Yagel S, Anteby E Y, Shen O, Cohen S M, Friedman Z, Achiron R
Department of Obstetrics and Gynecology, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel.
Ultrasound Obstet Gynecol. 1999 Oct;14(4):262-6. doi: 10.1046/j.1469-0705.1999.14040262.x.
To evaluate the role of placental blood flow measurements by simultaneous multigate spectral Doppler imaging in pregnancies complicated by intrauterine growth restriction (IUGR), and for early detection of placental vascular abnormalities in high- and low-risk pregnancies.
To assess the sensitivity and specificity of abnormal placental blood flow in detecting IUGR, we followed 22 women whose pregnancies were complicated by IUGR at 28-34 weeks' gestation, and compared the findings with those obtained in 22 matched controls. We defined placental blood flow impedance as abnormal when 10% of placental pulsatility index (PI) measurements were greater than, or equal to, the mean umbilical artery PI (placental PI/umbilical PI > or = 1). To determine the predictive value of abnormal placental blood flow measurement for identifying developing uteroplacental insufficiency, we examined an unselected group of 100 low- and high-risk patients at 20-22 weeks' gestation. We correlated the Doppler findings with the development of pre-eclampsia, IUGR, placental abruption, oligohydramnios and the presence of persistent late decelerations during labor.
Placental blood flow determination was more sensitive than umbilical artery blood flow in detecting abnormal umbilical-placental flow impedances as manifested by the presence of IUGR. Of the 100 mixed high- and low-risk patients examined at 20-22 weeks, 32 had abnormal placental blood flow. Of these, 19 (59.4%) subsequently developed pathologies associated with placental vascular disease. Of the 68 patients with normal placental blood flow, only six (8.8%) developed such pathologies. The sensitivity was 76% (19/25), with positive predictive value 59.4% (19/32); the specificity was 82.7% (62/75), with negative predictive value 91.2% (62/68).
Abnormal intraplacental blood flow at 28-34 weeks' gestation is strongly associated with IUGR. In addition, it has moderate positive and negative predictive values for identifying subsequent development of uteroplacental vascular abnormalities.
评估采用同步多门频谱多普勒成像测量胎盘血流在妊娠合并宫内生长受限（IUGR）中的作用，以及在高危和低危妊娠中早期检测胎盘血管异常的情况。
为评估异常胎盘血流检测IUGR的敏感性和特异性，我们对22例妊娠28 - 34周合并IUGR的孕妇进行随访，并将结果与22例匹配的对照组进行比较。当10%的胎盘搏动指数（PI）测量值大于或等于脐动脉平均PI（胎盘PI/脐PI >或 = 1）时，我们将胎盘血流阻抗定义为异常。为确定异常胎盘血流测量对识别正在发展的子宫胎盘功能不全的预测价值，我们在妊娠20 - 22周时对一组100例未选择的高危和低危患者进行检查。我们将多普勒检查结果与子痫前期、IUGR、胎盘早剥、羊水过少以及分娩期间持续性晚期减速的发生情况进行关联分析。
在检测由IUGR所表现出的异常脐 - 胎盘血流阻抗方面，胎盘血流测定比脐动脉血流测定更敏感。在20 - 22周检查的100例高低危混合患者中，32例胎盘血流异常。其中，19例（59.4%）随后出现与胎盘血管疾病相关的病变。在68例胎盘血流正常的患者中，只有6例（8.8%）出现此类病变。敏感性为76%（19/25），阳性预测值为59.4%（19/32）；特异性为82.7%（62/75），阴性预测值为91.2%（62/68）。
妊娠28 - 34周时胎盘内血流异常与IUGR密切相关。此外，它在识别子宫胎盘血管异常的后续发展方面具有中等程度的阳性和阴性预测价值。
