Korkalainen Noora, Räsänen Juha, Kaukola Tuula, Kallankari Hanna, Hallman Mikko, Mäkikallio Kaarin
Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland.
PEDEGO Research Unit, University of Oulu, Oulu, Finland.
Acta Obstet Gynecol Scand. 2017 Jan;96(1):69-77. doi: 10.1111/aogs.13052.
Fetal growth restriction is associated with short-term and long-term mortality and morbidity. We hypothesized that adverse outcome in children with fetal growth restriction at primary school age is associated with fetoplacental circulatory abnormalities.
Comprehensive ultrasonographic assessment of fetoplacental hemodynamics was performed in 72 growth-restricted fetuses prenatally, and short-term outcome data were collected. At the median age of 9 years, mortality and morbidity were determined using medical charts and questionnaires. The impact of abnormal fetoplacental hemodynamics on mortality and morbidity with significant developmental disorders or delay were studied.
Fetal growth restriction children with adverse long-term outcome were delivered earlier and with lower birthweights than were those with non-compromised outcome. Seventy percent of the fetal growth restriction group showed non-compromised long-term outcomes and participated in mainstream education at the appropriate age level. Absent/retrograde diastolic flow in the umbilical artery (p < 0.001), negative A-wave in the ductus venosus (p = 0.006), cardiomegaly (p = 0.02), hydrops (p = 0.006) and cardiovascular profile score <6 (p = 0.002) were associated with increased risk of adverse outcome. After adjustment for gestational age, these parameters demonstrated hazard ratios of 5.0-16.5 for adverse long-term outcome; increased systemic venous pulsatility and low cardiovascular profile score had the highest predictive power.
Absent or reversed end-diastolic flow in the umbilical artery, reversed A-wave in the ductus venosus, cardiomegaly, hydrops, and low cardiovascular profile score are associated with adverse outcomes at primary school age in fetal growth restriction children. These fetal parameters play a significant role in the prediction of long-term outcomes for fetal growth restriction children.
胎儿生长受限与短期及长期的死亡率和发病率相关。我们假设小学年龄段的胎儿生长受限儿童的不良结局与胎儿-胎盘循环异常有关。
对72例产前诊断为生长受限的胎儿进行了胎儿-胎盘血流动力学的全面超声评估，并收集了短期结局数据。在9岁的中位年龄时，使用病历和问卷确定死亡率和发病率。研究了异常的胎儿-胎盘血流动力学对伴有显著发育障碍或发育延迟的死亡率和发病率的影响。
长期结局不良的胎儿生长受限儿童比结局未受影响的儿童早产且出生体重更低。70%的胎儿生长受限组儿童长期结局未受影响，并在适当年龄水平接受主流教育。脐动脉舒张末期血流缺失/反向（p < 0.001）、静脉导管A波反向（p = 0.006）、心脏肥大（p = 0.02）、水肿（p = 0.006）和心血管评分<6（p = 0.002）与不良结局风险增加相关。在对孕周进行校正后，这些参数显示不良长期结局的风险比为5.0 - 16.5；全身静脉搏动增加和心血管评分低具有最高的预测能力。
脐动脉舒张末期血流缺失或反向、静脉导管A波反向、心脏肥大、水肿和心血管评分低与胎儿生长受限儿童小学年龄段的不良结局相关。这些胎儿参数在预测胎儿生长受限儿童的长期结局中起重要作用。
