296例胎儿生长受限临床分析

Clinical analysis of 296 cases of fetal growth restriction

目的探讨胎儿生长受限发生的相关危险因素、终止妊娠的时机及方式，对围产儿结局的影响，为早期预防胎儿生长受限及改善围产儿结局提供临床参考。方法回顾性分析2007年7月至2011年6月间苏州大学附属第一人民医院收治的10070例单胎分娩孕妇的临床资料，其中296例胎儿生长受限，随机选取300例新生儿出生体重正常的孕妇做对照。结果①胎儿生长受限发病因素中，母体因素占56．1％，其中妊娠期高血压疾病为36．5％，在母体因素中所占比率最高，且高于对照组（Х^2=105．895，P〈0．05）；②胎儿生长受限组中，经阴道分娩组的围产儿不良结局发生率（33．6％）显著高于剖宫产分娩组（8．5％）（Х^2=29．207，P〈0．05）；③胎儿生长受限组胎儿窘迫、新生儿窒息、死胎率高于对照组，差异均有统计学意义（矿值分别为19．128、27．039、14．503，均P〈0．05）；（少胎儿生长受限〈32周分娩或≥40周后分娩的严重不良围产儿结局发生率较高。结论加强围产期保健与筛查，积极治疗妊娠合并症及并发症，有助于及早发现、预防胎儿生长受限趋势并及早治疗。预产期前适时终止妊娠，适当放宽剖宫产指征，可改善围产儿预后。

Objective To explore the risk factors of fetal growth restriction （FGR） and the influence of the way and time of pregnancy termination on perinatal outcomes, so as to provide clinical references for preventing FGR and improve outcomes of FGR in clinics. Methods Clinical data of 296 cases with FGR in 10 070 pregnant women in First Affiliated Hospital to Soochow University from July 2007 to June 2011 was retrospectively analyzed. Meanwhile, 300 cases of pregnant women which had neonates with normal birth weight were chosen as control. Results In FGR cases, maternal factors accounted for 56.1% of pathogenesis of FGR, of which hypertensive disorders complicating pregnancy demonstrated the highest proportion （ 36.5% ） and was higher than that in control group （X^2 = 105. 895, P 〈 0.05 ）. Incidence of adverse perinatal outcomes in vaginal delivery group （33.6%） was significantly higher than that in cesarean delivery group （8.5 % ）. The incidence of fetal distress, neonatal asphyxia and stillbirth in FGR group was higher than that in control group, and the differences were significant （X2 value was 19. 128, 27. 039 and 14. 503, respectively, all P 〈 0. 05 ）. The rate of adverse perinatal outcomes was relatively high in women with less than 32 or more than 40 gestational weeks. Conclusion Intensive perinatal healthcare and screening, management of pregnant complications will contribute early diagnosis, preventing the tendency of FGR and early treatment. Cesarean delivery before expected date of confinement can be considered to effectively improve the outcomes.