Υπολειπόμενη Ανάπτυξη Εμβρύου (IUGR) Η συμβολή της μαίας / μαιευτή στη διαχείριση μιας κύησης με Υπολειπόμενη Ανάπτυξη του Εμβρύου
Περίληψη
Εισαγωγή:O όρος Ενδομήτρια Καθυστέρηση της Ανάπτυξης (IUGR), αναφέρεται σε ένα έμβρυο που αποτυγχάνει να φτάσει τη γενετικά καθορισμένη ανάπτυξή του. Αφορά περίπου το 5%-10% του συνόλου των κυήσεων και αποτελεί σημαντική αιτία περιγεννητικής θνησιμότητας και νοσηρότητας. Η υποψία IUGR τίθεται, όταν το εκτιμώμενο βάρος -υπερηχογραφικά- βρίσκεται κάτω από τη 10η εκατοστιαία θέση, για την ηλικία κύησης. Οι παράγοντες που επηρεάζουν την ενδομήτρια ανάπτυξη και αποτελούν δυνητικά αίτια για IUGR μπορεί να προέρχονται: από την μητέρα, το έμβρυο ή το πλακούντα ή/και τον ομφάλιο λώρο.
Σκοπός:Σκοπός της παρούσας βιβλιογραφικής ανασκόπησης είναι η ανάδειξη των πρόσφατων δεδομένων σχετικά με την επιπλεγμένη με IUGR κύηση. Επιπρόσθετα, διερευνάται ο ρόλος της μαίας-ευτή στη διαχείριση αυτών των κυήσεων.
Μέθοδοι: Πραγματοποιήθηκε ανασκόπηση της διεθνούς βιβλιογραφίας, μέσω αναζήτησης ερευνητικών μελετών, ανασκοπήσεων, μεταναλύσεων από βάσεις δεδομένων (MEDLINE, MEDCAPE, COCHRANE DATA BASE, PUBMED), καθώς και βιβλιογραφική ανασκόπηση ξενόγλωσσων και ελληνικών συγγραμμάτων και περιοδικών κυρίως της τελευταίας δεκαετίας.
Αποτελέσματα: Η Υπολειπόμενη Ανάπτυξη του Εμβρύου αποτελεί ένα μείζον πρόβλημα στη μαιευτική, όπου απαιτείται η έγκυρη διάγνωσή. Τα περισσότερα έμβρυα με IUGR, παρατηρούνται σε έγκυες χωρίς προδιαθεσιακούς παράγοντες. Πολυάριθμα πρωτόκολλα έχουν προταθεί για τη διάγνωση και την προγεννητική παρακολούθηση των IUGR εμβρύων, με κύριο στόχο να περιοριστεί ο κίνδυνος της εμβρυικής νοσηρότητας και θνησιμότητας.
Συμπεράσματα: . Αποτελεσματικά θεραπευτικά πρωτόκολλα στη διαχείριση του εμβρύου με IUGR δεν υπάρχουν, επιτυχία όμως θεωρείται, η μείωση της περιγεννητικής νοσηρότητας και θνησιμότητας. Αυτό επιτυγχάνεται με τη στενή παρακολούθηση, καθώς και την έγκαιρη και σωστή απόφαση για τοκετό. Οι μαίες-ευτές έχουν ύψιστο ρόλο, ως συνοδοιπόροι και συμμέτοχοι σε μία ομάδα διαχείρισης των κυήσεων αυτών. Απαιτείται συνεργασία, εκπαίδευση, δεξιότητες, για την κατάλληλη και έγκαιρη διευθέτηση των περιστατικών, ώστε να μειωθούν σημαντικά οι ενδεχόμενες επιπλοκές και να επιτευχθεί το βέλτιστο περιγεννητικό αποτέλεσμα.
Λέξεις κλειδιά
Αναφορές
l Qahtani, N., 2011. Doppler ultrasound in the assessment of suspected intra-uterine. Ann Afr Med, 10(4), pp. 266-71.
Balakrishna, R. & Teixeira, M., 2015. Early intervention for increased antenatal anxiety associated with foetal development risk. Community Pract, 88(4), pp. 42-6.
Barker, D. J., 2002. Fetal programming of coronary heart disease. Trends in Endocrinology & Metabolism, 1 November, 13(9), pp. 364-368.
Baschat, A. et al., 2007. Predictors of neonatal outcome in early-onset placental dysfunction. Obstetrics & Gynecology, February, pp. 253-61.
Baschat, A. & Weiner, C., 2000. Umbilical artery Doppler screening for detection of the small fetus in need of antepartum surveillance. American Journal of Obstetrics and Gynecology, 182(1(p.1)), pp. 154-8..
Baskett, T. et al.., 1987. Fetal biophysical profile and perinatal death. Obstet Gynecol, 70(3), pp. 357-60.
Beckmann, C. et al., 2002. Hypertension in Pregnancy. Στο: Obstetrics and Gynecology. Philadelphia: Lippincott, Williams & Wilkins.
Beker, R., 2006. Prenatal diagnosis. Στο: Obstetrics by Ten Teachers. London: Hodder Arnold.
Berkley, E., Chauhan, S., Abuhamad, A. & Committee, S. f. M.-F. M. P., 2012. Doppler assessment of the fetus with intrauterine growth restriction. Am J Obstet Gynecol., 206(4), pp. 300-8.
Bernstein, I. et al., 2000. Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. The Vermont Oxford Network.. American Journal of Obstetrics & Gynecology, January, 182(1), pp. 198-206.
Bilardo, C. et al., 2004. Relationship between monitoring parameters and perinatal outcome in severe, early intrauterine growth restriction.. Ultrasound Obstet Gynecol., 23(2), pp. 119-25.
Blickstein, I., Goldman, R. & Mazkereth, R., 2000. Risk for one or two very low birth weight twins: a population study.. Obstetrics & Gynecology , 96(3), pp. 400-402.
Burton, G., Woods, A., Jauniaux, E. & Kingdom, J., 2009. Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy. Placenta, June, 30(6), pp. 473-82.
Campbell, S, Thoms & A., 1977. Ultrasound measurement of the fetal head to abdomen circumference ratio in the assessment of growth retardation. British Journal of Obstetrics and Gynaecology, March, pp. 165-74.
Chamberlain, P. et al., 1984. Ultrasound evaluation of amniotic fluid volume. I. The relationship of marginal and decreased amniotic fluid volumes to perinatal outcome.. American Journal of Obstetrics and Gynecology, 150(3), pp. :245-9.
Chang, C. et al., 2007. Prenatal detection of fetal growth restriction by fetal femur volume: efficacy assessment using three-dimensional ultrasound.. Ultrasound in Medicine and Biology, 33(3), pp. 335-41.
Chang, C. et al., 2005. Fetal upper arm volume in predicting intrauterine growth restriction: a three-dimensional ultrasound study. Ultrasound in Medicine and Biology, 31(11), pp. 1435-9.
Chan, P. D. & Winkle, C. R., 2002. Current Clinical Strategies: Gynecology and Obstetrics 2002: With ACOG Guidelines. 6th επιμ. s.l.:Current Clinical Strategies Pub.
Chauhan, S. P., Gupta, L. M., Hendrix, N. W. & Berghella, V., 2009. Intrauterine growth restriction: comparison of American College of Obstetricians and Gynecologists practice bulletin with other national guidelines. American Journal of Obstetrics & Gynecology, 200(4), p. 409.e1–409.e6.
Chauhan, S. et al., 1999. Accuracy of sonographically estimated fetal weight with and without oligohydramnios. A case-control study.. The Journal of Reproductive Medicine , 44(11), pp. 969-973].
Chien, P. et al., 2000. How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intrauterine growth retardation and perinatal death? An overview.. BJOG, 107(2), pp. 196-208.
Chousawai, S. et al., 2012. he efficacy of rapid biophysical profile in predicting poor pregnancy outcomes in suspected intrauterine growth restriction fetuses : preliminary study. J Med Assoc Thai, 95(4), pp. 482-6.
Clerici, G., Luzietti, R., Narducci, P. & DiRenzo, G., 2003. Fetal cerebral blood flow. Ultrasound Rev Obstet Gynaecol, 3(2), pp. 111-116.
Cruz-Martinez, R. & Figueras, F., 2009. The role of Doppler and placental screening.. Best Practice & Research: Clinical Obstetrics & Gynaecology, 23(6), pp. 845-55.
Cunningham, F. et al., 2010. Teratology and medications that affect the fetus. Στο: F. Cunningham, et al. επιμ. Williams obstetrics. New York, NY: McGraw-Hill.
Cunningham, F. et al., χ.χ. Infectious Diseases. Στο: Williams Obstetrics. New York: McGraw-Hill , p. 2010a.
Davey, D. & MacGillivray, I., 1998. The classification and definition of the hypertensive disorders of pregnancy. American Journal of Obstentrics and Gynecology, 158(4), pp. 892-8.
Devoe, L. & Jones, C., 2002. Non-stress test: Evidence-based use in high-risk pregnancy. Clin Obstet Gynaeecol , 45(4), pp. 986-92.
Doubilet, P. M., Benson, C. B., Wilkins-Haug, L. & Ringer, S., 2003. Fetuses Subsequently Born Premature Are Smaller Than Gestational Age–Matched Fetuses Not Born Premature. Journal of Ultrasound, 1 April, 22(4), pp. 359-363.
Doyle, C., 2011. When delivery expectations change: the role nurses play in reducing parental stress. Nurs Womens Health, 15(6), pp. 465-9.
Duroseau, P. & Blakemore, K., 2002. Preconception counseling and prenatal care. Στο: B. Bankowski, et al. επιμ. The Johns Hopkins Manual of Gynecology and Obstetrics. Philadelphia: Lippincott Williams & Wilkins.
Ellison, J., Thomson, A., Walker, I. & Greer, I., 2003. Use of enoxaparin in a pregnant woman with a mechanical heart valve prosthesis. BJOG, 108(7), pp. 757-759.
Evertson, L., Gauthier, R., Schifrin, B. & Paul, R., 1979. Antepartum fetal heart rate testing. I. Evolution of the nonstress test. Am J Obstet Gynecol, 133(1), pp. 29-33.
Fairbrother, N. et al., 2017. The prevalence and incidence of perinatal anxiety disorders among women experiencing a medically complicated pregnancy. Archives of Women's Mental Health, 20(2), p. 311–319.
Firoozi, F. et al., 2012. Impact of maternal asthma on perinatal outcomes: a two-stage sampling cohort study. Eur J Epidemiol, 27(3), pp. 205-14.
Fong, K. et al., 1999. Prediction of perinatal outcome in fetuses suspected to have intrauterine growth restriction: Doppler US study of fetal cerebral, renal, and umbilical arteries. Radiology, 213(3), pp. 681-9.
Fowlie, A., 2004. Prenatal diagnosis. Στο: S. Arulkumaran, I. Symonds & A. Fowlie, επιμ. Handbook of Obstetrics & Gynecology. Oxford: Oxford University Press.
Gardosi, J., 2006. New definition of small for gestational age based on fetal growth potential. Hormone Research, 65(Suppl 3), pp. 15-8.
Gardosi, J., Mul, T., Mongelli, M. & Fagan, D., 1998. Analysis of birthweight and gestational age in antepartum stillbirths. British Journal of Obstetrics and Gynaecology, 105(5), pp. 524-30.
Gazala, E., Karplus, M., Liberman, J. & Sarov, I., 1985. The effects of maternal measles on the fetus. The Pediatric Infectious Disease Journal, Τόμος 4, pp. 203-204.
Gilbert, R., 2018. Toxoplasmosis and pregnancy. [Ηλεκτρονικό].
Gloeb, D., Sullivan, M. & Efantis, J., 1988. Human immunodeficiency virus infection in women: the effect of human immunodeficiency virus on pregnancy. American Journal of Obstetrics and Gynecology, Τόμος 159, p. 756.
Grivell, R., Dodd, J. & Robinson, J., 2009. The prevention and treatment of intrauterine growth restriction. Best Practice & Research Clinical Obstetrics & Gynaecology, December, 23(6), pp. 795-807.
Groom, K., Poppe, K., North, R. & McCowan, L., 2007. Small-for-gestational-age infants classified by customized or population birthweight centiles: impact of gestational age at delivery. American Journal of Obstetrics and Gynecology, 197(3), pp. 239.e1-5.
Gülmezoglu, M., de Onis, M. & Villar, J., 1997. Effectiveness of interventions to prevent or treat impaired fetal growth.. Obstetrical & Gynecological Survey, 52(2), pp. 139-49.
Hall, M. et al., 1985. The extent and antecedents of uncertain gestation. British Journal of Obstetrics and Gynaecology , 92(5), pp. 445-51.
HALL, M. H. et al., 1985. The extent and antecedents of uncertain gestation. BJOG: an international Journal of Obstetrics & Gynaecology, 92(5), pp. 445-451.
Hatch, E. E. et al., 2011. Preterm Birth, Fetal Growth, and Age at Menarche among Women Exposed Prenatally to Diethylstilbestrol (DES). Reproductive Toxicology, 31(2), pp. 151-157.
Helewa, M., Heaman, M., Robinson, M. & Thompson, L., 1993. Community-based home-care program for the management of pre-eclampsia: an alternative. CMAJ, 149(6), p. 829–834.
Holschneider, C., 2003. Surgical diseases & disorders in pregnancy. Στο: Current Obstetric & Gynecologic Diagnosis & Treatment. DeCherney. New York: Lange Medical Books.
Hume, O., 1972. Toxoplasmosis and pregnancy.. American Journal of Obstetrics and Gynecology, 114(5), pp. 703-15.
Jelks, A., Cifuentes, R. & Ross, M., 2007. Clinician bias in fundal height measurement. Obstetrics & Gynecology, 110(4), pp. 892-9.
JESPERSEN, C. S., LITTAUER, J. & SAGILD, U., 1977. MEASLES AS A CAUSE OF FETAL DEFECTS A Retrospective Study of Ten Measles Epidemics in Greenland. Acta Paediatrica, 66(3), pp. 367-372.
Jiang, H., Cao, L. & Chen, H., 2016. Blood folic acid, vitamin B12, and homocysteine levels in pregnant women with fetal growth restriction. Genetics and Molecular Research, December.15(4).
Jibodu, O. & Arulkumaran, S., 2000. Intrapartum fetal surveillance. Current Opinion in Obstetrics and Gynaecology, 12(2), pp. 123-127.
Kavle, J. & Landry, M., 2018. Addressing barriers to maternal nutrition in low- and middle-income countries: A review of the evidence and programme implications. Matern Child Nutr., 14(1).
Kinzler, W. & Kaminsky, L., 2007. Fetal growth restriction and subsequent pregnancy risks. Semin Perinatol., 31(3), pp. 126-34.
Leung, A., Sauve, R. & Davies, H., 2003. Congenital cytomegalovirus infection. J Natl Med Assoc, 95(3), pp. 213-8.
Mandruzzato, G. et al., 2008. Intrauterine restriction (IUGR).. Journal of Perinatal Medicine, 36(4), pp. 277-81.
Manning, F. A. et al., 1990. Fetal assessment based on fetal biophysical profile scoring. IV. An analysis of perinatal morbidity and mortality. American Journal of Obstetrics and Gynecology, 162(3), p. 703–709.
Manning, F. A., Morrison, I., Harman, C. R. & Menticoglou, S. M., 1990. The abnormal fetal biophysical profile score. V. Predictive accuracy according to score composition. American Journal of Obstetrics and Gynecology, 162(4), p. 918–927.
Manning, F. et al., 1985. Fetal assessment based on fetal biophysical profile scoring: experience in 12,620 referred high-risk pregnancies. I. Perinatal mortality by frequency and etiology. Am J Obstet Gynecol., 151(3), pp. 343-50.
Mari, G. et al., 2007. Middle cerebral artery peak systolic velocity: a new Doppler parameter in the assessment of growth-restricted fetuses. Ultrasound Obstet Gynecol, 29(3), pp. 310-6.
Medel, J. et al., 2008. Cervical preinduction and oligo-amnios. Ginecología y obstetricia de México Asociación Mexicana de Ginecología y Obstetricia., Τόμος 76, pp. 499-506.
Nawathea, A. & Davidbc, A. L., 2018. Prophylaxis and treatment of foetal growth restriction. Best Practice & Research Clinical Obstetrics & Gynaecology, March, Τόμος 49, pp. 66-78.
Newnham, J. et al., 1995. Low dose aspirin for the treatment of fetal growth restriction: a randomized controlled trial. Aust N Z J Obstet Gynaecol., 35(4), pp. 370-4.
Noor, S. et al., 2009. Pregnancy with fibroids and its and its obstetric complication.. Journal of Ayub Medical College Abbottabad, 21(4), pp. 37-40.
Perry, R., Mannino, B., Hediger, M. & Scholl, T., 1996. Pregnancy in early adolescence: are there obstetric risks?. The Journal of Maternal-Fetal & Neonatal Medicine, 5(6), pp. 333-9.
Pham, T. et al., 2006. Placental mesenchymal dysplasia is associated with high rates of intrauterine growth restriction and fetal demise: A report of 11 new cases and a review of the literature.. American Journal of Clinical Pathology, 1 July, 126(1), p. 67–78.
Platz, E. & Newman, R., 2008. Diagnosis of IUGR: Traditional Biometry. Seminars in Perinatology, June, 32(3), pp. 140-147.
Rahimian, J. & Varner, M., 2003. Disproportionate fetal growth. Στο: A. DeCheney & L. Nathan, επιμ. Current Obstetric & Gynecologic Diagnosis & Treatment. New York(NY): Lange Medical Books.
Rayburn, W. F., 2015. At-Risk Pregnancies. Obstetrics and Gynecology Clinics of North America, June, 42(2), p. xiii–xiv .
Reynolds, C., Mabie, W. & Sibai, B., 2003. Hypertencive States of Pregnancy. Στο: A. DeCherney & L. Nathan, επιμ. Current Obstetric & Gynecologic Diagnosis & Treatment. New York(NY): Lange Medical Books .
Richens, Y., 2001. New horizons on intrapartum electronic fetal monitoring. British Journal of Midwifery, 9(9), pp. 584-585.
Rosenberg, K., 2017. Aspirin Lowers the Risk of Preeclampsia. Am J Nurs, 10(62).
Ross, M. G., 2018. Fetal Growth Restriction. [Ηλεκτρονικό]
Available at: https://emedicine.medscape.com/article/261226-overview
Salafia, C., Charles, A. & Maas, E., 2006. Placenta and fetal growth restriction. Clinical Obstetrics and Gynecology, 49(2), pp. 236-56.
Salihu, H. et al., 2011. Impact of prenatal alcohol consumption on placenta-associated syndromes.. Alcohol, 45(1), pp. 73-79.
Sankaran, S. & Kyle, P., 2009. Aetiology and pathogenesis of IUGR. Best Practice & Research Clinical Obstetrics & Gynaecology, December, 23(6), pp. 765-777.
Saunders, N. & C, P., 1991. Can we abandon Naegele's rule?. Lancet, 337(8741), pp. 600-1.
Say, L., Gülmezoglu, A. & Hofmeyr, G., 2003. Hormones for suspected impaired fetal growth. Cochrane Database Syst Rev, Issue 1, p. CD000109.
Say, L., Gülmezoglu, A. & Hofmeyr, G., 2003. Maternal oxygen administration for suspected impaired fetal growth. Cochrane Database Syst Rev, Issue 1, p. CD000137.
Seeds, J., 1984. Impaired fetal growth: definition and clinical diagnosis. American Journal of Obstetrics and Gynecology, Τόμος 64, pp. 577-584.
Sibai, B., 1992. Management and counseling of patients with preeclampsia remote from term. Clin Obstet Gynaecol , 35(2), pp. 426-36.
Simchen, M. et al., 2004. The fetal cardiovascular response to antenatal steroids in severe early-onset intrauterine growth restriction. Am J Obstet Gynecol, 190(2), pp. 296-304.
Sperling, R. et al., 1992. HIV-1 seroprevalence in pregnant women testing positive on serologic screening for syphilis.. Mount Sinai Journal of Medicine, 59(1), pp. 67-68.
Symonds, E. & Symonds, I., 2004. Lesions of the Upper Genital . Στο: : Essential Obstetrics and Gynaecology. Edinburgh: Churchill Livingstone .
Teo, T. & Fisk, N., 1999. Hydramnios, oligohydramnios. Στο: D. James, P. Steer, C. Weiner & B. Gonik, επιμ. High Risk Pregnancy. Management options.. London: WB Saunders .
Torrance, H. et al., 2009. Is antenatal steroid treatment effective in preterm IUGR fetuses?. Acta Obstet Gynecol Scand, 88(10), pp. 1068-73.
Tulandi, T. & Al-Fozan, H. M., 2012. Spontaneous abortion: Risk factors, etiology, clinical manifestations, and diagnostic evaluation. [Ηλεκτρονικό]
Available at: https://www.uptodate.com/contents/spontaneous-abortion-risk-factors-etiology-clinical-manifestations-and-diagnostic-evaluation
Valsamakis, G., Kanaka-Gantenbein, C., Malamitsi-Puchner, A. & Mastorakos, G., 2006. Causes of intrauterine growth restriction and the postnatal development of the metabolic syndrome.. Annals of the New York Academy of Sciences, Τόμος 1092, pp. 138-47.
van Pampus, M. et al., 1999. High prevalence of hemostatic abnormalities in women with a history of severe preeclampsia.. American Journal of Obstetrics and Gynecology, 180(5), pp. 1146-50.
Weiner, C. & Baschat, A., 1999. Fetal growth restriction: evaluation and management. Στο: J. DK, S. PJ, W. CP & G. B, επιμ. High Risk Pregnancy. Management options. London: WB Saunders .
Wenstrom, K., 1999. Fetal tumors. Στο: D. James, P. Steer, C. Weiner & B. Gonik, επιμ. High Risk Pregnancy. Management options. London: WB Saunders.
Wildschut, H., 1999. Sociodemographic factor: Age, parity, social class and ethnicity. Στο: D. James, P. Steer, C. Weiner & G. B, επιμ. High Risk Pregnancy. Man-agement options. London: WB Saunders.
Wildschut, H., 2011. Maternal weight and weight (Constitutional and Environmental Factors Leading to a High Risk Pregnancy). Στο: D. James, et al. επιμ. High Risk Pregnancy. Management options.. s.l.:Saunders.
Williams, R. et al., 1982. Fetal growth and perinatal viability in California. Obstetrics and Gynecology , 59(5), pp. 624-632.
Winick, M., 1971. Cellular changes during placental and fetal growth. American Journal of Obstetrics & Gynecology, 1 January, 109(1), pp. 166-176.
Wong, R. J., Zhao, H. & Stevenson, D. K., 2012. A deficiency in haem oxygenase‐1 induces foetal growth restriction by placental vasculature defects. Acta Paediatrica, August, 101(8), pp. 827-834.
Woodring, T. et al., 2011. Prediction of placenta accreta by ultrasonography and color Doppler imaging.. Journal of Maternal-Fetal and Neonatal Medicine, 24(1), pp. 118-21.
Yoshida, S. et al., 2000. Prenatal detection of a high-risk group for intrauterine growth restriction based on sonographic fetal biometry. International Journal of Gynecology & Obstetrics, 68(3), pp. 225-32.
Πράπας, Ν., 2010. ΥπολειπόμενηΑνάπτυξηΕμβρύου. Στο: Κύηση υψηλού κινδύνου. Αθήνα: Ιατρικές Εκδόσεις Π. Χ. Πασχαλίδης, p. 288.
Σαλαμαλέκης, Ε., 1995. Κυήσεις Υψηλού Κινδύνου. Αθήνα: Ιατρικές Εκδόσεις Π. Χ. Πασχαλίδης.
Εισερχόμενη Αναφορά
- Δεν υπάρχουν προς το παρόν εισερχόμενες αναφορές.