住院治疗（住院治疗（ 22 ））

Department of

Reproductive centerLi ai bin

Fetal growth Fetal growth

restriction(FGR)restriction(FGR)

胎儿生长受限胎儿生长受限

Definition Definition 定义定义

孕 37周后，胎儿出生体重小于 2500g 或低于同孕龄平均体重的两个标准差，或低于同孕龄正常体重的第十百分数

when the unborn baby is at or below the 10th weightpercentile for his or her age (in weeks); Neonates Birth weights below 2500g

FGR

女性生殖系统生理2008\孕周全1.exe

IncidenceIncidence 发生率发生率 3 -3 -77% % of infants are growth of infants are growth

restrictedrestricted

Complications并发症

Maternal母体

Fetal胎儿

Neonatal新生儿

Risk factors for FGR危险因素

E

D C

B

A

FGR

mmaternalaternal 母体母体

ffetaletal 胎儿胎儿

placentalplacental胎盘胎盘

umbilical cordumbilical cord脐带脐带

unknow未知

Risk factors – maternalRisk factors – maternal

Malnutrition (anorexia nervosa)Malnutrition (anorexia nervosa) 营养 营养 Cardiovascular diseases (cardiac failures, hypCardiovascular diseases (cardiac failures, hyp

ertension,)ertension,) 心血管疾病心血管疾病 Gastroenteric diseases (chronic enteritis, malGastroenteric diseases (chronic enteritis, mal

absorption diseases)absorption diseases)

消化道疾病消化道疾病 Alcohol and drug abuse, smoking, Uterine abAlcohol and drug abuse, smoking, Uterine ab

normalities normalities 酗酒酗酒 .. 吸毒吸毒 .. 子宫畸形子宫畸形

Risk factors – fetalRisk factors – fetal

. . chromosomal abnormalitieschromosomal abnormalities

染色体染色体. . structural malformationsstructural malformations

结构结构

. . fetal infectionsfetal infections :TORCH :TORCH 胎儿感染胎儿感染. . multiple fetusmultiple fetus 多胎 多胎

Placental factors Placental factors 胎盘胎盘

PlacentalPlacental factors factors

abruptio placenta placenta previa

PlacentalPlacental factors factors

Cord abnormalitiesCord abnormalities脐 带 异 常脐 带 异 常

脐 带 异 常脐 带 异 常

正常脐带

单脐动脉 单脐动脉 Single cord arterySingle cord artery

normal umbilical cordnormal umbilical cord

AnencephalusAnencephalus

无脑儿无脑儿

Spina Bifida Spina Bifida 脊柱裂脊柱裂

Hydrocephalus Hydrocephalus 脑积水脑积水

脐 带 真 结脐 带 真 结 Cord hootCord hoot

OtherOther abnormal umbilical cordabnormal umbilical cord

长度异常 长度异常 Abnormal length of umbilical cordAbnormal length of umbilical cord

脐带缠绕 脐带缠绕 Cord entanglementCord entanglement

脐带扭转 脐带扭转 Torsion of cordTorsion of cord

脐带附着异常 脐带附着异常 Cord velamentous insertionCord velamentous insertion

Three types of patterns of FGRThree types of patterns of FGR

Symmetric Symmetric 匀称型匀称型

AsymmetricAsymmetric 非匀称型非匀称型

Mixed typeMixed type混合型混合型

FGR

Fetal growth has been Fetal growth has been divided into three phasesdivided into three phases

1-1-cellular cellular

hyperplasiahyperplasia

2- hyperplasy 2- hyperplasy

&hypertrophy&hypertrophy

3- 3- hhypertrophyypertrophy

cell sizecell size fat depositionfat deposition fetal weightfetal weight ga ga

inin as much as as much as 0.5 kg0.5 kg per per weekweek..

ClassificationClassification 分类分类

SymmetricSymmetricll AAsymmetricalsymmetrical

baby's brain is baby's brain is abnormally large when abnormally large when compared to the livercompared to the liver..may occur when the may occur when the fetusfetus experiences a problem experiences a problem during later developmentduring later development

the baby's head and the baby's head and body are body are proportionately smallproportionately small. . may occur when the may occur when the fetus fetus experiences a experiences a problem during early problem during early developmentdevelopment..

Mixed Mixed typetype

symmetrical

An early insult due to : chemical viral aneuploidy

Cell sizeCell num.

Proportionate reduction in head & body

Normal & Normal & FFGRGR

Newborn babiesNewborn babiesNormal & Normal & FFGR PlacentasGR Placentas

A late pregnancy insult such as A late pregnancy insult such as

placental insufficiency would placental insufficiency would

affect cell sizeaffect cell size

Asymmetrical

asymmetric growth restrictionasymmetric growth restriction非匀称型非匀称型

1. Heads usually normal.

2. Head larger than the abdomen.

3. Usually due to extrinsic factors

4. Something leads to decreased supply of nutrients and oxygen -the baby

头围正常头围大于腹围多由外因造成有害因素造成

胎儿营养和氧气

供给减少

mixed typemixed type 混合型混合型

Number of cellsNumber of cells↓↓

细胞数量细胞数量

The size of the cells The size of the cells ↓↓ 细胞体积细胞体积

•History 病史•Clinic indication

临床体征•Ultrasound test B 超•Biophysical tests 生物物理评分

Treatment Treatment 治疗治疗

FGR has FGR has many causes, therefore, causes, therefore,

there is not one treatment that there is not one treatment that

always worksalways works

ManagementManagement处理处理

根据监护情况，尽量延长孕龄，降低新生儿发病

率、死亡率越早越好

Maximizes estational agMaximizes estational age .e .Minimizing the risks oMinimizing the risks of neonatal morbidity anf neonatal morbidity and mortalityd mortalityTreatment as early as Treatment as early as possiblepossible

原则Depend on a surDepend on a surveillance planveillance plan . .

孕期治疗孕期治疗一般治疗 一般治疗 Maternal bed rest

补充营养 补充营养 nutritional

supplementation, zinc

supplementation, and oxygen therapy

药物治疗 药物治疗 Aspirin TherapyAspirin Therapy

Timing of deliveryTiming of delivery分娩时机分娩时机

Judge Optimum Time Of DeliveryJudge Optimum Time Of Delivery

Risk of stillbirth 死产风险

Risk of Prematurity早产风险

FFGR. REMOTE FROM TERMGR. REMOTE FROM TERM未足月的未足月的 FGRFGR

before 34 wkNormal （羊水正常） Amniotic volumeNormal （胎儿监护正常）fetal surveillance

Observation观察

Sono is repeated at interval 2-3 wk

终止妊娠指征终止妊娠指征治疗后无改善，治疗后无改善， NSTNST 无反应，生物无反应，生物

物理评分物理评分 44 －－ 66 分分胎儿宫内缺氧表现胎儿宫内缺氧表现治疗中妊娠合并症、并发症加重，继治疗中妊娠合并症、并发症加重，继

续妊娠危机母婴健康或生命续妊娠危机母婴健康或生命未足月，先促肺成熟未足月，先促肺成熟

分娩方式选择分娩方式选择

权衡利弊，综合判断，放宽权衡利弊，综合判断，放宽手术指征手术指征

阴道试产阴道试产 剖宫产剖宫产

Prevention Prevention 预防预防

More frequent prenatal More frequent prenatal

visits,early detection ,early visits,early detection ,early

diagnosis and treatment.diagnosis and treatment.

Pay attention - risk factorsPay attention - risk factors

Ultrasound testUltrasound test

Aspirin et alAspirin et al

Latest advancementLatest advancement最新进展最新进展

着床前诊断着床前诊断

多胎减胎技术多胎减胎技术

胎儿宫内手术问题胎儿宫内手术问题

What are difference among the three types of FGR ?

FGR

SymmetricSymmetric IntermediateIntermediate asymmetricasymmetric

The classroomThe classroom discussiondiscussion课堂讨论课堂讨论

Summary Summary 　　小结小结

Definition

Treatment principle

Diagnostic method

Aetiology FGR

What are the risk factors of FGR

?

Tell me how to prevent FGR ?

The treatment of FGR

Main ReferencesMain References主要参考文献主要参考文献

丰有吉 ,沈铿 ,马丁 ,妇产科学 [M]. 人民卫生出版社 ,2005,113-116

ANDREW McCARTHY, BILL HUNIER. Obstetric

s and Gynaecology[M].Beijing University Medci

al Press, BeiJing,2003;55-60

Preview Preview 预习预习Fetal MacrosomiaFetal Macrosomia

巨大儿