Baschat A A
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, Baltimore, MD 21201-1703, USA.
Ultrasound Obstet Gynecol. 2004 Feb;23(2):111-8. doi: 10.1002/uog.989.
This article provides an opinion on a study of relationships between umbilical artery (UA) Doppler, ductus venosus (DV) Doppler, fetal heart rate variation, and perinatal outcome in preterm, intrauterine growth-restricted (IUGR) fetuses published in the same issue of this journal by Bilardo and coworkers. Recent evidence on venous Doppler surveillance in preterm IUGR fetuses was also reviewed and discussed in the context of the study with a special emphasis on delivery timing. A search was conducted through MEDLINE and eight articles with similar inclusion criteria and reporting format of outcomes were identified. Numbers for perinatal mortality, intraventricular hemorrhage, respiratory distress syndrome, bronchopulmonary dysplasia and necrotizing enterocolitis (NEC) were extracted for cases where Doppler status was recorded in an identical format. Proportional distribution of outcomes was compared for fetuses with normal DV Doppler velocimetry, absent or reversed UA end-diastolic velocity (UA A/REDV), elevated DV Doppler index (abnormal DV) and absence or reversal of atrial velocity in the DV (DV-RAV). A total of 320 fetuses with normal and 202 with elevated DV Doppler indices were extracted. Of these fetuses, 101 with UA A/REDV only and 34 with DV-RAV were identified. Perinatal mortality was 5.6% (16/282) with normal DV, 11.9% (12/101) with UA A/REDV, 38.8% (64/165) with abnormal DV and 41.2% (7/17) with DV-RAV. With the exception of NEC, all complications were significantly more frequent with abnormal DV. With normal venous Doppler neonatal deaths account for most of the perinatal mortality, while with abnormal DV stillbirths and neonatal mortality are similar contributors to the significantly increased perinatal mortality. In conclusion, UA Doppler is a placental function test that provides important diagnostic and prognostic information in preterm IUGR. DV Doppler effectively identifies those preterm IUGR fetuses that are at high risk for adverse outcome (particularly stillbirth) at least 1 week before delivery, independent of the UA waveform. Relationships between perinatal outcome, arterial and venous Doppler status and gestational age require ongoing observational research effort. Randomized management trials are necessary to verify that delivery timing based on venous Doppler will impact on outcome in preterm IUGR.
本文针对Bilardo及其同事在同一期杂志上发表的关于早产、宫内生长受限（IUGR）胎儿的脐动脉（UA）多普勒、静脉导管（DV）多普勒、胎儿心率变化及围产期结局之间关系的研究发表了观点。还结合该研究对早产IUGR胎儿静脉多普勒监测的最新证据进行了回顾和讨论，特别强调了分娩时机。通过医学文献数据库（MEDLINE）进行检索，确定了8篇具有相似纳入标准和结局报告格式的文章。对于以相同格式记录多普勒状态的病例，提取了围产期死亡率、脑室内出血、呼吸窘迫综合征、支气管肺发育不良和坏死性小肠结肠炎（NEC）的数据。比较了DV多普勒测速正常、UA舒张末期血流速度缺失或反向（UA A/REDV）、DV多普勒指数升高（异常DV）以及DV心房血流速度缺失或反向（DV-RAV）的胎儿的结局比例分布。总共提取了320例DV多普勒指数正常的胎儿和202例DV多普勒指数升高的胎儿。在这些胎儿中，仅发现101例有UA A/REDV，34例有DV-RAV。DV正常时围产期死亡率为5.6%（16/282），UA A/REDV时为11.9%（12/101），异常DV时为38.8%（64/165），DV-RAV时为41.2%（7/17）。除NEC外，所有并发症在异常DV时均显著更常见。静脉多普勒正常时，新生儿死亡占围产期死亡的大部分，而异常DV时，死产和新生儿死亡对围产期死亡率显著增加的贡献相似。总之，UA多普勒是一种胎盘功能检查，可为早产IUGR提供重要的诊断和预后信息。DV多普勒能有效识别那些早产IUGR胎儿，这些胎儿在分娩前至少1周出现不良结局（尤其是死产）的风险很高，且与UA波形无关。围产期结局、动静脉多普勒状态和胎龄之间的关系需要持续的观察性研究。有必要进行随机管理试验，以验证基于静脉多普勒的分娩时机是否会影响早产IUGR的结局。
