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在胎儿生长受限且脐动脉舒张末期血流消失的妊娠中,母体给予倍他米松后胎儿的血流动力学变化。

Fetal hemodynamic changes following maternal betamethasone administration in pregnancies with fetal growth restriction and absent end-diastolic flow in the umbilical artery.

作者信息

Nozaki Alexandre M, Francisco Rossana P V, Fonseca Eduardo S V B, Miyadahira Seizo, Zugaib Marcelo

机构信息

Fetal Surveillance Unit, Department of Obstetrics and Gynecology, University of São Paulo, São Paulo, Brazil.

出版信息

Acta Obstet Gynecol Scand. 2009;88(3):350-4. doi: 10.1080/00016340902730334.

Abstract

OBJECTIVES

To examine the effects of betamethasone administration on umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV) Doppler flow.

DESIGN

Longitudinal prospective study.

SETTING

Fetal Surveillance Unit, Department of Obstetrics and Gynecology, University of São Paulo, São Paulo, Brazil.

POPULATION

Thirty-two singleton pregnancies complicated by fetal growth restriction with absent end-diastolic flow in the UA.

METHODS

Pulsatility index (PI) of the UA, MCA and DV was measured from 26 to 34 weeks prior to and within 24 or 48 hours after starting betamethasone treatment course. Analysis of variance for repeated measures was used to determine the changes in the fetal hemodynamic Doppler flow following maternal corticosteroid administration.

MAIN OUTCOME MEASURES

Improvement of UA-PI within 24 hours and DV-PIV (venous pulsatility) within 48 hours from the first betamethasone dose.

RESULTS

Mean gestational age at delivery was 29.3 (+/-1.8) weeks and birthweight was 806.6 (+/-228.2) g. A reduction in the UA-PI was observed in 29 (90.6%) cases, with return of end-diastolic flow in 22 (68.7%). The mean UA-PI were 2.84 (+/-0.52) before corticosteroid administration, 2.07 (+/-0.56) within 24 hours and 2.42 (+/-0.75) after 48 hours, with a significant difference along the evaluations (p<0.001). No significant changes in the MCA Doppler were observed. DV-PIV decreased from 1.06 (+/-0.23) prior corticosteroids administration to 0.73 (+/-0.16) within 24 hours and 0.70 (+/-0.19) after 48 hours (p<0.001).

CONCLUSIONS

There was reduction in the umbilical artery and in the DV pulsatility indices within 24 hours from betamethasone administration that was maintained up to 48 hours.

摘要

目的

研究倍他米松给药对脐动脉(UA)、大脑中动脉(MCA)和静脉导管(DV)多普勒血流的影响。

设计

纵向前瞻性研究。

地点

巴西圣保罗大学妇产科胎儿监测科。

研究对象

32例单胎妊娠合并胎儿生长受限且脐动脉舒张末期血流消失的孕妇。

方法

在开始倍他米松治疗疗程前26至34周以及治疗后24或48小时内测量脐动脉、大脑中动脉和静脉导管的搏动指数(PI)。采用重复测量方差分析来确定母体给予皮质类固醇后胎儿血流动力学多普勒血流的变化。

主要观察指标

从首次给予倍他米松剂量起24小时内脐动脉搏动指数(UA-PI)的改善情况以及48小时内静脉导管搏动指数(DV-PIV,静脉搏动)的改善情况。

结果

分娩时的平均孕周为29.3(±1.8)周,出生体重为806.6(±228.2)g。29例(90.6%)患者的脐动脉搏动指数降低,22例(68.7%)舒张末期血流恢复。皮质类固醇给药前脐动脉搏动指数的平均值为2.84(±0.52),24小时内为2.07(±0.56),48小时后为2.42(±0.75),各评估时间点之间存在显著差异(p<0.001)。大脑中动脉多普勒未见显著变化。静脉导管搏动指数在皮质类固醇给药前为1.06(±0.23),24小时内降至0.73(±0.16),48小时后降至0.70(±0.19)(p<0.001)。

结论

倍他米松给药后24小时内脐动脉和静脉导管的搏动指数降低,并持续至48小时。

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