Khalil Asma, Thilaganathan Basky
Fetal Medicine Unit, St George's Hospital, St George's University of London, Cranmer Terrace, London SW17 0RE, UK.
Best Pract Res Clin Obstet Gynaecol. 2017 Jan;38:38-47. doi: 10.1016/j.bpobgyn.2016.09.003. Epub 2016 Sep 23.
Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) - a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. The cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth.
识别足月时面临不良结局风险的胎儿对临床医生和研究人员来说都是一项挑战。尽管胎儿生长受限（FGR）是已知的死产风险因素，但至少三分之二的足月死产病例并非小于胎龄儿（SGA）——这是FGR常用的替代指标。然而，大多数SGA胎儿是体质性小婴儿，不会出现不良围产期结局。脑胎盘比率（CPR）正逐渐成为足月时未达到生长潜能的一个标志物。CPR是产时胎儿窘迫、足月时入住新生儿病房、死产、围产期死亡和新生儿发病的独立预测指标。孕晚期子宫动脉多普勒阻力升高与出生体重和CPR显著降低独立相关。孕晚期估计胎儿体重、CPR和子宫多普勒检查相结合，可以识别出大多数有死产风险的胎儿。
