子宫动脉多普勒扫描的实施：改善胎儿生长受限高危妇女和婴儿的护理。

Implementation of Uterine Artery Doppler Scanning: Improving the Care of Women and Babies High Risk for Fetal Growth Restriction.

机构信息

Obstetrics and Gynaecology, United Lincolnshire Hospitals NHS Trust, Lincoln LN2 5QY, UK.

Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK NG7 2UH.

出版信息

J Pregnancy. 2023 Jan 23;2023:1506447. doi: 10.1155/2023/1506447. eCollection 2023.

DOI:10.1155/2023/1506447

PMID:36726451

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9886456/

Abstract

INTRODUCTION

While stillbirth rates have declined in many countries, these declines are less marked in the UK. Fetal growth restriction (FGR) affects about 3% to 7% of all pregnancies and is by far the single strongest risk factor for stillbirth. FGR implies a pathological restriction of the genetic growth potential and is not synonymous with small-for-gestational age (SGA). The Royal College of Obstetricians and Gynaecologists (RCOG) defines SGA as an estimated fetal weight (EFW) or abdominal circumference (AC) less than the 10th centile. The likelihood of FGR is higher in severe SGA defined as an EFW or AC less than the 3rd centile. The second version of Saving Babies' Lives Care Bundle (SBLCBv2) recommends the second trimester uterine artery Doppler (UtAD) pulsatility index (PI) screening for pregnancies at high risk of FGR. This study was aimed at determining the prevalence of FGR and assess pregnancy outcomes following the implementation of UtAD at the United Lincolnshire Hospitals NHS Trust (ULHT).

METHODS

One-year retrospective cohort study (1st September 2020-31st August 2021) was conducted across both ULHT hospitals in the UK (Lincoln County Hospital in Lincoln and Pilgrim Hospital in Boston).

RESULTS

During the study period, 5197 women were booked at ULHT. Of 5197, 349 were identified as high risk for FGR. When numbers were compared for the two hospitals, FGR rate was higher in Lincoln 8.10% vs. 4.51% in Boston. In addition, an increased proportion of abnormal UtAD scans was observed in Lincoln (35.7%) vs. in Boston (22%) ( = 0.014). Of the 349 UtAD scans, 237 were normal (67.9%), 41 showed unilateral notching (11.7%), 43 bilateral notching (12.3%), and 28 raised PI (8%). Babies in the bilateral notching group exhibited the lowest birth weight ( = 0.005), born at an earlier gestation ( = 0.029), and with low Apgar scores at 1 ( = 0.007) and 5 minutes ( < 0.001). . UtAD is a useful second trimester screening tool for women identified as high risk for FGR and helps stratify the intensity of surveillance. However, the findings call into question a focus solely on the UtAD PI for improving FGR detection without taking into account bilateral notching.

摘要

简介

尽管许多国家的死产率有所下降，但英国的这一下降趋势并不明显。胎儿生长受限（FGR）影响所有妊娠的 3%至 7%，是死产的单一最强危险因素。FGR 意味着遗传生长潜力受到病理性限制，与小于胎龄儿（SGA）并不同义。皇家妇产科医师学院（RCOG）将 SGA 定义为估计胎儿体重（EFW）或腹围（AC）小于第 10 百分位数。严重 SGA（定义为 EFW 或 AC 小于第 3 百分位数）的 FGR 可能性更高。拯救婴儿生命护理包（SBLCBv2）的第二版建议对有 FGR 高风险的妊娠进行第二次 trimester 子宫动脉多普勒（UtAD）搏动指数（PI）筛查。本研究旨在确定 FGR 的患病率，并评估英国联合林肯郡医院 NHS 信托基金（ULHT）实施 UtAD 后的妊娠结局。

方法

对英国两家 ULHT 医院（林肯郡医院和波士顿朝圣者医院）进行为期一年的回顾性队列研究（2020 年 9 月 1 日至 2021 年 8 月 31 日）。

结果

在研究期间，ULHT 有 5197 名女性登记。在 5197 名女性中，有 349 名被确定为 FGR 高危。两所医院比较 FGR 发生率，林肯的发生率为 8.10%，而波士顿为 4.51%。此外，林肯的异常 UtAD 扫描比例更高（35.7%），而波士顿为 22%（ = 0.014）。在 349 次 UtAD 扫描中，237 次正常（67.9%），41 次单侧切迹（11.7%），43 次双侧切迹（12.3%），28 次升高的 PI（8%）。双侧切迹组的婴儿出生体重最低（ = 0.005），胎龄更早（ = 0.029），1 分钟和 5 分钟的 Apgar 评分较低（ = 0.007 和 < 0.001）。UtAD 是一种有用的第二次 trimester 筛查工具，可用于识别 FGR 高危女性，并有助于分层监测强度。然而，这些发现质疑了仅关注 UtAD PI 以提高 FGR 检测率的做法，而不考虑双侧切迹。