选择性胎儿生长受限的产前管理策略及妊娠结局

Prenatal Management Strategies and Observation of Pregnancy Outcomes of Selective Fetal Growth Restriction

目的探讨选择性胎儿生长受限(selective fetal growth restriction,sFGR)的产前管理策略及妊娠结局。方法回顾性分析2015年1月~2020年6月184例sFGR孕妇及新生儿的临床资料。其中sFGRⅠ型77例,Ⅱ型89例,Ⅲ型18例。产前采用射频或微波消融减胎手术20例(均为Ⅱ型),期待治疗164例。结果减胎手术20例,获得活产儿14个,分娩孕周(36.1±3.5)周,出生体重(2378.6±741.6)g,保留胎儿活产率70.0%(14/20),围产儿存活率93.3%(14/15),无早期新生儿死亡。期待治疗164例,获得活产儿293个,分娩孕周(33.1±2.0)周,活产儿出生体重(1682.2±519.3)g,胎儿活产率89.3%(293/328),围产儿存活率89.6%(283/316),早期新生儿死亡10例。结论Ⅰ型sFGR妊娠结局良好,期待治疗是其主要的管理方式。选择性减胎手术是Ⅱ型sFGR产前管理的一个选择,可能有利于改善大胎儿的结局。

Objective To investigate the prenatal management strategies and pregnancy outcomes of selective fetal growth restriction(sFGR).Methods Clinical data of 184 pregnancies diagnosed with sFGR and their newborns from January 2015 to June 2020 was retrospectively analyzed.Of all the 184 pregnancies,77 were diagnosed as Type-Ⅰ,89 with Type-Ⅱand 18 with Type-Ⅲ,respectively.A total of 20 Type-ⅡsFGR patients underwent prenatal radiofrequency ablation or microwave ablation for selective feticide,while 164 patients were managed expectantly.Results A total of 14 live births were obtained in the 20 patients who underwent selective feticide.The mean gestational age at delivery was(36.1±3.5)weeks with a mean birth weight of(2378.6±741.6)g.The conserved fetal survival rate was 70.0%(14/20),the perinatal survival rate was 93.3%(14/15),and there was no early neonatal death.A total of 293 live births were obtained in 164 patients managed expectantly.The mean gestational age at delivery was(33.1±2.0)weeks with a mean birth weight of(1682.2±519.3)g.The fetal survival rate was 89.3%(293/328),the perinatal survival rate was 89.6%(283/316),and there were 10 early neonatal deaths.Conclusions The pregnancy outcome of type-ⅠsFGR is good and expectant treatment is the main management method.Selective feticide is an option in prenatal management for Type-ⅡsFGR,which may be beneficial for improving the outcome of large fetuses.