- Intrauterine growth retardation/fetus small for gestational age: diagnostic criteria and management algorithm
Intrauterine growth retardation/fetus small for gestational age: diagnostic criteria and management algorithm
HEALTH OF WOMAN. 2019.7(143): 25–30; doi 10.15574/HW.2019.143.25
S.I. Zhuk1, N.V. Pehno2, O.A. Nochvina3
1Shupyk National Medical Academy of Postgraduate Education, Kiev
2Kyiv City Maternity Hospital No. 2
3Mother and Child Center, Vinnytsia
The article presents data on the informative value of instrumental research methods in the management of patients with IUGRP/MGHP, in particular, a dopplerometric examination of the blood flow of the uteroplacental-fetal complex, together with a cardiotocographic study by the Dose–Redman method. The diagnostic value of blood flow indicators in the umbilical artery, middle cerebral artery and venous duct, depending on the term of pregnancy, is analyzed.
Thus, observation of a fetus with IUGR diagnosed in early terms of pregnancy up to 32 weeks should include dopplerometry of the venous duct, since the highly resistant blood flow in it (IP> 95%) characterizes the initial changes in the fetus, while zero or reverse blood flow in this a vessel indicates the presence of acidosis and the risk of fetal death.
Critical of pregnancy management with a late type of IUGR is the appearance of abnormal blood flow in the middle cerebral artery (SMA). At the same time, a decrease in resistance in SMA (IP <5%) with IUGR diagnosed in later terms increases the risk of adverse perinatal consequences and the need for caesarean section, and a decrease in cerebroplacental ratio worsens perinatal consequences. CTG with IUGR must be carried out as part of antenatal care to monitor fetal condition in combination with dopplerometry of the uteroplacental-fetal complex.
The developed and implemented scientifically based pregnancy management algorithm allows monitoring the course of the gestational period, predicting the pathological condition of the fetus with timely consideration of the issue of early delivery. The widespread introduction of this algorithm will significantly reduce perinatal morbidity and mortality and improve the quality of obstetric care.
Key words: intrauterine growth retardation, fetus small for gestational age, antenatal fetal monitoring.
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