Afrakhteh Maryam, Moeini Aida, Taheri Morteza Sanei, Haghighatkhah Hamid Reza, Fakhri Mohammad, Masoom Nina
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Department of Obstetrics and Gynecology; Tajrish Hospital; Shahid Beheshti University of Medical Sciences - Tehran, Iran.
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Department of Radiology; Tajrish Hospital; Shahid Beheshti University of Medical Sciences - Tehran, Iran.
Rev Bras Ginecol Obstet. 2014 Jan;36(1):35-9. doi: 10.1590/S0100-72032014000100008.
The aim of this longitudinal study was to investigate the value of uterine artery Doppler sonography during the second and third trimesters in the prediction of adverse pregnancy outcome in low-risk women.
From July 2011 to August 2012, a total of 205 singleton pregnant women presenting at our antenatal clinic were enrolled in this prospective study and were assessed for baseline demographic and obstetric data. They underwent ultrasound evaluation at the time of second and third trimesters, both included Doppler assessment of bilateral uterine arteries to determine the values of the pulsatility index (PI) and resistance index (RI) and presence of early diastolic notch. The endpoint of this study was assessing the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Doppler ultrasonography of the uterine artery, for the prediction of adverse pregnancy outcomes including preeclampsia, stillbirth, placental abruption and preterm labor.
The mean age of cases was 26.4±5.11. The uterine artery PI and RI values for both second (PI: 1.1±0.42 versus 1.53±0.59, p=0.002; RI: 0.55±0.09 versus 0.72±0.13, p=0.000 respectively) and third-trimester (PI: 0.77±0.31 versus 1.09±0.46, p=0.000; RI: 0.46±0.10 versus 0.60±0.14, p=0.010 respectively) evaluations were significantly higher in patients with adverse pregnancy outcome than in normal women. Combination of PI and RI >95th percentile and presence of bilateral notch in second trimester get sensitivity and specificity of 36.1 and 97% respectively, while these measures were 57.5 and 98.2% in third trimester.
According to our study, it seems that uterine artery Doppler may be a valuable tool for the prediction of a variety of adverse outcomes in second and third trimesters.
本纵向研究旨在探讨孕中期和孕晚期子宫动脉多普勒超声检查在预测低风险孕妇不良妊娠结局中的价值。
2011年7月至2012年8月，共有205名单胎孕妇在我院产前门诊就诊并纳入本前瞻性研究，评估其基线人口统计学和产科数据。她们在孕中期和孕晚期接受超声检查，包括对双侧子宫动脉进行多普勒评估，以确定搏动指数（PI）和阻力指数（RI）的值以及是否存在舒张早期切迹。本研究的终点是评估子宫动脉多普勒超声检查对包括子痫前期、死产、胎盘早剥和早产在内的不良妊娠结局的预测的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
病例的平均年龄为26.4±5.11。不良妊娠结局患者孕中期（PI：1.1±0.42对1.53±0.59，p = 0.002；RI：0.55±0.09对0.72±0.13，p = 0.000）和孕晚期（PI：0.77±0.31对1.09±0.46，p = 0.000；RI：0.46±0.10对0.60±0.14，p = 0.010）的子宫动脉PI和RI值均显著高于正常女性。孕中期PI和RI>第95百分位数且双侧有切迹时，敏感性和特异性分别为36.1%和97%，而孕晚期这些指标分别为57.5%和98.2%。
根据我们的研究，子宫动脉多普勒检查似乎可能是预测孕中期和孕晚期各种不良结局的有价值工具。
