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宫内胎儿评估中动脉和静脉循环的血流动力学

Hemodynamics of arterial and venous circulation in the intrauterine fetal evaluation.

作者信息

Cancarevic Djajic Branka, Vilendecic Rade, Ecim-Zlojutro Vesna, Lucic Nenad, Draganovic Dragica, Savic Sasa

机构信息

Clinic of Gynecology and Obstetrics, Clinical Center Banja Luka, Bosnia and Herzegovina.

出版信息

Acta Inform Med. 2012 Dec;20(4):249-53. doi: 10.5455/aim.2012.20.249-253.

DOI:10.5455/aim.2012.20.249-253
PMID:23378693
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3558304/
Abstract

INTRODUCTION

The purpose of each antenatal control focuses on the detection and prevention of hypoxic-ischemic injury and fetal death (1)) using modern biophysical tests and Doppler parameters.

GOAL

This study examines the correlation of changes in arterial compared to venous hemodynamics of the fetus and is determined by the most sensitive and most specific Doppler parameter in the assessment of intrauterine fetal status.

MATERIAL AND METHODS

The study was conducted as prospective and included 119 pregnant women. All subjects underwent NST (nonstres test), and Doppler measurements of blood flow in the umbilical artery (Aum), fetal aorta (Ao) and the central cerebral artery (MCA). In case of borderline and pathological arterial flow was measured through the ductus venozus (DV) and umbilical vein (VU). At birth to the child was determined umbilical artery blood pH and Apgar score (AS) in the first minute. Based on the clinical condition of the newborn and outcome was calculated perinatal morbidity and mortality.

RESULTS

In all cases with a pathological arterial flow, which is verified during measurement also the pathological venous flow and confirmed fetal acidemia at birth and low Apgar scores? In this group, the two neonates died in the first week.

CONCLUSION

There is a justification for the analysis of venous flow in the event borderline and pathologic findings in fetal arterial system. It has been proven that the cerebroumbilical (C/U) index is most effective parameter in predicting changes in the venous system and this the most sensitive Doppler parameter in predicting fetal acidosis and the most specific Doppler flow through the central cerebral artery.

摘要

引言

每次产前检查的目的在于通过现代生物物理检测和多普勒参数来检测并预防缺氧缺血性损伤及胎儿死亡(1)。

目标

本研究探讨胎儿动脉与静脉血流动力学变化的相关性,并由评估宫内胎儿状况时最敏感且最具特异性的多普勒参数来确定。

材料与方法

本研究为前瞻性研究,纳入了119名孕妇。所有受试者均接受了无应激试验(NST),并对脐动脉(Aum)、胎儿主动脉(Ao)和大脑中动脉(MCA)的血流进行了多普勒测量。若动脉血流处于临界值及病理状态,则测量静脉导管(DV)和脐静脉(VU)的血流。出生时测定新生儿脐动脉血pH值及1分钟阿氏评分(AS)。根据新生儿的临床状况计算围产期发病率和死亡率。

结果

在所有动脉血流呈病理状态的病例中,测量时也证实了静脉血流病理状态,并在出生时确诊胎儿酸血症及阿氏评分较低。在该组中,有两名新生儿在第一周死亡。

结论

在胎儿动脉系统出现临界值及病理结果时,分析静脉血流是合理的。已证实脑脐(C/U)指数是预测静脉系统变化最有效的参数,也是预测胎儿酸中毒最敏感的多普勒参数以及大脑中动脉最具特异性的多普勒血流参数。

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本文引用的文献

1
Fetal arterial and venous Doppler in growth restricted fetuses for the prediction of perinatal complications.生长受限胎儿的胎儿动静脉多普勒检查用于预测围产期并发症
Turk J Pediatr. 2010 Jul-Aug;52(4):384-92.
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Pulsations in the umbilical vein during labor are associated with increased risk of operative delivery for fetal distress.分娩期间脐静脉的搏动与胎儿窘迫行剖宫产术分娩的风险增加有关。
Ultrasound Obstet Gynecol. 2009 Aug;34(2):177-81. doi: 10.1002/uog.6420.
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Umbilical artery Doppler and umbilical cord pH at birth in small-for-gestational-age fetuses: valid estimate of their relationship.小于胎龄儿出生时脐动脉多普勒检查及脐带血pH值:对其关系的有效评估
J Perinat Med. 2005;33(3):219-25. doi: 10.1515/JPM.2005.040.
4
Transcranial doppler measurement of cerebral velocity indices as a predictor of preeclampsia.经颅多普勒测量脑血流速度指数作为子痫前期的预测指标
Am J Obstet Gynecol. 2002 Dec;187(6):1667-72. doi: 10.1067/mob.2002.127594.
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Cerebral haemodynamics in pregnancy and pre-eclampsia as assessed by transcranial Doppler ultrasonography.经颅多普勒超声评估妊娠和子痫前期的脑血流动力学
Br J Anaesth. 2002 Nov;89(5):687-92.
6
Prognostic role of umbilical artery Doppler velocimetry in growth-restricted fetuses.脐动脉多普勒血流测定在生长受限胎儿中的预后作用
J Matern Fetal Neonatal Med. 2002 Mar;11(3):199-203. doi: 10.1080/jmf.11.3.199.203.
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Blood redistribution in the fetal brain during chronic hypoxia.慢性缺氧时胎儿脑内的血液重新分布
Ultrasound Obstet Gynecol. 2002 Aug;20(2):117-21. doi: 10.1046/j.1469-0705.2002.00758.x.
8
Liver blood perfusion as a possible instrument for fetal growth regulation.肝脏血液灌注作为胎儿生长调节的一种可能手段。
Placenta. 2002 Apr;23 Suppl A:S153-8. doi: 10.1053/plac.2002.0810.
9
Can the degree of retrograde diastolic flow in abnormal umbilical artery flow velocity waveforms predict pregnancy outcome?
Ultrasound Obstet Gynecol. 2002 Mar;19(3):229-34. doi: 10.1046/j.1469-0705.2002.00636.x.
10
Temporal sequence of abnormal Doppler changes in the peripheral and central circulatory systems of the severely growth-restricted fetus.严重生长受限胎儿外周和中心循环系统异常多普勒变化的时间序列。
Ultrasound Obstet Gynecol. 2002 Feb;19(2):140-6. doi: 10.1046/j.0960-7692.2002.00627.x.