Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA.
J Matern Fetal Neonatal Med. 2020 Oct;33(20):3484-3489. doi: 10.1080/14767058.2019.1575804. Epub 2019 Feb 13.
To test the hypothesis that third-trimester uterine artery Doppler (UAD) predicts adverse pregnancy and neonatal outcomes in a high-risk population. This is a nested case control study of women with singleton gestations referred for a fetal growth ultrasound between 24 and 36 weeks. Third-trimester UAD was performed if estimated fetal weight (Hadlock's chart) was <20th percentile as these patients were considered high risk for poor pregnancy outcomes. The primary outcomes assessed were neonatal small for gestational age (SGA) and hypertensive disorders. Secondary outcomes included pH <7.10, NICU admission, Apgar <7 at 5 minutes, respiratory distress syndrome, hypoglycemia, and a composite (presence of one or more of the secondary outcomes) neonatal adverse outcome. The sensitivity and specificity of the UAD indices for predicting these outcomes were compared. Among 200 women included, neonatal SGA occurred in 91 (46%) neonates, preeclampsia in 21 (10.5%), early preeclampsia in 4 (2%) and a composite adverse outcome in 67 (34%) neonates. Abnormal UAD indices, specifically left uterine artery notching and pulsatile index (PI) >95th percentile, were significantly correlated with an increased relative risk (RR) of a number of outcomes. Left uterine artery notching was significantly associated with SGA, RR 1.76 (1.03-3.04), preeclampsia, RR 2.53 (1.47-4.37) and early preeclampsia, RR 2.88 (1.34-6.20). The PI >95th percentile was significantly associated with SGA, RR 1.83 (1.21-2.76), NICU admission, RR 1.79 (1.14-2.79), preeclampsia, RR 1.98 (1.29-3.03), and early preeclampsia, RR 3.13 (2.54-3.86). The mean UAD PI >95th percentile had the best sensitivity for SGA, but the area under the ROC curve (AUC) was modest (0.60, 95% CI = 0.53-0.67). Left uterine artery notching and PI >95th percentile had similar predictive utility for preeclampsia AUC 0.65, 95% CI = 0.53-0.76 (mean uterine artery PI >95th percentile) and AUC 0.66, 95% CI = 0.54-0.77 (left uterine artery notching). Abnormal third-trimester UAD indices are associated with adverse perinatal outcomes including neonatal SGA, preeclampsia, and early preeclampsia. Though statistically significantly correlated, the predictive value of UAD indices for adverse pregnancy and neonatal outcomes was modest.
为了检验这样一个假设，即妊娠晚期子宫动脉多普勒（UAD）可以预测高危人群的不良妊娠和新生儿结局。这是一项对 24 至 36 周进行胎儿生长超声检查的单胎妊娠女性进行的巢式病例对照研究。如果估计胎儿体重（Hadlock 图表）<第 20 百分位，则进行妊娠晚期 UAD，因为这些患者被认为有不良妊娠结局的高风险。主要结局评估为新生儿小于胎龄（SGA）和高血压疾病。次要结局包括 pH<7.10、NICU 入院、5 分钟时 Apgar<7、呼吸窘迫综合征、低血糖和复合（存在上述一个或多个次要结局）新生儿不良结局。比较了 UAD 指数预测这些结局的敏感性和特异性。在纳入的 200 名女性中，91 名（46%）新生儿发生 SGA，21 名（10.5%）发生子痫前期，4 名（2%）发生早发型子痫前期，67 名（34%）新生儿发生复合不良结局。异常 UAD 指数，特别是左侧子宫动脉切迹和搏动指数（PI）>第 95 百分位，与多种结局的相对风险（RR）增加显著相关。左侧子宫动脉切迹与 SGA 显著相关，RR 1.76（1.03-3.04），子痫前期，RR 2.53（1.47-4.37）和早发型子痫前期，RR 2.88（1.34-6.20）。PI>第 95 百分位与 SGA 显著相关，RR 1.83（1.21-2.76），NICU 入院，RR 1.79（1.14-2.79），子痫前期，RR 1.98（1.29-3.03），早发型子痫前期，RR 3.13（2.54-3.86）。平均 UAD PI>第 95 百分位对 SGA 的敏感性最好，但受试者工作特征曲线（ROC）下面积（AUC）适中（0.60，95%CI=0.53-0.67）。左侧子宫动脉切迹和 PI>第 95 百分位对子痫前期的预测效用相似，AUC 为 0.65（95%CI=0.53-0.76，即平均子宫动脉 PI>第 95 百分位）和 AUC 0.66（95%CI=0.54-0.77，即左侧子宫动脉切迹）。异常妊娠晚期 UAD 指数与不良围生期结局相关，包括新生儿 SGA、子痫前期和早发型子痫前期。尽管具有统计学意义上的相关性，但 UAD 指数对不良妊娠和新生儿结局的预测价值适中。
