Nomura Roseli M Y, Ortigosa Cristiane, Fiorelli Lílian R, Liao Adolfo W, Zugaib Marcelo
Department of Obstetrics and Gynecology, São Paulo University Medical School, University of São Paulo, São Paulo, Brazil.
Gend Med. 2011 Jun;8(3):202-8. doi: 10.1016/j.genm.2011.05.001.
Placental insufficiency and fetal growth restriction may lead to fetal hypoxia and acidemia, which result in fetal cardiac injury.
The goal of this study was to compare the levels of fetal cardiac troponin T (cTnT) at birth and fetal Doppler parameters according to fetal gender in pregnancies complicated by placental insufficiency before 34 weeks' gestation.
Between March 2007 and November 2010, singleton pregnancies with placental insufficiency characterized by abnormal umbilical artery Doppler results were prospectively studied. All the patients delivered by cesarean section, and Doppler examinations were performed up to 48 hours before birth. Immediately after delivery, umbilical artery blood samples were obtained for fetal cTnT measurements.
Fifty high-risk pregnant women met the study criteria. The study groups were as follows: group 1 consisted of 23 male fetuses (46%) and group 2 consisted of 27 female fetuses (54%). cTnT levels were significantly higher in the group of male fetuses (median, 0.14; range, 0.01-0.85) compared with the group of female fetuses (median, 0.05; range, 0.01-0.27) (P = 0.039). In the group of male fetuses, Doppler results of the ductus venosus assessment revealed values of pulsatility index for veins ≥1.0 in 15 male fetuses (65.2%) and 9 female fetuses (33.3%) (P = 0.032).
Fetal gender was associated with cTnT level at birth in pregnancies complicated by placental insufficiency before 34 weeks' gestation, although the Doppler findings did not support gender differences. The fetal cardiac compromise and cardiac injury may be influenced by fetal gender, suggesting differences in the cardiovascular response to fetal hypoxia.
胎盘功能不全和胎儿生长受限可能导致胎儿缺氧和酸血症，进而造成胎儿心脏损伤。
本研究的目的是比较妊娠34周前合并胎盘功能不全的孕妇中，根据胎儿性别出生时胎儿心肌肌钙蛋白T（cTnT）水平及胎儿多普勒参数。
2007年3月至2010年11月，对以脐动脉多普勒结果异常为特征的胎盘功能不全单胎妊娠进行前瞻性研究。所有患者均行剖宫产分娩，出生前48小时内进行多普勒检查。分娩后立即采集脐动脉血样本用于测量胎儿cTnT。
50名高危孕妇符合研究标准。研究组如下：第1组由23名男性胎儿（46%）组成，第2组由27名女性胎儿（54%）组成。男性胎儿组的cTnT水平（中位数为0.14；范围为0.01 - 0.85）显著高于女性胎儿组（中位数为0.05；范围为0.01 - 0.27）（P = 0.039）。在男性胎儿组中，静脉导管评估的多普勒结果显示，15名男性胎儿（65.2%）和9名女性胎儿（33.3%）的静脉搏动指数值≥1.0（P = 0.032）。
妊娠34周前合并胎盘功能不全时，胎儿性别与出生时cTnT水平相关，尽管多普勒检查结果不支持性别差异。胎儿心脏功能损害和心脏损伤可能受胎儿性别的影响，提示对胎儿缺氧的心血管反应存在差异。
