Sénat M-V
Service de gynécologie-obstétrique, hôpital de Bicêtre, université Paris-Sud, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
J Gynecol Obstet Biol Reprod (Paris). 2011 Dec;40(8):785-95. doi: 10.1016/j.jgyn.2011.09.020. Epub 2011 Nov 9.
To evaluate the role of ultrasound and doppler assessment in the management of prolonged pregnancies and to state its modalities.
Medline, PubMed, embase and the Cochrane library were searched using terms prolonged pregnancy, post date pregnancy amniotic fluid, ultrasound assessment, doppler, biophysical profile.
Single deepest vertical pool measurement is the method of choice of the assessment of amniotic fluid. Indeed, when this method was used, significantly fewer case of oligohydramnios were diagnosed and fewer women had inductions of labor. However, this method is not superior to the amniotic fluid index in the prevention of poor perinatal outcomes. There is a significant difference in the incidence of fetal distress, meconium stained fluid and caesarean section for fetal distress when the amniotic fluid is reduced as compared with normal amniotic fluid. However, sensibility and predictive positive value of oligohydramnios to predict poor perinatal outcomes is moderate. Similary, in most studies, diagnosis of an abnormal uterine, umbilical, aortic or cerebral blood flow doppler was associated with a weak prediction of a poor perinatal outcome. Therefore, we do not recommend its use in management of prolonged pregnancy. There were significantly more diagnosis of oligoamnios and more abnormal antenatal monitoring results in the modified biophysical profile group as compared with the group managed with only single deepest pool but no differences in cord blood gases, neonatal outcome, or in outcomes related to labour and delivery were noted between the two groups. Therefore, biophysical profile including AFI offers no advantage in detecting adverse outcomes and may cause more interventions.
Close monitoring of fetal condition including assessment of amniotic fluid by single deepest pool twice a week from 41 weeks of gestation is recommended in the management of prolonged pregnancy. Induction of labor could be considered when oligohydramnios is diagnosed by single deepest pool less than 2 cm.
评估超声和多普勒评估在过期妊娠管理中的作用，并阐述其方式。
使用过期妊娠、过期妊娠羊水、超声评估、多普勒、生物物理评分等检索词，检索Medline、PubMed、embase和Cochrane图书馆。
单一最深垂直池测量是评估羊水的首选方法。确实，使用该方法时，诊断羊水过少的病例显著减少，引产的女性也更少。然而，该方法在预防围产期不良结局方面并不优于羊水指数。与正常羊水相比，羊水减少时胎儿窘迫、羊水粪染和因胎儿窘迫行剖宫产的发生率有显著差异。然而，羊水过少预测围产期不良结局的敏感性和预测阳性值中等。同样，在大多数研究中，子宫、脐、主动脉或脑血流多普勒异常的诊断与围产期不良结局的弱预测相关。因此，我们不建议在过期妊娠管理中使用。与仅采用单一最深池管理的组相比，改良生物物理评分组羊水过少的诊断显著更多，产前监测结果异常更多，但两组之间在脐血气、新生儿结局或与分娩相关的结局方面没有差异。因此，包括羊水指数的生物物理评分在检测不良结局方面没有优势，可能会导致更多干预。
在过期妊娠管理中，建议从妊娠41周开始每周两次通过单一最深池评估羊水等密切监测胎儿状况。当单一最深池诊断羊水过少小于2 cm时可考虑引产。
