Osaka Women's and Children's Hospital, Department of Maternal-Fetal Medicine, Osaka, Japan.
J Ultrasound Med. 2021 Nov;40(11):2307-2315. doi: 10.1002/jum.15614. Epub 2021 Jan 13.
Various patterns of Doppler deterioration exist in fetal growth restriction (FGR). However, the factors that differentiate these patterns are still unknown. The purpose of this study was to clarify the perinatal outcomes and factors to determine the pattern of Doppler deterioration in severe FGR.
We conducted a retrospective cohort study of preterm severe FGR with Doppler abnormality, wherein the clinical features, including maternal characteristics, medical history, and sonographic findings, were compared between the patterns of Doppler deterioration. We used the multivariable logistic regression analyses to identify the factors associated with the pattern of Doppler deterioration.
Of 322 eligible fetuses, 143 had Doppler abnormalities. Fetuses with Doppler deterioration from ductus venosus uniquely featured fetal and placental-umbilical abnormalities detected after birth. Gestational age (GA) at diagnosis of FGR and at the first diagnosis of Doppler abnormality in fetuses with Doppler deterioration from middle cerebral artery (MCA) were later than those from umbilical artery. In addition, the factor associated with Doppler deterioration from MCA was 31-week GA at the first diagnosis of Doppler abnormality (adjusted odds ratio [aOR]: 26.7; 95% CI: 8.35-103), not GA at diagnosis of FGR (aOR: 1.82; 95% CI: 0.50-5.96).
Characteristics of each Doppler deterioration pattern might reflect FGR etiology. Undetectable anomalies and umbilical-placental abnormalities were found in fetuses with Doppler deterioration from the ductus venosus. Doppler deterioration from the MCA was observed after 31 weeks of gestation not only in the late-onset FGR but also in the early-onset FGR with normal umbilical artery Doppler findings.
胎儿生长受限（FGR）存在多种多普勒恶化模式。然而，区分这些模式的因素尚不清楚。本研究旨在阐明严重 FGR 中多普勒恶化模式的围产期结局和决定因素。
我们对存在多普勒异常的早产严重 FGR 进行了回顾性队列研究，比较了多普勒恶化模式的临床特征，包括母体特征、病史和超声表现。我们使用多变量逻辑回归分析来确定与多普勒恶化模式相关的因素。
在 322 名符合条件的胎儿中，有 143 名胎儿存在多普勒异常。在具有从静脉导管恶化的多普勒异常的胎儿中，独特的特征是在出生后发现胎儿和胎盘-脐带异常。在诊断 FGR 时和在具有从中动脉（MCA）恶化的多普勒异常的胎儿中首次诊断多普勒异常时的胎龄（GA）晚于在具有从脐动脉恶化的多普勒异常的胎儿中。此外，与 MCA 恶化相关的因素是首次诊断多普勒异常时的 31 周 GA（调整后的优势比[aOR]：26.7；95%可信区间[CI]：8.35-103），而不是 FGR 诊断时的 GA（aOR：1.82；95%CI：0.50-5.96）。
每种多普勒恶化模式的特征可能反映了 FGR 的病因。在具有从静脉导管恶化的多普勒异常的胎儿中发现了不可检测的异常和脐带-胎盘异常。不仅在晚期 FGR 中，而且在具有正常脐动脉多普勒发现的早期 FGR 中，也观察到 MCA 恶化发生在 31 周后。
