Grzesiak Mariusz, Wilczynski Jan
Department of Feto-Maternal Medicine and Gynecology, "Polish Mother" Memorial Research Institute, Lodz, Poland.
Neuro Endocrinol Lett. 2013;34(7):681-6.
The aims were to investigate whether there are any changes in placental and fetal circulation during Atosiban tocolysis within the first 48 hours of therapy.
Detailed Doppler evaluation of placental and fetal circulation was performed prior to Atosiban administration and thereafter at 24 and 48 hours. Maternal heart rate and the pulsatility index (PI) in both uterine arteries (R-UtA, L-UtA) were assessed. Fetal heart rate (FHR), the resistance (RI) and pulsatility index (PI) of umbilical (UA) and middle cerebral artery (MCA) were measured. Additionally cerebroplacental ratio was calculated. E-wave/A-wave ratio (E/A) for atrioventricular valves, the myocardial performance index (MPI) and shortening fraction (SF) for both ventricles were calculated for both ventricles independently. To determine changes over time in all study variables analysis of variance (ANOVA) for repeated measurements followed by Tukey-Kramer's post hoc test was used. The effects of additional clinical covariates were checked.
Maternal heart rate and blood flow in (R-UtA/L-UtA) were not altered significantly during Atosiban administration. No significant changes in FHR as well as Doppler parameters (RI, PI, PSV) in UA and MCA were recorded after 24/48 hours of tocolytic treatment. The mean values of cerebroplacental ratio (CPR) remained unaltered during treatment. Detailed evaluation of fetal cardiac function parameters (E/A, SF, MPI) calculated independently for both ventricles, revealed no significant changes over the time.
To our best knowledge this study has been first evaluation of placental and fetal circulation with assessment of cardiac hemodynamic function during 48-hours administration of Atosiban. This kind of tocolysis treatment seems not to alter uterine nor fetal arterial blood flow pattern seriously. Hemodynamic cardiac activity in fetuses has remained unaffected. We cannot conclude definitely that there are absolutely no changes in the fetal hemodynamic condition due to Atosiban. Further studies should be performed to verify its possible influence on fetal venous blood flow.
旨在研究在阿托西班保胎治疗的头48小时内，胎盘和胎儿循环是否有任何变化。
在给予阿托西班之前以及之后的24小时和48小时，对胎盘和胎儿循环进行详细的多普勒评估。评估母体心率以及双侧子宫动脉（右侧子宫动脉、左侧子宫动脉）的搏动指数（PI）。测量胎儿心率（FHR）、脐动脉（UA）和大脑中动脉（MCA）的阻力（RI）和搏动指数（PI）。此外，计算脑胎盘比率。独立计算双侧心室的房室瓣E波/A波比率（E/A）、心肌性能指数（MPI）和缩短分数（SF）。为了确定所有研究变量随时间的变化，使用重复测量方差分析（ANOVA），随后进行Tukey-Kramer事后检验。检查其他临床协变量的影响。
在阿托西班给药期间，母体心率和（右侧子宫动脉/左侧子宫动脉）的血流没有显著改变。在保胎治疗24/48小时后，未记录到胎儿心率以及脐动脉和大脑中动脉的多普勒参数（RI、PI、PSV）有显著变化。治疗期间脑胎盘比率（CPR）的平均值保持不变。对双侧心室独立计算的胎儿心功能参数（E/A、SF、MPI）进行详细评估，结果显示随时间没有显著变化。
据我们所知，本研究首次在阿托西班给药48小时期间评估胎盘和胎儿循环，并评估心脏血流动力学功能。这种保胎治疗似乎不会严重改变子宫或胎儿动脉血流模式。胎儿的血流动力学心脏活动未受影响。我们不能肯定地得出结论，阿托西班对胎儿血流动力学状况绝对没有影响。应进行进一步研究以验证其对胎儿静脉血流的可能影响。
