Academic Department of Obstetrics and Gynaecology, UCL Institute for Women's Health, University College London, London, UK.
Ultrasound Obstet Gynecol. 2010 Jun;35(6):688-94. doi: 10.1002/uog.7611.
Antihypertensive drugs lower blood pressure by direct vascular effects or central vasodilatory mechanisms. Their effect on uterine artery Doppler resistance indices in hypertensive disorders of pregnancy is uncertain. This study aimed to evaluate the impact of antihypertensive therapy with alpha-methyldopa on maternal uterine artery Doppler pulsatility index (PI) and resistance index (RI) in women presenting with hypertensive disorders of pregnancy.
This was a cross-sectional study of 51 women with pre-eclampsia, 29 with gestational hypertension and 80 matched normotensive controls. Uterine artery PI and RI were measured at recruitment (between 24 and 40 weeks' gestation) and, in the hypertensive groups, 24-48 h after starting alpha-methyldopa. Differences between mild and severe, and between early- and late-onset pre-eclampsia were compared using the Mann-Whitney test. The Wilcoxon rank sum test was used to compare measurements before and after treatment.
Prior to treatment, uterine artery PI and RI were significantly higher in women with pre-eclampsia compared with those with gestational hypertension and controls (P < 0.0001). The median uterine artery PI multiple of the median (MoM) was significantly higher (P < 0.0001) in early-onset than in late-onset pre-eclampsia (1.83 (range, 0.88-3.65) vs. 1.19 (range, 0.91-1.72)) and in severe compared with mild disease (2.26 (range, 2.02-3.65) vs. 1.29 (range, 0.88-2.9)). Uterine artery PI- and RI-MoMs in both pre-eclampsia and gestational hypertension, before and after 34 weeks' gestation, were not affected by alpha-methyldopa treatment.
Antihypertensive therapy using alpha-methyldopa in women presenting with hypertensive disorders of pregnancy has no significant effect on uterine artery resistance to blood flow, suggesting that it does not impair uteroplacental circulation in these cases.
降压药通过直接的血管作用或中枢血管舒张机制降低血压。它们对妊娠高血压疾病中子宫动脉多普勒阻力指数的影响尚不确定。本研究旨在评估在患有妊娠高血压疾病的女性中，使用α-甲基多巴进行降压治疗对其子宫动脉多普勒搏动指数（PI）和阻力指数（RI）的影响。
这是一项横断面研究，共纳入 51 例子痫前期患者、29 例妊娠期高血压患者和 80 例匹配的正常血压对照组。在招募时（妊娠 24 至 40 周）测量子宫动脉 PI 和 RI，并在高血压组中，在开始使用α-甲基多巴后 24-48 小时再次测量。使用 Mann-Whitney 检验比较轻度和重度、早发型和晚发型子痫前期之间的差异。使用 Wilcoxon 秩和检验比较治疗前后的测量值。
在治疗前，子痫前期患者的子宫动脉 PI 和 RI 明显高于妊娠期高血压患者和对照组（P<0.0001）。早发型子痫前期患者的子宫动脉 PI 倍数中位数（MoM）明显高于晚发型子痫前期患者（1.83（范围，0.88-3.65）比 1.19（范围，0.91-1.72）），重度子痫前期患者的子宫动脉 PI 比轻度子痫前期患者高（2.26（范围，2.02-3.65）比 1.29（范围，0.88-2.9））。在 34 周妊娠前和妊娠后，子痫前期和妊娠期高血压患者的子宫动脉 PI 和 RI-MoM 不受α-甲基多巴治疗的影响。
在患有妊娠高血压疾病的女性中使用α-甲基多巴进行降压治疗对子宫动脉血流阻力没有显著影响，提示在这些情况下它不会损害胎盘循环。
