Bhatt A B, Tank P D, Barmade K B, Damania K R
Department of Obstetrics and Gynaecology, Seth G. S. Medical College, Parel, Mumbai-400 012, India.
J Postgrad Med. 2002 Jul-Sep;48(3):182-5; discussion 185.
Obstetric decision- making for the growth restricted foetus has to take into consideration the benefits and risks of waiting for pulmonary maturity and continued exposure to hostile intra-uterine environment. Necrotising Enterocolitis (NEC) results from continued exposure to hostile environment and is an important cause of poor neonatal outcome.
To evaluate the predictive value of abnormal Doppler flow velocimetry of the foetal umbilical artery for NEC and neonatal mortality.
A retrospective study carried out at a tertiary care centre for obstetric and neonatal care.
Seventy-seven neonates with birth weight less than 2000 gm, born over a period of 18 months were studied. These pregnancies were identified as having growth abnormalities of the foetus. Besides other tests of foetal well-being, they were also subjected to Doppler flow velocimetry of the foeto-placental vasculature. Obstetric outcome was evaluated with reference to period of gestation and route of delivery. The neonatal outcome was reviewed with reference to birth weight, Apgar scores and evidence of NEC.
Chi square test.
In the group of patients with Absent or Reverse End Diastolic Frequencies (A/R EDF) in the umbilical arteries, positive predictive value for NEC was 52.6%, (RR 30.2; OR 264). The mortality from NEC was 50%. When umbilical artery velocimetry did not show A/REDF, there were no cases of NEC or mortality. Abnormal umbilical or uterine artery flow increased the rate of caesarean section to 62.5% as compared to 17.6% in cases where umbilical artery flow was normal.
In antenatally identified pregnancies at risk for foetal growth restriction, abnormal Doppler velocimetry in the form of A/REDF in the umbilical arteries is a useful guide to predict NEC and mortality in the early neonatal period.
对于生长受限胎儿的产科决策，必须考虑等待肺成熟以及持续暴露于不利子宫内环境的益处和风险。坏死性小肠结肠炎（NEC）是持续暴露于不利环境导致的，是新生儿预后不良的重要原因。
评估胎儿脐动脉异常多普勒血流速度测定对坏死性小肠结肠炎和新生儿死亡率的预测价值。
在一家三级产科和新生儿护理中心进行的回顾性研究。
对18个月内出生的77例出生体重小于2000克的新生儿进行研究。这些妊娠被确定为胎儿生长异常。除了其他胎儿健康检查外，还对胎儿 - 胎盘血管系统进行了多普勒血流速度测定。根据妊娠时间和分娩途径评估产科结局。根据出生体重、阿氏评分和坏死性小肠结肠炎证据回顾新生儿结局。
卡方检验。
在脐动脉出现舒张末期血流缺失或反向（A/R EDF）的患者组中，坏死性小肠结肠炎的阳性预测值为52.6%，（相对危险度30.2；比值比264）。坏死性小肠结肠炎的死亡率为50%。当脐动脉血流速度测定未显示A/REDF时，无坏死性小肠结肠炎病例或死亡。脐动脉或子宫动脉血流异常使剖宫产率增加至62.5%，而脐动脉血流正常的病例中剖宫产率为17.6%。
在产前确定有胎儿生长受限风险的妊娠中，脐动脉出现A/REDF形式的异常多普勒血流速度测定是预测早期新生儿坏死性小肠结肠炎和死亡率的有用指标。
