Driul L, Londero A P, Della Martina M, Papadakis C, Campana C, Pontello D, Citossi A, Marchesoni D
Clinica di Ostetricia e Ginecologia, Azienda Ospedaliero-Universitaria, Santa Maria della Misericordia, Udine, Italy.
Minerva Ginecol. 2008 Jun;60(3):231-8.
This prospective study was performed to evaluate perinatal outcome and maternal risk factors in pregnancies complicated by fetal intrauterine growth restriction (IUGR).
A total of 3 537 women pregnant with a singleton gestation were enrolled in the study: 219 of these pregnancies were complicated by fetal growth restriction (6.2%). Statistical analysis was performed using Wilcoxon test, Kruskall-Wallis test, c2 analysis of variance and ANOVA test. Statistical significance was set at P-value <0.05. Correlations were calculated by Spearman's coefficient.
Ethnic group, physical demanding work, maternal smoking, alcohol abuse do not seem to be associated with lower birth weight and worse Apgar score. Sonographic assessment of fetal weight obtained by Hadlock's formula underestimate real newborn's weight. The difference between estimate weight and real weight is statistically significant. Women with intrauterine growth restriction underwent caesarean sections more often than women with appropriate fetal growth selected as controls (P<0.05).
In conclusion, the obstetrician must recognize and accurately diagnose inadequate fetal growth and attempt to determine its cause (especially placental factors) in order to reduce fetal and maternal risks and establish the appropriate clinical management, timing and mode of delivery. If the growth-restricted fetus is identified and appropriate management instituted, perinatal mortality can be reduced.
本前瞻性研究旨在评估合并胎儿宫内生长受限(IUGR)的妊娠的围产期结局及母体风险因素。
共有3537名单胎妊娠妇女纳入本研究:其中219例妊娠合并胎儿生长受限(6.2%)。采用Wilcoxon检验、Kruskall-Wallis检验、c2方差分析和ANOVA检验进行统计分析。统计学显著性设定为P值<0.05。相关性通过Spearman系数计算。
种族、体力要求高的工作、孕妇吸烟、酗酒似乎与低出生体重和较差的阿氏评分无关。通过Hadlock公式进行的胎儿体重超声评估低估了实际新生儿体重。估计体重与实际体重之间的差异具有统计学显著性。与选为对照的胎儿生长正常的妇女相比,宫内生长受限的妇女剖宫产率更高(P<0.05)。
总之,产科医生必须识别并准确诊断胎儿生长不足,并试图确定其原因(尤其是胎盘因素),以降低胎儿和母体风险,并确定适当的临床管理、分娩时机和方式。如果识别出生长受限胎儿并采取适当管理措施,可降低围产期死亡率。