Planning management and delivery of the growth-restricted fetus
Planning management and delivery of the growth-restricted fetus
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DOI：
10.1016/j.bpobgyn.2018.02.009
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发表时间：
2018-05-01
影响因子：
5.5
通讯作者：
Baschat, Ahmet A.
中科院分区：
文献类型：
--
作者：
Baschat, Ahmet A.
一个统一的方法来管理胎儿生长受限（FGR）改善结果，防止死产，并允许适当的定时分娩。如果胎儿体重低于10%，同时存在脐动脉（UA）、大脑中动脉（MCA）或脑胎盘比多普勒指数异常，则最好确定需要监测的小胎儿。胎盘灌注缺陷在妊娠早期更为常见；因此，早发性（32周）FGR在临床表型上存在差异。在早发性FGR中，UA多普勒异常的进展决定了临床加速，而静脉导管（DV）多普勒异常预示着生物物理变量的恶化和死产。因此，晚期DV多普勒变化，异常的生物物理变量，或异常的cCFG需要分娩。迟发性FGR， MCA多普勒异常先于恶化和死产。然而，从34到38周，缺乏最佳分娩时间的随机证据。从38周以后，新生儿和胎儿风险的平衡有利于分娩。(C) 2018年Elsevier Ltd.出版
A uniform approach to management of fetal growth restriction (FGR) improves outcome, prevents stillbirth, and allows appropriately timed delivery. An estimated fetal weight below the tenth percentile with coexisting abnormal umbilical artery (UA), middle cerebral artery (MCA), or cerebroplacental ratio Doppler index best identifies the small fetus requiring surveillance. Placental perfusion defects are more common earlier in gestation; accordingly, early-onset (32 weeks) FGR differ in clinical phenotype. In early-onset FGR, progression of UA Doppler abnormality determines clinical acceleration, while abnormal ductus venosus (DV) Doppler precedes deterioration of biophysical variables and stillbirth. Accordingly, late DV Doppler changes, abnormal biophysical variables, or an abnormal cCFG require delivery. In late-onset FGR, MCA Doppler abnormalities precede deterioration and stillbirth. However, from 34 to 38 weeks, randomized evidence on optimal delivery timing is lacking. From 38 weeks onward, the balance of neonatal versus fetal risks favors delivery. (C) 2018 Published by Elsevier Ltd.