Ozel Aysegul, Alici Davutoglu Ebru, Yildirim Sule, Madazli Riza
a Cerrahpasa Medicine Faculty, Department of Obstetrics and Gynaecology , Istanbul University, Perinatology Unit , Istanbul , Turkey.
b Department of Obstetrics and Gynaecology , Umraniye Training and Research Hospital , Istanbul , Turkey.
J Matern Fetal Neonatal Med. 2019 Oct;32(20):3458-3463. doi: 10.1080/14767058.2018.1465556. Epub 2018 Apr 26.
We aimed to determine the fetal cerebro-placental Doppler indices and modified myocardial performance index (Mod-myocardial performance index (MPI)) in this homogenous group of postdated pregnancies. A total of 92 singleton pregnant women were included in this prospective study. The study involved three groups; full term control (Group 1, = 42, 39 0/7 to 40 6/7 week' gestation), late term (Group 2, = 34, 41 0/7 to 41 6/7 week' gestation) and post term (Group 3, = 16, ≥ 42 0/7 weeks' gestation). Each participant underwent a Doppler assessment of the fetal umbilical artery (UA), middle cerebral artery (MCA), Mod-MPI. We determined the correlation of the Doppler indices and mod-MPI in patients with unfavorable outcome. MCA pulcatility indices (PI), cerebroplacental ratio (CPR) values were significantly higher in the control group than those in the late-term and post-term groups (Group 1: 1.63 ± 0.3, Group 2: 1.27 ± 0.51, Group 3: 1.13 ± 0.22, respectively, < .001). The Mod-MPI was significantly higher in the late-term and post-term groups than in the control group (Group 1:0.38 ± 0.1, Group 2: 0.59 ± 0.09, Group 3: 0.60 ± 0.08, respectively, < .001. MCA PI and CPR were only significantly lower in patients with unfavorable outcome). The threshold value for CPR levels for predicting unfavorable outcome in postdate pregnancies was calculated as 1.11 (area under curve [AUC] 0.762, confidence interval [CI] 0.575-0.95) with 72.7% sensitivity and 71.8% specificity. Fetal Mod-MPI does not differ in postdate pregnancies with favorable and unfavorable outcome. The monitorization of fetal well-being with CPR may help to clinicians to select patient for expectant management in postdate pregnancies.
我们旨在确定过期妊娠这一同质组中胎儿脑胎盘多普勒指数和改良心肌性能指数（Mod-心肌性能指数（MPI））。本前瞻性研究共纳入92名单胎孕妇。该研究包括三组：足月对照组（第1组，n = 42，妊娠39 0/7至40 6/7周）、晚期妊娠组（第2组，n = 34，妊娠41 0/7至41 6/7周）和过期妊娠组（第3组，n = 16，≥42 0/7周妊娠）。每位参与者均接受了胎儿脐动脉（UA）、大脑中动脉（MCA）、Mod-MPI的多普勒评估。我们确定了不良结局患者中多普勒指数与Mod-MPI的相关性。对照组的MCA搏动指数（PI）、脑胎盘比率（CPR）值显著高于晚期妊娠组和过期妊娠组（第1组：1.63±0.3，第2组：1.27±0.51，第3组：1.13±0.22，P均<0.001）。晚期妊娠组和过期妊娠组的Mod-MPI显著高于对照组（第1组：0.38±0.1，第2组：0.59±0.09，第3组：0.60±0.08，P均<0.001。仅不良结局患者的MCA PI和CPR显著较低）。过期妊娠中预测不良结局的CPR水平阈值计算为1.11（曲线下面积[AUC]0.762，置信区间[CI]0.575 - 0.95），敏感性为72.7%，特异性为71.8%。过期妊娠中结局良好和不良的胎儿Mod-MPI无差异。用CPR监测胎儿健康状况可能有助于临床医生选择过期妊娠中进行期待管理的患者。
