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Diabetes
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Microvascular injury to the kidney will damage the glomerular membrane, and protein will leak into the urine. As kidney function deteriorates, the loss of protein will cause fluid retention, and the kidneys will be less efficient at removing waste products such as creatinine. This is known as diabetic nephropathy and will contribute to complications in pregnancy including pre-eclampsia, hypertension, low birthweight and pre-term delivery. Strict glycaemic control, low dose aspirin and antihypertensive treatment is advocated. Assessment of renal function (see blood tests for renal function, Chapter 4), blood pressure and urinary protein is required21. Women with this condition may be admitted to hospital for close monitoring of their condition and that of the fetus. Intrauterine growth restriction (IUGR) is a common complicating factor. It can be difficult to distinguish between renal disease and pre-eclampsia as both conditions share similar features.
Approach to women with a history of previous intrauterine growth restriction
Published in Minakshi Rohilla, Recurrent Pregnancy Loss and Adverse Natal Outcomes, 2020
Intrauterine growth restriction (IUGR) is the term applied to a fetus when estimated fetal weight is less than the 10th percentile for that period of gestation or abdominal circumference on ultrasound is less than the 10th percentile [1]. This definition does not include fetuses that are small for gestational age (SGA) but are not pathologically small. However, approximately 50%–70% of fetuses are constitutionally small, and their weight is appropriate for their maternal height, weight, parity, and ethnicity and may be appropriately termed as SGA without any etiologically relevant growth restriction [2]. True growth restriction is a pathologic entity wherein a fetus fails to achieve its expected growth potential irrespective of its genetic constitution. IUGR may be symmetric or asymmetric, depending on the ratio of head circumference to abdominal circumference (HC/AC) (Figure 5.1).
The Epidemiology of Recurrent Pregnancy Loss
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
An association between RPL and perinatal complications has been reported in many studies. These complications are fully described in Chapter 18 of this book. It is debatable whether the risk of intrauterine growth restriction (IUGR) is associated with the previous consecutive miscarriages. However, Christiansen et al. [39] found that the mean birth weight of women with RPL themselves was 3265 g compared with 3414 g in matched female controls (p < 0.025) and the mean birth weight of women with ≥5 miscarriages at the time of admission was 2991 g (p < 0.001 compared with controls). The birth weights of the male partners did not differ from the birth weight of matched male controls. These data strongly suggest that the association between low birth weight and RPL is an inherent part of the RPL syndrome.
Maternal Serum and Umbilical Cord Brain Natriuretic Peptide Levels in Fetuses with Intrauterine Growth Restriction
Published in Fetal and Pediatric Pathology, 2022
Hasan Eroğlu, Mehmet Akif Erdöl, Nazan Vanlı Tonyalı, Gökçen Örgül, Derya Biriken, Aykan Yücel, Nuray Yazihan, Dilek Şahin
Intrauterine growth restriction (IUGR) is associated with an increase of perinatal morbidity and mortality and affects 5–10% of all pregnancies. IUGR refers to the inability of a fetus to achieve its genetically predetermined growth potential in utero [1,2]. Various fetal, maternal and placental conditions predispose to intrauterine growth restriction; however, in most cases involving healthy fetuses, the most common cause is uteroplacental vascular insufficiency [3]. In long-term follow-ups, fetuses with IUGR are at higher risk in terms of certain metabolic diseases such as obesity and Type 2 diabetes, neurodevelopmental delay, poor school performance and behavioral problems [4,5]. IUGR is clinically differentiated into either early-onset (< 32 weeks of gestation) or late-onset forms (diagnosis ≥32 + 0 weeks), suggesting that different pathophysiological mechanisms may contribute to the timing of onset of the this condition. Diagnosis is made by ultrasonography evaluation of estimated fetal weight and biometric parameters [6,7].
Abnormal chromosomes identification using chromosomal microarray
Published in Journal of Obstetrics and Gynaecology, 2022
Yunfang Shi, Xiaozhou Li, Duan Ju, Yan Li, Xiuling Zhang, Ying Zhang
A 32-year-old primigravida showed low risk in the second trimester maternal serum screening for trisomy 21 and 18. Ultrasound examination did not show any pathological findings before 28 weeks gestation. She had a previous spontaneous abortion. At the regular 32-week visit, the ultrasound scan showed the intrauterine growth restriction (IUGR). Cordocentesis was performed at a gestational age of 35 weeks. The foetal karyotype was 46,XX,del(18) and its breakouts were not known. SNP-array revealed a 5.1 Mb duplication in 7p22.3p22.1 and a 29.8 Mb deletion in 18q21.2q23, as well as a suspicious unbalanced translocation between chromosome 7 and 18 (Figure 2). The duplication region contained 31 OMIM genes and the deletion region contained 74 OMIM genes that were associated with Chromosome 18q deletion syndrome. A balanced translocation was screened in maternal karyotype 46,XX,t(7;18)(p22;q21.1), while the paternal karyotype revealed no obvious abnormalities. The pregnant woman and her family also terminated the pregnancy after genetic counselling.
Maternal and Placental Zinc and Copper Status in Intra-Uterine Growth Restriction
Published in Fetal and Pediatric Pathology, 2022
Özge Yücel Çelik, Sevginur Akdas, Aykan Yucel, Burcu Kesikli, Nuray Yazihan, Dilek Uygur
Intrauterine growth restriction (IUGR) is considered a pathological condition that occurs in approximately 710% of all pregnancies [1]. Due to the uncertainty of the cause of IUGR development, it has become an important problem in the field of birth and pediatrics [2,3]. Factors causing the development of IUGR can be grouped under 3 headings; placental factors, fetal factors, and maternal factors. Maternal factors include maternal age, maternal hypoxia status, socioeconomic status and nutritional deficiency, very high or low body mass index, hypertension, and chronic diseases, and maternal infections. Fetal factors include chromosomal anomalies, genetic syndromes, congenital anomalies, multiple gestations, congenital infections, and metabolic diseases [4]. Placental factors include weight (too large or small), abnormal uteroplacental vascularity, placental dysfunction, or reduced expression of enzymes that provide redox regulation [4,5].