Unterscheider Julia, Daly Sean, Geary Michael P, Kennelly Mairead M, McAuliffe Fionnuala M, O'Donoghue Keelin, Hunter Alyson, Morrison John J, Burke Gerard, Dicker Patrick, Tully Elizabeth C, Malone Fergal D
Royal College of Surgeons in Ireland, Dublin, Ireland.
Coombe Women and Infants University Hospital, Dublin, Ireland.
Eur J Obstet Gynecol Reprod Biol. 2014 Mar;174:41-5. doi: 10.1016/j.ejogrb.2013.11.022. Epub 2013 Dec 5.
To evaluate opinions among Irish obstetricians and obstetric trainees regarding the optimal definition, assessment and management of pregnancies affected by intrauterine growth restriction (IUGR).
An anonymous, structured, web-based survey that comprised 14 questions was sent to 200 obstetricians and obstetric trainees in Ireland.
Of the 113 participants (57% response rate), the majority (50%) were consultants, with over 10 years' clinical experience (46%), who worked in large maternity units (58%) with neonatal units providing care for preterm IUGR fetuses (94%). Eighty-three clinicians (74%) agreed that an estimated fetal weight (EFW) below the 10th centile constitutes small-for-gestational age (SGA). The majority (n=93; 82%) would deliver the SGA fetus between 37(+0) and 39(+6) weeks gestation. In total, the survey yielded 30 different IUGR definitions; the top three definitions were (i) an EFW below the 5th centile (n=18; 16%), (ii) an EFW below the 10th centile with oligohydramnios and abnormal umbilical artery (UA) Doppler (n=16; 14%), and (iii) an EFW below the 10th centile (n=12; 11%). In the evaluation of the preterm IUGR fetus with abnormal UA Doppler, the assessment of amniotic fluid volume, middle cerebral artery, ductus venosus, cardiotocograph (CTG) and biophysical profiling was performed in 74%, 60%, 60%, 54% and 52% respectively. The majority of clinicians applied three or more assessment modalities and 60% referred to a maternal-fetal medicine (MFM) subspecialist. Interestingly, even among MFM subspecialists there was no common consistent management approach. Most doctors (81%) would deliver the IUGR fetus for CTG abnormalities but MFM subspecialists more commonly deliver on the basis of absent end-diastolic flow in the UA alone (37% vs. 10%; p=0.006). Two-thirds of doctors (n=74) would implement customised growth charts if they became available for their population and over 80% thought that a national guideline on IUGR would be beneficial.
The results of this survey confirm the inconsistencies surrounding the clinical management of IUGR pregnancies and highlight the need for standardisation of terminology and antenatal surveillance, implementation of fetal weight customisation and national guidance for Ireland.
评估爱尔兰产科医生和产科实习医生对于受宫内生长受限（IUGR）影响的妊娠的最佳定义、评估和管理的看法。
向爱尔兰的200名产科医生和产科实习医生发送了一项包含14个问题的匿名、结构化网络调查。
在113名参与者（回复率57%）中，大多数（50%）是顾问医生，有超过10年临床经验（46%），在设有为早产IUGR胎儿提供护理的新生儿科的大型产科单位工作（58%）。83名临床医生（74%）同意估计胎儿体重（EFW）低于第10百分位数构成小于胎龄儿（SGA）。大多数（n = 93；82%）会在妊娠37（+0）至39（+6）周之间分娩SGA胎儿。该调查总共得出30种不同的IUGR定义；排名前三的定义分别为：（i）EFW低于第5百分位数（n = 18；16%），（ii）EFW低于第10百分位数且伴有羊水过少和脐动脉（UA）多普勒异常（n = 16；14%），以及（iii）EFW低于第10百分位数（n = 12；11%）。在评估UA多普勒异常的早产IUGR胎儿时，分别有74%、60%、60%、54%和52%的医生进行了羊水体积、大脑中动脉、静脉导管、胎心监护（CTG）和生物物理评分的评估。大多数临床医生应用了三种或更多评估方法，60%的医生会咨询母胎医学（MFM）亚专科医生。有趣的是，即使在MFM亚专科医生中也没有一致的常见管理方法。大多数医生（81%）会因CTG异常而分娩IUGR胎儿，但MFM亚专科医生更常见的是仅基于UA舒张末期血流消失进行分娩（37%对10%；p = 0.006）。三分之二的医生（n = 74）表示如果有针对其人群的定制生长图表就会采用，超过80%的医生认为关于IUGR的国家指南会有帮助。
本次调查结果证实了IUGR妊娠临床管理方面存在的不一致性，并强调了术语和产前监测标准化、胎儿体重定制的实施以及爱尔兰国家指南的必要性。
