Relative uteroplacental insufficiency of labor

IF 3.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Tullio Ghi, Stefania Fieni, Ruben Ramirez Zegarra, Susana Pereira, Andrea Dall'Asta, Edwin Chandraharan
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Abstract

Relative uteroplacental insufficiency of labor (RUPI-L) is a clinical condition that refers to alterations in the fetal oxygen “demand–supply” equation caused by the onset of regular uterine activity. The term RUPI-L indicates a condition of “relative” uteroplacental insufficiency which is relative to a specific stressful circumstance, such as the onset of regular uterine activity. RUPI-L may be more prevalent in fetuses in which the ratio between the fetal oxygen supply and demand is already slightly reduced, such as in cases of subclinical placental insufficiency, post-term pregnancies, gestational diabetes, and other similar conditions. Prior to the onset of regular uterine activity, fetuses with a RUPI-L may present with normal features on the cardiotocography. However, with the onset of uterine contractions, these fetuses start to manifest abnormal fetal heart rate patterns which reflect the attempt to maintain adequate perfusion to essential central organs during episodes of transient reduction in oxygenation. If labor is allowed to continue without an appropriate intervention, progressively more frequent, and stronger uterine contractions may result in a rapid deterioration of the fetal oxygenation leading to hypoxia and acidosis. In this Commentary, we introduce the term relative uteroplacental insufficiency of labor and highlight the pathophysiology, as well as the common features observed in the fetal heart rate tracing and clinical implications.

Abstract Image

Abstract Image

分娩时子宫胎盘相对不足。
分娩期相对子宫胎盘功能不全(RUPI-L)是一种临床症状,是指由于规律的子宫活动开始而引起的胎儿氧气 "供需 "方程的改变。RUPI-L 指的是一种 "相对 "的子宫胎盘功能不全,它与特定的应激情况(如开始有规律的子宫活动)有关。RUPI-L 在胎儿氧气供需比已经轻微下降的情况下可能更常见,例如亚临床胎盘功能不全、过期妊娠、妊娠糖尿病和其他类似情况。在开始有规律的子宫活动之前,有 RUPI-L 的胎儿可能在心动图上表现出正常特征。然而,随着宫缩的开始,这些胎儿开始表现出异常的胎心率模式,这反映了胎儿在一过性氧合减少时试图维持重要中央器官的充分灌注。如果不采取适当的干预措施,任由分娩继续进行,那么逐渐频繁而强烈的子宫收缩可能会导致胎儿氧合状况迅速恶化,从而导致缺氧和酸中毒。在这篇评论中,我们将介绍分娩期子宫胎盘相对不足这一术语,并着重介绍其病理生理学、胎儿心率描记中观察到的常见特征及临床意义。
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来源期刊
CiteScore
8.00
自引率
4.70%
发文量
180
审稿时长
3-6 weeks
期刊介绍: Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.
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