Tyrrell S N, Lilford R J, Macdonald H N, Nelson E J, Porter J, Gupta J K
Department of Obstetrics and Gynaecology, St James's Hospital, Leeds, Yorkshire.
Br J Obstet Gynaecol. 1990 Oct;97(10):909-16. doi: 10.1111/j.1471-0528.1990.tb02446.x.
To compare routine versus highly selective use of Doppler ultrasound and biophysical scoring in higher risk pregnancy.
A pragmatic randomized trial.
St James's University Hospital, Leeds.
500 pregnant women at high risk of intrauterine growth retardation or still birth.
Regular monitoring with biophysical profile assessment and Doppler velocity waveform recording in umbilical and uteroplacental arteries. Results immediately available to clinicians.
Gestational age at delivery, obstetric intervention rates and short-term neonatal morbidity.
Risk factors were distributed very evenly between the 250 patients in the study and control groups respectively. A total of 902 biophysical profile and Doppler assessments were done in the 250 study group patients and only in 12 patients in the control group. In the study group, absent end-diastolic flow was found in only 2.7% of all 902 measurements. A persistently abnormal biophysical score was always associated with absence of end-diastolic flow. The mean gestational age at induction of labour was statistically and clinically similar in the two groups and there was no overall statistically significant difference in intervention rates between the two groups. There was a statistically significant lower frequency of depressed 5-min Apgar scores in the study group. Serious neonatal morbidity was also statistically significantly more common in the control group than in the study group.
The use of Doppler ultrasound in higher risk pregnancies does not lead to an increase in iatrogenic preterm delivery. The total rate of positive tests on Doppler ultrasound is very low and persistently abnormal biophysical scores are unlikely to be found in patients where umbilical end-diastolic blood flow is present. Surrogate measures for fetal damage seem to be improved when clinicians have access to Doppler ultrasound assessments.
比较在高危妊娠中常规使用与高度选择性使用多普勒超声和生物物理评分的情况。
一项实用的随机试验。
利兹的圣詹姆斯大学医院。
500名有宫内生长受限或死产高风险的孕妇。
通过生物物理评分评估和记录脐动脉及子宫胎盘动脉的多普勒速度波形进行定期监测。结果可立即提供给临床医生。
分娩时的孕周、产科干预率和短期新生儿发病率。
危险因素在研究组和对照组的250名患者中分布非常均匀。研究组的250名患者共进行了902次生物物理评分和多普勒评估，而对照组仅12名患者进行了此类评估。在研究组中，在所有902次测量中仅2.7%发现舒张末期血流缺失。持续异常的生物物理评分总是与舒张末期血流缺失相关。两组引产时的平均孕周在统计学和临床上相似，两组间干预率总体上无统计学显著差异。研究组5分钟阿氏评分降低的频率在统计学上显著更低。对照组严重新生儿发病率在统计学上也显著高于研究组。
在高危妊娠中使用多普勒超声不会导致医源性早产增加。多普勒超声阳性检测的总发生率非常低，在存在脐动脉舒张末期血流的患者中不太可能发现持续异常的生物物理评分。当临床医生能够获得多普勒超声评估时，胎儿损伤的替代指标似乎有所改善。
