1) Ενδομήτρια καθυστέρηση της ανάπτυξης καθορίζεται ως βάρος γέννησης χαμηλότερο από τη 10η εκατοστιαία θέση για τη συγκεκριμένη ηλικία κύησης. Αναφέρεται σε έμβρυα που δεν μπόρεσαν να πετύχουν τη γενετικά καθορισμένη ανάπτυξη τους.
2) Μικρό για την ηλικία κύησης νεογνό (Small for dates) αναφέρεται σε έμβρυα με βάρος γέννησης χαμηλότερο από την 10η εκατοστιαία θέση, χωρίς ύπαρξη παθολογικού αίτιου.
Συχνότητα
Εάν δεχτούμε ότι ως Ε.Κ.Α. ορίζεται ένα έμβρυο με εκτιμώμενο βάρος ανάπτυξης για την ηλικία κύησης χαμηλότερο από τη 10η εκατοστιαία θέση, γνωρίζουμε ότι τουλάχιστον το 10% των συνολικών κυήσεων θα κατηγοριοποιηθεί ως έχοντες Ε.Κ.Α.
Παράγοντες κινδύνου:
Από το έμβρυο:
- Χρωμοσωμικές ανωμαλίες
- Δομικές ανωμαλίες
- Πολύδημες κυήσεις
- Εμβρυικές λοιμώξεις
Από τη μητέρα:
- Σοβαρή αναιμία
- Καρδιοαναπνευστική νόσος
- Νεφροπάθεια
- Αθηρωμάτωση
- Χρόνια υπέρταση
- Προεκλαμψία
- Σακχαρώδης διαβήτης
- Νοσήματα του κολλαγόνου
- Ναρκωτικά ,κάπνισμα
- Φάρμακα
- Το υπερηχογράφημα ανάπτυξης είναι η μέθοδος επιλογής για τη διάγνωση και εκτίμηση περιπτώσεων με ενδομήτρια καθυστέρηση της ανάπτυξης.
- Το πιο τυπικό εύρημα είναι σημαντική διαφορά σε όλες ή σε κάποιες από τις εμβρυικές βιομετρικές παραμέτρους.
- Η υπερηχογραφική εκτίμηση του εκτιμώμενου εμβρυικού βάρους, μπορεί να έχει απόκλιση μέχρι και 20% από το ακριβές βάρος των εμβρύων. Για αυτό το λόγο η διάγνωση και αντιμετώπιση εμβρύων με πιθανή Ε.Κ.Α. θα πρέπει να εκτιμάται συνολικά με σειρά υπερηχογραφημάτων.
- Η αντιμετώπιση της κύησης εξαρτάται από την ηλικία κύησης του εμβρύου, την αιτία που προκάλεσε Ε.Κ.Α. και τα αποτελέσματα από την υπερηχογραφική εξέταση.
- Η κατάσταση του εμβρύου εκτιμάται με σειρά υπερηχογραφημάτων ανάπτυξης και με την εξέταση Doppler όπου εξετάζεται η ροή αίματος στην ομφαλική αρτηρία, μέση εγκεφαλική αρτηρία, φλεβώδη πόρο και στις μητριαίες αρτηρίες, ώστε να μπορεί να εκτιμηθεί πιθανή εμβρυϊκή δυσχέρεια και να καθοριστεί η πιο ασφαλής στιγμή για τοκετό.
- Σε περίπτωση Ε.Κ.Α. η 37η εβδομάδα κύησης είναι η κατάλληλη στιγμή για να διεκπεραιωθεί προγραμματισμένος τοκετός.
Σε περίπτωση Ε.Κ.Α. μικρότερη των 37 εβδομάδων συνιστάται συνήθως συντηρητική αντιμετώπιση του εμβρύου με τακτική υπερηχογραφική παρακολούθηση.
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