Maggio Lindsay, Dahlke Joshua D, Mendez-Figueroa Hector, Albright Catherine M, Chauhan Suneet P, Wenstrom Katharine D
Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, Rhode Island; and the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, UT Health-University of Texas Medical School at Houston, Houston, Texas.
Obstet Gynecol. 2015 Apr;125(4):863-869. doi: 10.1097/AOG.0000000000000737.
To compare the composite neonatal morbidity of pregnancies with fetal growth restriction (estimated fetal weight less than the 10th percentile) and normal compared with elevated umbilical artery systolic-to-diastolic ratios.
This was a retrospective cohort study of all pregnancies complicated by fetal growth restriction with normal compared with elevated umbilical artery systolic-to-diastolic ratios from January 2008 to July 2012 at a single center. Exclusions were multiple gestation, prenatally diagnosed fetal anomalies, delivery at outside institution, and absent or reversed end diastolic flow. Maternal characteristics and perinatal outcomes including composite neonatal morbidity were compared between groups.
Of 11,785 pregnancies evaluated, 789 (7%) were diagnosed with fetal growth restriction. Among 512 that met inclusion criteria, 394 (77%) had normal and 118 (23%) had elevated umbilical artery systolic-to-diastolic ratios. When fetal growth-restricted pregnancies with elevated umbilical artery systolic-to-diastolic ratios were delivered at 37 weeks of gestation were compared with those with normal umbilical artery systolic-to-diastolic ratios delivered at 39 weeks of gestation, there was no difference in the rate of neonatal intensive care unit admission (101 [25.7%] compared with 51 [43.2%]; crude odds ratio [OR] 2.5, 95% confidence interval 1.5-4.0; adjusted OR 1.37, 95% CI 0.69-2.71) or composite neonatal morbidity (60 [15.2%] compared with 24 [20.3%]; crude OR 1.42, 95% CI 0.84-2.40; adjusted OR 0.91, 95% CI 0.45-1.84).
Composite neonatal morbidity is comparable in fetal growth-restricted pregnancies with elevated compared with normal umbilical artery systolic-to-diastolic ratios when delivered at 37 and 39 weeks of gestation, respectively. Planning delivery of pregnancies with fetal growth restriction and elevated systolic-to-diastolic ratios and without other complications at 37 weeks of gestation results in good outcomes.
比较胎儿生长受限（估计胎儿体重低于第10百分位数）与正常妊娠且脐动脉收缩压与舒张压比值升高时的新生儿综合发病率。
这是一项回顾性队列研究，研究对象为2008年1月至2012年7月在单一中心所有合并胎儿生长受限且脐动脉收缩压与舒张压比值正常或升高的妊娠。排除标准包括多胎妊娠、产前诊断的胎儿畸形、在外部机构分娩以及舒张末期血流消失或反向。比较两组之间的产妇特征和围产期结局，包括新生儿综合发病率。
在评估的11785例妊娠中，789例（7%）被诊断为胎儿生长受限。在符合纳入标准的512例中，394例（77%）脐动脉收缩压与舒张压比值正常，118例（23%）脐动脉收缩压与舒张压比值升高。将妊娠37周分娩的脐动脉收缩压与舒张压比值升高的胎儿生长受限妊娠与妊娠39周分娩的脐动脉收缩压与舒张压比值正常的妊娠进行比较，新生儿重症监护病房入住率无差异（101例[25.7%]与51例[43.2%]；粗比值比[OR]2.5，95%置信区间1.5 - 4.0；校正后OR 1.37，95% CI 0.69 - 2.71）或新生儿综合发病率无差异（60例[15.2%]与24例[20.3%]；粗OR 1.42，95% CI 0.84 - 2.40；校正后OR 0.91，95% CI 0.45 - 1.84）。
当分别在妊娠37周和39周分娩时，脐动脉收缩压与舒张压比值升高的胎儿生长受限妊娠与正常妊娠的新生儿综合发病率相当。对于妊娠37周时胎儿生长受限且收缩压与舒张压比值升高且无其他并发症的妊娠进行分娩计划，可获得良好结局。
