胎儿生长受限与脐动脉 pH 值相关的静脉导管和心动周期的时间间隔分析。
Time interval analysis of ductus venosus and cardiac cycles in relation with umbilical artery pH at birth in fetal growth restriction.
机构信息
Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku Osaka, Osaka, 545-8585, Japan.
Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka, Japan.
出版信息
BMC Pregnancy Childbirth. 2021 Oct 3;21(1):671. doi: 10.1186/s12884-021-04115-7.
BACKGROUND
The aims of this study were to evaluate the time intervals of flow velocity waveforms (FVW) of ductus venosus (DV) and cardiac cycles, as well as the pulsatility index of DV-FVW (DV-PI), in correlation with umbilical artery (UA) pH at birth in fetal growth restriction (FGR) complicated with placental insufficiency.
METHODS
Data were retrospectively retrieved from pregnancies complicated by FGR. FGR was defined as an estimated fetal weight below - 2.0 S.D. with an elevated UA-PI. Time interval assessments of DV-FVW were as follows: the duration of systolic wave was divided by the duration of diastolic wave and defined as DV-S/D. We also measured the following time intervals of ventricular inflow through tricuspid valve (TV) and mitral valve (MV): (iii), from the second peak of ventricular inflow caused by atrial contraction (A-wave) to the opening of atrio-ventricular valves and: (iv), from the opening of atrio-ventricular valves to the peak of A-wave. (iii)/(iv) was expressed as TV-S/D and MV-S/D, for TV and MV, respectively. The time interval data were transformed into z-scores.
RESULTS
Thirty-one FGR fetuses were included in this study. Both DV-PI and DV-S/D showed significant correlation with UA-pH (r = - 0.677, p = < 0.001 and r = 0.489, p = 0.005 for DV-PI and z-score of DV-S/D, respectively) and more significances were observed in FGR ≤ 28 + 6 gestational weeks (r = - 0.819, p < 0.001 and r = 0.726, p = 0.005, for DV-PI and z-score of DV-S/D, respectively) than in FGR > 28 + 6 gestational weeks (r = - 0.634, p = 0.007 and r = 0.635, p = 0.020, for DV-PI and z-score of DV-S/D, respectively). On the other hand, TV-S/D and MV-S/D showed no significant correlation with UA-pH, although these z-scores indicated significant decreases compared with normal references.
CONCLUSIONS
Time interval analysis of DV-FVW might be a valuable parameter, as well as DV-PI, for the antenatal prediction of fetal acidemia in the management of FGR fetuses.
背景
本研究旨在评估胎儿生长受限（FGR）合并胎盘功能不全时，静脉导管（DV）血流速度波形（FVW）时间间隔、心动周期以及 DV-FVW 搏动指数（DV-PI）与脐动脉（UA）pH 值的相关性。
方法
本研究回顾性分析了 FGR 患者的妊娠数据。FGR 定义为估计胎儿体重低于-2.0 个标准差，同时伴有 UA-PI 升高。评估 DV-FVW 的时间间隔如下：收缩波持续时间除以舒张波持续时间，定义为 DV-S/D。我们还测量了三尖瓣（TV）和二尖瓣（MV）心室流入的以下时间间隔：（iii），从心房收缩引起的心室流入的第二个峰值（A 波）到房室瓣开放：（iv），从房室瓣开放到 A 波峰值。（iii）/（iv）分别表示 TV-S/D 和 MV-S/D，用于 TV 和 MV。将时间间隔数据转换为 z 分数。
结果
本研究纳入了 31 例 FGR 胎儿。DV-PI 和 DV-S/D 均与 UA-pH 显著相关（r = -0.677，p < 0.001 和 r = 0.489，p = 0.005 用于 DV-PI 和 z 分数的 DV-S/D，分别），并且在 28+6 孕周之前（r = -0.819，p < 0.001 和 r = 0.726，p = 0.005 用于 DV-PI 和 z 分数的 DV-S/D，分别）比在 28+6 孕周之后观察到更显著的相关性（r = -0.634，p = 0.007 和 r = 0.635，p = 0.020 用于 DV-PI 和 z 分数的 DV-S/D，分别）。另一方面，TV-S/D 和 MV-S/D 与 UA-pH 无显著相关性，尽管这些 z 分数与正常参考值相比明显降低。
结论
DV-FVW 的时间间隔分析可能是一种有价值的参数，与 DV-PI 一样，可用于预测胎儿生长受限胎儿的胎儿酸中毒，并对其进行管理。
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