Fetal growth restriction: Difference between revisions
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''' | '''''Fetal growth restriction''''' (FGR) or intrauterine growth restriction/retardation (IUGR ) is a condition where the fetus is unable to reach its genetically determined size (small as a result of a pathological process). The result can be a [[hypotrophic newborn]] (weight below the 10th percentile), but also a newborn with a normal birth weight (above the 10th percentile).<ref name="janota2013">{{Citace | typ = kniha| isbn = 978-80-204-2994-0| příjmení1 = Janota| jméno1 = Jan| příjmení2 = Straňák| jméno2 = Zbyněk| titul = Neonatologie| vydání = 1| místo = Praha| vydavatel = Mladá fronta| rok = 2013|strany = 207-217}}</ref> | ||
The causes can be diverse, the most common arise as a result of pathologies of the placenta. Compared to normally growing individuals, they have increased [[morbidity]] and [[mortality]] (10 times higher risk of perinatal mortality). There is no cure. We strive for primary prevention of risk factors on the part of the mother (cessation of smoking, regular examinations). The correct timing of childbirth also plays an important role.<ref name="Rennie5thChapter10">{{Citace | typ = kniha| příjmení1 = Rennie| jméno1 = JM| kolektiv = ano| titul = Textbook of Neonatology| vydání = 5| vydavatel = Churchill Livingstone Elsevier| rok = 2012| strany = | |||
|isbn = 978-0-7020-3479-4}}</ref> | |isbn = 978-0-7020-3479-4}}</ref> | ||
== | ==Pathophysiology== | ||
[[Soubor:Fetal circulation.png|náhled|[[Krevní oběh plodu]]]] | [[Soubor:Fetal circulation.png|náhled|[[Krevní oběh plodu]]]] | ||
Centralization of blood circulation occurs during hypoxia. This can cause ischemic damage to the intestine and the development of [[necrotizing enterocolitis]], educed renal flow is often responsible for [[oligohydramnios]], impaired lung growth for chronic lung diseases. Shortening of femur length at the beginning of the second trimester is an early indicator of growth restriction. | |||
''Venous return is also affected'' (''flow through the ductus venosus'' increases during hypoxia). The consequence of this is a decrease in blood flow to the liver, which leads to damage to their functions and a breakdown in glycogen formation (slowing down the growth of the abdominal circumference). Reduced or absent flow in ''the ductus venosus'' during atrial systole is a late indicator of cardiac failure leading to intrauterine fetal death.<ref name="Rennie5thChapter10" /> | |||
== | ==Risk factors for FGR/IUGR== | ||
The physiological growth of the fetus requires an adequate supply of oxygen and nutrients mediated by the placenta. Disruption of placental regulation by endocrine agents can also limit fetal growth and development. | |||
* ''' | * '''From the side of the fetus''': [[Chromozomal aberation]], [[Congenital developmental defects|congenital development defects]], [[genetically determined diseases]], [[fetal infection]], multiple pregnancies. | ||
* ''' | * '''From the mother's side''': Obstetric history (FGR/IUGR, miscarriage, premature birth), short interval between pregnancies, [[malnutrition]], [[smoking]], [[alcoholism]], [[drugs]], [[psychopharmaceuticals]], psychiatric disease, excessive stress, [[IBD]], chronic hypertension, [[preeclampsia]], [[Diabetes mellitus in gravidity|gestational diabetes]], [[Sickle Cell Anemia|sickle cell anemia]], [[antiphospholipid syndrome]], [[Systemic Lupus Erythematosus (SLE)|systemic lupus erythematosus]], [[glomerulonephritis]], [[chronic renal failure]], [[Leiden Mutation|Leiden mutation]], [[COPD]], severe [[Bronchial asthma/PGS|bronchial asthma]] . | ||
* ''' | * '''From the side of the placenta''' (most common): [[Umbilical cord|Anomalies of the umbilical cord]], [[Gestational trophoblastic disease|tumors]], [[abruption of the placenta]], vascular malformation, [[thrombotic vasculopathy of the fetus]]. | ||
* ''' | * '''From the side of the uterus''': Abnormalities and developmental defects, [[assisted reproduction]]. | ||
* ''' | * '''Endocrine factors''': VEGF, PlGF, sFlt-1, PAPP-A, [[IGF]].<ref name="Rennie5thChapter10" /> | ||
==Důsledky== | ==Důsledky== | ||
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Pro diagnostiku konkrétní etiologie používáme rozdílná vyšetření (invazivní diagnostika strukturálních abnormalit, sérologie matky pro záchyt teratogenních infekcí, vyloučení strukturálních malformací na UZ apod.).<ref name="Rennie5thChapter10" /> | Pro diagnostiku konkrétní etiologie používáme rozdílná vyšetření (invazivní diagnostika strukturálních abnormalit, sérologie matky pro záchyt teratogenních infekcí, vyloučení strukturálních malformací na UZ apod.).<ref name="Rennie5thChapter10" /> | ||
<noinclude> | <noinclude> | ||
==Odkazy== | ==Odkazy== | ||
===Související články=== | ===Související články=== | ||
Revision as of 12:54, 8 April 2023
Fetal growth restriction (FGR) or intrauterine growth restriction/retardation (IUGR ) is a condition where the fetus is unable to reach its genetically determined size (small as a result of a pathological process). The result can be a hypotrophic newborn (weight below the 10th percentile), but also a newborn with a normal birth weight (above the 10th percentile).[1]
The causes can be diverse, the most common arise as a result of pathologies of the placenta. Compared to normally growing individuals, they have increased morbidity and mortality (10 times higher risk of perinatal mortality). There is no cure. We strive for primary prevention of risk factors on the part of the mother (cessation of smoking, regular examinations). The correct timing of childbirth also plays an important role.[2]
Pathophysiology
[[Soubor:Fetal circulation.png|náhled|Krevní oběh plodu]] Centralization of blood circulation occurs during hypoxia. This can cause ischemic damage to the intestine and the development of necrotizing enterocolitis, educed renal flow is often responsible for oligohydramnios, impaired lung growth for chronic lung diseases. Shortening of femur length at the beginning of the second trimester is an early indicator of growth restriction.
Venous return is also affected (flow through the ductus venosus increases during hypoxia). The consequence of this is a decrease in blood flow to the liver, which leads to damage to their functions and a breakdown in glycogen formation (slowing down the growth of the abdominal circumference). Reduced or absent flow in the ductus venosus during atrial systole is a late indicator of cardiac failure leading to intrauterine fetal death.[2]
Risk factors for FGR/IUGR
The physiological growth of the fetus requires an adequate supply of oxygen and nutrients mediated by the placenta. Disruption of placental regulation by endocrine agents can also limit fetal growth and development.
- From the side of the fetus: Chromozomal aberation, congenital development defects, genetically determined diseases, fetal infection, multiple pregnancies.
- From the mother's side: Obstetric history (FGR/IUGR, miscarriage, premature birth), short interval between pregnancies, malnutrition, smoking, alcoholism, drugs, psychopharmaceuticals, psychiatric disease, excessive stress, IBD, chronic hypertension, preeclampsia, gestational diabetes, sickle cell anemia, antiphospholipid syndrome, systemic lupus erythematosus, glomerulonephritis, chronic renal failure, Leiden mutation, COPD, severe bronchial asthma .
- From the side of the placenta (most common): Anomalies of the umbilical cord, tumors, abruption of the placenta, vascular malformation, thrombotic vasculopathy of the fetus.
- From the side of the uterus: Abnormalities and developmental defects, assisted reproduction.
- Endocrine factors: VEGF, PlGF, sFlt-1, PAPP-A, IGF.[2]
Důsledky
- Perinatální: úmrtí plodu.
- Neonatální: syndrom dechové tísně (RDS), srdeční selhání, akutní renální selhání, hypoglykémie (v důsledku snížených zásob glykogenu), hyperglykémie (při nízké produkci inzulinu u velmi nezralých novorozenců), hypotermie (malé tukové zásoby),hypoxicko-ischemická encefalopatie, křeče polycytémie, hyperviskózní syndrom, trombocytopenie, hyperbilirubinémie, potravinové intolerance, nekrotizující enterokolitida, koagulopatie, infekční komplikace, vrozené vývojové vady, adrenální insuficience, úmrtí novorozence.
- Dlouhodobé: bronchopulmonální dysplázie, opoždění vývoje kognitivních funkcí, dětská mozková obrna.
- V dospělosti: diabetes mellitus 2. typu, obezita, hypertenze, dyslipidémie, onemocnění srdce, infarkt, bronchitida, předčasná menopauza.[2]
Diagnostika
Provádí se v 36. týdnu těhotenství.
Provedeme biometrii plodu (určení velikosti a hmotnosti). Určíme dopplerovské průtokové parametry, změřením pulzatilního indexu (a. cerebri media, a. umbilicalis, ductus venosus a aa. uterinae). Následně posuzujeme naměřené hodnoty a vytváříme biofyzikální profil plodu. To nám poskytne informace o případných rizicích. A na základě toho můžeme plánovat další postup (včetně předčasného ukončení těhotenství).
Pro diagnostiku konkrétní etiologie používáme rozdílná vyšetření (invazivní diagnostika strukturálních abnormalit, sérologie matky pro záchyt teratogenních infekcí, vyloučení strukturálních malformací na UZ apod.).[2]
Odkazy
Související články
Reference
Kategorie:Pediatrie
Kategorie:Neonatologie
Kategorie:Porodnictví
