Morales-Roselló José, Khalil Asma, Fornés-Ferrer Victoria, Hervas-Marín David, Peralta-Llorens Nuria, Rubio-Moll Juan, Perales-Marín Alfredo
a Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe , Valencia , Spain.
c Fetal Medicine Unit , St George Hospital, University of London , London , UK.
J Matern Fetal Neonatal Med. 2018 Jan;31(1):70-79. doi: 10.1080/14767058.2016.1275551. Epub 2017 Jan 23.
Low cerebroplacental ratio (CPR) near term has emerged as a marker of fetal adverse outcome. The aim of this study was to evaluate the predictive accuracy of an alternative ratio using the vertebral artery (VA) (vertebroplacental ratio or VPR) for acid-base status at birth.
This was a prospective cohort study of 1470 pregnancies undergoing an ultrasound assessment of the umbilical artery, middle cerebral artery and VA Doppler beyond 34 weeks' gestation within 14 days of delivery. The CPR multiples of the median (MoM) and VPR MoM were calculated to adjust for gestational age. The relationship between the fetal Dopplers and the umbilical cord pH (arterial and venous) was evaluated statistically, and depicted graphically using three-dimensional (3D) trend surfaces, 2D contour graphs and ROC curves.
All the studied parameters were poorly associated with neonatal acid-base status, although this association was slightly better for venous pH. The importance of BW centile was smaller than that of CPR and VPR MoM, however, both hemodynamic parameters were similarly associated with neonatal pH.
Concerning fetal surveillance near term, the importance of cerebroplacental hemodynamics surpasses that of BW. Furthermore, in the evaluation of fetal wellbeing VPR behaves as a valid alternative to CPR.
近期低脑胎盘比（CPR）已成为胎儿不良结局的一个标志物。本研究的目的是评估使用椎动脉（VA）的替代比值（椎胎盘比或VPR）对出生时酸碱状态的预测准确性。
这是一项对1470例妊娠进行的前瞻性队列研究，这些孕妇在分娩前14天内妊娠34周后接受了脐动脉、大脑中动脉和VA多普勒超声评估。计算CPR中位数倍数（MoM）和VPR MoM以校正胎龄。对胎儿多普勒指标与脐动脉血pH值（动脉血和静脉血）之间的关系进行统计学评估，并使用三维（3D）趋势面、二维等高线图和ROC曲线进行图形化描述。
所有研究参数与新生儿酸碱状态的相关性均较差，尽管这种相关性在静脉血pH值方面略好。出生体重百分位数的重要性小于CPR和VPR MoM，然而，这两个血流动力学参数与新生儿pH值的相关性相似。
关于近期胎儿监测，脑胎盘血流动力学的重要性超过出生体重。此外，在评估胎儿健康状况时，VPR可作为CPR的有效替代指标。
