Rizzo Giuseppe, Pietrolucci Maria Elena, Mappa Ilenia, Bitsadze Victoria, Khizroeva Jamilya, Makatsariya Alexander, D'Antonio Francesco
Division of Maternal Fetal Medicine Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Roma, Italy.
Department of Obstetrics and Gynecology Moscow, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia.
J Matern Fetal Neonatal Med. 2022 May;35(9):1668-1676. doi: 10.1080/14767058.2020.1767060. Epub 2020 May 25.
Recent evidences highlight a considerable heterogeneity in the methodology of previously published studies reporting reference ranges for maternal and fetal Dopplers, which may have relevant implications in clinical practice. In view of these limitations, a standardized methodology to construct Doppler charts has been proposed. The aim of this study was to develop charts for pulsatility index (PI) of maternal and fetal Dopplers based upon the recently proposed standardized methodology and using quantile regression.
Prospective cross-sectional study including 2516 low-risk singleton pregnancies between 24 and 40 weeks of gestation. The mean uterine, umbilical (UA), middle cerebral (MCA) and their ratio (cerebroplacental ratio, CPR) centile values were established by quantile regression in the considered gestational interval. Interclass correlation coefficient (ICC) of each maternal and fetal vessel was also computed to assess the intra- and inter-observer agreement of the results.
There was a good intra- and inter-observer agreement for each of the explored vessels (ICC >0.92 and >0.91 for a single and two observers, respectively). The 5th, 10th, 50th, 90th and 95th centiles of the reference range for gestation were constructed by quantile regression and compared to previously established reference charts. All the Doppler indices significantly changed with gestation. Second-degree polynomial regression models better described the changes with gestation in PCR and MCA PI values while a linear model better predicted the changes of other Doppler indices with advancing gestation. When compared to other studies reporting reference ranges for maternal and fetal Dopplers, the present charts showed similar median values but different distribution from the median.
We provided prospective charts of maternal and fetal Dopplers based upon a previously proposed standardized methodology and using quantile regression. When compared to previously published studies, these new charts showed similar median values but different deviations from the median which may help in better differentiating cases at higher risk of placental insufficiency and adverse perinatal outcome.
近期证据表明，先前发表的报告母胎多普勒参考范围的研究方法存在相当大的异质性，这可能对临床实践产生相关影响。鉴于这些局限性，已提出一种构建多普勒图表的标准化方法。本研究的目的是基于最近提出的标准化方法并使用分位数回归，为母胎多普勒的搏动指数（PI）绘制图表。
前瞻性横断面研究，纳入2516例妊娠24至40周的低风险单胎妊娠。通过分位数回归确定在考虑的孕周区间内子宫、脐动脉（UA）、大脑中动脉（MCA）及其比值（脑胎盘比值，CPR）的平均百分位数。还计算了每个母胎血管的组内相关系数（ICC），以评估结果在观察者内和观察者间的一致性。
对于每个探索的血管，观察者内和观察者间均有良好的一致性（单个观察者和两个观察者的ICC分别>0.92和>0.91）。通过分位数回归构建了妊娠参考范围的第5、10、50、90和95百分位数，并与先前建立的参考图表进行比较。所有多普勒指数均随孕周显著变化。二次多项式回归模型能更好地描述PCR和MCA PI值随孕周的变化，而线性模型能更好地预测其他多普勒指数随孕周增加的变化。与其他报告母胎多普勒参考范围的研究相比，本图表显示出相似的中位数，但与中位数的分布不同。
我们基于先前提出的标准化方法并使用分位数回归，提供了母胎多普勒的前瞻性图表。与先前发表的研究相比，这些新图表显示出相似的中位数，但与中位数的偏差不同，这可能有助于更好地鉴别胎盘功能不全和围产儿不良结局风险较高的病例。
