From the Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Beune, Damhuis, Gordijn).
the Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands (Damhuis, Ganzevoort).
Arch Pathol Lab Med. 2021 Apr 1;145(4):428-436. doi: 10.5858/arpa.2020-0027-OA.
CONTEXT.—: Fetal growth restriction is a risk factor for intrauterine fetal death. Currently, definitions of fetal growth restriction in stillborns are heterogeneous.
OBJECTIVES.—: To develop a consensus definition for fetal growth restriction retrospectively diagnosed at fetal autopsy in intrauterine fetal death.
DESIGN.—: A modified online Delphi survey in an international panel of experts in perinatal pathology, with feedback at group level and exclusion of nonresponders. The survey scoped all possible variables with an open question. Variables suggested by 2 or more experts were scored on a 5-point Likert scale. In subsequent rounds, inclusion of variables and thresholds were determined with a 70% level of agreement. In the final rounds, participants selected the consensus algorithm.
RESULTS.—: Fifty-two experts participated in the first round; 88% (46 of 52) completed all rounds. The consensus definition included antenatal clinical diagnosis of fetal growth restriction OR a birth weight lower than third percentile OR at least 5 of 10 contributory variables (risk factors in the clinical antenatal history: birth weight lower than 10th percentile, body weight at time of autopsy lower than 10th percentile, brain weight lower than 10th percentile, foot length lower than 10th percentile, liver weight lower than 10th percentile, placental weight lower than 10th percentile, brain weight to liver weight ratio higher than 4, placental weight to birth weight ratio higher than 90th percentile, histologic or gross features of placental insufficiency/malperfusion). There was no consensus on some aspects, including how to correct for interval between fetal death and delivery.
CONCLUSIONS.—: A consensus-based definition of fetal growth restriction in fetal death was determined with utility to improve management and outcomes of subsequent pregnancies.
胎儿生长受限是宫内胎儿死亡的一个危险因素。目前，对于死产儿中胎儿生长受限的定义存在差异。
旨在为胎儿尸检中诊断的胎儿生长受限制定一个一致的定义，用于宫内胎儿死亡。
在围产病理学领域的国际专家小组中进行了一项改良的在线德尔菲调查，在小组层面进行反馈，并排除未回复者。该调查涵盖了所有可能的变量，并提出了一个开放性问题。有 2 名或更多专家提出的变量按 5 分制进行评分。在随后的几轮中，根据 70%的一致性来确定变量的纳入和阈值。在最后几轮中，参与者选择了共识算法。
52 名专家参加了第一轮调查；88%（52 名中的 46 名）完成了所有轮次。共识定义包括产前临床诊断的胎儿生长受限，或出生体重低于第 3 百分位，或至少有 10 个促成因素变量中的 5 个（产前临床病史中的危险因素：出生体重低于第 10 百分位，尸检时体重低于第 10 百分位，脑重量低于第 10 百分位，脚长低于第 10 百分位，肝脏重量低于第 10 百分位，胎盘重量低于第 10 百分位，脑重与肝重比值高于 4，胎盘重量与出生体重比值高于第 90 百分位，胎盘组织学或大体特征显示胎盘功能不全/灌注不良）。在一些方面，如如何校正胎儿死亡与分娩之间的间隔，尚未达成共识。
通过该研究制定了胎儿生长受限在胎儿死亡方面的一个基于共识的定义，有助于改善后续妊娠的管理和结局。
