Breborowicz Andrzej, Dubiel Mariusz, Pietryga Marek, Breborowicz Grzegorz H, Gudmundsson Saemundur
Division of Reproductive Endocrinology and Infertility, Department of Ob/Gyn & Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA.
Department of Obstetrics and Gynecology, Collegium Medicum, Nicolaus Copernicus University, Torun, Poland.
Ginekol Pol. 2014 Jan;85(1):26-30. doi: 10.17772/gp/1686.
Studies on fetal lung/brain circulation by means of power Doppler technique have suggested a marked reduction in lung perfusion in high-risk pregnancies as a sign of circulation redistribution. The ratio between lung/brain perfusion might therefore give a new method to predict fetal circulation centralization.
The aim of the present study was to obtain fetal lung and cerebral artery ratio in normal and high-risk pregnancies.
Doppler samples from proximal right pulmonary artery blood velocities and middle cerebral artery (MCA) were recorded cross-sectionally in 228 normal singleton pregnancies at gestational age 22 to 40 weeks. MCA/right pulmonary artery pulsatility index (PI) ratio was calculated. Doppler samples from proximal right pulmonary artery and MCA were also recorded in 89 high-risk singleton pregnancies and the results related to perinatal outcome.
In the normal controls, right pulmonary artery PI remained stable until 30 weeks of gestation with slight increase thereafter until term. The MCA to right pulmonary artery PI ratio increased between 22 and 28 weeks of gestation with the rapid fall towards term. In the high-risk pregnancies group, right pulmonary artery PI showed no significant correlation to perinatal outcome, but signs of brain-sparing in the MCA were correlated to all adverse outcome parameters.
Velocimetry of the middle cerebral artery is better than velocimetry of right pulmonary artery in predicting adverse outcome of pregnancy The brain/lung PI ratio does not improve the prediction of adverse outcome of pregnancy.
通过功率多普勒技术对胎儿肺/脑循环进行的研究表明，高危妊娠中肺灌注显著减少，这是循环重新分布的一个迹象。因此，肺/脑灌注比值可能提供一种预测胎儿循环集中化的新方法。
本研究的目的是获取正常和高危妊娠中的胎儿肺与脑动脉比值。
对228例孕龄为22至40周的正常单胎妊娠进行横断面记录，采集右肺动脉近端血流速度和大脑中动脉（MCA）的多普勒样本。计算MCA/右肺动脉搏动指数（PI）比值。还对89例高危单胎妊娠采集右肺动脉近端和MCA的多普勒样本，并将结果与围产期结局相关联。
在正常对照组中，右肺动脉PI在妊娠30周前保持稳定，此后略有增加直至足月。MCA与右肺动脉PI比值在妊娠22至28周之间升高，临近足月时迅速下降。在高危妊娠组中，右肺动脉PI与围产期结局无显著相关性，但MCA中脑保护的迹象与所有不良结局参数相关。
大脑中动脉测速在预测妊娠不良结局方面优于右肺动脉测速。脑/肺PI比值并不能改善对妊娠不良结局的预测。
