Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy.
Fetal Medicine Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK.
Acta Obstet Gynecol Scand. 2024 Oct;103(10):1910-1918. doi: 10.1111/aogs.14937. Epub 2024 Aug 6.
Relative uteroplacental insufficiency of labor (RUPI-L) is a clinical condition that refers to alterations in the fetal oxygen "demand-supply" equation caused by the onset of regular uterine activity. The term RUPI-L indicates a condition of "relative" uteroplacental insufficiency which is relative to a specific stressful circumstance, such as the onset of regular uterine activity. RUPI-L may be more prevalent in fetuses in which the ratio between the fetal oxygen supply and demand is already slightly reduced, such as in cases of subclinical placental insufficiency, post-term pregnancies, gestational diabetes, and other similar conditions. Prior to the onset of regular uterine activity, fetuses with a RUPI-L may present with normal features on the cardiotocography. However, with the onset of uterine contractions, these fetuses start to manifest abnormal fetal heart rate patterns which reflect the attempt to maintain adequate perfusion to essential central organs during episodes of transient reduction in oxygenation. If labor is allowed to continue without an appropriate intervention, progressively more frequent, and stronger uterine contractions may result in a rapid deterioration of the fetal oxygenation leading to hypoxia and acidosis. In this Commentary, we introduce the term relative uteroplacental insufficiency of labor and highlight the pathophysiology, as well as the common features observed in the fetal heart rate tracing and clinical implications.
相对产时胎盘功能不全（RUPI-L）是一种临床情况，指的是由于规律子宫活动的开始，胎儿氧“供需”平衡发生改变。RUPI-L 一词表示一种“相对”的胎盘功能不全状态，与特定的应激情况相关，例如规律子宫活动的开始。在那些胎儿氧供应与需求之间的比例已经略有降低的情况下，例如亚临床胎盘功能不全、过期妊娠、妊娠期糖尿病和其他类似情况，RUPI-L 可能更为普遍。在规律子宫活动开始之前，具有 RUPI-L 的胎儿可能在胎心监护图上表现出正常特征。然而，随着子宫收缩的开始，这些胎儿开始表现出异常的胎儿心率模式，反映了在短暂缺氧期间试图维持对重要中央器官的足够灌注。如果不进行适当的干预就让分娩继续进行，可能会导致更频繁、更强的子宫收缩，从而导致胎儿氧合迅速恶化，导致缺氧和酸中毒。在这篇评论中，我们引入了相对产时胎盘功能不全的概念，并强调了其病理生理学，以及在胎儿心率描记图中观察到的常见特征及其临床意义。
