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Treatment of Intra Uterine Growth Restriction / Fetal Growth Restriction
The treatment of Intra Uterine Growth Restriction/Fetal Growth Restriction is to be strictly done by an obstetrician trained in this speciality. The decisions taken by the obstrician are guided by the different blood test reports, ultrasound and colour doppler imaging studies. The treatment also depends on the gestational age of the fetus and the severity if the Intra Uterine Growth Restriction/Fetal Growth Restriction, maternal diseases like diabetes, hypertension, heart, and kidney disease etc. also need appropriate treatment at the same time.
The final treatment is always individualized and is tailor made based on the exact needs of the mother and baby.
Indentification of Pregnancies at risk of Intra Uterine Growth Restriction/Fetal Growth Restriction
Past history of patient
The patient should reveal past history of low birth weight babies or preterm babies in the past. Also any medical disorders that she has should be revealed to the doctor.
Patients undergoing preconceptional counseling have the best chance of treating any underlying cause of Intra Uterine Growth Restriction / Fetal Growth Restriction. However 40% Of Fetal Growth Restriction occurs in women without any known high-risk factors.
Poor maternal weight gain
Poor maternal weight gain is an insensitive sign of inadequate betel growth. However this may be the only tool in a poor setting like in remote villages.
It is a generalized practice to assess fetal growth by ultrasound if the maternal weight gain during pregnancy is poor.
Discordance between gestational age and uterine size
Measurement of uterine height is a simple method of estimate the fetal growth and identity women at risk of Fetal Growth Restriction in low risk population.
Inability to assess uterine growth during pregnancy
Evaluation of uterine height is difficult to obsess and overweight patients. Similar difficulties may arise in case of malpresentation , polyhydranmios, multifetal pregnancies.
Identifications of medical disorders
Disorders like preeclampsia, diabetes, anaemia, cardic and kidney disease, etc can be identified.
Ultrasound and colour Doppler
The ultrasound examination is the gold standard in the identification of Intra Uterine Growth Restriction/Fetal Growth Restriction. This helps in understanding the exact anatomy of the fetus and the placenta. It gives us an estimated fetal weight which can be assessed by serial ultrasound examination and guides the Obstetrician in making important decisions.
Colour Doppler in addition to ultrasound helps in measuring the blood flow in uterus (mother), fetus (baby) and the placental vessels (bridge between mother and fetus) the colour Doppler study also give the obstetrician vital information that guides the treatment of these delicate fetuses and also helps in making decision about delivery.
Intra Uterine Growth Restriction / Fetal Growth Restriction (simply called Low Birth Weight) affects roughly 10-20% of all births. Low Birth Weight (LBW) is a major problem in India. As per a survey in 2003, 3 million LBW babies are born annually in India and it accounts for nearly half of the neonatal deaths.
Internationally, 2500 Gms is considered as a cut off weight below which LBW is defined. However, some Pediatricians and obstetricians accept cutoff birth weights below 2250 Gms as being appropriate to the Indian population
Maternal, placental, and fetal conditions associated with fetal growth restriction
Maternal causes
Preeclampsia
Chronic hypertension
Chronic renal disease
Connective tissue disorder
Diabetes
Sickle cell anemia
Cardiac disease
Multifetal gestation
Severe malnutrition
Smoking
Alcohol ingestion
Hemoglobinopathies
Placental causes
Abnormal placentation
Chronic villitis
Placental infarcts
Placental hemangiomas
Chorioangiosis
Hemorrhagic endovasculitis
Placenta previa
Fetal
Chromosomal abnormalities
Multifactorial defects
Inborn errors of metabolism
Infections
INTRA UTERINE GROWTH RESTRICTION
The fetus requires several vital substances for normal growth. The most important of this are oxygen, glucose, and amino acid
The placenta forms the bridge between the mothers (i.e. mother’ uterus) and the fetus growing inside her womb. This placenta helps in the exchange (incoming and outgoing) of the vital substances mentioned above. Thus, it is of great importance that the mother’s placenta functions optimally.
Oxygen crosses the placenta by simple diffusion and is necessary for the formation of chemical energy in the form an energy releasing molecule called ATP. Glucose crosses the placenta by facilitated diffusion and its concentration in the fetus is determined by the maternal plasma glucose levels. Glucose helps in production of energy and in the provision of carbon-building blocks for the synthesis of lipids, glycogen, nudeotides and other building blocks of life. Amino acids cross the placenta by active transport and are essential for the synthesis of proteins. Any persistent decrease in the availability of these vital substances will limit the ability of the fetus to reach his/her growth potential. A severe deficiency of these vital substances may threaten the ability of the fetus to survive. A variety of different diseases affecting the mother, fetus and placenta are responsible for limiting the availability of these substances to the fetus.