30-34 孕周子宫动脉搏动指数预测不良围生结局的价值。
Uterine artery pulsatility index at 30-34 weeks' gestation in the prediction of adverse perinatal outcome.
机构信息
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Department of Fetal Medicine, Medway Maritime Hospital, Gillingham, Kent, UK.
出版信息
Ultrasound Obstet Gynecol. 2016 Mar;47(3):308-15. doi: 10.1002/uog.14898. Epub 2016 Feb 1.
OBJECTIVE
To investigate the potential value of uterine artery (UtA) Doppler at 30-34 weeks' gestation in the prediction of adverse perinatal outcome.
METHODS
This was a screening study in 30 780 singleton pregnancies at 30-34 weeks. UtA pulsatility index (UtA-PI) was measured and the values were converted to multiples of the median (MoM) after adjustment for variables relating to maternal characteristics and medical history that affect the measurements. Multivariable logistic regression analysis was used to determine if measuring UtA-PI improved the prediction of adverse perinatal outcome provided by screening with maternal characteristics, medical history and obstetric factors. The detection rate (DR) and false-positive rate (FPR) of screening by UtA-PI were estimated for stillbirth, Cesarean section for fetal distress, umbilical arterial cord blood pH ≤ 7.0 or umbilical venous cord blood pH ≤ 7.1 and 5-min Apgar score < 7.
RESULTS
The incidence of adverse perinatal outcome was higher in small-for-gestational-age (SGA) fetuses than in non-SGA fetuses, but the majority of cases with each adverse outcome were in the non-SGA group, including about 70% of stillbirths and more than 80% with Cesarean section for fetal distress, low cord blood pH and low Apgar score. The performance of UtA-PI > 95(th) percentile in screening for each adverse outcome was poor with DR of 6-16% and a FPR of 5-6%. The DR of adverse outcome when screening by high UtA-PI was greater in pregnancies complicated by SGA than in non-SGA pregnancies; 24% vs 13% for stillbirth, 15% vs 5% for Cesarean section for fetal distress, 30% vs 9% for low cord blood pH and 20% vs 3% for low 5-min Apgar score, respectively.
CONCLUSION
High UtA-PI at 30-34 weeks' gestation may be useful in the prediction of adverse perinatal outcome in pregnancies with a SGA fetus, however, in the absence of SGA, UtA-PI is a poor predictor of adverse outcome. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
目的
探讨 30-34 孕周子宫动脉（UtA）多普勒检测在预测不良围产结局中的潜在价值。
方法
这是一项在 30-34 孕周的 30780 例单胎妊娠中进行的筛查研究。测量 UtA 搏动指数（UtA-PI），并在调整与影响测量的母体特征和病史相关的变量后，将值转换为中位数倍数（MoM）。多变量逻辑回归分析用于确定测量 UtA-PI 是否可以改善基于母体特征、病史和产科因素的筛查对不良围产结局的预测。估计 UtA-PI 筛查的检出率（DR）和假阳性率（FPR），以检测死胎、因胎儿窘迫而行剖宫产术、脐动脉脐带血 pH 值≤7.0 或脐静脉脐带血 pH 值≤7.1 和 5 分钟 Apgar 评分<7。
结果
小于胎龄儿（SGA）胎儿的不良围产结局发生率高于非 SGA 胎儿，但每种不良结局的大多数病例均在非 SGA 组中，包括约 70%的死胎和超过 80%的因胎儿窘迫而行剖宫产术、脐带血 pH 值低和 Apgar 评分低。在筛查每种不良结局时，UtA-PI>第 95 百分位数的表现不佳，DR 为 6-16%，FPR 为 5-6%。在 SGA 合并妊娠中，高 UtA-PI 筛查不良结局的检出率更高；死胎分别为 24% vs 13%，因胎儿窘迫而行剖宫产术分别为 15% vs 5%，脐带血 pH 值低分别为 30% vs 9%，5 分钟 Apgar 评分低分别为 20% vs 3%。
结论
在 SGA 胎儿的妊娠中，30-34 孕周高 UtA-PI 可能有助于预测不良围产结局，但是在没有 SGA 的情况下，UtA-PI 对不良结局的预测效果不佳。版权所有©2015 ISUOG。由 John Wiley & Sons Ltd 出版。
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