Yu Yan-hong, Shen Li-yong, Zhong Mei, Zhang Yu, Su Gui-dong, Gao Yun-fei, Quan Song, Zeng Li
Department of Obstetrics and Gynecology, Nanfang Hospital, First Military Medical University, Guangzhou 510515, China.
Zhonghua Fu Chan Ke Za Zhi. 2004 Dec;39(12):793-6.
To investigate the clinical effect and safety of heparin in treating fetal growth restriction (FGR).
A total of 107 women diagnosed with FGR were randomized into three groups. Group 1 (standard heparin group, n = 37) received 50 - 75 mg standard heparin added to 500 ml 5% glucose sodium chloride, infused intravenously in 6 - 8 hours. Group 2 (low molecular weight heparin group, n = 31) received 0.2 - 0.4 ml low molecular weight heparin given by subcutaneous injection. Control group (n = 39) received 20 ml dan-shen added to 500 ml low-molecular-weight dextran infused intravenously. Fetal growth indices, biophysical score, umbilical artery blood flow, count of platelet (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), 1-minute Apgar score, body weight and gestational age of the neonates were measured. Babies prognosis was followed-up.
(1) Height of fundus of uterus was obviously increased per week in the groups of standard heparin (0.7 +/- 0.6) cm and low molecular weight heparin [(0.7 +/- 0.6) cm]] vs. control group [(0.5 +/- 0.4) cm, P < 0.05]. Biparietal diameter of fetus increased in standard heparin [(2.4 +/- 0.7) mm] and low molecular weight heparin [(2.5 +/- 0.8) mm] groups vs. control [(1.7 +/- 0.6) mm, P < 0.05]. The femur length, head circumference and abdominal circumference of fetus were significantly longer in heparin treated patients than in control group (P < 0.05). (2) Biophysical score improved in groups of standard heparin (9.7 +/- 0.8) and low molecular weight heparin (9.6 +/- 0.6) vs. control group (8.9 +/- 0.7) (P < 0.05). (3) Umbilical blood S/D ratio decreased in standard heparin (2.5 +/- 0.5) and low molecular weight heparin (2.4 +/- 0.5) groups vs. control group (2.9 +/- 0.6) (P < 0.05). Pulsatile index (PI) and resistance index (RI) were significantly lower also (P < 0.05).(4) Rate of one minute Apgar score (8 - 10) was 86% in group 1, 87% in group 2 and 74% in control group, respectively. Body weight of the neonates was significantly increased in group 1(3100 +/- 256 g) and in group 2 [(3080 +/- 225) g] vs. [(2580 +/- 304) g] in control group (P < 0.05). Gestational age was prolonged in group 1 [(38 +/- 3) w] and group 2 [(38 +/- 4) w] vs. control group [(37 +/- 4) w, P < 0.05]. (5) Incidence of term small for gestational age infant in groups of standard heparin and low molecular weight heparin was 5% and 6%, respectively, significantly lower than those in the control group (18%) (P < 0.05). (6) No difference was shown in PLT, PT and APTT before and after heparin treatment (P > 0.05). (7) There was no difference in fetal growth indices, biophysical score, umbilical blood, neonatal outcome between standard heparin and low molecular heparin groups.
Heparin can improve placenta function and obviously increase body weight of fetuses and neonates. It is safe for both pregnant women and their fetuses.
探讨肝素治疗胎儿生长受限（FGR）的临床疗效及安全性。
将107例诊断为FGR的孕妇随机分为三组。第1组（标准肝素组，n = 37），将50 - 75 mg标准肝素加入500 ml 5%葡萄糖氯化钠中，于6 - 8小时内静脉输注。第2组（低分子肝素组，n = 31），皮下注射0.2 - 0.4 ml低分子肝素。对照组（n = 39），将20 ml丹参加入500 ml低分子右旋糖酐中静脉输注。测量胎儿生长指标、生物物理评分、脐动脉血流、血小板计数（PLT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、1分钟阿氏评分、新生儿体重及孕周。对婴儿预后进行随访。
（1）标准肝素组（0.7±0.6）cm和低分子肝素组（0.7±0.6）cm子宫底高度每周明显增加，而对照组为（0.5±0.4）cm（P < 0.05）。标准肝素组（2.4±0.7）mm和低分子肝素组（2.5±0.8）mm胎儿双顶径增加，而对照组为（1.7±0.6）mm（P < 0.05）。肝素治疗患者胎儿的股骨长度、头围和腹围明显长于对照组（P < 0.05）。（2）标准肝素组（9.7±0.8）和低分子肝素组（9.6±0.6）生物物理评分改善，而对照组为（8.9±0.7）（P < 0.05）。（3）标准肝素组（2.5±0.5）和低分子肝素组（2.4±0.5）脐血S/D比值降低，而对照组为（2.9±0.6）（P < 0.05）。搏动指数（PI）和阻力指数（RI）也明显降低（P < 0.05）。（4）第1组、第2组和对照组1分钟阿氏评分（8 - 10）率分别为86%、87%和74%。第1组（3100±256 g）和第2组（3080±225）g新生儿体重明显高于对照组（2580±304）g（P < 0.05）。第甲组（3±3）周和第2组（38±4）周孕周延长，而对照组为（37±4）周（P < 0.05）。（5）标准肝素组和低分子肝素组足月小于胎龄儿发生率分别为5%和6%，明显低于对照组（18%）（P < 0.05）。（6）肝素治疗前后PLT、PT和APTT无差异（P > 0.05）。（7）标准肝素组和低分子肝素组在胎儿生长指标、生物物理评分、脐血、新生儿结局方面无差异。
肝素可改善胎盘功能，明显增加胎儿及新生儿体重。对孕妇及其胎儿均安全。
