Stampalija Tamara, Gyte Gillian Ml, Alfirevic Zarko
Department of Obstetrics and Gynaecology, Children's Hospital "V. Buzzi", Via Castelvetro 32, Milano, Italy, 20154.
Cochrane Database Syst Rev. 2010 Sep 8;2010(9):CD008363. doi: 10.1002/14651858.CD008363.pub2.
Impaired placentation can cause some of the most important obstetrical complications such as pre-eclampsia and intrauterine growth restriction and has been linked to increased fetal morbidity and mortality. The failure to undergo physiological trophoblastic vascular changes is reflected by the high impedance to the blood flow at the level of the uterine arteries. Doppler ultrasound study of utero-placental blood vessels, using waveform indices or notching, may help to identify the 'at-risk' women in the first and second trimester of pregnancy, such that interventions might be used to reduce maternal and fetal morbidity and/or mortality.
To assess the effects on pregnancy outcome, and obstetric practice, of routine utero-placental Doppler ultrasound in first and second trimester of pregnancy in pregnant women at high and low risk of hypertensive complications.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2010) and the reference lists of identified studies.
Randomised and quasi-randomised controlled trials of Doppler ultrasound for the investigation of utero-placental vessel waveforms in first and second trimester compared with no Doppler ultrasound. We have excluded studies where uterine vessels have been assessed together with fetal and umbilical vessels.
Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. We checked data entry.
We found two studies involving 4993 participants. The methodological quality of the trials was good. Both studies included women at low risk for hypertensive disorders, with Doppler ultrasound of the uterine arteries performed in the second trimester of pregnancy. In both studies, pathological finding of uterine arteries was followed by low-dose aspirin administration.We identified no difference in short-term maternal and fetal clinical outcomes.We identified no randomised studies assessing the utero-placental vessels in the first trimester or in women at high risk for hypertensive disorders.
AUTHORS' CONCLUSIONS: Present evidence failed to show any benefit to either the baby or the mother when utero-placental Doppler ultrasound was used in the second trimester of pregnancy in women at low risk for hypertensive disorders. Nevertheless, this evidence cannot be considered conclusive with only two studies included. There were no randomised studies in the first trimester, or in women at high risk. More research is needed to investigate whether the use of utero-placental Doppler ultrasound may improve pregnancy outcome.
胎盘形成受损可导致一些最重要的产科并发症，如子痫前期和胎儿生长受限，并与胎儿发病率和死亡率增加有关。子宫动脉水平血流高阻抗反映了滋养层血管未能发生生理性变化。利用波形指数或切迹对子宫胎盘血管进行多普勒超声研究，可能有助于识别妊娠早期和中期的“高危”女性，从而采取干预措施降低母婴发病率和/或死亡率。
评估妊娠早期和中期对高血压并发症低危和高危孕妇进行常规子宫胎盘多普勒超声检查对妊娠结局及产科实践的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2010年6月）以及已识别研究的参考文献列表。
与未进行多普勒超声检查相比，关于妊娠早期和中期利用多普勒超声检查子宫胎盘血管波形的随机和半随机对照试验。我们排除了同时评估子宫血管与胎儿及脐血管的研究。
两位作者独立评估纳入研究，评估偏倚风险并进行数据提取。我们检查了数据录入情况。
我们找到两项涉及4993名参与者的研究。试验的方法学质量良好。两项研究均纳入了高血压疾病低危女性，在妊娠中期进行子宫动脉多普勒超声检查。在两项研究中，子宫动脉出现病理结果后均给予小剂量阿司匹林治疗。我们未发现短期母婴临床结局存在差异。我们未找到评估妊娠早期或高血压疾病高危女性子宫胎盘血管的随机研究。
现有证据未能表明，对高血压疾病低危女性在妊娠中期进行子宫胎盘多普勒超声检查对婴儿或母亲有任何益处。然而，仅纳入两项研究，该证据不能被视为确凿。妊娠早期或高危女性中没有随机研究。需要更多研究来调查利用子宫胎盘多普勒超声检查是否可改善妊娠结局。
