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[胎儿宫内生长受限筛查模型。文献综述。]

[Intrauterine Fetal Growth Restriction- Screening Model. Literature Review.].

作者信息

Stratieva V, Chaveeva P, Yankova M, Shterev A

出版信息

Akush Ginekol (Sofiia). 2016;55(6):31-35.

Abstract

Placental dysfunction is involved in a spectrum of obs.tetric conditions including preeclampsia, placental abrution and intrauterine fetal growth restriction. Their timely and accurate recognition is often a chalange since diagnostic criteria are dill based on nonspecific signs and symptomes. Fetal growth restriction (FGR) refers to a fetus that has failed to achieve its genetically determined growth potential and affects up to 5-10% of pregnancies. FRR is associated with an increase in perinatal mortality and morbidity. The diagnoslic challenge is in distinguishing SGA pregnancies from FGR pregnancies because the majority of SGA pregnancies are associated with a good prognosis compared to FGR pregnancies. Multifetal gegations have a high incidence of FGR. About 20-30% of dichorionic twins will suffer from FGR, as will 40% of monochorionic twins. Ultrasound is the benchmark for accurate pregnancy dating and diagnosis of FGR. However, there is room for error and FGR is undetected in about 30% of routinely scanned cases and incorrectly detected in 50% of cases. In recent years, the main priority of the leading obstetric clinics in Europe and the USA is drafting a universal screening model for selecting patients at high risk of developing placental dysfunction. Now, this model is part of the standard screening for chromosomal aneuploidies in the firs and second trimester of pregnancy and prolonged screening in the second and third trimester in patients at high risk.

摘要

胎盘功能障碍与一系列产科疾病有关,包括子痫前期、胎盘早剥和胎儿宫内生长受限。由于诊断标准往往基于非特异性体征和症状,及时准确地识别这些疾病常常具有挑战性。胎儿生长受限(FGR)是指胎儿未能实现其遗传决定的生长潜力,影响多达5%-10%的妊娠。FGR与围产期死亡率和发病率的增加有关。诊断的挑战在于区分小于胎龄儿(SGA)妊娠和FGR妊娠,因为与FGR妊娠相比,大多数SGA妊娠预后良好。多胎妊娠中FGR的发生率很高。约20%-30%的双绒毛膜双胎会发生FGR,单绒毛膜双胎的发生率为40%。超声是准确确定孕周和诊断FGR的基准。然而,仍存在误差空间,在约30%的常规扫描病例中未检测到FGR,在50%的病例中检测错误。近年来,欧洲和美国主要产科诊所的首要任务是制定一个通用筛查模型,以筛选出发生胎盘功能障碍高危患者。现在,该模型是妊娠早期和中期染色体非整倍体标准筛查以及高危患者妊娠中期和晚期延长筛查的一部分。

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