Johnson P, Stojilkovic T, Sarkar P
Division of Paediatrics, Obstetrics and Gynaecology, Imperial College School of Medicine, Queen Charlotte's and Chelsea Hospital, London, UK.
Ultrasound Obstet Gynecol. 2001 May;17(5):416-20. doi: 10.1046/j.1469-0705.2001.00404.x.
To examine longitudinal changes in middle cerebral artery blood flow assessed by Doppler in severely growth restricted fetuses.
Eighteen structurally normal singleton pregnancies complicated by suspected intrauterine growth restriction were monitored by serial measurement of the pulsatility index of the middle cerebral artery over 7 to 72 days. Outcome measures included indication for delivery, umbilical venous pH and admission to and length of stay in neonatal intensive care.
Thirteen fetuses demonstrated severe intrauterine growth restriction based on subsequent birth weights being below the 2.5th centile, two had intrauterine growth restriction (birth weights between the 2.5th and 5th centiles), and three had birth weights between the 5th and 50th centiles. The middle cerebral artery pulsatility index showed rapid and sharp changes between examinations in those severely growth restricted fetuses which required delivery before 34 weeks. This pattern was not obvious in severely growth restricted fetuses delivered after 34 weeks, or in those less severely growth restricted, regardless of the gestation at delivery. Changes in middle cerebral artery pulsatility index contributed to the decision to deliver in three cases. The middle cerebral artery pulsatility index demonstrated greater variation in those fetuses with cord pHs of less than 7.25. The length of stay in neonatal intensive care decreased with increasing gestational age and birth weight.
The difference in the pattern of change in middle cerebral artery pulsatility index in intrauterine growth restricted fetuses may be a reflection of maturity in addition to the degree of fetal compromise. The decision to deliver was multifactorial. The middle cerebral artery pulsatility index only influenced the decision to deliver when changes in other parameters were evident.
通过多普勒检查评估严重生长受限胎儿大脑中动脉血流的纵向变化。
对18例结构正常的单胎妊娠合并疑似宫内生长受限的孕妇进行监测，在7至72天内连续测量大脑中动脉搏动指数。观察指标包括分娩指征、脐静脉pH值以及新生儿重症监护病房的入住情况和住院时间。
根据随后出生体重低于第2.5百分位数，13例胎儿表现为严重宫内生长受限，2例为宫内生长受限（出生体重在第2.5至第5百分位数之间），3例出生体重在第5至第50百分位数之间。在那些在34周前需要分娩的严重生长受限胎儿中，大脑中动脉搏动指数在检查之间显示出快速而急剧的变化。这种模式在34周后分娩的严重生长受限胎儿或那些生长受限程度较轻的胎儿中并不明显，无论分娩时的孕周如何。大脑中动脉搏动指数的变化在3例中促成了分娩决定。大脑中动脉搏动指数在脐带pH值小于7.25的胎儿中变化更大。新生儿重症监护病房的住院时间随着孕周和出生体重的增加而减少。
宫内生长受限胎儿大脑中动脉搏动指数变化模式的差异可能除了反映胎儿受损程度外，还反映了成熟度。分娩决定是多因素的。只有当其他参数明显变化时，大脑中动脉搏动指数才会影响分娩决定。
