Pooh R K, Pooh K H, Nakagawa Y, Maeda K, Fukui R, Aono T
Department of Obstetrics and Gynecology, Clinical Research Institute, National Zentsuji Hospital, Zentsuji City, Kagawa, Japan.
Obstet Gynecol. 1999 May;93(5 Pt 1):697-701. doi: 10.1016/s0029-7844(98)00546-8.
To investigate physiologic blood-flow-velocity waveform patterns of the fetal cerebral venous system during normal pregnancies by transvaginal Doppler studies and to evaluate cases with abnormal venous-flow patterns.
Internal cerebral veins and the three dural sinuses, those of the superior sagittal sinus, vein of Galen, and straight sinus, were examined in normal cephalic-presenting fetuses of 20-40 weeks' gestation. For analysis, the venous index was defined as maximum minus minimum velocity divided by maximum velocity. Different cases with intracranial abnormalities were evaluated with emphasis on abnormal venous blood-flow patterns.
Internal cerebral veins had pulsatile patterns with a venous index of 0.22 in 47.6% of fetuses, whereas all fetuses had pulsations in the dural sinuses. The vein of Galen had a significantly lower venous index (0.31) than the superior sagittal sinus (0.39) and the straight sinus (0.36), indicating that the amplitude of the intracranial venous pulsation might increase as the flow runs from the periphery toward the proximal portion. Significant regression lines of venous index were obtained, indicating the stability of the pulsation during pregnancy. A flat pattern of superior sagittal sinus flow was found in three cases of hydrocephalus and one of craniosynostosis.
We showed the normal patterns of fetal cerebral venous blood-flow velocity and the abnormal patterns which might be associated with increased intracranial pressure. Doppler assessment of the intracranial venous system enabled us to evaluate intracranial abnormalities accompanied by increased intracranial pressure that might have prognostic clinical importance.
通过经阴道多普勒研究，调查正常妊娠期间胎儿脑静脉系统的生理血流速度波形模式，并评估静脉血流模式异常的病例。
对妊娠20 - 40周、头先露的正常胎儿的大脑内静脉和三个硬脑膜窦，即上矢状窦、大脑大静脉和直窦进行检查。为了分析，静脉指数定义为最大速度减去最小速度再除以最大速度。对不同颅内异常病例进行评估，重点关注异常静脉血流模式。
47.6%的胎儿大脑内静脉呈搏动性模式，静脉指数为0.22，而所有胎儿的硬脑膜窦均有搏动。大脑大静脉的静脉指数（0.31）明显低于上矢状窦（0.39）和直窦（0.36），表明颅内静脉搏动幅度可能随着血流从周边向近端流动而增加。获得了静脉指数的显著回归线，表明妊娠期间搏动的稳定性。在三例脑积水和一例颅缝早闭病例中发现上矢状窦血流呈平坦模式。
我们展示了胎儿脑静脉血流速度的正常模式以及可能与颅内压升高相关的异常模式。对颅内静脉系统的多普勒评估使我们能够评估伴有颅内压升高的颅内异常情况，这可能具有重要的临床预后意义。
