Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia.
Department of Obstetrics & Gynaecology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.
Aust N Z J Obstet Gynaecol. 2023 Feb;63(1):19-26. doi: 10.1111/ajo.13547. Epub 2022 Jun 9.
Fetal growth restriction (FGR) is an obstetric complication associated with adverse perinatal outcomes. Doppler ultrasound can improve perinatal outcomes through monitoring at-risk fetuses and helping time delivery.
To investigate the prognostic value of different Doppler ultrasound measurements for adverse perinatal outcomes.
Individual participant data.
We performed a pooled analysis on individual participant data. We compared six prognostic models using multilevel logistic regression, where each subsequent model added a new variable to a base model that included maternal characteristics. Estimated fetal weight (EFW) and four Doppler ultrasound measurements were added in turn: umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI), cerebroplacental ratio (CPR), and mean uterine artery pulsatility index (mUtA PI). The primary outcome was a composite adverse perinatal outcome, defined as perinatal mortality, emergency caesarean delivery for fetal distress, or neonatal admission. Discriminative ability was quantified with area under the curve (AUC).
Three data sets (N = 3284) were included. Overall, the model that included EFW and UA PI improved AUC from 0.650 (95% CI 0.624-0.676) to 0.673 (95% CI 0.646-0.700). Adding more ultrasound measurements did not improve further the discriminative ability. In subgroup analysis, the addition of EFW and UA PI improved AUC in both preterm (AUC from 0.711 to 0.795) and small for gestational age pregnancies (AUC from 0.729 to 0.770), but they did not improve the models in term delivery or normal growth subgroups.
Umbilical artery pulsatility index added prognostic value for adverse perinatal outcomes to the already available information, but the combination of other Doppler ultrasound measurements (MCA PI, CPR or UtA PI) did not improve further prognostic performance.
胎儿生长受限（FGR）是一种与围产期不良结局相关的产科并发症。多普勒超声可以通过监测高危胎儿并帮助确定分娩时机来改善围产期结局。
探讨不同多普勒超声测量值对不良围产结局的预测价值。
个体参与者数据。
我们对个体参与者数据进行了汇总分析。我们使用多水平逻辑回归比较了六种预测模型，其中每个后续模型在包含产妇特征的基本模型中添加一个新变量。依次添加估计胎儿体重（EFW）和四项多普勒超声测量值：脐动脉搏动指数（UA PI）、大脑中动脉搏动指数（MCA PI）、脑胎盘比（CPR）和子宫动脉平均搏动指数（mUtA PI）。主要结局是复合不良围产结局，定义为围产儿死亡、因胎儿窘迫而行紧急剖宫产术或新生儿入院。用曲线下面积（AUC）来量化判别能力。
纳入了三个数据集（N=3284）。总的来说，包含 EFW 和 UA PI 的模型将 AUC 从 0.650（95%CI 0.624-0.676）提高到 0.673（95%CI 0.646-0.700）。进一步添加更多的超声测量值并不能进一步提高判别能力。在亚组分析中，在早产（AUC 从 0.711 提高到 0.795）和小于胎龄儿妊娠（AUC 从 0.729 提高到 0.770）中，添加 EFW 和 UA PI 提高了 AUC，但在足月分娩或正常生长亚组中，模型并没有得到改善。
UA PI 增加了不良围产结局的预测价值，但其与其他多普勒超声测量值（MCA PI、CPR 或 UtA PI）的组合并未进一步提高预测性能。
