胎儿生长受限的围分娩期监测
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摘要
文章以国内外指南、临床研究及专家共识为基础,阐述胎儿生长受限是胎儿生长体重低、临床上伴有胎盘以及脐带血流异常,介绍了围产期采用彩色多普勒各项指标检测的意义,以及各指标的临床应用价值,探讨了降低胎儿生长受限的围分娩期不良结局相关措施。
Based on domestic and international guidelines,clinical researches and expert consensus,it is stated that fetal growth restriction is the fetal low weight,clinically accompanied by abnormal placenta and umbilical cord blood flow.This paper summarized the significance and clinical value of the color Doppler detection during perinatal period,and discussed the measures to reduce the adverse outcome of fetal growth restriction during delivery.
Based on domestic and international guidelines,clinical researches and expert consensus,it is stated that fetal growth restriction is the fetal low weight,clinically accompanied by abnormal placenta and umbilical cord blood flow.This paper summarized the significance and clinical value of the color Doppler detection during perinatal period,and discussed the measures to reduce the adverse outcome of fetal growth restriction during delivery.
引文
[1]Gordijn SJ,Beune IM,Ganzevoort W.Building consensus and standards in fetal growth restriction studies[J].Best Pract Res Clin Obstet Gynaecol,2018,49:117-126.
[2]American College of Obstetricians and Gynecologists.Fetal growth restriction.Practice bulletin no.134[J].Obstet Gynecol,2013,121:1122-1133.
[3]Berkley E,Chauhan SP,Abuhamad A.Doppler assessment of the fetus with intrauterine growth restriction[J].Am J Obstet Gynecol,2012,206(4):300-308.
[4]Royal College of Obstetricians and Gynecologists.Fetal growth restriction-recognition,diagnosis&management.Clinical Practice Guideline[EB/OL].https://www.rcog.org.uk/en/guidelinesresearchservices/guidelines/gtg31/[.2018-12-28].
[5]Society of Obstetricians and Gynaecologists of Canada.Intrauterine growth restriction:screening,diagnosis,and management.SOGC Clinical Practice Guideline[J].J Obstet Gynaecol Can,2013,35(8):741-748.
[6]New Zealand Maternal Fetal Medicine Network.Guideline for the management of suspected small for gestational age singleton pregnancies and infants after 34 weeks’[EB/OL].https://www.asum.com.au/wp-content/uploads/2015/09/NZMFM-SGAGuidelineSeptember-2013.pdf[.2018-12-28].
[7]谢幸,孔北华,段涛.妇产科学[M].9版.北京:人民卫生出版社,2018:135-137.
[8]Gardosi J,Kady SM,McGeown P,et al.Classification of stillbirth by relevant condition at death(ReCoDe):population based cohort study[J].BMJ,2005,331(7525):1110.
[9]Corcoran P,Manning E,O’Farrell IB,et al.Perinatal mortality in Ireland:annual report 2014[EB/OL].https://hdl.handle.net/10147/619941[.2018-12-28].
[10]Savchev S,Sanz-cortes M,Cruz-martinez R,et al.Neurodevelopmental outcome of full-term small-for-gestational-age infants with normal placental function[J].Ultrasound Obstet Gynecol,2013,42(2):201-206.
[11]Tideman E,Marsal K,Ley D.Cognitive function in young adults following intrauterine growth restriction with abnormal fetal aortic blood flow[J].Ultrasound Obstet Gynecol,2007,29(6):614-618.
[12]Vayssie're C,Sentilhes L,Ego A,et al.Fetal growth restriction and intra-uterine growth restriction:guidelines for clinical practice from the French College of Gynaecologists and Obstetricians[J].Eur J Obstet Gynecol Reprod Biol,2015,193:10-18.
[13]Gardosi J,Madurasinghe V,Williams M,et al.Maternal and fetal risk factors for stillbirth:population based study[J].BMJ,2013,346:f108.
[14]陈敦金,余琳.预防可避免死胎,重视死胎病因管理[J].中国实用妇科与产科杂志,2018,34(12):1318-1321.
[15]陈素华.TORCH孕前咨询及产前诊断和处理要点[J].中国实用妇科与产科杂志,2018,34(12):1332-1335.
[16]Baschat AA.Planning management and delivery of the growthrestricted fetus[J].Best Pract Res Clin Obstet Gynaecol,2018,49:53-65.
[17]Dall'asta A,Brunelli V,Prefumo F,et al.Early onset fetal growth restriction[J].Matern Health Neonatol Perinatol,2017,3:2.
[18]American College of Obstetricians and Gynecologists.Fetal growth restriction:methods for estimating the due date[J].Obstet Gynecol,2017,129:150-154.
[19]Figueras F,Caradeux J,Crispi F,et al.Diagnosis and surveillance of late-onset fetal growth restriction[J].Am J Obstet Gynecol,2018,218(2):S790-S802.e1.
[20]Cnossen JS,Morris RK,ter Riet G,et al.Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction:a systematic review and bivariable meta-analysis[J].CMAJ,2008,178(6):701-711.
[21]Grivell RM,Wong L,Bhatia V.Regimens of fetal surveillance for impaired fetal growth(Review)[J].Cochrane Database Syst Rev,2012,(6):CD007113.doi:10.1002/14651858.CD007113.pub3.
[22]Arduini D,Rizzo G,Romanini C.The development of abnormal heart rate patterns after absent end-diastolic velocity in umbilical artery:analysis of risk factors[J].Am J Obstet Gynecol,1993,168(1):43-50.
[23]Brar HS,Platt LD.Reverse end-diastolic flow velocity on umbilical artery velocimetry in high-risk pregnancies:an ominous finding with adverse pregnancy outcome[J].Am J Obstet Gynecol,1988,159(3):559-561.
[24]Stampalija T,Arabin B,Wolf H,et al.Is middle cerebral artery Doppler related to neonatal and 2-year infant outcome in early fetal growth restriction?[J].Am J Obstet Gynecol,2017,216(5):521.e1-.e13.
[25]Figueras F,Gratacos E.Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol[J].Fetal Diagn Ther,2014,36(2):86-98.
[26]Flood K,Unterscheider J,Daly S,et al.The role of brain sparing in the prediction of adverse outcomes in intrauterine growth restriction:results of the multicenter PORTO study[J].Am JObstet Gynecol,2014,211(3):288 e1-5.
[27]Schwarze A,Gembruch U,Krapp M,et al.Qualitative venous Doppler flow waveform analysis in preterm intrauterine growthrestricted fetuses with ARED flow in the umbilical artery-correlation with short-term outcome[J].Ultrasound Obstet Gynecol,2005,25(6):573-579.
[28]Lees CC,Marlow N,van Wassenaer-leemhuis A,et al.Twoyear neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction(TRUFFLE):a randomised trial[J].Lancet,2015,385(9983):2162-2172.
[29]Frusca T,Todros T,Lees C,et al.Outcome in early-onset fetal growth restriction is best combining computerized fetal heart rate analysis with ductus venosus Doppler:insights from the Trial of Umbilical and Fetal Flow in Europe[J].Am J Obstet Gynecol,2018,218(2S):S783-S789.
[30]Bracero LA,Morgan S,Byrne DW.Comparison of visual and computerized interpretation of nonstress test results in a randomized controlled trial[J].Am J Obstet Gynecol,1999,181(5):1254-1258.
[31]Turan S,Turan OM,Berg C,et al.Computerized fetal heart rate analysis,Doppler ultrasound and biophysical profile score in the prediction of acid-base status of growth-restricted fetuses[J].Ultrasound Obstet Gynecol,2007,30(5):750-756.
[32]del Rio M,Martinez JM,Figueras F,et al.Doppler assessment of the aortic isthmus and perinatal outcome in preterm fetuses with severe intrauterine growth restriction[J].Ultrasound Obstet Gynecol,2008,31(1):41-47.
[33]Hassan WA,Brockelsby J,Alberry M,et al.Cardiac function in early onset small for gestational age and growth restricted fetuses[J].Eur J Obstet Gynecol Reprod Biol,2013,171(2):262-265.
[34]Henry A,Alphonse J,Tynan D,et al.Fetal myocardial performance index in assessment and management of small-for-gestationalage fetus:a cohort and nested case-control study[J].Ultrasound Obstet Gynecol,2018,51(2):225-235.
[35]McCowan Lesley ME,Harding JE,Stewart AW.Customised birthweight centiles predict SGA pregnancies with perinatal morbidity[J].BJOG,2005,112:1026-1033.
[36]Guzman ER,Vintzileos AM,Martins M.The efficacy of individual computer heart rate indices in detecting acidemia at birth in growth-restricted fetuses[J].Obstet Gynecol,1996,87(6):969-974.
[37]蒲杰.胎儿生长受限孕妇的识别、监测与转诊[J].中国计划生育和妇产科,2018,10(5):8-13.
[2]American College of Obstetricians and Gynecologists.Fetal growth restriction.Practice bulletin no.134[J].Obstet Gynecol,2013,121:1122-1133.
[3]Berkley E,Chauhan SP,Abuhamad A.Doppler assessment of the fetus with intrauterine growth restriction[J].Am J Obstet Gynecol,2012,206(4):300-308.
[4]Royal College of Obstetricians and Gynecologists.Fetal growth restriction-recognition,diagnosis&management.Clinical Practice Guideline[EB/OL].https://www.rcog.org.uk/en/guidelinesresearchservices/guidelines/gtg31/[.2018-12-28].
[5]Society of Obstetricians and Gynaecologists of Canada.Intrauterine growth restriction:screening,diagnosis,and management.SOGC Clinical Practice Guideline[J].J Obstet Gynaecol Can,2013,35(8):741-748.
[6]New Zealand Maternal Fetal Medicine Network.Guideline for the management of suspected small for gestational age singleton pregnancies and infants after 34 weeks’[EB/OL].https://www.asum.com.au/wp-content/uploads/2015/09/NZMFM-SGAGuidelineSeptember-2013.pdf[.2018-12-28].
[7]谢幸,孔北华,段涛.妇产科学[M].9版.北京:人民卫生出版社,2018:135-137.
[8]Gardosi J,Kady SM,McGeown P,et al.Classification of stillbirth by relevant condition at death(ReCoDe):population based cohort study[J].BMJ,2005,331(7525):1110.
[9]Corcoran P,Manning E,O’Farrell IB,et al.Perinatal mortality in Ireland:annual report 2014[EB/OL].https://hdl.handle.net/10147/619941[.2018-12-28].
[10]Savchev S,Sanz-cortes M,Cruz-martinez R,et al.Neurodevelopmental outcome of full-term small-for-gestational-age infants with normal placental function[J].Ultrasound Obstet Gynecol,2013,42(2):201-206.
[11]Tideman E,Marsal K,Ley D.Cognitive function in young adults following intrauterine growth restriction with abnormal fetal aortic blood flow[J].Ultrasound Obstet Gynecol,2007,29(6):614-618.
[12]Vayssie're C,Sentilhes L,Ego A,et al.Fetal growth restriction and intra-uterine growth restriction:guidelines for clinical practice from the French College of Gynaecologists and Obstetricians[J].Eur J Obstet Gynecol Reprod Biol,2015,193:10-18.
[13]Gardosi J,Madurasinghe V,Williams M,et al.Maternal and fetal risk factors for stillbirth:population based study[J].BMJ,2013,346:f108.
[14]陈敦金,余琳.预防可避免死胎,重视死胎病因管理[J].中国实用妇科与产科杂志,2018,34(12):1318-1321.
[15]陈素华.TORCH孕前咨询及产前诊断和处理要点[J].中国实用妇科与产科杂志,2018,34(12):1332-1335.
[16]Baschat AA.Planning management and delivery of the growthrestricted fetus[J].Best Pract Res Clin Obstet Gynaecol,2018,49:53-65.
[17]Dall'asta A,Brunelli V,Prefumo F,et al.Early onset fetal growth restriction[J].Matern Health Neonatol Perinatol,2017,3:2.
[18]American College of Obstetricians and Gynecologists.Fetal growth restriction:methods for estimating the due date[J].Obstet Gynecol,2017,129:150-154.
[19]Figueras F,Caradeux J,Crispi F,et al.Diagnosis and surveillance of late-onset fetal growth restriction[J].Am J Obstet Gynecol,2018,218(2):S790-S802.e1.
[20]Cnossen JS,Morris RK,ter Riet G,et al.Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction:a systematic review and bivariable meta-analysis[J].CMAJ,2008,178(6):701-711.
[21]Grivell RM,Wong L,Bhatia V.Regimens of fetal surveillance for impaired fetal growth(Review)[J].Cochrane Database Syst Rev,2012,(6):CD007113.doi:10.1002/14651858.CD007113.pub3.
[22]Arduini D,Rizzo G,Romanini C.The development of abnormal heart rate patterns after absent end-diastolic velocity in umbilical artery:analysis of risk factors[J].Am J Obstet Gynecol,1993,168(1):43-50.
[23]Brar HS,Platt LD.Reverse end-diastolic flow velocity on umbilical artery velocimetry in high-risk pregnancies:an ominous finding with adverse pregnancy outcome[J].Am J Obstet Gynecol,1988,159(3):559-561.
[24]Stampalija T,Arabin B,Wolf H,et al.Is middle cerebral artery Doppler related to neonatal and 2-year infant outcome in early fetal growth restriction?[J].Am J Obstet Gynecol,2017,216(5):521.e1-.e13.
[25]Figueras F,Gratacos E.Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol[J].Fetal Diagn Ther,2014,36(2):86-98.
[26]Flood K,Unterscheider J,Daly S,et al.The role of brain sparing in the prediction of adverse outcomes in intrauterine growth restriction:results of the multicenter PORTO study[J].Am JObstet Gynecol,2014,211(3):288 e1-5.
[27]Schwarze A,Gembruch U,Krapp M,et al.Qualitative venous Doppler flow waveform analysis in preterm intrauterine growthrestricted fetuses with ARED flow in the umbilical artery-correlation with short-term outcome[J].Ultrasound Obstet Gynecol,2005,25(6):573-579.
[28]Lees CC,Marlow N,van Wassenaer-leemhuis A,et al.Twoyear neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction(TRUFFLE):a randomised trial[J].Lancet,2015,385(9983):2162-2172.
[29]Frusca T,Todros T,Lees C,et al.Outcome in early-onset fetal growth restriction is best combining computerized fetal heart rate analysis with ductus venosus Doppler:insights from the Trial of Umbilical and Fetal Flow in Europe[J].Am J Obstet Gynecol,2018,218(2S):S783-S789.
[30]Bracero LA,Morgan S,Byrne DW.Comparison of visual and computerized interpretation of nonstress test results in a randomized controlled trial[J].Am J Obstet Gynecol,1999,181(5):1254-1258.
[31]Turan S,Turan OM,Berg C,et al.Computerized fetal heart rate analysis,Doppler ultrasound and biophysical profile score in the prediction of acid-base status of growth-restricted fetuses[J].Ultrasound Obstet Gynecol,2007,30(5):750-756.
[32]del Rio M,Martinez JM,Figueras F,et al.Doppler assessment of the aortic isthmus and perinatal outcome in preterm fetuses with severe intrauterine growth restriction[J].Ultrasound Obstet Gynecol,2008,31(1):41-47.
[33]Hassan WA,Brockelsby J,Alberry M,et al.Cardiac function in early onset small for gestational age and growth restricted fetuses[J].Eur J Obstet Gynecol Reprod Biol,2013,171(2):262-265.
[34]Henry A,Alphonse J,Tynan D,et al.Fetal myocardial performance index in assessment and management of small-for-gestationalage fetus:a cohort and nested case-control study[J].Ultrasound Obstet Gynecol,2018,51(2):225-235.
[35]McCowan Lesley ME,Harding JE,Stewart AW.Customised birthweight centiles predict SGA pregnancies with perinatal morbidity[J].BJOG,2005,112:1026-1033.
[36]Guzman ER,Vintzileos AM,Martins M.The efficacy of individual computer heart rate indices in detecting acidemia at birth in growth-restricted fetuses[J].Obstet Gynecol,1996,87(6):969-974.
[37]蒲杰.胎儿生长受限孕妇的识别、监测与转诊[J].中国计划生育和妇产科,2018,10(5):8-13.