Modern approaches to the problem of intrauterine growth restriction: from causes to long-term consequences

Abstract

Intrauterine growth restriction of the fetus (IUGR, FGR) denotes a condition in which the fetus is not able to reach its genetically determined potential dimensions under various conditions (external, congenital, etc.). This functional definition aims to isolate the fetal population whose perinatal consequences can be modified (to prevent antenatal death or the birth of a child with severe disability). Thus, the task of a clinician and an expert in ultrasound diagnostics (maternal-fetal medicine) is to identify precisely fetuses with fetal growth restriction (FGR), which have the highest risk of antenatal death due to a «hostile intrauterine environment» and which require a separate control algorithm and iatrogenic intervention for the purpose of early delivery. Also, it is necessary to clearly isolate fetuses with low gestational weight (LGW) in order to reduce iatrogenic risks for them. The most urgent is the development of such a diagnostic and clinical algorithm in the clinic of extragenital pathology, since the risk of FGR is significantly increased in women with severe pathology, primarily with systemic lupus erythematosus, arterial hypertension, Aerz's disease, and oncological pathology detected during pregnancy and required polychemotherapy.
The aim of our work was to analyze the data of world and our own research on this issue. Systematized data on the types, causes, timing of occurrence and characteristics of indicators, depending on the forms of FGR, are represented.
The main cause of FGR is the insufficient supply of oxygen and nutrients to the fetus, a violation of the oxygen delivery system or damage to the structures of the placental barrier due to maternal diseases. In FGR, a chain of complications arises that must be promptly diagnosed and adequate interventions are performed to prevent perinatal morbidity and mortality.
An algorithm for diagnosing ARI has been developed on the basis of the clinical course of pregnancy, data from laboratory, ultrasound, Dopplerometric studies, and an obstetric strategy for FGR has been created. If this pathology occurs, a multidisciplinary team must create an individual plan for monitoring the condition of the fetus, assessing the effectiveness of therapy for the underlying disease of a pregnant woman with EHP. As a maximum program, an increase in gestational age during delivery, minimization of the risks of morbidity and mortality in newborns is considered. The short-term goal is to identify the fetus with suspected ARI/MGV, with further confirmation or exclusion of ARI. The medium-term goal is to create an algorithm for the frequency and set of observations taking into account EGP and obstetric complications of a pregnant woman; the long-term goal is to optimize the term of delivery to minimize hypoxemia and maximize the gestational age and improve the outcome for the mother.
No conflict of interest were declared by the authors.