Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain; Fetal Medicine Unit, Clínica Dávila, Santiago, Chile.
Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain; Fetal Medicine Unit, Clínica Hospital Sinaí, Xalapa Veracruz, México.
Am J Obstet Gynecol. 2018 Feb;218(2S):S774-S782.e21. doi: 10.1016/j.ajog.2017.11.566. Epub 2017 Dec 9.
The objective of the study was to establish the risk of fetal death in early-onset growth-restricted fetuses with absent or reversed end-diastolic velocities in the umbilical artery or ductus venosus.
A systematic search was performed to identify relevant studies published in English, Spanish, French, Italian, or German using the databases PubMed, ISI Web of Science, and SCOPUS, without publication time restrictions.
The study criteria included observational cohort studies and randomized controlled trials of early-onset growth-restricted fetuses (diagnosed before 34 weeks of gestation), with information on the rate of fetal death occurring before 34 weeks of gestation and absent or reversed end-diastolic velocities in the umbilical artery and/or ductus venosus.
For quality assessment, 2 reviewers independently assessed the risk of bias using the Newcastle-Ottawa Scale for observational studies and the Cochrane Collaboration's tool for randomized trials. For the meta-analysis, odds ratio for both fixed and random-effects models (weighting by inverse of variance) were used. Heterogeneity between studies was assessed using tau, χ2 (Cochrane Q), and I statistics. Publication bias was assessed by a funnel plot for meta-analyses and quantified by the Egger method.
A total of 31 studies were included in this meta-analysis. The odds ratios for fetal death (random-effects models) were 3.59 (95% confidence interval, 2.3-5.6), 7.27 (95% confidence interval, 4.6-11.4), and 11.6 (95% confidence interval, 6.3-19.7) for growth-restricted fetuses with umbilical artery absent end-diastolic velocities, umbilical artery reversed end-diastolic velocities, and ductus venosus absent or reversed end-diastolic velocities, respectively. There was no substantial heterogeneity among studies for any of the analyses.
Early-onset growth-restricted fetuses with either umbilical artery or ductus venosus absent or reserved end-diastolic velocities are at a substantially increased risk for fetal death.
本研究旨在确定在脐动脉或静脉出现无舒张末期血流或舒张末期血流反向的早期生长受限胎儿中，胎儿死亡的风险。
系统检索了在英文、西班牙文、法文、意大利文或德文数据库 PubMed、ISI Web of Science 和 SCOPUS 中发表的相关研究，无时间限制。
研究标准包括对早期生长受限胎儿（诊断于 34 周前）的观察性队列研究和随机对照试验，其信息包括发生于 34 周前的胎儿死亡发生率以及脐动脉和/或静脉出现无舒张末期血流或舒张末期血流反向。
对于质量评估，两位审阅者独立使用纽卡斯尔-渥太华量表对观察性研究和 Cochrane 协作组对随机试验的工具进行偏倚风险评估。对于荟萃分析，使用固定和随机效应模型的比值比（加权为方差的倒数）。使用 tau、χ2（Cochrane Q）和 I 统计量评估研究间的异质性。通过漏斗图对荟萃分析进行发表偏倚评估，并通过 Egger 法进行量化。
共有 31 项研究纳入了这项荟萃分析。（随机效应模型）生长受限胎儿的胎儿死亡比值比为 3.59（95%置信区间，2.3-5.6）、7.27（95%置信区间，4.6-11.4）和 11.6（95%置信区间，6.3-19.7），分别对应于脐动脉无舒张末期血流、脐动脉舒张末期血流反向和静脉无舒张末期血流或舒张末期血流反向的胎儿。对于任何分析，研究间均无显著异质性。
早期生长受限胎儿中，无论是脐动脉还是静脉出现无舒张末期血流或舒张末期血流反向，胎儿死亡的风险都显著增加。
