A Study to Evaluate the Clinical Profiles of Asymmetric and Mixed Types of Intrauterine Growth Retardation

Introduction: The prevalence of intrauterine growth restriction (IUGR) is about 28% in the general population. IUGR posesincreased risk of fetal mortality and morbidity and also contributes to developmental origin of health and disease. Of the threetypes of IUGR, Type III is more common in developing countries. This study evaluates the clinical profiles of Type II and Type IIIIUGR and also to evaluate any differences between the two types.Materials and Methods: This cross-sectional, observational, and analytical study was conducted on 86 pregnant women withgestational age of more than 24 weeks, clinically diagnosed as IUGR and confirmed by ultrasound. They were followed up tilldischarge in the postnatal period. Any significant antenatal, intranatal, or postnatal events were recorded.Results: There were increased incidences of oligohydramnios, preterm birth, and requirement of cesarean section whichare increased in the cases of IUGR, more in Type II than in Type III IUGR. Furthermore, there were significant differences inmaternal Vitamin D levels between the low and normal birth weight groups in Type II IUGR.Conclusion: IUGR is associated with increased risk of preterm birth and operative delivery. Deficient maternal serum Vitamin Dlevels are a risk factor for low birth weight in asymmetric IUGR only, though further studies need to be conducted in this regard.

Role of sildenafil citrate therapy in pregnant women with foetal growth restriction and oligohydrominos from Northern India

Background: No specific treatment is available for severe early-onset IUGR. To best of my knowledge, very few studies have assessed the potential benefit of Sildenafil therapy targeted to improve perinatal outcomes in pregnancies complicated by severe early-onset IUGR in Indian pregnant women.Methods: The present hospital based prospective study was carried out on one hundred ANC pregnant women with early and late fetal growth restriction and oligohydrominos at Pannadhai Mahila Chikatsalya, Rabindra Nath Tagore (RNT) Medical College, Udaipur, during Jan to Dec 2017. Sildenafil citrate 25 mg three times in a day was  administered until delivery. Study subjects were subjected to fetal Doppler and ultrasound twice a week after the Sildenafil administration.Results: After sildenafil therapy, out of total 45 cases of IUGR alone, 39 cases (86.66 %) had improvement. Out of 35 cases of oligohydramnios alone, 28 cases (80 %) had improvement.  Out of 20 cases having both IUGR and Oligohydramnios 16 had improvement (80 %) and only 4 cases did not show any improvement. Among gestation age 27-30 weeks group at the time of admission, there were total 10 cases out of which 5 (50 %) had early premature delivery (32-34 weeks), 3 (30 %) had late premature delivery (34-37 weeks) and 2 cases (2 %) had term delivery i.e. between 37-39 weeks after giving sildenafil treatment.Conclusions: The findings of the present study indicate that sildenafil citrate may offer a potential therapeutic strategy to improve outcomes in pregnant women facing foetal growth restriction and oligohydrominos.