Karsdorp V H, van Vugt J M, Dekker G A, van Geijn H P
Department of Obstetrics and Gynecology, Free University Hospital, Amsterdam, The Netherlands.
Obstet Gynecol. 1992 Oct;80(4):679-83.
To determine the effects of maternal volume expansion on feto- and uteroplacental blood flow and neonatal outcome.
Seven women with pregnancies characterized by absent end-diastolic velocity in the umbilical artery were treated with bed rest, antihypertensive medication, and volume expansion (expanded group) and compared with seven similar cases treated with bed rest and antihypertensive medication (unexpanded group).
In the expanded group, end-diastolic flow reappeared temporarily in all cases after volume expansion. The pulsatility index in the umbilical artery decreased from 2.69 (95% confidence interval [CI] 2.1-3.2) to 2.15 (95% CI 1.74-2.56) 24 hours after maternal volume expansion (P less than .001). All cases in the unexpanded group continued to demonstrate absent end-diastolic velocity. There was no significant difference between the groups with regard to birth weight, which was 773 g (95% CI 521-1025) in the expanded group and 724 g (95% CI 429-1019) in the unexpanded group (P = .76). The gestational age at delivery was not significantly different between the groups: 203 days in the expanded group (95% CI 195-211) and 207 days in the unexpanded group (95% CI 189-225) (P = .71). The overall survival rate was significantly better in the expanded group: five of seven, versus one of seven in the unexpanded group (P less than .05).
These preliminary data suggest that it is possible to improve feto- and uteroplacental perfusion with maternal volume expansion. The results point toward an improvement in neonatal outcome. Randomized trials are necessary to confirm our observations.
确定母体容量扩充对胎儿及子宫胎盘血流以及新生儿结局的影响。
选取7例以脐动脉舒张末期血流速度消失为特征的妊娠女性，给予卧床休息、降压药物治疗及容量扩充（扩容组），并与7例接受卧床休息和降压药物治疗的类似病例（未扩容组）进行比较。
在扩容组中，容量扩充后所有病例的舒张末期血流均暂时恢复。母体容量扩充24小时后，脐动脉搏动指数从2.69（95%置信区间[CI]2.1 - 3.2）降至2.15（95%CI 1.74 - 2.56）（P <.001）。未扩容组所有病例持续表现为舒张末期血流速度消失。两组间出生体重无显著差异，扩容组为773 g（95%CI 521 - 1025），未扩容组为724 g（95%CI 429 - 1019）（P =.76）。两组间分娩时的孕周无显著差异：扩容组为203天（95%CI 195 - 211），未扩容组为207天（95%CI 189 - 225）（P =.71）。扩容组的总体生存率显著更高：7例中有5例，而未扩容组7例中有1例（P <.05）。
这些初步数据表明，母体容量扩充有可能改善胎儿及子宫胎盘灌注。结果提示新生儿结局有所改善。需要进行随机试验来证实我们的观察结果。
