胎儿生长受限诊疗中的"过"与"不及":从风险识别走向精准分层管理OA

Fetal growth restriction(FGR)is a major clini-cal concern in perinatal medicine,closely related to intra-uterine fetal death,neonatal asphyxia,hypoglycemia,neo-natal necrotizing enterocolitis,and long-term metabolic and neurodevelopmental abnormalities.With the wide-spread adoption of prenatal ultrasound and perinatal sur-veillance,the antenatal detection rate of FGR has steadily improved.Nevertheless,two opposing extremes-overtreat-ment and undertreatment-persist in clinical practice.On one hand,a proportion of constitutionally small but healthy fetuses are simplistically equated with FGR,resulting in overdiagnosis followed by high-frequency monitoring,hos-pital admission for observation,iatrogenic preterm birth,and even unnecessary cesarean section.On the other hand,some truly high-risk FGR cases,especially early-onset se-vere FGR,those accompanied by abnormal blood fow,or late-onset occult FGR,may fail to receive timely and ap-propriate management because of inadequate dynamic as-sessment,nonstandardized ultrasound surveillance,de-layed referral,or insufficient perinatal preparation.The core of FGR management is not simply to detect all fetuses below the 10th percentile,but to identify those at high risk due to genuine placental insufficiency,fetal hypoxia,or pro-gressive growth impairment,and to strike a balance be-tween the risk of intrauterine fetal death and the harms as-sociated with preterm birth.This commentary discusses the overtreatment and undertreatment in FGR diagnosis and management,and proposes the establishment of a continu-ous,stratified,and interpretable precision management sys-tem based on accurate gestational age dating,standardized ultrasound measurements,appropriate growth chart selec-tion,dynamic growth velocity assessment,Doppler blood flow evaluation,and comprehensive maternal-fetal etiologi-cal investigation,thus shifting FGR management from a"single-threshold-driven"approach to a"risk-evidence-driven"paradigm.