子宫动脉多普勒在早期妊娠丢失管理中的应用：一项前瞻性纵向研究。

Uterine artery Doppler in the management of early pregnancy loss: a prospective, longitudinal study.

作者信息

Guedes-Martins Luís, Saraiva Joaquim P, Gaio Ana R, Reynolds Ana, Macedo Filipe, Almeida Henrique

机构信息

Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal.

Hospital Centre of Porto EPE, Department of Women and Reproductive Medicine, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.

出版信息

BMC Pregnancy Childbirth. 2015 Feb 13;15:28. doi: 10.1186/s12884-015-0464-9.

DOI:10.1186/s12884-015-0464-9

PMID:25879688

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4332726/

Abstract

BACKGROUND

The pharmacological management of early pregnancy loss reduced substantially the need for dilation and curettage. However, prognostic markers of successful outcome were not established. Thus the major purpose of this study was to determine the sensitivity and specificity of the uterine artery pulsatility (PI) and resistance (RI) indices to detect early pregnancy loss patients requiring dilation and curettage after unsuccessful management.

METHODS

A cohort prospective observational study was undertaken to include women with early pregnancy loss, ≤ 12 weeks of gestation, managed with mifepristone (200 mg) and misoprostol (1600 μg) followed by PI and RI evaluation of both uterine arteries 2 weeks after. At this time, in 173/315 patients, incomplete miscarriage was diagnosed. Among them, 32 underwent uterine dilatation and curettage at 8 weeks of follow-up.

RESULTS

The cut-off points for the uterine artery PI and RI, leading to the maximum values of sensitivity (69.5%, CI95%: 61.5%-76.5% and 75.0%, CI95%: 57.9%-86.8%, respectively) and specificity (75.0%, CI95%: 57.9%-86.8% and 65.6%, CI95%: 48.3%-79.6%, respectively), for the discrimination between the women who needed curettage from those who resolved spontaneously were 2.8 and 1, respectively.

CONCLUSIONS

The potential usefulness of uterine artery Doppler evaluation to predict the need for uterine curettage in patients submitted to medical treatment for early pregnancy loss was demonstrated.

摘要

背景

早期妊娠丢失的药物治疗显著减少了刮宫术的需求。然而，成功结局的预后标志物尚未确立。因此，本研究的主要目的是确定子宫动脉搏动指数（PI）和阻力指数（RI）检测药物治疗失败后需要刮宫的早期妊娠丢失患者的敏感性和特异性。

方法

进行了一项队列前瞻性观察研究，纳入妊娠≤12周的早期妊娠丢失女性，给予米非司酮（200mg）和米索前列醇（1600μg）治疗，随后在2周后评估双侧子宫动脉的PI和RI。此时，在315例患者中的173例诊断为不全流产。其中，32例在随访8周时接受了子宫扩张刮宫术。

结果

子宫动脉PI和RI的截断点分别为2.8和1时，区分需要刮宫的女性与自然缓解的女性时，敏感性达到最大值（分别为69.5%，95%CI：61.5%-76.5%和75.0%，95%CI：57.9%-86.8%），特异性也达到最大值（分别为75.0%，95%CI：57.9%-86.8%和65.6%，95%CI：48.3%-79.6%）。