Fetal growth restriction: a modern approach
Fetal growth restriction: a modern approach
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DOI：
10.1097/gco.0b013e3282f7320a
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发表时间：
2008-04-01
影响因子：
2.1
通讯作者：
Vintzileos, Anthony M.
中科院分区：
文献类型：
--
作者：
Kinzler, Wendy L.;Vintzileos, Anthony M.
胎儿生长受限是一种复杂的围产期疾病，有多种原因。它与其他重要的疾病，如先兆子痫和早剥有共同的病理生理学。作为一个群体，这些与缺血性胎盘疾病相关的情况是导致很大比例的指示性早产的原因。准确预测、诊断和管理这些妊娠的能力具有重大而深远的影响，包括对成人长期健康的潜在影响。最近发现胎盘缺血是胎儿生长受限的最常见原因。胎盘发育的改变与各种血管生成介质有关，这可能在未来早期风险确定中使用。在此之前，使用超声波准确诊断胎儿生长受限和分娩时间是主要的管理方法。该领域的研究揭示了生长受限胎儿恶化的一些共性，但也表明并非每个受影响的胎儿都会遵循多普勒和其他健康参数的相同进展。最重要的是，分娩时的胎龄一直被记录为围产期发病率和死亡率的一个关键因素。胎儿生长受限是胎盘早期发育异常的晚期表现。一旦出现异常的多普勒测速，应根据产前检查结果和胎龄进行监测和分娩时机。
Purpose of reviewFetal growth restriction is a complicated perinatal condition, with multiple causes. It shares common pathophysiologies with other important disorders, such as preeclampsia and abruption. As a group, these conditions associated with ischemic placental disease are responsible for a large percentage of indicated preterm births. The ability to accurately predict, diagnose and manage these pregnancies has significant and far-reaching implications, including potential effects on long-term adult health.Recent findingsPlacental ischemia is the most common cause of fetal growth restriction. Alterations in placental development are being linked to various angiogenic mediators, which may be of future use in early risk-determination. Until then, the use of ultrasound to accurately diagnose fetal growth restriction and time delivery is the mainstay of management. Research in this area has revealed some commonalities in the deterioration of the growth restricted fetus, but has also indicated that not every affected fetus will follow the same progression in Doppler and other wellbeing parameters. Most importantly, gestational age at delivery is consistently being documented as a critical factor in perinatal morbidity and mortality.SummaryFetal growth restriction is a late manifestation of early abnormal placental development. Once abnormal Doppler velocimetry is present, surveillance and timing of delivery should be based on the antepartum test results and on the gestational age.