Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
PLoS One. 2023 May 4;18(5):e0285096. doi: 10.1371/journal.pone.0285096. eCollection 2023.
Placental dysfunction can lead to perinatal hypoxic events including stillbirth. Unless there is overt severe fetal growth restriction, placental dysfunction is frequently not identified in (near) term pregnancy, particularly because fetal size is not necessarily small. This study aimed to evaluate, among (near) term births, the burden of hypoxia-related adverse perinatal outcomes reflected in an association with birth weight centiles as a proxy for placental function.
A nationwide 5-year cohort of the Dutch national birth registry (PeriNed) including 684,938 singleton pregnancies between 36+0 and 41+6 weeks of gestation. Diabetes, congenital anomalies, chromosomal abnormalities and non-cephalic presentations at delivery were excluded. The main outcome was antenatal mortality rate according to birthweight centiles and gestational age. Secondary outcomes included perinatal hypoxia-related outcomes, including perinatal death and neonatal morbidity, analyzed according to birthweight centiles.
Between 2015 and 2019, 1,074 perinatal deaths (0.16%) occurred in the study population (n = 684,938), of which 727 (0.10%) antenatally. Of all antenatal- and perinatal deaths, 29.4% and 27.9% occurred in birthweights below the 10th centile. The incidence of perinatal hypoxia-related outcomes was highest in fetuses with lowest birthweight centiles (18.0%), falling gradually up to the 50th and 90th centile where the lowest rates of hypoxia-related outcomes (5.4%) were observed.
Perinatal hypoxia-related events have the highest incidence in the lowest birthweight centiles but are identifiable throughout the entire spectrum. In fact, the majority of the adverse outcome burden in absolute numbers occurs in the group with a birthweight above the 10th centile. We hypothesize that in most cases these events are attributable to reduced placental function. Additional diagnostic modalities that indicate placental dysfunction at (near) term gestation throughout all birth weight centiles are eagerly wanted.
胎盘功能障碍可导致围产期缺氧事件，包括死产。除非存在明显的严重胎儿生长受限，否则在（近）足月妊娠时通常无法识别胎盘功能障碍，特别是因为胎儿大小不一定较小。本研究旨在评估（近）足月分娩中，与胎龄相关的不良围产结局的负担，这些结局反映在与出生体重百分位相关的关联中，作为胎盘功能的替代指标。
一项全国性的荷兰国家出生登记处（PeriNed）的 5 年队列研究，包括 684938 例 36+0 至 41+6 周妊娠的单胎妊娠。排除糖尿病、先天性异常、染色体异常和分娩时非头位。主要结局是根据出生体重百分位和胎龄的产前死亡率。次要结局包括围产期缺氧相关结局，包括围产儿死亡和新生儿发病率，根据出生体重百分位进行分析。
在 2015 年至 2019 年期间，研究人群（n=684938）中发生了 1074 例围产儿死亡（0.16%），其中 727 例（0.10%）为产前死亡。所有产前和围产儿死亡中，29.4%和 27.9%发生在出生体重低于第 10 百分位的婴儿中。围产期缺氧相关结局的发生率在出生体重最低百分位的胎儿中最高（18.0%），逐渐下降至第 50 百分位和第 90 百分位，在这些百分位观察到最低的缺氧相关结局（5.4%）发生率。
围产期缺氧相关事件在最低出生体重百分位发生率最高，但可在整个范围内识别。事实上，在绝对数量方面，大多数不良结局负担发生在出生体重高于第 10 百分位的组中。我们假设，在大多数情况下，这些事件归因于胎盘功能降低。迫切需要在所有出生体重百分位范围内指示（近）足月妊娠胎盘功能障碍的其他诊断方法。
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