Intrauterine Wachstumsrestriktion – Diagnostik und Management

Die intrauterine Wachstumsrestriktion (IUGR) tritt in ca. 5–7 % aller Schwangerschaften auf. Betroffen sind Feten, die ihr genetisch vorgegebenes Wachstumspotential nicht ausschöpfen. Sie ist Hauptgrund der perinatalen Morbidität und Mortalität. Die IUGR ist zudem assoziiert mit einer Prädisposition für die Entwicklung chronischer Erkrankungen im weiteren Leben. Neben der rechtzeitigen Diagnose und Ursachenklärung ist vor allem die weitere Schwangerschaftsbetreuung mit der Wahl des optimalen Entbindungszeitpunktes eine geburtshilfliche Herausforderung. Ziel ist es, eine Schwangerschaftsprolongation zur Minimierung der Frühgeburtsmorbidität zu erreichen, jedoch rechtzeitig vor einer fetalen Bedrohung oder Schädigung zu intervenieren.

• Literatur

• 1 ACOG Practice bulletin no. 134: feal growth restriction. Obstet Gynecol 2013; 121 (5): 1122-1133
• 2 Garite TJ, Clark R, Thorp JA. Intrauterine growth restriction increases morbidity and mortality among premature neonates. Am J Obstet Gynecol 2004; 191 (2): 481-487
• 3 Crosby WM. Studies in fetal malnutrition. Am J Dis Child 1991; 145 (8): 871-876
• 4 Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, Uauy R. Maternal and Child Nutrition Study Group. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013; 382 (9890): 427-451
• 5 Menendez C, Ordi J, Ismail MR, Ventura PJ, Aponte JJ, Kahigwa E, Font F, Alonso PL. The impact of placental malaria on gestational age and birth weight. J Infect Dis 2000; 181 (5): 1740-1745
• 6 Desai M, Kuile FO ter, Nosten F, McGready R, Asamoa K, Brabin B, Newman ED. Epidemiology and burden of malaria in pregnancy. Lancet Infect Dis 2007; 7 (2): 93-104
• 7 Pallotto EK, Kilbride HW. Perinatal outcome and later implications of intrauterine growth restriction. Clin Obstet Gynecol 2006; 49 (2): 257-269
• 8 Barker DJ. Adult consequences of fetal growth restriction. Clin Obstet Gynecol 2006; 49 (2): 270-283
• 9 Gascoin G, Flamant C. [Long-term outcome in context of intra uterine growth restriction and/or small for gestational age newborns]. J Gynecol Obstet Biol Reprod (Paris) 2013; 42 (8): 911-920
• 10 Neitzke U, Harder T, Plagemann A. Intrauterine growth restriction and developmental programming of the metabolic syndrome: a critical appraisal. Microcirculation 2011; 18 (4): 304-311
• 11 Knox AJ, Sadler L, Pattison NS, Mantell CD, Mullins P. An obstetric scoring system: its development and application in obstetric management. Obstet Gynecol 1993; 81 (2): 195-199
• 12 Kean LH, Liu DT, Macquisten S. Pregnancy care of the low risk woman: the community-hospital interface. Int J Health Care Qual Assur 1996; 9 (5): 39-44
• 13 Leeson S, Aziz N. Customised fetal growth. Br J Obstet Gynceol 1997; 104 (6): 648-651
• 14 Jahn A, Razum O, Berle P. Routine screening for intrauterine growth retardation in Germany: low sensitivity and questionable benefit for diagnosed care. Acta Obstet Gynecol Scand 1998; 77 (6): 643-648
• 15 Sparks TN, Cheng YW, McLaughlin B, Esakoff TF, Caughey AB. Fundal height: a useful screening tool for fetal growth?. J Matern Fetal Neonatal Med 2011; 24 (5): 708-712
• 16 Goetzinger KR, Tuuli MG, Odibo AO, Roehl KA, Macones GA, Cahill AG. Screening for fetal growth disorders by clinical exam in the era of obesity. J Perinatol 2013; 33 (5): 352-357
• 17 Goetzinger KR, Cahill AG, Macones GA, Odibo AO. Isolated short femur length on second-trimester sonography: a marker for fetal growth restriction and other adverse perinatal outcomes. J Ultrasound Med 2012; 31 (12): 1935-1941
• 18 Morales-Roselló J, Peralta Llorens N. Outcome of fetuses with diagnosis of isolated short femur in the second half of pregnancy. ISRN Obstet Gynecol 2012; 2012: 268218
• 19 Özlü T, Ozcan T. Fetal isolated short femur in the second trimester and adverse pregnancy outcomes. Prenat Diagn 2013; 33 (11): 1063-1069
• 20 Bakalis S, Silva M, Akolekar R, Poon LC, Nicolaides KH. Prediction of small for gestational age neonates: screening by fetal biometry at 30–34 weeks.. Ultraound Obstet Gynecol 2015;
• 21 Alfirevic Z, Neilson JP. Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev 2010; 1 CD000073
• 22 Cnossen JS, Morris RK, ter Riet G, Mol BW, van der Jost JA, Coomarasamy A, Zwinderman AH, Robson SC, Bindels PJ, Kleijnen J, Khan KS. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. CMAJ 2008; 178 (6): 701-711
• 23 Bahado-Singh RO, Jodicke C. Uterine artery Doppler in first-trimester pregnancy screening. Clin Obstet Gynecol 2010; 53 (4): 879-887
• 24 Barati M, Shahbazian N, Ahmadi L, Masihi S. Diagnostic evaluation of uterine artery Doppler sonography for the prediction of adverse pregnancy outcomes. J Res Med Sci 2014; 19 (6): 515-519
• 25 Murata S, Nakata M, Sumie M, Sugino N. The Doppler cerebroplacental ratio predicts non-reassuring fetal status in intrauterine growth restricted fetuses at term. J Obstet Gynaecol Res 2011; 37 (10): 1433-1437
• 26 Morales-Roselló J, Khalil A, Morlando M, Papageorghiou A, Bhide A, Thilaganathan B. Changes in fetal Doppler indices as a marker of failure to reach growth potential at term. Ultrasound Obstet Gynecol 2014; 43 (3): 303-310
• 27 Crombach G, Vetter K. Intrauterine Wachstumsrestriktion Teil II. Klinisches Management. Gynäkologe 2007; 40 (12): 983-999
• 28 Schlembach D. Intrauterine Wachstumsrestriktion – Diagnostik und Management. Geburtshilfe Frauenheilk 2012; 72 (5): 373-375
• 29 Devoe L, Golde S, Kilman Y, Morton D, Shea K, Waller J. A comparison of visual analyses of intrapartum fetal heart rate tracings according to the new National Institute of Child Health and Human Development guidelines with computer analyses by an automated fetal heart rate monitoring system. Am J Obstet Gynceol 2000; 183 (2): 361-366
• 30 Serra V, Moulden M, Bellver J, Redman CW. The value of the short-term fetal heart rate variation for timing the delivery of growth-retarded fetuses. BJOG 2008; 115 (9): 1101-1107
• 31 Maulik D, Mundy D, Heitmann E, Maulik D. Evidence-based approach to umbilical artery Doppler fetal surveillance in high-risk pregnancies: an update. Clin Obstet Gynecol 2010; 53 (4): 869-878
• 32 Baschat AA. Neurodevelopment following fetal growth restriction and its relationship with antepartum parameters of placental dysfunction. Ultrasound Obstet Gynecol 2011; 37 (5): 501-514
• 33 Zollner U, Rehn M, Girschick G, Dietl J. Geburtshilfliches Management bei fetaler Retardierung. Z Geburtshilfe Neonatol 2011; 215 (2): 49-59
• 34 Marsal K. Obstetric management of intrauterine growth restriction. Best Pract Res Clin Obstet Gynaecol 2009; 23: 857-870
• 35 Cox P, Marton T. Pathological assessment of intrauterine growth restriction. Best Pract Res Clin Obstet Gynaecol 2009; 23: 751-764
• 36 Baschat AA. Fetal growth restriction – from observation to intervention. J Perinat Med 2010; 38: 239-246
• 37 Perrotin F, Simon EG, Potin J, Laffon M. Delivery of the IUGR etus. J Gynecol Obstet Biol Reprod (Paris) 2013; 42 (8): 975-984