Comparative Analysis Of Clinical Factors Of Early-and Late-Onset Single Fetal Growth Restriction

Objective:1.Compare and analyze the risk factor ratio of early-and late-onset FGR,so as to provide research basis for preventing the occurrence of FGR.2.The relationship between the onset gestational week of early-and late-onset FGR and neonatal outcome was analyzed,and early screening,early detection and early intervention were carried out for high-risk pregnant and parturient women to reduce the proportion of neonatal adverse outcome.3.The Doppler blood flow monitoring indexes of early-and late-onset FGR,especially the cerebral placenta ratio（CPR）,were compared and analyzed to optimize the optimal blood flow monitoring indexes.4.Analyze the birth situation of early-and late-onset FGR newborns,understand the perinatal risks involved in delivery of different gestational ages,actively cooperate with the neonatal team to grasp the prime time for treatment of high-risk infants,so as to reduce the neonatal asphyxia rate.5.To explore the relationship between the timing of pregnancy termination of early-and late-onset FGR and neonatal outcomes,so as to provide some reference for improving maternal and infant outcomes and improving the long-term quality of life of neonates.6.To study the relationship between pregnancy termination methods of early-and late-onset FGR and neonatal outcomes,and to select the best delivery methods to reduce the incidence of adverse outcomes of neonates.Methods:Retrospective analysis was performed on the clinical data of 308 cases of fetal growth restriction who were admitted to the obstetrics department of the First Hospital of Jilin University on January 1,2015 and January 1,2021.FGR was divided into two groups:early-onset group（gestational age of FGR<32 weeks,53cases）and late-onset group（gestational age≥32 weeks,255 cases）.1.The proportions of various risk factors for FGR in the two groups were analyzed.2.The relationship between the gestational week of FGR onset and neonatal outcome in the two groups was analyzed.3.The difference of FGR Doppler blood flow monitoring indexes between the two groups was compared.4.Compare the differences in birth conditions of FGR newborns between the two groups.5.To explore the relationship between the timing of pregnancy termination and neonatal outcome in the two groups of FGR.6.To study the relationship between the methods of FGR pregnancy termination and neonatal outcome in the two groups.Results:1.Analysis of the proportions of various risk factors between the early-and late-onset groupsThe results of univariate regression analysis showed that placental factors（such as viliform placenta,low insertion placenta,villous hemangioma,placental hypofunction and placental infarction,etc.）and hypothyroidism accounted for a large proportion in the early-onset group.The proportion of oligohydramnios in the late-onset group was large,and the differences were statistically significant（P<0.05）.Multiple Logistic regression analysis showed that the P values of the three associated risk factors were all greater than 0.05,suggesting that any type of FGR was the result of the joint action of multiple risk factors.2.Analysis of the relationship between the gestational week of early-and late-onset and neonatal outcomeThe results of gestational week showed that the percentage of adverse outcomes was the largest in the early-onset group at 28-28⁺⁶weeks.The late-onset group had the highest percentage of adverse outcomes at 32-32⁺⁶weeks.3.Comparison of Doppler ultrasonographic blood flow monitoring indexes between early-and late-onset groupsThe incidence of loss of diastolic blood flow or reverse flow of umbilical artery in early-onset group was significantly higher than that in late-onset group（P<0.001）.The values of S/D and PI of the umbilical artery in the early type group were significantly higher than those in the late type group（P<0.01）.According to ROC curve analysis,CPR index has higher predictive value than middle cerebral artery and umbilical artery blood flow monitoring indexes in predicting neonatal outcome.Especially in late-onset FGR,CPR is more advantageous in predicting adverse neonatal outcomes.4.Comparison of FGR neonates in early-onset group and late-onset group（1）In the 1-minute Apgar score,P=0.000 was obtained by the chi-square test between 0 and 3 groups.The chi-square test showed that P=0.072;The chi-square test showed that P=0.000.The results showed that early-onset FGR was more prone to neonatal asphyxia than late-onset FGR.（2）In the 5-minute Apgar score,the early-onset group had lower 5-minute Apgar score than the late-onset group,and the resuscitation effect was poor,leading to the increase of endotracheal intubation rate.（3）The difference between the birth weight of early-and late-onset FGR neonates and the average normal weight of neonates in corresponding gestational weeks was compared,and it was found that the weight difference of early-onset group was larger than that of late-onset group,with statistical difference（P=0.000）.5.Analysis of the relationship between the timing of pregnancy termination and neonatal outcomes in the early-and late-onset groupsGestational results showed that the highest percentage of newborns with pregnancy termination at 33-33⁺⁶weeks in the early-onset group had a good outcome.The highest percentage of newborns with a termination at 37-37⁺⁶weeks of gestation had a good outcome in the late-onset group.6.To analyze the relationship between the mode of pregnancy termination and neonatal outcome of early-and late-onset FGR.Both early-and late-onset FGR cesarean section delivery group had a greater proportion of good neonatal outcomes than vaginal delivery group.Conclusion:1.Early-and late-onset FGR,gestational hypertension disease is a major risk factor,while the comparative differences between the two groups,but the relatively high proportion of other risk factors,the placenta factor and hypothyroidism with early-onset the occurrence of fetal growth restriction relationship more closely,oligohydramnios is late hairstyle is one of the main clinical manifestations of fetal growth restriction.But any type of FGR is the result of a combination of factors.2.Early-onset FGR at 28-28⁺⁶weeks and late-onset FGR at 32-32⁺⁶weeks accounted for the largest percentage of adverse outcomes in neonates.Once FGR is diagnosed,close monitoring and early intervention should be initiated immediately to reduce the incidence of fetal adverse outcomes.3.The sensitivity and specificity of CPR in the diagnosis of FGR were higher than those of umbilical artery and middle cerebral artery blood flow.CPR is more advantageous in predicting neonatal adverse outcomes in late-onset FGR than early-onset FGR.4.The incidence of neonatal asphyxia was higher in early-onset FGR group than in late-onset FGR group.The difference of birth weight between early-onset FGR group and the normal weight of neonates in corresponding gestational weeks was larger than that in late-onset FGR group.5.The neonatal outcome of pregnancy termination at 33-33⁺⁶weeks in the early type group and 37-37⁺⁶weeks in the late type group was better.The fetal conditions in utero were comprehensively evaluated to select the best delivery time and reduce the adverse prognosis.6.Both early-and late-onset FGR cesarean section delivery group had better neonatal outcomes than vaginal delivery group.Therefore,compared with vaginal delivery,cesarean delivery to a certain extent can reduce the occurrence of adverse outcomes of neonates.