Intrauterine growth restriction is an important problem in neonatal care. Intrauterine growth restriction (IUGR) is defined as a fetal weight below the 10th percentile for gestational age. One of the main causes of IUGR is placental insufficiency. Nitric oxide(NO) increases placental blood flow. So,it might be useful to improve IUGR pregnancy outcome .
The study population includes pregnant women attending Antenatal care clinic of Ain Shams University Maternity Hospital who first time diagnosed of IUGR at our antenatal care outpatient clinic either referred for this cause After confirm diagnosis of IUGR and distributing patient into two groups Patient in first group will receive oral L-arginine 3000mg/day till delivery and Acetylesalicylic acid 75mg once daily. Patients in second group will receive Acetylesalicylic acid 75mg once daily. then follow up of both group by: 1. Daily fetal movement counting 2. Day after day CTG 3. Doppler twice weekly 4. Pelvic u/s weekly for: A) Head circumference, Abdominal circumference, femur length B) Fetal weight C) Liquor amount: Amniotic Fluid Index Or MeanVertical Pocket Decision of delivery will be determined when: A) Fetal distress (non stress CTG) B) Mother starts labour C) Reversed umbilical artery Doppler.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
260
l-arginine 1000mg capsule will be given every 8 hours till delivery and acetylesalicylic acid75mg tablet once starting of diagnosis till birth.
acetylsalicylic acid 75 mg will be given orally once daily for group B starting of diagnosis till birth.
Ain Shams University
Cairo, Egypt
RECRUITINGBirth weight
neonatal birth weight will be measured immediately following delivery and compared with the estimated fetal weight measured by ultrasound
Time frame: 15 min
Apgar score
The Apgar scale is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two, then summing up the five values thus obtained. The resulting Apgar score ranges from zero to 10. The five criteria are (Appearance, Pulse, Grimace, Activity, Respiration).
Time frame: at one and five minute after birth.
Amniotic fluid index
Amniotic fluid index (sum of the vertical diameter of the four pocket of amniotic fluid )
Time frame: evey one week from 28 weeks gestation till 40 weeks gestation
Umbilical artery Doppler
umbilical artery Doppler will measured by two dimensional ultrasound power Doppler twice weekly for the presence of any abnormality as: marked decreased diastolic blood flow, absent or reversed diastolic blood flow.
Time frame: every from 28 weeks gestation till 40 weeks gestation
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