We,
the practicing obstetrician how should we prevent of intrauterine growth retraction before such
an adverse outcome occur??
Prophylaxis
of FGR: How? What should we attempt ?? Part I:---Some factors
may increase the risk of IUGR
such as a) cigarette
smoking b) intake of liquor and c) poor maternal
nutrition . These should be avoided or kept to minimum prenatally and
intranatally. Therefore by avoiding such harmful lifestyles
and eating a healthy diet and
getting a regular prenatal care hopefully will decrease
the risks for FGR .
Regular antenatal checkup for early detection of FGR may also
help in appropriate treatment and good
outcome.
Treatment f FGR : Part
II :-
However once FGR is established medical treatement is not that much effective.
One can't increase the wt much...its only timely delivery which can prevent IUD
and other neonatal complications…
Part III: Etiology of FGR : Foetal growth restriction (FGR) and
associated placental pathologies such as pre-eclampsia and stillbirth arise in early pregnancy when inadequate remodeling
of maternal spiral arteries leads to persistent
high-resistance low-flow uteroplacental circulation. Current
interventions concentrate on targeting the placental ischaemia-reperfusion injury and oxidative
stress associated
with an imbalance in angiogenic/anti-angiogenic factors.
Part IV: Early prediction and drugs for
prevention?? Recent meta-analyses
confirm that 1) aspirin modestly
reduces the risk for small-for-gestational-age pregnancy in
high-risk women. A dose of ≥100 mg starting by 16 weeks of gestation is
recommended.
2) LMWH: -In vitro and in vivo studies
suggest that low-molecular-weight heparin may
prevent FGR; further research is needed to confirm efficacy.
Part V:
How to treat FGR Once FGR is diagnosed??
Ans No treatment will
improve foetal growth. Potential FGR therapies such as phosphodiesterase type-5 inhibitors or
maternal VEGF gene therapy aim to improve poor placentation and/or uterine blood flow. Melatonin, creatine and
N-acetyl cysteine have potential as novel neuroprotective and cardio protective
agents in FGR and may avoid autism, behavioural disorders in adult life.
We
,the practicing obstetricians have to react
as per DFMC, AFI, MVP and with Doppler
results to plan time delivery.ne can go through and adhere to diffident
guidelines issued by different academic bodies including green top guidelines
on IUGR which is simple to follow but main index of induction
of labour is Doppler which has revolutionized FGR management...
.
Is there any drug which can increase
the foetal wt or catch up the
EFW/AFI/MVP??
·
There is no firm documentation that external therapy
in the form of vitamin or protein supplements are proven benefit but people do
prescribe in a desperate attempt to improve foetal wt & AFI/MVP.
A)
. A) If early NT scan shows high PI in
uterines then ecosprin is added in the dose of 150mg a bedtime.
B)
arginine supplements as sachets
argihope in tablet form
C)
Inj: Hermin IV OD thrice a week - alternate
day. Inj alamine/Hermin over 3/4 hours slowly as they may cause allergic
reaction
D)
Routine iv fluid RL,DNS around 2 liter as twice/thrice a week
E)
Rest for 2 hrs in day and 8
hrs in night minimum
If nonveg: 2 boiled egg daily
& Fish 4 pcs . Meat /Curd etc For Veg:- Pulses/Curds & Protein powder
sprouts included daily
F)
Omega 3 fatty acids ,E cod plus, Femo
only DHA)Era) ,E-Cod soft gel,
G)
some use vaginal sildenafil in these cases
H)
Different Brand names that are used are
B complex series –like Beconex –GX, Multivite FM, Bevon CD
I)
Arginine: Argihope plus (mankind).
Arginix F (Era), Argin 3 Gm(Fourtts) , L-Argin (TTK), Fetlar(Arex),
J)
Protein
Powders : Revitalite ( Ranbaxy), Alprovit (Alkem) ,Nutramide tab(Cipla),Aminofit(Sanofi)
K)
Lycopene:-Lycogold,
Creatine sachet in tr of FGR!!!!!! Stretch
your imagination: Post delivery well being of neonate/infant where there is an
anticipation that fetus is so growth retarded that it has to be taken out by
30-234 weeks?? In such settings in addition of L arginine, Multivitamin, Sildenafil
vaginal, will creatine sachet administerd orally reduce subsequent MR (mental retardation)
, autism, or behavioral/Learning disorders after a FGR is born preterm . I have
a feeling that creatine sachets (many brands are available in Indian market designed
for nerve growth) will act better than Mag So4.
Why creatine sachets in FGR?? High creatine intake does not greatly increase plasma creatinine concentration, and increases only the
excretion of creatine, not of creatinine (Poortmans and Francaux, 1999).
How
does oral suppl f creatine helps in FGR foetus?? Ans: Creatine and creatine phosphate play important
roles in regulating cellular adenosine
triphosphate reservation.
The function is impaired in cerebral creatine deficiency syndromes. This group
of disorders includes a defect of the X-linked creatine transporter (XCrT) as
well as deficiencies of two enzymes involved in de novo creatine
synthesis, arginine-glycine
amidinotransferase (AGAT) and guanidinoacetate
methyltransferase (GAMT).
Major clinical
features include seizures, intellectual disability, autism, and speech delay.
While there is a significant amount of phenotypic overlap, these disorders are
distinct in their presentation and pathogenesis. Laboratory
diagnosis of these disorders relies on the determination of creatine and
guanidinoacetate in both plasma and urine. Whereas determination of plasma
creatine and guanidinoacetate levels are used for detecting AGAT and GAMT deficiencies,
measurement of urinary creatine to creatinine ratio is a
sensitive screening for XCrT deficiency. Management of cerebral creatine
deficiency syndromes generally includes creatine supplementation and attempts
to reduce offending intermediates such as guanidinoacetate. Do members’
believe that VEGF gene therapy aiming to
improve poor placentation and/or poor uterine blood flow will minimize FGR?? . How many member have a feeling
that Melatonin, creatine and N-acetyl cysteine have potential as novel neuroprotective and cardio protective
agents in established FGR.?
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