Leizer Julie M, Ibrahim Ammoura M, Foulke Llewellyn A, Tauber Kate A, Feustel Paul, Zelig Craig M
Obstetrics and Gynecology, Robert Wood Johnson (RWJ) Barnabas Health, Eatontown, USA.
Pathology, University of Miami Miller School of Medicine, Miami, USA.
Cureus. 2023 Jul 7;15(7):e41508. doi: 10.7759/cureus.41508. eCollection 2023 Jul.
In neonates, blood flow to the brain as measured by peak systolic velocity (PSV) in the middle cerebral artery (MCA) is altered in pregnancies affected by chorioamnionitis.
We aim to determine whether PSV and other measures of flow in the MCA in the fetus are altered prior to the development of clinical chorioamnionitis following preterm prelabor rupture of membranes (PPROM).
This was a prospective observational study. Fifty patients from one institution were recruited after being diagnosed with PPROM between 23 weeks zero days and 33 weeks six days gestation. We performed measurements of the PSV in the fetal MCA on a weekly basis following PPROM and used the value taken closest to the time of delivery for our statistical analysis. The primary outcome assessed was clinical chorioamnionitis, and the exposure of interest was MCA PSV. Additional independent variables of interest were other Doppler measures of the MCA. Secondary outcomes included histological chorioamnionitis and other measures of neonatal health, including sepsis, days in the neonatal intensive care unit (NICU), and death.
Of the 50 patients recruited to our study, eight (16%) developed clinical chorioamnionitis, similar to previously reported values in the general population. The PSV in the MCA was not significantly associated with the development of clinical chorioamnionitis. However, an elevated MCA pulsatility index (PI), a measure of resistance to flow, was associated with a higher probability of developing clinical chorioamnionitis.
There does not appear to be a difference in the PSV of the MCA of fetuses in pregnancies following PPROM with impending chorioamnionitis. However, elevated PI in the MCA could be a marker of impending chorioamnionitis in PPROM. Larger studies are needed to confirm these findings.
在新生儿中，受绒毛膜羊膜炎影响的妊娠中，通过大脑中动脉（MCA）的收缩期峰值速度（PSV）测量的脑血流量会发生改变。
我们旨在确定胎膜早破（PPROM）后临床绒毛膜羊膜炎发生之前，胎儿MCA中的PSV和其他血流测量指标是否发生改变。
这是一项前瞻性观察性研究。在23周零天至33周6天妊娠期间被诊断为PPROM后，从一个机构招募了50名患者。PPROM后，我们每周对胎儿MCA的PSV进行测量，并使用最接近分娩时间的值进行统计分析。评估的主要结局是临床绒毛膜羊膜炎，感兴趣的暴露因素是MCA PSV。其他感兴趣的独立变量是MCA的其他多普勒测量指标。次要结局包括组织学绒毛膜羊膜炎和其他新生儿健康指标，包括败血症、新生儿重症监护病房（NICU）住院天数和死亡。
在我们研究招募的50名患者中，有8名（16%）发生了临床绒毛膜羊膜炎，与先前报道的一般人群中的值相似。MCA中的PSV与临床绒毛膜羊膜炎的发生没有显著相关性。然而，MCA搏动指数（PI）升高，这是一种血流阻力测量指标，与发生临床绒毛膜羊膜炎的较高概率相关。
在即将发生绒毛膜羊膜炎的PPROM妊娠中，胎儿MCA的PSV似乎没有差异。然而，MCA中PI升高可能是PPROM中即将发生绒毛膜羊膜炎的一个标志物。需要更大规模的研究来证实这些发现。
