Sometimes pregnancy is clouded by diagnoses that scare parents. One of these is "intrauterine growth retardation syndrome."

Fetal growth retardation is diagnosed only on the basis of ultrasound. It is determined if the fetus has less weight in comparison with the norms characteristic of its age. In medical practice, special tables are used in which the norms for the size of the fetus are described according to its gestational age (gestational age is the age since fertilization, which is measured in weeks).

Roughly speaking, there are norms for each week of pregnancy. The unit of measure for such tables is percentile. And now, if the baby is less than 10 percentiles according to the table, then intrauterine fetal retention is diagnosed.

A baby can be born small for several reasons. The fact that such is his physiological feature ... Perhaps mom or dad is short and the baby inherited this from his parents. But even in this case, at a doctor's appointment, an intrauterine growth retardation is diagnosed.

Such a fact after childbirth is confirmed by the normal state of the child and the compliance of all reflexes of the newborn with the period at which the baby was born. Then the doctors state that the diagnosis of intrauterine growth retardation was associated with inherited genetics and this condition does not require treatment.

But there are reasons for delayed intrauterine development of the fetus, which can lead to fetal hypoxia, negative consequences of the development of the child after birth, and even the fading of pregnancy. Delayed fetal development is observed when the baby does not receive the proper amount of oxygen and nutrients , which play a major role in his life.

A decrease in the amount of substances and oxygen entering the fetus can be caused by the following factors:

• • violation of the development of the placenta or umbilical cord. The placenta may be located in the wrong place (diagnosis of "abnormal placenta previa"), be very small or flake off (diagnosis of "placental abruption");
  • diseases of the mother, which can interfere with the supply of essential substances for the normal development of the fetus. Such diseases include chronic high blood pressure, diseases of the cardiovascular system, anemia, chronic diseases of the respiratory tract;
  • plays a huge role in the development of the fetus chromosome set, which he receives from his parents at the time of conception. Sometimes it happens that there is a malfunction or abnormality in the chromosome set. So, for example, a disease occurs - Down's syndrome. Also, developmental pathologies such as kidney or abdominal wall defects can affect the overall development of the baby in the womb;
  • doctors around the world are talking about negative impact bad habits on the human body. Particular attention is paid to the body of a woman who, at least once, has to bear a child. Bad habits in a woman (even if she gets rid of them shortly before conception) can cause a delay in the intrauterine development of the fetus;

• transfer during pregnancy of such infectious diseases like rubella, syphilis, toxoplasmosis, cytomegalovirus can stop or slow down the development of the fetus. That is why it is so important to get vaccinated against infectious diseases even before conception (especially for women who work in hospitals, clinics and with children, because rubella is childhood disease) and be careful in choosing a sexual partner during pregnancy, if there is no permanent one;
• at every step the pregnant woman is told that she should eat for two... And indeed it is. If the baby lacks nutrients, then he draws them from the mother's body, thereby worsening her general well-being. But eating for two does not mean that you need to eat everything. Nutrition should be healthy and balanced. During pregnancy, you do not need to be afraid that you will gain weight, you cannot sit on diets. Only if you are diagnosed with a large fetus and the doctor himself prescribes the correct and useful diet in this case. Malnutrition leads to weight loss and developmental delay;
• medications during pregnancy are nullified for any type of disease. Their use is prescribed only in special cases, when nothing else can be helped. Self-administration of medications can lead not only to the development of pathologies in the fetus, but also to intrauterine growth retardation;
• multiple pregnancy can cause a lag in the development of one fetus or several at once. This happens because there are not enough nutrients for two or more fruits;
• intrauterine growth retardation syndrome is often diagnosed in women who live high above sea level... In such areas, there is increased pressure, and the fetus can suffer from hypoxia (lack of oxygen) for a long time, which also slows down development in the womb.
• often babies are born with low birth weight if childbirth occurs after 42 weeks pregnancy.

The consequences of intrauterine growth retardation

For 9 months, it is common for an expectant mother to worry about the health of her future baby. Scheduled examinations in the antenatal clinic are carried out in order to future mother and the doctor had the opportunity to realistically assess the situation and make a conclusion about the child's health.

Fear of abnormalities in the fetus most often causes these abnormalities. Stress is the first cause of developmental disabilities. The child feels everything. And there is also such an expression “thoughts materialize”. You need to think only positively, and if someone told you that intrauterine growth retardation is a horror, then do not believe it.

For every woman, pregnancy and childbirth take place individually. One with horror recalls 6 hours of the birth of a baby, and the other half an hour after birth tells her husband that she wants another child. Likewise with the diagnosis of "Delayed fetal development."

Yes, some difficulties and irregularities can arise during gestation and after the birth of a baby. But there are very few unsolvable problems with the level of today's medicine.

The degree of risk with such a diagnosis, first of all, depends on the cause of the phenomenon. So, if it is hereditary (parents of small stature), then the baby may be tiny, but with the normal development of all vital organs.

There is also a difference in the risk of problems depending on the degree of developmental disorder, the timing of pregnancy, when the diagnosis is made, and the period at which the baby is born.

The highest indicator of the degree of risk is reached by children who are born prematurely with a diagnosis of intrauterine growth retardation. Children born after such a diagnosis are more likely to develop diabetes mellitus, they are more sensitive than other children to infectious diseases and it is difficult for them to maintain their body temperature. This is why they are usually placed in special chambers after birth. This is a necessary measure to preserve the vital activity of the baby's organs, since the delay in development speaks not only of a low weight, but also an insufficient degree of development of vital organs.

Many babies who have been diagnosed with developmental delay in the womb, after a while, do not differ at all from their peers who were born with normal weight.

Children with this diagnosis are prone to fullness and high blood pressure ... But this does not mean that their existence will be reduced to a life on drugs and in hospitals. This only suggests that you will need to pay a little more attention to their nutrition and physical activity. But what's wrong with healthy way life, proper nutrition and regular moderate physical activity?

Fetal growth retardation: how to prevent?

The best prevention of fetal growth retardation is pregnancy planning ... When planning a pregnancy, a couple must undergo a complete examination of the body in six months and treat all chronic diseases. Treatment of caries and the genitourinary sphere should also not be overlooked. Quitting bad habits, at least six months in advance - the best way prevent this diagnosis.

Regular visits to antenatal clinics after being registered for pregnancy (and this must be done no later than 12 weeks), plays important role in the prevention of negative consequences in the diagnosis of delayed development of the fetus in the womb. The earlier the disease is detected and treated, the more likely it is to avoid negative consequences in the development of the fetus during gestation and after birth.

A new man grows inside a pregnant woman, and it is quite natural that she wants to protect, protect him from all the misfortunes of the world around her. One of the most alarming diagnoses in expectant mothers is intrauterine fetal growth retardation. Let's look at how dangerous this diagnosis is and how to deal with it? What are the deviations in the development of the fetus from the norm? When should you start worrying, and when is fear not justified?

Delayed fetal development: the main causes

All nutrients and oxygen enter the fetus through the placenta, therefore, any violations of it lead to a delay in the development of the child, characterized by a low fetal weight compared to generally accepted norms. Reasons leading to feto placental insufficiency(a condition when the placenta does not cope with its responsibilities to saturate the child with food and oxygen), quite a lot. The main ones are considered - late gestosis, increased uterine tone, Rh-conflict, previous infectious diseases, various abnormalities in the development of the uterus, placenta (premature aging, detachment, improper attachment, etc.) and umbilical cord, chronic diseases of the mother, for example, diabetes mellitus , heart disease, hypertension, etc. The correct development of the placenta also depends on the woman's age. Young girls are not yet quite ready for the upcoming stress on their bodies, and women after 30 years of age often have various chronic diseases, which also affect the development of the placenta. In addition to diseases, risk factors include smoking, alcohol abuse, drug addiction. All these bad habits cause vasoconstriction, therefore, uteroplacental blood flow decreases. Also, abnormalities in the development of the fetus can be in a healthy woman. This usually happens if a woman has multiple pregnancies. The delay in fetal development in this case is caused by the fact that nutrients go not to one baby, but to two or more.
With regard to diets, then the issue is quite controversial. Recent studies have shown that women who, for one reason or another, adhere to a low-calorie diet, can give birth to a completely healthy baby with a normal weight, that is, dietary food does not necessarily have to cause delayed fetal development.

How to determine?

Most often, the first signs of a delay in fetal development are found at 24-26 weeks, less often at 32 weeks. Distinguish between symmetrical delay and asymmetric. The first is characterized by a decrease in all organs of the baby evenly, and the second - by a decrease in size internal organs while the brain and skeleton are normal.

In order to determine the delayed development of the fetus, the following methods are used:

1. Measuring the height of the bottom of the uterus and the circumference of the abdomen at the level of the navel at each visit to the obstetrician-gynecologist and comparing them with the norms.
This is one of the simplest and available methods, which allows the doctor to judge the size of the fetus, but the indicators may not always be objective, since the measurement is influenced by the physique, the size of the abdominal wall, the amount amniotic fluid... But it is this method that contributes to the first detection of the slow development of the baby.
2. Study for the content of placental hormones (lactogen, alkaline phosphatase, etc.) in the mother's blood. If the hormones are normal, therefore, the placenta is functioning normally, then the baby is getting everything he needs in sufficient quantities.
3 ... CTG (cardiotocography) of the fetal cardiac activity, with the help of which it is possible to determine whether the fetus is receiving enough oxygen. Since the lack of air (hypoxia) can lead not only to malnutrition, but also to asphyxiation (suffocation) of the fetus.
4. Ultrasound (ultrasound) of the fetus, in which the head is measured, femur and the tummy of the baby. With the help of ultrasound, not only the possible low birth weight of the fetus is revealed, but also the proportionality of the development of the baby's organs, it is determined whether the placenta and umbilical cord are functioning normally. In case of any deviations from the norm, a Doppler study (a type of ultrasound) must be prescribed, with the help of which the doctor finds out the direction and speed of blood through the vessels of the umbilical cord and arteries of the fetus.

Treatment

The revealed abnormal development of the fetus requires immediate treatment, since placental insufficiency can lead not only to developmental delay, but also to fetal death due to a disturbance in the mother-placenta-fetus circulatory system.

Basically, medications are used to treat hypotrophy:
- tocolytic, designed to relax the uterus;
- vasodilators to increase blood flow to the placenta;
- solutions-blood substitutes, aimed at reducing the viscosity of blood, so that it passes faster and easier through the vessels and capillaries;
- vitamins and amino acids that replenish the lack of substances necessary for the tissues and organs of the fetus.

Hyperbaric oxygenation (breathing oxygen-enriched air), medical ozone, sleep, and other non-pharmacological agents are also considered very beneficial if abnormal fetal development associated with a lack of nutrients and oxygen is detected.
Naturally, during treatment, control with ultrasound and CTG is mandatory. In principle, with timely diagnosis, it is possible not only to increase the size of the fetus, but also to bring them to normal. The main thing to remember is that the goal is to normalize metabolic processes, and not to “feed” the baby.

Advance fetal development

It often happens that the fetus develops too quickly. This phenomenon is characterized by too rapid maturation of the placenta, which can also cause hypoxia and a lack of nutrients in the fetus. With such a diagnosis, a Doppler study is required and appropriate treatment is prescribed, since the anticipatory development of the fetus can lead to premature birth due to detachment of the placenta.

Description:

In the literature, you can find a huge number of terms: "delayed uterine development", "intrauterine growth retardation", "fetal malnutrition", "fetal retardation", "small to gestational age", etc. the concept of "stunted growth and lack of nutrition of the fetus."

The term "intrauterine growth retardation" means fetal pathology resulting from the influence of damaging factors. IUGR is diagnosed in children who are underweight at birth in relation to their gestational age, i.e. when the body weight is below 10% of the centile at a given gestational age of the mother and / or the morphological index of maturity is 2 or more weeks behind the true gestational age.

Violation of fetal development is one of the most common reasons for a decrease in the adaptation of a newborn in the neonatal period, high morbidity, disorders in the neuropsychic development of a child. Perinatal mortality with IUGR reaches 80–100%.

Symptoms:

There are three clinical variants of IUGR: hypotrophic, hypoplastic, and dysplastic. The severity of the hypoplastic variant is determined by the deficit in body length and head circumference in relation to gestational age: mild - 1.5–2 sigma deficit, medium - more than 2 sigma, and severe - more than 3 sigma. The severity of the dysplastic variant is determined not so much by the severity of the shortage of body length, but by the presence and nature of malformations, the number and severity of stigmas of dysembryogenesis, the state of the central nervous system, and the nature of the disease that led to IUGR.

In the English-language literature, instead of the term “hypotrophic IUGR”, the concept of “asymmetric IUGR” is used, and hypoplastic and dysplastic variants are combined with the concept of “symmetric IUGR”.

In his pediatrics textbook M.V. Yerman notes that on symmetrical version IUGR accounts for 25% of cases, asymmetric - 75%. T.M. Demina et al. observed the following situation: 56.4% of newborns with IUGR had a hypotrophic variant, 43.5% - a hypoplastic one. Interesting data is given by I.O. Kelmanson: different regions of the world are characterized by a different ratio of certain variants of IUGR. In developing countries, from 67.5 to 79.1% of all cases are attributable to hypoplastic IUGR, while in industrialized countries, hypoplastic IUGR accounts for 20–40%.

With the hypoplastic variant of IUGR in children, there is a relatively proportional decrease in all parameters of physical development - below 10% of the centile - with an appropriate gestational age. They look proportionally folded, but small. There may be single stigmas of dysembryogenesis (no more than 3-4). In the early neonatal period, they are prone to rapid cooling, the development of polycythemic, hypoglycemic, hyperbilirubinemic syndromes, respiratory disorders, and infection layers.

Dysplastic IUGR is usually a manifestation of hereditary pathology (chromosomal or genomic abnormalities) or generalized intrauterine infections, teratogenic influences. Typical manifestations of IUGR of this variant are malformations, constitutional disorders, and dysembryogenetic stigmas. The clinical picture significantly depends on the etiology, but, as a rule, severe neurological disorders, metabolic disorders, often signs of infection are typical. In children with hypotrophic IUGR, body weight is reduced disproportionately in relation to height and head circumference. Head circumference and height are closer to the expected percentiles for a given gestational age than body weight. These children have trophic skin disorders (dry, wrinkled, flaky, pale, may be cracked); the subcutaneous fat layer is thinned, and in severe cases it may be completely absent; tissue turgor is significantly reduced; muscle mass, especially gluteal and femoral, is reduced; the circumference of the child's head exceeds the circumference of the chest by 3 cm or more, the seams are wide, the large fontanelle is sunken, its edges are pliable, soft.

Usually, children with hypotrophic IUGR are prone to greater loss of initial body weight and slower recovery, prolonged transient jaundice of newborns, slow healing umbilical wound after the umbilical cord has fallen off.

Causes of occurrence:

Conventionally, the etiological factors leading to IUGR can be divided into 4 groups. The first group includes maternal factors - pregnancy-induced hypertension; weight gain less than 0.9 kg every 4 weeks (there is a clear correlation between maternal weight, weight gain during pregnancy and fetal weight); lag in increasing the height of the fundus of the uterus (less than 4 cm for a given gestational age); (in women with rheumatic heart defects, fetal IUGR is observed 2.8 times more often than in healthy mothers); nutritional deficiencies during pregnancy (a sharp deficiency of proteins, vitamins, zinc, selenium and other trace elements); the presence of bad habits in the mother - smoking (pregnant women who smoke more than 20 cigarettes a day have an increase in fetal weight by an average of 533 g less than non-smoking women), alcoholism (daily consumption of an average of 28.5 ml of alcohol before pregnancy and early dates reduces the weight of the fetus at birth by 91 g, and the consumption of the same amount of alcohol in late dates pregnancy leads to a decrease in fetal weight by 160 g), drug addiction; short term between pregnancies (less than 2 years); multiple pregnancy (pregnancy with two or more fetuses may be accompanied by IUGR of the fetus in 15-50% of cases); young age of the mother; diseases of the cardiovascular system, kidneys and lungs in the mother; hemoglobinopathy; Type I with vascular complications; ; connective tissue diseases; long sterile period; a history of miscarriages; the birth of children with IUGR in previous pregnancies; gestosis; taking certain medications (folic acid antimetabolites, beta-blockers, anticonvulsants, indirect anticoagulants, tetracyclines, etc.). There was a negative effect on the growth of the fetus of vibration, ultrasonic, production factors, overheating, cooling, mental stress. In a number of women, the causes of fetal IUGR may be constitutional anomalies, sexual and general infantilism due to the inadequacy of the adaptive reactions of the mother's body in response to developing pregnancy.

The second group of factors leading to fetal IUGR includes placental factors, i.e. factors that provide the fetus with an adequate amount of nutrients. This is, first of all, insufficient mass and surface of the placenta, its structural abnormalities (heart attacks, calcification, fibrosis, vascular thrombosis, placentitis, etc.), placental abruption, placental malformations (both primary and secondary to maternal pathology). There is a relationship between the development and growth of the fetus and the growth retardation of the pregnant uterus. Some scientists argue that fetal growth retardation during pregnancy depends on the location of the placenta. With a low and medium placement of the placenta in the uterus, the frequency increases, and children who were born with this pathology have a small body weight.

The third group includes socio-biological factors - the low socio-economic and educational level of the mother; adolescence(primiparas aged 15–17 years constitute a high risk group for fetal IUGR); accommodation in high-mountainous areas; 2 times more often fetal IUGR occurs in the group of unmarried pregnant women.

The last group includes hereditary factors - maternal and fetal genotypes. IUGR of the fetus is considered as one of the characteristic features of trisomies on the 13th, 18th, 21st and other pairs of chromosomes. In addition, with IUGR, a number of authors note trisomy for the 22nd pair of autosomes, Shereshevsky - Turner syndrome (45, XO), triploidy, additional X or Y chromosomes.

Treatment:

Particular attention should be paid to nursing children with IUGR. Treatment and nursing of such children is a rather expensive business, requiring large financial costs, high qualifications of doctors and nurses, and the provision of specialized care. However, the experience of economically developed countries shows that these costs are not in vain. Provided that such children are born and nursed in specialized well-equipped perinatal centers, mortality in the first 7 days of life is no more than 35%, and 54% among the survivors have no serious consequences.

Newborns with symmetric IUGR due to reduced growth ability usually have a poorer prognosis, while children with asymmetric IUGR who retain normal brain growth tend to have a better prognosis. In the first year of life, such children have a significantly higher infectious index compared to healthy children. Prospective observations have established that the lag in physical development observed in almost 60% of children, its disharmony - in 80%, retardation of the pace of psychomotor development - in 42%, neurotic reactions - in 20%. Persistent severe lesions of the central nervous system in the form of infantile cerebral, progressive, oligophrenia, etc. were observed in 12.6% of children. Such children 1.8 times more often suffer from rickets, 3 times more often get pneumonia.

The long-term consequences of IUGR began to be actively studied at the end of the last century. It has been proven that such children much more often than in the population have a low IQ in school age, neurological disorders. In the late 80s - early 90s, works appeared in which the connection between IUGR and the development of diabetes mellitus later in adulthood was proved.

Thus, the problem of IUGR remains relevant in modern medicine and, due to its social significance, requires further research in terms of studying the etiology, pathogenesis, diagnosis, treatment and prevention of this pathology.

In every tenth case of pregnancy, a diagnosis is made - intrauterine growth retardation of the fetus (the pathology is also known under the abbreviation IUGR). The doctor determines the deviations, which are characterized by a discrepancy between the size of the child and the normal indicators for a particular week of pregnancy. How dangerous this pathology is and what exactly is worth fearing is useful for every expectant mother to know, because no one is immune from such a phenomenon.

Intrauterine fetal growth retardation is diagnosed at various stages of pregnancy. This happens if the baby does not receive enough nutrients and oxygen, which are actively involved in the formation of a small organism. The reasons for this can be very different:

• pathology of the placenta: abnormal presentation or detachment;
• chronic diseases of the mother: high blood pressure, problems with cardiovascular system, anemia, malfunctioning of the respiratory tract;
• abnormalities in the chromosome set: Down's syndrome;
• pathology of intrauterine development: abdominal wall or kidney defects;
• bad habits of the mother;
• infectious diseases suffered by a woman during pregnancy: toxoplasmosis, syphilis, cytomegalovirus;
• insufficient or improper nutrition;
• constant stress;
• gynecological diseases;
• self-administration of medications during pregnancy without a doctor's prescription;
• multiple pregnancy;
• climatic conditions: living in an area that is located high above sea level.

Smoking and alcoholism while carrying a baby can lead to such a phenomenon as an asymmetric delay in fetal development, when, according to ultrasound, the baby's skeleton and brain are up to date, but the internal organs remain undeveloped. It is especially important to provide the fetus with everything necessary in the last weeks of pregnancy so that it successfully adapts to the new environment.

IUGR symptoms

The first signs of IUGR syndrome are detected already in the early stages of pregnancy (at 24–26 weeks), but a woman is not able to determine them on her own. This can only be done by a doctor. Symptoms are considered non-compliance with the norm of the following indicators:

• abdominal circumference at a certain level, the height of the bottom of the uterus (probed manually by the gynecologist);
• the size of the head, femur, abdomen of the baby;
• growth under constant supervision;
• the amount of amniotic fluid;
• dysfunction of the placenta (size or structure may change);
• blood flow velocity in the placenta and umbilical cord;
• baby's heart rate.

Often, even doctors are mistaken in the diagnosis, because sometimes the discrepancy between these parameters is nothing more than a genetic or hereditary predisposition. To avoid misdiagnosis, parents are asked what weight they were born with. Whereas a delay in fetal development for 2 weeks or more already gives serious grounds to believe that the diagnosis is accurate.

Treatment methods

Treatment largely depends on the degree of the observed deviations:

• delayed intrauterine development of the fetus of 1 degree - a 2-week lag (therapy can be quite successful and negate the negative consequences for the further development of the baby);
• 2 degrees - a delay of 3-4 weeks (enhanced treatment will be required, and the results may be completely unpredictable);
• Grade 3 - a lag of more than a month (even the most intensive therapy will not be able to compensate for such a large lag, and a child may be born with serious deviations from the norm).

Treatment includes:

• therapy for maternal diseases;
• treatment of pregnancy complications;
• increasing the resistance of a small organism to;
• normalization of placental insufficiency (as a rule, drugs are prescribed for vasodilation to improve blood supply to the fetus and uterus, as well as means to relax the muscles of the uterus).

Treatment is carried out stationary so that the mother and child are constantly under medical supervision... The timing and methods of delivery depend on the well-being of the mother and the condition of the fetus.

The consequences of fetal growth retardation syndrome can be very different. Children with this diagnosis may develop serious health problems after birth.

In infancy:

• obstetric complications during childbirth: hypoxia, neurological disorders;
• poor adaptation to new living conditions;
• hyperexcitability;
• increased or decreased muscle tone;
• poor appetite;
• small weight gain;
• psychomotor developmental delay;
• inability to maintain body temperature constant within normal limits;
• insufficient development of internal organs;
• high sensitivity to infectious diseases.

At an older age:

• diabetes;
• tendency to corpulence;
• high blood pressure.

In adulthood:

• cardiovascular diseases;
• obesity;
• non-insulin dependent diabetes mellitus;
• elevated blood lipids.

However, many babies diagnosed with intrauterine growth retardation over time may not differ at all from their peers, catching up with them in terms of both height and weight, without any consequences for their health at any age.