Department of Obstetrics and Gynecology, School of Medicine, Maternal-fetal medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Iran J Med Sci. 2024 Oct 1;49(10):632-642. doi: 10.30476/ijms.2024.100177.3231. eCollection 2024 Oct.
Routine Doppler study is a common tool for early diagnosis of Fetal Growth Restriction (FGR) and Small for Gestational Age (SGA) patients. It aimed to determine the role of the Foramen Ovale Pulsatility Index (FOPI) study beside routine Doppler study among patients with FGR and SGA fetuses.
This prospective study was conducted on 35 FGR, 32 SGA, and 33 Appropriate for Gestational Age (AGA) fetuses. Demographic data, amniotic fluid index, neonatal outcome, and Doppler velocimetry, including Umbilical Artery Pulsatility Index (UMAPI), Uterine Artery Pulsatility Index (UTAPI), Middle Cerebral Artery Pulsatility Index (MCAPI), Ductus Venosus Pulsatility Index (DVPI), and FOPI were documented. Kolmogorov-Smirnov normality test, one-way ANOVA, Mann-Whitney U, Kruskal-Wallis, non-parametric pairwise comparisons adjusted for Bonferroni correction, Pearson correlation test, Chi square, Fisher's exact test, and Receiver Operating Characteristic Curve (ROC) analysis with Youden's Index (sensitivity+specificity-1) to estimate cut-off point were used to analyze the data at significance level <0.05 for all tests.
FOPI cut-off points were 2.24 (sensitivity=77%, specificity=94%) and 1.15 (sensitivity=90%, specificity=20%) to predict FGR and SGA, respectively. FOPI showed a positive correlation with UMAPI and UTAPI (r=0.52 and r=0.30, P<0.001 and P=0.006, respectively), but not with MCAPI and DVPI (r=0.08 and r=0.12, P=0.50 and P=0.30, respectively). Besides, UMAPI, UTAPI, and FOPI were altered among patients with stages I and II FGR. Umbilical cord potential hydrogen (umbilical cord pH), 1- and 5-min Apgar score significantly increased by Birth weight centile; however, UMAPI, FOPI, and UTAPI significantly decreased.
UMAPI is recommended to predict short-term neonatal morbidities and demonstrate the early or late onset FGR. Besides, FOPI is suggested as the first-line Doppler study to detect abnormal growth velocity. More studies are warranted, especially considering long-term neonatal morbidities.
常规多普勒研究是早期诊断胎儿生长受限（FGR）和小于胎龄儿（SGA）的常用工具。本研究旨在探讨卵圆孔搏动指数（FOPI）在 FGR 和 SGA 胎儿中的作用。
本前瞻性研究纳入了 35 例 FGR、32 例 SGA 和 33 例适于胎龄儿（AGA）。记录了患者的人口统计学数据、羊水指数、新生儿结局以及多普勒血流速度，包括脐动脉搏动指数（UMAPI）、子宫动脉搏动指数（UTAPI）、大脑中动脉搏动指数（MCAPI）、静脉导管搏动指数（DVPI）和 FOPI。采用 Kolmogorov-Smirnov 正态性检验、单因素方差分析、Mann-Whitney U 检验、Kruskal-Wallis 检验、非参数两两比较（Bonferroni 校正）、Pearson 相关检验、卡方检验、Fisher 确切概率检验和受试者工作特征曲线（ROC 曲线）分析，以 P<0.05 为差异有统计学意义。
FOPI 的截断值分别为 2.24（敏感性=77%，特异性=94%）和 1.15（敏感性=90%，特异性=20%），可用于预测 FGR 和 SGA。FOPI 与 UMAPI 和 UTAPI 呈正相关（r=0.52 和 r=0.30，P<0.001 和 P=0.006），但与 MCAPI 和 DVPI 无相关性（r=0.08 和 r=0.12，P=0.50 和 P=0.30）。此外，Ⅰ期和Ⅱ期 FGR 患者的 UMAPI、UTAPI 和 FOPI 发生改变。脐带血 pH 值、1 分钟和 5 分钟 Apgar 评分随出生体重百分位数增加而升高，而 UMAPI、FOPI 和 UTAPI 则呈下降趋势。
UMAPI 推荐用于预测短期新生儿并发症，并可发现早期或晚期 FGR。此外，FOPI 作为首选多普勒研究，可用于检测异常生长速度。需要更多的研究，特别是要考虑长期新生儿并发症。
