Bhorat I E, Bagratee J S, Reddy T
Department of Obstetrics and Gynaecology, Subdepartment of Fetal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa.
Department of Obstetrics and Gynaecology, Subdepartment of Fetal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa.
Eur J Obstet Gynecol Reprod Biol. 2017 Mar;210:325-333. doi: 10.1016/j.ejogrb.2017.01.014. Epub 2017 Jan 16.
To determine whether fetuses in severe early onset pre-eclampsia (EO-PET) with or without intrauterine growth restriction has cardiac dysfunction across deteriorating stages of placental vascular resistance and whether this dysfunction influences perinatal outcome.
This was a prospective cross-sectional study performed in a tertiary care university medical centre. Sixty pregnant patients with severe early-onset pre-eclampsia between 27 and 32 weeks were recruited and matched with 60 patients having normal pregnancies. An analysis of cardiac function using the myocardial performance index (MPI) and early ventricular filling (E) and late active atrial contraction (A) ratios (E/A ratios) in the study group was performed compared to controls and further analysis was performed based on worsening placental vascular resistance and presence of growth restriction.
MPI values were increased in the pre-eclamptic group, irrespective if growth restriction co-exists, compared to controls (0.61 vs 0.38, p<0.001). Its median value progressively increased with worsening placental vascular resistance. For adverse perinatal outcome cut-off MPI values have been suggested. The E/A ratios were significantly decreased in the pre-eclamptic group compared to controls (0.66 vs 0.79, p<0.0001). No adverse outcomes were noted in the control group.
Fetal cardiac function is significantly impaired in pregnancies complicated by severe early onset pre-eclampsia, irrespective if growth restriction co-exists and worsens with deteriorating grades of placental vascular resistance. The MPI can potentially be integrated into routine fetal surveillance techniques.
确定患有或不患有宫内生长受限的重度早发型子痫前期（EO-PET）胎儿在胎盘血管阻力恶化阶段是否存在心脏功能障碍，以及这种功能障碍是否会影响围产期结局。
这是一项在三级护理大学医学中心进行的前瞻性横断面研究。招募了60例孕27至32周的重度早发型子痫前期孕妇，并与60例正常妊娠孕妇进行匹配。与对照组相比，对研究组使用心肌性能指数（MPI）以及早期心室充盈（E）和晚期心房主动收缩（A）比值（E/A比值）进行心脏功能分析，并根据胎盘血管阻力恶化情况和生长受限情况进行进一步分析。
与对照组相比，子痫前期组的MPI值升高，无论是否并存生长受限（0.61对0.38，p<0.001）。其中位数随着胎盘血管阻力恶化而逐渐增加。已提出不良围产期结局的MPI值临界值。与对照组相比，子痫前期组的E/A比值显著降低（0.66对0.79，p<0.0001）。对照组未观察到不良结局。
患有重度早发型子痫前期的妊娠中，胎儿心脏功能明显受损，无论是否并存生长受限，且随着胎盘血管阻力等级恶化而加重。MPI有可能被纳入常规胎儿监测技术中。
