Delay in growth and fetal development - Causes, symptoms and treatment. MF.

The delay in fetal development is the intrauterine lag of the fetal physical development.

These babies are very often called "small".In 30% of cases, they are born as a result of premature birth( up to 37 weeks of gestation) and only in 5% of cases with full term pregnancy( 38-41 weeks).

There are two main forms of intrauterine fetal development delay( abbreviated as VZRP): symmetrical and asymmetric. How do they differ from each other?

If the fetus has a body weight deficit, it lags along the length of growth and the head circumference from the prescribed normal indices for a given gestational age, then the symmetrical form of the RVRP is diagnosed.

Asymmetric form of IVF is observed in those cases when the fetus, despite the lack of body weight, there is no lag from the normal parameters of the length of growth and the circumference of the head. The asymmetric form of the ballistic missile is more common than the symmetric form.

There are three degrees of severity of IWRP:

I degree - fetal lag for 2 weeks;
II degree - backlog for 2-4 weeks;
III degree - fetal development retardation more than 4 weeks.

What causes can lead to the development of the ZVRP?

If we talk about a symmetric mass transfer, then, as a rule, it arises from chromosomal abnormalities of the fetus, genetic disorders of metabolism, hypothyroidism of the thyroid gland and hypophyseal nanism. An important role is also played by viral infections( rubella, herpes, toxoplasmosis, cytomegalovirus).

The asymmetric form of the NVRP is caused by placental pathologies in the third trimester of pregnancy, or more precisely, fetoplacental insufficiency( abbreviated as FPN).FPN is a pathology in which the placenta can not fully supply the fetus with nutrients that circulate in the mother's blood. As a result, FPN can cause fetal hypoxia, that is, oxygen starvation.

FPN may occur due to: late gestosis, abnormalities of umbilical cord development, multiple pregnancy, placenta previa, placental vessels.

To provoke any form of ZVRP in the form of unfavorable external factors - taking medications, exposure to ionizing radiation, smoking, consumption of alcohol and drugs. Also, the risk of occurrence of an ARV is increased if there is an abortion in the history.

In many cases, the true cause of the ERP is never established.

Symptoms of growth retardation and development of the fetus

Unfortunately, the symptoms of IVF are sufficiently erased. It is unlikely that she will suspect herself of such a diagnosis. Only regular supervision at the obstetrician-gynecologist during all pregnancy helps in a timely manner to diagnose and cure ZVRP.

It is widely believed that if a pregnant woman adds a little weight during pregnancy, then most likely the fruit is small. In part this is true. However, this does not always correspond to the truth. Of course, if a woman limits her intake of food to 1500 calories per day and is addicted to diets, this can lead to an EWS.But ZVRP is also found among pregnant women, who, on the contrary, are experiencing too much weight gain. Therefore, this feature is not reliable.

In the event of a severe mild urinary tract, the expectant mother may be wary of rarer and lethargic fetuses than usual. This is the reason for an emergency appeal to a gynecologist.

Examination with fetal growth growth

When a pregnant woman is examined with an ARV, the doctor may be alerted to the inconsistency of the height of the standing of the uterine fundus with the norms of this period of pregnancy, that is, the uterus will be slightly smaller than the normal size.

The most reliable method of diagnosing an IVF is ultrasound examination of the fetus, during which the doctor examines the fetal head circumference, abdominal circumference, hip, estimated fetal mass. In addition, using ultrasound can determine how the internal organs of the fetus function.

If suspicion of an IVF is necessary, dopplerometric examination( a kind of ultrasound) is required to evaluate blood flow in the vessels of the fetus and the placenta.

An important method of investigation is the cardiotocography( CTG) of the fetus, which also makes it possible to suspect the disease. With the help of CTG, the heartbeat of the baby is recorded. Normally, the fetal heartbeat ranges from 120 to 160 beats per minute. If the fetus lacks oxygen, then the palpitation becomes more frequent or less severe.

Regardless of the length of the pregnancy and the severity of the disease, the IVF needs to be treated in any case to maintain the vital functions of the fetus. In some cases, if there is a small lag in the fetus from the norm( approximately 1-2 weeks according to ultrasound data), this should be considered as a variant of the norm or as a "propensity for an AMS."In this case, a dynamic observation is carried out.

Treatment for growth retardation and fetal development of the fetus

For the treatment of ZVRP in obstetrics, a large arsenal of medications is used that improve uterine-placental blood flow.

These include:

- tocolytic drugs that help to relax the uterus: beta-adrenomimetiki( Ginipral, Salbutamol), antispasmodics( Papaverin, No-shpa);
- infusion therapy with the appointment of glucose, blood-substitution solutions to reduce the viscosity of the blood;
- preparations for improving microcirculation and metabolism in tissues( Actovegin, Curantil);
- vitamin therapy( magnesium B6, vitamins C and E).

Drugs are prescribed for a long period with careful monitoring of CTG for fetal status.

Eating a pregnant woman with an IVF should be balanced. Food should contain proteins, fats and carbohydrates. Do not "lean" on certain products. You can eat and you need everything. Especially do not neglect meat and dairy products, because they contain the largest number of proteins of animal origin, the need for which increases by the end of pregnancy by 50%.

However, it should not be forgotten that the main goal of the treatment of ZVRP is not to "fatten" the child, but to provide him with normal growth and development. Therefore, there is no need for overeating.

Pregnant women recommend daily walks in the fresh air, emotional rest. Traditionally, it is believed that an after-dinner sleep( if there is a desire, of course) has a beneficial effect on the physical condition of the fetus and the mother.

Non-pharmacological methods of treatment of ZVRP apply hyperbaric oxygenation( inhalation of air enriched with oxygen) and medical ozone.

The issue of delivery in the event of an emergency response is topical. In each case, it should be addressed individually, based on the condition of the fetus according to ultrasound and CTG, as well as on the state of the mother's health. If there is no certainty that a weakened child can be born on his own, the preference is given to the cesarean section. In severe cases, the operation is performed in an emergency.

Complications of AHRS:

- intrauterine fetal death;
- hypoxia( oxygen starvation) of the fetus;
- fetal development abnormalities.

Prophylaxis of AMS:

- a healthy lifestyle, rejection of bad habits before the planned pregnancy;
- abortion;
- timely examination and treatment of infectious diseases in a gynecologist before the planned pregnancy.

Consultation of obstetrician-gynecologist on the topic of fetal growth retardation:

1. According to ultrasound, the placenta is too small, but the height, weight of the fetus and the circumference of the head correspond to the norm. The doctor said that I have FPN.Is it so?
No. Only on the basis of the size of the placenta such a diagnosis is not posed.

2. Is it possible to cure an MRSA if there is much?
Unless DHS is associated with chronic malnutrition. In other cases, balanced nutrition should be combined with basic treatment.

3. Does the weight of the fetus depend on the weight of the mother?
In part, the weight of the fetus depends on many factors, including the weight of the mother.

4. If parents of small height and weight, then the child should be small?
Most likely, and this is the norm. In such cases, they do not diagnose the ZVRP.

5. I was diagnosed with "fetal hypotrophy" by ultrasound. What does it mean?
Hypotrophy of the fetus and RVPP mean the same - the lag in the development of the fetus.

6. Do I have to go to hospital if I have an emergency response?
This should be decided by your obstetrician-gynecologist, based on the data of ultrasound and CTG in dynamics. In the case of IGR, I degree, if there are no signs of fetal hypoxia, there is no need for hospitalization. With ZVRP II or III degree, hospitalization is mandatory.

7. I am 35 weeks pregnant, but when examined, the height of the uterine fundus corresponds to 32 weeks. What is it? FAR?
Small errors are possible when the doctor measures the height of the uterine fundus. If there are no deviations in ultrasound and CTG, then everything is in order.

8. On the last ultrasound, I was told that the fetal abdominal circumference lags 3 weeks from the due date, but all other indicators are normal. Is it a mass destruction facility? Need to be treated?
Most likely, this is an individual feature of the fetus, if the other parameters are within the norm. If there are no deviations in Doppler and CTG, there is no ZVRP and there is no need for treatment.

9. What is the "count up to 10" test, which is recommended for ZVRP?
The "count to 10" test is a test for assessing fetal movements. It is recommended to all pregnant women from 28-30 weeks, and with ZVRP it is especially relevant. The woman needs to count the wiggling of the fetus in the interval from 9:00 am to 9:00 pm every day. In norm they should be 10 or more. If they are less, this indicates an oxygen starvation of the baby.

10. According to ultrasound, the child falls behind by 2 weeks. CTG and Doppler is normal. Do I need to be treated?
A slight lag in the parameters of the fetus for 1-2 weeks is possible and normal. It is necessary to look in dynamics.

Obstetrician-gynecologist, Ph. D.Christina Frambos.