Weiss E, Hitschold T, Berle P
Frauenklinik des Städtischen Klinikums, Landeshauptstadt Wiesbaden.
Z Geburtshilfe Perinatol. 1989 Mar-Apr;193(2):60-7.
4 patients with ruptured membranes and spontaneous labour showed variable decelerations of the fetal heart rate. Blood flow velocities of the umbilical arteries were measured by means of pulsed Doppler ultrasound. The flow velocity waveforms, being normal between the contractions, showed a rapid change to absent and reverse diastolic flow during uterine contraction. By means of quantitative estimation the forward flow as as high as the measured reverse flow in the umbilical artery, resulting in a stop of placental perfusion. Computer-added reconstruction of the curve of fetal heart frequency revealed the exact temporal relation between reduction of umbilical artery perfusion and deceleration of fetal heart rate as well as the relation between recovery of the fetal heart rate and normalisation of blood flow in the umbilical artery. Using this noninvasive method, we could analyze for the first time the acute changes of umbilical artery perfusion in relation to changes of the fetal heart rate in human fetus. A stop in placental perfusion does not always mean an absence of any movement of the fetal blood column. We could demonstrate that this is due to a systolic forward and diastolic reverse flow in the same extent. The described acute flow alterations are discussed as a model for flow alterations described in high risk pregnancies with abnormal fetoplacental perfusion.
4例胎膜破裂并自然分娩的患者出现了胎儿心率变异减速。通过脉冲多普勒超声测量脐动脉的血流速度。宫缩间歇期血流速度波形正常，但在子宫收缩时显示舒张期血流迅速变为消失和反向。通过定量估计，脐动脉正向血流与测量到的反向血流一样高，导致胎盘灌注停止。计算机辅助重建胎儿心率曲线揭示了脐动脉灌注减少与胎儿心率减速之间的确切时间关系，以及胎儿心率恢复与脐动脉血流正常化之间的关系。使用这种非侵入性方法，我们首次能够分析人类胎儿脐动脉灌注的急性变化与胎儿心率变化的关系。胎盘灌注停止并不总是意味着胎儿血柱没有任何运动。我们能够证明这是由于收缩期正向和舒张期反向血流程度相同所致。所描述的急性血流改变被作为高危妊娠中胎儿胎盘灌注异常时血流改变的模型进行讨论。
