Lam H, Leung W C, Lee C P, Lao T T
Department of Obstetrics and Gynecology, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
Acta Obstet Gynecol Scand. 2005 Sep;84(9):844-8. doi: 10.1111/j.0001-6349.2005.00741.x.
This prospective observational study aims at determining the distribution of fetal cerebro-placental Doppler indices and amniotic fluid volume in a homogenous group of uncomplicated postdated pregnancies at 41 weeks. The correlation with incidence of passage of thick meconium-stained liquor in labor was analyzed to decide which parameter would be useful in the surveillance of postdated pregnancies.
The amniotic fluid volume, middle cerebral artery pulsatility index, umbilical artery pulsatility index, and cerebroplacental ratio were measured and distribution determined in 118 well-dated singleton pregnancies admitted for routine induction of labor at 41 weeks. The 10th centile and the 90th centile in each Doppler parameter and amniotic fluid volume were chosen to divide each parameter into three centile groups. The prevalence of thick meconium-stained liquor in labor in different Doppler and amniotic fluid volume centile groups was compared using Chi-square test for trend with P < 0.05 taken as statistically significant.
The prevalence of thick meconium-stained liquor in labor was significantly inversely correlated with the middle cerebral artery pulsatility index (P = 0.008), with significant difference across different middle cerebral artery pulsatility index centile groups (P = 0.02). There was no significant difference in the prevalence of thick meconium-stained liquor in labor or oligohydramnios across different umbilical artery pulsatility index centile groups. Neither was there significant difference in the prevalence of thick meconium-stained liquor in labor and oligohydramnios across different cerebroplacental ratio and amniotic fluid volume centile groups. Logistic regression using the 10th centile of middle cerebral artery pulsatility index confirmed that it was a significant independent predicting factor for risk of thick meconium-stained liquor in labor with adjusted odds ratio (95th CI) of 6.14 (1.6-24.1).
Middle cerebral artery pulsatility index is better than amniotic fluid volume or umbilical artery pulsatility index in predicting the risk of thick meconium-stained liquor in labor in uncomplicated postdated pregnancy at 41 weeks.
这项前瞻性观察性研究旨在确定41周单纯过期妊娠同质性组中胎儿脑胎盘多普勒指数和羊水量的分布情况。分析其与产时浓稠胎粪污染羊水发生率的相关性，以确定哪个参数对过期妊娠的监测有用。
对118例预产期准确的单胎妊娠进行测量，这些孕妇因41周常规引产入院，测量其羊水量、大脑中动脉搏动指数、脐动脉搏动指数和脑胎盘比值，并确定其分布情况。选择每个多普勒参数和羊水量的第10百分位数和第90百分位数，将每个参数分为三个百分位数组。使用趋势卡方检验比较不同多普勒和羊水量百分位数组中产时浓稠胎粪污染羊水的患病率，P<0.05被认为具有统计学意义。
产时浓稠胎粪污染羊水的患病率与大脑中动脉搏动指数呈显著负相关（P = 0.008），在不同大脑中动脉搏动指数百分位数组间存在显著差异（P = 0.02）。不同脐动脉搏动指数百分位数组中产时浓稠胎粪污染羊水或羊水过少的患病率无显著差异。不同脑胎盘比值和羊水量百分位数组中产时浓稠胎粪污染羊水和羊水过少的患病率也无显著差异。使用大脑中动脉搏动指数的第10百分位数进行逻辑回归分析证实，它是产时浓稠胎粪污染羊水风险的显著独立预测因素，调整后的优势比（95%可信区间）为6.14（1.6 - 24.1）。
在预测41周单纯过期妊娠产时浓稠胎粪污染羊水的风险方面，大脑中动脉搏动指数优于羊水量或脐动脉搏动指数。
