Hackett G A, Campbell S, Gamsu H, Cohen-Overbeek T, Pearce J M
Br Med J (Clin Res Ed). 1987 Jan 3;294(6563):13-6. doi: 10.1136/bmj.294.6563.13.
In 82 consecutive cases of intrauterine growth retardation managed by established criteria fetal Doppler studies identified 29 fetuses with absence of end diastolic frequencies in the fetal aorta. These same fetuses were significantly more growth retarded (p less than 0.001) and had an earlier gestational age at delivery (p less than 0.001) than those with end diastolic frequencies present. A subgroup of these cases was analysed in more detail to examine the prognostic value of this phenomenon for the neonate. Two groups of neonates of equivalent gestational age and with a birth weight below 2000 g were compared. There were 26 neonates with absent end diastolic frequencies (group 1) and 20 with end diastolic frequencies (group 2) in the fetal aorta. Those in group 1 were more likely to suffer perinatal death (p less than 0.05), necrotising enterocolitis (p less than 0.01), and haemorrhage (p less than 0.05). Only 4 (15%) of the babies in group 1 had an uncomplicated neonatal period compared with 15 (75%) in group 2 (p less than 0.001). The circulatory changes identified in these cases may provide a more sensitive measure of critical fetal compromise than current techniques and thus allow the clinician to deliver the fetus before irreversible tissue damage has occurred.
在按照既定标准处理的82例连续的宫内生长受限病例中，胎儿多普勒研究发现29例胎儿的主动脉舒张末期血流频率消失。与舒张末期血流频率存在的胎儿相比，这些胎儿的生长受限程度显著更严重（p<0.001），且分娩时的孕周更早（p<0.001）。对这些病例中的一个亚组进行了更详细的分析，以研究这一现象对新生儿的预后价值。比较了两组孕周相同且出生体重低于2000g的新生儿。胎儿主动脉舒张末期血流频率消失的有26例新生儿（第1组），舒张末期血流频率存在的有20例（第2组）。第1组的新生儿更易发生围产期死亡（p<0.05）、坏死性小肠结肠炎（p<0.01）和出血（p<0.05）。第1组中只有4例（15%）新生儿的新生儿期无并发症，而第2组中有15例（75%）（p<0.001）。这些病例中发现的循环变化可能比目前的技术提供更敏感的胎儿严重受损指标，从而使临床医生能够在不可逆转的组织损伤发生前娩出胎儿。
