Bhorat I, Pillay M, Reddy T
Department of Obstetrics and Gynaecology, Sub-Department of Foetal Medicine, University of Kwa-Zulu Natal, Durban, South Africa.
Biostatistics Unit, South African Medical Research Council of South Africa, Durban, South Africa.
Cardiovasc J Afr. 2018;29(5):310-316. doi: 10.5830/CVJA-2018-036. Epub 2018 Aug 15.
To determine whether a single elevated myocardial performance index (MPI) value in the third trimester of pregnancy is a marker for later adverse obstetric outcomes in stable placental-mediated disease, defined as well-controlled pre-eclampsia (PE) on a single agent and/or uncompensated intra-uterine growth restriction (IUGR).
Fifty-five foetuses whose mothers had stable placental-mediated disease, either mild pre-eclampsia controlled on a single agent, and/or uncompensated IUGR in the third trimester, attending the Foetal Unit at Inkosi Albert Luthuli Hospital, Durban, South Africa were prospectively recruited with 55 matched controls. Recorded data for the subjects included demographic data of maternal age and parity, sonographic data of estimated foetal weight (EFW) and amniotic fluid index (AFI), myocardial performance index (MPI), and foetal Doppler data of the umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV).
The mean gestational age in the controls, the IUGR and any PE cases was 31.4, 31.8 and 31.0 weeks, respectively. The distribution of MPI values was significantly lower in the controls compared to all other groups. The highest standardised MPI values were observed in the PE-IUGR group, where a median of 5.62 was observed. The only significant differences observed between the PE and IUGR groups was the UA resistance index ( = 0.01), where the IUGR cases tended to have higher UA values compared to the combined PE group. Borderline statistical significance was observed for the MCA resistance index values ( = 0.05) between these groups. The overall adverse event rate in the cases was 49%. The highest rate was observed in the PE + IUGR group, where eight out of 12 (67%) experienced adverse events. MPI -scores served as a good marker of adverse events, as evidenced by the total area under the curve (AUC) of 0.90 on the ROC curve. A cut-off value of 4.5 on the MPI z-score conferred a sensitivity of 89% and specificity of 68% for an adverse event later in pregnancy. In univariate logistic regression, MPI -score, AFI, EFW, UA Doppler, CPR category, DV Doppler and MCA Doppler were assessed separately as potential predictors of adverse outcome. The only significant predictor of adverse outcome was MPI -score.
A single elevated value of the MPI ( -score > 4.5) in the third trimester in stable placental-mediated disease was a strong indicator of adverse obstetric outcomes later in pregnancy. This has the potential to be incorporated in conjunction with standard monitoring models in stable placental-mediated disease to predict an adverse event later in pregnancy and thus to reduce perinatal morbidity and mortality.
确定妊娠晚期单次升高的心肌性能指数（MPI）值是否是稳定的胎盘介导疾病（定义为单药控制良好的先兆子痫（PE）和/或未代偿性宫内生长受限（IUGR））后期不良产科结局的标志物。
前瞻性招募了55例母亲患有稳定胎盘介导疾病的胎儿，这些母亲要么是单药控制的轻度先兆子痫，和/或妊娠晚期未代偿性IUGR，她们在南非德班因科西·阿尔伯特·卢图利医院胎儿科就诊，并与55例匹配的对照组进行比较。记录的受试者数据包括产妇年龄和产次的人口统计学数据、估计胎儿体重（EFW）和羊水指数（AFI）的超声数据、心肌性能指数（MPI）以及脐动脉（UA）、大脑中动脉（MCA）和静脉导管（DV）的胎儿多普勒数据。
对照组、IUGR组和任何PE组的平均孕周分别为31.4周、31.8周和31.0周。与所有其他组相比，对照组的MPI值分布显著更低。在PE - IUGR组中观察到最高的标准化MPI值，其中位数为5.62。PE组和IUGR组之间观察到的唯一显著差异是UA阻力指数（P = 0.01），与合并的PE组相比，IUGR病例的UA值往往更高。这些组之间的MCA阻力指数值（P = 0.05）观察到临界统计学显著性。病例组的总体不良事件发生率为49%。在PE + IUGR组中观察到的发生率最高，12例中有8例（67%）经历了不良事件。MPI评分是不良事件的良好标志物，ROC曲线下总面积（AUC）为0.90证明了这一点。MPI z评分的临界值为4.5时，对妊娠后期不良事件的敏感性为89%，特异性为68%。在单因素逻辑回归中，分别评估MPI评分、AFI、EFW、UA多普勒、CPR类别、DV多普勒和MCA多普勒作为不良结局的潜在预测因素。不良结局的唯一显著预测因素是MPI评分。
稳定胎盘介导疾病妊娠晚期单次MPI升高值（评分>4.5）是妊娠后期不良产科结局的有力指标。这有可能与稳定胎盘介导疾病的标准监测模型相结合，以预测妊娠后期的不良事件，从而降低围产期发病率和死亡率。
