Intrauterine growth restriction (IUBL) is when the baby in the mother's womb is smaller than it should be for the week of gestation. It is called intrauterine growth retardation (IUGR) in Turkish and intrauterine growth retardation (IUGR) in English. Since the word "retardation" has associations in patients with a retardation that will also occur in the baby's mental functions, it would perhaps be more accurate to express it with words such as "limitation". Although general IUBK is defined as the baby being smaller than expected according to the gestational age, there are other factors (physical characteristics of the mother and father) that determine the weight of the baby in the womb. Therefore, a better definition for IUBK is actually the fact that the baby (fetus) in the womb has not reached its growth potential.
Causes
Causes related to the baby (fetus):
1. Infections transmitted from mother to baby in the early stages of pregnancy (especially before the 20th week of pregnancy) (CMV, rubella, chickenpox, parvovirus infections).
2. Chromosomal disorders in the baby (most commonly trisomy 18, trisomy 13, trisomy 21) and congenital anomalies.
3. Twin pregnancy and other multiple pregnancies.
Maternal reasons:
1. Low socioeconomic level.
2.Malnutrition: It is known that severe nutritional deficiency (malnutrition) of the pregnant mother causes developmental delay in the unborn baby. Intrauterine growth retardation has also been observed in some intestinal diseases of the mother (Chron, ulcerative colitis) due to malnutrition of the pregnant mother.
3. The pregnant mother gaining less than normal weight during pregnancy.
4. Chronic diseases of the mother during pregnancy: They are responsible for 25-30% of intrauterine growth retardation. Early-onset severe pregnancy poisoning (preeclampsia), chronic kidney and liver diseases, prach cell anemia, congenital or acquired coagulation disorders (Thrombophilias): Antiphospholipid syndrome, an acquired coagulation disorder, may cause intrauterine growth retardation during pregnancy, miscarriage, late pregnancy losses. and may lead to intravascular clotting (thromboembolic event).
5. Living in high places, hypoxic diseases of the pregnant mother that cause low oxygen.
6. Drug use during pregnancy (teratogens): Epilepsy drugs (Anticonvulsants: phenytoin, trimethadone), narcotic analgesics and similar drugs.
7. Substance use during pregnancy: Alcohol, cocaine use. Smoking also causes developmental delay in the womb.
8. Some uterine deformities of the mother and extrauterine pregnancy.
Causes related to the baby's partner (placenta):
1. Partial separation of the baby's partner, tissue death (Infarct) in part of the baby's partner due to lack of blood supply.
2. Tumors (chorioangioma)
3. The baby's partner is young
4. The cord (umbilical cord) is connected to the baby's partner in an abnormal place.
Regardless of the cause, IUBK is divided into two groups: those that start early, before 32 weeks, and those that occur after the 32nd week of pregnancy.
How is intrauterine growth restriction detected?
During pregnancy; Early determination of gestational age, attention to the mother's weight gain, and careful measurement of uterine growth (fundus - pubis distance) enable the detection of most IUBK cases in pregnant women without risk factors. It is not always easy to diagnose true IUBK. In order to diagnose IUBK, the gestational age must first be known very well.
Sometimes, intrauterine growth retardation is suspected when the unborn baby's measurements are found to be retarded in routine ultrasound measurements or fundus-pubis distance measurements in the pregnant woman, and sometimes when the pregnant mother notices that her abdomen is not growing. In this case, an ultrasound examination is performed to confirm the diagnosis.
In the routine ultrasound examination, four separate measurements are made: head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL). According to the results of these 4 measurements, the ultrasound device determines a separate gestational week for each measurement by comparing the values obtained in the measurement with the preloaded values. If these determined weeks of pregnancy are two weeks or more behind the expectant mother's last menstrual period or according to previous ultrasounds, a preliminary diagnosis of intrauterine growth restriction is made.
Intrauterine growth restriction and birth decision
Babies with intrauterine growth restriction are at risk of both death and hypoxia and metabolic acidosis during birth. Therefore, it is necessary to follow the growth and well-being of the unborn baby very closely. Gestational age (gestational age) and the condition of the baby are very important in determining the appropriate time for birth. For babies who are at or near term, the decision to give birth should be made easily. The real problem is babies whose gestational age is too small. Various follow-up methods such as biophysical profile test (BPP), amniotic fluid amount, NST and Doppler ultrasonography of fetal vessels are used for these babies. After a slowdown in growth is observed, it is necessary to monitor both the fetal weight and the blood flows between the fetus and the placenta-fetus.
What should we do about intrauterine growth restriction?
There is no special treatment for growth restriction in the period far from term (time of birth). Various approaches such as nutritional support to the pregnant mother, plasma volume expanders, low-dose aspirin, and oxygen therapy to the pregnant mother have been tried, but none of them have been shown to be beneficial. The main goal in growth restriction follow-up is good timing of birth in babies with intrauterine growth restriction. The most important point in the follow-up of intrauterine growth restriction is choosing the most appropriate time for birth by weighing the risks of premature birth with the risks of remaining in the womb where the baby is no longer adequately nourished. Ideal birth timing requires serious experience and falls within the field of perinatology. It is also recommended to use steroids just before birth to reduce lung and central nervous system disabilities due to prematurity (baby born before term).
What problems may occur in a baby with intrauterine growth restriction?
Problems related to prematurity are higher in premature newborns with intrauterine growth restriction. This risk increases as the baby's birth week decreases. Particularly the worst outcomes have been reported in babies with significant blood flow disorders in the womb. If birth timing is done correctly and newborn care is carried out by an experienced team, intrauterine growth The long-term health outcomes of babies with growth restriction are no different from babies without growth restriction.
Babies with intrauterine growth restriction face long-term malnutrition and oxygen deficiency. This condition can lead to hypoxia (lack of oxygen) in the womb or during birth, ischemic brain damage in the newborn, meconium aspiration, polycythemia, hypoglycemia (low blood sugar levels) and other metabolic abnormalities. Therefore, it is very important to be able to optimally time the birth to avoid prolonged and progressive oxygen deficiency and nutritional deficiency in the unborn baby.
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