intrauterine growth retardation Archives - Revista Brasileira de Ginecologia e Obstetrícia
, , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(5):289-296
, , , Intrauterine growth restriction (IUGR) is associated with poor perinatal prognosis and a higher risk of stillbirth, neonatal death, and cerebral palsy. Its detection and the evaluation of its severity by new Doppler velocimetric parameters, such as aortic isthmus (AoI), are of great relevance for obstetrical practice. The AoI is a vascular segment that represents a point of communication between the right and left fetal circulations. It is considered to be a functional arterial shunt that reflects the relationship between the systemic and cerebral impedances, and has recently been proposed as a tool to detect the status of hemodynamic balance and prognosis of IUGR in fetuses. In the present review, we noticed that in healthy fetuses, the AoI net flow is always antegrade, but in fetuses with IUGR the deterioration of placental function leads to progressive reduction in its flow until it becomes mostly retrograde; this point is associated with a drastic reduction in oxygen delivery to the brain. The more impaired the AoI flow is, the greater is the risk of impairment in the Doppler velocimetry of other vessels; and the alterations of the AoI Doppler seem to precede other indicators of severe hypoxemia. Although there seems to be an association between the presence of retrograde flow in the AoI and the risk of long-term neurologic disability, its role in the prediction of perinatal morbi-mortality remains unclear. The AoI Doppler seems to be a promising tool in the management of fetuses with IUGR, but more studies are needed to investigate its employment in clinical practice.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(5):289-296
, , , Intrauterine growth restriction (IUGR) is associated with poor perinatal prognosis and a higher risk of stillbirth, neonatal death, and cerebral palsy. Its detection and the evaluation of its severity by new Doppler velocimetric parameters, such as aortic isthmus (AoI), are of great relevance for obstetrical practice. The AoI is a vascular segment that represents a point of communication between the right and left fetal circulations. It is considered to be a functional arterial shunt that reflects the relationship between the systemic and cerebral impedances, and has recently been proposed as a tool to detect the status of hemodynamic balance and prognosis of IUGR in fetuses. In the present review, we noticed that in healthy fetuses, the AoI net flow is always antegrade, but in fetuses with IUGR the deterioration of placental function leads to progressive reduction in its flow until it becomes mostly retrograde; this point is associated with a drastic reduction in oxygen delivery to the brain. The more impaired the AoI flow is, the greater is the risk of impairment in the Doppler velocimetry of other vessels; and the alterations of the AoI Doppler seem to precede other indicators of severe hypoxemia. Although there seems to be an association between the presence of retrograde flow in the AoI and the risk of long-term neurologic disability, its role in the prediction of perinatal morbi-mortality remains unclear. The AoI Doppler seems to be a promising tool in the management of fetuses with IUGR, but more studies are needed to investigate its employment in clinical practice.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):517-524
DOI 10.1590/S0100-72031998000900005
Purpose: to determine the behavior of doppler velocimetry during the course of risk pregnancies and to compare the perinatal results obtained for concepti with retarded intrauterine growth (RIUG) with those for concepti considered adequate for gestational age (AGA). Methods: a prospective study of the evolution of doppler ultrasound was made in 38 pregnant women with of idiopathic intrauterine growth retardation (IUGR) in previous pregnancy. A relationship was established between this antecedent and the new pregnancy. The pregnant women studied were divided into two groups in agreement with their neonates birthweight. Group 1 was associated with IUGR and group 2 with adequate birth weight. IUGR was confirmed in 23.7% of the cases. Umbilical and uterine artery doppler velocimetry was performed from 20 to 40 weeks of gestation. Middle cerebral artery doppler velocimetry was analyzed after 28 weeks of gestation, twice a month, being the last valued examination before birth. Results: the uterine and umbilical artery ratio at 24 and 28 weeks of gestation, respectively, correlated with the presence of IUGR. There was no difference between the two groups regarding the presence or absence of a small notch in the uterine artery wave form and middle cerebral artery doppler velocimetry ratio, at the last examination before birth. There was a relationship between neonatal stay in hospital for more than three days and the presence of IUGR. Conclusions: doppler ultrasound should be used in the follow-up of cases with a high risk of IUGR. It allows the detection of the fetuses at high risk of hypoxia and, by interrupting the pregnancy, fetal distress-related complications may be avoided.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):517-524
DOI 10.1590/S0100-72031998000900005
Purpose: to determine the behavior of doppler velocimetry during the course of risk pregnancies and to compare the perinatal results obtained for concepti with retarded intrauterine growth (RIUG) with those for concepti considered adequate for gestational age (AGA). Methods: a prospective study of the evolution of doppler ultrasound was made in 38 pregnant women with of idiopathic intrauterine growth retardation (IUGR) in previous pregnancy. A relationship was established between this antecedent and the new pregnancy. The pregnant women studied were divided into two groups in agreement with their neonates birthweight. Group 1 was associated with IUGR and group 2 with adequate birth weight. IUGR was confirmed in 23.7% of the cases. Umbilical and uterine artery doppler velocimetry was performed from 20 to 40 weeks of gestation. Middle cerebral artery doppler velocimetry was analyzed after 28 weeks of gestation, twice a month, being the last valued examination before birth. Results: the uterine and umbilical artery ratio at 24 and 28 weeks of gestation, respectively, correlated with the presence of IUGR. There was no difference between the two groups regarding the presence or absence of a small notch in the uterine artery wave form and middle cerebral artery doppler velocimetry ratio, at the last examination before birth. There was a relationship between neonatal stay in hospital for more than three days and the presence of IUGR. Conclusions: doppler ultrasound should be used in the follow-up of cases with a high risk of IUGR. It allows the detection of the fetuses at high risk of hypoxia and, by interrupting the pregnancy, fetal distress-related complications may be avoided.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(4):235-238
DOI 10.1590/S0100-72031999000400009
We report a case of nonmolar fetal triploidy detected by fetal blood sampling at 20 weeks of gestation, performed as an investigation of intrauterine growth retardation and severe oligohydramnios found by ultrasound scan. At 19 weeks of gestation very low levels of maternal free serum beta-subunit of human chorionic gonadotropin and unconjugated estriol, and normal levels of alpha-fetoprotein were found, which were interpreted as a high risk of fetal Edwards syndrome. Fetal death supervened the day after fetal blood sampling, and the pregnancy was terminated by vaginal delivery induced by misoprostol and oxytocin, under epidural anesthesia. Chromosome study of the fetal blood cells showed a 69,XXX karyotype. The severe intrauterine growth retardation and macrocephaly noted on pathological review plus the very low levels of hCG and unconjugated estriol suggest a fetal gynoid triploidy case, caused by the fertilization of a diploid egg by a haploid sperm.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(4):235-238
DOI 10.1590/S0100-72031999000400009
We report a case of nonmolar fetal triploidy detected by fetal blood sampling at 20 weeks of gestation, performed as an investigation of intrauterine growth retardation and severe oligohydramnios found by ultrasound scan. At 19 weeks of gestation very low levels of maternal free serum beta-subunit of human chorionic gonadotropin and unconjugated estriol, and normal levels of alpha-fetoprotein were found, which were interpreted as a high risk of fetal Edwards syndrome. Fetal death supervened the day after fetal blood sampling, and the pregnancy was terminated by vaginal delivery induced by misoprostol and oxytocin, under epidural anesthesia. Chromosome study of the fetal blood cells showed a 69,XXX karyotype. The severe intrauterine growth retardation and macrocephaly noted on pathological review plus the very low levels of hCG and unconjugated estriol suggest a fetal gynoid triploidy case, caused by the fertilization of a diploid egg by a haploid sperm.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):567-572
DOI 10.1590/S0100-72032000000900005
Purpose: to study the repercussion of arterial hypertension regarding body weight gain and body length, as well as liver and brain weight of offspring. Methods: a total of 82 animals in reproductive age were used. They were randomly assigned to 4 different groups (control, handled, nephrectomized and hypertensive). Renal hypertension was produced by a controlled constriction of the main left renal artery and contralateral nephrectomy, according to the technique described by Goldblatt (Goldblatt I: one kidney - one clip hypertension). Afterwards, they were distributed among nonpregnant and pregnant groups. The following newborn groups resulted from the pregnant groups: RN-C (control-newborn group of pregnant rats without surgical treatment), RN-M (manipulation-newborn group of the pregnant rats with surgical manipulation), RN-N (nephrectomized-newborn group of pregnant rats with nephrectomy) and Rn-H (hypertensive-newborn group of pregnant rats with hypertension). Results: the RN-N and RN-H groups showed body weight gain (
= 3,64 ± 0,50; or = 3,37 ± 0,44), body length ( = 3,89 ± 0,36; or = 3,68 ± 0,32) and brain weight ( = 0,16 ± 0,01; or = 0,16 ± 0,05), respectively, smaller than the control group ( = 5,40 ± 0,51; or = 4,95 ± 0,23 and or = 0,22 ± 0,04, respectively). In addition, the RN-H group showed the lowest liver weight ( = 0,22 ± 0,03) compared with the other three groups. Conclusion: after statistical analysis, the results obtained showed that the arterial hypertension determined a reduction in body weight, body length, and liver and brain weight of the offspring.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):567-572
DOI 10.1590/S0100-72032000000900005
Purpose: to study the repercussion of arterial hypertension regarding body weight gain and body length, as well as liver and brain weight of offspring. Methods: a total of 82 animals in reproductive age were used. They were randomly assigned to 4 different groups (control, handled, nephrectomized and hypertensive). Renal hypertension was produced by a controlled constriction of the main left renal artery and contralateral nephrectomy, according to the technique described by Goldblatt (Goldblatt I: one kidney - one clip hypertension). Afterwards, they were distributed among nonpregnant and pregnant groups. The following newborn groups resulted from the pregnant groups: RN-C (control-newborn group of pregnant rats without surgical treatment), RN-M (manipulation-newborn group of the pregnant rats with surgical manipulation), RN-N (nephrectomized-newborn group of pregnant rats with nephrectomy) and Rn-H (hypertensive-newborn group of pregnant rats with hypertension). Results: the RN-N and RN-H groups showed body weight gain ( = 3,64 ± 0,50; or = 3,37 ± 0,44), body length ( = 3,89 ± 0,36; or = 3,68 ± 0,32) and brain weight ( = 0,16 ± 0,01; or = 0,16 ± 0,05), respectively, smaller than the control group ( = 5,40 ± 0,51; or = 4,95 ± 0,23 and or = 0,22 ± 0,04, respectively). In addition, the RN-H group showed the lowest liver weight ( = 0,22 ± 0,03) compared with the other three groups. Conclusion: after statistical analysis, the results obtained showed that the arterial hypertension determined a reduction in body weight, body length, and liver and brain weight of the offspring.
