胎儿生长受限对围产儿结局及远期健康的影响

胎儿生长受限（fetal growth restriction，FGR）易造成胎儿窘迫、新生儿窒息等不良围产儿结局的发生，还会影响成年期多种慢性非传染性疾病的发生发展，对围产儿和远期健康均构成严重威胁。应加强对胎儿生长发育的监测，重视生命早期保健，对于全生命周期健康具有深远的影响。     

52例胎儿宫内生长受限孕妇的健康教育效果分析

胎儿宫内生长受限(FGR)是围产儿发病和死亡的重要原因。本文资料显示,越早筛查出FGR孕妇及时治疗并采取健康教育就能改善FGR预后,提高围产儿存活率。     

定制出生体重标准在胎儿生长受限及小于胎龄儿诊断中的应用

胎儿发育受限（fetal growth restriction,FGR）是产科重要并发症之一,也是造成围产儿死亡的重要原因,胎儿在宫内的生长发育受到遗传、营养、子宫-胎盘血液灌流量及胎儿-胎盘功能等多因素的影响,任何因素影响了胎儿与胎盘间的母-儿血循环及物质交换,均可导致发生胎儿宫内生长受限。     

胎儿生长受限的病因和治疗

胎儿生长受限是产科重要并发症之一,是围产儿死亡和发病的重要原因.该病的病因包括母体、胎儿、胎盘三方面的因素.B超可用于早期诊断.补充营养素,卧床休息,氧疗以及应用阿斯匹林、舒喘宁等药物可能会增加胎儿体重.孕晚期及时处理可以改善胎儿预后.     

胎儿生长受限的预测和预警

胎儿生长受限（FGR）是导致围产儿死亡的第二大原因,但其治疗手段有限,故而胎儿生长受限的预测和风险评估一直都是临床及研究的热点。近年来一些高质量研究在胎儿生长受限的母体高危因素、超声多普勒血流、磁共振等影像学指标、血清学生物标志物以及多参数预测评估方面取得一定进展,文章结合中国2019版FGR专家共识对此总结分析,以期能为FGR的预测和预警工作提供参考。     

胎儿生长曲线的建立及临床应用

文章系统介绍并分析比较了国际上常见各类胎儿生长曲线的建立方法、适用人群及用于临床筛查小于胎龄儿及预测不良围产儿结局的价值。提出选择合适的胎儿生长曲线，对提高小于胎龄儿产前筛查的敏感度、预测严重不良围产儿结局，进一步指导孕期监护和管理，减少围产儿死亡和相关并发症的发生具有重要意义。     

胎儿生长受限的宫内监护方法及评价

胎儿生长受限（FGR）不仅是围产儿患病和死亡的重要原因，还可能会对其远期的生长发育带来不良影响。因此，加强对FGR胎儿的监测十分重要，特别是动态评估其在宫内生长发育和氧供的情况，可为发现胎儿异常并及时采取处理措施提供指导。文章重点介绍目前临床上常用的胎儿宫内监护手段，评价各种监护方法在FGR胎儿监测中的价值。     

胎儿生长受限的管理新进展

胎儿生长受限(FGR)是妊娠期常见并发症,严重危害胎儿健康。目前,关于FGR的治疗方法有限、且疗效不显著,使得FGR的管理成为国内外产科关注的热点问题之一。本文基于最新观点,提出了FGR的诊断方法,有效监测胎儿生长发育的手段,并根据病情变化的不同阶段提出了如何选择最佳的分娩时机,以有利于改善新生儿的预后,对降低围产儿的发病率及死亡率至关重要。     

胎儿生长受限临床诊断

胎儿生长受限（fetal growth restriction，FGR）是指由于各种因素导致胎儿未达到其遗传生长潜能，是导致围产儿死亡及其他不良结局的重要原因。通过超声评估胎儿生长发育情况和寻找FGR相关高危因素是诊断FGR的重要前提。而临床诊断FGR后根据病因（尤其是是否伴结构畸形）、发病时间对其进行分类，对评估FGR胎儿预后具有重要的临床意义，有助于为后续的临床管理提供依据，从而降低母胎不良结局的发生风险。     

胎儿生长受限对子代的远期影响

胎儿生长受限（fetal growth restriction，FGR）是导致围产儿患病及死亡的重要因素。FGR对子代有着远期不良影响，神经发育障碍、糖尿病、冠心病、高血压等成人期慢性非传染性疾病的发生风险增加。文章参考相关临床研究，总结了FGR对子代的远期影响。     

Ischemic placental disease and risks of perinatal mortality and morbidity and neurodevelopmental outcomes

Preeclampsia, intrauterine growth restriction, and placental abruption are serious obstetrical complications that constitute the syndrome of ischemic placental disease and account for a disproportionate degree of perinatal morbidity and mortality. We review the risks of stillbirth and neonatal and infant mortality in relation to ischemic placental disease, focusing on population-based studies. We also review the risks of neonatal morbidity and neurodevelopmental outcomes in relation to ischemic placental disease. A synthesis of the findings of the relevant studies relating ischemic placental disease to adverse perinatal outcomes underscores two important observations. First, despite the low prevalence of each of the three obstetrical complications, all are associated with increased risks of adverse perinatal and infant outcomes, as well as neurodevelopmental deficits. Second, the burden of increased perinatal risks appears strongest during the preterm period. Efforts to reduce the risks of ischemic placental disease remain critically important and developing effective clinical interventions will be a target worthy for consideration.     

Therapeutic strategies for the prevention and treatment of pre-eclampsia and fetal growth restriction

Fetal growth restriction and pre-eclampsia are common pregnancy complications that contribute significantly to maternal and perinatal morbidity and mortality, and long term health outcomes. The underlying aetiology of these conditions is placental under-perfusion and ischemia. Most prophylactic and treatment measures for these conditions are hypothesized to have effect through improved placental perfusion, or reduced oxidative stress, inflammation and subsequent placental damage. However, while many therapies have biologic plausibility, there is a lack of high quality evidence that they substantially improve important outcomes such as birth weight, prematurity, mortality or serious morbidity. This review will describe therapies currently available in clinical practice for the prevention and treatment of pre-eclampsia and intrauterine growth restriction, and outline some promising new therapies, which may change the way these conditions are managed in the future.     

Growth abnormalities and multiple gestations

Growth abnormalities which include intrauterine growth restriction and weight discordance between twins are common in pregnancies complicated by multiple gestations and may be associated with poor perinatal outcomes. Knowledge of chorionicity is paramount when managing a multiple pregnancy. Monochorionic twins are at greater risk than dichorionic twins for growth issues, which may result in long-term complications including adverse neurological sequelae for the offspring. The purpose of the following article is to define normal and abnormal growth in multiples. In addition, the management of growth abnormalities in relationship to chorionicity will be discussed.     

Therapeutic strategies for the prevention and treatment of pre-eclampsia and intrauterine growth restriction

Intrauterine growth restriction and pre-eclampsia are common pregnancy complications that contribute significantly to maternal and perinatal morbidity and mortality, and long term health outcomes. The underlying aetiology of these conditions involves placental underperfusion and placental ischaemia. Most prophylactic and treatment measures for these conditions are hypothesized to have effect through improved placental perfusion, or reduced oxidative stress and subsequent placental damage. However, while many therapies have biologic plausibility, there is a lack of high quality evidence that they substantially improve important outcomes such as birth weight, prematurity, mortality or serious morbidity. This review will describe and evaluate therapies currently available in clinical practice for the prevention and treatment of pre-eclampsia and intrauterine growth restriction, and outline some promising new therapies, which may change the way these conditions are managed in the future.     

Therapeutic strategies for the prevention and treatment of pre-eclampsia and intrauterine growth restriction

Intrauterine growth restriction and pre-eclampsia are common pregnancy complications that contribute significantly to maternal and perinatal morbidity and mortality, and long term health outcomes. The underlying aetiology of these conditions involves placental under perfusion and placental ischaemia. Most prophylactic and treatment measures for these conditions are hypothesised to have effect through improved placental perfusion, or reduced oxidative stress and subsequent placental damage. However, while many therapies have biologic plausibility, there is a lack of high quality evidence that they substantially improve important outcomes such as birth weight, prematurity, mortality or serious morbidity. This review will describe and evaluate therapies currently available in clinical practice for the prevention and treatment of pre-eclampsia and intrauterine growth restriction, and outline some promising new therapies, which may change the way these conditions are managed in the future.     

Perinatal death and neurological damage as a sequential chain of poor outcome

Objective: We investigated the risk factors of perinatal death and neurological damage. Methods: Perinatal death and neurological damage were retrospectively investigated using a population-based study of 108 024 deliveries from 1998 to 2007. Main factors studied were asphyxia, growth restriction and preterm delivery < 34 weeks of gestation, since these three factors were most often associated with poor prognosis. The impact of each factor was identified by multiple regression analyses. Results: There were 459 perinatal deaths (4.3/1000) and 220 neurological damages (2.0/1000). Preterm delivery accounted for 50% of perinatal deaths and neurological damage, whereas it constituted 2.6% of total births. Multiple regression analyses showed that prematurity < 34 weeks (10-fold), asphyxia (10-fold) and growth restriction (2-fold) were independent and significant risk factors associated with poor outcomes, and that the magnitude was similar throughout the three consecutive critical events of fetal death, neonatal death and neurological damage. Conclusions: Prematurity < 34 weeks, asphyxia and growth restriction are independent and persistent risk factors from perinatal death to neurological damage.     

脐动脉血流监测在产科的应用

脐动脉血流监测做为非侵入性的胎儿胎盘血流动力学评估方法,广泛应用于产科临床。脐动脉多普勒血流波形主要反映胎盘的血管阻力,受绒毛血管发育状况的影响。同时,胎龄、胎儿心率、胎儿呼吸和呃逆、胎动、脐带的采样位置、胎儿性别、胎盘重量及胎儿体重等也对其有一定的影响。循证医学证据推荐将脐动脉超声多普勒检测作为胎儿生长受限及双胎选择性生长受限的胎儿监测。在低危人群中,脐动脉血流监测的意义还存在很多争议。舒张末期血流缺失或反向与围产期结局显著不良相关,需注意排除胎儿先天性异常及非整倍体异常。脐动脉血流异常的产科处理取决于脐动脉多普勒检查结果异常的严重程度、基础产科并发症的严重程度以及孕周,应个体化处理。     

Prognostic value of obstetric Doppler ultrasound in fetuses with fetal growth restriction: an observational study in a tertiary care hospital

Objective: To determine the prognostic value of umbilical artery Doppler (UAD) with fetal growth restriction (FGR) and their perinatal outcomes.

Methods: This was a retrospective cohort study of fetuses with growth?≤?5th centile from 2001 to 2012. Pregnancy outcomes were compared according to UAD findings for 253 cases. Doppler findings were categorized as; Normal End Diastolic Flow (NEDF), Reduced End Diastolic Flow (REDF) and Absent/Reverse End Diastolic Flow (AREDF). Mean and proportion were calculated and odds of perinatal complications were compared by using logistic regression for REDF and AREDF with NEDF at 5% level of significance.

Results: The perinatal morality rate was 3.2%. Neonates with abnormal Doppler were at increased risk of cesarean delivery, low birth weights and low Apgar scores. Among the perinatal morbidity, neonatal intensive care unit (NICU) admission was 4.2 and 15.3 times in neonates with REDF and AREDF and similarly the perinatal mortality of AREDF was 12.5 times higher as compared to NEDF. Other morbidities were also much higher in abnormal Doppler groups.

Conclusion: There is a prognostic value of UAD in predicting the outcomes for FGR fetuses and therefore recommend its use in the conservative management of such pregnancies to reduce perinatal mortality and morbidity.