Abstract：
To describe the incidence, clinical features and perinatal outcome of late-onset fetal growth restriction (FGR) associated with genetic syndrome or aneuploidy, structural malformation or congenital infection.
This was a retrospective multicenter cohort study of patients who attended one of four tertiary maternity hospitals in Italy. We included consecutive singleton pregnancies between 32 + 0 and 36 + 6 weeks\' gestation with either fetal abdominal circumference (AC) or estimated fetal weight < 10th percentile for gestational age or a reduction in AC of > 50 percentiles from the measurement at an ultrasound scan performed between 18 and 32 weeks. The study group consisted of pregnancies with late-onset FGR and a genetic syndrome or aneuploidy, structural malformation or congenital infection (anomalous late-onset FGR). The presence of congenital anomalies was ascertained postnatally in neonates with abnormal findings on antenatal investigation or detected after birth. The control group consisted of pregnancies with structurally and genetically normal fetuses with late-onset FGR. Composite adverse perinatal outcome was defined as the presence of at least one of stillbirth, 5-min Apgar score < 7, admission to the neonatal intensive care unit (NICU), need for respiratory support at birth, neonatal jaundice and neonatal hypoglycemia. The primary aims of the study were to assess the incidence and clinical features of anomalous late-onset FGR, and to compare the perinatal outcome of such cases with that of fetuses with non-anomalous late-onset FGR.
Overall, 1246 pregnancies complicated by late-onset FGR were included in the study, of which 120 (9.6%) were allocated to the anomalous late-onset FGR group. Of these, 11 (9.2%) had a genetic syndrome or aneuploidy, 105 (87.5%) had an isolated structural malformation, and four (3.3%) had a congenital infection. The most frequent structural defects associated with late-onset anomalous FGR were genitourinary malformations (28/105 (26.7%)) and limb malformation (21/105 (20.0%)). Compared with the non-anomalous late-onset FGR group, fetuses with anomalous late-onset FGR had an increased incidence of composite adverse perinatal outcome (35.9% vs 58.3%; P < 0.01). Newborns with anomalous, compared to those with non-anomalous, late-onset FGR showed a higher frequency of need for respiratory support at birth (25.8% vs 9.0%; P < 0.01), intubation (10.0% vs 1.1%; P < 0.01), NICU admission (43.3% vs 22.6%; P < 0.01) and longer hospital stay (median, 24 days (range, 4-250 days) vs 11 days (range, 2-59 days); P < 0.01).
Most pregnancies complicated by anomalous late-onset FGR have structural malformations rather than genetic abnormality or infection. Fetuses with anomalous late-onset FGR have an increased incidence of complications at birth and NICU admission and a longer hospital stay compared with fetuses with isolated late-onset FGR. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
This was a retrospective multicenter cohort study of patients who attended one of four tertiary maternity hospitals in Italy. We included consecutive singleton pregnancies between 32 + 0 and 36 + 6 weeks\' gestation with either fetal abdominal circumference (AC) or estimated fetal weight < 10th percentile for gestational age or a reduction in AC of > 50 percentiles from the measurement at an ultrasound scan performed between 18 and 32 weeks. The study group consisted of pregnancies with late-onset FGR and a genetic syndrome or aneuploidy, structural malformation or congenital infection (anomalous late-onset FGR). The presence of congenital anomalies was ascertained postnatally in neonates with abnormal findings on antenatal investigation or detected after birth. The control group consisted of pregnancies with structurally and genetically normal fetuses with late-onset FGR. Composite adverse perinatal outcome was defined as the presence of at least one of stillbirth, 5-min Apgar score < 7, admission to the neonatal intensive care unit (NICU), need for respiratory support at birth, neonatal jaundice and neonatal hypoglycemia. The primary aims of the study were to assess the incidence and clinical features of anomalous late-onset FGR, and to compare the perinatal outcome of such cases with that of fetuses with non-anomalous late-onset FGR.
Overall, 1246 pregnancies complicated by late-onset FGR were included in the study, of which 120 (9.6%) were allocated to the anomalous late-onset FGR group. Of these, 11 (9.2%) had a genetic syndrome or aneuploidy, 105 (87.5%) had an isolated structural malformation, and four (3.3%) had a congenital infection. The most frequent structural defects associated with late-onset anomalous FGR were genitourinary malformations (28/105 (26.7%)) and limb malformation (21/105 (20.0%)). Compared with the non-anomalous late-onset FGR group, fetuses with anomalous late-onset FGR had an increased incidence of composite adverse perinatal outcome (35.9% vs 58.3%; P < 0.01). Newborns with anomalous, compared to those with non-anomalous, late-onset FGR showed a higher frequency of need for respiratory support at birth (25.8% vs 9.0%; P < 0.01), intubation (10.0% vs 1.1%; P < 0.01), NICU admission (43.3% vs 22.6%; P < 0.01) and longer hospital stay (median, 24 days (range, 4-250 days) vs 11 days (range, 2-59 days); P < 0.01).
Most pregnancies complicated by anomalous late-onset FGR have structural malformations rather than genetic abnormality or infection. Fetuses with anomalous late-onset FGR have an increased incidence of complications at birth and NICU admission and a longer hospital stay compared with fetuses with isolated late-onset FGR. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
摘要：
为了描述发生率，与遗传综合征或非整倍体相关的晚发性胎儿生长受限（FGR）的临床特征和围产期结局，结构畸形或先天性感染。
这是一项回顾性多中心队列研究，对意大利四家三级妇产医院之一的患者进行了研究。我们纳入了妊娠32+0至36+6周的连续单胎妊娠，胎儿腹围(AC)或估计胎儿体重<胎龄的第10百分位数，或在18至32周之间进行超声扫描时测量的AC减少>50百分位数。研究组由患有迟发性FGR和遗传综合征或非整倍性的妊娠组成，结构畸形或先天性感染（异常迟发性FGR）。在产前检查发现异常或出生后发现的新生儿中，在出生后确定了先天性异常的存在。对照组包括结构和遗传正常胎儿的妊娠，并伴有迟发性FGR。复合不良围产期结局定义为至少有一次死胎，5分钟Apgar评分<7分，入院新生儿重症监护病房（NICU），出生时需要呼吸支持，新生儿黄疸和新生儿低血糖。该研究的主要目的是评估异常迟发性FGR的发生率和临床特征，并比较此类病例与无异常迟发性FGR胎儿的围产期结局。
总的来说，1246例妊娠合并迟发性FGR被纳入研究，其中120例(9.6%)被分配到异常晚发型FGR组.其中,11人（9.2％）患有遗传综合征或非整倍性，105(87.5%)有孤立的结构畸形，4人(3.3%)患有先天性感染。与迟发性异常FGR相关的最常见的结构缺陷是泌尿生殖系统畸形（28/105（26.7％））和肢体畸形（21/105（20.0％））。与非异常迟发性FGR组相比，晚发型FGR异常胎儿的复合不良围产期结局发生率增加(35.9%vs58.3%;P<0.01).新生儿异常，与那些没有异常的人相比，晚发型FGR在出生时需要呼吸支持的频率更高（25.8%vs9.0%；P<0.01），插管（10.0％vs1.1％；P<0.01），NICU入院（43.3%vs22.6%；P<0.01）和住院时间延长（中位数，24天（范围，4-250天）vs11天（范围，2-59天）；P<0.01）。
大多数妊娠合并异常迟发性FGR具有结构畸形，而不是遗传异常或感染。与具有孤立的晚发型FGR的胎儿相比，具有异常晚发型FGR的胎儿在出生和NICU入院时的并发症发生率增加，住院时间更长。©2022作者由JohnWiley&SonsLtd代表国际妇产科超声学会出版的妇产科超声。
这是一项回顾性多中心队列研究，对意大利四家三级妇产医院之一的患者进行了研究。我们纳入了妊娠32+0至36+6周的连续单胎妊娠，胎儿腹围(AC)或估计胎儿体重<胎龄的第10百分位数，或在18至32周之间进行超声扫描时测量的AC减少>50百分位数。研究组由患有迟发性FGR和遗传综合征或非整倍性的妊娠组成，结构畸形或先天性感染（异常迟发性FGR）。在产前检查发现异常或出生后发现的新生儿中，在出生后确定了先天性异常的存在。对照组包括结构和遗传正常胎儿的妊娠，并伴有迟发性FGR。复合不良围产期结局定义为至少有一次死胎，5分钟Apgar评分<7分，入院新生儿重症监护病房（NICU），出生时需要呼吸支持，新生儿黄疸和新生儿低血糖。该研究的主要目的是评估异常迟发性FGR的发生率和临床特征，并比较此类病例与无异常迟发性FGR胎儿的围产期结局。
总的来说，1246例妊娠合并迟发性FGR被纳入研究，其中120例(9.6%)被分配到异常晚发型FGR组.其中,11人（9.2％）患有遗传综合征或非整倍性，105(87.5%)有孤立的结构畸形，4人(3.3%)患有先天性感染。与迟发性异常FGR相关的最常见的结构缺陷是泌尿生殖系统畸形（28/105（26.7％））和肢体畸形（21/105（20.0％））。与非异常迟发性FGR组相比，晚发型FGR异常胎儿的复合不良围产期结局发生率增加(35.9%vs58.3%;P<0.01).新生儿异常，与那些没有异常的人相比，晚发型FGR在出生时需要呼吸支持的频率更高（25.8%vs9.0%；P<0.01），插管（10.0％vs1.1％；P<0.01），NICU入院（43.3%vs22.6%；P<0.01）和住院时间延长（中位数，24天（范围，4-250天）vs11天（范围，2-59天）；P<0.01）。
大多数妊娠合并异常迟发性FGR具有结构畸形，而不是遗传异常或感染。与具有孤立的晚发型FGR的胎儿相比，具有异常晚发型FGR的胎儿在出生和NICU入院时的并发症发生率增加，住院时间更长。©2022作者由JohnWiley&SonsLtd代表国际妇产科超声学会出版的妇产科超声。
