Schlembach Dietmar
Vivantes - Netzwerk für Gesundheit GmbH, Klinikum Neukölln, Klinik für Geburtsmedizin, Berlin, Germany.
Geburtshilfe Frauenheilkd. 2020 Oct;80(10):1016-1025. doi: 10.1055/a-1232-1418. Epub 2020 Sep 25.
Fetal or intrauterine growth restriction (FGR/IUGR) affects approximately 5 - 8% of all pregnancies and refers to a fetus not exploiting its genetically determined growth potential. Not only a major cause of perinatal morbidity and mortality, it also predisposes these fetuses to the development of chronic disorders in later life. Apart from the timely diagnosis and identification of the causes of FGR, the obstetric challenge primarily entails continued antenatal management with optimum timing of delivery. In order to minimise premature birth morbidity, intensive fetal monitoring aims to prolong the pregnancy and at the same time intervene, i.e. deliver, before the fetus is threatened or harmed. It is important to note that early-onset FGR (< 32 + 0 weeks of gestation [wks]) should be assessed differently than late-onset FGR (≥ 32 + 0 wks). In early-onset FGR progressive deterioration is reflected in abnormal venous Doppler parameters, while in late-onset FGR this manifests primarily in abnormal cerebral Doppler ultrasound. According to our current understanding, the "optimum" approach for monitoring and timing of delivery in early-onset FGR combines computerized CTG with the ductus venosus Doppler, while in late-onset FGR assessment of the cerebral Doppler parameters becomes more important.
胎儿生长受限（FGR/IUGR）约影响所有妊娠的5%-8%，指胎儿未发挥其遗传决定的生长潜能。它不仅是围产期发病和死亡的主要原因，还使这些胎儿在以后的生活中易患慢性疾病。除了及时诊断和确定FGR的原因外，产科面临的挑战主要包括持续的产前管理以及选择最佳分娩时机。为了将早产发病率降至最低，强化胎儿监测旨在延长孕周，同时在胎儿受到威胁或伤害之前进行干预，即分娩。需要注意的是，早发型FGR（妊娠<32+0周）的评估应与晚发型FGR（≥32+0周）不同。在早发型FGR中，静脉多普勒参数异常反映了病情的进行性恶化，而在晚发型FGR中，这主要表现为脑多普勒超声异常。根据我们目前的认识，早发型FGR监测和分娩时机的“最佳”方法是将计算机化CTG与静脉导管多普勒相结合，而在晚发型FGR中，脑多普勒参数的评估更为重要。
