足月妊娠胎儿产前和产后的脑血流动力学：与多普勒超声、出生体重和不良围产儿结局的相关性。
Pre- and postnatal brain hemodynamics in pregnancies at term: correlation with Doppler ultrasound, birthweight, and adverse perinatal outcome.
机构信息
Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy.
Department of Maternal Fetal Medicine, Cristo Re Hospital, Rome, Italy.
出版信息
J Matern Fetal Neonatal Med. 2022 Feb;35(4):713-719. doi: 10.1080/14767058.2020.1731456. Epub 2020 Mar 9.
PURPOSE
To elucidate the correlation between pre- and postnatal cerebral Doppler in pregnancies close to term and to explore whether they are associated with perinatal outcome.
MATERIALS AND METHODS
Prospective study on singleton pregnancies at 36-37 weeks of gestation. The primary outcome was a composite score of perinatal morbidity, while secondary outcomes were adverse intra-partum outcome and abnormal acid-base status. All pregnancies underwent ultrasound assessment of umbilical artery (UA), middle cerebral artery (MCA), uterine arteries (UtAs) pulsatility index (PI), and cerebroplacental ratio (CPR). At birth, neonatal MCA PI was measured 72 h from delivery and correlated with prenatal Doppler, primary and secondary outcomes. Fisher's test and multivariate logistic regression analysis were used to analyze the data.
RESULTS
One hundred and sixty-six fetuses with both pre- and postnatal Doppler assessment of the MCA were included in the study. The risk of composite perinatal morbidity was higher in fetuses (OR: 5.7, 95% CI 2.2-14.6) and newborns (OR: 4.1, 95% CI 1.8-9.6) with fetal MCA PI < 10th centile. Likewise, the incidence of abnormal acid-base status was higher both in fetuses (20 versus 4.2%, = .026) and newborns (17.1 versus 3.2%, = .001) with a low MCA PI before and at birth, respectively. At logistic regression analysis, fetal and neonatal MCAPI were independently associated with composite perinatal morbidity and abnormal acid-base status, but not with adverse intra-partum outcome. In small for gestational age (SGA) fetuses, the incidence of composite perinatal morbidity was higher in fetuses and new-borns presenting compared to those not presenting with an MCA PI < 10th centile (61.5 versus 20%, = .003 and 52.6% versus 7.1%, = .008, respectively), while such association was lost when considering non-SGA fetuses.
CONCLUSION
A low MCA PI is associated with adverse perinatal outcome in pregnancies at term and tends to persist after birth.
目的
阐明接近足月的妊娠胎儿产前和产后大脑多普勒之间的相关性，并探讨它们是否与围产期结局相关。
材料和方法
对 36-37 孕周的单胎妊娠进行前瞻性研究。主要结局是围产儿发病率的综合评分，次要结局是分娩期不良结局和酸碱状态异常。所有妊娠均行脐动脉（UA）、大脑中动脉（MCA）、子宫动脉（UtA）搏动指数（PI）和胎盘血流比（CPR）超声评估。出生时，在分娩后 72 小时测量新生儿 MCA PI，并与产前多普勒、主要和次要结局相关。采用 Fisher 检验和多变量逻辑回归分析进行数据分析。
结果
本研究共纳入 166 例胎儿进行 MCA 产前和产后多普勒评估。MCA PI < 第 10 百分位数的胎儿（比值比 [OR]：5.7，95%置信区间 [CI]：2.2-14.6）和新生儿（OR：4.1，95%CI：1.8-9.6）发生复合围产儿发病率的风险更高。同样，MCA PI 低值的胎儿（20 比 4.2%， = .026）和新生儿（17.1 比 3.2%， = .001）酸碱状态异常的发生率也更高。在逻辑回归分析中，胎儿和新生儿 MCA PI 与复合围产儿发病率和酸碱状态异常独立相关，但与分娩期不良结局无关。在小于胎龄儿（SGA）中，与 MCA PI < 第 10 百分位数的胎儿和新生儿相比，复合围产儿发病率更高（61.5 比 20%， = .003 和 52.6%比 7.1%， = .008），但在考虑非 SGA 胎儿时，这种相关性消失。
结论
接近足月的妊娠胎儿 MCA PI 低值与不良围产儿结局相关，且在出生后仍持续存在。
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