Melamed Nir, Baschat Ahmet, Yinon Yoav, Athanasiadis Apostolos, Mecacci Federico, Figueras Francesc, Berghella Vincenzo, Nazareth Amala, Tahlak Muna, McIntyre H David, Da Silva Costa Fabrício, Kihara Anne B, Hadar Eran, McAuliffe Fionnuala, Hanson Mark, Ma Ronald C, Gooden Rachel, Sheiner Eyal, Kapur Anil, Divakar Hema, Ayres-de-Campos Diogo, Hiersch Liran, Poon Liona C, Kingdom John, Romero Roberto, Hod Moshe
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA.
Int J Gynaecol Obstet. 2021 Mar;152 Suppl 1(Suppl 1):3-57. doi: 10.1002/ijgo.13522.
Fetal growth restriction (FGR) is defined as the failure of the fetus to meet its growth potential due to a pathological factor, most commonly placental dysfunction. Worldwide, FGR is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Ongoing advances in clinical care, especially in definitions, diagnosis, and management of FGR, require efforts to effectively translate these changes to the wide range of obstetric care providers. This article highlights agreements based on current research in the diagnosis and management of FGR, and the areas that need more research to provide further clarification of recommendations. The purpose of this article is to provide a comprehensive summary of available evidence along with practical recommendations concerning the care of pregnancies at risk of or complicated by FGR, with the overall goal to decrease the risk of stillbirth and neonatal mortality and morbidity associated with this condition. To achieve these goals, FIGO (the International Federation of Gynecology and Obstetrics) brought together international experts to review and summarize current knowledge of FGR. This summary is directed at multiple stakeholders, including healthcare providers, healthcare delivery organizations and providers, FIGO member societies, and professional organizations. Recognizing the variation in the resources and expertise available for the management of FGR in different countries or regions, this article attempts to take into consideration the unique aspects of antenatal care in low-resource settings (labelled “LRS” in the recommendations). This was achieved by collaboration with authors and FIGO member societies from low-resource settings such as India, Sub-Saharan Africa, the Middle East, and Latin America.
胎儿生长受限(FGR)的定义是由于病理因素导致胎儿未能发挥其生长潜能,最常见的原因是胎盘功能障碍。在全球范围内,FGR是死产、新生儿死亡以及短期和长期发病的主要原因。临床护理方面的不断进步,尤其是在FGR的定义、诊断和管理方面,需要努力将这些变化有效地传达给广泛的产科护理提供者。本文重点介绍了基于当前FGR诊断和管理研究的共识,以及需要更多研究以进一步明确建议的领域。本文的目的是提供现有证据的全面总结以及关于有FGR风险或并发FGR的妊娠护理的实用建议,总体目标是降低与此病症相关的死产、新生儿死亡和发病风险。为实现这些目标,国际妇产科联合会(FIGO)召集了国际专家来审查和总结FGR的现有知识。本总结针对多个利益相关者,包括医疗保健提供者、医疗保健服务组织和提供者、FIGO成员协会以及专业组织。认识到不同国家或地区在FGR管理方面可用资源和专业知识存在差异,本文试图考虑资源匮乏地区(在建议中标记为“LRS”)产前护理的独特方面。这是通过与来自印度、撒哈拉以南非洲、中东和拉丁美洲等资源匮乏地区的作者和FIGO成员协会合作实现的。