足月低风险孕妇围产期不良结局的筛查：子宫动脉多普勒、脑胎盘比率及估计胎儿体重

Screening for adverse perinatal outcomes: uterine artery Doppler, cerebroplacental ratio and estimated fetal weight in low-risk women at term.

作者信息

Bligh Larissa N, Alsolai Amal, Greer Ristan M, Kumar Sailesh

机构信息

a Faculty of Medicine and Biomedical Sciences , The University of Queensland , Herston , Queensland , Australia.

b Mater Research Institute, University of Queensland , South Brisbane , Queensland , Australia.

出版信息

J Matern Fetal Neonatal Med. 2018 Dec;31(24):3301-3307. doi: 10.1080/14767058.2017.1369518. Epub 2017 Oct 3.

DOI:10.1080/14767058.2017.1369518

PMID:28816083

Abstract

OBJECTIVE

To stratify apparently low-risk pregnant women into those who are at risk of adverse perinatal outcomes. Appropriate stratification would allow targeted prenatal and intrapartum management.

METHODS

This prospective, observational study included normotensive women with appropriately grown, non-anomalous, singleton pregnancies. Participants underwent fortnightly ultrasounds from 36 weeks' gestation and intrapartum and neonatal outcomes were recorded. The association between uterine artery pulsatility index (UtA-PI), the cerebroplacental ratio (CPR) and estimated fetal weight (EFW) were explored along with their screening performance for CS-IFC and CNM.

RESULTS

The final cohort included 429 women. As continuous variables, UtA-PI and the CPR were not correlated (rho = -0.05, p = .33). UtA-PI >95 centile and the CPR <10 centile were predictive of CS-IFC and CNM, with the highest sensitivity achieved by their combination (33.3%, 95% CI 11.6-55.1) for a false positive rate (FPR) of 15.8% (12.3-19.3). For CNM, the highest sensitivity (28.4%, 95% CI 18.6-38.2) and corresponding FPR (17.0%, 95% CI 13.0-20.9) was achieved by combining UtA-PI 95 centile, the CPR 10 centile and EFW 10 centile. EFW was the weakest of the three predictors.

CONCLUSION

In this population, UtA-PI 95 centile and the CPR 10 centile have modest screening performance for CS-IFC and CNM.

摘要

目的

将表面上低风险的孕妇分层为有不良围产期结局风险的孕妇。适当的分层将有助于进行有针对性的产前和产时管理。

方法

这项前瞻性观察性研究纳入了血压正常、胎儿生长正常、无异常的单胎妊娠妇女。参与者从妊娠36周开始每两周接受一次超声检查，并记录产时和新生儿结局。探讨子宫动脉搏动指数（UtA-PI）、脑胎盘比率（CPR）与估计胎儿体重（EFW）之间的关联，以及它们对剖宫产伴产妇发病率增加（CS-IFC）和剖宫产伴新生儿发病率增加（CNM）的筛查性能。

结果

最终队列包括429名妇女。作为连续变量，UtA-PI和CPR不相关（rho = -0.05，p = 0.33）。UtA-PI>第95百分位数和CPR<第10百分位数可预测CS-IFC和CNM，两者联合使用时敏感性最高（33.3%，95%CI 11.6 - 55.1），假阳性率（FPR）为15.8%（12.3 - 19.3）。对于CNM，联合UtA-PI第95百分位数、CPR第10百分位数和EFW第10百分位数时敏感性最高（28.4%，95%CI 18.6 - 38.2），相应的FPR为17.0%（95%CI 13.0 - 20.9）。EFW是三个预测指标中最弱的。