Major Fetal Hazards in Multiple Pregnancy

1976 ◽  
Vol 25 (1) ◽  
pp. 299-306 ◽  
Author(s):  
F. Leroy
Keyword(s):  
Early Diagnosis ◽  
Fetal Growth ◽  
Intrauterine Growth Retardation ◽  
Fetal Death ◽  
Multiple Pregnancy ◽  
Bed Rest ◽  
Fetal Ultrasonography ◽  
Intrauterine Growth ◽  
Clinical Methods ◽  
Mz Twins

Fetal risk in twin pregnancy is recognized as being about 2 to 4 times higher than in singletons. The main factors of this increased mortality are reviewed. Pathological effects associated with MZ origin are mainly due to the “third circulation” occurring in monochorial twins. Three situations can be distinguished: (a) hemodynamic equilibrium resulting in fetal growth impairment, (b) strong hemodynamic imbalance inducing fetal death, (c) moderate imbalance as the cause of “intertwin transfusion syndrome”. The acardiac and to some extent the papyraceus fetus can be considered as particular cases of the same problem. Other risks associated with MZ twins are the higher rate of malformations and umbilical cord entanglement in monoamniotic twins. The conjoined effects of prematurity and intrauterine growth retardation are undoubtedly the main cause of fetal death in multiple births. Therefore, some consideration is given to the underlying physiopathogenic factors. Prevention of twin weight defects demands early diagnosis of multiple pregnancy. As little can be expected from classical clinical methods, the obstetrician has to rely on more sophisticated techniques such as fetal ultrasonography. Even with an early diagnosis, at the present time there is no satisfactory treatment capable of preventing prematurity and retarded fetal growth. In this specific context, bed rest would appear as a fallacy.

Categories of intrauterine growth retardation

1993 ◽  
Vol 5 (4) ◽  
pp. 203-212 ◽  
Author(s):  
Roger A Fay ◽  
David A Ellwood
Keyword(s):  
Soft Tissue ◽  
Fetal Growth ◽  
Gestational Age ◽  
Growth Retardation ◽  
Large Scale ◽  
Intrauterine Growth Retardation ◽  
Low Birthweight ◽  
Ponderal Index ◽  
Intrauterine Growth ◽  
Different Types

Originally all low birthweight infants were considered to be premature. When prematurity was redefined in terms of gestational age (SGA) and not preterm. With the large scale collection of obstetric data the distributions of birthweight at different gestational ages were described and from these, infants who were SGA could be defined. SGA became synonymous with terms such as growth retardation, but it soon became appearent that the two were not necessarily interchangeable. Scott and Usher found that it was the degree of soft tissue wasting rather than birthweight that related to poor perinatal outcome. Miller and Hassanein stated that: “birthweight by itself is not a valid measure of fetal growth impairment”. They used Rorher’s Ponderal Index (weight (g) × 100/length (cm)) to diagnose the malnourished or excessively wasted infants with reduced soft tissue mass. Most studies of intrauterine growth retardation (IUGR) still use low birthweight for gestational age centile as their only definition of IUGR or only study infants who have a low birthweight. Altman and Hytten expressed disquiet about this definition and stated: “There is now an urgent need to establish true measures of fetal growth from which deviations indicating genuine growth retardation can be derived” and that “it is particularly important that some reliable measures of outcome should be established”. In large series of term deliveries published recently, two groups of IUGR infants with different growth patterens have been identified. These studies confirm that birthweight alone is inadequate to define the different types of IUGR. They established that low Ponderal Index (PI) is a measure of IUGR associated with an increased incidence of perinatal problems and that it is time to re-evaluate IUGR in terms of the different types of aberrant fetal growth.

Differential Effects of Maternal Heroin and Methadone Use on Birthweight

PEDIATRICS ◽  
1976 ◽  
Vol 58 (5) ◽  
pp. 681-685
Author(s):  
Stephen R. Kandall ◽  
Susan Albin ◽  
Joyce Lowinson ◽  
Beatrice Berle ◽  
Arthur I. Eidelman ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Growth Retardation ◽  
Intrauterine Growth Retardation ◽  
Methadone Maintenance ◽  
First Trimester ◽  
Control Group ◽  
Fetal Growth Retardation ◽  
Intrauterine Growth ◽  
Methadone Dosage ◽  
History Of

An analysis of birthweights of 337 neonates in relation to history of maternal narcotic usage was undertaken Mean birthweight of infants born to mothers abusing heroin during the pregnancy was 2,490 gm, an effect primarily of intrauterine growth retardation. Low mean birthweight (2,615 gm) was also seen in infants born to mothers who had abused heroin only prior to this pregnancy, and mothers who had used both heroin and methadone during the pregnancy (2,535 gm). Infants born to mothers on methadone maintenance during the pregnancy had significantly higher mean birthweights (2,961 gm), but lower than the control group (3,176 gm). A highly significant relationship was observed between maternal methadone dosage in the first trimester and birthweight, i.e., the higher the dosage, the larger the infant. Heroin causes fetal growth retardation, an effect which may persist beyond the period of addiction. Methadone may promote fetal growth in a dose-related fashion after maternal use of heroin.

The Prognostic Significance of Antenatal Diagnosis of Fetal Growth Retardation

1992 ◽  
Vol 8 (S1) ◽  
pp. 176-181 ◽  
Author(s):  
Ingemar Leijon
Keyword(s):  
Fetal Growth ◽  
Growth Retardation ◽  
Intrauterine Growth Retardation ◽  
Antenatal Diagnosis ◽  
Perinatal Asphyxia ◽  
Prognostic Significance ◽  
Optimal Time ◽  
Fetal Growth Retardation ◽  
Intrauterine Growth ◽  
The Individual

AbstractIntrauterine growth retardation is associated with high risk of perinatal asphyxia. The neonatal mortality rate of small-for-gestational-age (SGA) infants (birthweight ≤ 2 SD) in Sweden decreased from 5.6% in 1973 to 2.0% in 1987. During the same period, the number SGA infants with postnatal asphyxia (5 min Apgar score <7) decreased from 10% to 5%. Based on antenatal diagnosis of fetal growth retardation, an optimal time of delivery reduces the risk of major neurological and developmental sequelae of the individual infant.

HUMAN FETAL GROWTH RETARDATION: I. CLINICAL FEATURES OF SAMPLE WITH INTRAUTERINE GROWTH RETARDATION

PEDIATRICS ◽  
1972 ◽  
Vol 50 (4) ◽  
pp. 547-558
Author(s):  
J. Urrusti ◽  
P. Yoshida ◽  
L. Velasco ◽  
S. Frenk ◽  
A. Rosado ◽  
...  
Keyword(s):  
Birth Weight ◽  
Premature Infants ◽  
Fetal Growth ◽  
Gestational Age ◽  
Growth Retardation ◽  
Intrauterine Growth Retardation ◽  
Fetal Growth Retardation ◽  
Neonatal Deaths ◽  
Intrauterine Growth ◽  
Normal Term

Intrauterine growth was assessed in a series of 128 cases. Thirty-six infants were small for gestational age, and showed the usual signs of intrauterine growth retardation (IUM). The head circumference of these infants was small, with reference to normal term babies (FT) and comparable to premature infants, appropriately sized for a gestational age (ACA) five weeks less than that of the IUM's. There were 12 neonatal deaths, three among IUM infants within 24 hours and nine in the low birth weight AGA group within 72 hours. The mothers of these three groups of infants were similar with respect to age, weight, height, nutritional patterns, and prior pregnancy histories.

Increased lipolysis but diminished gene expression of lipases in subcutaneous adipose tissue of healthy young males with intrauterine growth retardation

2011 ◽  
Vol 111 (6) ◽  
pp. 1863-1870 ◽  
Author(s):  
Lise Højbjerre ◽  
Amra C. Alibegovic ◽  
Mette P. Sonne ◽  
Flemming Dela ◽  
Allan Vaag ◽  
...  
Keyword(s):  
Blood Flow ◽  
Adipose Tissue ◽  
Mrna Expression ◽  
Growth Retardation ◽  
Intrauterine Growth Retardation ◽  
Bed Rest ◽  
Whole Body ◽  
Intrauterine Growth ◽  
Glucose Clamp Technique

Intrauterine growth retardation (IUGR) is associated with a central fat distribution and risk of developing type 2 diabetes in adults when exposed to a sedentary Western lifestyle. Increased lipolysis is an early defect of metabolism in IUGR subjects, but the sites and molecular mechanisms involved are unknown. Twenty IUGR and 20 control (CON) subjects, aged 20–30 years, were studied before and after 10 days of bed rest using the glucose clamp technique combined with measurements of in vivo metabolism by microdialysis technique and blood flow by 133Xe washout technique in subcutaneous abdominal (SCAAT) and femoral (SCFAT) adipose tissue. Additionally, mRNA expression of lipases was evaluated in biopsies from SCAAT. Lipolysis in SCAAT was substantially higher in IUGR than in CON subjects despite markedly lower mRNA expression of lipases. Blood flow was higher in IUGR compared with CON in both SCAAT and SCFAT. Whole body insulin sensitivity did not differ between groups and decreased after bed rest. After bed rest, SCAAT lipolysis remained higher in IUGR compared with CON, and SCFAT lipolysis decreased in CON but not in IUGR. Prior to the development of whole body insulin resistance, young men with IUGR are characterized by increased in vivo adipose tissue lipolysis and blood flow with a paradoxically decreased expression of lipases compared with CON, and 10 days of physical inactivity underlined the baseline findings. Subjects with IUGR exhibit primary defects in adipose tissue metabolism.

scholarly journals Intrauterine Fetal Growth Retardation: A Comparison of Human Placental Lactogen Urinary Oestriol and Biparietal Diameter Measurements

1974 ◽  
Vol 11 (1-6) ◽  
pp. 15-17 ◽  
Author(s):  
H. P. Robinson ◽  
W. R. Chatfield ◽  
R. W. Logan ◽  
Frances Hall
Keyword(s):  
Fetal Growth ◽  
Growth Retardation ◽  
Intrauterine Growth Retardation ◽  
Placental Lactogen ◽  
Fetal Growth Retardation ◽  
Human Placental Lactogen ◽  
Reliable Prediction ◽  
Intrauterine Growth ◽  
Biparietal Diameter

Forty-two ‘at risk’ pregnancies were serially monitored by sonar biparietal cephalometry, 24 h urinary oestriol assays and determination of serum human placental lactogen. The results were assessed by a scoring system, and it was found that a combination of sonar cephalometry and 24 h urinary oestriol assays gave the most reliable prediction of intrauterine growth retardation.

scholarly journals Outcome of Pregnancy Complicated by Threatened Abortion

2012 ◽  
Vol 9 (1) ◽  
pp. 41-44 ◽  
Author(s):  
A Dongol ◽  
S Mool ◽  
P Tiwari
Keyword(s):  
Folic Acid ◽  
Spontaneous Abortion ◽  
Growth Retardation ◽  
Intrauterine Growth Retardation ◽  
Bed Rest ◽  
Folic Acid Supplementation ◽  
Intrauterine Death ◽  
Acid Supplementation ◽  
Intrauterine Growth ◽  
Threatened Abortion

Background Threatened abortion is the most common complication in the first half of pregnancy. Most of these pregnancies continue to term with or without treatment. Spontaneous abortion occurs in less than 30% of these women. Threatened abortion had been shown to be associated with increased incidence of antepartum haemorrhage, preterm labour and intra uterine growth retardation. Objective This study was to asses the outcome of threatened abortion following treatment. Methods This prospective study was carried out in Dhulikhel Hospital - Kathmandu University Hospital from January 2009 till May 2010. Total 70 cases of threatened abortion were selected, managed with complete bed rest till 48 hrs of cessation of bleeding, folic acid supplementation, uterine sedative, and hormonal treatment till 28 weeks of gestation. Ultrasonogram was performed for diagnosis and to detect the presence of subchorionic hematoma. Patients were followed up until spontaneous abortion or up to delivery of the fetus. The measures used for the analysis were maternal age, parity, gestational age at the time of presentation, previous abortions, presence of subchorionic hematoma, complete abortion, continuation of pregnancy, antepartum hemorrhage, intrauterine growth retardation and intrauterine death of fetus. Results Out of 70 cases subchorionic haematoma was found in 30 (42.9%) cases. There were 12 (17.1%) patients who spontaneously aborted after diagnosis of threatened abortion during hospital stay, 5 (7.1%) aborted on subsequent visits while 53 (75.8%) continued pregnancy till term. Among those who continued pregnancy intrauterine growth retardation was seen in 7 (13.2%), antepartum hemorrhage in 4 (7.5%), preterm premature rupture of membrane in 3 (5.66%) and IUD in 3 (5.66%). Spontaneous abortion was found more in cases with subchorionic hematoma of size more than 20 cm2. Conclusion In cases of threatened abortion with or without the presence of subchorionic hematoma, prognostic outcome is better following treatment with bed rest, uterine sedatives, folic acid supplementation and hormonal treatment.http://dx.doi.org/10.3126/kumj.v9i1.6261 Kathmandu Univ Med J 2011;9(1):41-4

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