Coleman M A, McCowan L M, North R A
Department of Obstetrics and Gynaecology, University of Auckland, New Zealand.
Ultrasound Obstet Gynecol. 2000 Jan;15(1):7-12. doi: 10.1046/j.1469-0705.2000.00014.x.
To assess the value of uterine artery Doppler ultrasound screening, when performed in a clinical setting, to predict complications of impaired uteroplacental blood flow in high-risk women.
A prospective audit.
A total of 116 pregnancies in 114 women at high risk of pre-eclampsia and/or small-for-gestational-age (SGA) babies attending a maternal-fetal medicine clinic at National Women's Hospital, a tertiary referral hospital, Auckland, New Zealand.
Uterine artery Doppler screening was performed as part of clinical practice between 22 and 24 weeks' gestation. A resistance index (RI) was calculated from each uterine artery and the presence or absence of a notch was determined. An RI of > 0.58 was defined as abnormal and an RI of > or = 0.7 was defined as very abnormal. The main outcome measures were: pre-eclampsia, SGA baby (birth weight < 10th centile), placental abruption, intrauterine death, 'all' and 'severe' outcomes.
Thirty-two (27.5%) women developed pre-eclampsia, 31 (26.7%) had SGA babies, 23 (20%) were delivered at < 34 weeks because of pregnancy complications, and there were three (2.6%) placental abruptions and three (2.6%) perinatal deaths. The sensitivity of any RI of > 0.58 for pre-eclampsia, SGA, 'all' outcomes and 'severe' outcome was 91%, 84%, 83% and 90%, respectively. The specificity of any RI of > 0.58 for these outcomes was 42%, 39%, 47% and 38%, respectively. The positive predictive value of any RI of > 0.58 for the same outcomes was 37%, 33%, 58% and 24%, respectively. Among women with both RI values of > or = 0.7, 58%, 67%, 85% and 58% developed pre-eclampsia, SGA, 'all' and 'severe' outcomes, respectively. In women with bilateral notches, 47%, 53%, 76% and 65% developed the respective outcomes. Women with both RI values of > or = 0.7 and women with bilateral notches had relative risks of 11.1 (95% CI 2.6-46.4) and 12.7 (95% CI 4.0-40.4) for developing severe outcome, respectively. Only 5% of women with both RI values of < 0.58 developed a severe outcome.
In high-risk women, uterine artery Doppler waveform analysis performed best in the prediction of severe adverse outcome and was better than clinical risk assessment in the prediction of pre-eclampsia and SGA babies. Further studies are necessary to determine how information from uterine artery Doppler studies should modify current practice in high-risk women.
评估在临床环境中进行子宫动脉多普勒超声筛查对预测高危女性子宫胎盘血流受损并发症的价值。
一项前瞻性审计。
新西兰奥克兰一家三级转诊医院——国家妇女医院的母婴医学诊所中，114名有先兆子痫和/或小于胎龄儿（SGA）风险的女性共116例妊娠。
在妊娠22至24周期间，作为临床实践的一部分进行子宫动脉多普勒筛查。计算每条子宫动脉的阻力指数（RI），并确定有无切迹。RI>0.58被定义为异常，RI≥0.7被定义为非常异常。主要结局指标为：先兆子痫、SGA儿（出生体重<第10百分位数）、胎盘早剥、宫内死亡、“所有”和“严重”结局。
32名（27.5%）女性发生先兆子痫，31名（26.7%）有SGA儿，23名（20%）因妊娠并发症在34周前分娩，有3例（2.6%）胎盘早剥和3例（2.6%）围产期死亡。RI>0.58对先兆子痫、SGA、“所有”结局和“严重”结局的敏感性分别为91%、84%、83%和90%。RI>0.58对这些结局的特异性分别为42%、39%、47%和38%。RI>0.58对相同结局的阳性预测值分别为37%、33%、58%和24%。在RI值均≥0.7的女性中，分别有58%、67%、85%和58%发生了先兆子痫、SGA、“所有”和“严重”结局。在有双侧切迹的女性中，分别有47%、53%、76%和65%发生了相应结局。RI值均≥0.7的女性和有双侧切迹的女性发生严重结局的相对风险分别为11.1（95%CI 2.6 - 46.4）和12.7（95%CI 4.0 - 40.4）。RI值均<0.58的女性中只有5%发生了严重结局。
在高危女性中，子宫动脉多普勒波形分析在预测严重不良结局方面表现最佳，在预测先兆子痫和SGA儿方面优于临床风险评估。有必要进行进一步研究以确定子宫动脉多普勒研究的信息应如何改变高危女性的当前实践。
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