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晚期胎儿生长限制的诊断标准的差异是否重要?

Bronacha Mylrea-Foley¹, Raffaele Napolitano², Sanne Gordijn³

¹Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom (Drs Mylrea-Foley and Lees); Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (Drs Mylrea-Foley and Lees).

American journal of obstetrics & gynecology MFM

|August 6, 2023

概括

根据所选择的定义和参考图表,诊断胎儿生长限制有很大差异,影响临床决策. 不同的方法产生不同的检测率和与不良围产期结果的关联.

科学领域:

产周医学产周医学
胎儿的发育胎儿的发育
诊断的准确性诊断的准确性

背景情况:

胎儿生长限制 (FGR) 诊断缺乏标准化的标准,导致变化.
国际指导方针和使用生物识别和多普勒参考图表存在差异.
这种异质性使得准确的FGR诊断和管理变得复杂.

研究的目的:

为了比较Delphi共识和母胎医学协会 (SMFM) 定义之间的FGR诊断标准.
评估不同胎儿生物识别标准和多普勒测速参考范围对FGR诊断的影响.
评估各种FGR定义的敏感性和特异性,以预测低出生体重和不良周产期结果.

主要方法:

从TRUFFLE 2可行性研究中分析了564例患有FGR风险的怀孕.
使用生物识别图表 (Hadlock,INTERGROWTH-21,GROW/Chitty) 和多普勒参考范围 (Arduini,Ebbing) 的FGR定义的比较.
对低出生体重 (<第10百分位) 和不良周产期结局的敏感性和特异性的评估.

主要成果:

结合了定义和参考图表,发现FGR的比例差异很大,从38%到93%不等.
没有任何单一的组合有效地预测了不良的围产期结果,低出生体重的相对风险在1.4和2.1之间.
多普勒参考范围 (埃宾与阿尔杜尼) 和生物识别图表显著影响了FGR识别率和与不良结果的关联.

结论:

选择FGR定义,生物识别标准和多普勒范围极大地影响了被确定为FGR的胎儿的比例.
虽然结果差异似乎很小,但它们可以显著影响干预率.
诊断工具的标准化对于一致的FGR管理和改善产周护理至关重要.

关键词:

在多普勒测试中,多普勒大脑节约大脑节约大脑大脑再分配的大脑再分配大脑胎盘比率的大脑胎盘比率图表图表图表图表图表胎儿生长限制限制胎儿生长限制子宫内生长限制子宫内生长中脑动脉中脑动脉标签: 参考参考参考参考对于妊娠年龄来说小.标准的标准的标准的标准的标准.带-大脑比率是什么意思

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