Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA.
Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA.
J Matern Fetal Neonatal Med. 2021 Feb;34(4):532-540. doi: 10.1080/14767058.2019.1610735. Epub 2019 May 6.
Current clinical practice incorporates an umbilical artery resistance index or a ratio of the middle cerebral artery (MCA PI) to the umbilical artery pulsatility index (UA PI) known as the cerebral placental ratio (CPR) to assess wellbeing in the small for gestational age fetus. Previous reports using the renal artery Doppler indices have not been consistent in regards to their design and clinical use. Our objective is to develop reference values for renal artery Doppler indices and validate their use compared with the UA PI or CPR to identify fetuses that will develop a composite neonatal outcome. We performed 9700 ultrasounds among 2852 women at 20-40 weeks of gestation at the University of Maryland between 1 June 2016 and 1 December 2016. Nomograms were first developed using one randomly selected scan from each of a subgroup of 860 women without any comorbidities. The nomograms were validated among a cohort of 550 women who subsequently delivered at the University of Maryland Medical Center. We compared the area under the receiver operating characteristic curve (AUROC) between the CPR and UA PI, and the renal artery Doppler parameters (renal artery pulsatility index (RA PI), systolic diastolic ratio (RA SDR), and peak systolic velocity (RA PSV)). The primary outcome was the development any one of the composite neonatal outcome components (death, intensive care unit admission, ventilator for more than 6 h, hypoxic ischemic encephalopathy or necrotizing enterocolitis) or admission to the neonatal intensive care unit (NICU) for any indication. The renal artery Doppler indices did not improve identification of fetuses that would subsequently develop one of the components of the composite neonatal outcome (AUROC for CPR 0.54, 95% CI (0.49-0.59), versus the UA PI: 0.59 (0.54-0.64) = .07, the RA PI: 0.51 (0.48-0.55) = .41, RA SDR 0.54 (0.49-0.58) = .99, or RA PSV 0.51 (0.47-0.55) = .37). There was no difference when comparing AUROC to detect NICU admission (AUROC for CPR 0.53, 95% CI (0.49-0.58), versus the UA PI: 0.57 (0.52-0.62) = .14, the RA PI: 0.50 (0.47-0.54) = .44, RA SDR: 0.54 (0.50-0.59) = .62 or RAPSV: 0.51 (0.47-0.55) = .54). The renal artery indices do not improve detection of fetuses at risk for adverse neonatal outcomes compared with the CPR or the UA PI.
目前的临床实践结合了脐动脉阻力指数或大脑中动脉（MCA PI）与脐动脉搏动指数（UA PI）的比值，称为脑胎盘比（CPR），以评估胎儿的生长发育情况。以前使用肾动脉多普勒指数的报告在设计和临床应用方面并不一致。我们的目的是为肾动脉多普勒指数制定参考值，并验证其与 UA PI 或 CPR 的使用情况，以确定哪些胎儿会出现复合新生儿结局。我们在 2016 年 6 月 1 日至 2016 年 12 月 1 日期间，在马里兰大学对 2852 名 20-40 周的女性进行了 9700 次超声检查。首先使用没有任何合并症的 860 名女性中的每一位的随机选择的扫描来开发列线图。在随后在马里兰大学医学中心分娩的 550 名女性队列中验证了列线图。我们比较了 CPR 和 UA PI 之间以及肾动脉多普勒参数（肾动脉搏动指数（RA PI）、收缩期舒张比（RA SDR）和收缩期峰值速度（RA PSV））的接收者操作特征曲线（AUROC）下面积。主要结局是出现任何一种复合新生儿结局成分（死亡、入住重症监护病房、呼吸机使用超过 6 小时、缺氧缺血性脑病或坏死性小肠结肠炎）或因任何原因入住新生儿重症监护病房（NICU）。肾动脉多普勒指数并不能提高对随后会出现复合新生儿结局成分之一的胎儿的识别能力（CPR 的 AUROC 为 0.54，95%CI（0.49-0.59），UA PI：0.59（0.54-0.64）=0.07，RA PI：0.51（0.48-0.55）=0.41，RA SDR 0.54（0.49-0.58）=0.99，或 RA PSV 0.51（0.47-0.55）=0.37）。比较 AUROC 以检测 NICU 入院时（CPR 的 AUROC 为 0.53，95%CI（0.49-0.58），UA PI：0.57（0.52-0.62）=0.14，RA PI：0.50（0.47-0.54）=0.44，RA SDR：0.54（0.50-0.59）=0.62 或 RAPSV：0.51（0.47-0.55）=0.54）时，没有差异。与 CPR 或 UA PI 相比，肾动脉指数并不能提高对有不良新生儿结局风险的胎儿的检测能力。
