Intrauterini zastoj rasta ploda

master's thesis

• Title (english): Intrauterine growth restriction
• Author: Karla Rogić
• Mentor: Sandra Stasenko (mentor)
• Committee member: Doroteja Pavan-Jukić (predsjednik povjerenstva)
• Committee member: Željko Duić (član povjerenstva)
• Committee member: Sandra Stasenko (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Intrauterini zastoj rasta ploda (IUZR) vodeći je uzrok perinatalnog mortaliteta te kratkoročnog i dugoročnog morbiditeta. Definira se kao usporenje rasta fetusa čiji je potencijal za rast veći od izmjerenog, a posljedica je djelovanja patoloških čimbenika i to najčešće uteroplacentarnih. Zahvaća do 10% trudnoća, a dijeli se na rano i kasno nastali IUZR te na simetrični i asimetrični zastoj u rastu. Rano nastali zastoj nastupa prije 32. tjedna trudnoće i ozbiljnije je stanje nego kasni IUZR, a glavni je cilj produžiti trudnoću da bi se omogućilo sazrijevanje fetalnih organa do najveće moguće mjere i da bi se tako izbjegle komplikacije prijevremenog porođaja. Simetrični zastoj rasta karakterizira jednakomjerno smanjenje svih biometrijskih mjerljivih parametara, a kod asimetričnog zastoja rasta bilježi se veće smanjenje opsega abdomena nego opsega glave. Iako etiologija nije do kraja razjašnjena, poznato je da fetalni, majčini i uteroplacentarni čimbenici mogu interferirati s normalnim mehanizmima fetalnog rasta i dovesti do zastoja u rastu. IUZR se u literaturi vrlo često naizmjenično koristi s terminom “malen za gestacijsku dob” (engl.small for gestational age, SGA), ali bitno je razlikovati ta dva pojma. SGA fetusi tjelesne su težine manje od 10.centile, ali su to oni fetusi koji su konstitucijski maleni i nisu pod rizikom za nepovoljan perinatalni ishod. IUZR fetusi mogu biti i tjelesne težine veće od 10.centile, a pod povećanim rizikom za nepovoljan kratkoročan i dugoročan ishod. Pri svakoj sumnji na zastoj u rastu fetusa potrebno je točno procijeniti gestacijsku dob i napraviti detaljan ultrazvučni pregled. Od iznimne je važnosti kontinuirano nadzirati takvu rizičnu trudnoću i postići konsenzus o vremenu porođaja. Osnovni elementi pri nadzoru fetusa koje bilježimo jesu kardiotokografija, biofizikalni profil i doplerska mjerenja. Djeca sa zastojem u rastu pod povećanim su rizikom za razvoj kroničnih kardiovaskularnih i metaboličkih bolesti kasnije u životu. IUZR značajan je problem suvremene perinatologije te je potrebno i dalje pronalaziti optimalna dijagnostička i terapijska rješenja.

Abstract (english)

Intrauterine growth restriction (IUGR) is a leading cause of perinatal mortality and short-term and long-term morbidity. It is defined as the failure of the fetus to meet its growth potential caused by pathological factors, most commonly placental dysfunction. It affects up to 10% of all pregnancies, and it is classified into early-onset and late-onset IUGR and also symmetrical and asymmetrical IUGR. Early-onset IUGR typically begins before 32 weeks’ gestation. It is usually more severe than late-onset IUGR and the main goal is to prolong pregnancy and maximize fetal organs maturation in order to avoid complications of premature birth. Symmetrical IUGR is characterized by reduction of all measured biometric parameters, while in asymmetrical IUGR the abdominal circumference is reduced more than head circumference. Although etiology is not fully clarified, it is known that fetal, maternal and placental factors may interfere with normal mechanisms of fetal growth and lead to IUGR. In the literature, IUGR is very often interchangeably used with term “small for gestational age” (SGA), but there is a difference between these two terms. SGA fetuses can be at less than 10th percentile in weight for gestational age, but those are fetuses that are constitutionally small and not at risk of adverse perinatal outcomes. IUGR fetuses can be above the 10th percentile, but at increased risk of adverse short-term and long-term outcome. When IUGR is suspected, it is necessary to precisely estimate gestational age and to perform an ultrasound examination. It is very important to continuously monitor such a high-risk pregnancy and to reach a consensus about the time of delivery. Fetal surveillance tests include cardiotocography, biophysical profile scoring and Doppler ultrasound. IUGR fetuses are at increased risk of developing chronic cardiovascular and metabolic diseases later in life. IUGR is a significant problem of modern perinatology and it is necessary to keep searching for other optimal diagnostic and therapeutic solutions.

• Keywords: intrauterini zastoj rasta ploda; malen za gestacijsku dob; doplerska mjerenja
• Keywords (english): intrauterine growth restriction; small for gestational age; Doppler ultrasound
• Language: croatian
• URN:NBN: urn:nbn:hr:105:436630
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-10-30 12:03:13