Department of Clinical Science and Education, Karolinska Institute, Soder Hospital, Stockholm, Sweden.
Department of Obstetrics and Gynecology, Soder Hospital, Stockholm, Sweden.
J Matern Fetal Neonatal Med. 2022 Dec;35(23):4543-4551. doi: 10.1080/14767058.2020.1855135. Epub 2020 Dec 1.
Pregnancies with reduced fetal movements (RFM) are at risk for poor neonatal outcomes and stillbirth.
To investigate whether Doppler measurements or angiogenic factors are good predictors of adverse neonatal outcomes in pregnancies with RFM.
This is a prospective pilot cohort study of 3243 women seeking care for RFM. Standard care was carried out in all cases. An extra Doppler examination was performed in 128 women to assess the flow in the middle cerebral artery, the umbilical artery, and the uterine artery. In 62/128 pregnancies, a maternal blood sample was obtained for angiogenic and antiangiogenic factors. The composite neonatal outcome of the study was one or more of the following factors: Apgar score <7 at 5', arterial aPh in the umbilical cord ≤7.1, transfer to Neonatal Intensive Care (NICU), stillbirth, and small for gestational age (SGA).
In 14.1% (18/128) of the Doppler group and 11.7% (365/3115) of the standard care group, there was an adverse neonatal outcome ( = .51). A higher intervention rate was found in the Doppler group (28% vs. 5.4%, < .01). The predictive model of adverse neonatal outcomes in women with RFM with angiogenic factors was 0.73 (95% CI 0.54-0.92). The area under the curve improved to 0.89 (CI 95% 0.81-0.97) when parity was added to the model.
Angiogenic factors may have a place in the prediction of the neonatal outcome of RFM pregnancies. The prediction model's capacity was driven by parity. The obstetrical intervention rate increased with additional Doppler examinations.
胎儿运动减少（RFM）的妊娠有发生不良新生儿结局和死产的风险。
探讨多普勒测量或血管生成因子是否能很好地预测 RFM 妊娠的不良新生儿结局。
这是一项针对 3243 名因 RFM 就诊的女性的前瞻性试点队列研究。所有病例均采用标准治疗。对 128 名女性进行了额外的多普勒检查，以评估大脑中动脉、脐动脉和子宫动脉的血流。在 62/128 例妊娠中，采集了母体血液样本以检测血管生成和抗血管生成因子。本研究的复合新生儿结局为以下一种或多种因素：5 分钟时 Apgar 评分<7，脐带动脉 pH 值≤7.1，转新生儿重症监护病房（NICU），死产和小于胎龄儿（SGA）。
在多普勒组的 14.1%（18/128）和标准治疗组的 11.7%（365/3115）中，新生儿结局不良（ = .51）。多普勒组的干预率较高（28%比 5.4%， < .01）。在 RFM 妇女中，添加血管生成因子后，不良新生儿结局的预测模型为 0.73（95%CI 0.54-0.92）。当将产次添加到模型中时，曲线下面积提高至 0.89（95%CI 0.81-0.97）。
血管生成因子可能在预测 RFM 妊娠的新生儿结局方面具有一定作用。预测模型的能力由产次驱动。增加额外的多普勒检查会增加产科干预率。
