Romero Arauz Juan Fernando, Ramos León Julio César, Rivera Velásquez Patricia, Álvarez Jiménez Guadalupe, Molina Pérez Carlos José
Departamento de complicaciones hipertensivas del embarazo, Hospital de Ginecología y Obstetricia Luis Castelazo Ayala, Instituto Mexicano del Seguro Social, México, DF.
Ginecol Obstet Mex. 2008 Aug;76(8):440-9.
Abnormal placentation is a main preeclampsia characteristic. Its cause is a maternal spiral veins trophoblastic invasion failure, which conditions vascular resistances raise and uterus-placental perfusion decrease.
To determine the relationship between umbilical artery Doppler waveform and adverse perinatal outcome in patients with severe preeclampsia.
A prospective, observational and transversal study was done to analyze patients between 27 to 33 weeks of gestation with expectant management of severe preeclampsia from January 2004 to January 2006. Umbilical artery velocimetry studies were performed at least once a week by means of pulsed Doppler equipment with a 3.5 MHz transducer. Only the results of the last Doppler examination performed within 7 days of delivery were considered in the correlation with perinatal outcomes. The indications for delivery were maternal or fetal (non reassuring nonstress test or biophysical profile < or = 4). An abnormal Doppler velocimetry was defined as pulsatility index being higher than percentile 95 for gestational age, or absent or reversed end diastolic velocity waveforms in umbilical artery. The statistical analysis was done with chi2 test and Student t test.
There were included 43 patients in this study. Twenty-two (52%) had an abnormal Doppler umbilical artery pulsatility index and 21 (49%) obtained a normal umbilical artery waveform. In the first group 13 (59%) had a positive end diastolic velocities with elevated pulsatility index values, end diastolic velocities were absent in seven cases (32%) and reversed in two cases (9%). Neonates with abnormal pulsatility index had a lower birth weight (1,174 vs 1,728 g), lower Apgar score at 5 minutes, higher admission to the neonatal intensive care unit (86.4 vs 43%), and significant neonatal morbidity compared with those with normal velocimetry (p < 0.05). There were no perinatal deaths with normal umbilical Doppler waveform. There were six perinatal deaths in the abnormal Doppler velocimetry. Two cases occurred with positive end diastolic velocity (15%), two cases with absent end diastolic velocity (28%) and two deaths with reversed flow of the umbilical artery (100%).
An abnormal Doppler umbilical artery waveform is associated with poor perinatal outcome and is a strong predictor of perinatal mortality.
胎盘形成异常是子痫前期的主要特征。其病因是母体螺旋小静脉滋养层浸润失败，导致血管阻力升高和子宫 - 胎盘灌注减少。
确定重度子痫前期患者脐动脉多普勒波形与围产期不良结局之间的关系。
进行了一项前瞻性、观察性横断面研究，分析2004年1月至2006年1月期间妊娠27至33周、采用期待疗法治疗重度子痫前期的患者。每周至少一次使用3.5MHz探头的脉冲多普勒设备进行脐动脉测速研究。仅将分娩前7天内进行的最后一次多普勒检查结果用于与围产期结局的相关性分析。分娩指征为母体或胎儿因素（无应激试验无反应或生物物理评分≤4分）。异常多普勒测速定义为搏动指数高于胎龄的第95百分位数，或脐动脉舒张末期血流速度波形缺失或反向。采用卡方检验和学生t检验进行统计分析。
本研究纳入43例患者。22例（52%）脐动脉搏动指数异常，21例（49%）脐动脉波形正常。第一组中，13例（59%）舒张末期血流速度为正向但搏动指数值升高，7例（32%）舒张末期血流速度缺失，2例（9%）舒张末期血流速度反向。搏动指数异常的新生儿出生体重较低（1174g对1728g），5分钟时阿氏评分较低，入住新生儿重症监护病房的比例较高（86.4%对43%），与测速正常的新生儿相比，新生儿发病率显著更高（p<0.05）。脐动脉多普勒波形正常者无围产期死亡。异常多普勒测速组有6例围产期死亡。2例发生在舒张末期血流速度为正向时（15%），2例发生在舒张末期血流速度缺失时（28%），2例发生在脐动脉血流反向时（100%）。
脐动脉多普勒波形异常与围产期不良结局相关，是围产期死亡率的有力预测指标。
