238例胎儿生长受限临床分析

目的:探讨胎儿生长受限(fetal growth restriction,FGR)的相关危险因素及终止妊娠的方式、时机以及对围产儿结局的影响,以提高产科质量。方法:对2005年1月～2009年12月郑州大学第三附属医院12146例孕妇中238例胎儿生长受限患者的临床资料进行回顾性分析。结果:①FGR发生率为1.96%。②FGR发病的主要相关因素中母体因素占43.7%,其中妊娠期高血压疾病27.7%,所占比率最高;其次为羊水过少14.3%、脐带异常8.0%,胎盘形态异常7.6%,胎儿因素占2.5%,不明原因者占23.9%;FGR组妊娠期高血压疾病、脐带异常、胎盘形态异常以及羊水过少的发生率高于对照组,差异有统计学意义(P0.05)。③FGR组剖宫产率、胎儿宫内窘迫率、新生儿窒息率及围产儿死亡率均高于对照组,差异有统计学意义(P0.05);FGR患者剖宫产分娩组围产儿窒息率及死亡率低于阴道分娩组,差异有统计学意义(P0.05);根据终止妊娠的不同孕周,≤31+6孕周组、32～33+6孕周组、34～36+6孕周组及37～42孕周组新生儿窒息率依次降低,差异有统计学意义(P0.05),其中34～36+6孕周组与≤31+6孕周组、32～33+6孕周组比较差异有统计学意义(P0.05),而与37～42孕周组比较,差异无统计学意义(P0.05);围产儿死亡率亦是依次降低(P0.05),其中32～33+6孕周组与34～36+6孕周组围产儿死亡率差异无统计学意义(P0.05)。结论:建立健全围产期保健网,加强围产期保健知识宣教,合理营养,积极治疗妊娠并发症及合并症,对高危人群进行筛查,早期诊断,早期治疗,可降低胎儿生长受限的发生率;剖宫产可以降低FGR围产儿不良结局,而延长孕周至足月并未明显降低围产儿不良结局,适时、适宜方式终止妊娠,有利于改善FGR的预后,提高患儿生存质量。

Clinical analysis on 238 cases with fetal growth restriction

Objective:To explore the related risk factors of fetal growth restriction (FGR) and the mode and opportunity of pregnancy termination and its effect on perinatal outcomes,and improve the quality of obstetrical development.Methods:The clinical data of 238 cases with FGR among 12 146 pregnant women in the hospital from January 2005 to December 2009 were analyzed retrospectively.Results:The incidence of FGR was 1.96% ;among the main related factors of pathogenesis of FGR,maternal factors accounted for 43.7% and the proportion of hypertensive disorder complicating pregnancy (HDCP) was the highest (27.7%),the secondary were oligohydramnios (14.3%),abnormality of umbilical cord (8.0%),abnormal placental morphology (7.6%),fetal factors (2.5%),unknown aetiology (23.9%).The incidences of HDCP,abnormality of umbilical cord,abnormal placental morphology and oligohydramnios in FGR group were significantly higher than those in control group (P < 0.05).The rate of cesarean section and the incidences of fetal intrauterine distress,neonatal asphyxia and perinatal mortality in FGR group were significantly higher than those in control group (P < 0.05) ;in FGR group,the incidence of perinatal asphyxia and mortality in cesarean section group were significantly lower than those in vaginal delivery group (P < 0.05) ;according to different gestational weeks of pregnancy termination,the incidences of neonatal asphyxia in ≤31 +6gestational weeks group,32 ～ 33 +6gestational weeks group,34 ～ 36 +6gestational weeks group and 37 ～ 42 gestational weeks group reduced gradually,there was significant difference among the four groups (P < 0.05) ;there was significant difference between 34 ～ 36 +6gestational weeks group and ≤31 +6gestational weeks group,32 ～ 33 +6 gestational weeks group,respectively (P < 0.05) ;but compared with 37 ～ 42 gestational weeks group,there was no significant difference (P > 0.05).Conclusion:The measures listed as follows can reduce the incidence of FGR:establishing and perfecting health care during perinatal period,enhancing propoganda and training of perinatal health care,reasonable nutrition,active therapy of complications during pregnancy,screening the high risk population,early diagnosis and early treatment;cesarean section can reduce the incidence of adverse perinatal outcomes;extending the gestational weeks till full term delivery doesn't reduce the incidence of adverse perinatal outcomes effectively;timely termination of pregnancy with proper method is helpful to improve the prognosis of FGR and improve the living quality of infants.