Baschat A A, Galan H L, Bhide A, Berg C, Kush M L, Oepkes D, Thilaganathan B, Gembruch U, Harman C R
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, USA.
Department of Obstetrics and Prenatal Medicine, University Hamburg-Eppendorf, Germany.
Ultrasound Obstet Gynecol. 2006 Jan;27(1):41-47. doi: 10.1002/uog.2657.
Multi-vessel Doppler ultrasonography and biophysical profile scoring (BPS) are used in the surveillance of growth restricted fetuses (IUGR). The interpretation of both tests performed concurrently may be complex. This study examines the relationship between Doppler ultrasonography and biophysical test results in IUGR fetuses.
Three hundred and twenty-eight IUGR fetuses (abdominal circumference < 5th percentile, elevated umbilical artery (UA) pulsatility index (PI)) had concurrent surveillance with UA, middle cerebral artery (MCA) and ductus venosus (DV) Doppler ultrasonography and BPS (fetal tone, movement, breathing, maximal amniotic fluid pocket and fetal heart rate). Patients were stratified into three groups according to their Doppler examination: (1) abnormal UA alone; (2) brain sparing (MCA-PI > 2 SD below mean for gestational age); and (3) abnormal DV (PI > 2 SD above the mean for gestational age) and BPS groups: (1) normal (> 6/10); (2) equivocal (6/10); and (3) abnormal (< 6/10). Predictions of short-term perinatal outcomes by both modalities were compared for stratification. The distribution and concordance of Doppler and BPS test results were examined for the whole patient group and based on delivery prior to 32 weeks' gestation.
Abnormal UA Doppler results alone were observed in 109 fetuses (33.2%), brain sparing in 87 (26.5%) and an abnormal DV in 132 (40.2%). The BPS was normal in 158 (48.2%), equivocal in 68 (20.7%) and abnormal in 102 (31.1%). Both testing modalities stratified patients into groups with comparable acid-base disturbance and perinatal outcome. Of the nine possible test combinations the largest subgroups were: abnormal UA alone/normal BPS (n = 69; 21%) and abnormal DV Doppler/abnormal BPS (n = 62; 18.9%). Assessment of compromise by both testing modalities was concordant in 146 (44.5%) cases. In 182 fetuses with discordant results the BPS grade was better in 115 (63.2%, P < 0.0001). Marked disagreement of test abnormality was present in 57 (17.4%) fetuses. Of these, abnormal venous Doppler in the presence of a normal BPS constituted the largest group (Chi-square P < 0.002). Stratification was not significantly different in patients delivered prior to 32 weeks' gestation.
Doppler ultrasonography and BPS effectively stratify IUGR fetuses into risk categories, but Doppler and BPS results do not show a consistent relationship with each other. Since fetal deterioration appears to be independently reflected in these two testing modalities further research is warranted to investigate how they are best combined.
多血管多普勒超声检查和生物物理评分（BPS）用于监测生长受限胎儿（IUGR）。同时进行这两项检查的结果解读可能较为复杂。本研究探讨IUGR胎儿多普勒超声检查与生物物理检查结果之间的关系。
328例IUGR胎儿（腹围<第5百分位数，脐动脉（UA）搏动指数（PI）升高）同时接受UA、大脑中动脉（MCA）和静脉导管（DV）多普勒超声检查及BPS（胎儿肌张力、运动、呼吸、最大羊水深度和胎儿心率）监测。根据多普勒检查结果将患者分为三组：（1）仅UA异常；（2）脑保护效应（MCA-PI比胎龄均值低2个标准差以上）；（3）DV异常（PI比胎龄均值高2个标准差以上）。BPS也分为三组：（1）正常（>6/10）；（2）可疑（6/10）；（3）异常（<6/10）。比较两种检查方法对短期围产儿结局分层的预测情况。检查整个患者组以及孕周小于32周分娩者的多普勒和BPS检查结果的分布及一致性。
109例胎儿（33.2%）仅UA多普勒检查结果异常，87例（26.5%）有脑保护效应，132例（40.2%）DV异常。BPS正常者158例（48.2%），可疑者68例（20.7%），异常者102例（31.1%）。两种检查方法均能将患者分层为具有相似酸碱平衡紊乱和围产儿结局的组。在9种可能的检查组合中，最大的亚组为：仅UA异常/BPS正常（n = 69；21%）和DV多普勒异常/BPS异常（n = 62；18.9%）。两种检查方法对胎儿窘迫的评估在146例（44.5%）病例中一致。在182例结果不一致的胎儿中，115例（63.2%）BPS分级更好（P < 0.0001）。57例（17.4%）胎儿检查异常结果存在明显分歧。其中，BPS正常但静脉多普勒异常的情况占最大比例（卡方检验P < 0.002）。孕周小于32周分娩的患者分层无显著差异。
多普勒超声检查和BPS能有效地将IUGR胎儿分层为不同风险类别，但多普勒和BPS结果之间未显示出一致的关系。由于胎儿情况恶化似乎在这两种检查方法中独立体现，因此有必要进一步研究如何最佳地联合使用这两种方法。
