Marsál K
Department of Obstetrics and Gynecology, University of Lund, Malmö General Hospital, Sweden.
J Perinat Med. 1994;22(6):463-74.
Doppler ultrasound velocimetry of uteroplacental, umbilical and fetal vessels provides the clinician with important information on the hemodynamics of respective vascular area. Gestational age-related reference values have been established for maternal uterine and arcuate artery, umbilical artery, fetal descending aorta, and fetal cerebral, renal and femoral arteries. Recently, velocimetry of the fetal central venous system gained increasing attention. In growth-retarded fetuses and fetuses developing intrauterine distress, the umbilical artery blood velocity waveform changes in a typical way: the diastolic velocity of the waveform decreases and eventually disappears. The absent or reverse end-diastolic flow (ARED flow) is associated with high risk of intrauterine demise and adverse perinatal outcome. Applied as a screening test in an unselected pregnant population, umbilical artery velocimetry has not been found useful. In a preselected population of high-risk pregnancies, especially pregnancies with SGA fetuses, the method has a high predictive value with regard to diagnosing fetal compromise and can be used for monitoring fetal health. A meta-analysis of randomized clinical trials showed that including Doppler velocimetry in the management of high-risk pregnancies lowers the perinatal mortality. Follow-up studies, few published so far, showed an association between the abnormal intrauterine umbilical and/or fetal blood flow and subsequent postnatal neurodevelopmental impairment. Doppler velocimetry of umbilical artery applied in management of high risk pregnancies improves the perinatal outcome and can thus be considered a clinical method of fetal surveillance.
子宫胎盘、脐血管和胎儿血管的多普勒超声测速技术为临床医生提供了各血管区域血流动力学的重要信息。已建立了与孕周相关的母体子宫动脉、弓状动脉、脐动脉、胎儿降主动脉以及胎儿脑动脉、肾动脉和股动脉的参考值。最近，胎儿中心静脉系统的测速技术越来越受到关注。在生长受限胎儿和发生宫内窘迫的胎儿中，脐动脉血流速度波形会发生典型变化：波形的舒张期速度降低，最终消失。舒张期末血流缺失或反向（ARED血流）与宫内死亡和不良围产期结局的高风险相关。在未经过选择的孕妇群体中作为筛查试验应用时，脐动脉测速技术并未被证明有用。在经过预先选择的高危妊娠群体中，尤其是胎儿生长受限的妊娠，该方法在诊断胎儿窘迫方面具有较高的预测价值，可用于监测胎儿健康状况。一项对随机临床试验的荟萃分析表明，在高危妊娠管理中纳入多普勒测速技术可降低围产期死亡率。目前发表的随访研究较少，这些研究显示宫内脐血管和/或胎儿血流异常与随后的出生后神经发育障碍之间存在关联。在高危妊娠管理中应用脐动脉多普勒测速技术可改善围产期结局，因此可被视为一种胎儿监测的临床方法。
