无创心排量NICOM在胎儿生长受限诊断中的应用
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胎儿生长受限(FGR)
Additionally, may be referred to Intrauterine Growth Restriction(IUGR)
• 胎儿不能达到其基因确定的大小胎儿在子 宫停止生长或放慢出现围产期并发症包括 发病和死亡发病率5% - 10of all pregnancies
PRE-ECLAMPSIA
Pre-eclampsia • Definition;
– Diastolic blood pressure is more than 90 mmHg on at least 2 x occasions 4 hours apart in previously normotensive women
• 胎儿生长受限依然生产时死胎和婴儿死亡 增加3-7 倍
• 败血症发生也增加3-7 倍 • 增加所有病因的死亡率Increase in all major
causes of foetal morbidity • 特别的，也与后期的身体不健康相关
Additionally, associated with poorer health in later life
产科 -胎儿生长受限FGR
Cheetah Medical 2015
1
CONTENT
• 胎儿生长受限是啥What is Foetal Growth restriction
• 胎儿生长受限风险人群Who is at risk of FGR • 胎儿生长受限的发展Development of FGR • 妊娠毒血症What is Pre-eclampsia • 事实和数据Facts and Figures • 治疗Current treatment • 临床研究Clinical Studies • NICOM的机遇 opportunities
– Proteinuria of 300 mg or more in 24 hours or two readings of at least ++ on dipstick analysis of midstream or catheter urine specimens if no 24 hour available
FGR是围产期出生前后立即病发和死亡的主要病症 (immediately before or after birth) mortality and morbidity
References; Foetal Growth Restriction – Michael Ross – Nov. 2015
3
源自文库
Maternal demographics & haemodynamics for the prediction of FGR at booking – Nick Kemetas 2015
• 40% are constitutionally small • 20% of foetus’s are intrinsically small secondary to chromosomal or environmental aetiology
4 Reference: Foetal Growth Restriction – Michael Ross
Timing of the delivery of a FGR baby poses a serious dilemma: • to deliver early exposes the neonate to morbidity associated with immaturity • to deliver too late risks serious additional morbidity secondary to foetal hypoxia
FGR CONSEQUENCES
Diagnosis:
• Most common and simplest – measuring the distance from the mother’s fundus to the pubic bone – performed after 20 weeks gestation (proven to be 50% accurate)
induced hypertension • 胎盘和脐带异常
Placental/Umbilical cord abnormalities
• All foetus at or below the 10th percentile are at high risk of potentially developing preventable perinatal death approximately 40%
Reference; Clinical Practise guidelines for FGR – Institute of obstetricians & Gynaecologists , Health Service Executive – UK & Ireland
5
Obstetrics-Gynaecology & Womens Health – Detection and surveillance of IUGR – Oct. 2013; Danielle Tate et al
胎儿生长受限- 风险
• 孕妇年龄Maternal Age • 吸烟Smokers • 药物和酒精Drug users and alcohol • 多胎妊娠Multiple gestations • 胎儿生长受限的历史Previous
history of FGR • 糖尿病Diabetes • 营养缺乏Poor nutrition • 妊娠高血压综合征Pregnancy
• In the presence of significant risk factors for FGR; amniotic fluid volume and umbilical artery doppler is recommended from 26 weeks gestation in 2-4 weekly intervals
胎儿生长受限(FGR)
Additionally, may be referred to Intrauterine Growth Restriction(IUGR)
• 胎儿不能达到其基因确定的大小胎儿在子 宫停止生长或放慢出现围产期并发症包括 发病和死亡发病率5% - 10of all pregnancies
PRE-ECLAMPSIA
Pre-eclampsia • Definition;
– Diastolic blood pressure is more than 90 mmHg on at least 2 x occasions 4 hours apart in previously normotensive women
• 胎儿生长受限依然生产时死胎和婴儿死亡 增加3-7 倍
• 败血症发生也增加3-7 倍 • 增加所有病因的死亡率Increase in all major
causes of foetal morbidity • 特别的，也与后期的身体不健康相关
Additionally, associated with poorer health in later life
产科 -胎儿生长受限FGR
Cheetah Medical 2015
1
CONTENT
• 胎儿生长受限是啥What is Foetal Growth restriction
• 胎儿生长受限风险人群Who is at risk of FGR • 胎儿生长受限的发展Development of FGR • 妊娠毒血症What is Pre-eclampsia • 事实和数据Facts and Figures • 治疗Current treatment • 临床研究Clinical Studies • NICOM的机遇 opportunities
– Proteinuria of 300 mg or more in 24 hours or two readings of at least ++ on dipstick analysis of midstream or catheter urine specimens if no 24 hour available
FGR是围产期出生前后立即病发和死亡的主要病症 (immediately before or after birth) mortality and morbidity
References; Foetal Growth Restriction – Michael Ross – Nov. 2015
3
源自文库
Maternal demographics & haemodynamics for the prediction of FGR at booking – Nick Kemetas 2015
• 40% are constitutionally small • 20% of foetus’s are intrinsically small secondary to chromosomal or environmental aetiology
4 Reference: Foetal Growth Restriction – Michael Ross
Timing of the delivery of a FGR baby poses a serious dilemma: • to deliver early exposes the neonate to morbidity associated with immaturity • to deliver too late risks serious additional morbidity secondary to foetal hypoxia
FGR CONSEQUENCES
Diagnosis:
• Most common and simplest – measuring the distance from the mother’s fundus to the pubic bone – performed after 20 weeks gestation (proven to be 50% accurate)
induced hypertension • 胎盘和脐带异常
Placental/Umbilical cord abnormalities
• All foetus at or below the 10th percentile are at high risk of potentially developing preventable perinatal death approximately 40%
Reference; Clinical Practise guidelines for FGR – Institute of obstetricians & Gynaecologists , Health Service Executive – UK & Ireland
5
Obstetrics-Gynaecology & Womens Health – Detection and surveillance of IUGR – Oct. 2013; Danielle Tate et al
胎儿生长受限- 风险
• 孕妇年龄Maternal Age • 吸烟Smokers • 药物和酒精Drug users and alcohol • 多胎妊娠Multiple gestations • 胎儿生长受限的历史Previous
history of FGR • 糖尿病Diabetes • 营养缺乏Poor nutrition • 妊娠高血压综合征Pregnancy
• In the presence of significant risk factors for FGR; amniotic fluid volume and umbilical artery doppler is recommended from 26 weeks gestation in 2-4 weekly intervals