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Intrauterine growth restriction (IUGR): current problems in diagnosis and optimal delivery option


Author: Iliadi-Tulbure Corina
Degree:doctor of medicine
Speciality: 14.00.01 - Obstetrics and Gynecology
Year:2009
Scientific adviser: Gheorghe Paladi
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Valentin Gudumac
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 11 November, 2008
Approved by NCAA on the 22 January, 2009

Abstract

Adobe PDF document0.52 Mb / in romanian

Thesis

CZU 618.33-073+618.5-089.888.61

Adobe PDF document 1.63 Mb / in romanian
128 pages


Keywords

intrauterine growth restriction (IUGR), USG exam, Doppler velocimetry, nitric oxide (NO), lactic acid (AL), ceasarian section (CS).

Summary

The IUGR currently constitutes one of the most complex issues of modern obstetrical and perinatal sciences, its incidence constantly increasing and influencing wellbeing indicators at birth. Up to this date, a diagnosis algorithm and an evidence-based decision on optimal delivery are missing notwithstanding numerous studies of various aspects of hypotrophy, the in-depth analysis of these problems constituting the goal of the research hereto.

The respective study has been undertaken on a sample of 410 pregnant women, 310 of them, diagnosed with IUGR, divided in 3 groups based on the degree of fetal distress; 50 pregnant women diagnosed with constitution hypotrophy and the control group constituted of 50 women. Depending on the delivery option, these have been divided in 2 subgroups each, segregated conventionally as deliveries per vias naturalis and ceasarian sections.

The study results indicate an increase in the incidence of IUGR from 3,19±1,1013% in 1993 to 6,2±0,06% in 2002-2006. The forecast on the incidence of IUGR has been estimated at 6,99±0,069% by 2011, if medical-social factors identified persist.

The study results have indicated risk factors in IUGR cases, as well as frequent pregnancy complications in these situations.

A distinction has been made between children with IUGR and children with low birth weight – having constitution hypotrophy as indicated by family history, paraclinical investigations and further harmonious development of these children for the longer term. The distinction is imperative in the light of the difference in obstetrical and oversight mechanisms.

The research has made possible the development of a hierarchy IUGR assessment methods, most effective being the USG exam, followed by Doppler velocimetry that represents a complementary, however important and necessary, diagnosis means. It has been stressed upon the need to use in utero growth curbs and the percentile concept. There have been established beyond doubt the estimative value, the diagnosis value and the high correlation rate of the paraclinic diagnosis methods. The levels of the biological markers (NO, AL) have reflected the severity degree of IUGR.

Based on the results of the assessment of the newborn according to the Apgar score, and the levels of the perinatal indicators, we have concluded that the ceasarian section is the preferred delivery option in the case of IUGR.

The long term examination of newborns with hypotrophy has indicated that significant differences in the development dynamics, children born by ceasarian section displaying more satisfactory perinatal results, compared to those born per vias naturalis.