37 周后出生的小于胎龄儿：风险分层方案的影响研究。

Small-for-gestational-age babies after 37 weeks: impact study of risk-stratification protocol.

机构信息

Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK.

Department of Obstetrics and Gynaecology, Ospedale Cristo Re, Rome, Italy.

出版信息

Ultrasound Obstet Gynecol. 2018 Jul;52(1):66-71. doi: 10.1002/uog.17544.

DOI:10.1002/uog.17544

PMID:28600829

Abstract

OBJECTIVE

Although no clear evidence exists, many international guidelines advocate early-term delivery of small-for-gestational-age (SGA) fetuses. The aim of this study was to determine whether a risk-stratification protocol in which low-risk SGA fetuses are managed expectantly beyond 37 weeks affects perinatal and maternal outcomes.

METHODS

This was an impact study examining data collected over a 39-month period (1 January 2013 to 30 April 2016) at a tertiary referral unit. The study included women who were referred to the fetal medicine unit with a singleton non-anomalous fetus diagnosed antenatally as SGA (estimated fetal weight < 10 centile) from 36 + 0 weeks' gestation. In 2014, a protocol for management of SGA was introduced, which included risk stratification with surveillance and expectant management after 37 weeks for lower-risk babies (protocol group). This was compared with the previous strategy, which recommended delivery at around 37 weeks (pre-protocol group). Primary outcome was neonatal composite adverse outcome.

RESULTS

In the pre-protocol group, there were 138 SGA babies; in the protocol group there were 143. Mean gestational ages at delivery were 37.4 weeks in the pre-protocol group and 38.2 weeks in the protocol group (P = 0.04). The incidence of neonatal composite adverse outcome was lower in the protocol group (9% vs 22%; P < 0.01), as was neonatal unit admission (13% vs 39%; P < 0.01). Induction of labor and Cesarean section rates were lower, and vaginal delivery rate (83% vs 60%; P < 0.01) was higher, in the protocol group. Most of the differences were as a result of delayed delivery of SGA babies that were stratified as low risk.

CONCLUSIONS

The findings of this study suggest that protocol-based management of SGA babies may improve outcome, and that identification of moderate SGA should not in isolation prompt delivery. Larger numbers are required to assess any impact on perinatal mortality. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

摘要

目的

尽管没有明确的证据，但许多国际指南都主张对小于胎龄儿（SGA）进行早期分娩。本研究旨在确定对低危 SGA 胎儿进行 37 周以上期待治疗的风险分层方案是否会影响围产儿和产妇结局。

方法

这是一项影响研究，对 2013 年 1 月 1 日至 2016 年 4 月 30 日期间在一家三级转诊中心收集的数据进行了研究。该研究纳入了在产前被诊断为 SGA（估计胎儿体重 <第 10 百分位数）的单胎非畸形胎儿的孕妇，这些孕妇在 36+0 周妊娠时被转至胎儿医学科。2014 年，引入了 SGA 的管理方案，包括风险分层和对低危婴儿的 37 周后监测和期待治疗（方案组）。这与之前的策略进行了比较，该策略建议在大约 37 周时分娩（前方案组）。主要结局是新生儿复合不良结局。

结果

前方案组有 138 例 SGA 婴儿，方案组有 143 例。前方案组的分娩时平均孕周为 37.4 周，方案组为 38.2 周（P=0.04）。方案组的新生儿复合不良结局发生率较低（9% vs 22%；P<0.01），新生儿入住新生儿重症监护病房的比例也较低（13% vs 39%；P<0.01）。方案组的引产和剖宫产率较低，阴道分娩率较高（83% vs 60%；P<0.01）。这些差异主要是由于将低危 SGA 婴儿的分娩时间推迟导致的。