Schwarze A, Gembruch U, Krapp M, Katalinic A, Germer U, Axt-Fliedner R
Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Lübeck, Germany.
Ultrasound Obstet Gynecol. 2005 Jun;25(6):573-9. doi: 10.1002/uog.1914.
The aim of this retrospective study was to examine the significance of severe Doppler waveform abnormalities in the ductus venosus (DV) and the umbilical vein (UV) for the prediction of adverse outcomes in very preterm growth-restricted fetuses with absent or reversed end-diastolic flow in the umbilical artery (UA) at 24-34 weeks of gestation.
Seventy-four fetuses with intrauterine growth restriction (IUGR) and absent or reversed end-diastolic (ARED) flow in the UA at 24-34 weeks of gestation, which were delivered before 34 weeks' gestation, were examined. Absent or reversed flow during atrial contraction (a-wave) in the DV and pulsatile flow in the UV were examined to predict severe perinatal outcomes (stillbirth, neonatal death, perinatal death, acidemia, 5 min Apgar < 7, intraventricular hemorrhage and elevated nucleated red blood cell counts at delivery).
Twelve (16.2%) perinatal deaths, of which eight were stillbirths (10.8%), and two (2.7%) neonatal deaths occurred among 74 fetuses. Logistic regression analysis confirmed that abnormal DV Doppler waveforms (R2 = 0.57, P < 0.001) together with gestational age at delivery (R2 = 0.57, P < 0.001) showed the strongest association with perinatal death, whereas only gestational age was significantly related to neonatal death (R2 = 0.67, P < 0.05). Abnormal DV Doppler waveforms (R2 = 0.86, P < 0.001) and gestational age (R2 = 0.49, P < 0.05) were strongly associated with adverse outcome (including stillbirth, perinatal death or neonatal death). Abnormal venous Doppler flow patterns performed better in the prediction of fetal or perinatal demise than did ARED flow or brain sparing.
Abnormal venous Doppler waveforms in preterm IUGR fetuses with ARED flow are strongly related to adverse fetal and perinatal outcomes before 32 weeks of gestation. The possible benefit of prolonging these pregnancies can only be evaluated in a prospective randomized study.
本回顾性研究旨在探讨静脉导管（DV）和脐静脉（UV）严重多普勒波形异常对于预测妊娠24 - 34周时脐动脉（UA）舒张末期血流缺失或反向的极早早产生长受限胎儿不良结局的意义。
对74例妊娠24 - 34周时出现宫内生长受限（IUGR）且UA舒张末期血流缺失或反向（ARED）、在妊娠34周前分娩的胎儿进行检查。检测DV心房收缩期（a波）血流缺失或反向以及UV搏动性血流，以预测严重围产期结局（死产、新生儿死亡、围产期死亡、酸血症、5分钟阿氏评分<7、脑室内出血以及分娩时核红细胞计数升高）。
74例胎儿中发生12例（16.2%）围产期死亡，其中8例为死产（10.8%），2例（2.7%）新生儿死亡。逻辑回归分析证实，异常的DV多普勒波形（R2 = 0.57，P < 0.001）以及分娩时的孕周（R2 = 0.57，P < 0.0
