College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
School of Medicine, The University of Queensland, Herston, Queensland, Australia.
Ultrasound Obstet Gynecol. 2018 Jun;51(6):799-805. doi: 10.1002/uog.17552.
To investigate prospectively the relationship of fetal cardiac function and Doppler ultrasound parameters with intrapartum fetal compromise (IFC) in appropriately grown term fetuses. Secondary aims were to correlate prenatal cardiac function with neonatal acid-base status, intrapartum fetal heart rate (FHR) abnormalities and adverse neonatal outcomes.
This was a blinded, prospective, observational, cohort study of 270 women with an uncomplicated singleton pregnancy who underwent fortnightly ultrasound assessment from 36 weeks' gestation until delivery at the Mater Mother's Hospital, Brisbane, Australia. Fetal cardiac output and blood flow parameters were assessed and correlated with intrapartum and neonatal outcomes. The primary outcome was need for operative (either Cesarean or instrumental vaginal) delivery for IFC. Secondary outcome measures were acidosis at birth, 5-min Apgar score ≤ 7, suspicious or pathological FHR abnormalities and admission to the neonatal intensive care unit.
Two hundred and seventy women were included in the analysis, of whom 51 (18.9%) had an emergency operative delivery for IFC. Fetuses that had emergency delivery for IFC showed lower mean left ventricular cardiac output (LVCO) (560 ± 44 mL/min vs 617 ± 73 mL/min; P < 0.001), lower mean LVCO/right ventricular cardiac output (RVCO) ratio (0.55 ± 0.07 vs 0.64 ± 0.11; P < 0.001), lower mean cerebroplacental ratio (CPR) (1.62 ± 0.3 vs 1.90 ± 0.5; P < 0.001) and higher mean RVCO (1026 ± 105 mL/min vs 978 ± 110 mL/min; P = 0.003) compared with those that did not develop IFC. Additionally, LVCO and CPR were lower in fetuses with adverse neonatal outcome.
Term fetuses with estimated fetal weight > 10 centile that develop IFC have evidence of lower LVCO and higher RVCO, which are in turn associated with poorer condition of the newborn. Fetal CPR is positively correlated with LVCO. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
前瞻性研究胎儿心功能和多普勒超声参数与足月适当生长胎儿产时胎儿窘迫（IFC）的关系。次要目的是将产前心功能与新生儿酸碱状态、产时胎儿心率（FHR）异常和不良新生儿结局相关联。
这是一项在澳大利亚布里斯班 Mater Mother's 医院进行的、盲法、前瞻性、观察性队列研究，共纳入 270 名单胎妊娠、无并发症的孕妇，从 36 孕周起每两周进行一次超声评估，直至分娩。评估胎儿心输出量和血流参数，并与产时和新生儿结局相关联。主要结局是需要行 IFC 的剖宫产术或器械助产术。次要结局包括出生时酸中毒、5 分钟 Apgar 评分≤7、可疑或病理性 FHR 异常以及入住新生儿重症监护病房。
270 名妇女纳入分析，其中 51 名（18.9%）因 IFC 行紧急剖宫产术。行紧急剖宫产术的 IFC 胎儿左心室心输出量（LVCO）均值较低（560±44 mL/min 比 617±73 mL/min；P<0.001），LVCO/右心室心输出量（RVCO）比值较低（0.55±0.07 比 0.64±0.11；P<0.001），脑胎盘比（CPR）较低（1.62±0.3 比 1.90±0.5；P<0.001），RVCO 均值较高（1026±105 mL/min 比 978±110 mL/min；P=0.003）。此外，LVCO 和 CPR 较低的胎儿发生不良新生儿结局的风险更高。
估计胎儿体重>第 10 百分位数、发生 IFC 的足月胎儿存在 LVCO 降低和 RVCO 升高的证据，这反过来与新生儿的不良状况相关。胎儿 CPR 与 LVCO 呈正相关。版权所有©2017 ISUOG。由 John Wiley & Sons Ltd 出版。
