Giles Warwick, Bisits Andrew, O'Callaghan Stephen, Gill Andrew
Discipline of Reproductive Medicine and Mothers and Babies Research Centre, Faculty of Medicine and Health Sciences, University of Newcastle, New South Wales 2308, Callaghan, Australia.
BJOG. 2003 Jun;110(6):593-7.
To assess the addition value of umbilical artery Doppler ultrasound added to standard ultrasound biometry measurements in the management of twin pregnancies.
A prospective randomised controlled multicentre trial of women with twin pregnancies.
Tertiary level referral hospitals in Australia, New Zealand and Southeast Asia.
Pregnant women with twin pregnancies.
Women were randomised at 25 weeks of gestation to receive either standard ultrasound biometric assessment or standard assessment plus Doppler ultrasound umbilical artery flow velocity waveform analysis. The studies were repeated at 30 and 35 weeks unless otherwise indicated. Physicians were advised to institute close fetal surveillance in the presence of an abnormal umbilical artery Doppler study or with biometry indicators of fetal compromise.
Standard obstetric (mode of delivery, perinatal mortality, hypertension, antenatal admissions and gestation at delivery) and neonatal (5 minute Apgar scores <5, admissions to neonatal nursery and requirements for ventilation) outcomes and statistical analysis was on intention-to-treat. There were no significant differences between the two groups with respect to demography, antenatal, peripartum and neonatal outcomes. There was no difference in the perinatal mortality rate in the no Doppler group (n = 264), which was 11/1000 live births, and the Doppler group (n = 262), which was 9/1000 live births. There were three unexplained intrauterine deaths in the no Doppler group and none in the Doppler group (OR 0.14, 95% CI 0.01-1.31). Two intrauterine deaths in the Doppler group were due to cord prolapse in labour and a fetomaternal haemorrhage, both very unlikely to be influenced by Doppler surveillance.
In this study, close surveillance in twin pregnancy resulted in a lower than expected fetal mortality from 25 weeks of gestation in both the no Doppler and Doppler groups. The lower rate of unexplained fetal death in the no Doppler group was not significantly different from the Doppler group.
评估脐动脉多普勒超声添加到标准超声生物测量中对双胎妊娠管理的附加价值。
一项针对双胎妊娠女性的前瞻性随机对照多中心试验。
澳大利亚、新西兰和东南亚的三级转诊医院。
双胎妊娠孕妇。
孕妇在妊娠25周时随机分组，分别接受标准超声生物测量评估或标准评估加脐动脉多普勒超声血流速度波形分析。除非另有说明，研究在30周和35周重复进行。若脐动脉多普勒研究异常或有胎儿窘迫的生物测量指标，建议医生加强胎儿监测。
标准产科结局（分娩方式、围产儿死亡率、高血压、产前入院情况及分娩孕周）和新生儿结局（5分钟阿氏评分<5分、入住新生儿重症监护室及通气需求），并采用意向性分析进行统计。两组在人口统计学、产前、产时及新生儿结局方面无显著差异。无多普勒组（n = 264）围产儿死亡率为11/1000活产，多普勒组（n = 262）为9/1000活产，无显著差异。无多普勒组有3例不明原因的宫内死亡，多普勒组无（比值比0.14，95%可信区间0.01 - 1.31）。多普勒组的2例宫内死亡分别因分娩时脐带脱垂和胎儿-母体出血，这两种情况极不可能受多普勒监测影响。
在本研究中，对双胎妊娠进行密切监测使无多普勒组和多普勒组从妊娠25周起的胎儿死亡率均低于预期。无多普勒组不明原因胎儿死亡发生率较低，但与多普勒组无显著差异。
