Vergani Patrizia, Roncaglia Nadia, Andreotti Camilla, Arreghini Alessandra, Teruzzi Michela, Pezzullo John C, Ghidini Alessandro
Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy.
Am J Obstet Gynecol. 2002 Oct;187(4):932-6. doi: 10.1067/mob.2002.127137.
We have investigated the use of uterine artery Doppler waveform analysis in growth restricted fetuses delivered at > or =34 weeks.
Included in the study were all consecutive euploid non-malformed singleton fetuses with accurate dating diagnosed as growth restricted (sonographic abdominal circumference <10th percentile) between January 1995 and December 1998 and who were delivered at > or =34 weeks. Delivery was expedited for biophysical profile 6 or less with nonreactive nonstress test, preeclampsia, oligohydramnios, absent fetal growth over 2 weeks, absent or reversed diastolic flow in the umbilical artery (UA), or UA pulsatility index (PI) greater than the 95th percentile after 37 weeks. Neonatal outcomes were compared in cases with normal versus abnormal Doppler waveforms at the uterine arteries (defined as average resistance index >0.58 or presence of bilateral notching) using one-way analysis of variance, chi(2) test, and logistic regression analysis. A two-tailed P <.05 or an odds ratio (OR) with 95% CI not inclusive of the unity was considered significant.
Growth-restricted fetuses with abnormal (n = 109) versus normal (n = 185) Doppler velocimetry results at the uterine arteries had similar ratios of head-to-abdominal circumference at diagnosis, but asymmetric body proportion at the last scan before delivery. Neonates of mothers with abnormal uterine artery Doppler waveforms were more frequently born of cesarean delivery, particularly for non-reassuring fetal testing (27% vs 10%, P <.001), had significantly lower gestational age at delivery (37.7 +/- 2.0 vs 38.8 +/- 1.6, P <.001), and lower birth weight percentiles (4.8 +/- 5.1 vs 9.3 +/- 10.2, P <.001). More importantly, although 5-minute Apgar scores and UA pH values were not significantly lower, they had a significantly greater risk of admission to intensive care unit for reasons other than low birth weight alone (36% vs 11%). After preeclampsia was controlled, such risk was associated with an OR of 4.1 (95% CI 2.2-7.5).
In growth-restricted fetuses delivered at > or =34 weeks, presence of abnormal Doppler waveforms at the uterine arteries at diagnosis is associated with a 4-fold increased risk of adverse neonatal outcome.
我们研究了子宫动脉多普勒波形分析在孕周≥34周时分娩的生长受限胎儿中的应用。
本研究纳入了1995年1月至1998年12月期间所有连续的整倍体、无畸形的单胎胎儿，这些胎儿经准确孕周诊断为生长受限（超声测量腹围<第10百分位数）且孕周≥34周。若生物物理评分≤6且无应激试验无反应、子痫前期、羊水过少、2周内胎儿无生长、脐动脉舒张期血流缺失或反向、或37周后脐动脉搏动指数（PI）大于第95百分位数，则加快分娩。使用单因素方差分析、卡方检验和逻辑回归分析比较子宫动脉多普勒波形正常与异常（定义为平均阻力指数>0.58或存在双侧切迹）的病例的新生儿结局。双侧P<0.05或95%置信区间的优势比（OR）不包括1被认为具有统计学意义。
子宫动脉多普勒测速结果异常（n = 109）与正常（n = 185）的生长受限胎儿在诊断时头围与腹围比值相似，但在分娩前最后一次扫描时身体比例不对称。子宫动脉多普勒波形异常的母亲所生新生儿剖宫产分娩更为频繁，尤其是因胎儿检测结果不令人放心时（27%对10%，P<0.001），分娩时孕周显著更低（37.7±2.0对38.8±1.6，P<0.001），出生体重百分位数更低（4.8±5.1对9.3±10.2，P<0.001）。更重要的是，尽管5分钟阿氏评分和脐动脉pH值没有显著降低，但他们因除低出生体重之外其他原因入住重症监护病房的风险显著更高（36%对11%）。子痫前期得到控制后，这种风险的OR为4.1（95%置信区间2.2 - 7.5）。
在孕周≥34周时分娩的生长受限胎儿中，诊断时子宫动脉多普勒波形异常与新生儿不良结局风险增加4倍相关。
