Department of Obstetrics and Gynaecology, University Gabriele d'Annunzio of Chieti Pescara Department of Medicine and Aging Science, Chieti, Italy.
Department of Obstetrics and Gynaecology, University of Rome Tor Vergata, Roma, Italy.
Ultraschall Med. 2021 Aug;42(4):404-410. doi: 10.1055/a-1072-5161. Epub 2020 Feb 10.
To elucidate the role of Doppler ultrasound in predicting perinatal outcome in appropriate for gestational age (AGA) fetuses at term.
Prospective study carried out in a dedicated research ultrasound clinic. The inclusion criterion was AGA fetuses, defined as those with an estimated fetal weight between the 10 and 90 percentile, at 36 + 0-37 + 6 weeks of gestation. The primary outcome was a composite score of adverse perinatal outcome including either adverse intrapartum events or abnormal acid-base status at birth. Secondary outcomes were the individual components of the primary outcome. The Doppler parameters explored were umbilical artery (UA) PI, middle cerebral artery (MCA) PI, uterine arteries (UtA) PI and cerebroplacental ratio (CPR). Attending clinicians were blinded to Doppler findings. Logistic regression and ROC curve analyses were used to analyze the data.
553 AGA fetuses were included. There was no difference in mean UA PI (p = 0.486), MCA PI (p = 0.621), CPR (p = 0.832) and UtA PI (p = 0.611) between pregnancies complicated by composite perinatal morbidity compared to those not complicated by composite perinatal morbidity. In pregnancies complicated by adverse intrapartum outcome, the mean MCA PI (1.47 ± 0.4 vs 1.61 ± 0.4, p = 0.0039) was lower compared to the control group, while there was no difference in UA PI (p = 0.758), CPR (p = 0.108), and UtA PI (p = 0.177). Finally, there was no difference in any of the Doppler parameters explored between AGA fetuses with abnormal acid-base status at birth compared to those without abnormal acid-base status at birth. In the logistic regression analysis, UA PI, MCA PI, CPR, UtA PI, EFW and AC percentiles were not independently associated with composite adverse outcome, adverse intrapartum outcome or abnormal acid-base status at birth in non-SGA fetuses. The diagnostic performance of all of these Doppler parameters for predicting composite adverse outcome, adverse intrapartum outcome and abnormal acid-base status was poor.
Cerebroplacental and maternal Doppler is not associated with or predictive of adverse pregnancy outcome in AGA fetuses close to term.
阐明多普勒超声在预测足月、适合胎龄（AGA）胎儿围产结局中的作用。
这是一项在专门的研究超声诊所进行的前瞻性研究。纳入标准为 AGA 胎儿，定义为估计胎儿体重在第 10 至 90 百分位数之间，孕龄为 36+0-37+6 周。主要结局是包括产时不良事件或出生时酸碱状态异常的不良围产结局综合评分。次要结局是主要结局的各个组成部分。探讨的多普勒参数包括脐动脉（UA）PI、大脑中动脉（MCA）PI、子宫动脉（UtA）PI 和脑胎盘比（CPR）。主治医生对多普勒检查结果不知情。采用逻辑回归和 ROC 曲线分析进行数据分析。
共纳入 553 例 AGA 胎儿。复合围产发病率的妊娠与无复合围产发病率的妊娠相比，UA PI（p=0.486）、MCA PI（p=0.621）、CPR（p=0.832）和 UtA PI（p=0.611）均值无差异。在产时不良结局的妊娠中，MCA PI（1.47±0.4 与 1.61±0.4，p=0.0039）均值低于对照组，而 UA PI（p=0.758）、CPR（p=0.108）和 UtA PI（p=0.177）无差异。最后，出生时酸碱状态异常的 AGA 胎儿与无异常酸碱状态的胎儿相比，任何多普勒参数均无差异。在逻辑回归分析中，UA PI、MCA PI、CPR、UtA PI、EFW 和 AC 百分位数与非 SGA 胎儿的复合不良结局、产时不良结局或出生时酸碱状态异常均无独立相关性。所有这些多普勒参数预测复合不良结局、产时不良结局和出生时酸碱状态异常的诊断性能均较差。
接近足月的 AGA 胎儿的脑胎盘和母体多普勒与不良妊娠结局无关，也不能预测不良妊娠结局。
