Leavitt Karla, Odibo Linda, Nwabuobi Chinedu, Tuuli Methodius G, Odibo Anthony
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. 2021 May;34(10):1565-1569. doi: 10.1080/14767058.2019.1640206. Epub 2019 Jul 21.
To compare the role of umbilical artery (UA) Doppler versus CPR in the prediction of neonatal SGA and short-term adverse neonatal outcome in a high-risk population.
We conducted a prospective study on women referred for fetal growth ultrasounds between 26 and 36 weeks of gestation and with an EFW <20th percentile by Hadlock standard. UA and middle cerebral artery (MCA) Doppler assessments were performed. Abnormal UA Doppler was defined as: pulsatility index (PI) above the 95th percentile and absent or reverse end-diastolic flow. The CPR, calculated as a ratio of the MCA PI by the UA PI, was defined as low if <1.08. The primary outcome was the sensitivity and specificity of the two Doppler assessments to predict neonatal SGA, defined as birthweight <10th percentile by using Alexander curves. The secondary outcomes included umbilical cord arterial pH <7.10, Apgars at 5 minutes <7, NICU admission, respiratory distress syndrome (RDS), hypoglycemia or a composite including any of these secondary outcomes. Chi-square was performed for statistical analysis.
Of the 199 women meeting inclusion criteria, 94 (47.2%) had SGA and 68 (34.2%) had a composite adverse outcome. A total of seven pregnancies with FGR had a low CPR. Abnormal UA Doppler showed a better sensitivity for predicting SGA and adverse neonatal outcomes with comparable specificity to low CPR. The area under the ROC curve (AUC) using abnormal UA Doppler for predicting SGA was 0.54, 95% CI 0.50-0.58; and 0.51, 95% CI 0.48-0.53 for low CPR. The AUC for predicting a composite adverse neonatal outcome are: 0.60, 95% CI 0.51-0.68 for abnormal UA Doppler; and 0.54, 95% CI 0.47-0.84 for low CPR.
The CPR did not improve our ability to predict neonatal SGA or other short-term adverse outcomes.
比较脐动脉（UA）多普勒检查与脑胎盘比率（CPR）在预测高危人群中新生儿小于胎龄儿（SGA）及新生儿短期不良结局方面的作用。
我们对妊娠26至36周因胎儿生长超声检查转诊且胎儿估计体重（EFW）低于哈得洛克标准第20百分位数的孕妇进行了一项前瞻性研究。进行了脐动脉和大脑中动脉（MCA）多普勒评估。异常脐动脉多普勒定义为：搏动指数（PI）高于第95百分位数且舒张末期血流缺失或反向。CPR计算为MCA PI与UA PI之比，若小于1.08则定义为低CPR。主要结局是两种多普勒评估预测新生儿SGA的敏感性和特异性，新生儿SGA定义为使用亚历山大曲线出生体重低于第10百分位数。次要结局包括脐动脉血pH<7.10、5分钟时阿氏评分<7分、入住新生儿重症监护病房（NICU）、呼吸窘迫综合征（RDS）、低血糖或包括这些次要结局中任何一项的综合结局。采用卡方检验进行统计分析。
在199名符合纳入标准的孕妇中，94名（47.2%）有SGA，68名（34.2%）有综合不良结局。共有7例胎儿生长受限（FGR）妊娠的CPR较低。异常脐动脉多普勒在预测SGA和新生儿不良结局方面显示出更好的敏感性，其特异性与低CPR相当。使用异常脐动脉多普勒预测SGA的ROC曲线下面积（AUC）为0.54，95%可信区间为0.50 - 0.58；低CPR的AUC为0.51，95%可信区间为0.48 - 0.53。预测综合新生儿不良结局的AUC为：异常脐动脉多普勒为0.60，95%可信区间为0.51 - 0.68；低CPR为0.54，95%可信区间为0.47 - 0.84。
CPR并未提高我们预测新生儿SGA或其他短期不良结局的能力。
