| Objective The incidence of FGR in pregnancies ranges from 3% to7%. FGR is one of the most important reasons for the death of perinatal infant, the mortality of which is about 42.3%. It has been reported that FGR not only can influence the prognosis of neonates, but also can result in higher occurrence of cardiovascular disease, metabolic disease, and nervous system disease in adult. The pathogeny of FGR is not clear, but some data suggested that the patient who had pregnancy-induced hypertention might have higher risk of FGR, the incidence of which ranges between 10.50% and 35.00%.Due to its complicated etiology and no effective treatments, FGR is still the subject of ongoing research.These days, the common treatment to FGR in clinical practice is to have patients rest in bed, to supply them with amino acid or to give them some low-molecule weight dextrose combined with dan-shen in vein. However, no effective results have been observed. Some injected glucose or amino acid into amniotic cavity for the sake of having foetus swallow and facilitate his growth; others applied hyperbaric oxygen to treat FGR. But the result of these treatments is not definite.It has been shown in some studies that there are a series of placental aging changes in FGR, including placental function insufficience, spiral arterioles sclerosed before entering intervillous spaceand, vescular bed decreased and fibers increased within villi, thrombosis and infarct in partial section. In addition, blood coagulatin function is up-regulated, blood viscosity and plasm viscosity are increasing and the ability of erythrocyte deformation is weaken; the resistance of blood stream is increasing. All these changes result in blood supplement to placenta decreased, which impair the exchange of material and gas of placenta and slow down the growth of fetus.Recently, it has been reported that heparin used to treat anticardiolipinsyndrome could have good efficacy. The velocity of umbilical artery and uterine artery could get improved and the weight of neonate could also get increased, after low-molecule-weight heparin combined with aspirin was applied to the treatment of FGR in some studies. There is no systemic study in using heparin to treat FGR. We have applied Heparin to treat FGR since 1995, and have achieved good performance.Methods 42 cases of FGR were divided into two groups at random,the studied group(n=21) and the control group(n=21), On the basis of routine therapy,the patients in the studied group were treated with heparin and in the control group with low-molecular-weigh dextrose combined with dan-shen. 31 cases of PIH with FGR were divided into two groups,the studied group(n=16) and the control group(n=15), On the basis of anti-convulsion,sedation,decompression, the former were treated with heparin and the latter were treated with low-molecular-weigh Dextrose combined with dan-shen.1. Before treatment and after a treatment course , the index as followed were examined respectively:1) The growth of fetal, amniotic fluid volum, fetal biophysical score and umbilical artery S/D,PI,RI were monitored by color ultrasonography;2) Level of E3 and HPL in the blood. 3) The change of hemorheology.2 .Platelet count, APTT, PT, AT-III in the blood were examined once every three days;3. Birth weight ,one-minute Apgar score and gestational age of newborns were recorded.4.The placentas of all the patients and 21 placentas of FGR who were not received any treatment and 21 normal placentas were collected and stored for detection of tissue morphologic change ,apoptosis and expression of apoptosis-relating gene. Results:1. Bitarietal diameter(BPD),femur length (FL), headcircumference(HC) , abdomen circumference(AC) ,amniotic fluid index (AFI) and biophysical score of fetus treated with heparin were significantly higher(i'<0.05)than that of the control group,and umbilical artery Doppler indices ( PI ,RI and S/D ratio) were significantly lower than the latter. (P< 0.05)2. The body w... |
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