脑胎盘比率和子宫动脉多普勒在足月小于胎龄儿不良围产期结局预测中的价值
Value of Cerebroplacental Ratio and Uterine Artery Doppler as Predictors of Adverse Perinatal Outcome in Very Small for Gestational Age at Term Fetuses.
作者信息
Karge Anne, Lobmaier Silvia M, Haller Bernhard, Kuschel Bettina, Ortiz Javier U
机构信息
Division of Obstetrics and Perinatal Medicine, Department of Obstetrics and Gynecology, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany.
Institute of AI Medical Informatics in Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany.
出版信息
J Clin Med. 2022 Jul 3;11(13):3852. doi: 10.3390/jcm11133852.
The aim of this study was to evaluate the association between cerebroplacental ratio (CPR), mean uterine artery (mUtA) Doppler and adverse perinatal outcome (APO) and their predictive performance in fetuses with birth weight (BW) <3rd centile (very small for gestational age, VSGA) in comparison with fetuses with BW 3rd−10th centile (small for gestational age, SGA). This was a retrospective cohort study including singleton pregnancies delivered at term (37 + 0−41 + 6) in a single tertiary referral center over a six-year period. APO was defined as a composite of cesarean section for intrapartum fetal compromise (IFC), umbilical artery pH < 7.20, and admission to the neonatal intensive care unit for >24 h. The characteristics of the study population according to BW (VSGA and SGA) as well as the presence of composite APO were assessed. The prognostic performance of CPR and mUtA-PI was evaluated using receiver operating characteristic (ROC) analysis. In total, 203 pregnancies were included. Of these, 55 (27%) had CPR <10th centile, 25 (12%) mUtA-PI >95th centile, 65 (32%) VSGA fetuses, and 93 (46%) composite APO. VSGA showed a non-significantly higher rate of composite APO in comparison to SGA (52% vs. 43%; p = 0.202). The composite APO rate was significantly higher in SGA with CPR <10th centile (36% vs. 13%; p = 0.001), while in VSGA with CPR <10th centile was not (38% vs. 35%; p = 0.818). The composite APO rate was non-significantly higher both in VSGA (26% vs. 10%; p = 0.081) and SGA (14% vs. 6%; p = 0.742) with mUtA-PI >95th centile. The ROC analysis showed a significantly predictive value of CPR for composite APO in SGA only (AUC 0.612; p = 0.025). A low CPR was associated with composite APO in SGA fetuses. VSGA fetuses were more frequently affected by composite APO regardless of Doppler values. The predictive performance of CPR and uterine artery Doppler was poor.
本研究的目的是评估脑胎盘比率（CPR）、子宫动脉平均血流速度（mUtA）多普勒与围产期不良结局（APO）之间的关联，以及它们对出生体重（BW）<第3百分位数（小于胎龄儿，VSGA）胎儿与BW为第3 - 10百分位数（小于胎龄儿，SGA）胎儿的预测性能。这是一项回顾性队列研究，纳入了在一个单一的三级转诊中心6年期间足月分娩（37 + 0 - 41 + 6）的单胎妊娠。APO被定义为因产时胎儿窘迫（IFC）行剖宫产、脐动脉pH < 7.20以及入住新生儿重症监护病房>24小时的综合情况。评估了根据BW（VSGA和SGA）以及综合APO情况的研究人群特征。使用受试者工作特征（ROC）分析评估CPR和mUtA搏动指数（PI）的预后性能。总共纳入了203例妊娠。其中，55例（27%）CPR <第10百分位数，25例（12%）mUtA - PI >第95百分位数，65例（32%）为VSGA胎儿，93例（46%）有综合APO。与SGA相比，VSGA的综合APO发生率无显著升高（52%对43%；p = 0.202）。CPR <第10百分位数的SGA中综合APO发生率显著更高（36%对13%；p = 0.001），而CPR <第10百分位数的VSGA中并非如此（38%对35%；p = 0.818）。mUtA - PI >第95百分位数的VSGA（26%对10%；p = 0.081）和SGA（14%对6%；p = 0.742）中综合APO发生率无显著升高。ROC分析显示仅CPR对SGA中的综合APO有显著预测价值（曲线下面积0.612；p = 0.025）。低CPR与SGA胎儿的综合APO相关。无论多普勒值如何，VSGA胎儿更频繁地受到综合APO的影响。CPR和子宫动脉多普勒的预测性能较差。
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