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INTRODUCCIÓN: La restricción del crecimiento fetal (RCF) se define como la disminución patológica de la tasa de crecimiento fetal, generalmente asociada a insuficiencia placentaria. Se diagnostica mediante ultrasonografía obstétrica y velocimetría Doppler, pero no existe un consenso global respecto a los parámetros referenciados. OBJETIVO: Brindar una revisión actualizada de la aproximación clínica de la RCF en Chile, enfocada en el uso de la ultrasonografía Doppler como herramienta fundamental para el diagnóstico, el pronóstico y el manejo de esta patología, y realizar una comparativa con respecto a otros países. MÉTODO: Se realizó una revisión con palabras clave en las bases de datos PubMed y SciELO. RESULTADOS: Se obtuvieron 89 referencias bibliográficas, logrando una revisión de datos actualizados del uso del Doppler en la RCF tanto en el mundo como en Chile. CONCLUSIONES: La Guía Perinatal 2015 publicada en Chile carece de actualización con los conocimientos y la evidencia científica más recientes. Sin embargo, concuerda en gran parte con los lineamientos y las pautas generales de manejo de la RCF de las diferentes guías clínicas analizadas. Las discrepancias entre las guías revisadas podrían explicarse por la gran variabilidad de la evidencia de los estudios científico-clínicos, los cuales es importante unificar a través de una guía que promueva una estandarización de la atención de la RCF en el país.
INTRODUCTION: Fetal growth restriction (FGR) is the pathological decrease in the fetal growth rate generally associated with placental insufficiency. Diagnosis is made by obstetric ultrasonography and Doppler velocimetry, assessing different biometric and hemodynamic parameters. However, there is no global consensus regarding the parameters to be referenced. OBJECTIVE: To provide an updated review of the FGR clinical approach in Chile, focused on the use of Doppler ultrasonography as a fundamental tool in the diagnosis, prognosis, and management of this pathology and to compare with other countries. METHOD: A literature search was conducted in the PubMed and SciELO databases, including relevant and updated articles. RESULTS: The search included 89 bibliographic references under which it was possible to make a review of the most current data on the use of Doppler in FGR both worldwide and in Chile. CONCLUSIONS: The 2015 Perinatal Guidelines published in Chile is not updated with the latest scientific evidence and knowledge. However, it largely agrees with international guidelines for FGR management. The discrepancies between the revised guidelines could be explained due to the variability of evidence from scientific-clinical studies, which are essential to unify for standardized care of FGR in the country.
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Humans , Female , Pregnancy , Ultrasonography, Prenatal , Fetal Growth Retardation/diagnostic imaging , ChileABSTRACT
Background: CPR is emerging as an important predictor of adverse pregnancy outcome and helps in management of high risk pregnancy. Therefore we undertook the study to find the correlation of CPR with perinatal outcomes in women with hypertensive disorder complicating during third trimester.Methods: 128 patients with hypertensive disorder of pregnancy, ≥32 weeks of singleton gestation, were randomly selected during their hospital visit. They were subjected to USG Doppler study to calculate MCA/UA pulsatility index-CPR. The CPR<1 was considered abnormal and >1 as normal. These results were compared with the perinatal outcome and adverse fetal outcome.Results: The present study revealed that the incidence of adverse outcomes like Apgar score <7 (36.5%), still birth (15.9%), NICU admission (69.8%) and LBW i.e. <2500 gm (68.3%) were significantly higher in abnormal CPR than normal CPR.Conclusions: Abnormal CPR is valuable in predicting the outcome of hypertensive disorders in pregnancy. CPR is an easy procedure which can be included in the routine antenatal sonographic evaluation to predict poor perinatal outcome and to detect or recognize those fetuses at risk.
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Background: The placenta is a dynamic organ to maintain the fetal homeostasis by performing a wide range ofphysiological functions. It undergoes various changes in terms of shape, size, surface area and structure duringpregnancy to support growth of the fetus. The efficiency in transfer of nutrients and oxygen through the placentais the primary determinant of birth weight.Detailed study of placenta gives a wide scope of knowledge on fetalgrowth. This study has attempted to find the correlation between umbilical cord length with birthweight and fetallength along with the correlation between other placental parameters and fetal parameters.Materials and methods: The placentas required for this study were collected from the labor room. After thoroughinspection of the placenta, shape and presence of any anomalies were noted and then the size of the placenta,which includes weight, thickness and diameter were measured. The length of the umbilical cord was measuredwith a tape calibrated in centimeters from cut end to placental end and also from cut end to fetal end. Summationof these two values gave the total length of the umbilical cord. The fetal parameters like birth weight wasmeasured by using a digital weighing machine, while the crown-heel length was measured with the help of aninfantometer.Results: 35% of placentas are round shape and 65% are of oval shape. Mean ± SD of placenta weight is 458±49.5gm,umbilical cord length is 56.2 ± 3.2cm, birth weight is 2.4 ± 0.4kg and crown-heel length is 45.8 ± 4.2cm.Conclusion: A significant relation was found between placenta size and birth weight. A non-significant relationwas found between umbilical cord length and birth weight along with umbilical cord length and crown heellength.
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Introduction:Placenta is a mirror which reflects the antepartum status of fetus in utero. Our present study aimed to analyse the morphometry of placenta in normal and assisted reproduction.Subjects and Methods:30 Placentas of natural conception and 42 placentas of assisted reproduction (18 cases of singleton pregnancies, 12 cases of twin pregnancies) were collected from OG department, Rajah Muthiah Medical College and from private fertility centre in and around Chidambaram immediately after delivery. Morphometric dimensions of placenta like thickness, diameter, area, number of cotyledons were measured placental weight, fetal weight were also measured.Results:Placental weight of natural conception was 489 ± 107.84 grams, 316.78 ± 88.24 grams in assisted reproduction. Thickness of placenta was 2.767 ± 0.68 cm in natural conception, 1.78 ± 0.68 cm in assisted reproduction. Number of cotyledons, fetal weight, feto - placental ratio were also reduced in assisted reproduction.Conclusion:This is the first study to analyse the morphometric dimensions of placenta in natural conception and in assisted reproduction. Overall there was a reduction in all dimensions of placenta in assisted reproduction. This will be useful for pediatricians who handle the newborns of assisted reproduction.
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The dimension of delivered placentae mirrors the cumulative growth of the placenta from conception to parturition. Placental weight is the gross summary of fetal growth under the influence of many extrinsic and intrinsic factors. Hence, the present study evaluated the influence of gestation, sex of the newborn, and parity on feto-placental ratio. The study was conducted on 391 placentae of singleton newborn from a teaching hospital of North Karnataka, India. Data was collected from August 2012 to January 2013 by using standard operating procedures. The Mean and standard deviations of placental morphometry, weight and birth weight are 440 ± 100gm and 2700±500 gm respectively. In gestational age 28 to 32 weeks, the feto-placental ratio was 5.61:1; this increased consistently up to 6.19:1 with increasing gestation group 37 weeks and above. Feto-placental ratio increased with increasing groups of gestational age. Feto-placental ratio in <37 weeks of gestation was in favor of primipara (6.0:1) whereas, the similar figures in term babies was more in multipara (6.3:1). The paritywise feto-placental ratio direction changed from preterm to term babies, but the differences were not statistically significant. However, irrespective of gestation, multipara had higher feto-placental ratio (6.2:1) as compared to primipara (6.1:1). However, irrespective of gestation, males had higher feto-placental ratio (6.2:1) as compared to females (6.1:1). Feto-placental ratio is influenced by variates of pregnancy like gestation, sex of the newborn and parity. Hence, variations in any of these factors lead to adverse pregnancy outcome by deviation of feto-placental ratio.
Subject(s)
Female , Fetal Weight/etiology , Gestational Age , Humans , Male , Placenta/anatomy & histology , Placenta/growth & development , Placenta/pathology , Pregnancy , Pregnancy OutcomeABSTRACT
Aims: To study the morphology and do the morphometric analysis of placenta and to correlate with the foetal parameters, in order to help in the assessment of the state of well being of foetus. To study the histomorphological features of placenta in various conditions complicating the pregnancy. Study Design: Descriptive type of study. Place and Duration of Study: Department of Pathology and Department of Obstetrics and Gynaecology, Sri Manakula Vinayagar Medical College, Puducherry, between July 2013 and August 2013. Methodology: We included 51 fresh placentae. Gross examination including weight, shape, thickness, feto-placental ratio, placental co-efficient was calculated. Later, histo- morphological study was done. Results: Out of the 51 placentae, 48 were circular in shape and 3 were oval in shape. In the present study the mean (± SD) diameter of the placenta was 14.65 cm and thickness of the placenta was 1.42 cm. The thickness of placenta was reduced (<1.5cm) in all cases of Pregnancy induced hypertension (PIH), Isoimmunisation, twin pregnancy, prematurity and anemia. Placental weight was reduced in all cases of PIH, low birth weight baby, prematurity and Increased placental weight was seen in the gestational diabetes. Fetoplacental ratio was 5.39:1(both sexes considered together) and placental coefficient was 0.19. In PIH, the average foeto-placental ratio was 5.20:1and the average placental coefficient was 0.19. Gestational diabetes showed a foeto-placental ratio of 5.30:1, the placental coefficient being 0.18 with a considerable increase in the birth weight and in the placental weight. Anaemia showed a significant reduction in the placental weight, with a foeto-placental ratio of 5:1 and an increase in the number of ill-defined cotyledons. In prematurity, average foeto-placental ratio was 4.43:1, while Rh isoimmunisation did not show any decrease in the foeto- placental ratio. Conclusion: As anticipated, in case of PIH complicating pregnancies, the morphometric values of the placenta like the diameter, number of cotyledons and the average placental and foetal birth weights were found to be lower than that of the normal, uncomplicated pregnancies. At the same time, all these parameters were increased in cases of diabetes. So morphometric investigation of the placenta will be tremendously useful in the early assessment of placental insufficiency and also the state of foetal well being.
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OBJECTIVE: To determine if the placental size is disproportionately increased in the large-for-gestational age infants in pregnancies complicated by impaired glucose tolerance controlled with insulin. PATIENS AND METHODS: A retrospective study was performed on 104 singleton pregnancies complicated by gestational impaired glucose tolerance controlled with insulin. The cases were categorized by the infant birthweight percentile into three groups, i.e. small-for-gestational age (90th percentile). Maternal and infant anthropometric data, glycemic status, and placental weight-to-birthweight ratio were compared among three groups. RESULTS: The maternal glucose level just after delivery, infant body mass index and placental weight showed a significant increment from the small-for-gestational age to the large-for-gestational age groups (p<0.05). The placental weight-to-birthweight ratio was significantly higher in the small-for-gestational group. On the other hand, there was no significant difference in the values of the oral glucose test, hemoglobin A1c and maternal body mass index among three groups. Maternal body mass index showed a increasing trend from the small-for gestational age to the large-for-gestational age groups. Placental weight-to-birthweight ratio was not significantly correlate with maternal glucose level. CONCLUSIONS: The results indicate that the placenta is disproportionately bigger, and rigid control of maternal blood glucose does not prevent the development of placental overgrowth. Maternal obesity in well- controlled gestational diabetes mellitus may be more significant than glucose control in the development of large-for-gestational-age infants. Different management strategies for women with gestational diabetes mellitus with different pregravid weights are warranted.
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Female , Humans , Infant , Pregnancy , Blood Glucose , Body Mass Index , Diabetes, Gestational , Gestational Age , Glucose , Hand , Insulin , Obesity , Placenta , Retrospective Studies , Weights and MeasuresABSTRACT
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.
Subject(s)
Female , Humans , Infant , Pregnancy , Amnion , Asphyxia , Birth Weight , Fetal Development , Hypertension, Pregnancy-Induced , Hypocalcemia , Meconium , Phototherapy , Retrospective StudiesABSTRACT
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.