Early Onset Intrauterine Growth Restriction—Data from a Tertiary Care Center in a Middle-Income Country

Abstract

Background and Objectives: In this study, we aimed to describe the clinical and ultrasound (US) features and the outcome in a group of patients suspected of or diagnosed with early onset intrauterine growth restriction (IUGR) requiring iatrogenic delivery before 32 weeks, having no structural or genetic fetal anomalies, managed in our unit. A secondary aim was to report the incidence of the condition in the population cared for in our hospital, data on immediate postnatal follow-up in these cases and to highlight the differences required in prenatal and postnatal care. Materials and Methods: We used as single criteria for defining the suspicion of early IUGR the sonographic estimation of fetal weight <p10 using the Hadlock 4 technique at any scan performed before 32 weeks’ gestation (WG). We used a cohort of patients having a normal evolution in pregnancy and uneventful vaginal births as controls. Data on pregnancy ultrasound, characteristics and neonatal outcomes were collected and analyzed. We hypothesized that the gestational age (GA) at delivery is related to the severity of the condition. Therefore, we performed a subanalysis in two subgroups, which were divided based on the GA at iatrogenic delivery (between 27+0 WG and 29+6 WG and 30+0–32+0 WG, respectively). Results: The prospective cohort study included 36 pregnancies. We had three cases of intrauterine fetal death (8.3%). The incidence was 1.98% in our population. We confirmed that severe cases (very early diagnosed and delivered) were associated with a higher number of prenatal visits and higher uterine arteries (UtA) pulsatility index (PI) centile in the third trimester—TT (compared with the early diagnosed and delivered). In the very early suspected IUGR subgroup, the newborns required significantly more NICU days and total hospitalization days. Conclusions: Patients with isolated very early and early IUGR—defined as ultrasound (US) estimation of fetal weight <p10 using the Hadlock 4 technique requiring iatrogenic delivery before 32 weeks’ gestation—require closer care prenatally and postnatally. These patients represent an economical burden for the health system, needing significantly longer hospitalization intervals, GA at birth and UtA PI centiles being related to it.

Pregestational Prediabetes Induces Maternal Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation and Results in Adverse Fetal Outcomes: Influences on HPA Axis and Development

“…This process often leads to the clinical manifestation of intrauterine growth restriction (IUGR), characterized by the development of growth-retarded fetuses [128,129]. The diagnosis of IUGR is assigned to infants with a birth weight below the 10th percentile for gestational age [130,131]. In diabetic pregnancy, IUGR is observed most commonly in patients with vasculopathy (retinal, renal, or chronic hypertension) [37][38][39]132].…”

Effectiveness of an Educational Program about Iatrogenic Skin Afflictions on Pediatric Nurses' Performance and Neonates' Clinical Outcomes

“…The duration of hospital stays and the level of prematurity are correlated with a heightened susceptibility to iatrogenic effects, with drug errors representing a significant portion of these incidents. Beyond pharmaceutical mishaps, other iatrogenic complications encompass skin injuries, environmental hazards, prolonged mechanical ventilation, invasive procedure insertions, nosocomial infections, and the administration of parenteral nutrition (Dinu et al, 2023). Innovations in care protocols are imperative to address and mitigate these challenges in neonatal critical care, ensuring the well-being of the vulnerable population under consideration.…”

Intrauterine Growth Restriction—Prediction and Peripartum Data on Hospital Care

“…The study period was 1 September 2019-1 September 2022. The methodology of enrolment and partial results (the Eo-IUGR cohort) were previously published [9].…”

“…The unit's intern protocol was previously described [9]. The case management was customized based on the GA and on the results of US surveillance, including the Doppler findings in UtA, UmbA, and the middle cerebral artery (MCA); the fetal biophysical profile score; and the EFW [9]. The attending physician was able to increase or decrease the intensity of prenatal care and to decide the frequency of US scans.…”