Boito S M E, Ursem N T C, Struijk P C, Stijnen T, Wladimiroff J W
Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands.
Ultrasound Obstet Gynecol. 2004 Feb;23(2):138-42. doi: 10.1002/uog.956.
To determine the relationship between umbilical venous (UV) volume flow and fetal behavioral states 1F (quiet sleep) and 2F (active sleep) in normal pregnancies at 36-40 weeks of gestation.
Fetal behavioral states were established in 17 normal pregnancies by means of combined assessment of fetal heart rate patterns (FHRP), and fetal eye and body movements. UV vessel area (mm(2)) as obtained by tracing the inner vessel area using Labview and Imaq Vision software and UV time-averaged flow velocity (mm/s Doppler) were multiplied to calculate UV volume flow (mL/min) including flow/kg fetus. The pulsatility index (PI) in the umbilical artery was also determined. In each woman, all parameters were measured between three and five times in each behavioral state. Data are reported as mean +/- 1 SD and analyzed by paired t-test.
No statistically significant behavioral-state-related changes were observed for UV time-averaged velocity and UV volume flow, resulting in UV volume flow/kg fetus of 69.1 +/- 14.9 mL/minkg at 1F and 71.6 +/- 12.1 mL/minkg at 2F (not significant). A statistically significant increase (P = 0.02) was established for UV cross-sectional area (46.4 +/- 8.6 mm(2) vs. 49.0 +/- 10.1 mm(2)) and for fetal heart rate (FHR) from 134.2 +/- 10.3 bpm in 1F to 144.2 +/- 7 bpm in 2F. Umbilical artery PI was not significantly different between the two behavioral states.
On the basis of high venous vessel wall compliance, the significant increase in UV cross-sectional area during fetal behavioral state 2F may be determined by a rise in mean venous pressure. The significant rise in FHR may reflect increased fetal cardiac output during state 2F while the resistance at the hepato-ductal pathway remains relatively constant with the purpose of meeting raised energy demands during the active sleep state. This is further supported by the observed trend towards an increase in UV volume flow.
确定妊娠36 - 40周正常妊娠中脐静脉（UV）容积流量与胎儿行为状态1F（安静睡眠）和2F（活跃睡眠）之间的关系。
通过对胎儿心率模式（FHRP）、胎儿眼睛和身体运动的综合评估，确定了17例正常妊娠的胎儿行为状态。使用Labview和Imaq Vision软件追踪血管内面积获得UV血管面积（mm²），并将UV时间平均流速（mm/s多普勒）相乘，以计算UV容积流量（mL/min），包括每千克胎儿的流量。还测定了脐动脉的搏动指数（PI）。在每位女性中，在每种行为状态下对所有参数进行了三到五次测量。数据报告为平均值±1标准差，并通过配对t检验进行分析。
未观察到UV时间平均流速和UV容积流量与行为状态相关的统计学显著变化，1F时每千克胎儿的UV容积流量为69.1±14.9 mL/min·kg，2F时为71.6±12.1 mL/min·kg（无显著性差异）。UV横截面积（46.4±8.6 mm²对49.0±10.1 mm²）和胎儿心率（FHR）从1F时的134.2±10.3次/分钟显著增加（P = 0.02）至2F时的144.2±7次/分钟。两种行为状态下脐动脉PI无显著差异。
基于高静脉血管壁顺应性，胎儿行为状态2F期间UV横截面积的显著增加可能由平均静脉压升高决定。FHR的显著升高可能反映了2F状态下胎儿心输出量增加，而肝导管途径的阻力保持相对恒定，以满足活跃睡眠状态下增加的能量需求。UV容积流量增加的观察趋势进一步支持了这一点。
