Steel S A, Pearce J M, McParland P, Chamberlain G V
Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK.
Lancet. 1990 Jun 30;335(8705):1548-51. doi: 10.1016/0140-6736(90)91376-l.
1198 nulliparous women were screened in early pregnancy (median 18 weeks' gestation) by the recording of doppler ultrasound waveforms from the uteroplacental circulation. After exclusions, the results of 1014 women were available for analysis; 118 (12%) of them had persistently abnormal waveforms on repeat ultrasound scans at 24 weeks and were taken to have a positive test result. Hypertension was significantly more frequent among those women than among women with normal doppler waveforms (29/118 [25%] vs 45/896 [5%]). In addition, hypertension in women with abnormal waveforms was more likely to be severe; 12 (10%) had proteinuria and 15 (13%) intrauterine growth retardation compared with 7 (0.8%) and 0, respectively, of those with normal waveforms. Overall, the test did poorly when assessed by standard statistical means. However, the sensitivity was high for hypertension associated with either proteinuria (63%) or intrauterine growth retardation (100%). The test is cheap, easy to carry out, and non-invasive, and it can be done in early pregnancy; it is therefore a useful means of identifying a high-risk group of pregnant women suitable for therapeutic intervention to reduce the incidence of hypertensive disorders and their complications.
1198名未生育女性在孕早期（妊娠中位数为18周）通过记录子宫胎盘循环的多普勒超声波形进行筛查。排除相关情况后，1014名女性的结果可供分析；其中118名（12%）在24周重复超声扫描时持续出现异常波形，并被视为检测结果呈阳性。这些女性中高血压的发生率显著高于多普勒波形正常的女性（29/118 [25%] 对比45/896 [5%]）。此外，波形异常的女性患高血压的病情更可能较为严重；12名（10%）出现蛋白尿，15名（13%）出现胎儿生长受限，相比之下，波形正常的女性中分别有7名（0.8%）出现蛋白尿，0名出现胎儿生长受限。总体而言，按照标准统计方法评估，该检测效果不佳。然而，对于伴有蛋白尿（63%）或胎儿生长受限（100%）的高血压，该检测的敏感性较高。该检测成本低廉、易于实施且无创，并且可在孕早期进行；因此，它是识别适合进行治疗性干预以降低高血压疾病及其并发症发生率的高危孕妇群体的一种有用手段。
