定性静脉多普勒波形分析可改善对早产生长受限胎儿围产期关键结局的预测。

Qualitative venous Doppler waveform analysis improves prediction of critical perinatal outcomes in premature growth-restricted fetuses.

作者信息

Baschat A A, Gembruch U, Weiner C P, Harman C R

机构信息

Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, MD 21201-1703, USA.

出版信息

Ultrasound Obstet Gynecol. 2003 Sep;22(3):240-5. doi: 10.1002/uog.149.

DOI:10.1002/uog.149

PMID:12942494

Abstract

BACKGROUND

Our aim was to test the hypothesis that qualitative ductus venosus and umbilical venous Doppler analysis improves prediction of critical perinatal outcomes in preterm growth-restricted fetuses with abnormal placental function.

METHODS

Patients with suspected intrauterine growth restriction (IUGR) underwent uniform fetal assessment including umbilical artery (UA), ductus venosus (DV) and umbilical vein (UV) Doppler. Absent or reversed UA end-diastolic velocity (UA-AREDV), absence or reversal of atrial systolic blood flow velocity in the DV (DV-RAV) and pulsatile flow in the umbilical vein (P-UV) were examined for their efficacy to predict critical outcomes (stillbirth, neonatal death, perinatal death, acidemia and birth asphyxia) before 37 weeks' gestation.

RESULTS

Seventeen (7.6%) stillbirths and 16 (7.1%) neonatal deaths were observed among 224 IUGR fetuses. Forty-one neonates were acidemic (19.8%) and seven (3.1%) had birth asphyxia. Logistic regression showed that UA-AREDV had the strongest association with perinatal mortality (R(2) = 0.49, P < 0.001), stillbirth (R(2) = 0.48, P < 0.001) and acidemia (R(2) = 0.22, P = 0.002) while neonatal death was most strongly related to DV-RAV and P-UV (R(2) = 0.33, P = 0.007). UA waveform analysis offered the highest sensitivity and negative predictive value and DV-RAV and P-UV had the best specificity and positive predictive values for outcome prediction. Overall, DV-RAV or P-UV offered the best prediction of acidemia and neonatal and perinatal death irrespective of the UA waveform. In fetuses with UA-AREDV, prediction of asphyxia and stillbirth was significantly enhanced by venous Doppler.

CONCLUSION

Prediction of critical perinatal outcomes is improved when venous and umbilical artery qualitative waveform analysis is combined. The incorporation of venous Doppler into fetal surveillance is therefore strongly suggested for all preterm IUGR fetuses.

摘要

背景

我们的目的是检验以下假设，即对静脉导管和脐静脉进行定性多普勒分析，可改善对胎盘功能异常的早产生长受限胎儿围产期关键结局的预测。

方法

疑似宫内生长受限（IUGR）的患者接受了统一的胎儿评估，包括脐动脉（UA）、静脉导管（DV）和脐静脉（UV）多普勒检查。检测脐动脉舒张末期血流缺失或反向（UA-AREDV）、静脉导管心房收缩期血流速度缺失或反向（DV-RAV）以及脐静脉搏动性血流（P-UV）在预测妊娠37周前关键结局（死产、新生儿死亡、围产期死亡、酸血症和出生窒息）方面的效能。

结果

在224例IUGR胎儿中，观察到17例（7.6%）死产和16例（7.1%）新生儿死亡。41例新生儿存在酸血症（19.8%），7例（3.1%）发生出生窒息。逻辑回归显示，UA-AREDV与围产期死亡率（R² = 0.49，P < 0.001）、死产（R² = 0.48，P < 0.001）和酸血症（R² = 0.22，P = 0.002）的相关性最强，而新生儿死亡与DV-RAV和P-UV的相关性最强（R² = 0.33，P = 0.007）。UA波形分析对结局预测的敏感性和阴性预测值最高，而DV-RAV和P-UV对结局预测的特异性和阳性预测值最佳。总体而言，无论UA波形如何，DV-RAV或P-UV对酸血症以及新生儿和围产期死亡的预测最佳。在UA-AREDV的胎儿中，静脉多普勒显著增强了对窒息和死产的预测。