Jurisić Aleksandar, Jurisić Zaklina, Pazin Vladimir, Vasiljević Mladenko, Janković-Raznatović Svetlana, Dragojević-Dikić Svetlana
Ginekolosko akuserska klinika Narodni front, Beograd, Srbija.
Vojnosanit Pregl. 2010 Jun;67(6):487-92. doi: 10.2298/vsp1006487j.
BACKGROUND/AIM: The use of color Doppler ultrasonography provides noninvasive observation, confirmation and quantification of pathophysiological processes in fetoplacental circulation in pregnant patients. By blood vessel mapping and the obtained waves spectral analysis it is posible to evaluate vascular resistency of the fetus blood vessels. The aim of the study was to evaluate cerebral-umbilical pulsatility index ratio in fetal circulation in prediction of fetal distress in patients with preeclampsia.
By measurement of pulsatility indices in medial cerebral and umbilical arteries in 400 patients with uncomplicated pregnancy, normal values were calculated for fetuses from 15-40 weeks. In our study group 70 patients with preeclampsia were included. Cerebral-umbilical (C/U) ratio was calculated after pulsatility indices in medial cerebral artery and umbilical artery determining by the spectral Doppler analysis of flow velocity waveforms in these vessels. Fetal outcome was analyzed by measurement of the Apgar score at the 5th minute and fetal pH at birth.
The mean C/U ratio values in the third trimester of normal pregnancy were between 1.8 and 1.9. The mean C/U ratio values in the patients complicated with preeclampsia were significantly lower comparing to normal pregnancies (ANOVA, p < 0.05). The mean 5th minute Apgar score in the study group was 6.35 +/- 1.58, and the mean fetal pH at birth was 7.16 +/- 0.15. Linear regression test showed a highly significant correlation between low C/U ratio and fetal pH at birth in patients with preeclampsia (r = 0.49, p < 0.01).
The C/U ratio values obtained from spectral Doppler analysis in fetal vessels showed a highly significant correlation with fetal pH at birth in the patients with preeclampsia. The results of our study confirmed the reliability of C/U ratio in estimation of fetal condition in preeclamptic patients. Very low C/U ratio values in patients with preeclampsia indicate that in these fetuses fetal acidosis and fetal distress may be expected.
背景/目的：彩色多普勒超声检查可对孕妇胎儿胎盘循环中的病理生理过程进行无创观察、确认和量化。通过血管绘图和所获波形的频谱分析，能够评估胎儿血管的阻力。本研究的目的是评估胎儿循环中的脑-脐搏动指数比，以预测子痫前期患者的胎儿窘迫。
通过测量400例正常妊娠患者大脑中动脉和脐动脉的搏动指数，计算出15至40周胎儿的正常值。我们的研究组纳入了70例子痫前期患者。通过对这些血管中血流速度波形进行频谱多普勒分析，测定大脑中动脉和脐动脉的搏动指数后，计算脑-脐（C/U）比。通过测量出生后第5分钟的阿氏评分和出生时的胎儿pH值来分析胎儿结局。
正常妊娠晚期的平均C/U比值在1.8至1.9之间。与正常妊娠相比，子痫前期患者的平均C/U比值显著降低（方差分析，p < 0.05）。研究组出生后第5分钟的平均阿氏评分为6.35 ± 1.58，出生时的平均胎儿pH值为7.16 ± 0.15。线性回归测试显示，子痫前期患者低C/U比与出生时胎儿pH值之间存在高度显著相关性（r = 0.49，p < 0.01）。
从胎儿血管频谱多普勒分析获得的C/U比值与子痫前期患者出生时的胎儿pH值高度显著相关。我们的研究结果证实了C/U比在评估子痫前期患者胎儿状况方面的可靠性。子痫前期患者极低的C/U比值表明，这些胎儿可能会出现胎儿酸中毒和胎儿窘迫。
