Fetal growth in low-risk Indian population at a tertiary centre and its comparison with INTERGROWTH-21 standards: a prospective cohort study

Background: The objective of this study was to compare the fetal growth pattern in low risk Indian population with the INTERGROWTH-21 standards.Methods: Low risk women were enrolled at 10 to 20 weeks of gestation and followed up until delivery. An experienced operator performed abdominal ultrasound every 5±1 week and measured biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) of the fetus. Newborn anthropometric measurements were taken within 12 hours of childbirth.Results: A total of 126 healthy women, enrolled at mean gestation of 16.8±1.6 weeks, completed the follow up until delivery. None of the participants developed any major obstetric or medical morbidity. The study subjects showed lower mean z scores for BPD (-0.7±1.3), HC (-0.4±1.3) and AC (-0.4±1.3) but a higher mean z-score for FL (0.3±1.7) as compared to INTERGROWTH-21 standards. From 1st through 5th visit, the z scores for BPD and HC improved whereas declined for AC and FL.Conclusions: The fetal growth in non-affluent healthy Indian women had a lower fetal growth compared to INTERGROWTH-21 standards.

Cirugía fetal láser en síndrome de transfusión feto feto y restricción selectiva del crecimiento intrauterino

Introduction: The monochorionic biamniotic twin pregnancy (MCBA) corresponds to approximately 15% of all twin pregnancies and an estimate of 10-15% develop complications proper of these types of pregnancies, such as selective intrauterine fetal growth restriction (IUGRs) and feto-fetal transfusion syndrome (FFTS). Laser fetal surgery allows treatment of these hemodynamic alterations of MCBA by fulguration of placental anastomoses, and it is currently considered the first-choice therapy for FFTS and some IUGR cases. Objectives: To highlight the general aspects of laser fetal surgery and to describe current evidence of its efficacy and safety in FFTS and IUGRs. Methods: Review of articles published during the last five years in indexed journals from the following databases: PUBMED, MEDLINE, EMBASE and Cochrane Library. Review papers, original papers, and systemic reviews were included. Classic relevant papers on fetal surgery history were also included. Results: By means of this nonsystematic review of the literature, 43 articles were considered for the present paper. Conclusion: This review evidences that laser fetal surgery improves the prognosis of FFTS fetuses. The use of this therapy in IUGRs cases has not improved survival.

Introducción. El embarazo gemelar monocorial biamniótico (MCBA) corresponde aproximadamente al 15% de los embarazos gemelares y, de estos, se estima que 10 a 15% desarrollan complicaciones propias de este tipo de embarazos, como la restricción selectiva del crecimiento intrauterino (RCIUS) y el síndrome de transfusión feto (STFF). La cirugía fetal láser permite tratar la causa de estas alteraciones hemodinámicas propias de los embarazos MCBA a través de la coagulación de las anastomosis placentarias, y es considerada actualmente la terapia de elección en el STFF y aplicable en algunos casos de RCIUS. Objetivos. Resaltar los aspectos generales de la cirugía fetal láser y describir la evidencia actual de la eficacia y seguridad de su uso en el STFF y la RCIUS. Metodología. Se realizó una búsqueda de la literatura de artículos publicados en revistas indexadas en las siguientes bases de datos: PUBMED, MEDLINE, EMBASE, Cochrane Library. Se incluyeron revisiones de tema, investigaciones originales y revisiones sistemáticas de la literatura, publicadas en los últimos 5 años. Además, se incluyen artículos clásicos relevantes en la historia de la cirugía fetal. Resultados. Producto de la revisión no sistemática de la literatura, se incluyeron 43 para la construcción de la presente revisión. Conclusiones. La presente revisión evidencia que la cirugía láser fetal mejora el pronóstico de los fetos con STFF. El uso de dicha terapia para los casos de restricción de crecimiento intrauterino selectivo no ha mejorado la sobrevida.

The Relationship between Placental Ratio and Neonatal Morbidity in Intrauterine Growth Restricted Infants / 대한산부인과학회잡지

An increased placental ratio has known to be associated with the occurrence of cardiovascular complications in adulthood among the intrauterine fetal growth restriction. A retrospective study on 202 singleton growth-restricted infants without major congenital anomalies born from Jan. 1995 to Feb. 2001 was performed to determine the relationship between placental ratio and neonatal morbidity. The cases were categorized into three groups according to the placental ratio (1SD above the mean). There were no differences in the maternal characteristics and antenatal complications except pregnancy induced hypertension between high placental ratio group and the other groups. It presented the trend that was toward the increase of placental weight and the decrease of birth weight in high placental ratio group. The infants with a high placental ratio had increasing tendencies of meconium stained amnionic fluid, hypocalcemia, phototherapy, asphyxia.

The Relationship between Placental Ratio and Neonatal Morbidity in Intrauterine Growth Restricted Infants / 대한산부인과학회잡지

An increased placental ratio has known to be associated with the occurrence of cardiovascular complications in adulthood among the intrauterine fetal growth restriction. A retrospective study on 202 singleton growth-restricted infants without major congenital anomalies born from Jan. 1995 to Feb. 2001 was performed to determine the relationship between placental ratio and neonatal morbidity. The cases were categorized into three groups according to the placental ratio (1SD above the mean). There were no differences in the maternal characteristics and antenatal complications except pregnancy induced hypertension between high placental ratio group and the other groups. It presented the trend that was toward the increase of placental weight and the decrease of birth weight in high placental ratio group. The infants with a high placental ratio had increasing tendencies of meconium stained amnionic fluid, hypocalcemia, phototherapy, asphyxia.

Relationship between Concentration of Cord Blood Leptin Level and Intrauterine Fetal Growth

PURPOSE: Leptin is a highly hydrophilic 16-kDa protein which is produced in the adipose tissue and participates in the regulation of food intake and energy expenditure. The aim of the present study was to examine the relation between umbilical cord blood leptin concentration and intrauterine growth. METHODS: Ninety-seven full-term newborn infants who were born in Yeungnam University Hospital from July to August 1998 were included in the study. They were divided into 3 groups related to birth weight : appropriate for gestational age(AGA) group(n=73), large for gestational age(LGA) group(n=17), small for gestational age(SGA) group(n=7). Birth weight, head circumference, mid-arm circumference, mid-arm circumference to head circumference ratio, Ponderal index, and BMI were measured at birth. Maternal body weight and placental weight were measured. Leptin concentrations of cord blood and maternal serum were measured by a RIA method, and testosterone, estradiol, insulin, c-peptide, glucose, white blood cell, hemoglobin, platelet count of cord blood were also measured. RESULTS: Leptin concentration in cord blood was positively correlated to birth weight and body length. Leptin concentrations(microgram/L) in cord blood were significantly different among groups(10.1+/-1.1 in LGA group, 8.7+/-0.9 in AGA group, 1.7+/-0.1 in SGA group). There was a statistically significant difference in leptin concentration of cord blood between female and male infants(11.6+/-1.9, versus 6.7+/-0.9). There was no significant correlations between leptin concentration of cord blood and placental weights or maternal leptin concentration. Therefore leptin concentration of cord blood can not inflect maternal leptin concentration but intrauterine fetal growth. CONCLUSION: Leptin in cord blood might originate mainly from fetal adipose tissue rather than the placenta, and may be related to fetal growth.

Clinical Study on Intrauterine Fetal Growth Restriction / 대한주산의학회잡지

This study was undertaken at the department of Obstetrics and Gynecology, Chonnam University Medical School, to investigate the association between some of the risk factor and the incidence of intrauterine fetal growth restriction(IUGR). The studied population was selected from patients who admitted at Chonnam University Hospital during January, 1992 through May, 1997, with following criteria, Korean, singletone pregnancy with live birth and known gestational weeks with 28 or more. And then, the risk factors were analyzed in terms of maternal factor, placental factor, and fetal factor. The following results were obtained. 1) The incidence of IUGR was 6.1%. 2) The incidence of IUGR was higher at young aged mother and nullipara. 3) Only 39.1% of etiologic factors for IUGR was found to have known causes. According to the risk factors for IUGR, hypertensive disorder during pregnancy, anemia, cardiac disease, leukemia, and pulmonary tuberculosis were associated with increased incidence of IUGR. 4) The relative risk of IUGR was much higher in neonates born with congenital anomalies. 5) According to the placental causes of IUGR, placenta previa and placenta abruption showed some association with IUGR.