Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, MD 21201, USA.
Ultrasound Obstet Gynecol. 2011 Sep;38(3):295-302. doi: 10.1002/uog.9011.
To study if the duration of individual Doppler abnormalities is an independent predictor of adverse outcome in fetal growth restriction (FGR) caused by placental dysfunction.
This was a secondary analysis of patients with FGR (abdominal circumference < 5(th) percentile and umbilical artery (UA) pulsatility index (PI) elevation) who had at least three examinations before delivery. Days of duration of absent/reversed UA end-diastolic velocity (UA-AREDV), low middle cerebral artery PI (brain sparing), ductus venosus (DV) and umbilical vein Doppler abnormalities were related to stillbirth, major neonatal morbidity and intact survival.
One hundred and seventy-seven study participants underwent a total of 1069 examinations. The duration of an absent/reversed a-wave in the DV (DV-RAV) was significantly higher in stillbirths (median, 6 days) compared with intact survivors and those with major morbidity (median, 0 days for both; P = 0.006 and P = 0.001, respectively). Duration of brain sparing was also longer in stillbirth cases compared with intact survivors (median, 19 days vs. 9 days, P = 0.02). Stepwise multinomial logistic regression showed that gestational age at delivery was a significant codeterminant of outcome for all arterial Doppler abnormalities when the DV a-wave was antegrade. However, when present, the duration of DV-RAV was the only contributor to stillbirth (probability of stillbirth = 1/(1 + exp - (interval to delivery × 1.03 - 2.28)), r2 = 0.73). Receiver-operating characteristics curve statistics showed that a DV-RAV for > 7 days predicted stillbirth (100% sensitivity, 80% specificity, likelihood ratio = 5.0, P < 0.0001). In contrast, neither neonatal death nor neonatal morbidity was predicted by the days of persistent DV-RAV.
The duration of absent or reversed flow during atrial systole in the DV is a strong predictor of stillbirth that is independent of gestational age. While prematurity remains the strongest predictor of neonatal risks it is unlikely that pregnancy can be prolonged by more than 1 week in this setting.
研究个体多普勒异常的持续时间是否可作为胎盘功能障碍导致胎儿生长受限（FGR）不良结局的独立预测因素。
这是对至少进行了 3 次产前检查的 FGR（腹围<第 5 百分位且脐动脉（UA）搏动指数（PI）升高）患者进行的二次分析。无/反向 UA 舒张末期速度（UA-AREDV）、大脑中动脉 PI 降低（脑保护）、静脉导管（DV）和脐静脉多普勒异常的持续时间与死胎、主要新生儿发病率和存活儿完整相关。
177 例研究参与者共进行了 1069 次检查。死胎（中位数 6 天）的 DV 反向 a 波（DV-RAV）持续时间明显长于存活儿（中位数 0 天；P=0.006 和 P=0.001）和有主要发病率的儿（中位数 0 天）。与存活儿相比，脑保护的持续时间在死胎病例中也更长（中位数 19 天比 9 天；P=0.02）。逐步多项逻辑回归显示，当 DV 正向 a 波时，分娩时的胎龄是所有动脉多普勒异常结局的显著共同决定因素。然而，当存在时，DV-RAV 的持续时间是死产的唯一决定因素（死产概率=1/（1+exp-（分娩间隔×1.03-2.28）），r2=0.73）。接收者操作特性曲线统计显示，DV-RAV>7 天预测死产（100%敏感性，80%特异性，似然比=5.0，P<0.0001）。相比之下，持续的 DV-RAV 天数并不能预测新生儿死亡或发病率。
DV 收缩期无或反向血流的持续时间是死产的一个有力预测因素，独立于胎龄。尽管早产仍然是新生儿风险的最强预测因素，但在这种情况下，妊娠不太可能延长超过 1 周。
