Department of Biomedicine and Prevention, Università di Roma Tor Vergata, Roma, Italy.
Division of Maternal Fetal Medicine, Ospedale Cristo Re, Roma, Italy.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):7139-7145. doi: 10.1080/14767058.2021.1945028. Epub 2021 Aug 3.
To explore the strength of association and the diagnostic accuracy of maternal hemodynamic parameters detected noninvasively in predicting an adverse perinatal outcome in labor.
Prospective cohort study of singleton women undergoing antepartum care at 37-39 weeks of gestation. A noninvasive ultrasonic cardiac output monitor (USCOM®) was used for cardiovascular assessment. The study outcome was a composite score of adverse perinatal outcome, which included at least one of the following variables: Cesarean or instrumental delivery for abnormal fetal heart monitoring, umbilical artery pH <7.10 or admission to neonatal special care unit. Attending clinicians were blinded to maternal cardiovascular indices. Multivariate logistic regression and area under the curve (AUC) analyses were used to test the diagnostic accuracy of different maternal and ultrasound characteristics in predicting adverse perinatal outcome.
A total of 133 women were recruited. The rate of adverse perinatal outcome was 25.6% (34/133). Women who delivered without abnormal perinatal outcome (controls) were more likely to be parous, compared to those who had an adverse perinatal outcome (44.4 vs. 73.5%; = .005). Control women had significantly lower systemic vascular resistance (SVR) (median, 1166 vs. 1352 dynes × s/cm, = .023) and SVR index (SVRI) (median, 2168 vs. 2627 dynes × s/cm/m, = .039) compared to women who had an adverse perinatal outcome. In this latter group the prevalence of SV <50 ml was significantly higher than in the control group (38.2% (13/34) vs. 11.1%, (11/99) = .0012). At multivariable logistic regression analysis, SVR (aOR 1.307; 95% CI 1.112-2.23), SV <50 ml (aOR 4.70; 95% CI 1.336-12.006) and parity (3.90: 95% CI 1.545-10.334) were the only variables independently associated with adverse perinatal outcome. A model considering only SVR showed an AUC of 0.631. Integration of SVR with SV <50 ml and parity significantly improves the diagnostic performance of SVR alone to predict adverse outcome (AUC 0.732; = .016).
Pre-labor modifications of maternal cardiovascular variables are associated with adverse perinatal outcome. However, their predictive accuracy for perinatal compromise is low, and thus their use as standalone screening test for adverse perinatal outcome in singleton pregnancies at term is not supported.
探讨在分娩期间预测不良围产结局的孕妇非侵入性血流动力学参数的关联强度和诊断准确性。
这是一项对 37-39 孕周进行产前检查的单胎女性进行的前瞻性队列研究。使用非侵入性超声心输出量监测仪（USCOM®）进行心血管评估。研究结果是不良围产结局的综合评分，包括以下至少一个变量：因胎儿监护异常行剖宫产或器械分娩、脐动脉 pH 值＜7.10 或入住新生儿特护病房。参与临床医生对孕妇心血管指数不了解。采用多元逻辑回归和曲线下面积（AUC）分析来检验不同的孕妇和超声特征在预测不良围产结局方面的诊断准确性。
共纳入 133 名女性。不良围产结局的发生率为 25.6%（34/133）。与无不良围产结局的对照组相比，发生不良围产结局的女性更有可能是经产妇（44.4% vs. 73.5%； = .005）。对照组的全身血管阻力（SVR）（中位数，1166 对 1352 dynes × s/cm， = .023）和 SVR 指数（SVRI）（中位数，2168 对 2627 dynes × s/cm/m， = .039）明显低于发生不良围产结局的女性。在后一组中，SV＜50ml 的患病率明显高于对照组（38.2%（13/34）对 11.1%（11/99） = .0012）。多变量逻辑回归分析显示，SVR（比值比 1.307；95%可信区间 1.112-2.23）、SV＜50ml（比值比 4.70；95%可信区间 1.336-12.006）和经产（比值比 3.90；95%可信区间 1.545-10.334）是唯一与不良围产结局相关的变量。仅考虑 SVR 的模型显示 AUC 为 0.631。将 SVR 与 SV＜50ml 和经产结合起来，可显著提高 SVR 单独预测不良结局的诊断性能（AUC 0.732； = .016）。
分娩前孕妇心血管变量的改变与不良围产结局相关。然而，它们对围产期并发症的预测准确性较低，因此不支持将其作为单独的筛查试验用于预测单胎足月妊娠的不良围产结局。
