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KMID : 0377619970620060519
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Korean Jungang Medical Journal
1997 Volume.62 No. 6 p.519 ~ p.520
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Prevention and Management of IUGR
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Bae Do-Hwan
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Abstract
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Intrauterine growth restriction (IUGR) is the second leading contributor to the prenatal mortality. The prenatal mortality rate for these infants is 6 to 10 times greater than that for normal babies.
Prevention and management of IUGR is an important subject. IUGR occurs due to poor maternal condition in which the fetus inappropriately grows comparing to the normal gestational age, there is creating a risky environment. Also intrapartum asphyxia in IUGR and fetal demise, meconium aspiration and hypothermia are increased, as is the prevalence of abnormal neurological development. A portion of these prenatal complications are preventable.
It is estimated that 4.5%(5.5%-11.1%) of infant are growth restricted. Occasionally causes of IUGR cases are unknown, but 46.9% of IUGR cases have a known cause. Among the 46.9%, the maternal factor accounts for 78.2%, the placental factor 19.8% and the fetal anomaly 4%. Among the maternal factor, pregnancy induced hypertension was the most common factor (64.5 %)(Kang et al).
The long term prognosis is clearly related to the nature and severity of the underlying problem. However, IUGR is caused due to placental failure in an otherwise normal fetus. Poor fetal growth is a result of early viral insults or genetic developmental abnormalities.
If fetal growth restriction is timely diagnosed and appropriately obstetric and neonatal managed, the neonatal mortality can be reduced. For the management of IUGR, intensive effort should be made to determine the risk condition. In the presence of anomalies, rapid kayos typing may be performed. Also there is a tendency of fetal growth restriction and low birth weight infant of successive birth. The risk of recurrent fetal growth restriction is increased in women who have previously had this complication(19 %, Choi et al).
For the screening and identification of IUGR, many tests such as non-stress test and contraction stress test, biophysical profile, ultrasonic measurements, fetal blood flow Doppler velocimetry and laboratory tests are used. The use of fetal umbilical Doppler flow velocimetry and fetal biophysical profile in the management of fetal growth restriction reduces prenatal mortality(Sun et al).
With IUGR near term, a prompt delivery is likely to afford. In the presence of oligohydramnios, the fetus will be delivered at 34 wks or beyond. When IUGR is diagnosed prior to 34 wks, observation is recommended. Ultrasonography is repeated at intervals of 2 to 3 wks. With IUGR remote from term, there is no specific treatment that will ameliorate the condition. It has also been proposed that early antiplatelets therapy with low dose of aspirin may prevent idiopathic IUGR. Recently reported improvement of fetal growth with the maternal administration of high concentration of oxygen. Takeda et al, also reported a in utero treatment of IUGR by applying new diagnostic and therapeutic devices.
Cesarean delivery is also increased in fetal growth restriction because breech presentation and fetal compromise occurs more commonly. The subsequent neurological and intellectual capabilities of IUGR cannot be predicted precisely. Finally, IUGR can be reduced and prevented with appropriate antenatal surveillance strategies and management which may include early delivery.
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KEYWORD
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