Alici Davutoglu Ebru, Ozel Aysegul, Oztunc Funda, Madazli Riza
Cerrahpaşa Medical Faculty, Obstetrics and Gynecology Department, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
Cerrahpaşa Medical Faculty, Pediatric Cardiology Department, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
J Matern Fetal Neonatal Med. 2020 Jan;33(2):277-282. doi: 10.1080/14767058.2018.1489534. Epub 2018 Jul 22.
To compare the fetal modified myocardial performance index (Mod-MPI) in appropriately grown, early (EO) and late onset (LO) fetal growth restricted (FGR) fetuses and to assess its prognostic significance for adverse perinatal outcome. In a prospective case-control study, Mod-MPI was performed in 22 and 51 fetuses with EO and LO-FGR fetuses, respectively. Mod-MPI values of FGR fetuses were compared against gestation-matched controls (34 for EO-, and 32 for LO-FGR, respectively). Correlation testing related with poor perinatal outcomes were performed. Incidences of pathologic uterine artery Doppler rate, cesarean section rate, 5-min Apgar score < 7, neonatal intensive care unit (NICU) admission and perinatal mortality were significantly higher in the EO-FGR group ( < .001). There was a decrease in Mod-MPI with gestational age in the normal (Pearson's = 0.401, < .001), and growth-restricted fetuses (Pearson's = 0.248, = .034). Mean Mod-MPI values were significantly higher in both EO- and LO-FGR group than gestation-matched controls ( < .001). There was no significant correlation between Mod-MPI values and perinatal deaths (Pearson's = 0.004, = .987) and 5-min Apgar score < 7 (Pearson's = 0.391, = .088) in the EO-FGR fetuses. There was a significant negative correlation between Mod-MPI values and cerebroplacental ratio (CPR) values (Pearson's = -0.288, = .041); however no significant correlation between Mod-MPI values and 5-min Apgar score< 7, and fetal distress during labor (Pearson's = 0.149, = 0.297) in the LO-FGR fetuses was noted. EO and LO-FGR fetuses have significantly higher Mod-MPI values, demonstrating prenatal cardiac dysfunction. Evaluating Mod-MPI is not so effective in predicting poor perinatal outcome in both EO and LO-FGR fetuses.
比较适宜生长、早发型（EO）和晚发型（LO）胎儿生长受限（FGR）胎儿的改良心肌性能指数（Mod-MPI），并评估其对围产期不良结局的预后意义。在一项前瞻性病例对照研究中，分别对22例早发型FGR胎儿和51例晚发型FGR胎儿进行了Mod-MPI检测。将FGR胎儿的Mod-MPI值与孕周匹配的对照组（早发型FGR为34例，晚发型FGR为32例）进行比较。进行了与围产期不良结局相关的相关性检测。早发型FGR组的病理性子宫动脉多普勒率、剖宫产率、5分钟Apgar评分<7、新生儿重症监护病房（NICU）入院率和围产期死亡率显著更高（<0.001）。正常胎儿（Pearson's =0.401，<0.001）和生长受限胎儿（Pearson's =0.248，=0.034）的Mod-MPI均随孕周增加而降低。早发型和晚发型FGR组的平均Mod-MPI值均显著高于孕周匹配的对照组（<0.001）。早发型FGR胎儿的Mod-MPI值与围产期死亡（Pearson's =0.004，=0.987）和5分钟Apgar评分<7（Pearson's =0.391，=0.088）之间无显著相关性。晚发型FGR胎儿的Mod-MPI值与脑胎盘比率（CPR）值之间存在显著负相关（Pearson's = -0.288，=0.041）；然而，晚发型FGR胎儿的Mod-MPI值与5分钟Apgar评分<7以及产时胎儿窘迫之间无显著相关性（Pearson's =0.149，=0.297）。早发型和晚发型FGR胎儿的Mod-MPI值显著更高，表明存在产前心脏功能障碍。评估Mod-MPI在预测早发型和晚发型FGR胎儿的围产期不良结局方面效果不佳。
