Недостаточный рост плода: задержка роста или малый для данного гестационного срока? Что известно о диагностике, профилактике и лечении

Доброхотова Ю.Э., Кузнецов П.А., Джохадзе Л.С., Шамугия В.В., Кравцова О.М. Недостаточный рост плода: задержка роста или малый для данного гестационного срока? Что известно о диагностике, профилактике и лечении. Гинекология. 2022;24(1):24–29. DOI: 10.26442/20795696.2022.1.201360

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Dobrokhotova YE, Kuznetsov PA, Dzhokhadze LS, Shamugia VV, Kravtsova OM. Insufficient fetal growth: fetal growth restriction or small for gestational age fetus? The difference between these conditions, what is known about diagnosis, prevention and treatment: A review. Gynecology. 2022;24(1):24–29.
DOI: 10.26442/20795696.2022.1.201360

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Аннотация

В статье приведены результаты анализа данных современной литературы относительно разницы между истинной задержкой роста плода и маловесным для гестационного срока плодом, приведены критерии диагностики, исторический взгляд на проблему и современные классификации состояний. Кроме того, обобщена информация о возможных этиологии и патогенезе задержки роста плода. Собраны сведения о методах диагностики, расставлены акценты над ключевыми показателями допплерометрии и кардиотокографии. Согласно последним данным, тактика ведения пациенток меняется в зависимости от срока гестации, существенны различия между ранней и поздней задержкой роста плода. Также мы попытались собрать информацию о возможных методах профилактики и лечения задержки роста плода. В анализ включены данные клинических рекомендаций РОАГ по преэклампсии и задержке роста плода. Проанализированная информация показала, что, несмотря на разработанные на сегодняшний день алгоритмы ведения данной категории пациенток, проблема задержки роста плода имеет много нерешенных задач и большой потенциал для дальнейших исследований.

Ключевые слова: задержка роста плода, маловесный для данного срока гестации плод, кардиотокография, допплерометрия

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The difference between the fetal growth restriction and the small-for-gestational-age fetus was analyzed in this article. The article describes the most complete definition of the fetal growth restriction according to ultrasound data. Information about possible ethology and pathogenesis of the fetal growth restriction, the modern classification of this condition was also summarized in the article. We provide classifications which were used in Russia and all over the world earlier. The article contains information about possible methods of diagnosing the fetal growth restriction with accents on key indicators of dopplerometry and cardiotocography. According to the latest data, the management of patients changes depending on the gestation period. There are significant differences between early and late fetal growth restriction. Futhermore, we tried to research universal methods of prevention and treatment of the fetal growth restriction. We also included data from Russian Society of obstetricians and gynecologists guidelines. The analyzed information shows that the problem of the fetal growth restriction has many unsolved problems and great potential for the further research.

Keywords: the fetal growth restriction, the small-for-gestational-age fetus, cardiotocography, doppler study

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Список литературы

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29. Magann EF, Haram K, Ounpraseuth S, et al. Use of antenatal corticosteroids in special circumstances: a comprehensive review. Acta Obstet Gynecol Scand. 2017;96:395-409. DOI:10.1111/aogs.13104
30. Savchev S, Figueras F, Sanz-Cortes M, et al. Evaluation of an optimal gestational age cut-off for the definition of early- and late-onset fetal growth restriction. Fetal Diagn Ther. 2014;36:99-105. DOI:10.1159/000355525
31. Crimmins S, Desai A, Block-Abraham D, et al. A comparison of Doppler and biophysical findings between liveborn and stillborn growth-restricted fetuses. Am J Obstet Gynecol. 2014;211:669.e1-10. DOI:10.1016/j.ajog.2014.06.022
32. Eixarch E, Meler E, Iraola A, et al. Neurodevelopmental outcome in 2-year-old infants who were small-for-gestational age term fetuses with cerebral blood flow redistribution. Ultrasound Obstet Gynecol. 2008;32:894-9. DOI:10.1002/uog.6249
33. Habek D, Salihagic A, Jugović D, Herman R. Doppler cerebro-umbilical ratio´ and fetal biophysical profile in the assessment of peripartal cardiotocography in growth-retarded fetuses. Fetal Diagn Ther. 2007;22:452-6. DOI:10.1159/000106354
34. Savchev S, Figueras F, Gratacos E. Survey on the current trends in managing intrauterine growth restriction. Fetal Diagn Ther. 2014;36:129-35. DOI:10.1159/000360419
35. Meher S, Hernandez-Andrade E, Basheer SN, Lees C. Impact of cerebral redistribution on neurodevelopmental outcome in small-for-gestational-age or growth-restricted babies: a systematic review. Ultrasound Obstet Gynecol. 2015;46:398-404. DOI:10.1002/uog.14818
36. Cruz-Martínez R, Figueras F, Hernandez-Andrade E, et al. Fetal Brain Doppler to Predict Cesarean Delivery for Nonreassuring Fetal Status in Term Small-for-Gestational-Age Fetuses. Obstet Gynecol. 2011;117(3):618-26. DOI:10.1097/aog.0b013e31820b0884

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1. Lees CC, Stampalija T, Baschat A, et al. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol. 2020;56(2):298-312. DOI:10.1002/uog.22134
2. Kleijer ME, Dekker GA, Heard AR. Risk factors for intrauterine growth restriction in a socio-economically disadvantaged region. J Matern Fetal Neonatal Med. 2005;18(1):23-30. DOI:10.1080/14767050500127674
3. Nohuz E, Riviere O, Coste K, Vendittelli F. Prenatal identification of small-for-gestational-age and risk of neonatal morbidity and stillbirth. Ultrasound Obstet Gynecol. 2020;55:621-8. DOI:10.1002/uog.20282
4. ROAG. Klinicheskie rekomendatsii. Nedostatochnyi rost ploda, trebuiushchii predostavleniia meditsinskoi pomoshchi materi (zaderzhka rosta ploda), 2021. Available at: https://roag-portal.ru/recommendations_obstetrics/ Accessed: 24.02.2022 (In Russian).
5. Committee Opinion No 700: Methods for Estimating the Due Date. Obstet Gynecol. 2017;129(5):e150-4. DOI:10.1097/AOG.0000000000002046
6. Levytska K, Higgins M, Keating S, et al. Placental Pathology in Relation to Uterine Artery Doppler Findings in Pregnancies with Severe Intrauterine Growth Restriction and Abnormal Umbilical Artery Doppler Changes. Am J Perinatol. 2016;34(05):451-7. DOI:10.1055/s-0036-1592347
7. Burton GJ, Woods AW, Jauniaux E, et al. Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy. Placenta. 2009;30:473-82. DOI:10.1016/j.placenta.2009.02.009
8. Richardson BS, Bocking AD. Metabolic and circulatory adaptations to chronic hypoxia in the fetus. Comp Biochem Physiol A Mol Integr Physiol. 1998;119:717-23.
DOI:10.1016/s1095-6433(98)01010-1
9. ROAG, AAR, AAAR. Klinicheskie rekomendatsii. Preeklampsiia. Eklampsiia. Oteki, proteinuriia i gipertenzivnye rasstroistva vo vremia beremennosti, v rodakh i poslerodovom periode, 2021. Available at: https://roag-portal.ru/recommendations_obstetrics/Accessed: 24.02.2022 (In Russian).
10. Makarov OV, Kozlov PV, Kuznetsov PA, et al. The role of vascular growth factors imbalance in the genesis of pregnancy complications. Bulletin of RSMU. 2014;4:34-7 (in Russian).
11. Gaccioli F, Sovio U, Cook E, et al. Screening for fetal growth restriction using ultrasound and the sFLT1/PlGF ratio in nulliparous women: a prospective cohort study. Lancet Child Adolesc Health. 2018;2:569-81. DOI:10.1016/S2352-4642(18)30129-9
12. Unterscheider J, Daly S, Geary MP, et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am J Obstet Gynecol. 2013;208(4):290.e1-6. DOI:10.1016/j.ajog.2013.02.007
13. Divon MY. Fetal growth restriction: Screening and diagnosis. D Levine, VA Barss (eds.). UpToDate, 2021. Available at: https://www.uptodate.com/contents/fetal-growth-restriction-screening-and-diagnosis?search=Fetal%20gr... Accessed: 24.02.2022.
14. Patterson RM, Prihoda TJ, Pouliot MR. Sonographic amniotic fluid measurement and fetal growth retardation: A reappraisal. Am J Obstet Gynecol. 1987;157(6):1406-10. DOI:10.1016/S0002-9378(87)80233-8
15. Turan S, Turan OM, Berg C, et al. Computerized fetal heart rate analysis, Doppler ultrasound and biophysical profile score in the prediction of acid-base status of growth-restricted fetuses. Ultrasound Obstet Gynecol. 2007;30:750-6. DOI:10.1002/uog.4101
16. Parker SE, Werler MM. Epidemiology of ischemic placental disease: a focus on preterm gestations. Semin Perinatol. 2014;38:133-8. DOI:10.1053/j.semperi.2014.03.004
17. Kehl S, Dötsch J, Hecher K, et al. Intrauterine Growth Restriction. Guideline of the German Society of Gynecology and Obstetrics (S2k-Level, AWMF Registry No. 015/080, October 2016). Geburtshilfe Frauenheilkd. 2017;77(11):1157-73. DOI:10.1055/s-0043-118908
18. Bondarenko KR, Kuznetsov PA, Dzhohadze LS, et al. Centile nomograms for body weight and length of multiple-birth infants. Russian Journal of Woman and Child Health. 2020;3(1):20-5 (in Russian). DOI:10.32364/2618-8430-2020-3-1-20-25
19. Magee LA, Duley L. Oral beta-blockers for mild to moderate hypertension during pregnancy. Cochrane Database Syst. Rev. 2003;(3):CD002863. DOI:10.1002/14651858.CD002863
20. Dashraath P, Wong JLJ, Lim MXK, et al. Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy. Am J Obstet Gynecol. 2020;222(6):521-31. DOI:10.1016/j.ajog.2020.03.021
21. Savelyeva GM, Shalina RI, Sichinava LG, et al. Akusherstvo: uchebnik. Moscow: GEOTAR-Media, 2015; p. 589-90 (in Russian).
22. Sidorova IS, Kulakov VI, Makarov IO. Rukovodstvo po akusherstvu. Moscow: Medicine, 2006; p. 436-42, 445-6 (in Russian).
23. Villar J, Altman DG, Purwar M, et al. The objectives, design and implementation of the INTERGROWTH-21. Project. BJOG. 2013;120:9-26. DOI:10.1111/1471-0528.12047
24. Ogge G, Chaiworapongsa T, Romero R, et al. Placental lesions associated with maternal underperfusion are more frequent in early-onset than in late-onset preeclampsia. J Perinat Med. 2011;39:641-52. DOI:10.1515/jpm.2011.098
25. Stampalija T, Arabin B, Wolf H, et al. TRUFFLE investigators. Is middle cerebral artery Doppler related to neonatal and 2-year infant outcome in early fetal growth restriction? Am J Obstet Gynecol. 2017;216:521.e1-13. DOI:10.1016/j.ajog.2017.01.001
26. Stanescu A-D, Banica R, Sima R-M, Ples L. Low dose aspirin for preventing fetal growth restriction: a randomised trial. J Perinat Med. 2018;46(7):776-9.
DOI:10.1515/jpm-2017-0184
27. Ting JY, Kingdom JC, Shah PS. Antenatal glucocorticoids, magnesium sulfate, and mode of birth in preterm fetal small for gestational age. Am J Obstet Gynecol. 2018;218(2S):S818-828. DOI:10.1016/j.ajog.2017.12.227
28. Royal College of Obstetricians and Gynecologists. Small-for-Gestational-Age Fetus, Investigation and Management (Green-top Guideline No. 31), 2013. Available at: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg31/ Accessed: 24.02.2022.
29. Magann EF, Haram K, Ounpraseuth S, et al. Use of antenatal corticosteroids in special circumstances: a comprehensive review. Acta Obstet Gynecol Scand. 2017;96:395-409. DOI:10.1111/aogs.13104
30. Savchev S, Figueras F, Sanz-Cortes M, et al. Evaluation of an optimal gestational age cut-off for the definition of early- and late-onset fetal growth restriction. Fetal Diagn Ther. 2014;36:99-105. DOI:10.1159/000355525
31. Crimmins S, Desai A, Block-Abraham D, et al. A comparison of Doppler and biophysical findings between liveborn and stillborn growth-restricted fetuses. Am J Obstet Gynecol. 2014;211:669.e1-10. DOI:10.1016/j.ajog.2014.06.022
32. Eixarch E, Meler E, Iraola A, et al. Neurodevelopmental outcome in 2-year-old infants who were small-for-gestational age term fetuses with cerebral blood flow redistribution. Ultrasound Obstet Gynecol. 2008;32:894-9. DOI:10.1002/uog.6249
33. Habek D, Salihagic A, Jugović D, Herman R. Doppler cerebro-umbilical ratio´ and fetal biophysical profile in the assessment of peripartal cardiotocography in growth-retarded fetuses. Fetal Diagn Ther. 2007;22:452-6. DOI:10.1159/000106354
34. Savchev S, Figueras F, Gratacos E. Survey on the current trends in managing intrauterine growth restriction. Fetal Diagn Ther. 2014;36:129-35. DOI:10.1159/000360419
35. Meher S, Hernandez-Andrade E, Basheer SN, Lees C. Impact of cerebral redistribution on neurodevelopmental outcome in small-for-gestational-age or growth-restricted babies: a systematic review. Ultrasound Obstet Gynecol. 2015;46:398-404. DOI:10.1002/uog.14818
36. Cruz-Martínez R, Figueras F, Hernandez-Andrade E, et al. Fetal Brain Doppler to Predict Cesarean Delivery for Nonreassuring Fetal Status in Term Small-for-Gestational-Age Fetuses. Obstet Gynecol. 2011;117(3):618-26. DOI:10.1097/aog.0b013e31820b0884

Авторы

Ю.Э. Доброхотова1, П.А. Кузнецов1, Л.С. Джохадзе1,2, В.В. Шамугия3, О.М. Кравцова*1,4

1 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2 ГБУЗ «Городская клиническая больница №24» Департамента здравоохранения г. Москвы, Москва, Россия;
3 ГБУЗ «Городская клиническая больница им. В.В. Вересаева» Департамента здравоохранения г. Москвы, Москва, Россия;
4 ГБУЗ «Городская клиническая больница им. Е.О. Мухина» Департамента здравоохранения г. Москвы, Москва, Россия
*seliverstova.o.m@gmail.com

________________________________________________

Yulia E. Dobrokhotova1, Pavel A. Kuznetsov1, Lela S. Dzhokhadze1,2, Valerian V. Shamugia3, Olga M. Kravtsova*1,4

1 Pirogov Russian National Research Medical University, Moscow, Russia;
2 City Clinical Hospital №24, Moscow, Russia;
3 Veresaev City Сlinical Hospital, Moscow, Russia;
4 Muhin City Сlinical Hospital, Moscow, Russia
*seliverstova.o.m@gmail.com

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