Gatta Luke A, McCarthy Allison M, Osmundson Sarah S
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Medical Center North.
Center for Biomedical Ethics and Society, Vanderbilt University School of Medicine.
Curr Opin Obstet Gynecol. 2025 Apr 1;37(2):49-54. doi: 10.1097/GCO.0000000000001010. Epub 2024 Dec 30.
A life-limiting fetal diagnosis (LLD) refers to a medical condition identified during pregnancy that is expected to lead to stillbirth, preclude ex utero survival, or significantly reduce neonatal life expectancy. The terms 'lethal' or 'life-limiting' are used to prognosticate early death for various anatomic or physiologic causes, although the expected timeframe is nonspecific. The purpose of this manuscript is to review how the terms 'lethal' or 'life limiting' are used in contemporary perinatal research.
Depending on the study design, 'life-limiting' is defined either prior to data analysis (such as prospective cohort studies), or after outcomes are assessed (such as case series). When 'life-limiting' is defined prior to data analysis, study-specific specific definitions may include timeframes from birth to death, probability of neonatal mortality, or a list of diagnoses based off billing codes.
Professional societies have guidelines to standardize the reporting of vital statistics, including early death. While these fall short of defining LLDs comprehensively, they present an opportunity for more specific prognostication following prenatal diagnosis, which may improve research standardization to facilitate a clearer understanding of LLDs in clinical practice.
致死性胎儿诊断（LLD）是指孕期发现的一种医学状况，预计会导致死产、无法宫外存活或显著缩短新生儿预期寿命。“致死性”或“危及生命”这些术语用于预测因各种解剖或生理原因导致的早期死亡，尽管预期时间范围并不明确。本手稿的目的是综述“致死性”或“危及生命”这些术语在当代围产期研究中的使用情况。
根据研究设计，“危及生命”要么在数据分析前定义（如前瞻性队列研究），要么在评估结果后定义（如病例系列研究）。当在数据分析前定义“危及生命”时，特定研究的定义可能包括从出生到死亡的时间范围、新生儿死亡概率或基于计费代码的诊断列表。
专业协会有标准化生命统计报告的指南，包括早期死亡报告。虽然这些指南未能全面定义致死性胎儿诊断，但它们为产前诊断后的更具体预后提供了机会，这可能会提高研究标准化程度，以便在临床实践中更清楚地理解致死性胎儿诊断。
