Parra-Saavedra M, Crovetto F, Triunfo S, Savchev S, Peguero A, Nadal A, Gratacós E, Figueras F
Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Maternal-Fetal Unit, CEDIFETAL, Centro de Diagnóstico de Ultrasonido e Imágenes, CEDIUL, Barranquilla, Colombia.
Ultrasound Obstet Gynecol. 2014 Sep;44(3):330-7. doi: 10.1002/uog.13358. Epub 2014 Aug 7.
To elucidate the association between Doppler parameters and histological signs of placental underperfusion in late-onset small-for-gestational-age (SGA) babies.
Umbilical, fetal middle cerebral and uterine artery pulsatility indices and umbilical vein blood flow (UVBF), which had been recorded within 7 days prior to delivery, were analyzed from a cohort of SGA singleton pregnancies delivered after 34 weeks' gestation and confirmed as having a birth weight < 10(th) percentile by local standards. In each case, the placenta was histologically evaluated for signs of placental underperfusion using a hierarchical and standardized classification system. The independent association of the Doppler parameters with placental underperfusion was evaluated using logistic regression and decision tree analysis.
In 51 cases (53.7%), there were 61 placental histological findings indicative of placental underperfusion. These cases had a significantly higher incidence of Cesarean section for non-reassuring fetal status (52.1% vs 11.9%; P < 0.001) and neonatal metabolic acidosis at birth (21.6% vs 0%; P = 0.001). Significant and independent contributions to the presence of placental underperfusion lesions were provided by increased mean UtA pulsatility index (PI) (P = 0.018; odds ratio (OR) 2 (95% CI, 1.1-3.7)) and decreased UVBF normalized to estimated fetal weight (P = 0.027; OR 0.97 (95% CI, 0.95-0.99)). The combination of both parameters revealed three groups with differing risks for placental underperfusion: normalized UVBF > 82 mL/min/kg (risk 31.3%), normalized UVBF ≤ 82 mL/min/kg and mean UtA-PI ≤ 95(th) percentile (risk 65.5%), and normalized UVBF ≤ 82 mL/min/kg and UtA-PI > 95(th) percentile (risk 94.4%).
In late-onset SGA pregnancies, uterine Doppler and UVBF are surrogates for placental underperfusion. These findings facilitate phenotypic profiling of cases of fetal growth restriction among the general population of late-onset SGA babies.
阐明晚发型小于胎龄儿（SGA）中多普勒参数与胎盘灌注不足组织学征象之间的关联。
对一组孕34周后分娩的SGA单胎妊娠进行分析，这些妊娠在分娩前7天内记录了脐动脉、胎儿大脑中动脉和子宫动脉搏动指数以及脐静脉血流（UVBF），并经当地标准确认出生体重<第10百分位数。对每例胎盘进行组织学评估，使用分级标准化分类系统判断胎盘灌注不足的征象。采用逻辑回归和决策树分析评估多普勒参数与胎盘灌注不足之间的独立关联。
51例（53.7%）中有61个胎盘组织学结果提示胎盘灌注不足。这些病例因胎儿状况不佳行剖宫产的发生率显著更高（52.1%对11.9%；P<0.001），出生时新生儿代谢性酸中毒的发生率也显著更高（21.6%对0%；P = 0.001）。子宫动脉平均搏动指数（PI）升高（P = 0.018；比值比（OR）2（95%CI，1.1 - 3.7））和根据估计胎儿体重标准化的UVBF降低（P = 0.027；OR 0.97（95%CI，0.95 - 0.99））对胎盘灌注不足病变的存在有显著且独立的影响。这两个参数的组合显示出三组胎盘灌注不足风险不同的情况：标准化UVBF>82 mL/min/kg（风险31.3%），标准化UVBF≤82 mL/min/kg且子宫动脉平均PI≤第95百分位数（风险65.5%），以及标准化UVBF≤82 mL/min/kg且子宫动脉PI>第95百分位数（风险94.4%）。
在晚发型SGA妊娠中，子宫多普勒和UVBF是胎盘灌注不足的替代指标。这些发现有助于在晚发型SGA婴儿总体人群中对胎儿生长受限病例进行表型分析。
