Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths.
Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths.
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DOI：
10.1186/1471-2458-11-s3-s1
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发表时间：
2011-04-13
影响因子：
4.5
通讯作者：
Bhutta ZA
中科院分区：
文献类型：
--
作者：
Imdad A;Yakoob MY;Siddiqui S;Bhutta ZA
死产和胎儿生长受限之间有很强的关联性。及早发现和处理IUGR可降低相关发病率和死亡率。本文综述了胎动监测和多普勒血流测速仪在高危妊娠检测和监测中的作用及其在预防死产中的作用。我们还综述了母亲体重指数(BMI)筛查、联合眼底高度测量和靶向超声在社区IUGR检测和分类中的作用。我们系统地回顾了所有已发表的文献，以确定与我们的干预相关的研究。我们搜索了PubMed、Cochrane图书馆和所有世界卫生组织地区数据库，并收录了各种语言的出版物。可用证据的质量使用分级标准进行评估。根据儿童健康流行病学小组制定的规则，对拯救生命工具(LIST)提出了建议。由于缺乏有关检测和处理IUGR对死产影响的证据，我们接受了该领域专家基于Delphi的评估。没有足够的证据建议或支持常规使用胎儿运动监测来促进胎儿健康。(1)通过(1a)母体BMI筛查、(1b)宫底高度测量和(1c)靶向超声对IUGR进行检测和分类，是降低IUGR相关围产儿发病率和死亡率的有效方法。16项研究的综合结果显示，对高危孕妇的脐动脉和胎儿动脉进行多普勒测速，加上适当的干预，可以将围产儿死亡率降低29%[RR 0.71，95%CI 0.52-0.98]。合并对死产影响的结果显示减少了35%[相对危险度0.65，95%可信区间0.41-1.04]；然而，结果没有达到有统计学意义的传统极限。这种干预措施可以潜在地推荐给高收入环境或中等收入国家，这些国家提高了以设施为基础的护理的比率和标准。在Delphi的基础上，结合母亲BMI、联合眼底高度和靶向超声进行筛查，然后进行适当的处理，可能会分别将产前和产中死产减少20%。目前建议将这一估计数列入清单。没有足够的证据支持或反对将胎动算作常规检测胎儿健康的方法。脐动脉和胎儿动脉的多普勒测速和适当的干预可使围产儿死亡率降低29%(95%可信区间2%至48%)。专家意见认为，通过母体BMI、联合眼底高度测量和靶向超声检测和处理IUGR，可有效减少IUGR相关死产20%。
There is a strong association between stillbirth and fetal growth restriction. Early detection and management of IUGR can lead to reduce related morbidity and mortality. In this paper we have reviewed effectiveness of fetal movement monitoring and Doppler velocimetry for the detection and surveillance of high risk pregnancies and the effect of this on prevention of stillbirths. We have also reviewed effect of maternal body mass index (BMI) screening, symphysial-fundal height measurement and targeted ultrasound in detection and triage of IUGR in the community. We systematically reviewed all published literature to identify studies related to our interventions. We searched PubMed, Cochrane Library, and all World Health Organization Regional Databases and included publications in any language. Quality of available evidence was assessed using GRADE criteria. Recommendations were made for the Lives Saved Tool (LiST) based on rules developed by the Child Health Epidemiology Group. Given the paucity of evidence related to the effect of detection and management of IUGR on stillbirths, we undertook Delphi based evaluation from experts in the field. There was insufficient evidence to recommend against or in favor of routine use of fetal movement monitoring for fetal well being. (1) Detection and triage of IUGR with the help of (1a) maternal BMI screening, (1b) symphysial-fundal height measurement and (1c) targeted ultrasound can be an effective method of reducing IUGR related perinatal morbidity and mortality. Pooled results from sixteen studies shows that Doppler velocimetry of umbilical and fetal arteries in ‘high risk’ pregnancies, coupled with the appropriate intervention, can reduce perinatal mortality by 29 % [RR 0.71, 95 % CI 0.52-0.98]. Pooled results for impact on stillbirth showed a reduction of 35 % [RR 0.65, 95 % CI 0.41-1.04]; however, the results did not reach the conventional limits of statistical significance. This intervention could be potentially recommended for high income settings or middle income countries with improving rates and standards of facility based care. Based on the Delphi, a combination of screening with maternal BMI, Symphysis fundal height and targeted ultrasound followed by the appropriate management could potentially reduce antepartum and intrapartum stillbirth by 20% respectively. This estimate is presently being recommended for inclusion in the LiST. There is insufficient evidence to recommend in favor or against fetal movement counting for routine use for testing fetal well being. Doppler velocimetry of umbilical and fetal arteries and appropriate intervention is associated with 29 % (95 % CI 2% to 48 %) reduction in perinatal mortality. Expert opinion suggests that detection and management of IUGR with the help of maternal BMI, symphysial-fundal height measurement and targeted ultrasound could be effective in reducing IUGR related stillbirths by 20%.