Insufficient antenatal identification of fetal growth restriction leading to intrauterine fetal death: a regional population-based study in Japan
Insufficient antenatal identification of fetal growth restriction leading to intrauterine fetal death: a regional population-based study in Japan
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DOI：
10.1080/14767058.2023.2167075
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发表时间：
2023-12-31
影响因子：
1.8
通讯作者：
Takahashi，Kentaro
中科院分区：
文献类型：
--
作者：
Tokoro，Shinsuke;Koshida，Shigeki;Takahashi，Kentaro
目的胎儿生长受限（FGR）与围产期不良结局相关，包括宫内胎儿死亡。产前未查明的FGR发生宫内胎儿死亡的风险高于产前已查明的FGR。因此，我们调查了宫内胎儿死亡中FGR的产前鉴定，并评估了与FGR鉴定相关的围产期因素。方法本回顾性、基于人群的研究回顾了2007 - 2016年日本滋贺县的所有死产，排除标准为多胎、未确定孕周或< 22孕周出生和致死性疾病。我们分析了FGR病例，使用日本临床定义：胎龄估计胎儿体重的z分数< - 1.5标准差（SD）。结果我们在429例死产中鉴定出94例FGR死产。37例在妊娠管理期间被产前发现（39%）。按az -评分- 2.5SD划分，51例≤- 2.5SD。51例az -评分< - 2.5SD的患者中有28例（55%）产前确诊为FGR，而43例az -评分≥- 2.5SD的患者中有9例（21%）产前确诊为FGR （p= 0.002）。在aZ-Score < - 2.5SD的病例中，妊娠28周以上的21例中有16例（76%），妊娠28周前的30例中有12例（40%）被产前诊断为FGR （p= 0.023）。结论在日本，胎儿生长受限导致宫内死胎的产前诊断率不到一半。产前鉴定FGR与生长受限的严重程度有关。
ObjectiveFetal growth restriction (FGR) is associated with perinatal adverse outcomes including intrauterine fetal death. Antenatally unidentified FGR has a higher risk of intrauterine fetal death than that identified antenatally. We, therefore, investigated the antenatal identification of FGR among intrauterine fetal deaths, and assessed the perinatal factors associated with the identification of FGR.MethodsThis retrospective and population-based study reviewed all stillbirths in Shiga Prefecture, Japan, from 2007 to 2016 with exclusion criteria of multiple births, births at unidentified gestational weeks or < 22 gestational weeks, and lethal disorders. We analyzed cases of FGR, using the Japanese clinical definition:Z-score of estimated fetal weight for gestational age <−1.5 standard deviations (SD).ResultsWe identified 94 stillbirths with FGR among 429 stillbirths. Thirty-seven cases were antenatally identified during pregnancy management (39%). Dividing cases by aZ-score of −2.5SD, 51 cases were classified as ≤−2.5SD. Twenty-eight of the 51 cases (55%) with aZ-score <−2.5SDwere antenatally identified as having FGR, whereas 9 of the 43 cases (21%) with aZ-score ≥−2.5 SD were antenatally identified as having FGR (p= .002). Among cases with aZ-Score <−2.5SD, 16 of 21 (76%) beyond 28 weeks’ gestation and 12 of 30 (40%) before 28weeks’ gestation were antenatally identified as having FGR (p= .023).ConclusionFetal growth restriction leading to intrauterine fetal death in Japan was antenatally identified in less than half of cases. Antenatal identification of FGR was associated with the severity of growth restriction.