Guzman E, Schulman H, Bracero L, Rochelson B, Farmakides G, Coury A
Department of Obstetrics and Gynecology, Newark Beth Israel Medical Center, New Jersey.
J Ultrasound Med. 1992 Jun;11(6):275-81. doi: 10.7863/jum.1992.11.6.275.
We evaluated continuous wave uterine-umbilical artery Doppler velocimetry for predicting pregnancy outcome in women with systemic lupus erythematosus (SLE). Lupus anticoagulant (LAC) and anticardiolipin (ACL) antibody status also were correlated with Doppler results and outcome. Three Doppler vascular patterns were identified in 27 pregnancies of 26 women with SLE. Patients with normal flow velocity in both vessels had normal outcomes (n = 18). Reduced flow velocity of the umbilical artery only was present in five women, whose newborn infants were of lesser gestational age and birthweight, two being small for gestational age. In four pregnancies reduced flow velocity was noted in both vessels. These cases had the poorest outcome, with three perinatal losses and all fetuses being small for gestational age. Doppler velocimetry showed 100% sensitivity and negative predictive value in the detection of the small for gestational age fetus and abnormal antepartum fetal heart rate tracing. Fourteen of 18 women with normal Doppler studies did not have preeclampsia or SLE flare-ups, whereas all nine women with abnormal Doppler studies had such complications. In all 27 pregnancies the women were screened for LAC, and 21 women also were tested for the ACL antibody. Poor correlation was found between antiphospholipid antibody status and Doppler results in three of the six pregnancies with positive antibody testing the patients had normal Doppler studies and outcomes. Thus, Doppler velocimetry may help determine when these substances will affect the outcome adversely. In this study the umbilical-placental vascular system was affected more often. Uterine-umbilical arterial Doppler velocimetry uniquely identified the fetus at risk for adverse perinatal outcome in pregnancies complicated by SLE. Thus, it is a potentially valuable tool in clarifying the pathophysiology and in the management of SLE in pregnancy.
我们评估了连续波子宫 - 脐动脉多普勒测速法在预测系统性红斑狼疮（SLE）女性妊娠结局中的作用。狼疮抗凝物（LAC）和抗心磷脂（ACL）抗体状态也与多普勒结果及结局相关。在26例患有SLE的女性的27次妊娠中识别出三种多普勒血管模式。两条血管流速均正常的患者结局正常（n = 18）。仅脐动脉流速降低的情况出现在5名女性中，她们的新生儿孕周和出生体重较小，其中2名胎儿小于孕周。在4次妊娠中，两条血管的流速均降低。这些病例结局最差，有3例围产期死亡，所有胎儿均小于孕周。多普勒测速法在检测小于孕周胎儿及异常产前胎儿心率描记方面显示出100%的敏感性和阴性预测值。18例多普勒检查正常的女性中有14例未发生先兆子痫或SLE病情加重，而9例多普勒检查异常的女性均出现了此类并发症。在所有27次妊娠中，对女性进行了LAC筛查，21名女性还检测了ACL抗体。在6例抗体检测呈阳性的妊娠中，有3例抗磷脂抗体状态与多普勒结果之间相关性较差，这些患者的多普勒检查和结局正常。因此，多普勒测速法可能有助于确定这些物质何时会对结局产生不利影响。在本研究中，脐 - 胎盘血管系统受影响更为常见。子宫 - 脐动脉多普勒测速法独特地识别出了SLE合并妊娠中围产期结局不良风险的胎儿。因此，它在阐明病理生理学及SLE妊娠管理方面是一种潜在有价值的工具。
