Nadel Allan, Prabhu Malavika, Kaimal Anjali
Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida.
Am J Perinatol. 2025 Jul;42(9):1223-1228. doi: 10.1055/a-2483-5684. Epub 2024 Nov 25.
An accurate diagnosis of fetal growth restriction relies on a precise estimation of gestational age based on a carefully obtained history as well as early ultrasound, since a difference of just a few days can lead to a significant error. There is a continuum of risk for adverse outcome that depends on the certainty of dates and presence or absence of comorbidities, in addition to the estimated fetal weight percentile and the umbilical artery waveform. The results of several studies, most notably the TRUFFLE trial, demonstrate that optimal management of fetal growth restriction with an abnormal umbilical artery waveform requires daily electronic fetal heart rate monitoring, and this monitoring does not require computerized interpretation. The role of ductus venosus waveform, biophysical profile, and middle cerebral artery waveform is less clear, and the results of these three modalities should be interpreted with caution. · A correct diagnosis of fetal growth restriction requires a very precise estimate of gestational age.. · In the presence of abnormal umbilical artery Doppler, the cornerstone of surveillance is daily electronic fetal heart rate monitoring.. · Surveillance with biophysical profile, ductus venosus waveform, and middle cerebral artery waveform are less important than daily electronic fetal heart rate monitoring..
胎儿生长受限的准确诊断依赖于基于详细病史及早期超声检查精确估算孕周，因为仅几天的差异就可能导致显著误差。除了估计的胎儿体重百分位数和脐动脉波形外，不良结局的风险存在连续性，这取决于孕周的确定性以及合并症的有无。多项研究结果，尤其是TRUFFLE试验表明，对于脐动脉波形异常的胎儿生长受限进行最佳管理需要每日进行电子胎心监护，且这种监护不需要计算机化解读。静脉导管波形、生物物理评分及大脑中动脉波形的作用尚不清楚，对这三种检查结果的解读应谨慎。· 胎儿生长受限的正确诊断需要非常精确地估算孕周。· 在脐动脉多普勒异常的情况下，监测的基石是每日进行电子胎心监护。· 生物物理评分、静脉导管波形及大脑中动脉波形监测不如每日电子胎心监护重要。
