Glasnik pulske bolnice, Vol. 5 No. 5, 2008.
Izvorni znanstveni članak
ANTENATAL TESTS AND PREGNANCY OUTCOME IN CASES OF SEVERE INTRAUTERINE GROWTH RESTRICTION THAT WERE PREMATURELY TERMINATED WITH ELECTIVE CAESAREAN SECTION ‒ EXPERIENCES FROM THE PULA GENERAL HOSPITAL
Dragan Belci
Davor Zoričić
Tomislav Perkov
Mirna Milevoj-Ražem
Adele Žužek
Gracijela Rogulj
Tatjana Ravnić-Bunčić
Anđelo Slivar
Ivan Grdinić
Elena Gattoni-Stepanov
Sažetak
Antenatal tests determining fetal growth are performed in order to recognize intrauterine growth restriction (IUGR) and find early signs of fetal compensatory mechanisms failure. Cardiotocography (non-stress and stress test), doppler measurements of fetal and placentar circulation and the fetal biophysical profile are presently used for this purpose. They should scan fetuses with risk for a bad pregnancy outcome. A severe IUGR can occur due to several reasons, but it is most commonly caused by a deranged placenta function leading to a respiratory insufficiency and fetal hypoxemia.
A delayed childbirth in such cases may lead to a deterioration of hypoxia, even of perinatal death. Apart from that, such children often show complications in their neurological development. This retrospective five-year study analyzed the application of antenatal tests and the pregnancy outcome in 18 patients with severe IUGR (fetal weight equal to or below the 5th percentile) who were hospitalized on the Pregnancy pathology ward of the Pula General hospital. In all the cases fetal monitoring was performed using a combination of tests (in most cases doppler measurements and a biophysical profile). The decision on a termination of pregnancy at 35-37 weeks of gestation was reached on the basis of one or more pathological tests (biophysical profile, Doppler or stress test), whereas the pathological test result of the biophysical profile was decisive for pregnancies of less than 35 weeks. The two groups of patients showed no differences in the Apgar score or the pH value
of umbilical blood (Apgar 8/8,6- 7,4/8,6 pH 7,29- 7,31). The most newborns from the 35-37 weeks group had normal CNS ultrasound results, as well as normal neuromotoric clinical findings 6 months after birth. The CNS ultrasound performed in the group under 35 weeks detected in most cases an bilateral periventricular echogenicity of the first or second grade, two newborns showed periventricular cystic spaces. All patients from this group had to exercise continuously in order to eliminate the effect of a slower neuromotoric development. Several studies confirmed the biophysical profile to be the best way of guiding pregnancies with intrauterine growth restriction of the fetus. It is the starting point in the procedure of reaching the decision on premature childbirth, especially before the 35th week of gestation. The clinical procedure in our hospital is based on these findings.
Ključne riječi
Hrčak ID:
32111
URI
Datum izdavanja:
22.12.2008.
Posjeta: 8.152 *