الفهرس 
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Abstract
A condition in which the fetus experiences pathological growth restriction within the uterus, intrauterine growth restriction (IUGR) continues to be a significant public health concern. While the terms are frequently applied interchangeably, ”small for gestational age” (SGA) denotes neonates whose birth weights fall below the 10th percentile for their gestational age.
IUGR is estimated to affect between 5 and 7 percent of pregnancies. IUGR is frequently caused by placenta-vascular insufficiency. IUGR is associated with an increased risk of preterm birth, decreased perinatal survival, and long-term complications (including insulin resistance in maturity and impaired neurodevelopmental progress in childhood), according to numerous studies.
NO significantly contributes to enhancing oxygen and nutrient delivery to the fetus during a typical pregnancy by modulating vasodilation in feto-placental circulation. Reduced NO availability may play a significant role in the pathophysiology of IUGR; prior research indicates that inhibition of NO synthesis could induce IUGR.
Hence, precursors (L-arginine) & NO donors (glyceryl trinitrate and isosorbide mononitrate) could potentially serve as therapeutic strategies for IUGR. L-arginine is an essential amino acid for the synthesis of NO in the organism. Nevertheless, numerous studies have demonstrated that arginine deficiency can manifest in expectant women and preterm infants. Furthermore, IUGR infants exhibited compromised arginine transport into endothelial cells in the umbilical endothelium.
• Primary outcome : the aim of this research is to examine the effects of L-Arginine supplementation as a therapeutic intervention for Intra-uterine fetal Growth Restriction at Minia Maternity University Hospital. The main objective under evaluation is the augmentation of growth velocity.
• Secondary outcome : the objective centering on enhancements in amniotic fluid or Doppler parameters in instances when impairment is detected.
This clinical study conducted at the Department of Obstetrics and Gynecology, Minia Maternity University Hospital from January to December 2023 after taking medical history, Clinical examination, and informed written consent from all subjects and after being approved by the Institutional ethical Committee.
The main results of the study showed the following:
1. There was no significant difference in age, BMI, parity, gravidity, and GA at assessment between both groups (P-value > 0.05).
2. There was no significant difference in maternal vital data between both groups (P-value > 0.05).
3. There was no significant difference in pre-operative hematological and biochemical data between both groups (P-value > 0.05).
4. FEW after receiving arginine treatment was statistically significantly higher than before treatment. Regarding FEW distributions, most of pre-treatment cases (80％) have FEW ≤1500gm while after treatment most of cases (83.3％) have FEW more than 1700gm.
5. FEW after receiving arginine treatment was statistically significantly higher than before treatment. Regarding FEW distributions, most of pre-treatment cases (83.3％) have FEW ≤1500gm while after treatment most of cases (40％) have FEW more than 1700gm.
6. There is statistically insignificant difference between arginine treated and Placebo groups in pre-treatment FEW distributions that showed 10% in each group were ≤ 1100 gm, 46.7% vs 53.3% were 1101-1300 gm, 23.3% vs 20% were 1301-1500 gm, 20% vs 16.7% were 1501-1700 gm.
7. There is statistically significant higher FEW in arginine treated than Placebo groups in post-treatment FEW distributions that showed 16.7% vs 53.3% were 1501-1700 gm, 56.7% vs 30% were 1701-1900 gm, 20% vs 10% were 1901-2100 gm, 6.7% vs 0% were 2101-2300 gm while those with FEW ≤ 1500 were 6.7% in Placebo group vs none in arginine treated group.
8. Post-treatment EFW was statistically significantly higher than pre-treatment FEW in arginine treated (1324.18±177.04 vs 1821.73±153.85; P-value ˂ 0.05).
9. Post-treatment estimated fetal weight was statistically significantly higher than pre-treatment FEW in Placebo group (1296.12±156.27vs 1645.17±160.49; P-value > 0.05).
10. There was no statistically significant difference in Pre-treatment estimated fetal weight between both groups (1324.18±177.04 vs 1296.12±156.27; P-value > 0.05).
11. There is statistically significant higher post-treatment FEW in arginine treated than Placebo groups (1821.73±153.85 vs 1645.17±160.49; P-value ˂ 0.05).
12. There is statistically significant higher birth weight in arginine treated than Placebo groups that showed 13.3% vs 50% were 1601-1800 gm, 40% vs 16.7% were 1801-2000 gm, 26.7% vs 16.7% were 2001-2200 gm, 20% vs 0% were 2201-2400 gm while those with birth weight ≤ 1600 were 16.7% in Placebo group vs none in arginine treated group.
13. There is statistically significant higher birth weight in arginine treated than Placebo groups (2021.10±158.62 vs 1789.70±176.29; P-value ˂ 0.05).
14. Fetal biometry was statistically significant higher after than before treatment in arginine treated groups (P-value ˂ 0.05).
15. Fetal biometry was statistically significant higher after than before treatment in Placebo groups (P-value ˂ 0.05).
16. Despite of statistically insignificant difference in baseline fetal biometry in arginine treated than Placebo groups, there is statistically significant higher post-treatment fetal biometry in arginine treated than Placebo groups including BPD (75.47±4.13 vs 68.80±5.24), HC (293.53±13.55 vs 282.37±12.13), AC (319.53±11.50 vs 311.03±11.45) and FL (75.30±3.20 vs 70.69±6.59).
17. There is statistically significant increase in AFI after than before treatment in arginine treated group (10.67±0.80 vs 13.433±1.63).
18. There is statistically significant increase in AFI after than before treatment in Placebo group (10.60±0.86 vs 12.50±1.57).
19. Despite that there is statistically insignificant difference in AFI between arginine treated and Placebo groups before treatment (10.67±0.80 vs 10.60±0.86), there is statistically significant increase in AFI in arginine treated than Placebo group (13.433±1.63 vs 12.50±1.57) after treatment.
20. There is statistically significant decrease in UA PI after than before treatment (1.806±0.281 vs 1.254±0.195) and in UA PSV/DV ratio after than before treatment (2.133±0.297 vs 1.481±0.207) in arginine treated group.
21. There is statistically significant decrease in UA PI after than before treatment (1.799±0.101 vs 1.400±0.112) and in UA PSV/DV ratio after than before treatment (2.056±0.232 vs 1.713±0.193) in Placebo group .
22. Despite of statistically insignificant difference in baseline UA Doppler parameters in arginine treated than Placebo groups. There was statistically significant decline in post-than pretreatment UA Doppler parameters in females who received arginine than those who did not received arginine for both UA PI (1.254±0.195 vs 1.400±0.112) and UA PSV/DV ratio (1.481±0.207 vs 1.713±0.193) (P-value < 0.05).
23. Despite that NICU admission frequency in females who did not received arginine than those who received arginine (33.3% vs 46.7%) but the difference was statistically insignificant (p-value >0.05). Also, IUFD was higher in in females who did not received arginine than those who received arginine, but the difference was statistically insignificant (p-value >0.05). there was statistically insignificant difference in mode of delivery and fetal sex between females who did not received arginine and those who received arginine.