Zollner U, Rehn M, Girschick G, Dietl J
Universitäts-Frauenklinik Würzburg, Josef-Schneider-Strasse, 4 97080 Würzburg.
Z Geburtshilfe Neonatol. 2011 Apr;215(2):49-59. doi: 10.1055/s-0030-1255023. Epub 2011 May 3.
Intrauterine growth restriction (IGUR) can have different etiologies, but placental insufficiency is the clinically most relevant. Fetuses with IUGR have a significantly higher morbidity and mortality than normally grown fetuses of the same gestational age. It is important to distinguish a growth restricted fetus from a normal, small fetus and from a fetus being small because of a disease, e.g., an aneuploidy. This differentiation requires the knowledge of the gestational age and the use of multiple imaging modalities. Serial assessments of fetal growth by ultrasound are necessary to recognize declining growth. Doppler sonography can detect changes in the uteroplacentar and the fetal perfusion. Blood vessels of clinical relevance are the uterine arteries, the umbilical artery, the middle cerebral artery and the ductus venosus. When no fetal anomalies can be detected, fetal growth is parallel to the percentiles and Doppler sonography measurements are normal, IUGR is unlikely. In most IUGR fetuses, a typical sequence of circulatory changes and ultrasound findings can be observed. As there is no evidence-based treatment option for IUGR until now, obstetric management consists in defining the optimal time of delivery. This means weighing the risks of prematurity against the risks of a potentially hostile intrauterine environment.
宫内生长受限（IGUR）可有不同病因，但胎盘功能不全是临床上最相关的病因。与相同孕周的正常生长胎儿相比，宫内生长受限胎儿的发病率和死亡率显著更高。区分生长受限胎儿与正常的小胎儿以及因疾病（如非整倍体）而小的胎儿很重要。这种区分需要了解孕周并使用多种成像方式。通过超声对胎儿生长进行系列评估对于识别生长减缓是必要的。多普勒超声检查可检测子宫胎盘和胎儿灌注的变化。具有临床相关性的血管是子宫动脉、脐动脉、大脑中动脉和静脉导管。当未检测到胎儿异常、胎儿生长与百分位数平行且多普勒超声检查测量正常时，宫内生长受限的可能性不大。在大多数宫内生长受限胎儿中，可观察到典型的循环变化和超声表现序列。由于目前尚无基于证据的宫内生长受限治疗方案，产科管理在于确定最佳分娩时间。这意味着要权衡早产风险与潜在不利宫内环境的风险。
