Related Experiment Videos
Perinatal risk factors. With special reference to intrauterine growth retardation and neonatal respiratory adaptation
Insights
This study identified risk factors for intrauterine growth retardation (IUGR) and found that while antenatal prediction of neonatal respiratory disorders (RD) is difficult, certain delivery events and intrauterine stress may influence respiratory adaptation.
Area of Science:
- Perinatal Medicine
- Neonatology
- Obstetrics
Background:
- Intrauterine growth retardation (IUGR) and neonatal respiratory disorders (RD) are significant perinatal challenges.
- Identifying high-risk pregnancies and understanding factors influencing neonatal respiratory adaptation are crucial.
Purpose of the Study:
- To develop a scoring system for identifying pregnant women at increased risk of IUGR.
- To analyze the relationship between IUGR and neonatal RD.
- To evaluate the impact of delivery events on neonatal respiratory adaptation.
Main Methods:
- Epidemiological methods were primarily used.
- A scoring system based on eight risk factors was developed for IUGR prediction.
- Prospective screening of newborns for RD was conducted.
Main Results:
- A scoring system identified 7% of pregnancies at risk for IUGR, capturing all IUGR cases, with IUGR infants comprising 34% of this group.
- Antenatal prediction of neonatal RD risk was not feasible.
- Full-term small for gestational age (SGA) infants had a higher incidence of RD.
- A "u-shaped" relationship was observed between rupture-delivery interval and RD risk in preterm and post-CS term infants.
- Ominous cardiotocography (CTG) patterns during delivery were unexpectedly associated with a reduced incidence of RD.
Conclusions:
- A risk scoring system can effectively identify pregnancies at risk for IUGR.
- Neonatal respiratory adaptation may be positively influenced by intrauterine stress, as suggested by CTG findings.
- Optimal delivery timing after membrane rupture appears to be within a specific window, avoiding immediate or prolonged delays.
Abstract:
Intrauterine growth retardation (IUGR) and neonatal respiratory disorders (RD) are two dominating problems in perinatal medicine. The aims of this study were to analyze the possibilities of selecting groups of pregnant women with increased risk of either problem, to analyze the relationship between IUGR and neonatal respiratory disorders and to evaluate the influence on neonatal respiratory adaptation of different events during delivery. For these purposes epidemiological methods were mainly used but in paper V an animal model was applied. In the whole population of pregnant women attending the antenatal clinic of the department during a six month period the items which had the best discriminating power between normal and IUGR pregnancies were selected. These eight items (previous infants less than or equal to 2,500 g, hypertension, kidney diseases, smoking, bleeding with or without uterine contractions, insufficient increase of weight, girth or fundal height) were used as a scoring system. With a risk population of 7%, all IUGR cases were included. The IUGR infants constituted 34% of the risk group. For one year all newborns of mothers living in Göteborg were screened prospectively for signs of respiratory disorders. It was not possible to indicate antenatally pregnancies with increased risks of neonatal respiratory disturbances. Preterm small for gestational age (SGA) infants were found to have the same risk of RD as non-SGA infants. Full term SGA infants had a higher incidence of RD, which could not be explained by their higher incidence of cesarean sections (CS) and low Apgar scores. In preterm infants and in full term infants after CS the relation between rupture-delivery interval and risk for RD was "u-shaped". There was a higher incidence of RD if delivery was immediately at rupture than a few hours up to 36 h later. After more than 36 h the risk increased again. Consequently there seems to be no advantage in postponing delivery more than 36 h after ROM. The impact of CTG (cardiotocography) pattern on RD during delivery, was analyzed in two subgroups of infants (greater than or equal to 37 weeks, delivered by CS). Infants with ominous CTG patterns were unexpectedly found to have a reduced incidence of RD, 6% compared to 21% in infants with normal patterns. A possible explanation could be that "intrauterine stress" might exert a positive effect on neonatal respiratory adaptation.(ABSTRACT TRUNCATED AT 400 WORDS)