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目的:探讨晚发型胎儿生长受限(fetal growth restriction,FGR)的相关因素及其对围产儿结局的影响。方法 :收集2012年5月~2013年10月在南京医科大学附属南京妇幼保健院分娩的140例晚发型FGR的孕妇及新生儿的临床资料,分别按有无妊娠并发症、分娩孕周(32~33+6周为Ⅰ组,34~36+6周为Ⅱ组,37~40+4周为Ⅲ组)、分娩方式分组,比较各组间新生儿的体格发育及主要疾病患病率。结果:有妊娠并发症组晚发型FGR新生儿的出生体重、身长均明显小于无并发症组;新生儿败血症、新生儿肺炎、新生儿呼吸窘迫综合征(ARDS)的患病率明显高于无并发症组。新生儿生长发育各指标与总孕周的回归系数均小于Ⅱ组,与Ⅰ组、Ⅲ组无回归关系;Ⅰ组、Ⅱ组在新生儿败血症、新生儿肺炎及ARDS的患病率均高于Ⅲ组。足月儿的出生体重、身长在剖宫产组明显小于阴道分娩组,其他在分娩方式间比较均无统计学意义。结论:晚发型FGR的胎儿在孕34~36+6周生长发育较快,其足月儿的新生儿主要疾病患病率相对较低,因此孕期可在积极治疗、密切监护的前提下,尽可能延长孕周至37周;其围产儿的结局相对较好,可以在严密监护下阴道试产。
Objective: To investigate the related factors of late-onset fetal growth restriction (FGR) and its effect on perinatal outcome. METHODS: The clinical data of 140 late-onset FGR pregnant women and newborns delivered at Nanjing Maternal and Child Health Hospital affiliated to Nanjing Medical University from May 2012 to October 2013 were collected according to the presence or absence of pregnancy complications, gestational age at birth (32 ~ 33 + 6 weeks for the group Ⅰ, 34 ~ 36 + 6 weeks for the Ⅱ group, 37 ~ 40 +4 weeks for the group Ⅲ), mode of delivery grouping, comparison between groups of newborns in the physical development and the prevalence of major diseases. Results: The birth weight and length of late-onset FGR neonates with pregnancy complications were significantly less than those without complications. The prevalence of neonatal sepsis, neonatal pneumonia and neonatal respiratory distress syndrome (ARDS) was significantly higher than that of no complications Complication group. Neonatal growth and development of each index and the total gestational weeks regression coefficients were less than Ⅱ group, and Ⅰ, Ⅲ group no regression relationship; Ⅰ group, Ⅱ group neonatal sepsis, neonatal pneumonia and ARDS prevalence were higher than Group Ⅲ. Full-term children’s birth weight, length in the cesarean section was significantly less than the vaginal delivery group, the other in the mode of delivery were no statistically significant. CONCLUSION: Fetal, late-onset FGR grows faster during 34-36 + 6 weeks of gestation and has a relatively lower prevalence of major diseases in term infants. Therefore, under the premise of active treatment and close monitoring during pregnancy, May extend the gestational age to 37 weeks; the outcome of their perinatal relatively good, can be closely monitored vaginal trial production.