Bahado-Singh R O, Kovanci E, Jeffres A, Oz U, Deren O, Copel J, Mari G
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Am J Obstet Gynecol. 1999 Mar;180(3 Pt 1):750-6. doi: 10.1016/s0002-9378(99)70283-8.
Our purpose was to determine whether the Doppler cerebroplacental ratio predicts perinatal outcome in fetuses at risk for intrauterine growth restriction.
The middle cerebral and umbilical artery pulsatility index values were measured in 203 fetuses at risk for intrauterine growth restriction, of which 123 were delivered <3 weeks after the last Doppler examination. Perinatal outcome was categorized as (1) birth weight <10th percentile, (2) birth weight <5th percentile, (3) perinatal complications (meconium-stained fluid, cesarean section for fetal distress, 5-minute Apgar score <7, perinatal death, neonatal intensive care unit stay >24 hours, hypoglycemia, or polycythemia), (4) birth weight <10th percentile plus complications, and (5) birth weight <5th percentile plus complications. The cerebroplacental ratio (middle cerebral artery pulsatility index divided by umbilical artery pul-satility index) values were expressed as multiples of the normal median. Receiver-operator characteristic curves (sensitivity vs false-positive rates) were plotted for the prediction of each category of perinatal outcome and the areas under the curves were determined. Stepwise logistic regression analyses were used to determine whether the cerebroplacental ratio improved outcome prediction over umbilical artery Doppler imaging alone.
There was a statistically significant increase in perinatal morbidity and mortality in cases with an abnormal cerebroplacental ratio. The areas under the receiver-operator curves characteristics for the prediction of perinatal outcome with use of the cerebroplacental ratio were statistically very significant. For birth weight <10th percentile we noted P <.001, with P <.0001 for each of the other 4 outcome categories. As shown by regression analyses, the cerebroplacental ratio appeared to improve the prediction of perinatal outcome compared with umbilical artery velocimetry alone. An interesting finding was that the cerebroplacental ratio did not appear to correlate significantly with outcome in fetuses at >34 weeks.
Doppler identification of the fetal "brain-sparing" effect strongly predicts outcome in fetuses at risk for intrauterine growth restriction. The brain-sparing effect predicted perinatal problems only in fetuses <34 weeks' gestation at the Doppler examination.
我们的目的是确定多普勒脑胎盘比值是否能预测有宫内生长受限风险胎儿的围产期结局。
对203例有宫内生长受限风险的胎儿测量大脑中动脉和脐动脉搏动指数值，其中123例在末次多普勒检查后<3周分娩。围产期结局分为以下几类：（1）出生体重<第10百分位数；（2）出生体重<第5百分位数；（3）围产期并发症（羊水胎粪污染、因胎儿窘迫行剖宫产、5分钟Apgar评分<7、围产期死亡、新生儿重症监护病房住院时间>24小时、低血糖或红细胞增多症）；（4）出生体重<第10百分位数加并发症；（5）出生体重<第5百分位数加并发症。脑胎盘比值（大脑中动脉搏动指数除以脐动脉搏动指数）值表示为正常中位数的倍数。绘制受试者工作特征曲线（灵敏度与假阳性率）以预测每种围产期结局类别，并确定曲线下面积。采用逐步逻辑回归分析确定脑胎盘比值与单独脐动脉多普勒成像相比是否能改善结局预测。
脑胎盘比值异常的病例围产期发病率和死亡率有统计学显著增加。使用脑胎盘比值预测围产期结局的受试者工作特征曲线下面积具有统计学极显著性。对于出生体重<第10百分位数，我们注意到P<.001，其他4种结局类别中的每一类P<.0001。回归分析表明，与单独的脐动脉血流速度测定相比，脑胎盘比值似乎能改善围产期结局的预测。一个有趣的发现是，脑胎盘比值与孕周>34周胎儿的结局似乎无显著相关性。
通过多普勒识别胎儿的“脑保护”效应能有力地预测有宫内生长受限风险胎儿的结局。脑保护效应仅在多普勒检查时孕周<34周的胎儿中预测围产期问题。
