INTRAUTERINE GROWTH RETARDATION Ann ROLE of ALLYLESTRENOL (GESTANIN) in ITS MANAGEMENT

INTRAUTERINE GROWTH RETARDATION ANn ROLE OF ALLYLESTRENOL (GESTANIN) IN ITS MANAGEMENT

J A TISWAR SINGH MEENAKUMARI DEVI and Y. LAKSHMI DEVI

SUMMARY

Infrauterine growth retardation poses a great problem in the developing countries, specially in states, like ours. Modern amenities and sophistications have hardly benefited the rural Population. We found Allylestrenol (gestanin) quite helpful in the manage ment of IUGR. Physical rest for 2-3 hours in the afternoon has shown better results.

Introduction previleged pregnant women throughout the world. This has encouraged us to take up I Perinatal mortality still remains the only the present study for trying to improve the accepted, though crude, yardstick of obste incidence of IUGRj LBW/ SGA infants tric care throughout the world. The risk of when detected antenatally. SGA/LBW infants is three times greater than infants born with birth weight above Material and methods 2.5 Kg. The risk is sixteen times greater From among the pregnant women of 20 among low socio-economic group. World weeks attending antenatal clinic at R . M. C. Health Organisation study in several coun Hospital, Imphal from July 1982 to Janu tries has shown 5% to 20% occurrence rate ary 1984 we selected 250 subjects belonging of LBW. In India 20% to 30% of babies to similar socio-economic group living under are born with LBW, contributing to 60% of similar environments, whom we diagnosed perinatal deaths. The long term risk of LBW I clinically as having IUGR after three con SGA/Dysmature infants require careful secutive visits. These cases were given ally study and should draw attention from all. lestrenol ( Gestanin, for 16 to 18 weeks Sophistication and modernisation in obstetric in doses of 5 to 20 mg daily and fol biophysics is not a remedial measure neithe~; lowed till delivery. Seventy of them became would offer salv:age to 22 million LBW in complicated with EPH gestosis and other fants bO'rn annually (1975), as these facilities. diseases. We analysed only those cases who will continue to be limited to those few delivered in our hospital. Another 100 cases From: Department of Obstetric and Gynaeco very without giving allylestrenol. In this logy, R.M.. C. lmphal. control group only 66 cases deliverec! in '. Accepted for publication on 8-4-85. our hospital. INTRAUTERINE GROWlli RETARDATION & ROLE OF ALLYLESTRENOL 491

Gravidogram was employed to detect and 70 women complicated with EPH gestosis ...- - diagnose IUGR. This included LMP, (62), uterine fibroid ( 4), diabetes (4) and maternal weight gain, uterine fundal height, heart disease (1). Total foetal salvage w.as abdominal girth, clinical estimation of fo=tal 123 live births of which 105 (77.2%) had size and liquor volume as dictated by our birth weight above 2.5 Kg. (average 2.7 g) past experience. Routine blood Hb, group and 18 (13.2%) below 2.5 Kg. Among 100 ing, urine analysis, B. P., and maternal control (non-Gestanin), 66 delivered in the weight were recorded. Blood urea and hospital and only 18 (27.2%) had birth creatinine were estimated in 70 case>. weight above 2.5 Kg. and 32 (48.5%) below Among the study group, only 136 women 2.5 Kg., as shown in Table I. There were delivered in our hospital and the rest were 13 IUD/Still births (9.5%) in the study thus excluded. At delivery, birth weight. group and 12 (18.2%) in the control group placental morphology and weight, gestation as seen in. Table II. We found only slight al age and foetal measurements were care variation in the gestational period in this fully recorded. IUD and still births among series. One hundred twenty-six (92.65%) the study and control groups were critically women with allylestrenol delivered after 37 · reviewed. The findings are studied and completed weeks (38 to 42 weeks), 3 .after statistically analysed. 42 weeks and 7 (5.1 %) before 37 weeks of gestation. Similarly, among the control group Results 60 (90.1 %) women delivered after 3 7 weeks Out of 250 ca

TABLE I Birth weight of the infants

Study group Control group Weight in Kg No. of infants Percentage No. of infants Percentage

More than 2 . 5 105 77.2 18 27.3

Less than 2 . 5 *31 22.8 *48 72.7 -- Total 136 1{)0 66 100 ':' This is inclusive of still births/IUD/PNM.

TABLE II Perinatal loss was 13 (9.5%) and 16 IV D and Still Births (24.2%) for the study and control groups Cases No. of IUD/Still Percen respectively, indicating significant charge in births tage foetal salvage with allylestrenol administer ed during pregnancy as revealed in Table Study group 7 5.2 IV. The causes of IUDjStillbirths are indi Control group 12 18.2 cated in Table V. In this analysis we have 492 JOURNAL OF OBSTETRICS AND GYNAECOLOGY OF INDIA

TABLE Ill ------Gestational Weeks at Delivery Gestational Study group Control group Weeks No. of cases Percentage No. of cases Percen:tage Less than 37 7 5.15 5 7.57 Above 37 to 42 126 92.65 60 9().9 Above 42 3 2.2 1 1.51

Total 136 100 66 100 excluded all those cases who had allylestre abortions and irritable uterus, but continued nol for other associated conditions or early pregnancy till term. pregnancy complications like threatened

TABLE IV Perinatal Loss and JUDlSB

Cases llJD/ SB Perinatal Total Percentage deaths Study group 7 6 13 9.5 Control group 12 4 16 24.2

TABLE V Causes of Perinatal Deaths a11d IUD/SB Causes Eclampsia RDS Ace. Hge. Heart disease Total Study group 6 (4.4% ) 6 1 Nil 13 (4.4%) (0. 74 % ) (9.5%)

Control group 7 (10.6%) 4 4 1 (1.5%) 16 (6.1%) (6.1% ) (24.2%)

D iscussions causes of IUGR. Most of these factors lead ing to IUGR could be prevented if diagnos:;,. The hazards of IUGR/ LBW/ SGAj Dys ed in the early stage of pregnancy. This mature infants are well recognised and in could also reduce appreciably the perinatal the last two decades extensive studies have loss, when treated during pregnancy. Tsuy been carried out without much remedial shi Kaneoka et al ( 1983) advocated day outcome. Maternal nutrition, role of physical time bed rest, high protein diet, intravencus works during pregnancy, placental insuffi infusion of maltose or oral allylestren0l ciency, smoking during pregnancy, multiple and Yoshihiko Takeda (1983) maternal pregnancy, high altitude, genetic factors, maltose heparin infusion. Bed rest may drugs, infections, alcoholism and environ play a positive rule in the antenatal manage ~ mental factors are considered as important ment of IUGR. In our long experience in INTRAUTERINE GROWTII RETARDATION & ROLE OF ALLYLESTRENOL 493

this field we have observed appreciable in rest; rather they have to work more specially crease in birth weight if the pregnant woman in the joint family having several members was ensured of two to three hours of bed in the same home. They are often deprived rest daily during the day time from 28 of adequate calorie against their requ;re weeks till term, in addition to rest at night. ment of dietary supplement thus leading to This was advocated by many workers also LBW infant at delivery. Improvement of (Dawn, 1982; Prema, 1983 and Mehta, socio-economic condition or compulwry die 1981). It is well accepted that maternal tary supplement (free) during pregnancy variables and her health status invariably would be the only answer for long tenn modify the birth weight of the infant (Devi remedy of such social hazards of IUGR/ et al, 1981; Singh et at 1980) and under SGA/ LBW infants. We have tried therapeu unfavourable circumstances may deliver tic measures for the'e mothers by giving LBW j SGAj Dysmature infant, which at allylestrenol for 16 to 18 weeks starting present we label as IUGR. Abdominal from 20 to 24 weeks of gestation with g0od decompression with Heyns suit \\-as once results. suggested without much acceptance. Long term use of oral tocolytic drugs (isoxsu References prine) and administration of anticoagu Ian t s were also employed, to minimise the risks 1. Dawn, C. S.: Text book of Obstetrics, 8th of IUGR. It is evident that low socio-eco Edn (Calcutta); page 287-291, 1982. 2. Mehta, A.: Monograph on Intrauterine nomic group of mothers are prone to have Growth Retardation; (Calcutta), 129, 1981. IUGR infants more frequently than thf.'ir 3. Prema, K.: R"'cent Trends in Perinato educated high socio-economic status coun- logy (A Nachiketa publication) page 9- ,... terpart. For the later antenatal correction 20 1982 (Cal.cutta). of faulty diet, anaemia, PIH, infections and 4. Singh, J., Sharma, H., Randhoni Devi, Singh I. and Lakshmi Devi: Asian Med. other diseases are easily and readily done. J. 23: 626, 1980. For them extra hours of rest in bed during 5. Tsuyoshi Kaneoka; Proceedings of the the day is also readily provided thus facili Third Asia-Oceania Congress of Perina tating prevention and early correction of tology; 65 1983. IV GR. 6. Lakshmi Devi, Y., Singh, I., Singh, N. and Singh, J.: Asian Med. J. 24: 498, 1981. In our experience, women belonging to 7. Yoshihiko Takeda; Proceedings of the poor family with low socio-economic back Third Asia-Oceania Congress of Perina ground could hardly afford daytime bed tology; 163-168; 1983.