目的:比较根据2015年发表的国际妇产科超声学会(ISUOG)定义诊断的选择性胎儿生长受限(sFGR)的单绒毛膜妊娠队列的结局,以及根据2019年发表的新专家共识诊断参数被视为sFGR的队列。方法:这是一项回顾性研究,在2010年1月1日至2019年7月30日期间进行。我们回顾了我们中心所有单绒毛膜妊娠的医疗记录,包括围产期结局。怀孕并发胎儿异常,感染,双胎输血综合征,双胎贫血-红细胞增多症序列和双胎反向动脉灌注序列被排除.根据2015年ISUOG定义将患者分组为:正常(第1组),sFGR(第2组),和生长异常的单绒毛膜妊娠不符合sFGR的全部标准(第3组)。在进行了初步分类之后,一个额外的群体,被创造,包括根据2019年专家共识参数(第4组)重新分类为sFGR的所有妊娠。结果:在研究期间,我们中心跟踪291例单绒毛膜妊娠,其中132人符合纳入最终分析的资格。在将基于专家共识的参数应用于研究人群后,sFGR的患病率从17.4%增加到26.5%。与第1组相比,第2组的急诊剖宫产率更高,新生儿重症监护入院,有创和无创通气,表面活性剂的使用,代谢紊乱和出生时胎龄较低。相比之下,第1组和第4组的新生儿结局无显著差异.结论:当2019年基于共识的sFGR诊断参数应用于我们的研究人群时,sFGR病例数量增加了50%以上,围产期结局没有任何改善。需要更大的前瞻性研究来检查这些新参数对单绒毛膜妊娠sFGR的潜在临床意义。
Objective: To compare the outcomes of a cohort of monochorionic pregnancies with selective fetal growth restriction (sFGR) diagnosed according to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) definition published in 2015 with a cohort considered as sFGR according to new expert
consensus-based diagnostic parameters published in 2019.Methods: This was a retrospective study, conducted between January 1st 2010 and July 30th 2019. We reviewed the medical records of all the monochorionic pregnancies followed in our center including perinatal outcomes. Pregnancies complicated by fetal anomalies, infection, twin-twin transfusion syndrome, twin anaemia-polycythemia sequence and twin reversed arterial perfusion sequence were excluded. Patients were grouped according to the 2015 ISUOG definition into: normal (Group 1), sFGR (Group 2), and monochorionic pregnancies with abnormal growth that did not fulfill the full criteria for sFGR (Group 3). After the initial classifications were made, an additional group, was created, including all pregnancies reclassified as sFGR according to the 2019 expert
consensus parameters (Group 4).Results: During the study period, 291 monochorionic pregnancies were followed in our center, 132 of whom were eligible for inclusion in the final analysis. The prevalence of sFGR increased from 17.4% to 26.5% after applying the expert
consensus-based parameters to the study population. Compared to group 1, group 2 had higher rates of emergency cesarean, neonatal intensive care admissions, invasive and noninvasive ventilation, surfactant use, metabolic disorders and lower gestational ages at birth. In contrast, the neonatal outcomes of Groups 1 and 4 were not significantly different.Conclusion: When the 2019
consensus-based diagnostic parameters for sFGR were applied to our study population, the number of sFGR cases increased by over 50%, without any improvements in perinatal outcomes. Larger prospective studies are needed to examine the potential clinical implications of these new parameters for sFGR in monochorionic pregnancies.