| Abstract | Intrauterini zastoj u rastu (IUZR) poznat je i kompleksan opstetrički problem. Povezan je sa perinatalnim mortalitetom i morbiditetom, a pogađa 10-15% trudnica. Fetus iz trudnoće sa IUZR-om definiran je kao fetus koji nije uspio dostići svoj puni potencijal za rast te ima težinu manju od 10-te percentile. Sumnja na trudnoću sa IUZR-om započinje anamnezom i analizom rizičnih faktora, a ultrazvučnom biometrijom se potvrđuje težina manja od 10-te percentile. Tri glavna čimbenika nastanka su maternalni (hipertenzija, dijabetes, anemija, malnutricija, pušenje, alkohol, droga i dr.), fetalni (aneuploidija, kongenitalne malformacije, infekcije, višeplodna trudnoća i dr.) i placentarni (placentarna insuficijancija, infarkt, moacizam i dr.). Intrauterini rast ima utjecaj na perinatalni, postnatalni i adultni razvitak. Povezan je sa povećanim rizikom za razvoj metaboličkih bolesti kao što su hipertenzija, dijabetes i pretilost u zreloj dobi. Fetusi sa dijagnozom usporenog rasta imaju 5-10 puta veću mogućnost za intrauterinu smrt. Otprilike pola preterminski rođene djece i četvrtina terminski rođene djece je imalo intrauterini zastoj u rastu. Rizik za loš ishod fetusa sa usporenim rastom ovisi o etiologiji IUZR-a, gestacijskoj dobi kada je dijagnosticiran usporen rast i ultrazvučnoj evaluaciji Dopplerom. Ovakva djeca imaju povećan rizik za intrapartalnu asfiksiju, prijevremeno rođenje, respiratorni disterss sindrom, intravertikularnu hemoragiju, nekrotizirajući enterokolitis, snižen broj Apgar skale, nizak ph pupkovine i neonatalnu smrt. Uloga primalje u zbrinjavanju ovakvih trudnoća je neosporna. Primalja brine o stanju majke i fetusa te svakodnevno ispituje o pokretima djeteta a uz pomoć CTG uređaja registrira i čedinje otkucaje srca. Ukoliko primalja uoči nepravilnosti u stanju majke ili fetusa, dužna je obavijestiti liječnika. Terapija intrauterinog zastoja u rastu je najčešće ekspektativna a ne medikamentozna, a sam način i vrijeme dovršenja poroda ovise o stanju djeteta i majke. |
| Abstract (english) | Intrauterine growth retardation (IUZR) is a known and complex obstetric problem. It is associated with perinatal mortality and morbidity, and affects 10-15% of pregnant women. IUZR is defined as a fetus that has failed to reach its full growth potential and weights less than the 10th percentile. The identification of IUZRs begins with the analysis of risk factors, and ultrasound biometrics confirms a weight less than the 10th percentile. The three main factors are maternal (hypertension, diabetes, anemia, malnutrition, smoking, drug, alcohol, etc.), fetal (aneuploidy, congenital malformations, infections, multiple pregnancies, etc.) and placental (placental insufficiency, infarction, moacism, etc.). .). Intrauterine growth determines perinatal postnatal and adult development. It is associated with an increased risk of developing metabolic diseases such as hypertension, diabetes and obesity in adulthood. Fetuses diagnosed with slow growth are 5-10 times more likely to have intrauterine death. About half of preterm infants and a quarter of preterm infants had intrauterine growth retardation. The risk of death of a fetus of slow growth depends on the etiology of IUZR, gestational age when diagnosed with slow growth and ultrasound evaluation by Doppler. Such children are at increased risk for intrapartal asphyxia, preterm birth, respiratory distress syndrome, intraverticular hemorrhage, necrotizing enterocolitis, decreased Apgar scale, low umbilical cord pH, sepsis and neonatal death. The role of the midwife in the management of such pregnancy has been enhanced. The nurse takes care of the condition of the fetus and monitors the movements daily with the help of a CTG device and the baby's heart rate. She also cares for the mother by performing the given therapy, taking the necessary data and taking samples for analysis. If the midwife spots an abnormality of the mother or fetus, she is obliged to inform the doctor. Therapy of intrauterine growth retardation is more expectorant than medicamentous, but of course it depends on the etiological factor of onset, and the manner and time of termination of pregnancy depends on the condition of the mother and the child. |
