Pregnancy management complicated by intrauterine growth restriction
Objective. To analyze the data available in the current literature on the problem of intrauterine growth restriction (IUGR), as well as to evaluate the existing various various guidelines devoted to pregnancy management in IUGR patients.Ganichkina M.B., Mantrova D.A., Kan N.E., Tyutyunnik V.L., Khachaturyan A.A., Ziganshina M.M.
Material and methods. We reviewed various sources of information published in Medline, Pubmed and other databases. 199 sources of information devoted to the investigation of pregnancy management in IUGR patients were found, 47 of them were included to this review.
Results. International theoretical and clinical aspects of pregnancy management in IUGR patients in are summarized in the review. Evidence-based medicine recommendations concerning optimization of management in IUGR women are also included.
Conclusion. Problem of the development of contemporary guideline based on Russian and international experience remains unsolved.
Keywords
intrauterine growth restriction
management
diagnostics
prophylaxis
treatment
References
1. Gardosi J., Madurasinghe V., Williams M., Malik A., Francis A. Maternal and fetal risk factors for stillbirth: population based study. BMJ. 2013; 346: f108.
2. Mayer C., Joseph K.S. Fetal growth: a review of terms, concepts and issues relevant to obstetrics. Ultrasound Obstet. Gynecol. 2013; 41(2): 136-45.
3. Anderson N.H., Sadler L.C., Stewart A.W., McCowan L.M. Maternal and pathological pregnancy characteristics in customised birthweight centiles and identification of at-risk small-for-gestational-age infants: a retrospective cohort study. BJOG. 2012; 119(7): 848-56.
4. Voskamp B.J., Kazemier B.M., Ravelli A.C., Schaaf J., Mol B.W., Pajkrt E. Recurrence of small-for-gestational-age pregnancy: analysis of first and subsequent singleton pregnancies in The Netherlands. Am. J. Obstet. Gynecol. 2013; 208(5): 374. e1-6.
5. Wijs L.A., de Graaff E.C., Leemaqz S., Dekker G. Causes of stillbirth in a socioeconomically disadvantaged urban Australian population – a comprehensive analysis. J. Matern. Fetal Neonatal Med. 2017; 30(23): 2851-7.
6. Resnik R., Lockwood C.J., Levine D., Barss V.A. Fetal growth restriction. Evaluation and management. UCSD School of Medicine; 2016. Available at: http://www.uptodate.com/contents/fetal-growth-restricition-evaluation-and-management?source=search_result&search=IUGR&selectedTitle=1%7E150
7. Макаров И.О., Юдина Е.В., Боровкова Е.И. Задержка роста плода. Врачебная тактика. М.: МЕДпресc-информ; 2016. [Makarov I.O., Yudina E.V., Borovkova E.I. Intrauterine growth restriction. Management. Moscow: MEDpress-inform; 2016. (in Russian)]
8. Стрижаков А.Н., Игнатко И.В., Тимохина Е.В., Белоцерковцева Л.Д. Синдром задержки роста плода. Патогенез. Диагностика. Лечение. Акушерская тактика. М.: ГЭОТАР-Медиа; 2012. [Strizhakov A.N., Ignatko I.V., Timohina E.V., Belotserkovtseva L.D. Fetal growth retardation. Pathogenesis. Diagnostics. Treatment. Obstetric tactics. Moscow: GEOTAR-Media, 2012. (in Russian)]
9. Figueras F. Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis and management. Am. J. Obstet. Gynecol. 2011; 204(4): 288-300.
10. Fernández-Blanco L., Peguero A., Eixarch E., Oltra M., Mazarico E., Gómez Roig M. et al. Pregnancy and perinatal outcomes in a cohort of second trimester intrauterine growth restricted (IUGR) fetuses. Ultrasound Obstet. Gynecol. 2016; 48(Suppl. 1):320.
11. Lausman A., Kingdom J.; Maternal fetal medicine committee. Intrauterine growth restriction: screening, diagnosis and management. J. Obstet. Gynaecol. Can. 2013; 35(8): 741-8.
12. Zelop C.M., Javitt M.C., Glanc P., Dubinsky T., Harisinghani M.G., Harris R.D. et al.; American College of Radiology. ACR Appropriateness Criteria® growth disturbances – risk of intrauterine growth restriction. Ultrasound Q. 2013; 29(3): 147-51.
13. Gardosi J., Figueras F., Clausson B., Francis A. The customised growth potential: an international research tool to study the epidemiology of fetal growth. Paediatr. Perinat. Epidemiol. 2011; 25(1): 2-10.
14. Savchev S., Figueras F., Sanz-Cortes M., Cruz-Lemini M., Triunfo S., Botet F., Gratacos E. Evaluation of an optimal gestational age cut-off for the definition of early- and late-onset fetal growth restriction. Fetal Diagn. Ther. 2014; 36(2): 99-105.
15. Unterscheider J., Daly S., Geary M.P., Kennelly M.M., McAuliffe F.M., O’Donoghue K. et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am. J. Obstet. Gynecol. 2013; 208(4): 290. e1-6.
16. Grivell R.M., Wong L., Bhatia V. Regimens of fetal surveillance for impaired fetal growth. Cochrane Database Syst. Rev. 2012; (6): CD007113.
17. Barker E.D., McAuliffe F.M., Alderdice F., Unterscheider J., Daly S., Geary M.P. et al. The role of growth trajectories in classifying fetal growth restriction. Obstet. Gynecol. 2013; 122(2, Pt 1): 248-54.
18. RCOG. Green-top Guideline no. 31. The investigation and management of the small–for–gestational–age fetus. 2014.
19. Sharma D., Sharma P., Shastri S. Genetic, metabolic and endocrine aspect of Intrauterine growth restriction: an update. J. Matern. Fetal Neonatal Med. 2016; 30(19): 2263-75.
20. ACOG Practice bulletin no. 134: fetal growth restriction. Obstet. Gynecol. 2013; 121(5): 1122-33.
21. Alfirevic Z., Stampalija T., Gyte G.M. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Syst. Rev. 2013; (11): CD007529.
22. O’Dwyer V., Burke G., Unterscheider J., Daly S., Geary M.P., Kennelly M.M. et al. Defining the residual risk of adverse perinatal outcome in growth-restricted fetuses with normal umbilical artery blood flow. Am. J. Obstet. Gynecol. 2014; 211(4): 420. e1-5.
23. Baschat A.A. Fetal growth restriction – from observation to intervention. J. Perinat. Med. 2010; 38(3): 239-46.
24. Stampalija T., Casati D., Monasta L., Sassi R., Rivolta M.W., Muggiasca M.L. et al. Brain sparing effect in growth-restricted fetuses is associated with decreased cardiac acceleration and deceleration capacities: a case-control study. BJOG. 2016; 123(12): 1947-54.
25. Simeone S., Pina Rambaldi M., Serena C., Ottanelli S., Mecacci F. D4. MCA/UtA ratio at first observation is associated with birthweight in late onset IUGR. J. Matern. Fetal Neonatal Med. 2016; 29(Suppl. 2): 19.
26. Levytska K., Higgins M., Keating S., Melamed N., Walker M., Sebire N.J., Kingdom J.C. Placental pathology in relation to uterine artery Doppler findings in pregnancies with severe intrauterine growth restriction and abnormal umbilical artery Doppler changes. Am. J. Perinatol. 2017; 34(5): 451-7.
27. Balcı S. Predictive values of maternal serum PAPP-A level, uterine artery Doppler velocimetry, and fetal biometric measurements for poor pregnancy and poor neonatal outcomes in pregnant women. J. Turk. Ger. Gynecol. Assoc. 2016; 17(3): 143-9.
28. Schenone M.H., Mari G. The MCA Doppler and its role in the evaluation of fetal anemia and fetal growth restriction. Clin. Perinatol. 2011; 38(1): 83-102.
29. Morales-Roselló J., Khalil A. Fetal cerebral redistribution: a marker of compromise regardless of fetal size. Ultrasound Obstet. Gynecol. 2015; 46(4): 385-8.
30. Regan J., Masters H., Warshak C.R. Estimation of the growth rate in fetuses with an abnormal cerebroplacental ratio compared to those with suspected growth restriction without evidence of centralization of blood flow. J. Ultrasound Med. 2015; 34(5): 837-42.
31. Khalil A.A., Morales-Rosello J., Elsaddig M., Khan N., Papageorghiou A., Bhide A., Thilaganathan B. The association between fetal Doppler and admission to neonatal unit at term. Am. J. Obstet. Gynecol. 2015; 213(1): 57. e1-7.
32. Khalil A.A., Morales-Rosello J., Morlando M., Hannan H., Bhide A., Papageorghiou A., Thilaganathan B. Is fetal cerebroplacental ratio an independent predictor of intrapartum fetal compromise and neonatal unit admission? Am. J. Obstet. Gynecol. 2015; 213(1): 54. e1-10.
33. Gordon A., Raynes-Greenow C., McGeechan K., Morris J., Jeffery H. Stillbirth risk in a second pregnancy. Obstet. Gynecol. 2012; 119: 509-17.
34. Morris R.K., Malin G., Robson S.C., Kleijnen J., Zamora J., Khan K.S. Fetal umbilical artery Doppler to predict compromise of fetal/neonatal wellbeing in a high-risk population: systematic review and bivariate meta-analysis. Ultrasound Obstet. Gynecol. 2011; 37(2): 135-42.
35. Maggio L., Dahlke J.D., Mendez-Figueroa H., Albright C.M., Chauhan S.P., Wenstrom K.D. Perinatal outcomes with normal compared with elevated umbilical artery systolic-to-diastolic ratios in fetal growth restriction. Obstet. Gynecol. 2015; 125(4): 863-9.
36. Najam R., Gupta S., Shalini. Predictive Value of cerebroplacental ratio in detection of perinatal outcome in high-risk pregnancies. J. Obstet. Gynaecol. India. 2016; 66(4): 244-7.
37. Vasconcelos R.P., Brazil Frota Aragão J.R., Costa Carvalho F.H., Salani Mota R.M., de Lucena Feitosa F.E., Alencar Júnior C.A. Differences in neonatal outcome in fetuses with absent versus reverse end-diastolic flow in umbilical artery Doppler. Fetal Diagn. Ther. 2010; 28(3):160-6.
38. Turan O.M., Turan S., Berg C., Gembruch U., Nicolaides K.H., Harman C.R., Baschat A.A. Duration of persistent abnormal ductus venosus flow and its impact on perinatal outcome in fetal growth restriction. Ultrasound Obstet. Gynecol. 2011; 38(3): 295-302.
39. Lees C.C., Marlow N., van Wassenaer-Leemhuis A., Arabin B., Bilardo C.M., Brezinka C. et al.; TRUFFLE study group. 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial. Lancet. 2015; 385(9983): 2162-72.
40. Berkley E., Chauhan S.P., Abuhamad A. Society for Maternal-Fetal Medicine Publications Committee. Doppler assessment of the fetus with intrauterine growth restriction. Am. J. Obstet. Gynecol. 2012; 206: 300-8.
41. Rodger M.A., Gris J.C., de Vries J.I., Martinelli I., Rey É., Schleussner E. et al. Low-molecular-weight heparin and recurrent placenta-mediated pregnancy complications: a meta-analysis of individual patient data from randomised controlled trials. Lancet. 2016, 388(10060): 2629-41.
42. Visser G.H., Bilardo C.M., Derks J.B., Ferrazzi E., Fratelli N., Frusca T. et al.; TRUFFLE group investigators. Fetal monitoring indications for delivery in 310 IUGR infants with 2 year’s outcome delivered before 32 weeks of gestation. Ultrasound Obstet. Gynecol. 2017; 50(3): 347-52.
43. Ажибеков С.А., Путилова Н.В., Третьякова Т.Б., Пестряева Л.А. Роль генетически детерминированных особенностей энергетического обмена в формировании плацентарной недостаточности с исходом в синдром задержки роста плода. Акушерство и гинекология. 2016; 11: 11-5. http://dx.doi.org/10.18565/aig.2016.11.11-5 [Azhibekov S.A., Putilova N.V., Tretyakova T.B., Pestryaeva L.A. Role of the inherited characteristics of energy metabolism in the development of placental insufficiency with an outcome to intrauterine growth restriction. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2016; (11): 11-5. (in Russian) http://dx.doi.org/10.18565/aig.2016.11.11-5]
44. Палади Г., Илиади-Тулбуре К., Табуйка У. Задержка роста плода: диагностика и оптимальный метод родоразрешения. Акушерство и гинекология. 2011; 5: 45-8. [Paladi G., Iliadi-Tulbure K., Tabuika U. Fetal growth retardation: diagnosis and an optimal delivery method. Akusherstvo i ginekologiya/Obstetrics and Gynecology. 2011; 5: 45-8. (in Russian)]
45. Groom K.M., McCowan L.M., Stone P.R., Chamley L.C., McLintock C.; EPPI trial Study Group. Enoxaparin for the prevention of preeclampsia and intrauterine growth restriction in women with a prior history – an open-label randomised trial (the EPPI trial): study protocol. BMC Pregnancy Childbirth. 2016; 16(1): 367.
46. Abalos E., Duley L., Steyn D.W. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst. Rev. 2014; (2): CD002252.
Received 24.01.2017
Accepted 17.02.2017
About the Authors
Ganichkina Maria B., postgraduate student of the Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79152397743. E-mail: mariaganichkina@yandex.ru
Mantrova Diana A., postgraduate student of the Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79096367259. E-mail: d-mantrova@yandex.ru
Kan Natalia E., PhD, MD, the head of the obstetric department, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79262208655. E-mail: kan-med@mail.ru. Researcher ID B-2370-2015. ORCID ID 0000-0001-5087-5946
Tyutyunnik Victor L., PhD, MD, the head of the obstetric physiological department, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79039695041. E-mail: tioutiounnik@mail.ru. Researcher ID B-2364-2015. ORCID ID 0000-0002-5830-5099
Khachaturyan Anyuta A., postgraduate student of the Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79096367259. E-mail: x.anyt37@mail.ru
Ziganshina Marina Mikhailovna, Ph.D. (Biology), senior researcher of the Laboratory of Clinical Immunology, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954381183. E-mail: mmz@mail.ru
For citations: Ganichkina M.B., Mantrova D.A., Kan N.E.,
Tyutyunnik V.L., Khachaturyan A.A., Ziganshina M.M. Pregnancy management
complicated by intrauterine growth restriction. Akusherstvo i Ginekologiya/
Obstetrics and Gynecology. 2017; (10): 5-11. (in Russian)
https://dx.doi.org/10.18565/aig.2017.10.5-11
Similar Articles
