Intrauterine growth retardation of fetus
Last reviewed: 23.04.2024
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Do not confuse prematurity (immaturity) and intrauterine growth retardation: infants of these two different types differ from each other for a number of problems that arise after birth.
The causes of intrauterine growth retardation of the fetus. Newborns with growth retardation (small or lightweight for their age) are infants whose birth weight is below the norm by 10 centigrams. Predisposing factors include multi-prenatal pregnancy; developmental defects; infection, smoking mother; diabetes; arterial hypertension (for example, with the development of preeclampsia); severe anemia; heart disease and kidney problems. About 10% are mothers who have only small children. In the presence of placental insufficiency, a relatively small circumference of the head is noted in the newborn (since the life-support of the fetus was insufficient).
Prenatal diagnosis. Almost 50% of the causes can not be detected before birth. Measuring the height of the standing of the uterine fundus over the pubic symphysis is a fairly accurate method for quantifying the growth of the fetus, especially if the centile scale is used. A weak increase in the body weight of the mother allows one to assume an intrauterine growth retardation of the fetus (from the 30th week of pregnancy the mother should add 0.5 kg / week weight). Malnutrition and poor motor activity of the fetus also indicate placental insufficiency. If suspected of delaying fetal growth, it is advisable to monitor the circumference of the head and abdomen of the fetus with ultrasound examinations. Before the 32nd week of pregnancy, the head circumference normally exceeds the circumference of the abdomen, but from the 32nd week the girth of the abdomen should increase faster than the circumference of the head. The function of the placenta should be monitored. If the results of Doppler ultrasound examination of blood flow in the umbilical cord are normal, the outcome of pregnancy with a delay in intrauterine development is more favorable (less likely to premature birth and miscarriage). It should be recommended that the mother stop smoking, note and fix the movements of the fetus and observe rest.
Childbirth and postnatal care. The fetus with intrauterine growth retardation is more susceptible to hypoxia, therefore the birth should be closely monitored. After birth, an adequate temperature regime is extremely important, therefore care of infants with a body weight of less than 2 kg should be carried out in an incubator. Since the fetus is in utero in the state of hypoxia, the hemoglobin content in the blood in it increases in compensation, and in the subsequent often jaundice of newborns is observed. In such babies glycogen reserves are small enough, and therefore they are prone to hypoglycemia. These newborns should be fed in the first 2 hours after birth and measure the blood glucose level before each feeding, which is performed at a 3-hour interval. If a newborn, despite regular meals, still develops hypoglycemia, then it is transferred to a specialized department. Such infants are more susceptible to infection. After childbirth, it is usually possible to establish what were the causes of intrauterine growth retardation.
Difference between intrauterine growth retardation and prematurity (immaturity of the fetus). Until 34 weeks, the fetus lacks the rudiments of the mammary glands, then they begin to develop, their diameter increases by 1 mm / week. Ear cartilage develops between the 35th and 39th weeks, so the ears of premature babies do not straighten out after bending. Eggs are in the inguinal canal at 35th week, in the scrotum - at 37th week. In preterm girls, the labia minora are unclosed and underdeveloped (the sexual gap gapes). Normally, the folds of the skin on the anterior third of the surface of the foot are found from the 35th week (in the front V, the surface of the foot - from the 39th week, everywhere - from the 39th week). In premature infants, the skin is red, covered with hair. The raw (original) grease begins to form from the 28th week, the maximum this process reaches by the 36th week. Preterm infants do not lie in the womb with bent limbs until the 32nd week. All their limbs are bent only starting from the 36th week. With intrauterine growth retardation, the diameter of the head is relatively small.
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