Becker Rolf, Vonk Richard, Vollert Walter, Entezami Michael
Free University of Berlin, Klinikum Benjamin Franklin, Berlin, Germany.
J Perinat Med. 2002;30(5):388-94. doi: 10.1515/JPM.2002.060.
To assess the diagnostic value of Doppler sonography of the uterine arteries (DSUA) at 20-23 gestational weeks as screening procedure in a low risk population.
The study group consisted of 7508 singleton low-risk pregnancies. Doppler sonography of both uterine arteries was performed as routine part of anomaly scan. Impedance of both uterine arteries was registered using the mean PI of the two uterine arteries. In case of notch, "Notch-Index" was defined as (C-D)/C with D = post-systolic nadir and C = following zenith of the waveform. Outcome variables were placental abruption, pre-eclampsia, intrauterine growth retardation, intrauterine/neonatal death and preterm delivery before 32 completed gestational weeks. To discriminate normal and pathological waveform, incidence of adverse pregnancy outcome was related to four different definitions of pathological waveform. To describe the severity of impairment of perfusion, the frequency of adverse pregnancy outcome was related to different classes of impedance.
To find a simple discrimination between normal and pathological uterine perfusion, best diagnostic performance was reached by a definition using a combination of high impedance and notch (no notch and mean PI > P'95 or unilateral notch and mean PI > P'90 or bilateral notch and mean PI > P'50). The prevalence of notch in nulliparae (8.5%) was higher than in parae (4.7%) and decreased with increasing gestational age (20 weeks: 8.6%-23 weeks: 5.4%). We found a clear relation between elevation of impedance, depth of notch and frequency of adverse pregnancy outcome with a frequency of complications varying from 3.2% (mean PI < or = 0.8, mean NI = 0.1) to 38.4% (mean PI > 2.0, mean NI > 0.1).
Doppler sonography of the uterine arteries at 20-23 weeks has the capacity to predict at least a part of severe forms of adverse pregnancy outcome and to assess the probability of complications by quantification of the impairment of the uterine blood flow.
评估孕20 - 23周时子宫动脉多普勒超声检查（DSUA）作为低风险人群筛查方法的诊断价值。
研究组包括7508例单胎低风险妊娠。双侧子宫动脉多普勒超声检查作为常规畸形扫描的一部分进行。使用双侧子宫动脉的平均搏动指数（PI）记录双侧子宫动脉的阻力。若出现切迹，“切迹指数”定义为（C - D）/C，其中D = 收缩期末最低点，C = 波形随后的顶点。结局变量包括胎盘早剥、子痫前期、胎儿宫内生长受限、宫内/新生儿死亡以及孕32周前早产。为区分正常和病理性波形，不良妊娠结局的发生率与病理性波形的四种不同定义相关。为描述灌注受损的严重程度，不良妊娠结局的频率与不同等级的阻力相关。
为找到正常与病理性子宫灌注之间简单的区分方法，通过使用高阻力和切迹组合的定义（无切迹且平均PI > P'95或单侧切迹且平均PI > P'90或双侧切迹且平均PI > P'50）可达到最佳诊断性能。初产妇中切迹的发生率（8.5%）高于经产妇（4.7%），且随孕周增加而降低（20周：8.6% - 23周：5.4%）。我们发现阻力升高、切迹深度与不良妊娠结局频率之间存在明确关系，并发症频率从3.2%（平均PI≤0.8，平均切迹指数 = 0.1）到38.4%（平均PI > 2.0，平均切迹指数 > 0.1）不等。
孕20 - 23周时子宫动脉多普勒超声检查有能力预测至少部分严重形式的不良妊娠结局，并通过量化子宫血流受损情况评估并发症发生的可能性。
