant difference between LIG and AAG. The balance of body oxidate/antioxidate system was disturbed and the uteroplacental-fetal circulation was obstracted in IUGR. Ligustrazine could inhibit oxygen free radical, rise SOD, GSH-Px activity, regulate TXA2/PGI2 balance, promote fetal growth.

Importance of milk and diet on the ontogeny and adaptation of the intestine.

Importance of milk and diet on the ontogeny and adaptation of the intestine.

The physiology and pathophysiology of intrauterine growth retardation.

Insulin-like growth factor I (IGF-I) is the primary hormone influencing fetal growth in later gestation. The regulation of fetal IGF-I in utero is primarily influenced by placental glucose transfer, which regulates fetal insulin release. Furthermore, insulin has direct adipogenic effects on the fetus; fetal growth hormone (GH) may also have additional modes of action on fetal growth. Swallowed amniotic fluid contains IGF-I and may influence gastrointestinal maturation and fetal growth. Furthermore, both fetal and maternal IGF-I can influence placental metabolism. Experimentally, the maternal administration of GH and IGF-I can affect placental function and thus influence fetal growth; this may suggest therapeutic approaches to the treatment of intrauterine growth retardation (IUGR) in utero. Both experimental and clinical evidence support our hypothesis that IUGR is a multihormone relative resistance syndrome; relative resistance to insulin, IGF-I and GH can be demonstrated. Such resistance may be the basis of altered programming by which fetal growth retardation is associated with postnatal growth failure and a greater propensity to develop cardiovascular and metabolic disease in later life.

Aspirin and Other Platelet-Active Drugs: The Relationship Among Dose, Effectiveness, and Side Effects

Aspirin and Other Platelet-Active Drugs: The Relationship Among Dose, Effectiveness, and Side Effects

Maternal Hyperoxygenation for the Treatment of Fetal Growth Retardation

Maternal hyperoxygenation has been demonstrated to improve fetal pO2, and was suggested as a treatment for intrauterine growth retardation. Our initial results with such treatment are presented. Four patients with fetal growth retardation were continuously treated with oxygen enriched air breathed through a face mask. Growth retardation was determined by sonographic estimates of low weight, increased head to abdominal circumference ratio, oligohydramnios, and abnormal resistance to flow in the umbilical artery. In all cases prolongation of pregnancy has become possible, doppler flow parameters have improved, and the immediate perinatal outcome was good. Additional clinical experience, with maternal hyperoxygenation, is needed before its usefulness in the treatment of intrauterine growth retardation can be determined.

Low-dose aspirin in prevention and treatment of intrauterine growth retardation and pregnancy-induced hypertension

International Journal of Gynecology & ObstetricsVolume 43, Issue 1 p. 91-91 Citations from the literature diseases in pregnancy Low-dose aspirin in prevention and treatment of intrauterine growth retardation and pregnancy-induced hypertension F. Parazzini, F. ParazziniSearch for more papers by this authorC. Benedetto, C. BenedettoSearch for more papers by this authorT. Frusca, T. FruscaSearch for more papers by this authorG. Gregorini, G. GregoriniSearch for more papers by this authorL. Bocciolone, L. BoccioloneSearch for more papers by this authorL. Marozio, L. MarozioSearch for more papers by this authorM. Romero, M. RomeroSearch for more papers by this authorV. Danesino, V. DanesinoSearch for more papers by this authorG. De Gaetano, G. De GaetanoSearch for more papers by this authorA. Gastaldi, A. GastaldiSearch for more papers by this authorM. Massobrio, M. MassobrioSearch for more papers by this authorG. Remuzzi, G. RemuzziSearch for more papers by this authorG. Tognoni, G. TognoniSearch for more papers by this authorS. Guaschino, S. GuaschinoSearch for more papers by this authorC. Bianchi, C. BianchiSearch for more papers by this authorA. Valcamonico, A. ValcamonicoSearch for more papers by this authorM. Giambuzzi, M. GiambuzziSearch for more papers by this authorD. Ammendola, D. AmmendolaSearch for more papers by this authorF. Casucci, F. CasucciSearch for more papers by this author F. Parazzini, F. ParazziniSearch for more papers by this authorC. Benedetto, C. BenedettoSearch for more papers by this authorT. Frusca, T. FruscaSearch for more papers by this authorG. Gregorini, G. GregoriniSearch for more papers by this authorL. Bocciolone, L. BoccioloneSearch for more papers by this authorL. Marozio, L. MarozioSearch for more papers by this authorM. Romero, M. RomeroSearch for more papers by this authorV. Danesino, V. DanesinoSearch for more papers by this authorG. De Gaetano, G. De GaetanoSearch for more papers by this authorA. Gastaldi, A. GastaldiSearch for more papers by this authorM. Massobrio, M. MassobrioSearch for more papers by this authorG. Remuzzi, G. RemuzziSearch for more papers by this authorG. Tognoni, G. TognoniSearch for more papers by this authorS. Guaschino, S. GuaschinoSearch for more papers by this authorC. Bianchi, C. BianchiSearch for more papers by this authorA. Valcamonico, A. ValcamonicoSearch for more papers by this authorM. Giambuzzi, M. GiambuzziSearch for more papers by this authorD. Ammendola, D. AmmendolaSearch for more papers by this authorF. Casucci, F. CasucciSearch for more papers by this author First published: October 1993 https://doi.org/10.1016/0020-7292(93)90287-7Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume43, Issue1October 1993Pages 91-91 RelatedInformation

Effect of transamniotic administration of epidermal growth factor on fetal rabbit small intestinal nutrient transport and disaccharidase development

As fetal swallowing is documented in utero, supplementation of the ingested amniotic fluid with nutrients or hormones has been postulated as a potential prenatal treatment for intrauterine growth retardation (IUGR). To study the effect of epidermal growth factor (EGF) on the developing fetal small intestine, 12 pregnant rabbits underwent operation on day 24 of a normal 31-day gestation. Bilateral ovarian end fetuses underwent catheterization of their respective amniotic cavities with attachment to a miniosmotic pump. Study fetuses received recombinant human EGF at approximately 300 micrograms/kg/d for 1 week; controls received carrier solution only at an equivalent rate. On gestational day 31, fetuses were delivered by cesarean section and somatic measurements were recorded. The small intestine was harvested and proximal, middle, and distal regions were analyzed for lactase and maltase enzyme activity. Additionally, the uptake of radiolabeled glucose and proline was measured by a standard everted mucosal sleeve technique for each segment. Results were analyzed by Student's paired t test and reported as mean +/- SEM. Nine fetal pairs survived (75%). Small intestinal (SI) length was increased in EGF fetuses (54.8 +/- 1.9 cm) versus control (50.4 +/- 2.7 cm) (P = .02). Lactase activity, reported as UE/g protein, was significantly increased in the proximal segments in the EGF-infused fetuses; maltase was significantly increased in both the proximal and middle segments (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Low-Dose Aspirin in Prevention and Treatment of Intrauterine Growth Retardation and Pregnancy-Induced Hypertension

Low-Dose Aspirin in Prevention and Treatment of Intrauterine Growth Retardation and Pregnancy-Induced Hypertension

Low-dose aspirin in prevention and treatment of intrauterine growth retardation and pregnancy-induced hypertension

Meta-analysis of data from several controlled trials has shown that low-dose aspirin reduces the risk of pregnancy-induced hypertension (PIH) and intrauterine growth retardation (IUGR) in women at high risk of these disorders. We have assessed the efficacy of low-dose aspirin in women judged to be at moderate risk.Women were included on prophylactic criteria— age under 18 or over 40 years, mild or moderate chronic hypertension (diastolic pressure between 90 and 110 mm Hg), nephropathy with normal renal function and blood pressure, history of PIH or IUGR, and twin pregnancy—or therapeutic criteria—PIH or early signs of IUGR in current pregnancy. Eligible women were randomly assigned treatment with 50 mg aspirin daily until delivery (583) or no treatment (523); 18 and 46 women, respectively, were lost to follow-up. The groups were well matched for baseline characteristics. We found no differences between the no-treatment and aspirin groups in numbers of spontaneous (5 vs 2) or therapeutic (1 vs2) abortions, stillbirths (14 vs 13), perinatal mortality (35·7 vs 28·6 per 1000 births), mean birthweight (2858 [SD 729] vs 2874 [795] g), proportion of infants with birthweights below the 10th centile (95 [18·3%] vs 117 [19·0%]), or births before 37 weeks' gestation (184 [35·6%] vs 209 [33·9%]). Nor did the groups differ in the frequency of PIH with or without proteinuria (51 [15·2%] vs 81 [19·3%]). There was no difference in mean birthweight between the treatment groups in separate analyses according to criteria for trial entry and week of gestation at randomisation.Our study gives little support to the notion that low-dose aspirin is beneficial in women at moderate risk of PIH or IUGR.

Maternal hyperoxygenation in the treatment of intrauterine growth retardation

In the current study the efficacy of maternal hyperoxygenation on growth-retarded fetuses was evaluated. Thirty-six pregnant women with intrauterine growth retardation were studied. The patients were divided in oxygen-treated (n = 17) and untreated (n = 19) groups. Doppler analysis of the fetal circulation was performed on the arrival to the hospital, after 12 hours, and thereafter on alternate days until delivery. Fetal blood was sampled by cordocentesis for immediate blood gas analysis at entrance to the study and the day of delivery. Significant improvement in Doppler flow patterns in treated patients were found when compared with untreated women. The Doppler variations were associated with complementary modifications in fetal blood gas. These differences resulted in a significant modification in perinatal mortality with an incidence of 29% and 68% (p less than 0.01) in treated and untreated groups, respectively. Our data suggest a benefit of maternal hyperoxygenation in the treatment of fetal growth retardation.

Upregulation of nutrient transport in fetal rabbit intestine by transamniotic substrate administration

Delivery of nutrients to the developing fetal gastrointestinal tract has been advocated as a potential prenatal treatment for intrauterine growth retardation. To examine the effect of intrauterine nutrient administration on the uptake capacity of the intestine, 16 maternal rabbits underwent bilateral ovarian-end transamniotic catheter placement on gestational Day 24. Study fetuses received a galactose solution; the contralateral controls received mannitol, a physiologically inert carbohydrate. Infusions were continued until Day 30 when an everted sleeve technique was used to measure radiolabeled uptake of both galactose and glucose in the proximal, middle, and distal small intestine. Mucosal scrapes were obtained, weighed, and the percentage of weight was calculated. Results were analyzed by ANOVA and Student's t test with P < 0.05 being considered significant. There were 2 maternal deaths with 11 fetal pairs surviving (79%). There was increased uptake of galactose in the study fetuses compared to controls reaching significance in the middle and distal segments. Similarly, glucose uptake was significantly increased in the proximal and distal segments. Mucosal weight was increased in all regions, reaching significance in the proximal segment. Total intestinal uptake of galactose and glucose was significantly increased in the study fetuses compared to controls. Intraamniotic galactose infusion caused not only upregulation of its own mucosal transport but also that of glucose, along the entire fetal small intestine, achieving statistical significance particularly in distal segments. Fetal implications for transamniotic feeding are under investigation.

Uptake and distribution of continuously infused intraamniotic nutrients in fetal rabbits

Nutrient delivery via the fetal gastrointestinal tract may be a potential prenatal treatment for intrauterine growth retardation. Uptake from continuous intraamniotic infusions with nutrient incorporation into developing fetal tissues has not previosly been shown. To study this, ovarian-end fetuses of 18 time-mated rabbit does underwent amniotic cavity catheterization and either esophageal ligation (EL) or sham operation (SH) on gestational day 23 (term, 33 days). Saline plus 14C D-glucose and 3H proline were infused into the amniotic fluid for 4 days. Nutrients absorbed by the EL fetus represent only those taken up into the maternal circulation and subsequently redelivered hematogenously to the fetus. Radioactivity of fetal blood and organs was determined using a liquid scintillation counter. All infused does and 10 of 18 infused fetuses (56%) survived the entire study period. In SH fetuses, uptake of 14C per mg of tissue was highest in the lung and significantly greater in the stomach, jejunum, ileum, and lung than in fetal blood ( P < .05). Uptake of 3H per mg of tissue was also highest in the lung and significantly greater than fetal blood in the stomach, small intestine, lung, and liver ( P < .05). Each organ's 14C and 3H uptake was greater in SH than in EL fetuses ( P < .001). The authors conclude that (1) developing rabbit fetuses swallow infused nutrients, which appear to be transported the length of the small intestine; (2) nutrients absorbed from the fetal intestine are concentrated into fetal tissues; and (3) only 1 5 th to 1 20 th of incorporated nutrients can be attributed to absorption from the amniotic cavity into the maternal circulation with subsequent redelivery to the fetus via the umbilical vein.

Fetal rabbit intestinal absorption: Implications for transamniotic fetal feeding

Delivery of nutrients to the fetus via the developing gastrointestinal tract has been advocated as a potential prenatal treatment for intrauterine growth retardation. Previous studies have demonstrated significant increases in fetal length and weight following continuous intraamniotic nutrient infusions in animals. The ideal composition of intraamniotic feedings has yet to be determined. Thirteen time-mated rabbit does underwent cesarean section between gestational days 27 and 33 to deliver 54 fetuses. The everted intestinal sleeve technique was used to measure radiolabeled carbohydrate and amino acid uptake rates from 1-cm segments of midjejunum. Uptake of galactose was more than double that of glucose and fructose. Active uptake of glucose, fructose, and galactose increased by 3.3-fold, 6.2-fold, and 2.1-fold, respectively, during the final 7 days of gestation when expressed as uptake per mg intestine. In contrast, uptake of the amino acids leucine, lysine, and proline decreased by 41%, 34%, and 17%, respectively, during the final 5 days of gestation. The demonstrated changes in intestinal absorption and nutrient delivery in the rabbit model, during the last days of gestation, suggest that certain substrates are absorbed more rapidly than others. Galactose may be the preferred intraamniotic carbohydrate for fetal growth.

Prenatal diagnosis and treatment of intrauterine growth retardation.

Prenatal treatment consisting of daytime bedrest, high protein diet and oral administration of allylestrenol was assessed in a prospective study of 30 patients with IUGR infants whose ultrasonically estimated body weight was less than the 10th percentile. In these pregnancies, the gestational age was confirmed in the first trimester, and the fetal weight was estimated from the BPD and AC measurements in the third trimester (Fig. 1). Following treatment, ultrasonic and biochemical determinations were performed. As results: The estimated fetal weight of 1,362 g at 32.9 g gestational weeks increased to 2,678 g at 39.2 weeks on average. The average weekly weight gain was significantly higher than the standard, and 16 cases (53.3%) were more than 10th percentile at birth (Tab. I, Fig. 2). A significant correlation (r = 0.94) between the estimated fetal weight and the birth weight was found. Following prenatal treatments, maternal plasma and urinary estriol, plasma HPL and progesterone increased significantly (Tab. II).