背景:腹裂和脐膨出是两种最常见的先天性胎儿腹壁缺损。两种畸形通常都与胎龄小的新生儿有关。然而,生长受限的程度和原因在腹裂和脐膨出中仍然存在争议,没有相关的畸形或非整倍体。
目的:本研究旨在研究胎盘和出生体重与胎盘重量比在腹壁缺陷胎儿中的作用。
方法:本研究包括2001年1月至2020年12月在我院检查的所有腹壁缺损病例,并从医院软件中检索数据。有任何其他合并先天性异常的胎儿,已知的染色体异常,或失去随访被排除。总的来说,28例单胎妊娠伴腹裂和24例单胎妊娠伴脐膨出符合纳入标准。对患者特征和妊娠结局进行了回顾。主要结果是研究分娩后测量的腹壁缺陷妊娠中出生体重与胎盘重量之间的关系。校正胎龄并比较胎盘总重量,计算了单胎中给定胎龄的观察出生体重和预期出生体重之间的比率.将缩放指数β与参考值0.75进行比较。使用GraphPadPrism(8.2.1版;GraphPad软件,圣地亚哥,CA)和IBMSPSSStatistics。<.05的P值表示统计学显著性。
结果:胎儿腹裂的孕妇明显更年轻,更常见的是未产。此外,在这个群体中,分娩的胎龄明显提前,几乎完全用于剖宫产.28个孩子,13例(46.7%)出生时小于胎龄,其中只有3例(10.7%)胎盘重量<10%。出生体重百分位数和胎盘体重百分位数之间没有相关性(P=不显著)。然而,在脐膨出组中,24名儿童中有4名(16.7%)出生时小于胎龄(<10%),所有儿童的胎盘重量也<10%。出生体重百分位数与胎盘体重百分位数之间存在显著相关性(P<0.0001)。出生体重与胎盘体重的比率在诊断为腹裂的妊娠和诊断为脐膨出的妊娠之间存在显着差异(4.48[3.79-4.91]vs6.05[5.38-6.47],分别;P<.0001)。异速代谢缩放显示,并发腹裂的胎盘和并发脐膨出的胎盘不随出生体重而缩放。
结论:腹裂胎儿宫内发育受损,这似乎不同于经典的胎盘功能不全生长限制。
BACKGROUND: Gastroschisis and omphalocele are the 2 most common congenital fetal abdominal wall defects. Both malformations are commonly associated with small-for-gestational-age neonates. However, the extent and causes of growth restriction remain controversial in both gastroschisis and omphalocele without associated malformations or aneuploidy.
OBJECTIVE: This study aimed to examine the role of the placenta and the birthweight-to-placental weight ratio in fetuses with abdominal wall defects.
METHODS: This study included all cases of abdominal wall defects examined at our hospital between January 2001 and December 2020, retrieving the data from the hospital\'s software. Fetuses with any other combined congenital anomalies, known chromosomal abnormalities, or lost to follow-up were excluded. Overall, 28 singleton pregnancies with gastroschisis and 24 singleton pregnancies with omphalocele met the inclusion criteria. Patient characteristics and pregnancy outcomes were reviewed. The primary outcome was to investigate the association between birthweight and placental weight in pregnancies with abdominal wall defects as measured after delivery. To correct for gestational age and to compare total placental weights, ratios between the observed and expected birthweights for the given gestational age in singletons were calculated. The scaling exponent β was compared with the reference value of 0.75. Statistical analysis was performed using GraphPad Prism (version 8.2.1; GraphPad Software, San Diego, CA) and IBM SPSS Statistics. A P value of <.05 indicated statistical significance.
RESULTS: Women pregnant with a fetus with gastroschisis were significantly younger and more often nulliparous. In addition, in this group, the gestational age of delivery was significantly earlier and almost exclusively for cesarean delivery. Of 28 children, 13 (46.7%) were born small for gestational age, only 3 of them (10.7%) had a placental weight <10th percentile. There is no correlation between birthweight percentiles and placental weight percentiles (P=not significant). However, in the omphalocele group, 4 of 24 children (16.7%) were born small for gestational age (<10th percentile), and all children also had a placental weight <10th percentile. There is a significant correlation between birthweight percentiles and placental weight percentiles (P<.0001). The birthweight-to-placental weight ratio differs significantly between pregnancies diagnosed with gastroschisis and pregnancies diagnosed with omphalocele (4.48 [3.79-4.91] vs 6.05 [5.38-6.47], respectively; P<.0001). Allometric metabolic scaling revealed that placentas complicated by gastroschisis and placentas complicated by omphalocele do not scale with birthweight.
CONCLUSIONS: Fetuses with gastroschisis displayed impaired intrauterine growth, which seemed to differ from the classical placental insufficiency growth restriction.