MEDICAL AND SOCIAL BACKGROUNDS OF FETAL GROWTH RESTRICTION DEVELOPMENT

Abstract

Fetal growth restriction (FGR) occurs in 5-10% of pregnancies and it is one of the main causes of perinatal morbidity and mortality. The aim of the study. To establish medical and social peculiarities in pregnant women with fetal growth restriction. The object and methods of research. 140 pregnant women were examined in the third trimester of gestation with the verified diagnosis of FGR and formed the basic group, 97 patients of them had FGR I degree (I group) and 43 – FGR II-III degree (II group). The control group included 30 pregnant women, in which the sizes of the fetus corresponded to the period of gestation. Results. The average age of the examined women was practically the same in all groups – 23.5±0.7 years in the control group and 25.2±1.1 and 24.8±2.3 years in the I and II groups, respectively. Primipara persons were majority of pregnant women accounted for 73.3% in the control group and 75.7 % in the basic group. Among them 22.6 % of women with FGR II-III degree delivered the first child in critical years (before 18 and after 40 years old), which was in 5.0 times more often than among healthy subjects (4.5 %). 16.7% of pregnant women in the control group had gynecological diseases. The history of gynecological pathology had more than half of observed women with FGR – 54.3 % (?2=12.55, p<0.001, OR=5.93, 95% CI=2.15-16.40, p<0.001), FGR I degree – 52.6 % (?2=10.57, p<0.001, OR=5.54, 95% CI=1.96-15.68, p=0.001), FGR II-III degree – 58.1 % (?2= 0.90, p<0.001, OR=6.94, 95% CI=2.23-21.61, p<0.001). In the group of persons with fetal normotrophy, the rate of women who had complicated obstetric history, not connected with this pregnancy, was 13.3 % and increased with FGR I and II-III degrees up to 27.8 % and 34.9 % respectively. In the control group, extragenital pathology was diagnosed in 26.7% of women, in the basic group – in 2.2 times more often, 57.9 % (?2=8.43, p=0.003, OR=3.77, 95% CI=1.57-9.06, p=0,003), in group I – in 56,7 %, in II – 60,5 %. At the same time, two or more diseases were diagnosed in 19.6 % and 20.9 %, respectively, in the groups with FGR. It should be noted that all women with FGR had complicated pregnancy and in most persons in basic group the combination of 2-4 pathologies was observed. All women with FGR and 40.0 % of controls (?2=87.72, p<0.001) had placental dysfunction. The rate of threatened of interruption of pregnancy was in 1.6 times higher in patients in the basic group (65.0 %) versus 40.0 % of pregnant women in control one (?2=28.05, p<0.001, OR=17.06, 95% CI=4.92-59.14, p<0.001). Gestosis of the second half of pregnancy was noted in 6.6 % of controls, which was in 4.7 times less than in women of basic main group (30.7 %, ?2=6.16, p=0.01, OR=6.21, 95% CI=1.41-27.23, p=0.02), in the I group – in 4.4 times (28.9 %, ?2=5.09, p=0.02, OR=5.68, 95% CI=1.27-25.47, p=0.02)), in II – in 5.3 times (34.9 %, ?2=6.38, p=0.01, OR=7.50, 95% CI=1.57-35.89, p=0.01). Diseases of the upper respiratory tract (acute respiratory viral infection, pneumonia, bronchitis) were in 40.0 % of women in the basic group. TORCH- infection was diagnosed in 2.2 times more often in women with FGR (37.1 %) compared with 16.7 % of females with fetal normotrophy (?2=3.77, p=0.05, OR=2.95, 95% CI=1.07-8.19, p=0.04), 32.9 % of pregnant women in group ² and 46.5 % – II (?2=5.72, p=0.02, OR=4.35, 95% CI=1.40-13.48, p=0.01). Conclusion. FGR is a multifactorial pathology, in the development of which the special role is assigned to the disorders of the reproductive system, the presence of extragenital pathology, complications of pregnancy.

Keywords

• fetal growth restriction
• risk factors
• pregnancy course