课件：无创心排量在胎儿生长受限诊断中的应用.pptx

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,2,胎儿生长受限(FGR),Additionally, may be referred to Intrauterine Growth Restriction(IUGR),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,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 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,3,References; Foetal Growth Restriction Michael Ross Nov. 2015 Maternal demographics & haemodynamics for the prediction of FGR at booking Nick Kemetas 2015,胎儿生长受限- 风险,4,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 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% 40% are constitutionally small 20% of foetuss are intrinsically small secondary to chromosomal or environmental aetiology Reference: Foetal Growth Restriction Michael Ross,5,5,FGR CONSEQUENCES,Diagnosis: Most common and simplest measuring the distance from the mothers fundus to the pubic bone performed after 20 weeks gestation (proven to be 50% accurate) 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,Reference; Clinical Practise guidelines for FGR Institute of obstetricians Danielle Tate et al,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,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 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 Symptoms; Hypertension Proteinuria Sudden weight gain Headaches Vision impairment Can occur from 20 weeks gestation up to 6 weeks postpartum 5 10% of all pregnancies Increased risk amongst diabetic mothers, over 40 yrs and BMI 35,6,2019/4/23,7,可编辑,FGR FACT AND FIGURES,8,Reference; European perinatal health report,9,9,FGR- TREATMENT,Ultrasound in Obstetrics Tiralongo et al,In the presence of significant risk factors for FGR, the use of low dose Aspirin in relation to FGR prevention is recommended and should be initiated prior to 16 weeks gestation Another study found that given a gene medicine ( Vascular Endothelia Growth Factor VEGF) to uterine arteries increased maternal blood flow to the placenta which increased foetal growth and birth weight Studies have also shown that in the 1st trimester decreased Cardiac Output and Stroke volume and increased peripheral resistance have been shown in women that develop FGR Studies in normotensive FGR gestations have shown the Cardiac output is reduced in the 2nd and 3rd trimester,10,10,CHEETAH STARLING SV - SOLUTION,Cardiac output/ Stroke volume Peripheral Resistance,Low dose of aspirin (daily),CO TPR,Reduced risk of FGR and pre eclampsia by 50%,11,CLINICAL STUDIES,12,12,CHEETAH STARLING SV,100% non-invasive can be used in the perinatal clinical no requirement for invasive lines Quick and easy results within 70 seconds - no additional time required during busy clinical Can be performed by the midwife no requirement for obstetrician to obtain results Cardiac output, Stroke volume and total peripheral resistance may be assessed along with Cardiac power (function