Tanis J C, Schmitz D M, Boelen M R, Casarella L, van den Berg P P, Bilardo C M, Bos A F
Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Fetal Medicine, Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Ultrasound Obstet Gynecol. 2016 Dec;48(6):772-778. doi: 10.1002/uog.15903. Epub 2016 Nov 13.
To investigate whether Doppler pulsatility indices (PIs) of the fetal circulation in cases of fetal growth restriction (FGR) are associated with the general movements (GMs) of the neonate after birth.
This was a prospective observational cohort study including pregnancies with FGR diagnosed between June 2012 and September 2014. A diagnosis of FGR was based on an abdominal circumference or estimated fetal weight < 10 percentile (in conjuction with abnormal Doppler) or declining fetal growth of at least 30 percentiles with respect to previous size measurements. Doppler parameters of the umbilical artery (UA), fetal middle cerebral artery (MCA) and ductus venosus (DV) were measured maximally 1 week prior to delivery. Cerebroplacental ratio (CPR) was calculated as MCA-PI divided by UA-PI. We assessed the quality of neonatal GMs 7 days after birth, around the due date if cases were born preterm, and at 3 months post-term. We performed a detailed analysis of the motor repertoire by calculating a motor optimality score (MOS).
Forty-eight FGR cases were included with a median gestational age at delivery of 35 (range, 26-40) weeks. UA-PI, MCA-PI and CPR correlated strongly (ρ, -0.374 to 0.472; P < 0.01) with the MOS on day 7 after birth, but DV-PI did not. Doppler PI measurements did not correlate with MOS at 3 months post-term.
Fetal arterial Doppler measurements are associated with the quality of neonatal GMs 1 week after birth, but this association is no longer evident at 3 months post-term. Brain sparing in particular is associated strongly with GMs of an abnormal quality. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
探讨胎儿生长受限（FGR）病例中胎儿循环的多普勒搏动指数（PI）与出生后新生儿的一般运动（GMs）是否相关。
这是一项前瞻性观察队列研究，纳入了2012年6月至2014年9月间诊断为FGR的妊娠病例。FGR的诊断基于腹围或估计胎儿体重＜第10百分位数（结合异常多普勒检查），或相对于先前测量的大小胎儿生长下降至少30个百分位数。在分娩前最多1周测量脐动脉（UA）、胎儿大脑中动脉（MCA）和静脉导管（DV）的多普勒参数。脑胎盘比率（CPR）计算为MCA-PI除以UA-PI。我们在出生后7天、如果早产则在预产期左右以及足月后3个月评估新生儿GMs的质量。我们通过计算运动最优性评分（MOS）对运动技能进行了详细分析。
纳入了48例FGR病例，分娩时的中位孕周为35（范围26 - 40）周。UA-PI、MCA-PI和CPR与出生后第7天的MOS密切相关（ρ，-0.374至0.472；P＜0.01），但DV-PI不相关。多普勒PI测量与足月后3个月的MOS不相关。
胎儿动脉多普勒测量与出生后1周新生儿GMs的质量相关，但在足月后3个月这种相关性不再明显。特别是脑保护与异常质量的GMs密切相关。版权所有©2016国际妇产科超声学会。由约翰·威利父子有限公司出版。
