www.ksmf.org/arhimed   arhimed@ksmf.org   [5/10/2025 5:26:05 PM] http://www.ksmf.org/arhimed/poglej.asp?id=44 Zastoj plodove rasti v maternici: problemi odkrivanja Avtor: Eva Cedilnik Mentor: prof. dr. Živa Novak-Antolic, dr. med Izhodišca Znotrajmaternicni zastoj rasti (ZZR) je vzrok za višjo perinatalno obolevnost in umrljivost ter višjo obolevnost v otroštvu in odrasli dobi. Odkrivanje ZZR med nosecnostjo je pri nas in v svetu slabo, kar onemogoca ucinkovito zdravljenje in raziskovanje. V Sloveniji je mrtvorojenost že zadnjih 10 let skoraj nespremenjena. Menimo, da bi lahko z boljšim odkrivanjem ZZR mrtvorojenost zmanjšali, odkrivanje pa bi lahko izboljšali z višjo kvaliteto ultrazvocnih pregledov med nosecnostjo in z boljšim izkorišcanjem presejevalnih metod, ki jih že imamo. Naš namen je bil ugotoviti, kako bi spremenili predporodno varstvo, da bi se odkrivanje ZZR izboljšalo. Metode Vkljucenih je bilo 323 otrocnic, za katere smo zbrali podatke o poteku nosecnosti in dejavnikih tveganja za ZZR, o opravljenih ultrazvocnih pregledih in o rojenem otroku. Podatke smo zbirali iz Porodnega zapisnika, Materinske knjižice in Novorojenckovega zapisnika. Pri 137 otrocnicah smo izvedli še anketo o socialnoekonomskih dejavnikih tveganja za ZZR. Raziskava je bila prospektivna. Otrocnice smo razvrstili v štiri skupine: kontrolno (ni bilo suma na ZZR, otrok rojen AGA), lažno negativno (ni bilo suma, otrok SGA), lažno pozitivno (postavljen sum, otrok AGA) in pravilno pozitivno (postavljen sum, otrok SGA). Podatke smo statisticno obdelali. Rezultati Vecje tveganje za pojav ZZR imajo starejše, manjše, lažje, neporocene ženske, ki med nosecnostjo pridobijo manj teže, z osnovno ali nižjo izobrazbo, ki ne obiskujejo šole za starše, ki bodo rodile prvic ali cetrtic ali veckrat, imajo hipertenzivne bolezni med nosecnostjo, so zanosile po umetni oploditvi, med nosecnostjo dobivajo tokolitike, gestagene, deksametazon, antihipertonike, antikonvulzive, aspirin in rhogam, in so med nosecnostjo doživele bolezen v družini (p<0.1). V pravilno pozitivni skupini, je bilo napravljenih vec UZ pregledov (5.2) kot v kontrolni (3.6, p=0.001) in lažno negativni (3.7, p=0.02), ne pa lažno pozitivni (4.5, p=0.151). V pravilno pozitivni skupini je bilo opravljenih tudi znacilno vec meritev BIP in dolžine femurja okrog 20. tedna kot v lažno pozitivni (100% proti 75%, p=0.069), vec meritev obsega abdomna okrog 20. tedna kot v kontrolni skupini (85.7% proti 67.5%, p=0.083) in lažno negativni skupini (50%, p=0.068) ter vec meritev obsega abdomna v 30. tednu kot v kontrolni (85.7% proti 66.8%, p=0.074) in lažno negativni skupini (63.8%, p=0.067). Okrog 10. tedna so v pravilno pozitivni skupini veckrat dolocili gestacijsko starost kot v kontrolni (85.7% proti 65.9%, p=0.062). V pravilno pozitivni skupini so imele nosecnice veckrat v celoti vrisane meritve BIP in obsega abdomna kot v kontrolni (78.6% proti 32.0%, 0=0.001) ali lažno negativni (43.8%, p=0.029); ter veckrat vsaj delno vrisane meritve razdalje simfiza-fundus kot v prvi (50% proti 17.6%, p=0.004) ali v drugi (21.9%, p=0.084). Zakljucki Menimo, da bi se odkrivanje ZZR izboljšalo z vecjo pozornostjo na nosecnice, ki imajo dejavnike tveganja za ZZR in z izboljšanjem kvalitete UZ pregledov. To bi pomenilo prvi pregled okrog 10. tedna za natancno dolocanje gestacijske starosti, merjenje BIP, dolžine femurja in obsega abdomna okrog 20. tedna in obvezno merjenje obsega abdomna na tretjem ultrazvocnem pregledu okrog 30. tedna oziroma vsaj enkrat v tretjem trimesecju. Potrebno bi bilo redno vrisovati izmerjene meritve v graf v Materinski knjižici, kot presejalni test pa bi morali izvajati tudi merjenje razdalje simfiza-fundus. «» [Abstract / English version] The problems of intrauterine growth restriction detection Author: Eva Cedilnik Mentor: prof. dr. Živa Novak-Antolic, dr. med Background Intrauterine growth restriction (IUGR) is associated with a higher degree of perinatal morbidity and mortality and higher morbidity in childhood and adulthood. Detection of IUGR during pregnancy is uneffective in Slovenia and elsewhere in the world, complicating management and research work. In Slovenia the stillbirths rate has been almost unchanged during the last 10 years. We believe that better detection of IUGR could lower the stillbirths rate. Detection could be improved by raising the quality of ultrasound (US) examinations during pregnancy and by more efficient use of existing screening methods. We wished to find out how to improve detection of IUGR. Patients and methods From 323 women data about pregnancy and risk factors for IUGR, US examinations and baby's health were collected from Birth reports, Maternity booklets and Newborn's reports. 137 women also answered questionnaries about socio-economic risk factors of IUGR. Study was perspective. Women were classified into four groups: control (IUGR was not suspected, the baby is AGA), falsely negative (IUGR was not detected, the baby is SGA), falsely positive (IUGR was suspected, baby is AGA) and accurately positive group (IUGR was suspected, baby is SGA). The data was statistically evaluated. Results Older, smaller, lighter, unmarried women with less weight gain during pregnancy, with elementary or lower education, not enrolling into parent's school, giving birth for the first or fourth or higher time, with hypertension during pregnancy, who got pregnant after artificial fertilization, took tocolitics, gestagens, dexamethazone, antihypertensives, anticonvulsives, aspirin and rhogam during pregnancy and/or experienced an illness in family during pregnancy are at higher risk for IUGR (p<0.1). In correctly diagnosed group on average more US examinations (5.2) were performed than in control (3.6, p=0.001) and falsely negative group (3.7, p=0.02), but not in falsely positive (4.5, p=0.15). In correctly diagnosed group more measurings of biparietal diameter (BPD) and femur lenght (FL) around 20. week were performed than in falsely positive (100% v. 75%, p=0.069 in both cases), more abdominal circumference (AC) measurings around 20. week than in control (85.7% v. 67.5%, p=0.083) and falsely negative group (50%, p=0.068) and more AC measurings around 30. week than in control (85.7% v. 66.8%, p=0.074) and falsely negative group (63.8%, p=0.067). Gestational age around 10. week was more often estimated in correctly diagnosed group than in control group (85.7% v. 65.9%, p=0.062). In correctly diagnosed group pregnant women more often had completely marked US measurements into curves in Maternity booklets than in control (78.6% v. 32.0%, p=0.001) or falsely negative group (43.8%, p=0.029), and more often at least partly marked measurements of S-F lenght in curve in Maternity booklets than in control (50% v. 17.6%, p=0.004) or in falsely negative group (21.9%, p=0.084). Conclusions Detection of IUGR could be improved by paying greater attention to pregnant women with risk factors for IUGR and with improving quality of US examinations. This means first examination around 10. week for exact estimation of gestational age, measuring BPD, FL and AC around 20. week, and mandatory AC measuring around 30. week or at least once in third trimester. We also recommend marking BPD and AC measurements in curves in Maternity booklets and measuring S-F length as a screening test.