子宫动脉多普勒在孕中期异常与 PAPP-a 正常时的不良产科及新生儿结局

Second trimester abnormal uterine artery Dopplers and adverse obstetric and neonatal outcomes when PAPP-a is normal.

机构信息

Ultrasound Screening Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, United Kingdom of Great Britain and Northern Ireland.

UCL EGA Institute for Women's Health, UCL, London, United Kingdom of Great Britain and Northern Ireland.

出版信息

J Matern Fetal Neonatal Med. 2023 Dec;36(2):2230515. doi: 10.1080/14767058.2023.2230515.

DOI:10.1080/14767058.2023.2230515

PMID:37401032

Abstract

OBJECTIVES

To explore the association between abnormal uterine artery Dopplers (combined PI > 2.5) - with normal PAPP-A - and adverse obstetric/neonatal outcomes.

METHODS

This was a retrospective cohort study of 800 patients between 1 March 2019 - 23 November 2021 in a tertiary UK hospital, where it is routine to measure uterine artery Dopplers of all pregnancies during their anomaly scans. 400 nulliparous women/birthing people with complete data were included. 400 nulliparous controls scanned in the same time frame (1.5 years) with normal PAPP-A and uterine artery Dopplers were matched for age and BMI. Outcomes included: mode of birth, postpartum complications, birth weight/centile, Apgar score, gestational age at delivery, neonatal unit admission, and clinical neonatal hypoglycemia. Multivariable analysis was used.

RESULTS

Compared to controls, pregnancies with abnormal uterine artery Dopplers and normal PAPP-A were at increased risk of induction (46.5% vs 35.5%, = .042), cesarean section (46.0% vs 38.0%, = .002), emergency cesarean section (35.0% vs 26.5%, = .009), and pre-eclampsia 5.8% vs 2.5%, = .021). Their babies were more likely to be admitted to the neonatal unit - mostly for prematurity (15.3% vs 6.3%, = .0004), hypoglycemia (4.0% vs 1.0%, = .007), be small for gestational age (26.5% vs 11.5%, = .0001), had intrauterine growth restriction (10.8% vs 1.3%, = .0001), and be born prematurely (10.0% vs 3.5%, = .002). Routine measurement of uterine artery Dopplers increased the detection rate of small for gestational age fetuses by 15.1%. Over half of the babies admitted with neonatal hypoglycemia in pregnancies with abnormal uterine artery Dopplers had an unexplained cause.

CONCLUSIONS

Pregnancies with abnormal uterine Dopplers are not only at increased risk of pre-eclampsia and small for gestational age fetuses/intrauterine growth restriction, but are also at increased risk of emergency cesarean section and adverse neonatal outcomes. The increased incidence of neonatal hypoglycemia is likely driven to some degree by prematurity and placental complications, but possibly also by undiagnosed glucose dysmetabolism. This may warrant routine measurement of uterine artery Dopplers in all pregnancies (regardless of risk), where feasible, to aid antenatal management and counseling.

摘要

目的

探讨子宫动脉多普勒异常（联合 PI＞2.5）伴正常妊娠相关蛋白 A（PAPP-A）与不良产科/新生儿结局之间的关系。

方法

这是一项回顾性队列研究，纳入了 2019 年 3 月 1 日至 2021 年 11 月 23 日期间在英国一家三级医院就诊的 800 例患者，该医院常规对所有妊娠患者的子宫动脉多普勒进行检查。纳入了 400 例具有完整数据的初产妇/分娩者。同时匹配了 400 例初产妇/分娩者作为对照，这些对照者在同一时间段（1.5 年）接受了子宫动脉多普勒检查，且 PAPP-A 和子宫动脉多普勒均正常。结局包括：分娩方式、产后并发症、出生体重/百分位、阿普加评分、分娩时的孕龄、新生儿病房入院情况以及临床新生儿低血糖症。采用多变量分析。

结果

与对照组相比，子宫动脉多普勒异常且 PAPP-A 正常的妊娠患者更有可能接受引产（46.5% vs. 35.5%， = .042）、剖宫产（46.0% vs. 38.0%， = .002）、急诊剖宫产（35.0% vs. 26.5%， = .009）和子痫前期（5.8% vs. 2.5%， = .021）。这些患者的婴儿更有可能被送入新生儿病房，主要是因为早产（15.3% vs. 6.3%， = .0004）、低血糖症（4.0% vs. 1.0%， = .007）、胎儿小于胎龄（26.5% vs. 11.5%， = .0001）、宫内生长受限（10.8% vs. 1.3%， = .0001）和早产（10.0% vs. 3.5%， = .002）。常规测量子宫动脉多普勒将胎儿小于胎龄的检出率提高了 15.1%。在子宫动脉多普勒异常的妊娠患者中，有一半以上因不明原因而出现新生儿低血糖症。

结论

子宫动脉多普勒异常的妊娠不仅子痫前期和胎儿小于胎龄/宫内生长受限的风险增加，而且还会增加急诊剖宫产和不良新生儿结局的风险。新生儿低血糖症的发生率增加可能在一定程度上是由早产和胎盘并发症引起的，但也可能由未确诊的糖代谢紊乱引起。因此，在可行的情况下，可能需要在所有妊娠（无论风险如何）中常规测量子宫动脉多普勒，以辅助产前管理和咨询。