Department of Psychology, Institute of Psychiatry, King's College London, London, United Kingdom; and the UCD Obstetrics and Gynecology, School of Medicine and Medical Science, National Maternity Hospital, University College Dublin, Royal College of Surgeons in Ireland, Coombe Women and Infants University Hospital, and Rotunda Hospital, Dublin, University College Cork, Cork University Maternity Hospital, Cork, Royal Jubilee Maternity Hospital, Belfast, National University of Ireland, Galway, and Graduate Entry Medical School, University of Limerick, Limerick; University College Dublin Center for Human Reproduction, Coombe Women and Infants University Hospital, Dublin; Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin; and School of Nursing and Midwifery, Queens University, Belfast, Ireland.
Obstet Gynecol. 2013 Aug;122(2 Pt 1):248-254. doi: 10.1097/AOG.0b013e31829ca9a7.
To examine the validity of a growth trajectory method to discriminate between pathologically and constitutionally undergrown fetuses using repeated measures of estimated fetal weight.
In a prospective, observational, multicenter study in Ireland, 1,116 women with a growth-restricted fetus diagnosed participated with the objective of evaluating ultrasound findings as predictors of pediatric morbidity and mortality. Fetal growth trajectories were based on estimated fetal weight.
Between 22 weeks of gestation and term, two fetal growth trajectories were identified: normal (96.7%) and pathologic (3.3%). Compared with the normal trajectory, the pathologic trajectory was associated with an increased risk for preeclampsia (odds ratio [OR] 8.1, 95% confidence interval [CI] 2.6-23.4), increased umbilical artery resistance at 30 weeks of gestation (OR 12.6, 95% CI 4.6-34.1) or 34 weeks of gestation (OR 28.0, 95% CI 8.9-87.7), reduced middle cerebral artery resistance at 30 weeks of gestation (OR 0.33, 95% CI 0.12-0.96) or 34 weeks of gestation (OR 0.14, 95% CI 0.03-0.74), lower gestational age at delivery (mean 32.02 weeks of gestation compared with 38.02 weeks of gestation; P<.001), and higher perinatal complications (OR 21.5, 95% CI 10.5-44.2). In addition, 89.2% of newborns with pathologic fetal growth were admitted to neonatal intensive care units compared with 25.9% of those with normal growth.
Fetal growth trajectory analysis reliably differentiated fetuses with a pathologic growth pattern among a group of women with growth-restricted fetuses. With further development, this approach could provide clarity to how we define, identify, and ultimately manage pathologic fetal growth.
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使用重复估计胎儿体重的方法来检查生长轨迹方法鉴别病理性和体质性生长受限胎儿的有效性。
在爱尔兰的一项前瞻性、观察性、多中心研究中，1116 名胎儿生长受限的孕妇参与了该研究，目的是评估超声检查结果作为儿科发病率和死亡率的预测因素。胎儿生长轨迹基于估计的胎儿体重。
在 22 周至足月期间，确定了两种胎儿生长轨迹：正常（96.7%）和病理（3.3%）。与正常轨迹相比，病理轨迹与子痫前期风险增加相关（优势比[OR]8.1，95%置信区间[CI]2.6-23.4），30 周时脐动脉阻力增加（OR 12.6，95% CI 4.6-34.1）或 34 周时（OR 28.0，95% CI 8.9-87.7），30 周时大脑中动脉阻力降低（OR 0.33，95% CI 0.12-0.96）或 34 周时（OR 0.14，95% CI 0.03-0.74），分娩时胎龄较低（平均 32.02 周与 38.02 周；P<.001），围产期并发症较高（OR 21.5，95% CI 10.5-44.2）。此外，89.2%的病理性胎儿生长新生儿被收入新生儿重症监护病房，而正常胎儿生长的新生儿仅为 25.9%。
在一组胎儿生长受限的孕妇中，胎儿生长轨迹分析可靠地区分了病理性生长模式的胎儿。随着进一步的发展，这种方法可以为我们如何定义、识别和最终管理病理性胎儿生长提供清晰的认识。
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