Intrauterine fetal growth restriction—the biochemical rationale of treatment modalities including extraperitoneal transamniotic fetal supplements

摘要

Intrauterine fetal growth restriction (IUGR) is an affliction of a disparaging spectrum, placental insufficiency being the major inciting pathology. The resultant fetal hypoglycemia is alleviated by intravenous hypertonic D-glucose 25-50% maternal supplements, by improving the V_max of placental substrate transfer, as per Michaelis-Menten model. Fetal normoglycemia so restored in turn surprisingly improves fetal hypoxia, hypercapnia if any, lactic acidemia, acidosis, oliguria with/without oligohydromnios, hypertriglyceridemia, and the fetal nutrient, mineral and vitamin acquisition. The list being phenomenal can only convince an inquiring reader by a biochemical sojourn into the aquatic world of the fetus, herein described. Maternal carbohydrate predominant, essential amino acids/fatty acids rich IUGR-diet incorporating maximal amounts of vitamin and minerals are highly beneficial for attainable placental V_max. Transamniotic isotonic D-glucose supplement via minimally invasive ‘Suprapubic extraperitonial pelvic approach’ for amniotomy (Sumathi Paturu's technique) with a Subcutaneously Implanted Pregnancy Port (SIPP) catheter is the additional therapy advocated.