Obstetrics and GynecologyObstetrics and GynecologyАкушерство и гинекология0300-90922412-5679Bionika Media63604810.18565/aig.2024.93ReviewsОбзорыReview ArticleAnalytical review of the national and international clinical guidelines for the management of pregnancies complicated by fetal growth restrictionАналитический обзор национальных и международных клинических рекомендаций по ведению беременности, осложненной задержкой роста плодаhttps://orcid.org/0000-0001-8159-3714KhodzhaevaZulfiya S.ХоджаеваЗульфия Сагдуллаевна
Russian Federation

Dr. Med. Sci., Professor, Deputy Director, Institute of Obstetrics

д.м.н., профессор, заместитель директора по научной работе, Институт акушерства

z_khodzhaeva@oparina4.ruhttps://orcid.org/0009-0001-2049-3119StolyarovaElizaveta V.СтоляроваЕлизавета Валерьевна
Russian Federation

PhD Student, 1st Obstetric Department of Pregnancy Pathology

аспирант, 1-е отделение акушерское патологии беременности

ev_stolyarova@oparina4.ruhttps://orcid.org/0000-0002-4068-9805KholinAlexey M.ХолинАлексей Михайлович
Russian Federation

PhD, Head of the Department of Telemedicine

к.м.н., руководитель отдела телемедицины

a_kholin@oparina4.ruhttps://orcid.org/0000-0003-1377-3128GusAlexander I.ГусАлександр Иосифович
Russian Federation

Dr. Med. Sci., Chief Researcher at the Department of Ultrasound and Functional Diagnostics; Head of the Department of Ultrasound Diagnostics, Medical Institute

д.м.н., профессор, главный н.с. отделения ультразвуковой и функциональной диагностики, Отдел визуальной диагностики; заведующий кафедрой ультразвуковой диагностики факультета непрерывного медицинского образования Медицинского института

a_gus@oparina4.ruAcademician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава РоссииPatrice Lumumba Peoples’ Friendship University of RussiaФГАОУ ВО «Российский университет дружбы народов имени Патриса Лумумбы»1808202485131509202415092024Copyright ©; 2024, Bionika MediaCopyright ©; 2024, ООО «Бионика Медиа»2024Bionika MediaООО «Бионика Медиа»https://journals.eco-vector.com/0300-9092/article/view/636048

Fetal growth restriction (FGR) affects about 10% of pregnancies and it is a leading cause of stillbirth, neonatal mortality and morbidity. In addition to immediate complications, it has metabolic imprinting and affects perinatal programming.

Among the great obstetrical syndromes, FGR occupies a special place, primarily due to the lack of clinical manifestations. In this regard, modern obstetric tactics are based solely on functional methods of diagnostics of the fetal condition. The existing clinical guidelines and protocols on this issue make it much easier for clinicians to decide on an emergency delivery. At the same time, clinical situations where a balance must be achieved between prolongation of pregnancy and the risk of antenatal fetal death require close monitoring of specific anatomical zones of fetal-placental circulation, depending on the gestational age. This review presents the analysis of the national (Russian Society of Obstetricians and Gynecologists) and international (FIGO, ISUOG, SMFM, ACOG) clinical guidelines and protocols in order to form a consensus approach and, if necessary, to identify areas for further research to standardize obstetric management of pregnant women with FGR.

Conclusion: Future research should focus on determining differentiated functional diagnostic test scores based on estimated fetal weight, gestational age, patient condition, and neonatal development. Such a practical approach based on randomized trials and its implementation in clinical guidelines will reduce perinatal morbidity and mortality, as well as improve long-term outcomes in late FGR.

Задержка роста плода (ЗРП) осложняет около 10% беременностей, является ведущей причиной мертворождения, неонатальной смертности и заболеваемости, в рамках концепции фетального и перинатального программирования оказывает эффекты метаболического импринтинга.

Среди больших акушерских синдромов ЗРП занимает особое место, в первую очередь из-за отсутствия клинических проявлений, в связи с чем современная акушерская тактика основана исключительно на функциональных методах диагностики состояния плода. Существующие клинические рекомендации и протоколы по данному вопросу значительно облегчают задачу врачам-клиницистам в случаях принятия решения об экстренном родоразрешении. Вместе с тем клинические ситуации, требующие балансирования между пролонгированием беременности и риском антенатальной гибели плода, требуют тщательного мониторинга конкретных анатомических зон плодово-плацентарного кровообращения в зависимости от срока беременности. Данный обзор посвящен анализу отечественных (РОАГ) и международных (FIGO, ISUOG, SMFM, ACOG) клинических рекомендаций и протоколов с целью возможности формирования консенсусного подхода, а при необходимости – определения направлений дальнейших исследований для стандартизации акушерского менеджмента беременных с ЗРП.

Заключение: По нашему мнению, будущие исследования должны быть перенесены в плоскость определения дифференцированных показателей тестов функциональной диагностики в зависимости от предполагаемой массы плода, гестационного возраста, состояния пациентки и особенностей развития новорожденных. Подобный практический подход, основанный на проведении рандомизированных исследований, и внедрение его в клинические рекомендации позволят снизить перинатальную заболеваемость и смертность, а также улучшить отдаленные исходы при поздней ЗРП.

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