标题：早发型胎儿生长受限合并血流异常对围产结局的影响

      作者：田刘曼 1，姬荣伟 2，王莹莹 1，王林林 1    1.西北妇女儿童医院产科，陕西 西安 710061；2.西安外事学院医学院，陕西 西安 710000

      卷次： 2023年34卷18期

      【摘要】 目的 研究早发型胎儿生长受限(FGR)合并血流异常对围产结局的影响。方法 回顾性分析2018年1月至2021年12月在西北妇女儿童医院产科分娩的158例FGR孕妇的临床资料。按照胎儿是否存在血流异常将孕妇分为研究组 108例(胎儿血流异常)和对照组50例(胎儿血流正常)。比较两组孕妇的围产结局和新生儿结局。结果 研究组孕妇合并妊娠期高血压(HDP)和应用糖皮质激素的比例分别为43.52%、54.63%，明显高于对照组的26.00%、28.00%，差异均有统计学意义(P<0.05)；但两组孕妇的孕前BMI、年龄、经产妇、孕期增重、诊断孕周、孕次≥2次、合并免疫系统疾病比例比较，差异均无统计学意义(P>0.05)；研究组孕妇合并羊水过少占比、剖宫产率、选择剖宫产率分别为34.26%、80.56%、22.22%，明显高于对照组的18.00%、64.00%、6.00%，差异均有统计学意义(P<0.05)；研究组孕妇胎盘重量、胎盘体积、分娩孕周分别为(405.68±101.82) g、(493.76±108.52) cm3、(34.92±2.58)周，明显低于对照组的(473.52±80.31) g、(628.35±201.74) cm3、(37.11±2.60)周，差异均有统计学意义(P<0.05)；研究组新生儿出生体质量为(1 753.26±481.35) g，明显低于对照组的(2 207.59±356.42) g，新生儿早产、脑室出血、1 min Apgar评分≤7分占比、入住NICU率分别为60.19%、10.19%、32.41%、83.33%，明显高于对照组的26.00%、0、4.00%、54.00%，差异均有统计学意义(P<0.05)。结论 FGR合并血流异常会影响围产结局，应加强FGR合并血流异常孕妇妊娠期间监测，尽可能延长孕周。如出现胎儿宫内窘迫及较为严重并发症时，应及时终止妊娠。
      【关键词】 早发型胎儿生长受限；血流异常；围产结局；新生儿结局
      【中图分类号】 R714.43 【文献标识码】 A 【文章编号】 1003—6350（2023）18—2608—04

Effect of early onset fetal growth restriction combined with abnormal blood flow on perinatal outcomes.
TIAN Liu-man 1,JI Rong-wei 2, WANG Ying-ying 1, WANG Lin-lin 1. 1. Department of Obstetrics, Northwest Women and Children's Hospital,Xi'an 710061, Shaanxi, CHINA; 2. Medical College, Xi'an International University, Xi'an 710000, Shaanxi, CHINA
【Abstract】 Objective To investigate the impact of early onset fetal growth restriction (FGR) combined withabnormal blood flow on perinatal outcomes. Methods The clinical data of 158 FGR pregnant women who gave birthin the Department of Obstetrics, Northwest Women and Children's Hospital from January 2018 to December 2021 wereretrospectively analyzed. According to whether the fetus has abnormal blood flow, the pregnant women were divided in-to a study group (n=108, pregnant women with abnormal fetal blood flow) and a control group (n=50, pregnant womenwith normal fetal blood flow). The perinatal and neonatal outcomes were compared between the two groups of pregnantwomen. Results The proportion of pregnant women with gestational hypertension (HDP) and the use of glucocorti-coids in the study group were 43.52% and 54.63%, which were significantly higher than 26.00% and 28.00% in the con-trol group (P<0.05). However, there was no statistically significant difference between the two groups of pregnant wom-en in terms of pre-pregnancy BMI, age, postpartum women, weight gain during pregnancy, diagnostic gestational week,gestational frequency≥2, and the proportion of concomitant immune system diseases (P>0.05). The proportion of oligo-hydramnios, cesarean section rate, and selective cesarean section rate in the study group were 34.26% , 80.56% , and22.22%, which were significantly higher than 18.00%, 64.00%, and 6.00% in the control group (P<0.05). The placen-tal weight, volume, and gestational age of the study group were (405.68±101.82) g, (493.76±108.52) cm3, and (34.92±2.58) weeks, which were significantly lower than (473.52±80.31) g, (628.35±201.74) cm3, and (37.11±2.60) weeks in thecontrol group (P<0.05). The birth weight of newborns in the study group was (1 753.26±481.35) g, which was signifi-cantly lower than (2 207.59±356.42) g of the control group; the proportion of premature birth, ventricular hemorrhage,1-minute Apgar score≤7, and admission rate to NICU were 60.19%, 10.19%, 32.41%, and 83.33%, which were signifi-cantly higher than 26.00%, 0, 4.00%, and 54.00% in the control group; the differences were statistically significant (P<0.05). Conclusion FGR combined with abnormal blood flow can affect perinatal outcomes. Monitoring of pregnantwomen with FGR combined with abnormal blood flow during pregnancy should be strengthened to extend the gestation-al week as much as possible. If fetal distress and serious complications occur in the uterus, pregnancy should be terminat-ed in a timely manner.
      【Key words】 Early onset fetal growth restriction; Abnormal blood flow; Perinatal outcomes; Neonatal outcomes